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BRIEF COMMUNICATION
Year : 2015  |  Volume : 33  |  Issue : 5  |  Page : 126-128
 

Declining trends of Syphilis seroprevalance among antenatal clinic cases and STD clinic cases in a tertiary care centre: From January 2002 to December 2012


1 All India Institute of Medical Sciences, New Delhi, India
2 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
3 Maulana Azad Medical College, New Delhi, India
4 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Date of Submission04-Feb-2014
Date of Acceptance12-Jul-2014
Date of Web Publication6-Feb-2015

Correspondence Address:
B K Das
Department of Microbiology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.150917

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 ~ Abstract 

Syphilis affects nearly 1.36 million pregnant women, majority of these cases being concentrated in the developing countries. We aimed at analysing the 11 years' trends in syphilis seroprevalence in antenatal clinics (ANC) and STD clinic cases. Laboratory data of syphilis cases from 2002-2012 were retrospectively analysed. Out of the total 73642 cases, 393 (0.53%) tested positive for Syphilis. A statistically significant decline in syphilis prevalence was found in both ANC and STD clinic cases. The efforts of various interventional programs should continue to make the screening and treatment facilities readily accessible to continue the decline in syphilis seropositivity.


Keywords: Antenatal, seroprevalence, sexually transmitted diseases, syphilis, trends


How to cite this article:
Chopra S, Garg A, Chopra M, Ghosh A, Sreenivas V, Sood S, Kapil A, Das B K. Declining trends of Syphilis seroprevalance among antenatal clinic cases and STD clinic cases in a tertiary care centre: From January 2002 to December 2012. Indian J Med Microbiol 2015;33, Suppl S1:126-8

How to cite this URL:
Chopra S, Garg A, Chopra M, Ghosh A, Sreenivas V, Sood S, Kapil A, Das B K. Declining trends of Syphilis seroprevalance among antenatal clinic cases and STD clinic cases in a tertiary care centre: From January 2002 to December 2012. Indian J Med Microbiol [serial online] 2015 [cited 2020 Feb 17];33, Suppl S1:126-8. Available from: http://www.ijmm.org/text.asp?2015/33/5/126/150917



 ~ Introduction Top


Syphilis is a sexually transmitted disease (STD) transmitted primarily through sexual intercourse, the other less common modes being blood transfusion and contaminated needles among intravenous drug users. In 2008, World Health Organisation (WHO) estimated approximately 1.36 million pregnant women to be infected with syphilis globally, nearly 0.5 million cases culminating in adverse pregnancy outcomes. Previous reports from India prior to 2007 suggest a decline in the prevalence of syphilis among pregnant women. [1],[2] Despite the previous reports suggesting a decline in the prevalence of syphilis, majority of the recent reports from the developed nations including United States of America, Canada, Great Britain and Australia have observed an upsurge in its incidence. [3] Moreover, two recent reports from New Delhi, India have found a constant trend in syphilis from 2001-2009 and 2005-2009, respectively. [4],[5] A clear overview of the recent changes in the prevalence of syphilis is essential in targeting the efforts of the future interventions. In view of the above discussed regional as well as temporal variations in the trends of syphilis seroprevalence, this study was aimed at analysing the past 11 years' syphilis trends in a tertiary care hospital in Northern India.


 ~ Materials and Methods Top


The study data comprised of 73,642 cases screened for syphilis using standard Venereal Disease Research Laboratory (VDRL) test from 2002 to 2012. VDRL titre of 1:8 or more dilution was considered to indicate active syphilis infection. The data were statistically analysed in Group I comprising apparently asymptomatic patients from antenatal clinic (ANC), group II comprising of symptomatic patients referred from STD clinic and other departments (Cardiology, Neurology, Paediatrics and ART clinic) and both groups together. Logistic regression in Stata 12.1 was used for the analysis. P < 0.05 was considered significant.


 ~ Results Top


Out of the total 73642 cases, 393 (0.53%) tested positive for syphilis. Of 61348 (83.3%) apparently asymptomatic ANC cases (pregnant women and their spouses, Group I), 161 (0.26%) were VDRL reactive. Among the 12294 (16.7%) symptomatic patients referred from STD clinic and other departments (Group II), 232 (1.89%) were VDRL reactive. The odds of a case in group II being VDRL reactive were 7.23 times higher than that in group I, and it was statistically significant (P < 0.01). [Table 1] and [Figure 1] show the yearly trend of VDRL reactivity.
Figure 1: Trends of syphilis seroprevalence in total cases

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Table 1: Percentage VDRL reactivity in males and females belonging to Group I, Group II and total

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Seroprevalence of syphilis declined significantly (P < 0.01) for both males and females among ANC, STD clinic and total cases from 2002 to 2012. The percentage drop of VDRL reactivity with each passing year was 22.8% [95% confidence interval (CI), 18.0-27.3%], 15.5% (95% CI, 11.7-19.1%) and 18.1% (95%, CI 15.1-20.9%) for Antenatal cases, STD clinic cases and total cases, respectively, from 2002 to 2012.

For total cases and group II cases, VDRL reactivity was significantly (P < 0.01) more in males as compared to females. The odds of a female being VDRL reactive were 41.6% (95% CI, 33.8-51.1%) of males for the total cases and 46.7% (95% CI 34.2-63.7%) of males for Group II cases. For the group I cases as well, VDRL reactivity was more in males (husbands of asymptomatic pregnant women) though not statistically significant.

In group I cases, we observed a significant (P = 0.019) increase in syphilis seroprevalence with age. In Group II cases, maximum VDRL reactivity was observed in the age group of 20-29 years, though not statistically significant. After applying multivariate logistic regression with year, age, sex and department as variables, the results retained statistical significance.


 ~ Discussion Top


In this study, we found statistically significant declining trends in VDRL reactivity in both males and females among ANC and STD clinic cases. The various reasons for the decline in syphilis seroprevalence could be explained by sex education in schools, increased awareness about AIDS leading to safer sexual practices, better living standards, early treatment-seeking behaviour and increase in the antenatal clinic attendees. Decline in syphilis seroprevalence could also be largely attributed to the efforts of the National AIIDS control organisation (NACO). NACO is providing STI services through 1112 STI clinics (commonly referred to as 'Suraksha Clinics') all over the nation, successfully treating more than 7.45 million STI episodes in the year 2011. [6] Another similar initiative named Avahan was launched in 2003 in six states of India by Bill and Melinda Gates Foundation to target the spread of HIV. [7]

Nevertheless, syphilis is still reported as the most common STD by various studies. [8] Not only can untreated syphilis be lethal, syphilis in pregnancy can also result in serious implications in both newborn as well as maternal health. In India, there has been an increase in the proportion of pregnant women attending at least one ANC visit from 75% in 2007-2008 to 96% in 2010; however, significantly fewer attend the four ANC visits recommended by WHO [9] which might result in fewer women getting treated for syphilis. Global WHO estimates show that 66% of adverse pregnancy outcomes due to syphilis occurred in women with at least one ANC visit but who were either not screened or did not receive complete treatment. [10] Therefore, it is important to make efforts towards ensuring complete follow-up as well as adequate treatment of the VDRL reactive pregnant women in addition to universal access to early ANC. We observed a higher syphilis seroprevalence in husbands of pregnant women as compared to the latter; hence, we recommend that husbands of pregnant women should also get screened at the first ANC visit.

As compared to HIV, syphilis has about 3-20 times greater infectivity per sex act. Its duration of transmissibility is significantly reduced after treatment. Henceforth, treating syphilis plays an important role in aborting the transmission chain. [1] Syphilis screening and treatment are inexpensive and are cost-effective even in the low prevalence areas. [10] Therefore, despite the declining trends in syphilis seropositivity, efforts should be taken to continue to make the screening facilities and treatment readily accessible, especially for antenatal women, their husbands and the high-risk group including commercial sex workers, intravenous drug users and homosexual men.

 
 ~ References Top

1.
Arora P, Nagelkerke NJ, Moineddin R, Bhattacharya M, Jha P. Female sex work interventions and changes in HIV and syphilis infection risks from 2003 to 2008 in India: A repeated cross-sectional study. BMJ Open 2013;3.  Back to cited text no. 1
    
2.
Sethi S, Sharma K, Dhaliwal LK, Banga SS, Sharma M. Declining trends in syphilis prevalence among antenatal women in Northern India: A 10-year analysis from a tertiary health care centre. Sex Transm Infect 2007;83:592.  Back to cited text no. 2
    
3.
Promed mail: International Society for Infectious Diseases. Available from: http://www.promedmail.org/[Last accessed on 2013 Nov 20].  Back to cited text no. 3
    
4.
Sharma A, Rawat D, Bhalla P. Trend of syphilis in a tertiary care hospital, New Delhi: 2001 - 2009. Indian J Public Health 2013;57:117-8.  Back to cited text no. 4
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5.
Jain A, Mendiratta V, Chander R. Current status of acquired syphilis: A hospital-based 5-year study. Indian J Sex Transm Dis 2012;33:32-4.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Department of AIDS Control. National AIDS Control Organisation. Ministry of Health and Family Welfare Government of India. Annual Report 2011 - 2012. Available from: http://www.nacoonline.org [Last accessed on 2013 Jan 18].  Back to cited text no. 6
    
7.
"Bill Gates India scheme ′spared 100,000 from HIV′". Available from: http://www.bbc.co.uk [Last accessed on 2013 Oct 18].  Back to cited text no. 7
    
8.
Nair TG, Asha LK, Leelakumari PV. An epidemiological study of sexually transmitted diseases. Indian J Dermatol Venereol Leprol 2000;66:69-72.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Government of India, Ministry of Health and Family Welfare, District Level Household and Facility Survey 2007 - 2008, Final Report. Available from: http://www.unicef.org/french/aids/files/hiv_pmtctfactsheetIndia.pdf [Last accessed on 2013 Nov 25].  Back to cited text no. 9
    
10.
Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A, et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: Analysis of multinational antenatal surveillance data. PLoS Med 2013;10:e1001396.  Back to cited text no. 10
    


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