Effect of positive deviation on the diagnosis and treatment of gestational syphilis, and the prevention of congenital syphilis: A cohort study

Abstract

Objectives: To describe the application of Positive Deviance (PD) and its outcomes in the diagnosis and treatment of gestational syphilis (GS) and the prevention of congenital syphilis (CS).

Material and methods: A descriptive cohort study was conducted. Women treated at the Subred Sur (SRS) of Bogotá, diagnosed with GS in 2017-2018, were included. The 2018 cohort was exposed to Positive Deviance (PD) to identify useful practices for CS prevention, implement them, and overcome existing barriers. Adherence to the Colombian Guideline for GS management and CS incidence were described.

Results: A total of 284 GS cases were confirmed. Timely treatment initiation increased from 81.8 % to 90.2 %, penicillin sensitivity testing decreased from 38 % to 12.9 %, and complete treatment improved from 43.8 % to 82.6 %. In 2018, 97.5 % received at least one dose of penicillin. The incidence rate of CS decreased from 41.9 % to 29.6 %. Of the patients, 45% were diagnosed with GS in the third trimester, among whom the CS incidence rate was 59 %.

Conclusions: This study describes the effects of applying PD as an innovative approach to improve adherence to timely and appropriate GS treatment and prevent CS. Prospective studies with a control group are needed to more robustly evaluate the benefits of this methodology in process and outcome indicators, as well as its impact on reducing mother to child transmission of syphilis.