Antenatal Screening for Syphilis: Ten Years of Observation Amongst Pregnant Women Receiving Care at the Maternity Units of the Province of Trento in Northern Italy

Abstract

Introduction. Serology screening for syphilis infection in pregnancy is an internationally recommended practice. For some time, in the province of Trento (northern Italy), data regarding antenatal serology screening for syphilis have been acquired through the birth assistance certificate, whose completion by the healthcare professionals providing assistance at birth is mandatory in Italy. This study describes the coverage of serology screening and the seroprevalence of syphilis infection amongst pregnant women receiving care in the maternity facilities of the province of Trento between 2008 and 2017. Materials and methods. The results of serological screening are recorded in the electronic birth assistance certificate as: test not performed; negative test, positive test, or results pending. In cases of a positive test or results pending, the Authors consulted the hospital information system (SIO), an electronic repository containing data regarding all services provided to users of the Provincial Health Service. This operation also made it possible to recover full data regarding the serological profile, any treatments administered and the obstetric/neonatal outcomes. The Authors calculated screening coverage, the seroprevalence of the infection and the occurrence of cases of congenital syphilis, by analysing the neonates’ health status for the first two years of life. Results. Between 01.01.2008 and 31.12.2017, 46,627 pregnant women received care at maternity units of the province of Trento. Screening coverage was found to be higher than 99%. A total of 95 pregnant women were found to be true positives at serology screening for syphilis (15 Italian nationals and 80 foreign women). Seroprevalence for all pregnant women was 2/1000 (0.4/1000 amongst Italian women and 6.8/1000 amongst foreign women). Amongst the latter, the highest value was observed amongst women originating from Eastern European countries (9.3/1000). 62% of positive cases were identified as prior, already treated syphilis and 38% were identified as an early or late latent infection. Antibiotic therapy with penicillin was prescribed in all cases for which it was indicated. No considerable differences were observed with regard to the obstetric/neonatal outcomes between seropositive ad seronegative women. No cases of congenital syphilis were observed. Conclusions. Screening coverage concerned almost all the pregnant women who received care. The seroprevalence calculated in this study was consistent with the available Italian and European data. Our findings confirmed that there is a higher proportion of cases amongst the foreign population, especially amongst women from Eastern European countries, who nevertheless have an antenatal care profile not unlike that of seronegative women.