Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes

Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant women was recruited in Tanzania. Birth outcomes were compared among women treated for high-titer ( ; rapidnp 133 plasma reagin [RPR] titer 1:8 and Treponema pallidum hemagglutination assay [TPHA]/ fluorescent treponemal antibody [FTA] positive) and low-titer ( ; RPR titer!1:8 andnp 249 TPHA/FTA positive) active syphilis and 950 uninfected women. Stillbirth or low-birth-weight live births were observed in 2.3 % and 6.3%, respectively, of women treated for high-titer active syphilis and in 2.5 % and 9.2%, respectively, of seronegative women. There was no increased risk for adverse pregnancy outcome for women treated for high-titer active syphilis (odds ratio [OR], 0.76; 95 % confidence interval [CI], 0.4–1.4) or low-titer active syphilis (OR, 0.95; 95 % CI, 0.6–1.5), compared with seronegative women. Single-dose treatment is effective in preventing adverse pregnancy outcomes attributable to maternal syphilis. Maternal syphilis remains an important cause of adverse pregnancy outcome in sub-Saharan Africa [1–5]. A recent stud