The Surge of Maternal and Congenital Syphilis in a Tertiary Care Center in Bangkok, Thailand

Main Article Content

Yada Kunpalin
Anongnart Sirisabya
Surasith Chaithongwongwatthana


Objectives: Globally, syphilis in pregnancies remains a significant health concern, because the infection results in numerous maternal and fetal complications. However, in Thailand, documented evidence regarding the disease in the mothers and their newborns is scarce. Therefore, we conducted the study to explore the disease’s trends in the aforementioned populations.
Materials and Methods: A 10-year retrospective descriptive study (1st January 2006 – 31st December 2015) was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Hospital records of syphilis-infected pregnant women and their infants were extensively reviewed by 2 obstetricians and a neonatologist. Descriptive statistics was leveraged to present patient’s demographic and syphilis-related data.
Results: The percentage of syphilis-infected pregnant women increased from 0.05% in 2006 to 0.5% in 2015. Following the same trend, the percentage of infants with proven or possible congenital syphilis rose from 0% in 2006 to 0.06% and 0.13% in 2015, respectively. Interestingly, teenage pregnant women were particularly affected by the disease in the recent years; the incidence escalated from 10% to 30%. There were 16.4% (n = 12) of infected pregnant women who did not receive treatment antenatally, half of them were asymptomatic with positive serologic results (CMIA+, RPR-, TPPA+ results).
Conclusion: This study adds new information regarding the surge of maternal and congenital syphilis cases particularly in young pregnant women. This update will help to increase the awareness of obstetricians regards to syphilis screening and treatment during pregnancy period. Moreover, it emphasizes the importance of medical personnel’s’ familiarity with the reverse syphilis screening algorithm before applying to clinical practice.


Download data is not yet available.

Article Details

Original Article


1. Wendel GD, Jr., Sheffield JS, Hollier LM, Hill JB, Ramsey PS, Sanchez PJ. Treatment of syphilis in pregnancy and prevention of congenital syphilis. Clin Infect Dis 2002;35(Suppl 2):S200-9.
2. Galvao TF, Silva MT, Serruya SJ, Newman LM, Klausner JD, Pereira MG, et al. Safety of benzathine penicillin for preventing congenital syphilis: a systematic review. PLoS One 2013;8:e56463.
3. McGough LJ, Erbelding, E. . Historical evidence of syphilis and other treponemes. Norwick, UK: Caister Academic Press 2006.
4. Wijesooriya NS, Rochat RW, Kamb ML, Turlapati P, Temmerman M, Broutet N, et al. Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study. Lancet Glob Health 2016;4:e525-33.
5. Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ 2013;91:217-26.
6. Qin J, Yang T, Xiao S, Tan H, Feng T, Fu H. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis. PLoS One 2014;9:e102203.
7. Kuznik A, Habib AG, Manabe YC, Lamorde M. Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa. Sex Transm Dis 2015;42:369-75.
8. Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD, Jr. Fetal syphilis: clinical and laboratory characteristics. Obstet Gynecol 2001;97:947-53.
9. Centers for Disease C, Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006;55(RR-11):1-94.
10. Workowski KA, Berman S, Centers for Disease C, Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010;59(RR-12):1-110.
11. Workowski KA, Bolan GA, Centers for Disease C, Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(RR-03):1-137.
12. 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.
13. Joseph Davey DL, Shull HI, Billings JD, Wang D, Adachi K, Klausner JD. Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015: A Systematic Review. Sex Transm Dis 2016;43:450-8.
14. Wu Z, Xu J, Liu E, Mao Y, Xiao Y, Sun X, et al. HIV and syphilis prevalence among men who have sex with men: a cross-sectional survey of 61 cities in China. Clin Infect Dis 2013;57:298-309.
15. Hallmark CJ, Hill MJ, Luswata C, Watkins KL, Thornton L, McNeese M, et al. Deja vu? A Comparison of Syphilis Outbreaks in Houston, Texas. Sex Transm Dis 2016;43:549-55.
16. Tanprasert S. Assessment of congenital syphilis situation in Thailand. Weekly Epidemiological Surveillance Report 2013;44:81-8.
17. Cassell JA, Mercer CH, Sutcliffe L, Petersen I, Islam A, Brook MG, et al. Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database. BMJ 2006;332(7537):332-4.
18. Cliffe SJ, Tabrizi S, Sullivan EA, Pacific Islands Second Generation HIVSG. Chlamydia in the Pacific region, the silent epidemic. Sex Transm Dis 2008;35:801-6.
19. Sena AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis 2010;51:700-8.
20. Centers for Disease C, Prevention. Discordant results from reverse sequence syphilis screening--five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep 2011;60:133-7.
21. Binnicker MJ, Jespersen DJ, Rollins LO. Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol 2012;50:148-50.
22. Gratrix J, Plitt S, Lee BE, Ferron L, Anderson B, Verity B, et al. Impact of reverse sequence syphilis screening on new diagnoses of late latent syphilis in Edmonton, Canada. Sex Transm Dis 2012;39:528-30.
23. Qin JB, Feng TJ, Yang TB, Hong FC, Lan LN, Zhang CL, et al. Risk factors for congenital syphilis and adverse pregnancy outcomes in offspring of women with syphilis in Shenzhen, China: a prospective nested case-control study. Sex Transm Dis 2014;41:13-23.
24. Hong FC, Yang YZ, Liu XL, Feng TJ, Liu JB, Zhang CL, et al. Reduction in mother-to-child transmission of syphilis for 10 years in Shenzhen, China. Sex Transm Dis 2014;41:188-93.
25. Su JR, Brooks LC, Davis DW, Torrone EA, Weinstock HS, Kamb ML. Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013. Am J Obstet Gynecol 2016;214:381 e1-9.
26. Hawkes SJ, Gomez GB, Broutet N. Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis. PLoS One 2013;8:e56713.
27. Bradley H, Gruber D, Introcaso CE, Foxhood J, Wendell D, Rahman M, et al. Congenital syphilis investigation processes and timing in Louisiana. Sex Transm Dis 2014;41:560-3.