May 30, 2013

WHO Wants HIV, Syphilis Treated Together

The Director of Reproductive Health and Research at the World Health Organisation (WHO) Dr Marleen Temmerman has advised that HIV, cervical cancer and syphilis be dealt with together.

Addressing journalists on the side-lines of the ongoing Women Deliver’s 3rd global conference on girls and women in Kuala Lumpur, Malaysia, Dr Temmerman said the message to girls and women should be for them to go for screenings and treatments for HIV and syphilis at one go.

Dr Temmerman says far more pregnant women have syphilis than HIV and yet focus has mainly been on HIV. She says syphilis too has a greater chance of causing maternal and new born births.

The WHO official says that whereas untreated maternal HIV infection is transmitted to infants in about one third of the cases, untreated maternal syphilis nearly always results in an adverse pregnancy outcome.  The adverse pregnancy outcomes that can result from syphilis include fetal death, stillbirth or premature birth, low birth weight and congenital syphilis infection.

For these reasons, the WHO says syphilis is as important an infection during pregnancy as infection with HIV. It says it, therefore, makes sense to build on global efforts to prevent and treat HIV infection during pregnancy to strengthen the fight against maternal syphilis.

Aware that progress on congenital syphilis elimination has been slow, in June 2012 WHO updated its elimination strategy to twin the prevention of mother-to-child transmission (PMTCT) of HIV with that of syphilis.

Thus, PMTCT should no longer be seen as applicable to HIV infection alone, but to both HIV and syphilis. Such integration is a major step towards the comprehensive prevention of both HIV and syphilis.

The WHO also says that maternal syphilis greatly increases the risk of mother-to-child HIV transmission, hence identifying and treating maternal syphilis in mothers co-infected with HIV should further reduce the mother-to-child transmission of HIV infection.

Dr Temmerman said inclusion of syphilis in PMTCT is important because PMTCT of HIV are better resourced and have stronger external and internal stakeholders than those for the prevention of syphilis.

She said tests for syphilis are simple and widely available, stressing that a single dose of benzathine penicillin early in pregnancy is highly effective at preventing adverse pregnancy outcomes. She said testing and treatment combined cost less than one US dollar.

Prof. Joy Lawn of London School of Hygiene and Tropical Medicine, said the problem is not a lack of affordable tests or treatment, but the absence of political will and gaps in the healthcare systems, especially in developing countries.

In Africa the most syphilis hit countries are Tanzania, the Central African Republic, Ghana, Madagascar, Mozambique and Zambia. These are among 12 countries recognized by WHO as high priority countries for congenital syphilis elimination.

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