Abstract Ref Number = APCP64
An iceberg phenomenon of Congenital Syphilis :
Indonesian pediatrician should increase the awareness for disease burden and it’s management
Department of Childhealth, Faculty of Medicine Universitas Padjadjaran
Dr Hasan Sadikin Hospital
Since the advent of penicillin, syphilis is not only treatable but also preventable. Despite this, it remains a global problem with an estimated 12 million people infected each year. There is an increase evidence that sexually transmitted infections,including syphilis, increase woman’s chances of becoming infected with HIV. Pregnant women who are infected by treponema pallidum can transmit the infection to their fetus, causing congenital syphilis with serious adverse effect on the pregnancy. Untreated primary or secondary syphilis in pregnancy results in 25% risk of stillbirth, a 14% risk of neonatal death, a 41% risk of giving birth to alive but infected infant and only a 20% chance of giving birth to a healthy, uninfected infant. This burden of congenital syphilis is still under-appreciated in many countries especially in developing or underdevelop countries. In 2007, WHO published the global elimination of congenital syphlilis : rationale and strategy for action; congenital syphlilis can be eliminated through effective screening of pregnant women for syphlilis and treat of those infected. Despite the strengthening of antenatal screening and treatment of pregnant women and her partner(s), the specific goal of elimination of congenital syphilis can be achieved by understanding the indication for antibiotic prophylaxis, detecting clinical signs of congenital syphilis, and treatment of congenital syphilis; the role of pediatrician is important in this part of action.
The building blocks for congenital syphilis prevention are already in place in many countries, however in Indonesia the policy on screening pregnant women for syphilis along with HIV and Hepatitis B just begun on November 2017 by the release of Ministry of Health Regulation number 52/2017 about Elimination of the transmission of HIV virus, Syphilis and Hepatitis B from mother to children.
Study on the prevalence of congenital syphilis in Indonesia is difficult to find, however, the report of Directorate General of Prevention and Diseases Control-Ministry of Health, March 23,2018, revealed that from 2016, the cascade number of pregnant women who visit antenatal care for the first time were 149.209, among them a 108.403 pregnant women tested for syphilis. The positive serology test for syphilis found in 8092 (7.5%) pregnant women, however, only 1.706 (21.1 %) among them received treatment. These data indicates that there will be a high number of high risk infants for congenital syphilis born from infected mother, especially those with inadequate or without treatment. This is the challenge for us, Indonesian pediatrician, to increase the awareness of congenital syphilis and understanding it’s management.