Syphilis among pregnant women
Export Indicator
A. Percentage of women attending antenatal care services who received syphilis testing.
B. Percentage of women attending antenatal care services who received syphilis testing and who had a positive syphilis serology.
C. Percentage of women attending antenatal care services who had a positive syphilis serology and who were treated adequately.
Testing (screening) coverage, the prevalence of syphilis in women attending antenatal care services, and treatment coverage are all key indicators for assessing a country's progress towards eliminating vertical transmission of syphilis. At the country level, these data can be used to identify areas with the greatest need for comprehensive congenital syphilis prevention interventions. At the global level, these data are also used to estimate the perinatal mortality and morbidity caused by syphilis that could be averted with effective programmes to eliminate vertical transmission of syphilis.
A. Testing all pregnant women for syphilis early in pregnancy is important for the pregnant woman's health and that of the foetus. This indicator also contributes to monitoring the quality of antenatal care and services to prevent sexually transmitted infections (including HIV) among pregnant women.
B. The prevalence of syphilis in antenatal care attendees can be used to highlight areas within a country that require additional support, and it may provide early warning of potential changes in HIV and sexually transmitted infection transmission in the general population. The data are also an important source of information for generating national, regional and global incidence and prevalence estimates for syphilis and congenital syphilis.
C. Treating antenatal care attendees who test positive for syphilis is essential for reducing vertical transmission of syphilis.
A. Number of women attending antenatal care services who were tested for syphilis.
B. Number of women attending antenatal care services who tested positive for syphilis.
C. Number of women attending antenatal care services with a positive syphilis test who received at least one dose of benzathine penicillin 2.4 million units intramuscularly.
A. Number of women attending antenatal care services.
B. Number of women attending antenatal care services who were tested for syphilis.
C. Number of women attending antenatal care services who tested positive for syphilis.
Numerator/denominator (for A, B and C, respectively)
Testing (screening) may be done using either a nontreponemal test (e.g., venereal disease research laboratory [VDRL] or rapid plasma reagin [RPR]) or a treponemal test (e.g., Treponema pallidum haemagglutination assay [TPHA], Treponema pallidum particle agglutination assay [TPPA], enzyme immunoassay or rapid treponemal test). For this indicator, having either type of test (treponemal or nontreponemal) is sufficient, although being tested with both is preferred.
Ideally, national programme records aggregated from health-facility data should be used. However, if such data are not available, data from sentinel surveillance or special studies can be reported. Specify the source and coverage of your data (e.g., national programme data from all 12 provinces) in the comments section.
The following sources of data may be used: national programme records aggregated from health-facility data, sentinel surveillance or special surveys. In the comments section, specify the source and coverage of your data: for example, sentinel surveillance of all antenatal care attendees in two of 10 provinces.
Countries are encouraged to use unique identifiers or registries that separate first and subsequent tests to avoid double counting and that reflect the true prevalence or incidence of syphilis rather than test positivity. Please specify the source and coverage of your data in the comments section.
C. Pregnant women with positive syphilis serology should be treated with benzathine penicillin, ideally on the same day as they are tested in order to prevent vertical transmission. For the purposes of this indicator, documentation of a single dose of penicillin is sufficient. Treatment of syphilis in pregnant women should be based on national treatment guidelines. Knowledge of treatment policies and practices should be used to interpret trends in treatment.
Please specify the source and coverage of your data in the comments section.
Annual
Please document in the comments section the tests or algorithm used to define positivity among pregnant women and if this is the same across the country, or if it has changed since the last Global AIDS Monitoring report.
Please comment on whether the data you are providing are deemed to be representative of the entire country. Submit the digital version of any available survey reports using the upload tool.
If data are available on the stage of pregnancy when a woman receives testing, and on the time between testing and treatment, please provide them.
Programmes that test pregnant women separately for syphilis and HIV should collaborate to align and enhance the effectiveness of their work. Preventing congenital syphilis requires testing early in pregnancy, since stillbirth may occur in the second trimester. Knowing that women are being tested late in pregnancy indicates that women are not accessing antenatal care early or that testing is not occurring early in pregnancy.
Knowledge of testing practices within the country (such as the proportion of treponemal versus nontreponemal testing used) and any changes over time are key to interpreting disease trends.
National-level monitoring of the achievement of universal access to reproductive health: conceptual and practical considerations and related indicators. Geneva: World Health Organization; 2008 (http://www.who.int/reproductivehealth/publications/monitoring/9789241596...).
Methods for surveillance and monitoring of congenital syphilis elimination within existing systems. Geneva: World Health Organization; 2011 (http://www.who.int/reproductivehealth/publications/rtis/9789241503020/en).
Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/handle/10665/112858).
WHO guidelines on syphilis screening and treatment of pregnant women. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/9789241550093).
Dual HIV/syphilis rapid diagnostic tests can be used as the first test in antenatal test. Geneva: World Health Organization; 2019 (https://www.who.int/publications/i/item/WHO-CDS-HIV-19.38).
Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization, 2022 (https://www.who.int/publications/i/item/9789240055315)
Related Indicators
ST.1 Syphilis screening coverage (in ANC), 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).
ST.2 Syphilis treatment coverage (in ANC), 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).