The reality of undiagnosed syphilis for mothers and babies

by MedAccess

Photo credit: Arete / Bernard Kalu / MedAccess

Nigeria is ramping up the use of a test which can detect both HIV and syphilis simultaneously. But why is this test so vital to the health of mothers and their babies?

A relatively high proportion women are tested for HIV during pregnancy in many low-and middle-income countries. But far fewer pregnant women are tested for syphilis. We wanted to use innovative finance to change this, and so we negotiated a volume guarantee with SD Biosensor, which makes an HIV/syphilis dual test.

The dual test means women coming to antenatal appointments can test for both HIV and syphilis at the same time, helping bring syphilis testing rates up to HIV testing rates. Under the agreement, SD Biosensor’s test is now the first available at under $1. The price reduction is helping more countries to expand access.

We spoke to healthcare workers in Nigeria about why the test is so important to help diagnose and treat syphilis for mothers and babies.

Testing for two highly prevalent illnesses

“It is important to test pregnant women, because the prevalence of HIV and syphilis in society today cannot be overemphasized,” says Godwin Neebeh, a medical laboratory scientist.

Godwin Neebeh is a medical laboratory scientist at River State University Teaching Hospital Port Harcourt, Rivers State. Photo credit: Arete / Bernard Kalu / MedAccess

HIV and syphilis are both transmissible from mother to child during pregnancy. A dual test lets a pregnant woman and her healthcare worker know if she is positive for either from a single finger-prick sample.

While the percentage of women tested for HIV in Nigeria is relatively low, it is still much higher than the testing rates for syphilis. In Nigeria, just 16.1% of women are tested for syphilis while they are pregnant.

Interrupting the transmission

“HIV and syphilis are two of the most devastating diseases a child can be born with”, says Dr Akudo Ikpeazu, public health physician and director and head of Nigeria’s national AIDS, viral hepatitis and STIs control program.

Dr Akudo Ikpeazu is a public health physician and works as the director and head of Nigeria’s national  AIDS, viral hepatitis and STIs control program in the Federal Ministry of Health. Photo credit: Arete / Bernard Kalu / MedAccess

Increasing these testing rates is essential to the health of women and their babies. If a positive result is returned, steps can be taken to interrupt that transmission.

Fortunately, that interruption comes in a simple form of treatment for syphilis. It’s usually administered the same day as the test result.

“If caught early, the treatment for syphilis, Benzathine Penicillin G injection, is usually given in a single dose and of course, it’s safe for pregnant women and for the babies too,” says Queen Ohaka, a nurse.

Queen Ohaka is a nurse at the Rivers State University Teaching Hospital in Port Harcourt, Rivers State. Photo credit: Arete / Bernard Kalu / MedAccess

The impact of undiagnosed syphilis can be devastating

While those who are tested can access rapid and effective treatment, many women progress through their pregnancy with no knowledge of a syphilis infection. Sadly, the impact can be devastating.

“The impact of undiagnosed syphilis in women can have devastating consequences on their health. The early stage of syphilis is asymptomatic so a lot of the time it spreads totally unnoticed. And then if these women are not diagnosed early on, it starts to endanger their health, there will be complications that will set in fast. Which will affect or cause damage to their brain, their hearts, even their skin, and so many other complications”, says Queen.

Dr Ime Usanga is one of the doctors working with the Akwa Ibom State Ministry of Health, coordinating the AIDS program. Photo credit: Arete / Bernard Kalu / MedAccess

Dr Ime Usanga, doctor, describes the effects of untreated syphilis on babies. “Congenital and maternal syphilis can have extremely destructive effects on unborn children. Syphilis in pregnant women can cause miscarriage, stillbirth, or the baby’s death shortly after birth. A lot of babies born to women with untreated syphilis can be stillborn or die from the infection as a new-born. Babies born with congenital syphilis can have bone damage, severe anaemia, enlarged liver and spleen, jaundice, nerve problems causing blindness or deafness, meningitis, or skin rashes,” he says.

“Unfortunately, in many cases the children who are born with syphilis have a high mortality rate. This is such terrible line of events because the treatment for syphilis is very simple”, says Veronica Effiong, HIV program manager.

Veronica Effiong is the HIV program manager for St Luke’s Hospital Anua in Uyo, Akwa Ibom State. Photo credit: Arete / Bernard Kalu / MedAccess

Testing for two infections at once

Dr Gbenga Ijaodola has championed the dual test as a method to prevent such complications from the start. As both public health physician and national lead for prevention of mother to child transmission of HIV, syphilis and hepatitis, he believes the dual test must be one of the key health packages for every pregnant woman in Nigeria.

“The idea is simply to ensure that every pregnant woman has access to the kits. And these dual test kits have given us the opportunity now to be able to use one single drop of blood to test for HIV and syphilis,” he says.

Dr Gbenga Ijaodola
Dr Gbenga Ijaodola is a public health physician and national lead for prevention of mother to child transmission of HIV, syphilis and hepatitis in the Federal Ministry of Health. Photo credit: Arete / Bernard Kalu / MedAccess

“Beyond the cost saving [of combining the tests into one], the woman doesn’t have to come back for another test. Before we would have to say ‘maybe come today for HIV, then come the next time for syphilis’. There is no case of having to prick or collect blood samples more than once,” describes Dr Ufuoma Edewor, public health physician and program manager.

Dr Ufuoma Edewor is a public health physician and the program manager for the state AIDS and STI control program at the Rivers State Ministry of Health. Photo credit: Arete / Bernard Kalu / MedAccess

Dr Gbenga describes how scaling up access to the dual tests relies on knowing exactly where each pregnant woman is and which healthcare centre she is likely to visit. “Currently, we’ve been able to achieve that,” he says. “The next step is now for us to know exactly what we need to have, and the quantity of test kits to be procured across the board.”

Creating awareness is key

Healthcare workers are eager to see the test rolled out more widely.

“Me and my team are very excited that this has brought some change, we can move faster. We are testing for both HIV and syphilis at the same time. And a lot of work is going on to see how this can be expanded at a community level,” says Dr Akudo Ikpeazu.

Queen describes wanting to create awareness of syphilis among more women. “Having that knowledge during the early stages could help many lives. As it’s asymptomatic they may not even know that they’re having these issues, until they are being screened for it or it’s too late. So, I think that creating awareness is key,” she says.

“Hopefully soon we can eradicate the possibility of any of these diseases being passed down to a child who is just starting their life.” – Dr Akudo Ikpeazu

In November 2021, MedAccess, the Clinton Health Access Initiative (CHAI) and SD Biosensor announced a partnership to significantly increase access to innovative combined rapid testing for syphilis and HIV. Find out more about the partnership.