Syphilis in pregnancy in Tuscany, description of a case series from a global health perspective.

Objective: To estimate the epidemiological impact of syphilis in pregnancy and congenital syphilis in Tuscany and to better delineate their determinants in this region. Methods: Features of pregnant women with syphilis attending the Tuscany Reference Center for Infectious Diseases in Pregnancy between 2000 and 2010 and their infants were retrospectively reviewed. Results: One hundred and eighty-seven pregnancies were observed. The number of pregnancies evaluated increased steadily from 24 in 2000-2002 to 70 in 2009-2010. The majority of women were Italian (20.32%) and East European (44.39%). Eight cases of congenital syphilis were diagnosed (5.60% of pregnancies with known outcome). Italian women had more often an early stage of syphilis (11.76 vs. 1.34%; p = 0.016), an rapid plasma regain (RPR) title ≥ 1:8 (15.79 vs. 5.37%; p = 0.041) and a partner with positive test (60.00 vs. 21.69%; p < 0.001) compared with migrant women. Migrant women received treatment after the first trimester more often compared with Italian ones (40.94 vs. 18.42%; p = 0.013). Conclusions: Syphilis in pregnancy is emerging in Tuscany. Italian and migrant women with syphilis show two different "risk patterns" of vertical transmission. An additional screening test for syphilis in the third trimester and educational campaigns about maternal and sexual health could be effective in combating congenital syphilis in Italy.