Syphilis in pregnancy in Florence: immigration and unfaithfulness

Syphilis in pregnancy and related congenital syphilis are reemerging concerns in Italy.1 The resurgence of these two problems is linked to both the spread of risky sexual behavior in Italian general population and to migration flows from countries with higher prevalence. The main risk factors for mother to child transmission of syphilis are an high non-treponemal test title, a maternal recently acquired infection and the lack of early diagnosis and treatment in pregnancy. Most of the cases of congenital syphilis are potentially preventable with early identification of infected pregnant women and appropriate therapy. In Italy the screening for syphilis in pregnant women is free and scheduled by law within the first trimester (Ministerial Decree, September 1998), nevertheless congenital syphilis still occur. Methods and materials: We retrospectively reviewed anagraphic, ethnical, socio-economic and clinical features of 186 syphilitic pregnant women presenting to the Tuscan Referral Center for Infectious Diseases in Pregnancy from 2000 to 2010 in order to investigate whether certain subgroups have more identified risk factors for developing adverse outcome. We followed 142 women until the end of pregnancy. Their outcomes were recorded in order to identify new risk factors for adverse events in our setting. Univariate statistical analysis were performed using Fisher test. Results: Figure 1 show the number of cases of syphilis in pregnancy and congenital syphilis by years. Figure 2 show the flow of patient through the different steps of follow-up. Table 1 summarize the main features of pregnant women with syphilis and the association of these features with diagnosis of congenital syphilis in their children. All women were treated with an appropriate regimen according to the stage of syphilis. Recent stages of infection (primary, secondary and early latent syphilis) were treated with 2,4 MU of penicillin weekly for two weeks. Conclusions: Our data show that syphilis in pregnancy is a remerging concern also in our region. Undocumented migrants and Asian migrants are two social group at increased risk of vertical transmission of syphilis because they are poorly integrated and they have great difficulties in accessing services. Positive association between male partners test positivity and vertical transmission of syphilis is due to infidelity of male partner (anamnestic data) which lead to an unexpected seroconversion of woman during pregnancy (in some case after a negative screening test in the first trimester) and the consequent lack of adequate therapy.