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Syphilis: tackling the last taboo in public health

Imagine if you could prevent half a million baby deaths a year and hundreds of thousands more cases of blindness and deafness with a simple blood test and some cheap antibiotics.

That is a very real possibility but the key first step is acknowledging the source of the problem, and that's probably the hardest part.

That's because the mass killer and maimer of children is rarely spoken of in those terms, if at all; rather, it is known as the "last taboo" in public health.

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Syphilis is usually viewed as an Old World scourge, a sexually-transmitted infection that's been virtually eliminated.

But, in the era of AIDS, syphilis remains a little-discussed but very real problem, one that carries with it a considerable amount of shame.

According to the World Health Organization, some 2.1 million women with syphilis give birth every year. Almost 70 per cent of their babies are stillborn, and many of the rest suffer from low birth weight (putting them at great risk for a host of illnesses), hearing loss, vision loss and facial deformities.

Very few of the mothers-to-be know they have syphilis. The infection causes lesions, but they are usually painless and hidden in the genital tract. Syphilis is known as the great imitator because its symptoms are largely indistinguishable from a host of other diseases. There are also no public health awareness campaigns the way there are for HIV-AIDS and vaccine preventable illnesses.

(Syphilis is caused by a bacterium, Treponema pallidum, which is transmitted through contact with sores, which generally appear on the genitals or in the mouth. There is no vaccine, but the infection can be treated with penicillin.) For the fetus, however, infection in utero, or while still in the womb, is often deadly – the bacterium attacks the brain, the heart and other vital organs. Babies can also be infected in the birthing canal, and blindness can result.

A new group, the Global Congenital Syphilis Partnership, is trying to change this grim situation. Their plan: To make screening for syphilis a routine part of pregnancy care with the goal of eliminating congenital syphilis.

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In Western countries like Canada, screening has been the norm for decades. But doing a blood test, sending it off to a lab for analysis, then expecting the patient to come back for results, is not practical in most of the developing world.

As an aside, it should be noted that syphilis is not exclusively a problem in the developing world. The disease was virtually eliminated from Canada a decade ago, a by-product of hammering home the safe-sex message. But syphilis is now spreading rapidly, particularly in minority communities, like men who have sex with men, intravenous drug users and first nations. The effectiveness of treatments have made people less concerned about the risk of HIV-AIDS and safe sex more generally. We are also quite cavalier about syphilis because of the ease of treatment.

Yet, despite screening programs, fancy technology and powerful drugs, about a dozen children a year in Canada die because of congenital syphilis. Sadly, most are first nations communities, where poverty is endemic and antenatal screening leaves a lot to be desired.

In the developing world, the deaths are counted in the hundreds of thousands.

Putting the brakes on that carnage is now doable and affordable.

There is a rapid test for syphilis that, with a few drops of blood, can provide a pretty accurate diagnosis within 15 minutes andantibiotics can be injected on the spot, curing the infection.

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The partnership – which includes the Bill & Melinda Gates Foundation, Save The Children, the U.S. Centers for Disease Control and Prevention, the London School of Hygiene and Tropical Medicine, and the WHO – wants to make that test standard.

So far, they have tested the idea in seven countries – Brazil, China, Haiti, Peru, Zambia, Uganda and Tanzania – and the results were so immediate, that each jurisdiction adopted the approach permanently. (And, in an era where health dollars are tight, that speaks volumes.) The syphilis test – and treatment where necessary – costs only about $1.50. It can also be done at the same time as a rapid HIV test, which is now routine for women in virtually all developing countries. (Moms infected with HIV can avoid passing the virus on to their babies with a drug cocktail that is cheap and highly effective.)

A study published in the medical journal Lancet Infectious Diseases showed just how impactful such a program can be. The research team, led by Sarah Hawkes of University College in London, reviewed 10 published studies. The team found that the blood test and antibiotics combo reduced stillbirths in women with syphilis by an impressive 58 per cent and, overall, adverse outcomes fell by 69 per cent.

And, most impressive of all about these numbers is that they are not theoretical. These studies were not done in controlled conditions, they were done in the real world.

The ability to save lives is there. The cost is negligible. The only real impediment, in the words of David Mabey of the London School of Hygiene and Tropical Medicine, is the "perception among many public health experts, program managers and policy makers that syphilis has disappeared has probably been the greatest barrier to preventing syphilis deaths in babies"

This level of ignorance – and related inaction – is deadly, and unconscionable.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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