Audit of Syphilis Screening in Pregnancy

Audit of Syphilis Screening in Pregnancy Tables Table 1: Syphilis confirmatory test results for forty nine   pregnant woman 18 Table 2: Syphilis s creening results of eleven new-borns of   positive syphilis mother 24 Table 3: Positive s yphilis confirmat ory test results for sixteen   pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening   for mothers 28 Figure 2: The laboratory turnaround time of syphilis screening   for new-borns 28 Tables Table 1: Syphilis confirmatory test results for forty nine pregnant woman 18 Table 2: Syphilis s creening results of eleven new-borns of positive syphilis mothers 24 Table 3 : Positive s yphilis confirmat ory test results for sixteen pregnant woman 30 Figure s Figure 1: The laboratory turnaround time of syphilis screening for mothers Figure 2: The laboratory turnaround time of syphilis screening for new-borns ABSTRACT Objective: A re-audit of syphilis screening in pregnancy was carried out to ensure that the improvements in laboratory and clinical aspects of management for the antenatal of pregnant women with positive syphilis screening and their new-born babies fully met were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). Methods: Patients’ data were collected via query of the three databases: Clinisys Labcentre , Telepath and EuroKing . The n the data were analysed using Microsoft Access 2013. Results: Samples from F orty nine 49 pregnant woman with positive syphilis results serology were referred to a reference laboratory laboratory were sent to MRI for syphilis serological confirmatory testing. Sixteen pregnant woman with of these women were confirmed to have had had positive syphilis were identified . Ten pregnant woman were re-tested screened at least twice during their pregnancy and six pregnant woman were only screened tested once during pregnancy. Over-testing of for treponemal IgM were seen in nineteen patients [h1] with non-reactive RPR titre. Only eleven babies born to mothers with syphilis were followed-up with serial serological test s for syphilis. Only four new-borns were fully screened. Some of the new-borns were not tested with treponemal IgM due to sample insufficiency. Conclusion: There were some improvements seen since the first audit which includes the changes of the confirmatory testing schedule in MRI, lower screening false positive rate, and increased follow-up of the new-borns. There were also things to improve in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of syphilis in new-borns should give priority to RPR test and treponemal IgM to prevent under- testing [h2] . In-house confirmatory testing should be considered to allow reduction of test turnaround time’s thereby aiding patient management. Improvements [h3] should be made in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to preven t over-testing of patients. The test algorithm for screening of syphilis in new-borns should give priority to RPR test and treponemal IgM to prevent under- testing [h4] . 1.0   INTRODUCTION 1.1   Syphilis Syphilis is an infectious disease caused by Treponema pallidum (T.pallidum) subspecies pallidum . The disease is transmitted from human to human, and humans are its only known natural host (Woods 2005). Epidemiologically, in the UK, cases of syphilis have increased in England since 1997 led by a series of outbreaks reported from Manchester, London and Brighton (Health Protection Agency 2009). Since 1999, diagnoses of infectious syphilis have been made in heterosexuals where the outbreaks are linked to sex work, students and young people. But, there was a changing pattern of infection between 1999 and 2008, when seventy three percent of new diagnoses of infectious syphilis were reported in men who have sex with men (Health Protection Agency 2009). The transmission is primarily by sexual activity (Zeltser & Kurban 2004) (vaginal and anal intercourse) and by direct contact with active primary or secondary lesions (Lafond & Lukehart 2006) for example through oral sex and kissing at or near an infectious lesion (Kent & Romanelli 2008). T.pallidum may invade the host through normal mucosal membranes and also through minor abrasions in the skin (Zeltser & Kurban 2004) such as from sexual trauma, causing an inflammation, ulcer and then spreading through the blood stream to other parts of the body (Goh 2005) .