Nigeria is ramping up the use of a test that 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 of women are tested for HIV during pregnancy in many low- and middle-income countries. But far fewer pregnant women are tested for syphilis. However, a dual test kit ensures that 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.
Dr Yewande Olaifa, the deputy director overseeing the Gender and Human Rights Division at the National Agency for the Control of AIDS (NACA), said the dual test testing is to prevent an increasing number of babies that may be born with congenital malformations due to syphilis.
“That’s why it is a standard protocol that every woman that becomes pregnant, you must always test her for syphilis and treat her if she has syphilis,” she added.
She spoke at the HIV media training by Journalists Against AIDS (JAAIDS) Nigeria and LivingHealth International, with support from PEPFAR Nigeria through the Henry Jackson Foundation Medical Research International in Lagos.
Even in Nigeria, syphilis has not gone on totally. Without its diagnosis and treatment in pregnant women, it can cause what is called congenital syphilis in a newborn baby. Testing for syphilis is done as soon as the pregnant women come to register for antenatal care.
Dr Mercy Morka, an assistant director at the National AIDS, Viral Hepatitis, and STI Control Programme of the Federal Ministry of Health, declared that data on syphilis is also taken along with other infections like HIV, hepatitis B, and C.
“This is reported routinely to NASCAP, the Federal Ministry of Health; we are getting cases of syphilis, a sexually transmitted infection. There are some cases. But the focus is on the child because it’s not just about treating syphilis. A child who is exposed to syphilis may come out with abnormalities. That’s why we are focussing on syphilis,” she added.
Dr Olaifa said the dual test is to prevent an increasing number of babies that may be born with HIV and congenital malformations due to syphilis, adding that the service available in primary health centres is free.
“At least from my experience working here in Lagos at the primary-level care centres, there were a few cases. And the treatment is cheap. Penicillin is the cheapest, although other drugs can be used.
“Now that we’re having the prevention of mother-to-child transmission of HIV (PMCT) scale up, it is to encourage women, irrespective of where they have decided to deliver, to make sure that they have access to getting tested for HIV, syphilis, hepatitis B, and hepatitis C.
“And that if, by any chance, there are any of those infections, they get treated. They can choose where they want to deliver, but they should avail themselves of the opportunity of being assessed as to whether they have risky pregnancies.”
A high-risk pregnancy is defined as any pregnancy in which there is evidence of an actual or potential threat of harm to the life or health of the mother and her baby.
Some pregnancies become high-risk as they progress, while some women are at increased risk for complications even before they get pregnant for a variety of reasons.
Reasons that a pregnancy may be considered high-risk include medical conditions that exist before pregnancy, like diabetes and hypertension. Also, a history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are risk factors for a high-risk pregnancy.
However, high-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby.
Infants infected with HIV appear to be normal and healthy. However, Dr Olaifa said that those born with syphilis, in contrast, can have skeletal and facial deformities, as well as deafness and blindness, and up to 40% of those with congenital syphilis are stillborn or die early.
“The early stage of syphilis is asymptomatic, so a lot of the time it spreads unnoticed. And then, if these women are not diagnosed early on, it starts to endanger their health, and there will be complications that will set in fast, affecting or causing damage to their brain, their hearts, even their skin, and so many other complications.
“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 newborn. 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,” she added.
Both the CDC and a joint guideline issued by the American Academy of Paediatrics (AAP) and the American College of Obstetricians and Gynaecologists suggest that repeat screening is beneficial for pregnant women, especially those at high risk for infection, including those who live in areas with a high prevalence of syphilis, those with HIV, and those who have been previously incarcerated or have a history of commercial sex work.
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