Feasibility of Rapid Testing for Syphilis and Extent of Non-Venereal Treponematoses in Rural, Public Health Clinics in Mali

Background: We investigated high syphilis sero-positivity (>10%) among women attending antenatal care in Northeastern Mali, where no laboratory capacity exists.

Objectives: We assessed feasibility of rapid treponemal testing to prevent congenital syphilis and estimated extent of non-venereal treponematoses.

Methods: We studied women attending antenatal, reproductive health and immunization clinics in Gao, Mali.  Participants had rapid syphilis tests onsite; RPR/TPPA tests were sent away.   For consenting women, we examined and tested their children < 15 years.   

 

Results: Of 600 women enrolled February – March 2009, 590 (98%) had rapid syphilis tests; 77 (13%) were positive; 61/77 (79%) had positive RPR/TPPA tests (active syphilis infections). Of 513 negative women, 19 (3.7%) had positive RPR/TPPAs (missed infections); 16/590 (2.7 %) women who initially tested positive with the rapid test had negative RPR/TPPAs (over-treated).  The sensitivity of the rapid test conducted in study sites was 76.3% (61/80) and the specificity was 96.3% (494/513).

We examined/tested 475 children of 243 (41%) consenting women: 10 children had clinical findings suggesting non-venereal treponematoses (bony deformities (2/10), eczema-like skin lesions (8/10); 20 (4.2%) had positive rapid tests of which 16 were < 10 years of age.   Sero-positive children were five times more likely to have seropositive mothers than negative children (OR 5.1, 95% CI 1.7 – 15.8).  Two family clusters of positive women with several positive children were identified.

 

Conclusions: Rapid syphilis testing for prevention of congenital syphilis is feasible in public health settings in this remote, rural region, although test sensitivity was less robust than in other field studies.  Use of rapid testing allowed treatment of many syphilis positive women who would have been missed. However, the rapid tests missed some infections, and a few women were treated unnecessarily.  Low levels of non-venereal treponematosis may continue in Mali, although this could not be definitively confirmed.

 

Implications for Program, Policy, and Research:  Rapid syphilis tests can facilitate antenatal screening and congenital syphilis prevention in remote locations.

Learning Objectives:

By the end of the session, participants will be able to:

1) Understand why rapid treponemal tests are useful in certain settings.

2) Better understand challenges in global congenital syphilis prevention