# Prevalence and management of syphilis at primary healthcare level in the Free State, South Africa

## TL;DR

This study examines the prevalence and treatment of maternal syphilis in South African clinics, finding gaps in screening and care that risk neonatal health.

## Contribution

The study highlights specific management gaps in maternal syphilis treatment at primary healthcare clinics in the Free State, South Africa.

## Key findings

- The prevalence of maternal syphilis was 2.3% at the studied clinics.
- 44.7% of syphilis-negative women were not retested, and 20% of syphilis-positive women did not receive complete treatment.
- Two syphilis-exposed neonates had complications despite maternal treatment.

## Abstract

Maternal syphilis (MS) is of special concern because of the risks of vertical transmission resulting in high rates of stillbirths and neonatal infections, especially in low- and middle-income countries (LMICs), such as South Africa (SA).

To assess the clinical management of MS at two primary healthcare clinics.

This was a retrospective evaluation of the antenatal records from 2020 to 2023 at two clinics in the Free State, SA. Demographic and clinical data, including MS mono rapid plasma reagin test and HIV status measured using the mono rapid HIV test, foetal and perinatal outcomes were collected.

668 records were reviewed. Fifteen tested (2.3%) positive for MS, but only 12/15 received complete treatment. Of the syphilis negative women, only 365 (55.3%) were retested. 28% of all pregnant women were HIV-positive. Four of the 15 (27%) women with MS had HIV, while 11 of the 15 (73%) of the HIV-negative pregnant women had syphilis. Among syphilis-exposed neonates, two had complications due to syphilis exposure and one had low birthweight despite maternal treatment.

The prevalence of MS at the study sites was 2.3%. 44.7% of the women who tested negative for syphilis were not retested, and three women with syphilis did not receive complete treatment. Incomplete treatment of the mothers’ results in complications in syphilis-exposed neonates. There is an urgent need for continuing training for the nurses and midwives on antenatal screening and treatment protocols for MS at primary healthcare settings in the Free State, SA.

This work will benefit the community by alerting the Department of Health on the short comings found at antenatal care clinics, with the goal to improve the management of pregnant women.