Maternal and congenital syphilis in four provinces in Bolivia

Assess frequencies of maternal and congenital syphilis, mother-child transmission and variables associated with syphilis in six urban hospitals in Bolivia. A cross-sectional study was performed between May and September 2004. We administered the Abbot Determine-TP rapid test and quantitative RPR to postpartum women without prior RPR. Sociodemographic variables and prior prenatal care visits were studied. Newborns of syphilis positive mothers were studied with Western Blot IgM p47 and ELISA IgM. Serum samples were analyzed at the Central Reference Laboratory (INLASA). Statistical analysis included bivariate and multivariate analyses to establish association with positive diagnosis of T. pallidum. Syphilis prevalence among 1 594 postpartum women was 7.2%. Mother to child transmission was 15.7%. Congenital syphilis prevalence by serology was 1.1% and 94% of these newborns displayed no symptoms. Despite 70.5% prenatal care coverage in Bolivia some women still go directly to a facility to give birth without prior routine tests for syphilis. Low education levels in both parents (< 8 years) and failure to attend prenatal care were strong predictors of congenital syphilis. Rapid syphilis tests constitute an important tool to strengthen early diagnosis of syphilis during pregnancy. Preventing congenital and maternal syphilis in Bolivia remains a public health priority.