Centers for Disease Control and Prevention, Atlanta, makers might have chosen to give 1 Mabey D, Peeling RW. Syphilis, still a major
GA, USA (THH); and Medical Research Council, Cape cause of infant mortality. Lancet Infect Dis
little attention to the scourge of 2011; 11: 654–55.
Town, South Africa (RR, TM)
congenital syphilis in part because 2 Hawkes S, Matin N, Broutet N, Low N.
1 Holtz TH, Kabera G, Mthiyane T, et al. Use of a
WHO-recommended algorithm to reduce of two Cochrane systematic Eﬀectiveness of interventions to improve
screening for syphilis in pregnancy: a
mortality in seriously ill patients with HIV reviews,4,5 which they incorrectly systematic review and meta-analysis.
infection and smear-negative pulmonary
tuberculosis in South Africa: an observational claimed showed “no good evidence Lancet Infect Dis 2011; 11: 684–91.
cohort study. Lancet Infect Dis 2011; that the treatment of syphilis 3 Walker DG, Walker GJ. Forgotten but not gone:
11: 533–40. the continuing scourge of congenital syphilis.
in pregnant women improved Lancet Infect Dis 2002; 2: 432–36.
2 WHO. Improving the diagnosis and treatment
of smear-negative pulmonary and pregnancy outcome”. However, the 4 Walker GJA. Antibiotics for syphilis diagnosed
extrapulmonary tuberculosis among adults systematic review,4 authored by one during pregnancy. Cochrane Database Syst Rev
and adolescents: recommendations for HIV- 2001; 3: CD001143.
prevalent and resource-constrained settings. of us, concluded that “...there is no 5 Blencowe H, Cousens S, Kamb M, Berman S,
Geneva: World Health Organization; 2007. doubt that penicillin is eﬀective in Lawn JE. Lives saved tool supplement
3 Wilson D, Mbhele L, Badri M, et al. Evaluation detection and treatment of syphilis in
the treatment of syphilis in pregnancy pregnancy to reduce syphilis related stillbirths
of the World Health Organization algorithm
for the diagnosis of HIV-associated sputum and the prevention of congenital and neonatal mortality. BMC Public Health
smear-negative tuberculosis. syphilis”. The second review5 men- 2011; 11 (suppl 3): S9.
Int J Tuberc Lung Dis 2011; 15: 919–24. 6 Walker DG, Walker GJA. Prevention of
4 Schaaf HS, Nel ED, Beyers N, Gie RP, Scott F,
tioned by Mabey and Peeling1 states congenital syphilis—time for action.
Donald PR. A decade of experience with that “detection and appropriate, Bull World Health Organ 2004; 82: 401.
Mycobacterium tuberculosis culture from timely penicillin treatment is a highly 7 Walker GJA, Walker DG. Congenital syphilis:
children: a seasonal inﬂuence on incidence of a continuing but neglected problem.
childhood tuberculosis. Tuber Lung Dis 1996; eﬀective intervention to reduce Semin Fetal Neonatal Med 2007; 12: 198–206.
77: 43–46. adverse syphilis-related pregnancy
5 Koole O, Colebunders R. Reducing mortality outcomes”.
from HIV infection and tuberculosis.
Lancet Infect Dis 2011; 11: 494–95. To misinterpret the ﬁndings We read with interest Sarah Hawkes
of systematic reviews and place and colleagues’ Article1 that assessed
responsibility on them for the failure the eﬀectiveness of interventions
to adequately control congenital to improve screening for syphilis in
Syphilis: still a major syphilis diverts attention away from pregnancy. The investigators highlight
organisations such as WHO, which several possible interventions during
cause of infant should be working with governments pregnancy and suggest that antenatal
mortality and other partners to increase syphilis screening could reduce the
We agree with David Mabey and eﬀorts to tackle congenital syphilis. incidence of perinatal death and
Rosanna Peeling1 that the Review Unfortunately, babies in countries as stillbirths attributable to syphilis by
by Sarah Hawkes and colleagues2 diverse as Australia, Belarus, China, 50%. In addition to the interventions
is a “timely reminder that syphilis and Haiti continue to be born with during pregnancy, we would like to
has not disappeared, and remains a congenital syphilis. This situation draw attention to the importance
major, although entirely preventable, should be unacceptable. That of premarital syphilis screening for
cause of death in newborn babies”. antenatal screening and treatment prevention of adverse syphilis-related
This reminder echoes what we can work is well known, and yet there pregnancy outcomes in syphilis-
wrote 10 years ago3 and highlights has been limited success over the epidemic countries such as China.
the absence of progress made in past decade in controlling, let alone In China, premarital check-ups
the intervening years. In 2007, WHO eliminating, congenital syphilis. As that include syphilis screening were
launched its global initiative to we have argued previously on several requested by the Law Concerning the
eliminate congenital syphilis. 5 years occasions,3,4,6,7 the time has come to Mother and Infant Care in 1994.2 As a
later, evidently, little has changed. be more ambitious, resourceful, and result of implementation of the Law,
In 2002, we argued for a task-force innovative in preventing this tragedy. the proportion of prospective couples
approach by international health Business as usual is not an option. receiving premarital syphilis checkups
agencies, which gives a focused but We declare that we have no conﬂicts of interest.
increased steadily to a national rate
ﬂexible commitment to dealing with of 68% in 2002.3 However, this rate
this tragic situation, rather than one Damian G Walker, Godfrey J A Walker dropped substantially to less than
relying only on traditional antenatal email@example.com 5% after introduction of the revised
screening and treatment.3 Mabey and Health Economics and Financing, Global Health, Bill Regulations Governing Marriage
and Melinda Gates Foundation, Seattle, WA, USA
Peeling1 and Hawkes and colleagues2 (DGW); and School of Reproductive and
Registration in 2003, in which
ignored the conclusions of our 2002 Developmental Medicine, Division of Perinatal and compulsory premarital check-ups
Personal View. Furthermore, Mabey Reproductive Medicine, The University of Liverpool, were abolished,4 partly because of
Liverpool, UK (GJAW)
and Peeling1 suggest that policy the negative attitude toward the
www.thelancet.com/infection Vol 12 April 2012 269