Congenital syphilis rate (live births and stillbirth)

Export Indicator

Percentage of reported congenital syphilis cases (live births and stillbirths)
What it measures

Progress in eliminating the mother-to-child transmission of syphilis

Rationale

Untreated syphilis infection in pregnancy can not only increase the risk of the mother and the infant transmitting and acquiring HIV but also lead to stillbirth, neonatal death and congenital disease (collectively defined as congenital syphilis). Given the high efficacy, simplicity and low cost of syphilis testing and treatment, global and regional initiatives to eliminate the mother-to-child transmission of syphilis have been launched. The rate of congenital syphilis is a measure of the impact of programmatic interventions to eliminate the mother-to-child transmission of syphilis.

Numerator

Number of reported congenital syphilis cases (live births and stillbirths) in the past 12 months

Denominator

Number of live births

Calculation

Numerator/denominator

Method of measurement

Routine health information systems. It is important to indicate in the comment section the case definition of congenital syphilis used in your country.

Measurement frequency

The data should be recorded daily and reported quarterly to the national or subnational level. They should also be consolidated annually and reported to WHO.

Disaggregation

None

Additional information requested

Countries should comment on any major differences between the national case definition and the global surveillance case definition, available on page 15 of: Baseline report on global sexually transmitted infection surveillance 2012. Geneva: World Health Organization; 2013 (http://www.who.int/ reproductivehealth/publications/rtis/9789241505895/en/index.html).

In particular, countries should note whether or not their national case definition counts stillbirths.

Strengths and weaknesses

Diagnosing congenital syphilis is most reliable when specific diagnostic tests are used that are seldom available even in high-income countries. In most countries, therefore, diagnosis relies on clinical history and examination, making surveillance challenging. Although WHO has a global case definition for surveillance purposes, the actual case definition may vary between and within countries and regions.

It is important that countries, when reporting on syphilis, communicate on the extent to which the data are deemed representative of the national population. If a country is unable to report on the denominator, WHO will use the denominator from the United Nations Population Division.

Given the difficulties in diagnosing congenital syphilis, and depending on the case definition used, underreporting and overreporting can be a problem. The likely magnitude of such reporting errors should always be considered when looking at rates of congenital syphilis. However, using a consistent case definition may make trends over time useful.

Further information

Methods for surveillance and monitoring of congenital syphilis elimination within existing systems. Geneva: World Health Organization; 2011 (https://extranet.who.int/iris/restricted/handle/10665/44790).

Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/handle/10665/112858).