Percentage of antenatal care attendees who were positive for syphilis

Export Indicator

Percentage of antenatal care attendees who were positive for syphilis
What it measures

The percentage of pregnant women attending antenatal clinics with a positive (reactive) syphilis serology

Rationale

Syphilis infection in antenatal care attendees can be used to guide STI prevention programme needs, and may provide early warning of potential changes in HIV transmission in the general population.

Numerator

Number of antenatal care attendees who tested positive for syphilis

Denominator

Number of antenatal care attendees who were tested for syphilis

Calculation

Numerator / Denominator

Method of measurement

How to measure: Syphilis positivity can be measured using either non-treponemal tests (e.g., RPR or VDRL), treponemal tests (e.g. TPHA, TPPA, EIA, or a variety of available rapid tests), or ideally a combination of both. A reactive non-treponemal test, particularly if the titre is high, is suggestive of active infection, whereas positivity with a treponemal test indicates any previous infection even if treated successfully. For the purposes of this indicator (intended to measure seropositivity), it is acceptable to report positivity based on a single test result. If both treponemal and non-treponemal test results on an individual patient are available, then syphilis positivity should be defined as having positive results on both tests. Use of rapid treponemal test has allowed syphilis testing to occur in settings without laboratory capacity, greatly increasing the number of women who can be tested and treated for syphilis in pregnancy. Data should be collected annually.

Measurement tools: National programme records aggregated from health facility data, sentinel surveillance, or special surveys, using serologic tests to detect reaginic and/or treponemal antibody may be used. Please specify the source and coverage of your data (for example, sentinel surveillance of all ANC attendees in 2 of 10 provinces) as well as what test type is generally used in your country in the "Comments" section.

Data Quality Control and Notes for the Reporting Tool: Please comment on if the data you are providing is routine programme data, if it is felt to be representative of the entire country, and what test type was used to define positivity (e.g., non-treponemal, treponemal, patients positive on both, or mixed/unknown).

Measurement frequency

Annual

Disaggregation

Age group: 15 years - 24 years, > (greater than) 24 years

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

Strengths: Data on syphilis positivity in pregnant women are available in most countries through routine health system reporting.
Weaknesses: Differences in test type used or changes in testing practices may affect data. Knowledge of testing practices within the country (e.g., proportion of treponemal vs. non-treponemal testing used) should be used to assist with interpretation of disease trends.

Additional considerations: • Countries are encouraged to use unique identifiers or registers that separate first and subsequent tests so that the data reflect syphilis true prevalence or incidence rather than test positivity.
• Since most countries will have data from a variety of test types, sub-analysis (disaggregation) in 15 to 24 year old women may increase the likelihood that test positivity reflects recent infection.

Data utilization: Global/regional: Estimate perinatal mortality and morbidity caused by syphilis that could be averted with effective programmes to eliminate MTCT of syphilis. Identify areas at greatest need of comprehensive congenital syphilis prevention interventions.
Local: Follow trends over time to assess changes in burden of disease and STI prevention programme needs.
All levels: Compare data on trends of syphilis and HIV to look for early warning of increased risk of HIV transmission.

Further information

Other References: Recommended indicator in "National-Level Monitoring of the Achievement of Universal Access to Reproductive Health: Conceptual and practical considerations and related indicators" and "Methods for Surveillance and Monitoring of Congenital Syphilis Elimination within Existing Systems".