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      Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis

      review-article
      1 , 2 ,
      ,
      Cureus
      Cureus
      congenital syphilis, syphilis serodiagnosis, sexually transmitted diseases, vertical transmission, antenatal care, pregnancy, disease prevention

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          Abstract

          This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy.

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          Point-of-care tests for diagnosing infections in the developing world.

          Infectious diseases continue to cause an enormous burden of death and disability in developing countries. Increasing access to appropriate treatment for infectious diseases could have a major impact on disease burden. Some common infections can be managed syndromically without the need for diagnostic tests, but this is not appropriate for many infectious diseases, in which a positive diagnostic test is needed before treatment can be given. Since many people in developing countries do not have access to laboratory services, diagnosis depends on the availability of point of care (POC) tests. Historically there has been little investment in POC tests for diseases that are common in developing countries, but that is now changing. Lack of regulation of diagnostic tests in many countries has resulted in the widespread use of sub-standard POC tests, especially for malaria, making it difficult for manufacturers of reliable POC tests to compete. In recent years increased investment, technological advances, and greater awareness about the importance of reliable diagnostic tests has resulted in rapid progress. Rapid, reliable and affordable POC tests, requiring no equipment and minimal training, are now available for HIV infection, syphilis and malaria, but POC tests for other infections are urgently needed. Many countries do not have established criteria for licensing and introducing new diagnostic tests, and many clinicians in developing countries have become disillusioned with diagnostic tests and prefer to rely on clinical judgment. Continuing advocacy and training in the use of POC tests are needed, and systems for quality control of POC tests need to be developed if they are to achieve their maximum potential.
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            Point-of-Care Tests to Strengthen Health Systems and Save Newborn Lives: The Case of Syphilis

            Rosanna Peeling and colleagues describe their experience of introducing point-of-care testing to screen for syphilis in pregnant women living in low- and middle-income countries.
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              Treatment of syphilis: a systematic review.

              The incidence of syphilis in the United States is increasing; it is estimated that more than 55,000 new infections will occur in 2014. Treatment regimens are controversial, especially in specific populations, and assessing treatment response based on serology remains a challenge.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                9 March 2016
                March 2016
                : 8
                : 3
                : e525
                Affiliations
                [1 ] School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS
                [2 ] Edipucrs University Publisher, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS
                Author notes
                Eleonor G. Lago eglago@ 123456pucrs.br
                Article
                10.7759/cureus.525
                4829408
                27081586
                d91269e9-1a8d-454a-ab38-9c775e4bd859
                Copyright © 2016, Lago et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 September 2015
                : 9 March 2016
                Categories
                Obstetrics/Gynecology
                Infectious Disease
                Preventive Medicine

                congenital syphilis,syphilis serodiagnosis,sexually transmitted diseases,vertical transmission,antenatal care,pregnancy,disease prevention

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