Prenatal syphilis infection is a possible cause of pre-term delivery among immigrant women from Eastern Europe

OBJECTIVE: To evaluate the prevalence of maternal syphilis at delivery and neonatal syphilis infection in an Italian urban area, in connection with the increased immigration flow. STUDY DESIGN: A prospective surveillance study was carried out in Bologna, Italy, from November 2000 to March 2006. All pregnant women were screened for syphilis at delivery. Infants born to seropositive mothers were enrolled in a prospective follow-up. RESULTS: During the study period 19205 women gave birth to 19548 infants. Eighty five women were seropositive for syphilis at delivery. The overall syphilis seroprevalence in pregnant women was 0.44% but it was 4.3% in women from Eastern Europe and 5.8% in women from Central-South America. Ten women were first found positive at delivery as they did not receive any prenatal care. Nine of these were from Eastern Europe. All their infants were asymptomatic, but 6 had both reactive IgM WB and RPR tests and were considered prenatally infected. Three out of six were preterm (gestational age < 37 weeks). CONCLUSIONS: In Italy congenital syphilis infection is strictly related to the immigration from Eastern Europe. It is asymptomatic, but it could cause premature delivery. Therefore it is necessary to perform serological tests during the third trimester in mothers coming from endemic areas to adequately treat syphilis in pregnancy and prevent congenital infection. If the mother’s tests are not available at delivery it is necessary to investigate the newborn, especially if it is born prematurely.