This investigation aims to investigate the recent rise in cases of syphilis in pregnant women and their babies, with a particular focus on exploring what may be contributing to the inequities that exist. The New Zealand government has committed to eliminating syphilis (Syphilis Action Plan) and improving health outcomes for Maaori in relation to sexually transmitted infections and blood borne diseases (The Sexually Transmitted and Blood Borne Infection (STBBI) strategy).
It is hoped that the findings from this study will be able to contribute to service and systems changes to improve inequities and advance towards these goals.
Grounded in the principles of kaupapa Maaori epidemiology methodology, this observational registry cohort study will review the journey and outcomes of woman diagnosed with syphilis in their pregnancy from 2017-2022. National ESR data of reported cases of syphilis in pregnancy will be identified (Part A). It is estimated this will be approximately 120 cases. Demographic data will be analysed and information gathered on mechanism of diagnosis and neonatal outcomes where known. A sub-study of the clinical care and outcomes for women who were managed by Hamilton Sexual Health Service (Part B). Clinical records of each case will be reviewed including hospital, laboratory, and prescribing records, as well as from the Sexual Health patient management system. Demographic information will be collected including age, ethnicity and socioeconomic deprivation. Clinical data will be collected including syphilis diagnosis (primary, secondary etc) (based on clinical and laboratory features). Information pertaining to treatment and follow up will be gathered. Finally match maternal dyad records will be reviewed to understand the outcomes of the babies, assessment at delivery, diagnosis, management and follow up.
Syphilis in pregnancy is an easily treated infection. Untreated syphilis during pregnancy can have devastating consequences for both mothers and babies including miscarriage, stillbirth, low birth weight, neonatal death and congenital syphilis. There are extreme inequities, for example 26 of the 29 cases of congenital syphilis since 2016 were of either Maaori or Pacific Island ethnicity. This study aims to review national data from 2017-2022 and also investigate and document the journey of women in the Waikato who have had syphilis in pregnancy, and the outcomes for their babies. It is hoped findings will lead to system improvements.
By investigating and documenting the epidemiology, method of detection, clinical care and outcomes for women diagnosed with syphilis in pregnancy, and their babies, any gaps in patient journey can be identified. This is an extremely under-researched area of health, that has significant impact on both mother and neonate. This study will increase information about the current state of the issue of syphilis in pregnancy, and it is hoped that the study will be able to identify areas for improvement along the care pathway and inform service and system developments to reduce the significant inequities that exist.