Evidence map›Paper›PMID 33401033›Full record

ArticleInternational journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases2021

Failure to recognize Low non-treponemal titer syphilis infections in pregnancy May lead to widespread under-treatment.

Emma Jane Swayze, Karin Nielsen-Saines, Eddy R Segura, Eduardo Saad, Dahai Yue, Warren Scott Comulada, Mary Catherine Cambou

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.8field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 11 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

Emma Jane SwayzeWestern Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA; David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., 90095‑1688, CHS 37‑121, Los Angeles, CA, USA. Electronic address: emma.swayze@med.wmich.edu.
Karin Nielsen-SainesDavid Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., 90095‑1688, CHS 37‑121, Los Angeles, CA, USA.
Eddy R SeguraDavid Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., 90095‑1688, CHS 37‑121, Los Angeles, CA, USA; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú Prolongación Primavera 2390, Lima 15023, Peru.
Eduardo SaadNew York City Department of Health and Mental Hygiene, 160 W 100th St, Fl 1, New York, NY 10025, USA.
Dahai YueUniversity of Maryland Department of Health Policy and Management, 4200 Valley Drive College Park, MD 20742, USA.
Warren Scott ComuladaDavid Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., 90095‑1688, CHS 37‑121, Los Angeles, CA, USA.
Mary Catherine CambouDavid Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., 90095‑1688, CHS 37‑121, Los Angeles, CA, USA.
University of California, Los Angeles · USMaryland Department of Health · USNew York City Department of Health and Mental Hygiene · USStryker (United States) · US

Funding

UCLA Rapid, Relevant, Rigorous Implementation Science HubP30MH058107 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI RAPHAEL J LANDOVITZ · 1997 to 2026
$53.5M
UCLA AIDS Prevention and Treatment Clinical Trials UnitUM1AI069424 · NIAID · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Judith S. Currier, RAPHAEL J LANDOVITZ · 2012 to 2026
$51.8M
Optimizing the HIV Treatment Continuum with a Stepped Care Model for Youth Living with HIVU19HD089886 · NICHD · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI FERNANDEZ, MARIA ISABEL, ROTHERAM-BORUS, MARY JANE · 2016 to 2022
$23.4M
Postdoctoral Training in Global AIDS Prevention ResearchT32MH080634 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JESSE LAWTON CLARK, Pamina Mae Gorbach · 2007 to 2026
$6.4M
South American Program in HIV Prevention Research (SAPHIR)R25MH087222 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JESSE LAWTON CLARK, Karin Nielsen · 2011 to 2026
$3.9M
NIAID NIH HHS UM1 AI069424NICHD NIH HHS U19 HD089886NIMH NIH HHS P30 MH058107NIMH NIH HHS R25 MH087222NIMH NIH HHS T32 MH080634
6 · The paper itself

Abstract

objectivesRates of maternal syphilis have increased five-fold in Brazil in the past decade. While penicillin remains the only appropriate treatment for maternal syphilis, we hypothesized that low non-treponemal titers (<1:16) may lead to reduced penicillin treatment in Brazil.

methodsUsing Brazilian Ministry of Health data on women diagnosed with maternal syphilis between January 1, 2010, and December 31, 2018, we conducted a random-effects logistic regression model with a cluster correction at the state level to evaluate predictive factors of penicillin treatment.

resultsWe observed yearly increases in cases of pregnant women with syphilis from 2010 to 2018. There was significant variation by state: 52,451 cases were reported in São Paulo, followed by 26,838 in Rio de Janeiro. Among 215,937 cases of maternal syphilis, 91·3% received penicillin. In the random-effects model, a non-treponemal titer ≥1:16 was associated with 1·44 higher odds of receiving penicillin (95% confidence interval [CI]: 1·391·48), and prenatal care was associated with a 2·12 increased odds of receiving penicillin (95% CI: 2·022·21). Although there is an association between the absence of prenatal care and inadequate treatment for syphilis, 83·2% of women in this cohort who did not receive penicillin were engaged in prenatal care.

conclusionsProviders may inappropriately exclude low non-treponemal titers and thereby fail to use penicillin treatment in maternal syphilis. While the cause of the maternal syphilis epidemic in Brazil is multifactorial, we believe our findings can be used to develop targeted interventions throughout Brazil as well as shape public health initiatives globally.

Indexed as

AdultAnti-Bacterial AgentsBrazilCohort StudiesFemaleHumansPenicillinsPregnancyPregnancy Complications, InfectiousPregnant PeoplePrenatal CareSyphilisYoung AdultAnti-Bacterial AgentsPenicillinsBrazilHealth policyPenicillinPregnancySyphilisTreatment

Identifiers

PMID33401033
PMCPMC8012229
OpenAlexW3119224729

What OpenQuestion holds

Textmetadata
LicenceTDM
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.