Table 1

Factors affecting the effectiveness of prenatal screening programmes for syphilis

Factors in favour of a prenatal syphilis screening programmeWhy has syphilis remained a major cause of stillbirth and neonatal mortality?
Most countries have a national policy for prenatal syphilis screeningImplementation rate of national policy has remained poor due to lack of political commitment and funding
Stillbirth and neonatal mortality cannot be attributed to syphilis unless women are screened early in pregnancySyphilis in pregnancy is invisible or asymptomatic. Lack of knowledge regarding possible causes of adverse pregnancy outcome
75–85% of women attend antenatal clinics; affordable diagnostic tests for screening are availableMost clinics lack the capacity to offer screening on a consistent basis due to personnel shortage, supply chain failures for tests, gloves and other consumables
Infection can be cured and transmission to fetus can be prevented with inexpensive curative therapyFailure to comply with the same-day test and treatment (STAT) strategy, requiring women to return for results and treatment, stock-out of drugs
Prenatal screening for syphilis is one of the most cost-effective public health interventionsLack of capacity for assessing the impact and cost-effectiveness of adopting a new diagnostic technology