Treatment and its associated factors among syphilitic mothers

Objective To investigate the treatment status of syphilitic mothers, and the factors associated with receiving treatment after being diagnosed (RTABD) and receiving treatment during pregnancy (RTDP). Methods Women aged ≥18 years who received prenatal care in Shenzhen obstetric centers, were diagnosed with syphilis between January 1, 2012 and December 31, 2014, had childbirth outcomes and agreed to participate in the study were recruited. Information on participants' demographic characteristics, disease condition, treatment status and pregnancy outcomes were obtained using a structured questionnaire. Univariate analysis was performed with Chi-square test, and multivariate analysis was performed with the binary logistic regression model (forward stepwise regression method). Results A total of 1 748 syphilitic mothers who fulfilled the inclusion criteria were recruited. Of these cases, 167 cases (9.55%) did not receive treatment (including 104 cases who had adequate treatment before pregnancy but no treatment during pregnancy, 51 cases refused treatment and 12 cases had no record of treatment), and 1 581(90.45%) RTABDs with syphilis. Of these 1 581 cases, 1 294 RTDPs and 287 received treatment during or after childbirth. Maternal living address, duration of residence in Shenzhen, gestational week at the first antenatal visit, disease stage, serological titer and utilization of free treatment services were associated with RTABD (χ2=7.24, 8.82, 41.62, 16.77, 102.01 and 14.84, all P 12-≤27 gestational weeks, >27-≤36 gestational weeks, and >36 gestational weeks, respectively, when compared to those visiting at ≤12 gestational weeks. The OR (95%CI) was 0.18 (0.13-0.26) for RTABD in mothers with latent syphilis when compared to those treated before pregnancy. The OR (95%CI) was 1.74 (1.02-2.96) for RTABD in mothers with a serological titer ≥1∶8, when compared to those with a serological titer ≤1∶4. The OR (95%CI) was 0.64 (0.45-0.92) for RTDP in mothers who received prenatal care in Baoan, Longgang, Guangming, Pingshan, Longhua and Dapeng districts, when compared to those receiving prenatal care in Luohu, Futian, Nanshan and Yantian districts. The OR (95%CI) was 2.41 (1.07-5.41) for RTDP in mothers who accepted free treatment services, when compared to those paying for treatment themselves. Conclusions The percentage of RTABD is high among syphilitic mothers in Shenzhen. However, some mothers still refuse to accept treatment and some receive treatment after childbirth. Mothers' education level, disease condition, utilization of prenatal care services and free treatment services are associated with RTABD and/or RTDP. Key words: Pregnancy complications, infectious; Syphilis; Patient compliance; Treatment refusal; Uncompensated care