{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T18:24:28Z","timestamp":1772821468948,"version":"3.50.1"},"reference-count":36,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sexually Transmitted Infections"],"published-print":{"date-parts":[[1987,10,1]]},"DOI":"10.1136\/sti.63.5.320","type":"journal-article","created":{"date-parts":[[2008,11,12]],"date-time":"2008-11-12T20:58:44Z","timestamp":1226523524000},"page":"320-325","source":"Crossref","is-referenced-by-count":6,"title":["Pregnancy loss, infant death, and suffering: legacy of syphilis and gonorrhoea in Africa."],"prefix":"10.1136","volume":"63","author":[{"given":"K F","family":"Schulz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W","family":"Cates","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P R","family":"O'Mara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","reference":[{"key":"ref_1","article-title":"Non-infected infant produce widely disparate outcomes of pregnancy (table 3). Assumptions regarding the early or late status of syphilis are therefore essential to the accurate estimation of outcome of pregnancy for pregnant women with syphilis. In the study that documented early and late status, 73% of patients were classified as having early syphilis.'3 In a recent report from Africa, RPR card test measured results for seroreactive women were analysed: 70% had a titre of 1\/8 or more, which corresponds to that found in early untreated syphilis.9 The outcomes from the 1951 study therefore seem to be roughly applicable to Africa, and we have used them as theoretical estimates to be applied to untreated pregnant women with syphilis in Africa","unstructured":"Non-infected infant produce widely disparate outcomes of pregnancy (table 3). Assumptions regarding the early or late status of syphilis are therefore essential to the accurate estimation of outcome of pregnancy for pregnant women with syphilis. In the study that documented early and late status, 73% of patients were classified as having early syphilis.'3 In a recent report from Africa, RPR card test measured results for seroreactive women were analysed: 70% had a titre of 1\/8 or more, which corresponds to that found in early untreated syphilis.9 The outcomes from the 1951 study therefore seem to be roughly applicable to Africa, and we have used them as theoretical estimates to be applied to untreated pregnant women with syphilis in Africa."},{"key":"ref_2","article-title":"The relation between syphilis during pregnancy and stillbirths is well established. A recent case control study of the relation between stillbirths and high titre RPR card test seroreactivity in Zambia yielded a relative risk of 28 (95% confidence interval of 12 to 63).9 This result is consistent with the 1951 study from the United States of America, which showed that the relative risk of stillbirths for a mother with untreated early syphilis was 32 times greater than for a noninfected mother","unstructured":"The relation between syphilis during pregnancy and stillbirths is well established. A recent case control study of the relation between stillbirths and high titre RPR card test seroreactivity in Zambia yielded a relative risk of 28 (95% confidence interval of 12 to 63).9 This result is consistent with the 1951 study from the United States of America, which showed that the relative risk of stillbirths for a mother with untreated early syphilis was 32 times greater than for a noninfected mother."},{"key":"ref_3","first-page":"276","article-title":"Observations on syphilis in Addis Ababa. 2. Prevalence and natural history","volume":"53","author":"Friedmann, P.S.; Wright, D.J.M.","year":"1977","unstructured":"Friedmann PS, Wright DJM. Observations on syphilis in Addis Ababa. 2. Prevalence and natural history. British Journal of Venereal Diseases 1977;53:276-80.","journal-title":"British Journal of Venereal Diseases"},{"key":"ref_4","first-page":"163","article-title":"Congenital syphilis in Addis Ababa","volume":"8","author":"Larsson, Y.; Larsson, V.","year":"1970","unstructured":"Larsson Y, Larsson V. Congenital syphilis in Addis Ababa. Ethiop Med J 1970;8:163-72.","journal-title":"Ethiop Med J"},{"key":"ref_5","first-page":"651","article-title":"Maladies transmises par voie sexuelle dans une population rurale en Centrafrique. In: Rapport final, 13' conference technique","author":"Widy-Wirski, R.; D'Costa, J.","year":"1980","unstructured":"Widy-Wirski R, D'Costa J. Maladies transmises par voie sexuelle dans une population rurale en Centrafrique. In: Rapport final, 13' conference technique. Yaounde, Cameroon: OCEAC, 1980:651-4."},{"key":"ref_6","first-page":"627","article-title":"Problemes en obstetrique et gynecologie","volume-title":"et maladies au Rwanda","author":"A, De Clercq","year":"1982","unstructured":"De Clercq A. Problemes en obstetrique et gynecologie. In: Meheus A, Butera S, Eylenbosch W, Gatera G, Kivits M, Musafili I, eds. Sante et maladies au Rwanda. Bruxelles: Adminstration Generale de la Cooperation au Developpement, 1982:627-56."},{"key":"ref_7","first-page":"212","article-title":"Genital infections in prenatal and family planning attendants in Swaziland","volume":"57","author":"Meheus, A.; Freidman, F.; Van Dyck, F.; Gruyver, T.","year":"1980","unstructured":"Meheus A, Freidman F, Van Dyck F, Gruyver T. Genital infections in prenatal and family planning attendants in Swaziland. East Afr Med J 1980;57:212-7.","journal-title":"East Afr Med J"},{"key":"ref_8","first-page":"75","article-title":"Sexually transmitted diseases in pregnant women","volume":"14","author":"Ratnam, A.V.; Din, S.N.; Chatterjee, T.K.","year":"1980","unstructured":"Ratnam AV, Din SN, Chatterjee TK. Sexually transmitted diseases in pregnant women. Med J Zambia 1980;14:75-8.","journal-title":"Med J Zambia"},{"key":"ref_9","first-page":"355","article-title":"Syphilis in pregnant women in Zambia","volume":"58","author":"Ratnam, A.V.; Din, S.N.; Hira, S.K.","year":"1982","unstructured":"Ratnam AV, Din SN, Hira SK, et al. Syphilis in pregnant women in Zambia. British Journal of Venereal Diseases 1982;58:355-8.","journal-title":"British Journal of Venereal Diseases"},{"key":"ref_10","first-page":"1","article-title":"Epidemiology of maternal and congenital syphilis in Lusaka and Copperbelt Provinces of Zambia","author":"Hira, S.K.","year":"1984","unstructured":"Hira SK. Epidemiology of maternal and congenital syphilis in Lusaka and Copperbelt Provinces of Zambia. Lusaka, Zambia: Republic of Zambia, 1984:1-40."},{"key":"ref_11","first-page":"803","article-title":"A case-control study of stillbirths at a teaching hospital in Zambia, 1979-80: serological investigations for selected infectious agents","volume":"62","author":"Watts, T.E.; Larsen, S.A.; Brown, S.T.","year":"1984","unstructured":"Watts TE, Larsen SA, Brown ST. A case-control study of stillbirths at a teaching hospital in Zambia, 1979-80: serological investigations for selected infectious agents. Bull WHO 1984;62:803-8.","journal-title":"Bull WHO"},{"key":"ref_12","first-page":"355","article-title":"Syphilis in pregnant women in Mozambique","volume":"61","author":"Liljestrand, J.; Bergstrom, S.; Nieuwenhuis, F.; Hederstedt, B.","year":"1985","unstructured":"Liljestrand J, Bergstrom S, Nieuwenhuis F, Hederstedt B. Syphilis in pregnant women in Mozambique. Genitourin Med 1985;61:355-8.","journal-title":"Genitourin Med"},{"key":"ref_13","first-page":"14","article-title":"World Health Organisation Scientific Group. Treponemal infections. WHO Tech Rep Ser","volume":"674","year":"1982","unstructured":"World Health Organisation Scientific Group. Treponemal infections. WHO Tech Rep Ser 1982;674:14-8."},{"key":"ref_14","first-page":"352","article-title":"Staying the plague","volume-title":"Congenital syphilis","author":"Harman, N.","year":"1984","unstructured":"Harman N. Staying the plague. London: Methuen, 1917. Cited by Murphy FK, Patamasucon P. Congenital syphilis. In: Holmes KK, Mardh P-A, Sparling PF, Wiesner PJ, eds. Sexually transmitted diseases. New York: McGraw Hill 1984:352-74."},{"issue":"31","key":"ref_15","first-page":"60","article-title":"The value of penicillin alone in the prevention and treatment of congenital syphilis","volume":"1951","author":"Ingraham, N.R.","unstructured":"Ingraham NR. The value of penicillin alone in the prevention and treatment of congenital syphilis. Acta Derm Venereol (Stockh) 1951;31 suppl 24:60-88.","journal-title":"Acta Derm Venereol (Stockh)"},{"key":"ref_16","first-page":"306","article-title":"Congenital syphilis in Lusaka. II. Incidence at birth and potential risk among hospital delivered infants","volume":"59","author":"Hira, S.K.; Bhat, G.J.; Ratnam, A.V.; Chintu, C.; Mulenga, R.C.","year":"1982","unstructured":"Hira SK, Bhat GJ, Ratnam AV, Chintu C, Mulenga RC. Congenital syphilis in Lusaka. II. Incidence at birth and potential risk among hospital delivered infants. East Afr Med J 1982;59:306-10.","journal-title":"East Afr Med J"},{"key":"ref_17","first-page":"241","article-title":"Congenital syphilis in Lusaka. I. Incidence in a general nursery ward","volume":"59","author":"Hira, S.K.; Ratnam, A.V.; Sehgal, D.B.; Bhat, G.J.; Chintu, C.","year":"1982","unstructured":"Hira SK, Ratnam AV, Sehgal DB, Bhat GJ, Chintu C. Congenital syphilis in Lusaka. I. Incidence in a general nursery ward. East Aft Med J 1982;59:241-6.","journal-title":"East Aft Med J"},{"key":"ref_18","first-page":"374","article-title":"Congenital syphilis in Lusaka. III. Incidence in neonatal intensive care unit","volume":"59","author":"Bhat, G.J.; Hira, S.K.; Ratnam, A.V.; Chintu, C.; Mulenga, R.C.","year":"1982","unstructured":"Bhat GJ, Hira SK, Ratnam AV, Chintu C, Mulenga RC, Congenital syphilis in Lusaka. III. Incidence in neonatal intensive care unit. East Afr Med J 1982;59:374-8.","journal-title":"East Afr Med J"},{"key":"ref_19","first-page":"63","article-title":"Causes of perinatal mortality in an African City","volume":"55","author":"Naeye, R.L.; Tafari, N.; Marboe, C.C.; Judge, D.M.","year":"1977","unstructured":"Naeye RL, Tafari N, Marboe CC, Judge DM. Causes of perinatal mortality in an African City. Bull WHO 1977;55:63-5.","journal-title":"Bull WHO"},{"key":"ref_20","series-title":"Proceedings of the third African regional conference on sexually transmitted diseases. Basle","first-page":"148","article-title":"Prevention of congenital syphilis","author":"Bishaw, T.; Tafari, N.; Zewdie, M.; Haile, D.; Mascola, L.; Brown, S.","year":"1983","unstructured":"Bishaw T, Tafari N, Zewdie M, Haile D, Mascola L, Brown S. Prevention of congenital syphilis. In: Nsanze H, Widy-Wirski RH, Ellison RH, eds. Proceedings of the third African regional conference on sexually transmitted diseases. Basle, Switzerland: Ciba Geigy, 1983:148-53."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1056\/NEJM198102053040607","article-title":"In vitro fertilization and embryo transfer in human beings","volume":"304","author":"Biggers, J.D.","year":"1981","unstructured":"Biggers JD. In vitro fertilization and embryo transfer in human beings. N Engl J Med 1981;304:336-42.","journal-title":"N Engl J Med"},{"key":"ref_22","first-page":"554","article-title":"Fetal loss following implantation: a prospective study","volume":"i:","author":"Miller, J.F.; Williamson, E.; Glue, J.; Gordon, Y.B.; Grudzinskas, J.G.; Sykes, A.","year":"1980","unstructured":"Miller JF, Williamson E, Glue J, Gordon YB, Grudzinskas JG, Sykes A. Fetal loss following implantation: a prospective study. Lancet 1980;i:554-6.","journal-title":"Lancet"},{"key":"ref_23","first-page":"48","article-title":"Abortion: pathogenesis, cytogenetics","volume-title":"Perinatal medicine: the basic science underlying clinical practice","author":"Poland, B.J.; Carr, D.H.","year":"1976","unstructured":"Poland BJ, Carr DH. Abortion: pathogenesis, cytogenetics. In: Chance GW, ed. Perinatal medicine: the basic science underlying clinical practice. 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Die Verkutung der Augentzundung der Neugeborenen. Archiv fur Gynakologie 1881;17:50-3, 18:367-70, 1883;21:179-95."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1056\/NEJM196603312741308","article-title":"Specific prophylaxis of gonococcal ophthalmia neonatorum: a review","volume":"274","author":"Barsam, P.C.","year":"1966","unstructured":"Barsam PC. Specific prophylaxis of gonococcal ophthalmia neonatorum: a review. N Engl J Med 1966;274:731-4.","journal-title":"N Engl J Med"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1093\/infdis\/153.5.862","article-title":"Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis","volume":"153","author":"Fransen, L.; Nsanze, H.; Klauss, V.","year":"1986","unstructured":"Fransen L, Nsanze H, Klauss V, et al. Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. J Infect Dis 1986;153:862-9.","journal-title":"J Infect Dis"},{"key":"ref_29","first-page":"83","article-title":"Ophthalmia neonatorum: problems ofprophylaxis and treatment in Africa","author":"Quarcoopome, C.O.","year":"1983","unstructured":"Quarcoopome CO. Ophthalmia neonatorum: problems ofprophylaxis and treatment in Africa. Geneva, Switzerland: World Health Organisation, 1983:PBL\/ON\/83-1, 1-4."},{"key":"ref_30","first-page":"95","article-title":"Gonococcal ophthalmia neonatorum: the case for prophylaxis in tropical Africa","volume":"62","author":"Galega, F.P.; Heymann, D.L.; Nasah, B.T.","year":"1984","unstructured":"Galega FP, Heymann DL, Nasah BT. Gonococcal ophthalmia neonatorum: the case for prophylaxis in tropical Africa. Bull WHO 1984;62:95-8.","journal-title":"Bull WHO"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/j.1879-3479.1980.tb00240.x","article-title":"trichomonas and candida among gravid and nongravid women in Cameroon","volume":"18","author":"Nasah, B.T.; Nguematcha, R.; Eyong, M.; Gonorrhea, Godwin S.","year":"1980","unstructured":"Nasah BT, Nguematcha R, Eyong M, Godwin S. Gonorrhea, trichomonas and candida among gravid and nongravid women in Cameroon. Int J Gynaecol Obstet 1980;18:48-52.","journal-title":"Int J Gynaecol Obstet"},{"key":"ref_32","first-page":"301","article-title":"Genital and neonatal chlamydial infection in a trachoma endemic area","volume":"ii:","author":"Mabey, D.C.W.; Whittle, H.C.","year":"1982","unstructured":"Mabey DCW, Whittle HC. Genital and neonatal chlamydial infection in a trachoma endemic area. Lancet 1982;ii:301-2.","journal-title":"Lancet"},{"key":"ref_33","first-page":"301","article-title":"Comparison of tetracycline and silver nitrate for the prophylaxis of chlamydial and gonococcal ophthalmia neonatorum","author":"Laga, M.; Nsanze, H.; Plummer, F.A.; Ndinya-Achola, J.O.; Brunham, R.C.; Piot, P.","year":"1986","unstructured":"Laga M, Nsanze H, Plummer FA, Ndinya-Achola JO, Brunham RC, Piot P. Comparison of tetracycline and silver nitrate for the prophylaxis of chlamydial and gonococcal ophthalmia neonatorum. In: Oriel D, Ridgeway G, Schachter J, TaylorRobinson D, Ward M, eds. Chlamydial infections. Cambridge, England: Cambridge University Press, 1986:301-4."},{"key":"ref_34","first-page":"1145","article-title":"Epidemiology of ophthalmia neonatorum in Kenya","volume":"ii:","author":"Laga, M.; Plummer, F.A.; Nzanze, H.; etal","year":"1986","unstructured":"Laga M, Plummer FA, Nzanze H, etal. Epidemiology of ophthalmia neonatorum in Kenya. 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