{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T06:44:21Z","timestamp":1774680261121,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.4190.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T00:00:00Z","timestamp":1431648000000}}],"reference-count":38,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T00:00:00Z","timestamp":1431648000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>Objective: The antenatal prevalence of syphilis and HIV\/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates.<\/ns4:p>\n                  <ns4:p>Methods: From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.<\/ns4:p>\n                  <ns4:p>Results: Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17\/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14\/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1\/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13\/2,123). The three active (VDRL\u22651:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (&gt;75% were &lt; 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.<\/ns4:p>\n                  <ns4:p>Conclusion: As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.<\/ns4:p>","DOI":"10.12688\/f1000research.4190.2","type":"journal-article","created":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T12:10:05Z","timestamp":1431691805000},"page":"123","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study"],"prefix":"10.12688","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-3257","authenticated-orcid":false,"given":"Rose","family":"McGready","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joy","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Watts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Ellen G","family":"Tyrosvoutis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam B.","family":"Torchinsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aung Myo","family":"Htut","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nay Win","family":"Tun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily","family":"Keereecharoen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chirapat","family":"Wangsing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borimas","family":"Hanboonkunupakarn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois H.","family":"Nosten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2015,5,15]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"e1001396","DOI":"10.1371\/journal.pmed.1001396","article-title":"Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data.","volume":"10","author":"L Newman","year":"2013","journal-title":"PLoS Med."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/1752-1947-1-90","article-title":"Congenital syphilis, still a reality in 21st century: a case report.","volume":"1","author":"M Chaudhary","year":"2007","journal-title":"J Med Case Rep."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"1303-32","DOI":"10.1586\/14787210.2013.851601","article-title":"On the pathway to better birth outcomes? 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Evidence from a meta-analysis.","volume":"8","author":"Y Jafari","year":"2013","journal-title":"PLoS One."},{"key":"ref-36","doi-asserted-by":"publisher","first-page":"CD010385","DOI":"10.1002\/14651858.CD010385.pub2","article-title":"Strategies of testing for syphilis during pregnancy.","volume":"10","author":"S Shahrook","year":"2014","journal-title":"Cochrane Database Syst Rev."},{"key":"ref-37","article-title":"War's Human Cost","year":"2013"},{"key":"ref-38","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.1044120","article-title":"HIV and syphilis antenatal screening data at SMRU 2012\u201313.","author":"R McGready","year":"2014","journal-title":"figshare."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/3-123\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/3-123\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/3-123\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T02:48:10Z","timestamp":1599014890000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/3-123\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5,15]]},"references-count":38,"URL":"https:\/\/doi.org\/10.12688\/f1000research.4190.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.6971.r10130","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.6971.r10130","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5,15]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/3-123\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.4486.r5072, Matthew Chico, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK, 27 Jun 2014, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/3-123\/v1#referee-response-5072","order":0,"name":"referee-response-5072","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Rose McGready<\/b>; <i>Posted: 05 May 2015<\/i>; We appreciate and would like to sincerely thank the significant effort of both reviewers in regards to this manuscript. We apologize for the tardiness of the response. We have provided a point by point response to the comments below. <b>This is a well-written paper on an important topic, for which there is limited data: What is the prevalence below which routine screening of all pregnant women for HIV and, in particular, syphilis is no longer advisable?&nbsp;Specific comments:<\/b> <b>1.Syphilis is far more deleterious to birth outcomes than other bacterial sexually transmitted infections and, therefore, the potential risks associated with missed diagnoses should be made in clearer in the paper.&nbsp; Among unscreened pregnant women in Tanzania, 51% of stillbirths, 24% of preterm live births, and 17% of all adverse pregnancy outcomes were attributable to maternal syphilis <\/b> <b><sup>1<\/sup><\/b> <b>.&nbsp;The authors should consider citing the comprehensive summary of the effect of curable STIs on birth outcomes by Chico <i>et al.<\/i> (Table 1. Effect of curable STIs\/RTIs on pregnancy outcomes) <\/b> <b><sup>2<\/sup><\/b> <b>.<\/b>We agree this is important and have amended the text as suggested in the 2 <sup>nd<\/sup> paragraph of the introduction.&nbsp; <b>2.Clearly the rates of HIV and syphilis were low among the refugees and migrants tested along the Thai-Myanmar border.&nbsp; However, it is not clear in the manuscript (1) the proportion of pregnant women in these two populations who seek antenatal care services, and (2) the prevalence of syphilis and HIV in the two populations who do not seek ANC services.&nbsp; Are the pregnant women attending these health facilities healthier than the overall population?&nbsp; Pregnant women are encouraged to attend ANC clinics as frequently as every fortnight.&nbsp; This makes it more difficult to generalise results beyond the study population.<\/b>Thank you for pointing this out and this information has been added to the methods section.We estimate the proportion at 90% - see 2 <sup>nd<\/sup> paragraph of the methods section.&nbsp;The \u201cprevalence of syphilis and HIV in the two populations who do not seek ANC services\u201d is impossible to answer. Data of HIV rates from the border wide camp Health information system suggest similarly low prevalence and this has been added to the discussion first paragraph.The ANC has always encouraged fortnightly voluntary visits (and care during childbirth in the clinic) and 4 or less antenatal visits in this setting has been associated with an increased risk of maternal death: AOR 2.50 (95%CI 1.41\u20134.43) ( doi: 10.1371\/journal.pone.0040244) and this detail has been been added to the methods first paragraph.&nbsp; <b>3.The refugee and migrant populations in this setting are unique for cultural reasons described in the paper.&nbsp;There should be some discussion about <u>other contexts<\/u> in which women are at elevated risk of HIV and syphilis infection, and that women may enter into transient marital relationships that are based in personal security, but expose them to other risks.<\/b>This has been added into the discussion towards the end of the first paragraph in the conclusions. <b>4.There should be some discussion about the use of rapid point of care (POC) tests for syphilis, in place of VDRL and THPA assays.&nbsp; POC tests for syphilis simplify the screening and treatment procedures.&nbsp; The World Health Organization currently recommends the use of POC tests for syphilis in the antenatal care setting <\/b> <b><sup>3<\/sup><\/b> <b>. Using POC tests will expedite case finding and treatment because results will be available during the same consultation.&nbsp;Although published results are not yet available, a combination HIV and syphilis POC test has recently been validated.<\/b>We have not got experience with POC for syphilis. Our experience with POC for HIV (higher positivity rate than syphilis) has not been good as explained in the results \u2013 nearly &frac12; were false positive. As the incidence goes down the false positive rate goes up and this is one of the reasons we have not moved to POC tests for syphilis in this population. Currently the turn around time with the local Thailand hospital where the POC positive results are sent for confirmation and the distance involved is a minimum of 3 days (usually a week). This is very stressful for women. This has been added to the discussion. We are not against POC tests and use malaria POC testing frequently. POC tests have limitations in their own right and the limitations and advantages need to be determined locally.On another note we have also found that hepatitis B POC tests also present us with a similar problem but to a lesser degree (the incidence of Hepatitis B in adults in this area approaches 10%). Approximately 10% of Hepatitis B Surface Ag POC positive tests turn out to be incorrect. This is not a problem when the point is to screen for healthy donors but it is a problem when you are telling an individual they have a chronic disease.We would be delighted to be a site for testing sensitivity and specificity of such tests. <b>5.The paper would benefit from a table that delineates the demographic and birth-outcome data for the 14 women who were found to have syphilis.&nbsp;The risk profile in Table 3 suggests that (1) migrant women, (2) who have been married more than once, (3) who are above the age of 30, (4) whose parents are not Karen, and (5) who have lived at their present address less than six months, are most likely to have a syphilis infection. Considering these five risk factors, how many women had just one, or two, or three, or four, or all five?<\/b>We appreciate this suggestion as a method to try to focus on at risk women. We have looked at this in 2 ways: scoring the number of risk factors a woman has (below)We appreciate this suggestion as a method to try to focus on at risk women. We have looked at this in 2 ways: scoring the number of risk factors a woman has (below)ScoreSyphilis n=14No syphilis n=357800 (0)646 (100%)12* (0.2%)1082 (99.8%)20 (0)1032 (100%)34 (0.7%)99.3%)45 (2.3%)216 (97.7%)53 (10.0%)27 (90.0%) <i>*Scored: one woman scored 1 because of \u2018migrant\u2019 status; and one woman scored 1 because of age <\/i> <i>\u2265 30 y.<\/i>&nbsp;A risk factor score of \u2265 &nbsp;3 includes &nbsp;1.44% (12\/831) and a &nbsp;score &lt;3 includes 0.07% ( 2\/2762).&nbsp;And trying to identify if a pattern of risk factors is common (below)&nbsp;Finally as suggested by the 2 <sup>nd<\/sup> reviewer we have run a multivariate analysis which can be found at the request of the 2 <sup>nd<\/sup> reviewer (see comments). The main message of the manuscript is not to identify risk factors (which also does not seem practical given the low number of positive case).&nbsp; <b>References<\/b>1. Watson-Jones D, Chanhalucha J, Gumodoka B, Weiss H, Rusizoka M, Ndeki L, Whitehouse A, Balira R, Todd J, Ngeleja D, Ross D, Buv&eacute; A, Hayes R, Mabey D: Syphilis in pregnancy in Tanzania. I. Impact of maternal syphilis on outcome of pregnancy. <i>J Infect Dis<\/i>. 2002; <b>186<\/b> (7): 940-947 PubMed Abstract | Publisher Full Text | Reference Source2. Chico RM, Hack BB, Newport MJ, Ngulube E, Chandramohan D: On the pathway to better birth outcomes? A systematic review of azithromycin and curable sexually transmitted infections. <i>Expert Rev Anti Infect Ther<\/i>. 2013; <b>11<\/b> (12): 1303-1332 PubMed Abstract | Free Full Text | Publisher Full Text | Reference Source3. World Health Organization: The use of rapid syphilis tests: Geneva:WHO. 2006. Reference Source","URL":"https:\/\/f1000research.com\/articles\/3-123\/v2#referee-comment-1335","order":1,"name":"referee-comment-1335","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.6971.r10130, Nitika Pant Pai, Division of Clinical Epidemiology, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada, 26 Aug 2015, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/3-123\/v2#referee-response-10130","order":2,"name":"referee-response-10130","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by a grant from the Wellcome Trust of Great Britain for the Thailand\/Laos Major Overseas Programme 2010-2015 (Grant B9RTOZ2) jointly awarded to MORU and LOMRU. The Shoklo Malaria Research Unit is part of the Wellcome Trust Mahidol University Oxford Tropical Medicine (MORU) Research Programme.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Data associated with the article are available under the terms of the Creative Commons Zero \"No rights reserved\" data waiver (CC0 1.0 Public domain dedication).","order":0,"name":"copyright-info","label":"Copyright"}]}}