This study aims to present current data and improve the management of syphilis in pregnant women in the city of Kisangani.

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To improve the management of syphilis in pregnant women in the city of Kisangani.

Our study population consisted of all pregnant women who attended the prenatal consultation service at Makiso Kisangani General Referral Hospital (HGR) during the period from July 1, 2023, to December 1, 2023.

We tested a total of 976 pregnant women. Of the 165 syphilis-positive women, only 145 had been present until delivery. Another group of 145 syphilis-negative women were selected from the 811 syphilis-negative women. Our total sample size was therefore 290 pregnant women, of whom 145 were syphilis positive and 145 syphilis were negative.

For our study, we included: •

All pregnant women admitted to and/or followed up at HGR Makiso Kisangani during the study period;

The following were excluded: •

Pregnant women who did not attend at least four PNCs during their pregnancy;

We conducted an analytical case-control study.

For data collection, screening tests were performed, and medical records of all consenting pregnant women who attended the PNC service and were followed until delivery at HGR Makiso Kisangani during the study period were reviewed. Data were collected using a pre-established data collection form, which included the following parameters: •

Age

Data entry was performed using Google Forms, and data analysis was conducted using R software version 4.3.

Results are presented in tables within means and standard deviations calculated for quantitative variables and frequencies and percentages calculated for qualitative variables Univariate logistic regression was used to calculate the odds ratio and to identify risk factors for syphilis during pregnancy.

The prevalence of syphilis in this study is calculated taking into account the total number of women who tested positive for syphilis, 165, compared to the total number of women tested, 976.

This study was approved by the Ethics Committee of the University of Kisangani, UNIKIS/CER/024/2023 on 7th of June 2023. This study was conducted in accordance with the requirements of good clinical practices and the principles of the Helsinki Declaration of the World Medical Association, along with any subsequent relevant amendments. Consent was obtained from the authorities of the participating institutions, and measures were taken to ensure that no information allowing patient identification was collected.

All participants have given their consent by signing the written document, the consent form.

The participants also gave their consent for their data to be published. Our data collection was done anonymously. We have taken all measures not to publish any data that could facilitate the identification of participants.

The table below presents the cases of syphilis according to the sociodemographic characteristics of the pregnant women.

The most represented age group was between 20 and 34 years (61.4%). Married pregnant women in a monogamous relationship accounted for 72.4%. Housewives made up 22.1% of the study population, while women whose spouses were unemployed were also the most represented. Additionally, women with a secondary level of education constituted 46.2% (see Table 1 on page 5-6).

Table 2 shows that out of a total of 976 pregnant women who participated in our study, 165 were positive for syphilis during their pregnancies, i.e. a hospital prevalence of 16.9% (see Table 2 on page 6).

Distribution of syphilis cases according to obstetrical

The table below presents syphilis cases by obstetric history.

It emerges from this table that: Pregnant women with a gestational age between 26 and 37 weeks were 59.3%; 62.1% of pregnant women with syphilis had a singleton pregnancy; 83.5% were multi-procedure, 75.9% of pregnant women with syphilis had given birth vaginally in the past (see Table 3 on page 6-7).

Distribution of syphilis cases according to others histories

The table below presents the cases of syphilis according to other histories.

It appears from this table that pregnant women with a notion of sexually transmitted infection were the most represented with a frequency of 53.1%. Pregnant women who had a history of syphilis were the most affected with a frequency of 40.3% (see Table 4 on page 7).

Distribution of syphilis cases according to s yphilis treatment

The table below presents syphilis cases that received treatment for syphilis.

It appears from this table that 66.2% of pregnant women had received anti-syphilitic treatment (see Table 5 on page 8).

The table below shows the outcome of the pregnancy and fetal prognosis according to the cases of syphilis

It emerges from this table that 50 pregnancies or 34.4% ended in a full-term delivery. It appears from this table that 18 abortions, or 62.1%, were late. 75% of pregnancies ended in a live fetus (see Table 6 on page 8).

Sociodemographic characteristics

The table below presents the risk factors according to sociodemographic characteristics.

Some of the husband’s occupation, certaines places of residence and the level of education are risk factors in our study. Women whose spouses were drivers, shopkeepers, students, and unemployed were more likely to contract syphilis than those whose spouses were teachers. Women who lived in Mangobo commune and those who resided in Tshopo commune were more likely to develop syphilis Women with primary education were 2.76 times more likely to develop syphilis than women with university education (see Table 7 on page 8-9).

Antécédents

Women with a history of STIs were 2.97 times more likely to develop. Women who were on ARV treatment were 1.92 times more likely to develop syphilis. Pregnant women who had more than one sexual partner were 1.88 times more likely to develop syphilis (see Table 8 on page 10).

According to Table 7, it emerges that: •

Pregnant women whose partners were drivers, merchants, students, and unemployed were at a higher risk of developing syphilis compared to those whose partners were teachers;

Our findings are consistent with those of Katenga B. et al., ¹³ who found that having a partner who is a merchant was a risk factor for developing syphilis. Similarly, Meng Zhang et al. ¹⁴ in China identified a primary level of education as a risk factor.

Considering the poverty in our community, merchants, drivers, and students are more likely to attract women and may have multiple sexual partners without using protective measures against STIs.

Pregnant women with a primary level of education lack sufficient knowledge about STIs, their prevention, and protection measures.

Table 8 indicates that having a history of STIs, receiving ARV treatment, and having multiple sexual partners were risk factors for developing syphilis among our pregnant women.

Our findings align with those of Jacob S et al. ¹⁵ in Zambia, who confirmed that a history of STIs, multiple sexual partners, and HIV were significantly associated with maternal syphilis.

M. Tardieu et al. ¹⁶ in France also found that a history of STIs and multiple sexual partners were the most frequently reported risk behaviors among pregnant women with syphilis.

Our findings could be explained by the fact that prevention and protection measures against STIs are not yet fully accepted and implemented in our communities due to certain religious and cultural beliefs that often oppose the use of some protective methods, such as condoms.

Our results showed that 75% of pregnancies in pregnant women with syphilis resulted in the birth of a live fetus.

Our results are lower than those found by Moraes et al. ¹⁷ in Brazil, where 86.5% of pregnancies had a favorable outcome and 13.5% had unfavorable outcomes. Similarly, Carles G. et al. ¹⁸ in French Guiana reported a 20% fetal mortality rate.

This could be explained by the fact that, according to Fatima LUBUELA in the DRC, ¹⁹ 80% of pregnant women start prenatal consultations late. Consequently, the detection and management of various pathologies occur late, increasing the risk of adverse pregnancy outcomes in case of complications.

Based on observations made during our study, our findings align with the conclusions drawn by this author.

Age

We found that the most affected age group was between 20 and 34 years old (61.4%),

Our result is close to that found by Cyprin K. et al. ²⁰ in Cameroon (68%).

This could be explained by the fact that, according to Roger T. et al. ²¹ in the DRC, "84% of young girls have their first sexual intercourse at an average age of 15.98 years, and it is often unprotected." They are therefore not well informed about STI prevention and protection measures and have more time to develop such infections.

Marital status

The distribution of pregnant women by marital status shows a predominance of married women ( 61.4%) in our setting.

Cyprien K. et al. ²⁰ in Cameroon and Nacer et al. ²² in Morocco found that 80.3% and 96.9%, respectively, of married women or those living in cohabitation were affected by syphilis.

Our results can be explained by the fact that in our setting, the majority of pregnant women are married or living in cohabitation.

Occupation

Our study found that the majority of pregnant women with syphilis were housewives ( 22.1%).

Our results are similar to those found by Cyprien K. et al. ²⁰ in Cameroon ( 49.4%) and those of Sangu K. et al. ²³ in Benin, who made similar observations.

This could be explained by the fact that housewives are more numerous in the general population and are less informed about STIs and their prevention and protection measures, making them more vulnerable to contracting STIs.

Partner’s occupation

We observed that pregnant women whose partners were unemployed were the most affected ( 26.9%).

Kelah Z. et al. ²⁴ in Tanzania observed a predominance of pregnant women whose partners were employed in the private sector.

This could be explained by the fact that 80% of the population in the DRC is unemployed, according to the summary of the book “Instruments of Economic Policy and the Fight Against Unemployment in the DRC.” As a result, they do not always have the financial means to acquire protection against STIs.

Educational level

In our study, we observed a high frequency of syphilis among pregnant women with a secondary level of education ( 46.2%).

Cyprien K. et al. ²⁰ in Cameroon found that 43.0% of pregnant women with secondary education were affected by syphilis.

According to the secondary analysis of EDS-RDC, “educated women are more likely to engage in high-risk sexual behavior than uneducated women.”

However, based on our observations, our study does not align with this analysis, as pregnant women with a moderate level of education are more affected by syphilis in our setting.