International Journal of STO & AIDS 1999; 10: 405-408 SHORT REPORT Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field? M Temmerman MD PhD l, K Fonck MD l ,2, F Bashir DMLT 2 , I Inion MOl, J 0 Ndinya-Achola MD PhD 2 , J Bwayo MD 2 , P Kirui MD 3 , P Claeys MOl and L Fransen MD PhD 4 IInternational Centre for Reproductive Health, University of Ghent, Belgium, 2Department 0/ ¥,edical Microbiplogy, U,niversitY,of Nairobi, Kenya, 3Nairobi City Council and 4DIVlSlOn of Health and FamIly Planmng/AIDS-DG VIII of the European Commission Summary: Untreated maternal syphilis during pregnancy will cause adverse pregnancy outcomes in more than 60% of the infected women. In Nairobi, Kenya, the prevalence of syphilis in pregnant women of 2.9%in 1989,showed a rise to 6.5% in 1993, parallel to an increase of HIV-1 prevalence rates. Since the early 1990s, STD/HIV prevention and control programmes, including a specific syphilis control programme, were developed in the public health facilities of Nairobi. Since 1992 the prevalence of syphilis in pregnant women has been monitored. This paper reports the findings of 81,311 pregnant women between 1994 and 1997. A total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7-7.7) in 1994, 7.3% (95% CI: 6.9-7.7) in 1995, 4.5% (95% CI: 4.3-4.8) in 1996 and 3.8% (95%CI: 3.6-4.0) in 1997.In conclusion, a marked decline in syphilis seroprevalence in pregnant women in Nairobi was observed since 1995-96 (P < 0.0001, Chi-square test for trend) in contrast to upward trends reported between 1990 and 1994-95 in the same population. Keywords: Syphilis, pregnancy, HIV, Kenya INTRODUCTION Untreated maternal syphilis infection during preg- nancy will cause adverse pregnancy outcomes in more than 60% of the cases. The risks of abortion, stillbirth, prematurity, congenital syphilis and perinatal death are well documented in several African settingsl-'. In Nairobi, Kenya, the preva- lence of syphilis in pregnant women was 2.9% in 1989, showed a rapid rise to 5.3% in 1991, parallel to a rise in prevalence of HIV-1 infection". Since the early 1990s the National STD Control Unit of the Ministry of Health has been strengthened, and decentralized STD/HIV prevention and control programmes were developed in Kenya. In Nairobi, medical staff at 10 Nairobi City Council (NCC) health centres were trained in syndrome approach and counselling to manage sexually transmitted diseases (STDs) by joint efforts of the government of Kenya supported by the European Commission Correspondence to: Professor Marleen Temmerman, Interna- tional Centre for Reproductive Health (ICRH), University of Ghent, De Pintelaan 185, 9000 Ghent, Belgium E-mail: marleen.temmerman@rug.ac.be (EC) and the Canadian Development Agencies the University of Nairobi. In addition, and decentralized programmes, aiming at congenital syphilis, were set up in NCC pubhc health clinics with the support of the EC's AIDS programme whose strategies have always on the fight against AIDS and STDs in a combined approach. The supervision, monitoring and evaluation activities of the syphilis programme are the of a task force consisting of of the NCC, the Ministry of Health, the University of Nairobi and the University of Ghent, Belgiumf>. In 1992-93, an overall syphilis prevalence of 6.5% (95%CI: was found in over 13,000pregnant women vi.sitIngthese prenatal clinics", In this paper we descnbe the trend in syphilis prevalence in pregnant women between 1994 and 1997. METHODS Population Nairobi and its peri-urban area have a population of approximately 2.7 million inhabitants, of whom the larger part live in peri-urban slums. Public 405