Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani

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In such cases, early treatment is crucial in determining obstetric prognosis. Objective This study aims to present current data and improve the management of syphilis in pregnant women in the city of Kisangani. Methods This is an analytical case-control study covering the period from July 1, 2023, to December 1, 2023. The study was conducted at Makiso Kisangani General Referral Hospital, with a study population of 976 pregnant women. A non-exhaustive sampling method was used, selecting a sample of 145 pregnant women diagnosed with syphilis and 145 others diagnosed with out syphilis. Data were analyzed using R software version 4.3. Results The prevalence of syphilis during pregnancy was 16.9%. The most represented age group was 20 to 34 years (61.4%). The majority of pregnant women with syphilis were married (61.4%), in monogamous relationships (72.4%), and had unemployed partners (26.9%). The most common risk factors were having a partner who was a driver (OR: 3.31; p = 0.028), a trader (OR: 8.08; p <0.001), and having a history of STIs (p <0.001) or multiple sexual partners (p = 0.011). In 75% of cases, pregnancy resulted in the birth of a live fetus. Conclusion The prevalence of syphilis among pregnant women in the city of Kisangani is on the rise compared to previous years. Adverse pregnancy outcomes associated with syphilis could be reduced through early detection and standard treatment of syphilis for pregnant women and their husbands/sexual partners. 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F1000Research 2025, 14 :232 ( https://doi.org/10.12688/f1000research.161666.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] Likilo Osundja Jérémie https://orcid.org/0009-0002-5773-6580 1 , Tshodi Bulanda Arsène https://orcid.org/0009-0005-4132-1606 2 , Lufuluabu Mpemba Alphonse https://orcid.org/0009-0009-7359-1466 3 , Mbohou Kouaming Aminate Nawal 1 , Komanda Likeweke Emmanuel 1 , Katenga Bosunga Gédéon 1 Likilo Osundja Jérémie https://orcid.org/0009-0002-5773-6580 1 , Tshodi Bulanda Arsène https://orcid.org/0009-0005-4132-1606 2 , [...] Lufuluabu Mpemba Alphonse https://orcid.org/0009-0009-7359-1466 3 , Mbohou Kouaming Aminate Nawal 1 , Komanda Likeweke Emmanuel 1 , Katenga Bosunga Gédéon 1 PUBLISHED 25 Feb 2025 Author details Author details 1 gynécology et obstétric, University of Kisangani, Kisangani, TSHOPO, Democratic Republic of the Congo 2 Gynecology and obstetric, University of MBUJIMAYI, MBUJIMAYI, Eastern Kasai, Democratic Republic of the Congo 3 Internal medecine, University of Mbujimayi, MBUJIMAYI, Eastern Kasai, Democratic Republic of the Congo Likilo Osundja Jérémie Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Tshodi Bulanda Arsène Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Lufuluabu Mpemba Alphonse Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Mbohou Kouaming Aminate Nawal Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Komanda Likeweke Emmanuel Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Katenga Bosunga Gédéon Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Syphilis is a cosmopolitan infection, with recent infections (primary or secondary syphilis <1 year) posing the highest risk of mother-to-child transmission. In such cases, early treatment is crucial in determining obstetric prognosis. Objective This study aims to present current data and improve the management of syphilis in pregnant women in the city of Kisangani. Methods This is an analytical case-control study covering the period from July 1, 2023, to December 1, 2023. The study was conducted at Makiso Kisangani General Referral Hospital, with a study population of 976 pregnant women. A non-exhaustive sampling method was used, selecting a sample of 145 pregnant women diagnosed with syphilis and 145 others diagnosed with out syphilis. Data were analyzed using R software version 4.3. Results The prevalence of syphilis during pregnancy was 16.9%. The most represented age group was 20 to 34 years (61.4%). The majority of pregnant women with syphilis were married (61.4%), in monogamous relationships (72.4%), and had unemployed partners (26.9%). The most common risk factors were having a partner who was a driver (OR: 3.31; p = 0.028), a trader (OR: 8.08; p <0.001), and having a history of STIs (p <0.001) or multiple sexual partners (p = 0.011). In 75% of cases, pregnancy resulted in the birth of a live fetus. Conclusion The prevalence of syphilis among pregnant women in the city of Kisangani is on the rise compared to previous years. Adverse pregnancy outcomes associated with syphilis could be reduced through early detection and standard treatment of syphilis for pregnant women and their husbands/sexual partners. READ ALL READ LESS Keywords Syphilis, prevalence, risk factors of syphilys in pregnancy, maternel and fetal prognosis. Corresponding Author(s) Likilo Osundja Jérémie ( [email protected] ) Tshodi Bulanda Arsène ( [email protected] ) Lufuluabu Mpemba Alphonse ( [email protected] ) Close Corresponding authors: Likilo Osundja Jérémie, Tshodi Bulanda Arsène, Lufuluabu Mpemba Alphonse Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Jérémie LO et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Jérémie LO, Arsène TB, Alphonse LM et al. Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.12688/f1000research.161666.1 ) First published: 25 Feb 2025, 14 :232 ( https://doi.org/10.12688/f1000research.161666.1 ) Latest published: 19 Sep 2025, 14 :232 ( https://doi.org/10.12688/f1000research.161666.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Syphilis is caused by Treponema pallidum. This sexually transmitted infection can also be transmitted vertically. If left untreated, syphilis can lead to complications during the second or third trimesters of pregnancy. 1 , 2 La transmission verticale survient dans 50% des cas et conduit à beaucoup des complications. such as early fetal death, stillbirth, preterm birth, low birth weight, neonatal death, and congenital infection in infants. 3 , 4 In 2016, maternal syphilis cases were estimated to have resulted in 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm births or low birth weight cases, and 109,000 cases of clinical congenital syphilis. 5 An infected and untreated mother can also transmit the disease to her child through transplacental transmission, which can occur as early as the 11th week of amenorrhea (WA) and is certain by the 16th WA, continuing throughout pregnancy. Transmission can also occur during delivery through contact with infected maternal secretions. 6 The diagnosis of syphilis is simple and its treatment less expensive and not contraindicated during pregnancy. But syphilis in pregnant women is still an underestimated public health problem. According to the WHO, 2 million women are infected with syphilis worldwide and among untreated cases there are 65% of fetal complications. 7 , 8 It is estimated that 2.7% of pregnant women in sub-Saharan Africa are infected with syphilis, representing more than 900,000 at-risk pregnancies each year. 9 Despite the implementation of various guidelines to control sexually transmitted infections in the Democratic Republic of the Congo, the burden of syphilis persists. There are inconsistencies in the quality and utilization of services, which may be influenced by the knowledge of healthcare providers and pregnant women. Additionally, the prevalence of syphilis in urban and rural areas is different. Many factors such as diagnosis, treatment, frequency of visits, behavioral factors, sociodemographic and gyneco-obstetrical factors can change the burden of this desease. 10 – 12 Moreover, data on syphilis in the Democratic Republic of the Congo, particularly in our study area, are scarce. Therefore, this study targets to determine the prevalence of syphilis in pregnant women and its associeted factors. in the city of Kisangani. The aim is to raise awareness among pregnant women about measures to prevent the adverse effects of this disease during pregnancy and to provide scientists with insights into the current syphilis rate and its most common complications among pregnant women in Kisangani. To conduct this research, we asked the question: What are the epidemiological aspects of syphilis among pregnant women in Kisangani? General objective This study aims to present current data and improve the management of syphilis in pregnant women in the city of Kisangani. Specific objectives • To improve the management of syphilis in pregnant women in the city of Kisangani. • To identify the risk factors for syphilis among study participants. • To determine the maternal and fetal prognosis of syphilis during pregnancy. Methods Study population 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. Inclusion criteria For our study, we included: • All pregnant women admitted to and/or followed up at HGR Makiso Kisangani during the study period; • All pregnant women who attended at least four prenatal consultations (PNCs) during their pregnancy; • All pregnant women diagnosed with syphilis during pregnancy confirmed by VDRL and TPHA tests; • All pregnant women with a PNC record and a complete medical file; • All pregnant women who consented to screening. Exclusion criteria The following were excluded: • Pregnant women who did not attend at least four PNCs during their pregnancy; • Pregnant women with incomplete PNC records or medical files; • Pregnant women who did not consent to screening. Type of study We conducted an analytical case-control study. Data collection technique 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 • Marital status • Occupation (of the pregnant woman and her spouse) • Address • Educational level • Socioeconomic status • Type of marriage • Obstetric formula • Gestational age • Medical history • Paraclinical examinations • Newborn weight and observed anomalies at birth • Placental weight. Statistical analysis 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. Ethical considerations 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. Consent to publish 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. Results Sociodemographic characteristics of pregnant women with syphilis The table below presents the cases of syphilis according to the sociodemographic characteristics of the pregnant women. Table 1. Distribution of syphilis cases by sociodemographic characteristics. Sociodémographic characterics Number (N = 145) Percentage Age (year) < 20 17 11.7 20 à 34 89 61.4 ≥ 35 39 26.9 Marital status Maried 89 61.4 Single 56 38.6 Type of marriage Monogamic 63 72.4 Polygamic 24 27.6 Occupation House kipper 32 22.1 Etudent 29 20.0 Unemployed 29 20.0 Trader 23 15.9 State agent 17 11.7 Private sector employee 15 10.3 Husband occupation Unemployed 39 26.9 Trader 38 26.2 State agent 29 20.0 Driver 17 11.7 Student 14 9.7 teacher 8 5.5 Adresse Mangobo 67 46.2 Tshopo 54 37.2 Makiso 24 16.6 Level of education Elementary school 43 29.7 High school 67 46.2 University 35 24.1 Socio-economic level High 34 23.5 Middle 67 46.2 Low 44 30.3 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). Prevalence of syphilis 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). Table 2. Prevalence of syphilis in pregnancy. Prevalence Number Percentage syphilis positive cases 165 16.9 syphilis négative cases 811 83.0 TOTAL 976 99.9 Distribution of syphilis cases according to obstetrical The table below presents syphilis cases by obstetric history. Table 3. Distribution of cases by obstetrical history. Obstetrical hystories Number (N = 145) Percentage Gestational age (in weeks of amenorrhea) 15-25 59 40.7 26-37 86 59.3 Pregnancy type Monofetal 90 62.1 Twin 41 28.3 Multiple 14 9.7 Gesture Primigravida 5 3.5 Second-gesture 19+ 13.1 Multigesture 121 83.5 Parity Nulliparous 14 9.7 Primiparous 37 25.5 Second-parous 42 29.0 Multiparous 52 35.9 Abortion 0 96 66.2 1 33 22.8 2 8 5.5 3 8 5.5 Death 0 101 69.7 1 44 30.3 Past route of delivery Cesarean 50 34.5 Vaginnaly 110 75.9 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. Table 4. Distribution of cases by others histories. Others histories Number (N = 145) Percentage Concept of STI 77(n) 53.1 Syphilis 31 40.3 Gonorrhea 20 26 Condyloma 13 16.9 Trichomonas vaginalis 13 16.9 Notion of more than one sexual partner 63 43.5 Concept of male condom use 41 28.3 Anti retroviral treatment 37 25.5 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. Table 5. Presentation of cases by syphilis treatment received. Syphilis treatment Fréquency Percentage Yes 96 66.2 No 49 33.8 TOTAL 145 100.0 It appears from this table that 66.2% of pregnant women had received anti-syphilitic treatment (see Table 5 on page 8). Pregnancy outcome and fetal prognosis The table below shows the outcome of the pregnancy and fetal prognosis according to the cases of syphilis Table 6. Distribution of cases by pregnancy outcome, type of abortion, fetal prognosis. Pregnancy outcome Number (N = 145) Percentage Abortion 29 20.0 MIU 29 20.0 Premature birth 37 25.5 Full-terme delivery 50 34.4 Abortion type Number (N = 29) Percentage Early 11 37.9 Late 18 62.1 Fetal pronosis Number (N = 116) Percentage In live 87 75 Died 29 25 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). Risk factors for syphilis in pregnancy Sociodemographic characteristics The table below presents the risk factors according to sociodemographic characteristics. Table 7. Syphilis risk factors by sociodemographic characteristics. Socio-démographic characteristics Syphilis Négative (n = 145) Positive (n = 145) OR 95% IC p-value Age < 20 ans 16 (48.5%) 17 (51.5%) — — 20 à 34 ans 90 (50.3%) 89 (49.7%) 0.93 0.44 – 1.96 0.8 ≥ 35 ans 39 (50.0%) 39 (50.0%) 0.94 0.41 – 2.13 0.9 Marital status Maried 100 (52.9%) 89 (47.1%) — — Single 45 (44.6%) 56 (55.4%) 1.4 0.86 – 2.28 0.2 Occupation Private sector 17 (53.1%) 15 (46.9%) — — State agent 25 (59.5%) 17 (40.5%) 0.77 0.30 – 1.95 0.6 Trader 21 (47.7%) 23 (52.3%) 1.24 0.50 – 3.12 0.6 Student 23 (44.2%) 29 (55.8%) 1.43 0.59 – 3.49 0.4 House keepper 28 (46.7%) 32 (53.3%) 1.3 0.55 – 3.09 0.6 Unemployed 31 (51.7%) 29 (48.3%) 1.06 0.45 – 2.52 0.9 Husband occupation Teacher 17 (68.0%) 8 (32.0%) — — State agent 30 (50.8%) 29 (49.2%) 2.05 0.79 – 5.72 0.2 Driver 10 (37.0%) 17 (63.0%) 3.61 1.18 – 11.9 0.028 Trader 10 (20.8%) 38 (79.2%) 8.08 2.81 – 25.4 0.9 Kisangani 11 (100.0%) 0 (0.0%) 0 >0.9 Lubunga 6 (100.0%) 0 (0.0%) 0 >0.9 Mangobo 37 (35.6%) 67 (64.4%) 2.94 1.55 – 5.69 0.001 Tshopo 33 (37.9%) 54 (62.1%) 2.66 1.37 – 5.24 0.004 Educational level University 54 (60.7%) 35 (39.3%) — — Elementary school 24 (35.8%) 43 (64.2%) 2.76 1.45 – 5.39 0.002 High school 67 (50.0%) 67 (50.0%) 1.54 0.90 – 2.67 0.12 Socio-economic level High 39 (53.4%) 34 (46.6%) — — Low 31 (41.3%) 44 (58.7%) 1.63 0.85 – 3.14 0.14 Middle 75 (52.8%) 67 (47.2%) 1.02 0.58 – 1.81 >0.9 Type of marriage Monogamic 73 (53.7%) 63 (46.3%) — — Polygamic 27 (52.9%) 24 (47.1%) 1.03 0.54 – 1.96 >0.9 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). Table 8. Risk factors for syphilis in pregnancy by history. Histories Syphilis Négative (N = 145) Positive (N = 145) OR 95% IC P-valeur Age (in in weeks of amenorrhea) 15-25 59 (50.0%) 59 (50.0%) — — 26-37 86 (50.0%) 86 (50.0%) 1 0.63 – 1.60 >0.9 Parity Nulliparous 14 (50.0%) 14 (50.0%) — — Primiparous 37 (50.0%) 37 (50.0%) 1 0.42 – 2.40 >0.9 Secondiparous 42 (50.0%) 42 (50.0%) 1 0.42 – 2.37 >0.9 Multiparous 52 (50.0%) 52 (50.0%) 1 0.43 – 2.32 >0.9 Gestité Primigravida 5 (50.0%) 5 (50.0%) — — Secondigesture 19 (50.0%) 19 (50.0%) 1 0.24 – 4.15 >0.9 Multigesture 121 (50.0%) 121 (50.0%) 1 0.27 – 3.68 >0.9 Type de grossesse Monofetal 90 (50.0%) 90 (50.0%) — — Twin 41 (50.0%) 41 (50.0%) 1 0.59 – 1.69 >0.9 Multiple 14 (50.0%) 14 (50.0%) 1 0.45 – 2.23 >0.9 Concept of STI No 105 (60.7%) 68 (39.3%) — — Yes 40 (34.2%) 77 (65.8%) 2.97 1.83 – 4.88 <0.001 Type of STI Gonorrhea 11 (35.5%) 20 (64.5%) 1.95 — 0.1 Condyloma 7 (35.0%) 13 (65.0%) 1.29 0.37 – 4.61 0.7 Gonococcie 5 (33.3%) 10 (66.7%) 1.38 0.36 – 5.73 0.6 Syphilis 12 (27.9%) 31 (72.1%) 1.79 0.60 – 5.31 0.3 Trichomonas 6 (37.5%) 10 (62.5%) 1.15 0.31 – 4.47 0.8 Anti-retroviral treatment No 123 (53.2%) 108 (46.8%) — — Yes 22 (37.3%) 37 (62.7%) 1.92 1.07 – 3.49 0.03 Notion of more than one sexual partner No 103 (55.7%) 82 (44.3%) — — Yes 42 (40.0%) 63 (60.0%) 1.88 1.16 – 3.08 0.011 Concept of male condom use No 104 (50.0%) 104 (50.0%) — — Yes 41 (50.0%) 41 (50.0%) 1 0.60 – 1.67 >0.9 Discussion Our study proves that the rate of syphilis among pregnant women in the city of Kisangani is on the rise. This may be explained by the increasing population in Kisangani in recent years, the decrease in awareness campaigns encouraging women to seek adequate treatment in case of STIs, and also the reluctance of some patients to consult a healthcare professional when experiencing STI symptoms. The prevalence of syphilis among the study participants was 16.9% ; Our results are higher than those found by Katenga B. et al., 13 who reported a prevalence of 10.9% in Kisangani in 2014. Risk factors for syphilis during pregnancy 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; • Pregnant women residing in the communes of Mangobo and Tshopo were more likely to develop syphilis compared to those living in the Makiso commune; • Pregnant women with a primary level of education were 2.76 times more likely to develop syphilis compared to those with secondary or university education. 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. Maternal-fetal outcome 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. Profile of pregnant women 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. Author contributions • Conception and implementation: All authors • Financial support: All authors • Administrative support: All authors • Provision of study material or patients: All authors • Data collection and assembly: All authors • Data analysis and interpretation: All authors • Manuscript writing: All authors • Final manuscript approval: All authors • Responsible for all aspects of the work: All authors Disclosure statement The authors are employees of the University of Kisangani and the University of Mbujimayi. Ethics and consent This study received approval from the ethics committee of the University of Kisangani on UNIKIS/CER/024/2023 of 7th June 2023. It 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. All women who have participated in this study have provided their consent by signing a written document. Consent to publish 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. Contexte key findings • The prevalence of syphilis among pregnant women was 16.9% . • This prevalence is higher than previous studies. • This prevalence indicates the progression of this pathology in our setting. • The risk factors were having a partner who is a driver, trader, student, or unemployed. • Others risk factors were primary education level, history of STIs, ARV treatment, and multiple sexual partners. • The maternal-fetal prognosis was favorable, with 75% of pregnancies resulting in live births. • This shows the importance of diagnosing and treating syphilis in pregnant women. Global health impact on policies and actions • Targeted education for at-risk groups, such as drivers, shopkeepers, students, and people with multiple partners. • Integrate syphilis testing into antenatal care to identify and treat infected pregnant women. • Ensure the availability of penicillin, the treatment of choice for syphilis, in all health centres. • Establish protocols to screen and treat newborns at risk of congenital syphilis. • Improved data collection to better monitor prevalence and assess the effectiveness of interventions. Data availability Underlying data Figshare: Syphilis in pregnancy: prevalence, risk factors and maternal-fetal prognosis in Kisangani. Doi: https://doi.org/10.6084/m9.figshare.28292933.v2 . 25 This project contains the following underlying data: • Base de données syphilis.xlsx Data.xlsx [anonymised results of microscopic syphlis in pregnancy, Marital status (Married=1, Single =2), occupation (unemployed=1, State agent=2, Houde keeper=3, Private sector=4, trader=5, student=6), Adress (Makiso=1, Mangobo=2, Tshopo=3, Kabondo=4, Kisangani=5, Lubunga=6), Educational level ( Elementary school=1, High school=2, university= 3), socio-economic level ( low=1, Middle=2, high=3), Type of marriage ( Monogamic=1, Polygamic=2), Type of pregnancy ( Monofœtale=1,Gémellaire=2, Multiple=3 ), Route of past delivery ( vaginnaly=1, cesarean=2 ), concept of STI ( yes=1, No=2 ) ARV treatment ( yes=1, No=2 ) ]. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). 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Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 25 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 gynécology et obstétric, University of Kisangani, Kisangani, TSHOPO, Democratic Republic of the Congo 2 Gynecology and obstetric, University of MBUJIMAYI, MBUJIMAYI, Eastern Kasai, Democratic Republic of the Congo 3 Internal medecine, University of Mbujimayi, MBUJIMAYI, Eastern Kasai, Democratic Republic of the Congo Likilo Osundja Jérémie Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Tshodi Bulanda Arsène Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Lufuluabu Mpemba Alphonse Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Mbohou Kouaming Aminate Nawal Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Komanda Likeweke Emmanuel Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Katenga Bosunga Gédéon Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 19 Sep 2025, 14:232 https://doi.org/10.12688/f1000research.161666.2 version 1 Published: 25 Feb 2025, 14:232 https://doi.org/10.12688/f1000research.161666.1 Copyright © 2025 Jérémie LO et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Jérémie LO, Arsène TB, Alphonse LM et al. Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.12688/f1000research.161666.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 25 Feb 2025 Views 0 Cite How to cite this report: Marks M. Reviewer Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.177732.r375522 ) The direct URL for this report is: https://f1000research.com/articles/14-232/v1#referee-response-375522 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Apr 2025 Michael Marks , London School of Hygiene and Tropical Medicine, London, UK Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.177732.r375522 Introduction. In general this needs restructuring - the first 5-6 paragraphs jumps back and forth between burden estimates, impact of disease etc. Please try and make this clearer. In particular you need to make clearer that syphilis at any ... Continue reading READ ALL Introduction. In general this needs restructuring - the first 5-6 paragraphs jumps back and forth between burden estimates, impact of disease etc. Please try and make this clearer. In particular you need to make clearer that syphilis at any stage of pregnancy is associated with adverse outcomes. This could all be restructured into 1-2 paragraphs. Please note some sentences are still written in French mixed in with English and need translating. Please try and use more person centered language - i.e. pregnant women with syphilis rather than syphilis-positive or syphilis-negative. The methods jumps straight into the number of individuals with/without syphilis - but there is no description of how people were identified, screened and their disease status classified. Was this all pregnant women? What tests were performed etc - were they study specific tests or routine tests etc. This is then touched on in the inclusion/exclusion but is hard to follow. The numbers of eventual participants should also be in results not methods. There is no CONSORT diagram for study inclusion/exclusion which should be inclued. I. would be worried that your inclusion and exlcusion criteria introduce significant bias. You have only included people who attended at least 4 ANC visits. This is likely to mean you have under-represented populations most at risk of syphilis and of adverse outcomes. Some of the variables need to be explained such as 'type of marriage' , obstetric formula. Please review and make sure all variables are clear. This statement " 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." doesn't make any sense. Was a sample size calculation actually performed? Throughout only point estimates are provided without confidence intervals. This needs to be looked at through all the results. Table 1&3 could likely be combined into a single table. I am not sure table 2 adds anything to the information in the text. I dont understand what is meant by concept of STI in table 4. Table 5 - how was treatment defined? Did this mean a single dose of BPG or 3 doses? Some of the participants appear to be young - are there any participants <18 & if so how was consent obtained from this group? In general there are too many table and a lot of repetition. I would suggest a single table for demographics and baseline features, one for syphilis status overall and by baseline characteristics, one on pregnancy outcome would be much easier to follow. The discussion really needs a complete overhaul as its currently written almost in bullet point fashion. Please revisit this once you have revised other parts of the manuscript. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Epidemiology, Syphilis, Sexually Transmitted Infections, Clinical Trials I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Marks M. Reviewer Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.177732.r375522 ) The direct URL for this report is: https://f1000research.com/articles/14-232/v1#referee-response-375522 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Sep 2025 lufuluabu mpemba Alphonse , Internal medecine, University of Mbujimayi, MBUJIMAYI, Democratic Republic of the Congo 26 Sep 2025 Author Response Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with ... Continue reading Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with this journal. And this way of presenting seems clear and sufficient for interpretation to the journal. The treatment was based on the IV administration of BPG, taking into account the stage of the disease and whether the woman was allergic to penicillin or not. we merged tables 1 and 4 into table 1 and tables 5 and 6 in table 3, taking into account comments from the first reviewer. we deleted table 2. The new version has 5 tables only. Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with this journal. And this way of presenting seems clear and sufficient for interpretation to the journal. The treatment was based on the IV administration of BPG, taking into account the stage of the disease and whether the woman was allergic to penicillin or not. we merged tables 1 and 4 into table 1 and tables 5 and 6 in table 3, taking into account comments from the first reviewer. we deleted table 2. The new version has 5 tables only. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Sep 2025 lufuluabu mpemba Alphonse , Internal medecine, University of Mbujimayi, MBUJIMAYI, Democratic Republic of the Congo 26 Sep 2025 Author Response Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with ... Continue reading Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with this journal. And this way of presenting seems clear and sufficient for interpretation to the journal. The treatment was based on the IV administration of BPG, taking into account the stage of the disease and whether the woman was allergic to penicillin or not. we merged tables 1 and 4 into table 1 and tables 5 and 6 in table 3, taking into account comments from the first reviewer. we deleted table 2. The new version has 5 tables only. Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with this journal. And this way of presenting seems clear and sufficient for interpretation to the journal. The treatment was based on the IV administration of BPG, taking into account the stage of the disease and whether the woman was allergic to penicillin or not. we merged tables 1 and 4 into table 1 and tables 5 and 6 in table 3, taking into account comments from the first reviewer. we deleted table 2. The new version has 5 tables only. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Kufa T. Reviewer Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.177732.r372411 ) The direct URL for this report is: https://f1000research.com/articles/14-232/v1#referee-response-372411 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Apr 2025 Tendesayi Kufa , National Institute for Communicable Diseases, Johannesburg, South Africa Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.177732.r372411 Thank you for the opportunity to review this paper. It addresses the important topic of maternal syphilis, the demographic and clinical risk factors as well as outcomes. The paper presents finding from a hospital based case –control study meant to ... Continue reading READ ALL Thank you for the opportunity to review this paper. It addresses the important topic of maternal syphilis, the demographic and clinical risk factors as well as outcomes. The paper presents finding from a hospital based case –control study meant to study risk factors. The paper was not very well presented and have highlighted areas for improvement. 1. Abstract • Objectives: the author state that the objective of the study was to present current data and improve management of syphilis. They don’t state what data is being referred to. • Methods: the abstract methods don’t state where in the hospital the women were enrolled from. Also what was the inclusion/ exclusion criteria was? • Results: in the abstract results the authors state the prevalence of syphilis was 16.9%. In which population was this. Ordinarily if it’s a case control study, it makes no sense to present the prevalence as the cases and controls are selected. In the manuscript text, the authors report that it was among women screened for eligibility to enroll. This should be stated explicitly in the abstract. Also include other non-live birth outcomes in the abstract Manuscript text Introduction • Paragraph 1 - First let the reader know what syphilis is before discussing the cause • Paragraph 2 – the first sentence in the paragraph is in French. I am unable to read French • General objective – again the authors list the general objective as that to present current data without stating which data they are talking about. The objectives have to be specific o e.g. describe maternal syphilis seropositivity among women attending ANC at Makiso Kisangani General Referral Hospital (HGR) during the period from July 1, 2023, to December 1, 2023. o To identify the demographic and clinical risk factors for syphilis among study participants o To determine the maternal and fetal prognosis of syphilis during pregnancy. The study itself cannot improve the management of syphilis but its findings can inform the management Methods • Study population- can the authors describe the setting of the study a little better. Where is this hospital, which pregnant women are referred to this hospital’s obstetric services? What is the attendance at this clinic per month etc.? • Were all the 976 women attending the clinic or there was some selection to get to the 976 women? • Is the inclusion / exclusion criteria for the initial syphilis screening (that gave rise to the 976 women) or it was specifically for cases • Under type of study – remove analytical in describing the design as case-control. Case-control studies are by definition analytical • In the section on statistical analysis the authors refer to results being presented in tables. What results are being referred to here? The statistical methods should be described in such a way that the analysis is reproducible by others • Data on the syphilis prevalence belongs to the results section • Ethical considerations need to be better described. What were the women consenting to? How was their data kept confidential? Results • Table 1: please also include the socio-demographic characteristics of controls as well • Table 2 is confusing. Were the 976 part of the study or not. If the study is a case-control study including 145 cases and 145 controls, then the prevalence of syphilis shouldn’t be reported as its artificial. The authors should report syphilis positivity among those screened for eligibility to take part in the case control study • In table 3 – also include data on the controls • What is meant by deaths in Table 3. Are these previous fetal deaths? • Also include data on the controls in table 4 • In table 4 can the authors also include other maternal comorbidities that can predispose women to poor obstetric outcomes. These maybe gestational hypertension, diabetes, heart disease, TB etc. • There are too many tables. Tables 1, 2 and 4 can be combined in one table • Table 6 – what is meant by MIU. Include data on controls in table 6 • Can the authors please present pregnancy outcomes of controls as well. Was • In table 8 – the ART variable could be coded as HIV-, HIV+ on ART and HIV + not on ART • Some results are written in French. Made it difficult to follow Discussion • The authors wrote that their study proved the rate of syphilis among pregnant women went up. The study doesn't proof this. Without prior data the authors cannot say this. Without describing how the women got to be selected when they attended the hospital you can say this either • Please clarify who the study participants were. In the methods women were screened and then enrolled. Only those enrolled are considered participants • The study found that having a partner who was a driver, trader, student or unemployed was associated with higher odds of having syphilis. What is the intervention or public health action associated with this finding? The same goes for all the factors identified in the analysis • This discussion is written in lines and not proper paragraphs. Can the authors address this? • The study does not discuss any strengths or limitations. Please add these Data availability The dataset is in French. Can the authors provide one in English too? Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Epidemiology, infectious diseases, syphilis, STIs I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kufa T. Reviewer Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.177732.r372411 ) The direct URL for this report is: https://f1000research.com/articles/14-232/v1#referee-response-372411 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Sep 2025 lufuluabu mpemba Alphonse , Internal medecine, University of Mbujimayi, MBUJIMAYI, Democratic Republic of the Congo 26 Sep 2025 Author Response Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it ... Continue reading Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it includes the case-control matching factors. we deemed it appropriate to present only the cases for a good and easy interpretation. As explained in the methodology, the selected pregnant women had no known medical comorbidities. those who did were excluded to avoid confusion. Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it includes the case-control matching factors. we deemed it appropriate to present only the cases for a good and easy interpretation. As explained in the methodology, the selected pregnant women had no known medical comorbidities. those who did were excluded to avoid confusion. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Sep 2025 lufuluabu mpemba Alphonse , Internal medecine, University of Mbujimayi, MBUJIMAYI, Democratic Republic of the Congo 26 Sep 2025 Author Response Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it ... Continue reading Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it includes the case-control matching factors. we deemed it appropriate to present only the cases for a good and easy interpretation. As explained in the methodology, the selected pregnant women had no known medical comorbidities. those who did were excluded to avoid confusion. Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it includes the case-control matching factors. we deemed it appropriate to present only the cases for a good and easy interpretation. As explained in the methodology, the selected pregnant women had no known medical comorbidities. those who did were excluded to avoid confusion. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 25 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 19 Sep 25 read read Version 1 25 Feb 25 read read Tendesayi Kufa , National Institute for Communicable Diseases, Johannesburg, South Africa Michael Marks , London School of Hygiene and Tropical Medicine, London, UK Ryosuke Tajiri , University of Occupational and Environmental Health, Kitakyushu, Japan Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tajiri R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Nov 2025 | for Version 2 Ryosuke Tajiri , University of Occupational and Environmental Health, Kitakyushu, Japan 0 Views copyright © 2025 Tajiri R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Title: Review of “Syphilis in pregnancy: Risk factors and maternal-fetal prognosis in Kisangani (version 2)” Overall recommendation: Not approved (at this stage). The topic is important and the dataset is potentially valuable. However, fundamental issues in design/analysis alignment , definition of exposure (infection vs seropositivity) , reporting of perinatal outcomes by group , and language/ethics wording require major revision before the article can be considered for indexing. Major comments Matched case–control design not respected in analysis The paper states that 1:1 individual matching was performed on age (±5 years), gestational-age group, parity, gestational weeks, and pregnancy type (Methods). However, the Statistical analysis section reports reliance on univariate logistic regression only. For a matched design, the primary analyses must use conditional logistic regression (or exact conditional methods where sparse) and present adjusted odds ratios (aORs) with 95% CIs for all prespecified covariates. Please re-analyze accordingly and clearly separate crude from adjusted estimates. Case definition conflates active infection with seropositivity Cases are defined as VDRL-positive with TPHA confirmation , but non-treponemal titers (e.g., RPR/VDRL), clinical staging (primary/secondary/latent), and treatment history/timing are not reported. This makes it impossible to distinguish active infection from past treated infection with persistent treponemal antibodies , and therefore undermines causal interpretation for perinatal outcomes. Please re-specify the case definition , add titers/staging/treatment timing , and interpret estimates as seropositivity unless activity is demonstrable. Perinatal outcomes are not compared between cases and controls Table 3 presents outcomes among cases only (abortion, death in utero, preterm, term delivery; fetal “in live/died”) and does not show the corresponding distribution in controls; thus, no effect estimates for case vs control can be inferred. Please add a dedicated case-vs-control perinatal outcome table (stillbirth definition; neonatal death 0–7 days; preterm <37w; LBW <2500 g; NICU; congenital syphilis) and report matched aORs with 95% CIs . Stratify by gestational age and treatment timing (diagnosis-to-delivery interval) . Prevalence/positivity is framed as a core case–control result “Context key findings” emphasizes “The prevalence of syphilis … was 16.9%.” This figure reflects screening positivity in the antenatal source population , not an inferential result from the matched case–control analysis. Please separate screening positivity from analytic results, and avoid presenting it as a principal “prevalence” finding of the case–control design. Language quality and code-switching There is French–English mixing and colloquial/incorrect wording (e.g., “Socio-démographic”, “Adress”, “Vaginnaly”), which hampers readability. A thorough technical English edit is required to standardize terminology (e.g., stillbirth , address , vaginally ) and ensure consistency across tables and text. Ethics wording requires correction The manuscript states: “We had assent of the pregnant minors and the consent of their owners .” This should be corrected to parents/guardians (or equivalent per local regulation). Please also expand on confidentiality protections for minors. Minor comments and suggestions Outcome definitions : Provide explicit definitions (e.g., stillbirth ≥ X weeks by national standard; distinguish fetal vs neonatal death). Consider a DAG to clarify confounding/mediation (SES, HIV, mobility). Reporting : For all risk-factor tables, report aOR with 95% CI (not p-values alone) and state a prespecified confounder set ; describe missing-data handling . Some tables show 50/50 splits that reflect matching; ensure analysis respects this. Reproducibility : Underlying data are shared on Figshare; please add an English data dictionary and the R scripts used (variable coding, model formulae, missing-data strategy) to enable full replication. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise placental pathology, obstetrics infection I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Tajiri R. Peer Review Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.188042.r430971) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-232/v2#referee-response-430971 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kufa T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Sep 2025 | for Version 2 Tendesayi Kufa , National Institute for Communicable Diseases, Johannesburg, South Africa 0 Views copyright © 2025 Kufa T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review a revised version of this manuscript. It reads better than the previous version and better laid out. The manuscript however still has issues with grammar and presentation. It may help getting a language editor to assist Competing Interests No competing interests were disclosed. Reviewer Expertise Epidemiology, infectious diseases, syphilis, STIs I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Kufa T. Peer Review Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.188042.r415499) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-232/v2#referee-response-415499 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Marks M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Apr 2025 | for Version 1 Michael Marks , London School of Hygiene and Tropical Medicine, London, UK 0 Views copyright © 2025 Marks M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Introduction. In general this needs restructuring - the first 5-6 paragraphs jumps back and forth between burden estimates, impact of disease etc. Please try and make this clearer. In particular you need to make clearer that syphilis at any stage of pregnancy is associated with adverse outcomes. This could all be restructured into 1-2 paragraphs. Please note some sentences are still written in French mixed in with English and need translating. Please try and use more person centered language - i.e. pregnant women with syphilis rather than syphilis-positive or syphilis-negative. The methods jumps straight into the number of individuals with/without syphilis - but there is no description of how people were identified, screened and their disease status classified. Was this all pregnant women? What tests were performed etc - were they study specific tests or routine tests etc. This is then touched on in the inclusion/exclusion but is hard to follow. The numbers of eventual participants should also be in results not methods. There is no CONSORT diagram for study inclusion/exclusion which should be inclued. I. would be worried that your inclusion and exlcusion criteria introduce significant bias. You have only included people who attended at least 4 ANC visits. This is likely to mean you have under-represented populations most at risk of syphilis and of adverse outcomes. Some of the variables need to be explained such as 'type of marriage' , obstetric formula. Please review and make sure all variables are clear. This statement " 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." doesn't make any sense. Was a sample size calculation actually performed? Throughout only point estimates are provided without confidence intervals. This needs to be looked at through all the results. Table 1&3 could likely be combined into a single table. I am not sure table 2 adds anything to the information in the text. I dont understand what is meant by concept of STI in table 4. Table 5 - how was treatment defined? Did this mean a single dose of BPG or 3 doses? Some of the participants appear to be young - are there any participants <18 & if so how was consent obtained from this group? In general there are too many table and a lot of repetition. I would suggest a single table for demographics and baseline features, one for syphilis status overall and by baseline characteristics, one on pregnancy outcome would be much easier to follow. The discussion really needs a complete overhaul as its currently written almost in bullet point fashion. Please revisit this once you have revised other parts of the manuscript. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Epidemiology, Syphilis, Sexually Transmitted Infections, Clinical Trials I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 26 Sep 2025 lufuluabu mpemba Alphonse, Internal medecine, University of Mbujimayi, MBUJIMAYI, Democratic Republic of the Congo Thank you for the comments. we added many of them in the new version. We did not include the confidence intervals because our style of data presentation is consistent with this journal. And this way of presenting seems clear and sufficient for interpretation to the journal. The treatment was based on the IV administration of BPG, taking into account the stage of the disease and whether the woman was allergic to penicillin or not. we merged tables 1 and 4 into table 1 and tables 5 and 6 in table 3, taking into account comments from the first reviewer. we deleted table 2. The new version has 5 tables only. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Marks M. Peer Review Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.177732.r375522) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-232/v1#referee-response-375522 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kufa T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Apr 2025 | for Version 1 Tendesayi Kufa , National Institute for Communicable Diseases, Johannesburg, South Africa 0 Views copyright © 2025 Kufa T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this paper. It addresses the important topic of maternal syphilis, the demographic and clinical risk factors as well as outcomes. The paper presents finding from a hospital based case –control study meant to study risk factors. The paper was not very well presented and have highlighted areas for improvement. 1. Abstract • Objectives: the author state that the objective of the study was to present current data and improve management of syphilis. They don’t state what data is being referred to. • Methods: the abstract methods don’t state where in the hospital the women were enrolled from. Also what was the inclusion/ exclusion criteria was? • Results: in the abstract results the authors state the prevalence of syphilis was 16.9%. In which population was this. Ordinarily if it’s a case control study, it makes no sense to present the prevalence as the cases and controls are selected. In the manuscript text, the authors report that it was among women screened for eligibility to enroll. This should be stated explicitly in the abstract. Also include other non-live birth outcomes in the abstract Manuscript text Introduction • Paragraph 1 - First let the reader know what syphilis is before discussing the cause • Paragraph 2 – the first sentence in the paragraph is in French. I am unable to read French • General objective – again the authors list the general objective as that to present current data without stating which data they are talking about. The objectives have to be specific o e.g. describe maternal syphilis seropositivity among women attending ANC at Makiso Kisangani General Referral Hospital (HGR) during the period from July 1, 2023, to December 1, 2023. o To identify the demographic and clinical risk factors for syphilis among study participants o To determine the maternal and fetal prognosis of syphilis during pregnancy. The study itself cannot improve the management of syphilis but its findings can inform the management Methods • Study population- can the authors describe the setting of the study a little better. Where is this hospital, which pregnant women are referred to this hospital’s obstetric services? What is the attendance at this clinic per month etc.? • Were all the 976 women attending the clinic or there was some selection to get to the 976 women? • Is the inclusion / exclusion criteria for the initial syphilis screening (that gave rise to the 976 women) or it was specifically for cases • Under type of study – remove analytical in describing the design as case-control. Case-control studies are by definition analytical • In the section on statistical analysis the authors refer to results being presented in tables. What results are being referred to here? The statistical methods should be described in such a way that the analysis is reproducible by others • Data on the syphilis prevalence belongs to the results section • Ethical considerations need to be better described. What were the women consenting to? How was their data kept confidential? Results • Table 1: please also include the socio-demographic characteristics of controls as well • Table 2 is confusing. Were the 976 part of the study or not. If the study is a case-control study including 145 cases and 145 controls, then the prevalence of syphilis shouldn’t be reported as its artificial. The authors should report syphilis positivity among those screened for eligibility to take part in the case control study • In table 3 – also include data on the controls • What is meant by deaths in Table 3. Are these previous fetal deaths? • Also include data on the controls in table 4 • In table 4 can the authors also include other maternal comorbidities that can predispose women to poor obstetric outcomes. These maybe gestational hypertension, diabetes, heart disease, TB etc. • There are too many tables. Tables 1, 2 and 4 can be combined in one table • Table 6 – what is meant by MIU. Include data on controls in table 6 • Can the authors please present pregnancy outcomes of controls as well. Was • In table 8 – the ART variable could be coded as HIV-, HIV+ on ART and HIV + not on ART • Some results are written in French. Made it difficult to follow Discussion • The authors wrote that their study proved the rate of syphilis among pregnant women went up. The study doesn't proof this. Without prior data the authors cannot say this. Without describing how the women got to be selected when they attended the hospital you can say this either • Please clarify who the study participants were. In the methods women were screened and then enrolled. Only those enrolled are considered participants • The study found that having a partner who was a driver, trader, student or unemployed was associated with higher odds of having syphilis. What is the intervention or public health action associated with this finding? The same goes for all the factors identified in the analysis • This discussion is written in lines and not proper paragraphs. Can the authors address this? • The study does not discuss any strengths or limitations. Please add these Data availability The dataset is in French. Can the authors provide one in English too? Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Epidemiology, infectious diseases, syphilis, STIs I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 26 Sep 2025 lufuluabu mpemba Alphonse, Internal medecine, University of Mbujimayi, MBUJIMAYI, Democratic Republic of the Congo Thank you very much for your comments. we have integrated most except for certain "results": we did not add the controls to table 3 (currently table 2) because it includes the case-control matching factors. we deemed it appropriate to present only the cases for a good and easy interpretation. As explained in the methodology, the selected pregnant women had no known medical comorbidities. those who did were excluded to avoid confusion. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Kufa T. Peer Review Report For: Syphilis in pregnancy: Prevalence, risk factors and maternal-fetal prognosis in Kisangani [version 1; peer review: 2 not approved] . F1000Research 2025, 14 :232 ( https://doi.org/10.5256/f1000research.177732.r372411) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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