infection and are potentially at risk of blindness, if adequate measures are not taken. Puning babies at risk One very effective measure is to carefully wash the eyes immediately after birth with clean water, and then to apply an antibiotic (one per cent Gonorrhoea, syphilis and AIDS are three of the tetracycline eye ointment) or an anti­ STDs that can be passed from the infected septic (one per cent silver nitrate eye mother to the infant before, during and after drops) to the conjunctiva. If this method is applied to all birth unless she takes certain precautions babies, the condition will occur only sporadically. Furthermore all mothers should be informed that if they notice sticky eyes, they should bring the baby by Andre Meheus urgently to the health worker. All health workers should be trained to suspect gonococcal ophthalmia neonatorum, and they must consider it he environment of the womb has general availability of penicillin, the as a medical emergency in order to so evolved that the foetus is condition can now also be effectively manage it adequately. And the mother 11 cocooned and protected against treated. For health policy makers, the should of course also receive standard almost all infections. Unfortunately a medical profession and the public treatment for gonorrhoea. comparatively small number of infec­ at large, gonococcal ophthalmia neo­ Congenital syphilis is a less frequent tions can be transmitted by the mother natorum has become a condition of no disease than gonorrhoea, but it is an to the unborn baby. These include concern. important infection because of its seri­ certain sexually transmitted diseases, However, the situation has changed ous consequences for the health among them gonorrhoea, syphilis and rapidly in recent years, to the point of mothers and for the outcome of AIDS. where WHO is again emphasising con­ pregnancy. Gonococcal ophthalmia neonatorum trol measures against the disease. Why If a woman has untreated · syphilis, is the medical term for a condition is this so? Firstly, in many countries she is infectious to her unborn child. affecting the eyes of the newborn eye care at birth has been discon­ Syphilis could be suspected in the babies, who become infected from the tinued, was incompletely applied or mother if she has a persistent skin rash mother's uterine cervix when the baby was not available to large parts of the or genital ulceration, or if it is known is passing through the birth canal. community. Secondly, 1976 saw the that her partner has the disease. But it Between two and seven days after arrival on the scene of the so-called is typical for syphilis to pass through a birth the baby develops sticky eyes. If PPNG strains of gonococci (penicillin­ latent stage, when the person has no the infection is gonococcal, in the ase producing Neisseria gonorrhoeae ), symptoms at all but the organism is absence of early and adequate treat­ which are totally resistant to penicillin still present in the blood. If this is the ment, the lesions progress rapidly and its homologues. These strains case in a pregnant woman, the tre­ from an infection localised on the spread rapidly, and in Africa and poneme-the causative organism of conjunctiva-the delicate membrane South-East Asia they are now respon­ syphilis-can cross the placenta and that lines the eyes and eyelids-until sible for 20 to 80 per cent of gonococ­ infect the unborn foetus. they perforate the cornea and to­ cal infections. If a newborn baby de­ The effect on the foetus can be a tally involve the eye. This results in velops gonococcal ophthalmia due to late miscarriage (from the second blindness. such a PPNG strain, penicillin treat­ trimester onwards), a still-birth, an At the turn of the last century, no ment is of no help. The newer and infant death or a living child with effective control measures for this more expensive antibiotics have to be some symptoms of congenital syphilis. condition existed. At that time, 20 to used, but these are often not available, The risk of these adverse effects 75 per cent of children in institutions particularly in country areas of the occurring in the case of an untreated for the blind in Europe were there as developing world. syphilitic mother is approximately a result of gonococcal ophthalmia Studies in Africa have shown that 65 per cent, and her chances of deliv­ neonatorum. Karl Crede, a German between three and 18 per cent of pre­ ering a healthy child are only around obstetrician, showed in 1881 that plac­ gnant women have a gonococcal infec­ 35 per cent. The more recent the in­ ing silver nitrate drops in the baby's tion of the cervix. The transmission fection is in the mother, the higher is eyes at birth prevented eye infection. rate of the infection from the cervix the risk of an abortion, still-birth or a This practice became compulsory by to the baby's eyes is approximately baby with congenital syphilis. law in many countries and the infec­ 30 per cent, which means that between The frequency of syphilis in preg­ tion ceased to be a public health one and six per cent of all new-born nancy is very variable around the problem. Since the 1950s, with the children in Africa could acquire this world. It has become a rare condition 22 W oRLD HEALTH , November 1986 in industrialised countries where fewer than one per cent of women attend­ ing antenatal clinics are infected. But in some African countries figures between four and 20 per cent have been documented. What can be done about it? The most efficient strategy is, of course, to prevent mothers from contracting syphilis, through general control mea­ sures for sexually transmitted diseases, which are discussed elsewhere. But there is a specific way of preventing congenital syphilis. All mothers should have a blood test done (it is called a serological test for syphilis) , as early in the pregnancy as possible. Ideally the test should be repeated near the end of pregnancy. If this test proves positive, it indicates that the mother has syphilis and she must be treated. Treatment is highly efficacious and consists of one to three intramuscular injections of a high dose of a long­ acting penicillin. AIDS is a very recent and alarming development. Several million people worldwide have already been infected with the human immunodeficiency virus (HIV), the causative agent of the acquired immunodeficiency syndrome (AIDS). The highest infection rates are found in North America, Europe and Africa. Risk factors associated with over 80 per cent of AIDS cases in the industrialised world are male homo­ sexuality and intravenous drug abuse. The epidemiology of the infection is different in Central Africa, where transmission of the virus is mainly through heterosexual contact. This has resulted in a large proportion of women of child-bearing age already Marc Chagall portrayed the protected life in be advised and encouraged to have being infected with HIV in those the womb of a mother-to-be. Painting in the stable marital and sexual relations, areas ; in a number of studies the Stedelijk Museum, Amsterdam, Netherlands. particularly if a pregnancy is planned prevalence of sero-positive pregnant or is in progress. Casual sex encoun­ women varied between two and eight ters must be avoided, or intercourse per cent. must take place with a preservative (a The mother can transmit the infec­ sequently develop AIDS and the im­ sheath for males) . tion to the baby in the womb, or at pact that infection with the virus has If a woman is seropositive for HIV, birth through exposure to infected on the general health of these children she should not become pregnant and maternal blood, or after birth through are still being closely studied. should be counselled about contracep­ breastfeeding. The risk of transmission The most important counter-mea­ tion. If an infected woman becomes from the infected mother to the baby sure is to prevent women of childbear­ pregnant-and a therapeutic abortion is not exactly known, but is probably ing age from becoming infected with is not available to her-not much can at least 25 per cent. This means that the virus. Through health education, actually be done for her and her baby. one to two per cent of newborn babies the public should be informed of the· This makes prevention of HIV infec­ are already being infected with HIV. risks entailed in being sexually promis­ tion of the utmost importance in all The proportion of these who will sub- cuous. Young men and women should societies today. • W oRLD HEALTH, November 1986 23 .