METHODS
This was a cross-sectional study conducted at Gyn & Obs clinic of Ghulam Muhammad Mahar Medical College Teaching Hospital, Sukkur. The woman almost belonged to remote area of Sindh, Pakistan. Most of the women were residents of those areas where people work as laborers, farmers and some do odd jobs selling forest products. Houses are made of mud or bricks and cements without any cement plaster. Most of them did not have clean water supply. Many women were illiterate and even many of them were not properly guided about their basic ethics of their religions.
Study population : Patients were enrolled after taking their informed consent attending Gyn & Obs clinic of Ghulam Muhammad Mahar Medical College Teaching Hospital, Sukkur with history of recurrent miscarriages. Ghulam Muhammad Mahar Medical College Teaching Hospital, Sukkur provides health care services not only to the people of Sukkur constituency, but also to a large number of patients from other locality of Sindh and Baluchistan province. The study was conduct over a period of 14 months which was stared in May, 2012.
Data collection: The patients were interviewed by using a structured questionnaire to collect the bio-data and history of patients. General physical examination was made by the help of lady doctor and blood samples were obtained for serological analysis.
Blood sample: Approximately 5ml Blood sample were drawn by using disposable syringe through vein puncture technique from cubital vein. Approximately 2.5 ml blood was transferred into an aliquot containing EDTA immediately after collection of blood sample for hematological analysis, and remaining blood was transferred into a plain tube for biochemical analysis. Samples were taken to the laboratory as soon as possible. The plain tubes were centrifuged at 3000 rpm for 10 minutes to obtain the serum which was tested for syphilis using both VDRL and FTA-ABS assay.
Syphilis serology testing and case definition: The serum was tested for Venereal Disease Research Laboratory (VDRL) test and Fluorescent Treponemal Antibody – Absorption (FTA-ABS) assay. The definition of active syphilis (both VDRL and FAT-ABS positive) used in this study was based on the serological finding expected for the various stage of disease. Women who had both a non-reactive VDRL test and a non-reactive FAT-ABS assay were considered to be negative for syphilis. Those who were reactive with VDRL test and non-reactive FTA-ABS were considered to be false-positive. And those who were reactive with FTA-ABS and non-reactive with VDRL were considered as old treated.