Table of Content

Dedication 3
Acknowledgement 4
Declaration 5
Certification 6
Table of content 8
List of table 8
List of Abbreviation 8
Abstract 7
CHAPTER ONE 10
Introduction 10
1.2 Aims and Objectives 11
CHAPTER TWO 13
2.1 Literature review 13
2.2 Geographical distribution 13
2.3 Transmission 14
2.4 Symptoms 15
2.5 Risk of chronic disease 15
2.5.1 In infants and children 15
2.5.2 In adult 15
2.6 HBV-HIV coinfection 16
2.7 Diagnosis 16
2.8 Treatment 17
2.9 Prevention 19
2.10 SYPHILIS (Treponema pallidum) 21
2.11 Structure and Biology 21
2.12 Classification and Antigenic Types 21
2.13 Subspecies 21
2.14 Genome 22
2.15 Pathogenesis 22
2.16 Mode of transmission 22
2.17 Clinical Manifestations of syphilis. 23
2.18 Epidemiology 24
2.19 Laboratory identification 25
2.20 Host Defenses 25
2.21 Vaccine 26
2.22 Problems associated with syphilis during pregnancy. 26
2.23 Treatment 27
2.24 Control 28
CHAPTER THREE 29
3.0 Materials and Methods 29
3.1 Study Design 29
3.2 Study Population 29
3.3 Sample Collection and Administration of Questionnaire 29
3.4 Sample Analysis 30
3.5 Procedures and interpretation of the result 30
3.6 Statistical Analysis 31
CHAPTER FOUR 32
4.1 General Characteristics 34
4.2 Sero-prevalence of HBV and Treponema pallidum 34
CHAPTER FIVE 36
5.0 Discussion 36
5.1 Limitations of the Study 37
5.2 Conclusion 38
5.2 Recommendation 38
References 39

List of tables
Table 1 Pregnancy category of US Food and Drug Administration-approved
treatments for chronic hepatitis B virus. 9
Table 1: Prevalence of HBV and Treponema pallidum in Akwa Ibom State 9

Table 2: Age-Specific distribution of HBV and Treponema pallidum
in Akwa Ibom State 9

Table 3: Sociodemographic Characteristic of HBV/Treponema pallidum
in Akwa Ibom State 9

Table 4: Demographic Characteristic of HBV/Treponema pallidum
in Akwa Ibom State 9

List of Abbreviation

HBV Hepatitis B virus
TP Treponema pallidum
GHO General Hospital Oron
IHE Immanuel Hospital Eket
GHI General Hospital Ikot Abasi
PHC Public health centre
PC Private clinic

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Hepatitis B virus (HBV) infection is a global public health problem. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with mother to child transmission (MTCT) accounting for approximately half of the transmission routes of chronic HBV infections. Prevention of MTCT is an essential step in reducing the global burden of chronic HBV. Natal transmission accounts for most of MTCT, and providing immunoprophylaxis to newborns is an excellent way to block natal transmission. Prenatal transmission is responsible for the minority of MTCT not preventable by immunoprophylaxis. Because of the correlation between prenatal transmission and the level of maternal viremia, some authors find it sound to offer lamivudine in women who have a high viral load (more than 8 to 9 log10copies/mL). In addition to considerations regarding the transmission of HBV to the child, the combination of HBV infection and pregnancy raises several unique management issues. Chronic HBV infection during pregnancy is usually mild but may flare after delivery or with discontinuing therapy. Management of chronic HBV infection in pregnancy is mostly supportive with antiviral medications indicated in a small subset of HBV infected women with rapidly progressive chronic liver disease.
Hepatitis is usually caused by drugs, toxic agents, or viral infections, but it may also arise as a result of an autoimmune response. (Alberti et.,al 1999) The recognition of hepatitis B virus (HBV) infection as a disease of public health importance came into existence when it appeared as an adverse event associated with a vaccination program. (Shepard C.W et., al 2006) HBV infection is a serious disease of humanity and constitutes a global public health problem. (Obi R.K et., al 2006) HBV can be transmitted by several routes which include vertical transmission, early life horizontal transmission, and adult horizontal transmission. (Custer B et., al 2004). HBV infection in Nigeria is still a public health issue. (Akani C.I et.,al 2005) It remains a major cause of mortality, especially in underdeveloped countries. In this low-resource setting, vertical transmission of HBV infection is thought to be a major route of transmission. Despite the above, routine antenatal screening for Hepatitis B infection is not practiced in many Nigerian hospitals. (Workowski and Berman 2010). When a fetus comes into contact with the hepatitis B antigen early in embryonic development, it becomes immunologically tolerant to the antigen as a result of the inability to eliminate the virus and a chronic HBV infection state supervenes. (Gambarin-Gelwan M 2007)
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum, but little is known about its mechanism of action or what determines virulence of infection (Berman 2004). Untreated syphilis in pregnancy leads to adverse outcomes among more than half of the women with active disease, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborn babies (Ingall and Sanchez 2001). Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

1.1 Justification for the study
The presence of asymptomatic carriers among pregnant women makes HBV and Treponema pallidum a serious public health challenge.
Heavy economic losses are incurred due to high mortality and morbidity rates of infant in developing countries.
Carriage of HBV and Treponema pallidum identified as high risk vehicles for the transmission of hepatitis and syphilis.
Syphilis and hepatitis B virus is sexually transmitted infection in Akwa Ibom State and data on the prevalence is limited.
1.2 Aims and Objectives
To determine the Sero-prevalence of both HBV and Treponema pallidum infections in AKS.
To determine age specific distribution of HBV and Treponema pallidum in Pregnancy
To determine the distribution of Hepatitis B/Syphilis positive pregnant women according to their demographic factor.