Temmerman M, Gichangi P, Fonck K, Apers L, Claeys P, Van Renterghem L, Kiragu D, Karanja G, Ndinya-Achola J, Bwayo J
Department of Obstetrics and Gynaecology, University of Ghent, Belgium.
Sex Transm Infect. 2000 Apr;76(2):117-21. doi: 10.1136/sti.76.2.117.
To assess the impact of a syphilis control programme of pregnant women on pregnancy outcome in Kenya.
Women who came to deliver to Pumwani Maternity Hospital (PMH) between April 1997 and March 1998 were tested for syphilis. Reactive rapid plasma reagin (RPR) tests were titrated and confirmed with treponema haemagglutination test (TPHA). Equal numbers of RPR and TPHA negative women were enrolled. Antenatal syphilis screening and treatment history were examined from the antenatal cards.
Of 22,466 women giving birth, 12,414 (55%) were tested for syphilis. Out of these, 377 (3%) were RPR reactive of whom 296 were confirmed by TPHA. Syphilis sero-reactive women had a more risky sexual behaviour and coexistent HIV antibody positivity; 26% were HIV seropositive compared with 11% among syphilis negative mothers. The incidence of adverse obstetric outcome defined as low birth weight and stillbirth, was 9.5%. Syphilis seropositive women had a higher risk for adverse obstetric outcome (OR 4.1, 95% CI 2.4-7.2). Antenatal treatment of RPR reactive women significantly improved pregnancy outcome but the risk of adverse outcome remained 2.5-fold higher than the risk observed in uninfected mothers.
These data confirm the adverse effect of syphilis on pregnancy outcome. This study also shows the efficacy of antenatal testing and prompt treatment of RPR reactive mothers on pregnancy outcome.
评估肯尼亚一项针对孕妇的梅毒控制项目对妊娠结局的影响。
对1997年4月至1998年3月期间到普姆瓦尼妇产医院（PMH）分娩的妇女进行梅毒检测。对快速血浆反应素环状卡片试验（RPR）呈阳性反应的结果进行滴定，并采用梅毒螺旋体血凝试验（TPHA）进行确认。纳入数量相等的RPR和TPHA检测均为阴性的妇女。通过产前卡片检查产前梅毒筛查和治疗史。
在22466名分娩妇女中，12414名（55%）接受了梅毒检测。其中，377名（3%）RPR呈阳性反应，其中296名经TPHA确认。梅毒血清反应阳性的妇女有更危险的性行为且同时存在HIV抗体阳性；26%的梅毒血清反应阳性妇女HIV血清学呈阳性，而梅毒血清反应阴性的母亲中这一比例为11%。定义为低出生体重和死产的不良产科结局发生率为9.5%。梅毒血清反应阳性的妇女发生不良产科结局的风险更高（比值比4.1，95%可信区间2.4 - 7.2）。对RPR呈阳性反应的妇女进行产前治疗显著改善了妊娠结局，但不良结局的风险仍比未感染母亲中观察到的风险高2.5倍。
这些数据证实了梅毒对妊娠结局的不良影响。本研究还表明了对RPR呈阳性反应的母亲进行产前检测和及时治疗对妊娠结局的有效性。
