Griemberg G, Ravelli M R, Etcheves P C, Orfus G, Pizzimenti M C
Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires.
Medicina (B Aires). 2000;60(3):343-7.
Syphilis may be transmitted vertically, especially if the mother is in an early stage with a high bloodstream treponema concentration, although it may also be transmitted to a lesser degree in late latency, when non-treponemic serology may become negative spontaneously with persistence of treponemic serology. The prenatal control for syphilis is routinely carried out by means of a non-treponemic reaction such as VDRL or rapid plasma reagin (RPR) which, when positive, should be confirmed by treponemic techniques such as fluorescent treponemal antibody absorption (FTA-abs) and/or hemagglutination (MHA-Tp). Prevalence of syphilis should be defined on the basis of positive treponemic reactions. To define the seroprevalence and the validity of these control guidelines, 1,056 pregnant women attending the Hospital de Clínicas for their initial control were evaluated by means of serological treponemic and non-treponemic methods. Serological results disclosed 4 distinct groups. Group 1 (n = 17 or 1.61%) presented both types of reactive tests, while Group II (n = 22 or 2.08%) only presented reactive treponemic tests, and both groups were seroreactive for syphilis. Group III (n = 7 or 0.66%) only showed reactive non-treponemic tests, which were considered biological false-positive (BFP) reactions. Five of them were reactive for antiphospholipid antibodies. Group IV (n = 1,010 or 95.65%) fell to present serological evidence of syphilis. To conclude: 1) global seroprevalence in this population was 3.69%; 2) since 2.08% of pregnant seroreactive mothers had not been detected by routine screening, it would be advisable to perform simultaneous treponemic and non-treponemic techniques for prenatal control. 3) This methodology should identify the BFP tests in the same screening.
梅毒可垂直传播，尤其是当母亲处于早期且血液中梅毒螺旋体浓度较高时，不过在晚期潜伏阶段也可能有较低程度的传播，此时非梅毒螺旋体血清学检查可能会自发转阴，而梅毒螺旋体血清学检查仍持续阳性。梅毒的产前检查通常通过非梅毒螺旋体反应进行，如性病研究实验室试验（VDRL）或快速血浆反应素试验（RPR），若结果呈阳性，则应通过梅毒螺旋体技术进行确认，如荧光梅毒螺旋体抗体吸收试验（FTA - abs）和/或血凝试验（MHA - Tp）。梅毒的患病率应根据梅毒螺旋体反应阳性来确定。为了确定这些检查指南的血清学患病率及有效性，对1056名到临床医院进行初次检查的孕妇采用梅毒螺旋体血清学和非梅毒螺旋体血清学方法进行了评估。血清学结果显示有4个不同的组。第1组（n = 17，占1.61%）两种检测均呈阳性反应，而第2组（n = 22，占2.08%）仅梅毒螺旋体检测呈阳性反应，这两组梅毒血清学均呈阳性。第3组（n = 7，占0.66%）仅非梅毒螺旋体检测呈阳性反应，这些被认为是生物学假阳性（BFP）反应。其中5人抗磷脂抗体呈阳性。第4组（n = 1010，占95.65%）未出现梅毒的血清学证据。结论如下：1）该人群的总体血清学患病率为3.69%；2）由于2.08%的血清反应阳性孕妇未通过常规筛查检测出来，因此建议在产前检查时同时采用梅毒螺旋体和非梅毒螺旋体检测技术；3）这种方法应能在同一次筛查中识别出BFP检测结果。
