Warner L, Rochat R W, Fichtner R R, Stoll B J, Nathan L, Toomey K E
Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia, USA.
Sex Transm Dis. 2001 Feb;28(2):92-8. doi: 10.1097/00007435-200102000-00006.
Despite recent declines in syphilis rates nationally, recent outbreaks suggest that prevention of congenital syphilis remains an ongoing public health problem.
To identify missed opportunities for congenital syphilis prevention during prenatal care.
Retrospective medical record review of 157 live birth or stillbirth deliveries that involved cases of congenital syphilis from Grady Memorial Hospital (Atlanta, GA).
The hospital congenital syphilis prevalence was 8.2 cases per 1,000 live births. Six percent of case patients were HIV positive. Opportunities for earlier maternal screening, treatment, or diagnosis were missed in 60% of case patients who received timely prenatal care. Congenital syphilis cases attributable to preventable missed opportunities were significantly more common among case patients with fewer prenatal visits (66% versus 28%, P = 0.01).
Provider efforts to reduce congenital syphilis in high-risk populations receiving prenatal care should focus on (1) screening patients at the first opportunity, at both the first prenatal visit and during the third trimester (i.e., 28 weeks); (2) performing on-site testing and same-day treatment; (3) providing appropriate treatment to infected women with penicillin allergy; (4) referring sex partners for treatment to prevent reinfection; and (5) screening all pregnant women attending emergency clinics.
尽管近期全国梅毒发病率有所下降，但近期的疫情表明，预防先天性梅毒仍然是一个持续存在的公共卫生问题。
确定产前护理期间先天性梅毒预防的错失机会。
对格雷迪纪念医院（佐治亚州亚特兰大）157例涉及先天性梅毒病例的活产或死产分娩进行回顾性病历审查。
该医院先天性梅毒患病率为每1000例活产8.2例。6%的病例患者为艾滋病毒阳性。在接受及时产前护理的60%的病例患者中，错过了早期母体筛查、治疗或诊断的机会。在产前检查次数较少的病例患者中，可预防的错失机会导致的先天性梅毒病例明显更为常见（66%对28%，P = 0.01）。
医疗服务提供者为减少接受产前护理的高危人群中的先天性梅毒所做的努力应集中在：（1）在第一次产前检查和孕晚期（即28周）的第一个机会对患者进行筛查；（2）进行现场检测和当日治疗；（3）为对青霉素过敏的感染妇女提供适当治疗；（4）转诊性伴侣进行治疗以防止再次感染；（5）对所有前往急诊诊所的孕妇进行筛查。
