Jones Hugh, Taylor Darlene, Montgomery Carolyn A, Patrick David H, Money Deborah, Vipond Joseph C F, Morshed Muhammad G, Ruissard Douglas A, Rekart Michael L
BC Centre for Disease Control, Vancouver, British Columbia, Canada.
J Obstet Gynaecol Can. 2005 May;27(5):467-72. doi: 10.1016/s1701-2163(16)30529-1.
To describe the incidence of maternal syphilis and the corresponding rate of infection in exposed neonates in British Columbia before and after a serious outbreak of infectious syphilis in the heterosexual population.
We conducted a retrospective chart review of pregnant women with positive syphilis serology and reported cases of congenital syphilis in British Columbia from 1994 to 2003. Clinical charts were reviewed for demographic information, staging of maternal syphilis, and stage of pregnancy when treatment was received. The primary outcome measure was the number of cases of congenital syphilis. We conducted a 2-sided z-test and Fisher's exact test to determine differences in the proportion of infectious syphilis in mothers and the number of cases of congenital syphilis before and during the major outbreak.
In 389 478 live births in British Columbia between 1994 and 2003, 77% of mothers had prenatal syphilis serology. A diagnosis of syphilis was made in 183 mothers, resulting in 5 cases of congenital syphilis. Four of these were in infants whose mothers did not undergo prenatal syphilis testing. The proportion of pregnant women with infectious syphilis was significantly higher after the onset of a major outbreak of syphilis in the community than it was before (P = 0.001), but there was no significant difference in the number of cases of congenital syphilis (3 before and 2 after the outbreak, P = 0.36).
Although syphilis rates in British Columbia during the study period rose steadily, the prevalence of congenital syphilis remained low. Our findings suggest that, in the context of a major outbreak, universal screening and prenatal syphilis testing may contribute to controlling rates of congenital syphilis.
描述不列颠哥伦比亚省异性恋人群中发生严重传染性梅毒疫情前后孕产妇梅毒的发病率以及暴露新生儿的相应感染率。
我们对1994年至2003年不列颠哥伦比亚省梅毒血清学检测呈阳性的孕妇以及先天性梅毒报告病例进行了回顾性病历审查。审查临床病历以获取人口统计学信息、孕产妇梅毒分期以及接受治疗时的妊娠阶段。主要结局指标是先天性梅毒病例数。我们进行了双侧z检验和费舍尔精确检验，以确定疫情爆发前和爆发期间母亲中传染性梅毒比例以及先天性梅毒病例数的差异。
在1994年至2003年不列颠哥伦比亚省的389478例活产中，77%的母亲进行了产前梅毒血清学检测。183名母亲被诊断为梅毒，导致5例先天性梅毒病例。其中4例发生在母亲未进行产前梅毒检测的婴儿中。社区梅毒大爆发后，患有传染性梅毒的孕妇比例显著高于爆发前（P = 0.001），但先天性梅毒病例数没有显著差异（爆发前3例，爆发后2例，P = 0.36）。
尽管研究期间不列颠哥伦比亚省的梅毒发病率稳步上升，但先天性梅毒的患病率仍然较低。我们的研究结果表明，在大规模疫情爆发的背景下，普遍筛查和产前梅毒检测可能有助于控制先天性梅毒的发病率。
