哥伦比亚太平洋沿岸地区的妊娠和先天性梅毒流行。

From the *Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia; †Hospital Departamental de Buenaventura, Buenaventura, Colombia; ‡Secretaría de Salud Departamental del Valle, Cali, Colombia; and §Departments of Pediatrics and Immunology, University of Connecticut Health Center, Farmington, CT; ¶Division of Infectious Diseases, Connecticut Children's Medical Center, Hartford, CT.

Sex Transm Dis. 2013 Oct;40(10):813-8. doi: 10.1097/OLQ.0000000000000020.

BACKGROUND

Congenital syphilis (CS) is a major global public health problem. Buenaventura, a socioeconomically deprived municipality in the Colombian Pacific Coast, accounts for 6.6% of all CS cases in Colombia. To begin to understand the main reasons for the high rates of the disease in Buenaventura, we conducted a retrospective electronic health record analysis of all infants admitted with CS during the first 7 months of 2011 to the Hospital Departamental de Buenaventura, the city's main birthing hospital.

METHODS

The diagnosis of gestational syphilis and CS was based on a predefined Colombian public health service algorithm. Clinical, laboratory, and sociodemographic parameters for all infants studied, including maternal access to prenatal care, syphilis serologic diagnosis, and adequacy of penicillin treatment, were abstracted and analyzed.

RESULTS

A total of 89 infants met the case definition for CS. Most mothers (80%) were affiliated with government-regulated or private health care insurance plans. While 64 (70%) of 92 attended at least 1 antenatal care visit and 59 of these 64 (84%) were screened for syphilis, only 5 (8%) of 59 received appropriate antibiotic therapy. Although most infants were asymptomatic at birth, prematurity (15/82) was common. Two infants died in the neonatal period, and 5 pregnancies ended in stillbirth.

CONCLUSIONS

Our findings confirm that Buenaventura has a very high incidence of CS and demonstrate that existing antenatal care gestational syphilis programs are flawed. Prevention strategies should emphasize enhanced early syphilis screening in pregnancy, preferably through the implementation of point-of-care testing in the community and same-day treatment with at least 1 dose of penicillin.

背景

先天性梅毒（CS）是一个重大的全球公共卫生问题。布埃纳文图拉，一个位于哥伦比亚太平洋沿岸的社会经济贫困市镇，占哥伦比亚所有 CS 病例的 6.6%。为了开始了解布埃纳文图拉高发病率的主要原因，我们对 2011 年 7 月前该市主要分娩医院——布埃纳文图拉地区医院收治的所有 CS 婴儿进行了回顾性电子病历分析。

方法

根据预先设定的哥伦比亚公共卫生服务算法，对妊娠梅毒和 CS 的诊断进行了评估。对所有研究婴儿的临床、实验室和社会人口统计学参数进行了提取和分析，包括产妇获得产前保健、梅毒血清学诊断以及青霉素治疗的充分性。

结果

共有 89 名婴儿符合 CS 的病例定义。大多数母亲（80%）参加了政府监管或私人医疗保险计划。尽管 92 名婴儿中有 64 名（70%）至少接受了 1 次产前检查，其中 64 名中的 59 名（84%）接受了梅毒筛查，但只有 59 名中的 5 名（8%）接受了适当的抗生素治疗。尽管大多数婴儿出生时无症状，但早产（15/82）很常见。有 2 名婴儿在新生儿期死亡，5 例妊娠以死胎告终。