Division of Infectious Diseases, University of Alberta, Edmonton, Alberta;
Saskatchewan Disease Control Laboratory, Regina, Saskatchewan;
Can J Infect Dis Med Microbiol. 2015 Jan-Feb;26 Suppl A(Suppl A):23A-8A. doi: 10.1155/2015/589085.
Despite universal access to screening for syphilis in all pregnant women in Canada, cases of congenital syphilis have been reported in recent years in areas experiencing a resurgence of infectious syphilis in heterosexual partnerships. Antenatal screening in the first trimester continues to be important and should be repeated at 28 to 32 weeks and again at delivery in women at high risk of acquiring syphilis. The diagnosis of congenital syphilis is complex and is based on a combination of maternal history and clinical and laboratory criteria in both mother and infant. Serologic tests for syphilis remain important in the diagnosis of congenital syphilis and are complicated by the passive transfer of maternal antibodies which can affect the interpretation of reactive serologic tests in the infant. All infants born to mothers with reactive syphilis tests should have nontreponemal tests (NTT) and treponemal tests (TT) performed in parallel with the mother's tests. A fourfold or higher titre in the NTT in the infant at delivery is strongly suggestive of congenital infection but the absence of a fourfold or greater NTT titre does not exclude congenital infection. IgM tests for syphilis are not currently available in Canada and are not recommended due to poor performance. Other evaluation in the newborn infant may include long bone radiographs and cerebrospinal fluid tests but all suspect cases should be managed in conjunction with sexually transmitted infection and/or pediatric experts.
尽管在加拿大所有孕妇中都普遍可以进行梅毒筛查，但近年来在异性恋伴侣中感染性梅毒重新出现的地区，仍有先天性梅毒病例报告。在妊娠早期进行产前筛查仍然很重要，应在 28 至 32 周时再次进行筛查，并在有感染梅毒高风险的女性分娩时再次进行筛查。先天性梅毒的诊断较为复杂，需要结合母亲的病史和母亲及婴儿的临床及实验室标准来综合判断。梅毒血清学检测在先天性梅毒的诊断中仍然很重要，但由于母体抗体的被动转移，这会影响婴儿中反应性血清学检测的解读，因此检测较为复杂。所有母亲梅毒检测呈反应性的婴儿都应与母亲的检测同时平行进行非梅毒螺旋体检测（NTT）和梅毒螺旋体检测（TT）。婴儿在出生时 NTT 的滴度呈四倍或更高提示先天性感染，但 NTT 滴度未呈四倍或更高并不排除先天性感染。目前加拿大尚无梅毒 IgM 检测，且不建议使用，因为其性能不佳。新生儿的其他评估可能包括长骨 X 光片和脑脊液检查，但所有疑似病例都应与性传播感染和/或儿科专家一起进行管理。
