University of Rochester Medical Center, Department of Obstetrics and Gynecology, Rochester, NY.
Curr Opin Obstet Gynecol. 2021 Apr 1;33(2):78-85. doi: 10.1097/GCO.0000000000000683.
Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology of T. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options.
A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely.
Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.
在美国和全球范围内，母体和先天性梅毒感染呈上升趋势。如果没有充分的检测或医生对感染的识别，治疗可能会被忽视，从而导致严重的围产期发病率和死亡率。本文综述了苍白密螺旋体的流行病学，描述了新的诊断检测方法，并考虑了扩大治疗选择的必要性。
一种新的化学发光免疫分析方法可用于反向序列算法，在孕妇中的敏感性和特异性比以前报道的更高，有助于识别新生儿先天性梅毒风险最高的孕妇。即时检测可用于检测早期梅毒，并提供当天的检测和治疗。口服头孢克肟治疗梅毒的随机对照试验为在孕妇中潜在应用铺平了道路。在怀孕期间进行青霉素皮肤试验、挑战和脱敏是安全的。
先天性梅毒在现代世界是一种可预防的疾病和可治疗的感染，但我们在消灭它方面仍然面临挑战。我们应该推进有效的实验室检测，扩大医疗治疗，并实施公共卫生措施，以遏制该疾病的上升。
