Hospital Base de Valdivia, Valdivia, Chile.
Facultad de Medicina, Campus Isla Teja, Universidad Austral de Chile, Valdivia, Chile.
Rev Med Chil. 2021 Mar;149(3):348-356. doi: 10.4067/s0034-98872021000300348.
National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating.
To explore syphilis rates among PW in a southern Chilean region and to describe clinical features of mothers and offspring.
We selected PW with positive VDRL or T. pallidum micro-he-magglutination (MHA-TP) reactive tests, referred to a high-risk obstetrical pathology center between 2011 and 2019. Clinical information of mothers and their offspring was obtained from their medical records.
Syphilis rates among PW increased from 0.4 to 7.2 per 1,000 live births in the reference center from 2013 to 2019, along with a national and regional increase in both sexes. Twenty-nine cases of PW with syphilis were identified with a median age of 28 years (interquartile range 23-32). Seventeen percent had a history of drug abuse, and 14% had previous sexually transmitted diseases. In seven cases (24%), the diagnosis occurred at delivery. Three percent of patients had a primary syphilis, 14% a secondary syphilis, 24% an early latent syphilis, and 59% a latent syphilis. All cases except one case were treated with benzathine penicillin G and the remaining with erythromycin due to allergy suspicion. Penicillin desensitization was required in two cases (7%). Treatment timing was inadequate in 10 cases (34.5%). Of 19 patients with available serological follow-up, 10 (53%) showed a significant decrease in VDRL titers (≥ 2 dilutions) and two cases had re-infection. Two patients (7%) had an abortion, two had congenital syphilis (7%), and six had premature births (21%), totaling 35% of adverse-pregnancy outcomes.
Resurgence of syphilis among pregnant women is happening in southern Chile and is associated to adverse-pregnancy outcomes.
近年来，智利全国的艾滋病毒、淋病和梅毒发病率有所上升，但尚不清楚孕妇（PW）中的梅毒是否也在上升。
探讨智利南部某地区孕妇梅毒发病率，并描述母婴临床特征。
我们选择了 2011 年至 2019 年期间在高危产科病理学中心就诊的 VDRL 或梅毒螺旋体微量血凝试验（MHA-TP）阳性的 PW 患者。从她们的病历中获取母亲及其子女的临床信息。
从 2013 年到 2019 年，参考中心 PW 的梅毒发病率从每 1000 例活产 0.4 例上升到 7.2 例，同时全国和地区的发病率在男女性别中均有所上升。共发现 29 例 PW 梅毒病例，中位年龄为 28 岁（四分位距 23-32 岁）。17%有吸毒史，14%有既往性传播疾病。7 例（24%）在分娩时诊断。3%的患者为一期梅毒，14%为二期梅毒，24%为早期潜伏梅毒，59%为潜伏梅毒。除 1 例外，所有患者均接受了苄星青霉素 G 治疗，其余因疑似过敏而接受了红霉素治疗。2 例（7%）需要青霉素脱敏。10 例（34.5%）治疗时机不当。19 例有随访血清学结果的患者中，10 例（53%）VDRL 滴度显著下降（≥2 稀释度），2 例再感染。2 例（7%）流产，2 例先天性梅毒（7%），6 例早产（21%），不良妊娠结局共计 35%。
智利南部孕妇梅毒的死灰复燃与不良妊娠结局有关。
