Rosenthal Margot, Poliquin Vanessa
Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.
Can Commun Dis Rep. 2022 Feb 24;48(2-3):111-114. doi: 10.14745/ccdr.v48i23a09.
The incidence of syphilis among Canadian women of childbearing age has risen dramatically in the past decade, with a resurgence of infants born with congenital syphilis. While guidelines exist to guide maternal infection during pregnancy, there is little evidence available to guide management in situations where the developing fetus is found to be severely affected.
Our patient presented in the second trimester of her pregnancy as syphilis contact. Positive serologic tests (venereal disease research laboratory titre of 1:64) and a chancre suggested primary infection. Ultrasound demonstrated a fetus at 19+3 weeks gestation with hydrops fetalis and a markedly abnormal brain. Amniocentesis confirmed congenital syphilis infection on polymerase chain reaction testing. After nine days of intravenous penicillin G, the fetal status had worsened, and the family ultimately chose a medical termination of the pregnancy.
Evolving ultrasound technology has allowed us to identify severely affected fetuses, who may historically have been delivered stillborn. Following routine syphiliotherapy with benzathine penicillin, these abnormal ultrasound features may take weeks or months to reverse, which poses a challenge in prognostication and counselling. Case reports data suggests intensive treatment with intravenous penicillin may be effective in severe cases where fetal hydrops is present.
This case highlights the potential morbidity of fetal syphilis infection and underscores the paucity of current literature. Information sharing will be essential to build a modern knowledge base on treating this ancient disease.
在过去十年中，加拿大育龄妇女梅毒发病率急剧上升，先天性梅毒患儿数量再度出现增长。虽然有指南指导孕期母体感染的处理，但对于已发现发育中的胎儿受到严重影响的情况，几乎没有可用的证据来指导管理。
我们的患者在妊娠中期作为梅毒接触者前来就诊。血清学检测呈阳性（性病研究实验室滴度为1:64）且出现硬下疳提示为原发性感染。超声检查显示一名妊娠19 + 3周的胎儿患有胎儿水肿且脑部明显异常。羊水穿刺经聚合酶链反应检测确诊为先天性梅毒感染。静脉注射青霉素G九天后，胎儿状况恶化，家属最终选择了人工终止妊娠。
不断发展的超声技术使我们能够识别出严重受影响的胎儿，而这些胎儿在过去可能会胎死腹中。在使用苄星青霉素进行常规梅毒治疗后，这些异常的超声特征可能需要数周或数月才能恢复正常，这在预后评估和咨询方面构成了挑战。病例报告数据表明，对于存在胎儿水肿的严重病例，静脉注射青霉素强化治疗可能有效。
本病例突出了胎儿梅毒感染的潜在发病率，并强调了当前文献的匮乏。信息共享对于建立关于治疗这种古老疾病的现代知识库至关重要。
