Kaminiów Konrad, Kotlarz Agnieszka, Kiołbasa Martyna, Pastuszczak Maciej
Clinical Department of Dermatology, Medical University of Silesia, Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Poland.
Chair of Gynaecology and Obstetrics, Jagiellonian University Medical College, Mikołaja Kopernika 23, 31-501 Krakow, Poland.
J Clin Med. 2024 Jul 10;13(14):4031. doi: 10.3390/jcm13144031.
Maternal syphilis can lead to serious adverse pregnancy outcomes, including neonatal death. A 4-fold decline in blood non-treponemal titer at six months after the treatment of syphilis compared to the baseline is considered as an adequate serological response. However, the duration of normal human gestation does not allow the ascertainment of an adequate serological response. The aim of this study was to assess correlations between the lack of a 4-fold decrease in non-treponemal titer by delivery after syphilis treatment and fetal and newborns' condition and serological outcomes. Fourteen pregnant patients (gestational age 16-22 weeks) diagnosed with early syphilis (secondary or latent) were treated with intramuscular benzathine penicillin and subsequently monitored clinically, serologically, and ultrasonographically at monthly intervals. Based on the non-treponemal test results at delivery, patients were stratified into two groups: those with a 4-fold decline in titers and those without such a decline. All newborns were clinically and serologically assessed for congenital syphilis at birth and then monitored until serological tests became negative. Fifty percent of the included women did not achieve a 4-fold decline in non-treponemal titer by delivery. Patients from the group showing a 4-fold decline in RPR titer at delivery and those without such a decline did not differ in basic demographic and clinical characteristics or in ultrasound parameters used for fetal assessment. Based on the clinical and laboratory assessments of newborns on the day of delivery and during a 6-month follow-up, none were diagnosed with congenital syphilis or required treatment for syphilis. The lack of an adequate serological response to syphilis therapy by delivery among patients treated between 16 and 22 weeks of pregnancy does not appear to be associated with adverse fetal and neonatal outcomes.
孕产妇梅毒可导致严重的不良妊娠结局，包括新生儿死亡。梅毒治疗后6个月时血液中非梅毒螺旋体滴度相较于基线下降4倍被认为是足够的血清学反应。然而，人类正常妊娠期的时长使得无法确定是否有足够的血清学反应。本研究的目的是评估梅毒治疗后至分娩时非梅毒螺旋体滴度未下降4倍与胎儿及新生儿状况和血清学结局之间的相关性。14例诊断为早期梅毒（二期或潜伏性）的妊娠患者（孕周16 - 22周）接受了苄星青霉素肌内注射治疗，随后每月进行临床、血清学和超声检查监测。根据分娩时非梅毒螺旋体检测结果，患者被分为两组：滴度下降4倍的患者和未下降的患者。所有新生儿在出生时均进行先天性梅毒的临床和血清学评估，然后进行监测直至血清学检测结果转为阴性。纳入的女性中有50%至分娩时非梅毒螺旋体滴度未下降4倍。分娩时RPR滴度下降4倍的组与未下降的组在基本人口统计学和临床特征或用于胎儿评估的超声参数方面并无差异。根据分娩当天及6个月随访期间对新生儿的临床和实验室评估，无一例被诊断为先天性梅毒或需要进行梅毒治疗。妊娠16至22周之间接受治疗的患者至分娩时对梅毒治疗缺乏足够的血清学反应似乎与不良胎儿及新生儿结局无关。
