Dos Santos Fabiana Ferreira, Acosta Lisiane Morelia Weide, da Silva Clécio Homrich
Universidade Federal do Rio Grande do Sul (UFRGS) Departamento de Pediatria Porto Alegre (RS) Brasil Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Pediatria, Porto Alegre (RS), Brasil.
Universidade do Vale do Rio dos Sinos (UNISINOS) Programa de Pós-Graduação em Saúde Coletiva São Leopoldo (RS) Brasil Universidade do Vale do Rio dos Sinos (UNISINOS), Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo (RS), Brasil.
Rev Panam Salud Publica. 2024 Dec 4;48:e133. doi: 10.26633/RPSP.2024.133. eCollection 2024.
To assess the sensitivity and specificity of the modified criteria for case definition of congenital syphilis implemented in 2017, which excluded treatment of the sexual partner as a necessary condition for adequate maternal treatment.
This retrospective cohort study involved epidemiological monitoring of 503 children born in 2018 and living in Porto Alegre, Brazil: 412, including miscarriages and stillbirths, had been reported as congenital syphilis cases; 91, who had been exposed to syphilis during pregnancy, were no longer considered cases after partner treatment was excluded as a criterion for adequate maternal treatment. The study involved observation of treatment at birth, laboratory follow-up with non-treponemal tests up to age 18 months or treponemal tests after age 18 months, and symptom-based screening for cohort closure.
A total of 286 cases and 126 non-cases were identified using the criteria for reportable cases. Among those exposed but who did not meet the criteria for reportable cases, three cases and 88 non-cases were identified < 0.001). Considering the current case definition of congenital syphilis for reporting purposes, the sensitivity was 98.9% (95%CI: 97.0 to 99.7), and the specificity, 41.0% (95%CI: 34.4 to 48.0). The monitoring strategy for case closure had a sensitivity of 69.4% (95%CI: 64.7 to 73.8) and a specificity of 96.7% (95%CI: 90.7 to 99.3).
The current case definition of congenital syphilis case for reporting purposes proved sensitive, but less specific. We suggest that it be reviewed in light of the possibility of missing true-positive diagnoses.
评估2017年实施的先天性梅毒病例定义修改标准的敏感性和特异性，该标准将性伴侣治疗不作为产妇充分治疗的必要条件。
这项回顾性队列研究对2018年出生并居住在巴西阿雷格里港的503名儿童进行了流行病学监测：412例（包括流产和死产）被报告为先天性梅毒病例；91例在孕期接触过梅毒的儿童，在将性伴侣治疗排除在产妇充分治疗标准之外后不再被视为病例。该研究包括观察出生时的治疗情况、对18个月龄以下儿童进行非梅毒螺旋体试验的实验室随访或对18个月龄以上儿童进行梅毒螺旋体试验，以及基于症状的筛查以完成队列研究。
使用报告病例标准共识别出286例病例和126例非病例。在那些接触过梅毒但未达到报告病例标准的儿童中，识别出3例病例和88例非病例（P<0.001）。考虑到目前用于报告目的的先天性梅毒病例定义，敏感性为98.9%（95%CI：97.0至99.7），特异性为41.0%（95%CI：34.4至48.0）。病例完成监测策略的敏感性为69.4%（95%CI：64.7至73.8），特异性为96.7%（95%CI：90.7至99.3）。
目前用于报告目的的先天性梅毒病例定义被证明具有敏感性，但特异性较低。我们建议鉴于可能漏诊真阳性诊断的情况对其进行审查。
