Klass P E, Brown E R, Pelton S I
Department of Pediatrics, Boston University School of Medicine, MA.
Pediatrics. 1994 Jul;94(1):24-8.
To examine the incidence and epidemiologic correlates of congenital syphilis at an inner-city Boston hospital, and draw comparisons with the situation at the same hospital 40 years ago.
Chart review and comparison with data collected in 1951.
Maternity and pediatric services at Boston City Hospital.
A study conducted in 1951 on the maternity service of Boston City Hospital in which demographic data were collected on all women admitted in labor over a 5-month period was replicated. Serologic testing for syphilis was carried out on these women, and the demographic and medical correlates of positive maternal syphilis serology were examined. This study was repeated exactly 40 years later, using the cord blood screening for syphilis done routinely at delivery and a review of prenatal records.
From a group made up largely of married white women in 1951, the study population shifted in 1991 to a group made up mostly of minority women, with 75% unmarried. In 1951, 24 patients were diagnosed with syphilis either before or during the pregnancy, giving a prevalence rate of 2.4%. In 1991, 25 of 647 women were diagnosed with syphilis, for a prevalence rate of 3.9%. The women with positive cord blood serologies had a higher rate of other sexually transmitted diseases and substance abuse. No symptomatic cases of congenital syphilis were seen in 1951 or in 1991, although at least 11 of the 26 infants born to mothers with positive serologies in 1991 received intravenous penicillin therapy.
The continued prevalence of diagnosed syphilis in women at delivery reflects an inner-city epidemic of congenital syphilis that is tied to substance abuse, human immunodeficiency virus, and changing social patterns, as well to older problems of serologic screening, prenatal care, treatment failures, and maternal reinfection. It is essential that screening programs be maintained and improved in this high-risk population, and that infants born to mothers with positive serologies receive full and adequate treatment if there is any doubt at all about their infection status.
调查波士顿市中心一家医院先天性梅毒的发病率及其流行病学相关因素，并与40年前该医院的情况进行比较。
病历回顾并与1951年收集的数据进行比较。
波士顿市医院的妇产科和儿科服务部门。
重复1951年在波士顿市医院妇产科进行的一项研究，该研究收集了5个月内所有分娩入院妇女的人口统计学数据。对这些妇女进行梅毒血清学检测，并检查母亲梅毒血清学阳性的人口统计学和医学相关因素。40年后，使用分娩时常规进行的脐带血梅毒筛查和产前记录回顾，精确重复了这项研究。
1951年的研究人群主要由已婚白人女性组成，到1991年转变为主要由少数族裔女性组成的群体，其中75%为未婚。1951年，有24名患者在怀孕前或怀孕期间被诊断出患有梅毒，患病率为2.4%。1991年，647名妇女中有25名被诊断出患有梅毒，患病率为3.9%。脐带血血清学阳性的妇女患有其他性传播疾病和药物滥用的比例更高。1951年和1991年均未发现先天性梅毒的症状性病例，尽管1991年26名血清学阳性母亲所生的婴儿中至少有11名接受了静脉注射青霉素治疗。
分娩时确诊梅毒在女性中的持续流行反映了市中心先天性梅毒的流行，这与药物滥用、人类免疫缺陷病毒以及不断变化的社会模式有关，也与血清学筛查、产前护理、治疗失败和母亲再次感染等较老的问题有关。在这一高危人群中维持和改进筛查项目至关重要，如果对感染状况有任何疑问，血清学阳性母亲所生的婴儿应接受充分和适当的治疗。
