Narducci F, Switala I, Rajabally R, Decocq J, Delahousse G
Pavillon Paul-Gellé, Roubaix.
J Gynecol Obstet Biol Reprod (Paris). 1998 Mar;27(2):150-60.
Testing for syphilis during pregnancy reveals a positive serologic status in 0.02% of cases. However, a 66% rate of stillbirths is noted in women who are infected and who have not benefited from any treatment. Routine screening is at present performed during the early stages of pregnancy but a second serologic test during the third trimester is useful in the diagnosis of a late infection especially in drug users or HIV (human immunodeficiency virus) positive patients. Congenital syphilis is diagnosed in utero when a positive maternal serologic status is associated with ultrasound images showing fetal abnormalities; these include hepatosplenomegaly, hyperechogenic bowel, signs of bowel obstruction or fetal hydrops. Maternal syphilis is treated by delayed action penicillin and is indicated even for patients allergic to the antibiotic which in this particular case is delivered after desensitization. First line therapy by intravenous penicillin is indicated when confronted with the following high risk factors of congenital syphilis: an elevated titre of VDRL (venereal disease research laboratory) at the time of diagnosis or delivery, unknown date of the precise onset of the infection, the appearance of a rash or of a chancre during pregnancy, ultrasound fetal abnormalities or late therapy during the third trimester. Treatment of the new-born child will depend on the results of clinical, serologic and X-ray evaluation. Long term follow-up for at least a year is mandatory.
孕期梅毒检测显示，0.02%的病例血清学状态呈阳性。然而，在未接受任何治疗的感染女性中，死产率为66%。目前在妊娠早期进行常规筛查，但在孕晚期进行第二次血清学检测有助于诊断晚期感染，尤其是在吸毒者或艾滋病毒（人类免疫缺陷病毒）阳性患者中。当母亲血清学状态呈阳性且超声图像显示胎儿异常时，可在子宫内诊断先天性梅毒；这些异常包括肝脾肿大、肠回声增强、肠梗阻迹象或胎儿水肿。母亲梅毒采用延迟作用青霉素治疗，即使对该抗生素过敏的患者也需治疗，在这种特殊情况下，需在脱敏后给药。当出现以下先天性梅毒高危因素时，建议采用静脉注射青霉素进行一线治疗：诊断或分娩时性病研究实验室（VDRL）滴度升高、感染确切起始日期不明、孕期出现皮疹或硬下疳、超声显示胎儿异常或孕晚期治疗延迟。新生儿的治疗将取决于临床、血清学和X线评估结果。必须进行至少一年的长期随访。
