Larkin J A, Lit L, Toney J, Haley J A
Division of Infectious Disease at the University of South Florida College of Medicine in Tampa, Fla, USA.
Medscape Womens Health. 1998 Jan;3(1):5.
The number of primary and secondary syphilis cases in young women rose dramatically in the late 1980s and early 1990s, due to illicit drug use and the exchange of drugs for sex. Of infants born to mothers with primary or secondary syphilis, up to 50% will be premature, stillborn, or die in the neonatal period; further, most of these children are born with congenital disease that may not be apparent for years. While appropriate treatment of the pregnant female can prevent congenital syphilis, the major deterrent has been the inability to effectively identify these women and get them to undergo treatment. In determining a penicillin regimen, the clinician must consider the stage of maternal infection, the length of fetal exposure, and physiologic changes in pregnancy that can affect the pharmacokinetics of antibiotics. Treatment decisions may be further complicated in patients who are allergic to penicillin or infected with HIV. The pathogenesis of congenital syphilis is not completely understood, but placental invasion is the presumed major route. All women should be screened for syphilis with a nontreponemal test (eg, rapid plasma reagin [RPR] or venereal disease research laboratory [VDRL] test) in the first trimester. Those at high risk should be retested at 28 weeks and near delivery. Even with appropriate treatment of syphilis during pregnancy, fetal infection may still occur in up to 14% of cases. Treating syphilis during pregnancy can be difficult due to physiologic changes that can alter drug levels and the risk that drugs will induce uterine contractions or compromise the health of the fetus. While there are added risks and potential complications, treatment regimens parallel those in nonpregnant women.
20世纪80年代末和90年代初，年轻女性的一期和二期梅毒病例数急剧上升，原因是非法药物使用以及以性换毒。患有一期或二期梅毒的母亲所生的婴儿中，高达50%会早产、死产或在新生儿期死亡；此外，这些儿童中的大多数出生时患有先天性疾病，这些疾病可能在数年内都不明显。虽然对怀孕女性进行适当治疗可以预防先天性梅毒，但主要障碍一直是无法有效识别这些女性并促使她们接受治疗。在确定青霉素治疗方案时，临床医生必须考虑母亲感染的阶段、胎儿接触的时长以及孕期可能影响抗生素药代动力学的生理变化。对于对青霉素过敏或感染了HIV的患者，治疗决策可能会更加复杂。先天性梅毒的发病机制尚未完全明了，但胎盘侵袭被认为是主要途径。所有女性在孕早期都应通过非梅毒螺旋体试验（如快速血浆反应素[RPR]或性病研究实验室[VDRL]试验）进行梅毒筛查。高危人群应在孕28周和临近分娩时再次检测。即使孕期梅毒得到了适当治疗，仍有高达14%的病例可能发生胎儿感染。由于生理变化会改变药物水平，以及药物可能诱发子宫收缩或危及胎儿健康，孕期治疗梅毒可能会很困难。虽然存在额外风险和潜在并发症，但治疗方案与非怀孕女性的方案相似。
