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中华产科急救电子杂志 ›› 2020, Vol. 09 ›› Issue (04) : 251 -256. doi: 10.3877/cma.j.issn.2095-3259.2020.04.013

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消除梅毒母婴传播的挑战与对策
肖湛松1, 樊尚荣1,()   
  1. 1. 518036 深圳,北京大学深圳医院妇产科
  • 收稿日期:2020-07-17 出版日期:2020-11-18
  • 通信作者: 樊尚荣

Challenge and Countermeasure of eliminating mother-to-child transmission of syphilis

Zhansong Xiao1, Shangrong Fan1()   

  • Received:2020-07-17 Published:2020-11-18
  • Corresponding author: Shangrong Fan
引用本文:

肖湛松, 樊尚荣. 消除梅毒母婴传播的挑战与对策[J]. 中华产科急救电子杂志, 2020, 09(04): 251-256.

Zhansong Xiao, Shangrong Fan. Challenge and Countermeasure of eliminating mother-to-child transmission of syphilis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2020, 09(04): 251-256.

图1 一期梅毒、二期梅毒及先天性梅毒患儿的特征图[1]。A:硬下疳;B:扁平湿疣;C:掌跖梅毒疹;D:新生儿先天性梅毒
表1 妊娠期梅毒的分期治疗[1]
表2 妊娠合并梅毒孕妇分娩新生儿的处理[27,28,35]
梅毒感染所属阶段及疾病情况 治疗方案
S1:很可能:诊断或高度怀疑先天梅毒的依据为典型的先天梅毒临床症状和体征,从病变部位、胎盘或脐带处找到梅毒螺旋体,RPR滴度≥4倍母血RPR浓度 (1)水剂青霉素,出生7 d内,5万U/kg,1次/12 h,静脉滴注;出生7 d后,5万U/kg,1次/8 h,静脉滴注,连续10~14 d
(2)普鲁卡因青霉素,5万U/kg,1次/d,肌内注射,连续10~14 d
S2:可能:妊娠合并梅毒孕妇分娩婴儿,体检无异常发现,RPR滴度<4倍母血RPR滴度,对婴儿应进行有关梅毒检测和评估,检测和评估指征包括母亲患梅毒而未经治疗或未恰当治疗,分娩前不到1个月时间内开始梅毒治疗,妊娠期应用非青霉素治疗,经治疗后RPR滴度未获预期降低或升高及缺乏充分抗梅毒治疗证据 (1)水剂青霉素,出生7 d内,5万U/kg,1次/12 h,静脉滴注;出生7 d后,5万U/kg,1次/8 h,静脉滴注,连续10~14 d
(2)普鲁卡因青霉素,5万U/kg,1次/d,肌内注射,连续10~14 d
(3)苄星青霉素G,5万U/kg,肌内注射,共1次
S3:较少可能:对妊娠合并梅毒孕妇所分娩婴儿,体检无异常发现,RPR滴度<4倍母血RPR滴度;若母亲已经在分娩前1个月恰当治疗,经治疗后RPR滴度降低超过4倍或晚期潜伏梅毒RPR滴度维持低水平(≤1∶4),孕妇无梅毒复发或再感染证据,无需对婴儿进行有关临床和实验室检测 无需对婴儿治疗或选择以下治疗:苄星青霉素G,5万U/kg,肌内注射,共1次
S4:几乎不可能:对妊娠合并梅毒孕妇所分娩婴儿体检无异常发现,RPR滴度≤4倍母血RPR滴度,若母亲在怀孕前得到恰当治疗;孕期和产时非梅毒螺旋体抗原血清抗体稳定地维持在低水平(RPR≤1∶4),则无需对婴儿进行有关临床和实验室检测 无需对婴儿治疗或选择以下治疗:苄星青霉素G,5万U/kg,肌内注射,共1次
[1]
Fan S, Wang A, Wang L. Elimination of mother-to-child transmission of syphilis: challenge and solution[J]. Maternal-Fetal Med, 2019, 1(2):95-104
[2]
WHO. Report on Global Sexually Transmitted Infection Surveillance, 2018[R/OL].(2018-12-19)[2020-10-22].

URL    
[3]
Korenromp EL, Rowley J, Alonso M, et al. Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012 [J]. PLoS One, 2019, 14(2):e0211720.
[4]
Gomez GB, Kamb ML, Newman LM, et al. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis [J]. Bull World Health Organ. 2013, 91(3):217-226.
[5]
Adhikari Emily H.. Syphilis in Pregnancy[J]. Obstet Gynecol, 2020,135(5):1121-1135.
[6]
樊尚荣,黎婷. 妊娠合并梅毒的诊断和处理专家共识解读 [J]. 中华产科急救电子杂志,2013, 2(2):37-41.
[7]
Qin J, Yang T, Xiao S, et al. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis[J]. PLoS One, 2014, 9(7):e102203.
[8]
WHO. The global elimination of congenital syphilis: rationale and strategy for action[M/OL]. Geneva: WHO Press,2007 [2020-10-22].

URL    
[9]
Tsai S, Sun MY, Kuller JA, et al. Syphilis in Pregnancy[J]. Obstet Gynecol Surv, 2019, 74(9):557-564.
[10]
Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016[J]. Bull World Health Organ, 2019, 97(8):548-562.
[11]
WHO. WHO guidelines for the treatment of Treponema pallidum (syphilis)[M/OL]. Geneva: WHO Press,2016 [2020-10-22].

URL    
[12]
WHO. Investment case for eliminating mother-to-child transmission of syphilis: promoting better maternal and child health and stronger Health systems[M/OL]. Geneva: WHO Press,2012 [2020-10-22].

URL    
[13]
邓宝清,晏瑞琳,黄志明,等. 深圳市宝安区妊娠梅毒患者性伴梅毒感染情况及影响因素分析[J].中国皮肤性病杂志,2019,33(4):442-446.
[14]
邱莉霞,胡瑞娟,许宗严,等. 深圳市福田区2005-2011年妊娠梅毒患者流行病学分析[J]. 实用预防医学,2012,19(8):1215-1217.
[15]
Zhang XH, Xu J, Chen DQ, et al. Effectiveness of treatment to improve pregnancy outcomes among women with syphilis in Zhejiang Province, China[J]. Sex Transm Infect, 2016, 92(7):537-541.
[16]
Zhang X, Yu Y, Yang H, et al. Surveillance of Maternal Syphilis in China: Pregnancy Outcomes and Determinants of Congenital Syphilis [J]. Med Sci Monit, 2018, 24:7727-7735.
[17]
Li HX, Tan JJ, Luo ZW, et al. Standardized treatment and determinants on 9,059 syphilis?infected pregnant women during 2015-2018 in Hunan, China[J]. Sci Rep, 2020, 10(1):12026.
[18]
Dou L, Wang X, Wang F, et al. Epidemic profile of maternal syphilis in China in 2013[J]. Biomed Res Int, 2016:9194805.
[19]
Su JR, Brooks LC, Davis DW, et al. Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013[J]. Am J Obstet Gynecol, 2016, 214(3):381.e1-e9.
[20]
Kidd S, Bowen VB, Torrone EA, et al. Use of national syphilis surveillance data to develop a congenital syphilis prevention cascadeand estimate the number of potential congenital syphilis cases averted[J]. Sex Transm Dis, 2018, 45(9S Suppl 1):S23-S28.
[21]
Trinh T, Leal AF, Mello MB, et al. Syphilis Management in Pregnancy: A Review of Guideline Recommendations From Countries Around the World [J]. Sex Reprod Health Matters. 2019, 27(1):69-82.
[22]
Cavalcante PAM, Pereira RBL, Castro JGD. Syphilis in pregnancy and congenital syphilis in Palmas, Tocantins State, Brazil, 2007-2014 [J]. Epidemiol Serv Saude, 2017, 26(2):255-264.
[23]
Enkhbat E, Korenromp EL, Badrakh J, et al. Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000-2016: Estimates using the Spectrum STI tool [J]. Infect Dis Model, 2018, 3:13-22.
[24]
Silva Neto SED, Silva SSBED, Sartori AMC. Syphilis in pregnancy, congenital syphilis, and factors associated with mother-to-child transmission in Itapeva, S?o Paulo, 2010 to 2014[J]. Rev Soc Bras Med Trop, 2018, 51(6):819-826.
[25]
Kuznik A, Habib AG, Manabe YC, et al. Estimating the public health burden associated with adverse pregnancy outcomes resulting from syphilis infection across 43 countries in Sub-Saharan Africa[J]. Sex Transm Dis, 2015, 42(7):369-375.
[26]
WHO. WHO Guideline on Syphilis Screening and Treatment for Pregnant Women [M/OL]. Geneva: WHO Press,2017 [2020-10-22].

URL    
[27]
樊尚荣;中华医学会妇产科学分会感染性疾病协作组.妊娠合并梅毒诊断和治疗专家共识[J]. 中华妇产科杂志,2012,39(6):430-431.
[28]
Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015[J]. MMWR Recomm Rep,2015, 64(RR-03):1-137.
[29]
Clement ME, Okeke NL, Hicks CB, et al. Treatment of syphilis: a systematic review[J]. JAMA, 2014, 312(18):1905-1917.
[30]
Hong FC, Wu XB, Yang F, et al. Risk of congenital syphilis (CS) following treatment of maternal syphilis: results of a CS control program in China[J]. Clin Infect Dis, 2017, 65(4):588-594.
[31]
Liu H, Chen N, Yu J, et al. Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment[J]. BMC Infect Dis, 2019, 19(1):292.
[32]
Rac MW, Bryant SN, McIntire DD, et al. Progression of ultrasound findings of fetal syphilis after maternal treatment[J]. Am J Obstet Gynecol, 2014, 211(4):426.e1-e6.
[33]
Wu Z, Zhou P. Syphilis and social upheaval in China[J]. N Engl J Med, 2010, 363(11):1088.
[34]
Ye X, Tang SK, Dai X, et al. Over reporting of congenital syphilis in Guangzhou, China[J]. Sex Health, 2015, 12(2):174-175.
[35]
Janier M, Hegyi V, Dupin N, et al. 2014 European guideline on the management of syphilis[J]. J Eur Acad Dermatol Venereol, 2014, 28(12): 1581-1593.
[36]
Torres RG, Mendon?a ALN, Montes GC, et al. Syphilis in pregnancy: the reality in a public hospital[J]. Rev Bras Ginecol Obstet, 2019, 41(2):90-96.
[37]
Gliddon HD, Peeling RW, Kamb ML, et al. A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis[J]. Sex Transm Infect, 2017, 93(S4):S3-S15.
[38]
WHO. Global Guidance on Criteria and Processes for Validation: Elimination of Mother-to-child Transmission (EMTCT) of HIV and Syphilis[M/OL]. Geneva: WHO Press,2014 [2020-10-22].

URL    
[39]
WHO. Global guidance on criteria and processes for validation: elimination of Mother-to-child Transmission of HIV and Syphilis, 2nd edition[M/OL]. Geneva: WHO Press,2017 [2020-10-22].

URL    
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