Prevention And Treatment Of Syphilis During Pregnancy

The adverse effects of syphilis on children’s health have been known for more than 500 years, but the World Health Organization did not target the elimination of congenital syphilis until 2007.

The proportion of pregnant women with syphilis detected and treated is unknown, but it is estimated that less than 10%. About a third of untreated HIV-infected pregnant women transmit the virus to their babies, but almost all untreated syphilis pregnant women have adverse pregnancy outcomes.

The adverse pregnancy outcomes caused by syphilis include stillbirth, stillbirth or premature delivery, low birth weight and congenital syphilis infection. Therefore, as important as HIV infection, prevention and treatment of syphilis infection in pregnancy need to be paid attention.

Syphilis in Pregnancy

Syphilis is a chronic and systemic sexually transmitted disease caused by Treponema pallidum. Most of them are transmitted through sexual channels. They can be clinically manifested as primary syphilis, secondary syphilis, tertiary syphilis and latent syphilis. Infectious diseases mainly manifest as pudendal erosion, skin rash, muscle and bone pain, skin nucleation and ulceration, and dementia.

Pregnancy syphilis refers to Treponema pallidum (TP) infection found during pregnancy, which can occur before and during pregnancy. Its seriousness not only endangers the health of pregnant women, but also infects the fetus through vertical transmission, causing congenital damage to the fetus.

Treponema pallidum can pass through the placenta at any time of pregnancy, leading to intrauterine infection of the fetus, seriously interfering with pregnancy, causing abortion, stillbirth, fetal edema, intrauterine growth restriction of the fetus, perinatal death, or serious sequelae to infected surviving infants.

After diagnosis of syphilis during pregnancy, is pregnancy continued or terminated?

Detection of syphilis during pregnancy is not a sign of termination of pregnancy. Standard treatment with penicillin within 21 weeks of pregnancy can prevent more than 70% of fetal syphilis, but all pregnant syphilis patients should be informed of the harm of syphilis to the fetus.

Although standardized treatment can cure pregnant women, control premature birth, stillbirth and reduce neonatal fetal syphilis, if the treatment is late, the fetus has been damaged in the maternal body, then the treatment can only prevent its further deterioration, can not fully recover, and any syphilis treatment program may fail, even standardized treatment can not completely eradicate fetal syphilis.

If syphilis is diagnosed after 20 weeks of gestation, fetal ultrasonography should be performed. For those who show signs of syphilis, the risk of failure of fetal treatment is higher.

If the mother suffers from early syphilis, and after pregnancy without treatment or from treatment to delivery time < 30 days, RPR titer (> 1:32), B ultrasound shows signs of fetal syphilis can consider whether to terminate pregnancy.

How to provide treatment for syphilis in pregnancy?

Studies have found that Treponema pallidum can cross the placenta to infect the fetus with umbilical cord blood in the early, middle and late stages of pregnancy, but in the early pregnancy, the immune system of the fetus is not fully developed, the immune receptor of placental trophoblasts is not developed, and syphilis can not be recognized, so there is no inflammatory response to syphilis infection.

Therefore, if pregnant women infected with syphilis in early pregnancy can receive timely, standardized and adequate treatment to remove syphilis, Treponema pallidum can be killed to block its further vertical transmission; after the second trimester of pregnancy, the fetal immune system has identified syphilis, which has caused placental villus damage or fetal organ damage, at this time, the treatment of syphilis has no therapeutic effect on the damage that has occurred.

Therefore, when syphilis is found in the second and third trimesters of pregnancy, pregnant women should treat syphilis in time, and screen for syphilis by amniocentesis, umbilical vein blood extraction or fetal ultrasound.

How to prevent syphilis during pregnancy?

Pregnancy syphilis prevention mainly through prenatal examination and prenatal examination. Dominant syphilis can be diagnosed by history and signs; latent syphilis has no clinical symptoms, but can be diagnosed by serological examination. Latent syphilis is the main cause of syphilis in pregnancy.

Therefore, couples of childbearing age should have syphilis serological examination before planning pregnancy. If syphilis infection is found, pregnancy should be postponed and systematic treatment should be carried out. At the same time, the spouse should be examined and the time of pregnancy should be decided under the guidance of the doctor.

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Written by STDsSTIs

STDsSTIs is here to help people think, discuss and take responsible action on some of life’s biggest decisions – ones that often don’t get enough attention. We help raise the tough questions and ask young people to consider what really makes sense for them. Together, we can help Coloradans lead healthier lives and raise healthier families.