摘要：Early identification and treatment of syphilis infections in pregnancy is crucial to the prevention of transmission of infection from women to their unborn infants. Untreated syphilis infections in pregnant women or acquired infections during pregnancy can result in stillbirth, preterm birth, congenital abnormalities or neonatal disease. Transmission typically occurs transplacentally but can also occur at the time of delivery through contact with vaginal lesions. Although any stage of untreated syphilis infections can result in vertical transmission of infection, the risk of transmission is highest (i.e., 70%-100%) with primary or secondary syphilis infection. (1,2)
Universal prenatal syphilis screening is recommended as one facet in the strategy for the elimination of congenital syphilis, (3) however there is limited literature on maternal characteristics associated with poor compliance with prenatal syphilis testing. Studies have shown that lack or late initiation of prenatal care, (4-8) single marital status, (5) tobacco, alcohol or drug use, (4,5,8) and rural residence (4) are associated with congenital syphilis infections and may represent factors associated with barriers to prenatal screening.
In 2007, a syphilis outbreak was declared in the Canadian province of Alberta. The provincial infectious syphilis rate increased from 0.6/100,000 in 2000 to 6.4/100,000 in 2006 with 28 congenital syphilis cases (stillborn and live births) diagnosed between 2006 and 2011. (9) These perinatal transmissions took place despite a Provincial Prenatal Screening Program, implemented in 2002, whereby all pregnant women seeking prenatal care are tested for syphilis and four other infectious disease markers (hepatitis B, HIV, rubella and varicella) at their first prenatal visit. (10) When the outbreak was declared in 2007, many of the mothers of infants with congenital syphilis had limited or no prenatal care or screening. (6,7) However the mother of at least one congenital syphilis case had tested negative at her first trimester screen but acquired syphilis infection later in pregnancy from a believed-to-be monogamous relationship. (11) In response to the syphilis outbreak and rise in congenital syphilis cases, a prenatal syphilis rescreening program was recommended by Alberta Health and was implemented in the spring of 2009. In addition to first trimester syphilis screening, it was recommended that all pregnant women be rescreened for syphilis at 24-28 weeks gestation to coincide with their glucose tolerance test and again at labour and delivery. (12) The addition of the mid-gestation syphilis screen was to provide another opportunity to identify infection missed by the first trimester screen so that timely treatment could be given during pregnancy to possibly prevent vertical transmission, while rescreening at delivery served to detect new cases acquired in the third trimester to allow for appropriate clinical treatment and follow-up of the mother and infant. (13) Detailed information about the syphilis outbreak and the new rescreening policies were widely circulated to health care personnel who provided prenatal and/or perinatal care in the province, including general practitioners, family physicians, obstetricians and midwives as well as targeting hospitals and health care centres that provide obstetric care in the province.
