What is syphilis and by what means is it transmitted? Syphilis is a chronic systemic infection caused by the syphilis spirochete, which is transmitted mainly through sexual contact. Pregnant women can transmit the syphilis spirochete to their fetus through the placenta, resulting in congenital syphilis in the fetus. How to interpret the serological test results of syphilis? 1. RPR+, TPPA-: false positive RPR, syphilis infection is not considered; 2. RPR+, TPPA+: present syphilis, partly late syphilis; 3. RPR-, TPPA+: very early syphilis, or previous syphilis infection, or early syphilis after treatment, or partly late syphilis; 4. RPR-, TPPA-: syphilis infection is basically ruled out, or it may be very early syphilis (just contacted with syphilis spirochetes, the body has not yet had time to produce antibodies), or very late syphilis, or HIV/AIDS patients with co-infection with syphilis. What is the effect of syphilis on the fetus? Syphilis spirochetes can infect the fetus through the placenta, causing miscarriage, stillbirth, premature birth, severe malformations or congenital syphilis in the fetus. Syphilis spirochetes can be transmitted through the placenta at any stage of pregnancy; the higher the syphilis serum titer of a pregnant woman, the higher the incidence of stillbirth or stillbirth. Those who have been ill for more than 2 years and have not been treated can still transmit the infection to the fetus, although they are no longer capable of sexual transmission, but the longer the illness lasts, the less infectious it becomes. Even if a child with congenital syphilis survives, the disease is more severe. The early stage of congenital syphilis is characterized by skin blisters, rash, rhinitis and nasal congestion, enlarged liver and spleen, and enlarged lymph nodes; the late stage of syphilis appears mostly after 2 years of age and is characterized by cuneiform teeth, interstitial keratitis, osteochondritis, and neurological deafness, etc. The death and disability rates are significantly higher. Some fetuses, although developing normally, may still be infected by contact with genital lesions while passing through the birth canal. It is an acquired obstetric transmission, and newborns often develop a hard chancre on the head or shoulder abrasion. Mothers with early syphilis have higher rates of miscarriage, stillbirth, fetal congenital syphilis, or neonatal mortality than mothers with advanced syphilis. Therefore, syphilis in pregnant women is very harmful to the fetus and must be given high priority. Can a person with syphilis get pregnant? Patients with syphilis who have received regular treatment and follow-up are not at risk to the fetus and can become pregnant. However, if there is any doubt about the last treatment and follow-up or if there are signs of syphilis activity during the current prenatal check-up, it is safe to undergo further treatment for syphilis. How is syphilis screening and treatment during pregnancy performed? All pregnant women should be screened for syphilis serology at their first prenatal visit. Due to the change in sexual attitudes, the incidence of syphilis has increased in coastal areas of China. For pregnant women in areas with a high incidence of syphilis or at high risk, re-screening is recommended in late pregnancy and at delivery. The principles of treatment are as follows: 1. regular and adequate treatment – irregular treatment can increase recurrence and contribute to early onset of late damage; 2. adequate follow-up after treatment; 3. timely treatment and early treatment. If syphilis is diagnosed, apply a course of antisepsis treatment in the first 3 months of pregnancy; apply a course of antisepsis treatment in the last 3 months of pregnancy, and for syphilis found after 3 months of pregnancy, strive to complete 2 courses of antisepsis treatment with an interval of 2 weeks. Treatment early in pregnancy has the potential to prevent the fetus from being infected, and if missed, remedial treatment in the middle and late stages of pregnancy can also cure the already infected fetus before birth. Penicillin, procaine penicillin or benzathine penicillin are preferred for antimelanotic treatment, and desensitization and post-desensitization penicillin therapy should be preferred for penicillin allergy. Erythromycin and azithromycin have poor efficacy and are not recommended. Pregnant women need to be followed up once a month after treatment. Syphilis patients who are already receiving regular treatment and follow-up at the time of pregnancy do not require further treatment. A word of caution: all sexual partners of syphilis-infected pregnant women should be tested for syphilis serology and treated for syphilis. Do I need to be hospitalized for syphilis treatment during pregnancy? Half of pregnant women with syphilis who are treated for syphilis have the following manifestations: fever, malaise, headache, chills, tachycardia, mild hypotension, and temporary worsening of existing damage. It can lead to intrauterine distress and preterm delivery. Contractions, decreased fetal movement and temporary late fetal heart rate decelerations may also occur, and in severe cases, they may even be life-threatening. Therefore, the patient should be hospitalized for treatment and observation, which usually requires only 1-2 days of hospitalization, and most patients can be discharged on the same day. How is the newborn treated? Can I breastfeed? For children born with congenital syphilis, they should be treated with penicillin as early as possible. Syphilis spirochetes can be transmitted to the child through breast milk. Only patients who are tested negative for RPR before delivery and whose titer of TPPA is gradually decreasing can breastfeed after delivery. How to follow up after delivery? The postpartum period should be followed up for 2-3 years, once every 3 months in the first year and once every 6 months thereafter, requiring blood tests and physical examinations.