I. Syphilis in pregnancy
The diagnosis and treatment of syphilis in all pregnant women should be carried out in accordance with the “latest Ministry of Health-issued STD treatment norms and recommended programs for the treatment of STDs” in 2000. In the specific clinical work should pay attention to the following issues.
1. All normal pregnant women should be screened for syphilis serology at the first antenatal checkup, 28-32 weeks of gestation and once each before delivery.
If a pregnant woman is serologically positive for syphilis and syphilis cannot be ruled out, she should undergo anti-syphilis treatment again in order to protect the fetus, even though anti-syphilis treatment has been performed in the past.
3. If a pregnant woman with syphilis has received regular treatment and follow-up during pregnancy, no further treatment is necessary.
4.If there is any doubt about the last treatment and follow-up or if the current examination reveals signs of syphilis activity, she should receive another course of treatment.
5.Treat with the appropriate penicillin regimen according to the different stages of syphilis in pregnancy. Early syphilis (stage I syphilis, stage II syphilis and early latent syphilis) and late syphilis (except cardiovascular syphilis and neurosyphilis) are given benzathine penicillin 2.4 million U, intramuscular injection, once/week, 4 times. For those who are allergic to penicillin, erythromycin is used for treatment (the infant born should be treated with penicillin supplementation). If necessary, increase the course of treatment. The use of strongylin or tetracycline is contraindicated.
6. A course of treatment is required for the first trimester and the last trimester of pregnancy. Pregnant women with syphilis need to check the non-spirochete serum quantitative test once a month until delivery in order to observe the changes of the disease in time.
7.Gi-hai reaction during the treatment of pregnant women can lead to intrauterine distress and premature delivery. Treatment should not be stopped due to the appearance of GI-Hai reaction (full communication with the patient should be made).
Neonatal syphilis
The diagnosis and treatment of neonatal syphilis should be carried out in accordance with the “Latest STD Treatment Standards and Recommended Program for STD Treatment” issued by the Ministry of Health in 2000. In the specific clinical work should pay attention to the following issues.
1, all babies born of pregnant women with syphilis should undergo serological examination for syphilis. At present, the serological examination of syphilis (RPR and TPPA) carried out in our hospital cannot be used as the basis for confirming the diagnosis of syphilis in newborns. The need for further testing and treatment of newborns with positive syphilis serology should take into full consideration the following circumstances.
1) Whether the mother’s syphilis is confirmed;
2) Treatment of the mother’s syphilis;
3) The clinical, laboratory and imaging manifestations of syphilis in the newborn;
4) The difference in the titer of the non-spirochete serum test between the mother and the infant in the same laboratory.
2, syphilis serology positive newborns should undergo cerebrospinal fluid (CSF) examination. If the cerebrospinal fluid examination cannot be performed, the baby should be treated according to the abnormal cerebrospinal fluid.
3, diagnosis or high suspicion of neonatal syphilis based on: mother syphilis confirmed; clinical signs and symptoms of congenital syphilis; newborn blood non-syphilis spirochete antibody titer more than 4 times higher than the mother’s blood.
The following items should be checked: CSF test; routine blood test. Other tests can be done according to clinical needs, such as long bone X-ray, X-ray chest X-ray, liver function test, cranial ultrasound, fundus examination, brainstem visual response examination, etc.
Treatment options.
1).Aqueous penicillin: Within 7 days of birth, 50,000 U/Kg, intravenous drip, 1 time/12h. After 7 days of birth, 50,000 U/Kg, intravenous drip, 1 time/8h, for 10-14 days.
2) If the treatment is interrupted for 1 day, the whole treatment process should be restarted.
4. Indications for syphilis testing and evaluation of newborns when there are no abnormal findings on physical examination and blood non-syphilis spirochete antibody titers ≤ 4 times the maternal blood antibody titer or the same as the mother: (1), the mother has untreated syphilis or is not formally treated; (2), less than 4 weeks of prenatal syphilis treatment; (3), application of non-penicillin therapy treatment during pregnancy.
The following items should be examined: (1) CSF examination; (2) routine blood tests; (3) X-ray examination of long bones.
Newborns diagnosed by examination or highly suspected of congenital syphilis need the following treatment: for abnormal CSF, aqueous penicillin, within 7 days of birth, 50,000 U/Kg, intravenous drip, 1 time/12h. after 7 days of birth, 50,000 U/Kg, intravenous drip, 1 time/8h, for 10 days. for normal CSF, benzathine penicillin 50,000 U/Kg, single intramuscular injection.
If the mother has been properly treated 4 weeks before delivery and there is no evidence of syphilis recurrence or reinfection. Consult the newborn’s family for relevant clinical and laboratory tests (CSF test, routine blood tests). The following treatment may be chosen: benzathine penicillin 50,000 U/Kg, single intramuscular injection.
5.Follow up and course evaluation
All infants with positive blood non-syphilis spirochete antibodies are retested once at 1, 2, 3, 6 and 12 months after birth for RPR titers until the result turns negative or the titer decreases 4-fold. Infants with confirmed elevated CSF cell counts should be retested every 6 months until the CSF cell count is normal.