Infectious Disease Update in Obstetrics: A Modern Approach to the Patient with a Positive Screening Test for Syphyilis in Pregnancy

Screening for maternal syphilis has been an essential component of routine antenatal screening tests in most countries for many years. This is not only because of the virulence of the spirochete which causes the infection but also because of its vertical transmission rate and the potential severe adverse complications/morbidity that can result from its transmission to the fetus. Although the incidence of maternal syphilis and its fetal sequalae in low-income countries has been considerable for several years, the disease has been almost non-existent in high income countries with wide antenatal screening coverage and effective treatment programmes for Syphilis. The recent alarming increase in the incidence of maternal syphilis in high income countries has spawned a renewed public health interest in the infection, with several countries updating and strengthening public health guidance in an attempt to stem this dramatic trend. This is a short clinical update for the practising obstetrician on how to manage the antenatal patient with a positive syphilis screening test.

伴有口腔扁平湿疣及指甲损害的少见神经梅毒1例

报告1例少见的伴有口腔扁平湿疣及指甲损害的神经梅毒。患者男,49岁,因双手铜红色斑疹2个月,舌尖疣状斑块1个月,左眼黑影1周就诊。皮肤科检查:左侧大拇指、右侧食指指甲凹凸不平,部分增厚。双手散在绿豆大小铜红色斑疹,周围覆以领圈样脱屑。舌尖粘膜可见平顶、颗粒感疣状斑块。左耳听力较右耳轻度下降。矫正视力下右眼视力1.0,左眼视力0.8。实验室检查:血清TPPA>1∶1280(+),TRUST 1∶64(+),脑脊液TRUST 1∶1(+),TPPA 1∶640(+),VDRL 1∶2(+)。宏基因组二代测序技术对舌尖疣状斑块进行微生物DNA测序,确认口腔梅毒螺旋体的存在。诊断为:神经梅毒,二期梅毒(口腔扁平湿疣)。予水剂青霉素400万U每4 h 1次,治疗2周后,几乎所有临床表现均改善。3个月后复查血清TRUST降至1∶8,目前仍在随访中。

以脓疱疹及扁平湿疣为主要表现的二期梅毒1例

患者女,28岁,孕8周。面部及外阴出现皮疹,伴瘙痒和疼痛20余天。皮肤科情况:前额、鼻旁、口周及颈前可见散在分布绿豆至花生大斑丘疹和脓疱;头皮可见数个蚕豆大结节,部分结节破溃和流脓;外阴及肛周可见密集分布疣状斑块。RPR 1:32(+),TPPA(+)。诊断:梅毒(二期)。