| Background: Syphilis is a chronic infectious disease caused by infection with Treponema pallidum(TP),mainly through sexual contact and blood transmission.This disease can invade all organs of the body and is extremely harmful.In the past 10 years,the incidence of syphilis in China has increased rapidly,with an average annual increase of 13.37%.It cannot be isolated and cultured by TP,which means that syphilis serological detection technology plays a crucial role in the diagnosis of syphilis.At present,domestic routine detection methods such as detection of serum RPR(rapid plasma Reagent)and TPPA(treponema pallidum particle agglutination test)are detecting IgG type antibodies,which can pass through the placenta and blood-brain barrier.The positive rate of RPR in the early and late stages of syphilis infection is very low,and most of the TPPA tests are positive for life.Therefore,the 19 sIgM test is clinically useful for early diagnosis of fetal syphilis,syphilis treatment.The 19 sIgM antibody of Treponema pallidum is an IgM type antibody,which has the characteristics of not passing through the placental barrier and the blood-brain barrier,appearing early after infection,rapidly disappearing after treatment,an there is re-infection or recurrence when disease is recurrent.Therefore,the 19 sIgM antibody of Treponema pallidum plays a crucial role in the early diagnosis of syphilis,especially in the early diagnosis of syphilis in pregnant women and newborns.This study intends to evaluate the condition of syphilis in pregnant women and their newborn babies with gestational syphilis during pregnancy,and to detect the serum levels of syphilis RPR and TPPA in patients with peripheral blood.Providing future evaluation of syphilis and syphilis during pregnancy,diagnosis and treatment data and experience.Objective: To understand the diagnostic effect and assessment of syphilis in patients with syphilis and 19 sIgM antibodies and to find out the treatment effect of benzathine penicillin G and erythromycin Research methods: According to the inclusion and exclusion criteria,a total of 144 pregnant syphilis patients who were diagnosed in the dermatology department of our hospital and their syphilis seropositive infants were included.Each patient was first testedin the laboratory of our hospital for syphilis serum RPR and TPPA,and then peripheral blood serum samples were collected.The IIFT(indirect immunofluorescence test)method was used to detect the level of 19 SIgM in the peripheral serum of patients.When the baby of a pregnant syphilis patient was born,follow-up and testing were immediately performed.Results:A total of 144 people(which included pregnant women diagnosed with syphilis and their seropositive infants)were enrolled in this study.88 patients were followed up successfully and 56 patients were lost in the follow up procedures(all 56 of them were pregnant women).They were diagnosed in our hospital during pregnancy,and they were tested negative for 19 SIgM and it was planned that the infants will be born in our hospital and followed up accordingly,we lost these patients maybe because of different place of birth and other personal reasons).Among the 88 people followed up successfully,number of patients who were 19 SIgM positive: 14 patients,the positive rate were 10.29%.74 people were 19 SIgM Negative.Out of these 88 patients followed up,25 were mothers and their infants.Among them,9 pairs of mother and child were 19 SIgM Positive,and are grouped as follow:1.Mother 19SIgM+ and infant 19SIgM+: 2 pairs.These patients with syphilis in pregnancy were treated with intramuscular injection of Benzathine penicillin G 2.4million units per week.One case was diagnosed as syphilis during the first trimester the later was diagnosed as syphilis in the third trimester.2.Mother 19 SIgM +,infant 19SIgM-: 4 pairs.All 4 patients were treated with Intramuscular injection of Benzathine penicillin G 2.4 million units per week.Two cases were diagnosed as syphilis in early pregnancy,and two later cases were diagnosed as syphilis in the third trimester.3.Mother 19SIgM-,Infant 19SIgM+: 3 pairs.All 3 cases were allergic to Benzathine penicillin G and treated with erythromycin.1 case was diagnosed with syphilis 4 years ago,and was treated with oral erythromycin(dosage unknown);2 cases were diagnosed as syphilis in the middle and late pregnancy,and erythromycin was intravenously administered for 15 days.4.Mother 19SIgM-,child 19SIgM-: 16 pairs.All of them were treated with intramuscular injection of Benzathine penicillin G 2.4 million units per week.5.3 cases were mother's 19SIgM+,and their sons were lost to follow-up.These patients with syphilis in pregnancy were treated with intramuscular injection of Benzathine penicillin G 2.4 million units per week.One case was found to be infected with syphilis in early pregnancy,and two cases were found to be infected with syphilis in the third trimester.6.38 cases were infants with 19SIgM-and their mothers were lost to follow-up.We called them by telephone and asked for medical history,and all of them were treated with intramuscular injection of Benzathine penicillin G 2.4 million units per week.There were3 cases of infection in the first trimester,7 cases of infection in the third trimester,and 6cases of previous syphilis.Conclusion:A Negative 19 SIgM test doesn't rule out infection with Treponema Pallidum after normal treatment.After treating patients diagnosed with syphilis if 19 SIgM test is positive it has a diagnostic value but if 19 SIgM test is negative it doesn't rule out syphilis.If Patients are infected in the third trimester of pregnancy even if 19 SIgM is Negative,Fetus infection of syphilis can't be ruled out.Treatment with erythromycin has a very high chance of no or very low efficacy thus treatment fails.In some cases treatment with traditional intramuscular Benzathine penicillin G may also fail.Another reason for treatment failure was treating patients at a very late stage of pregnancy.. |
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