"Aimeiyi" prevention and treatment knowledge series - Syphilis

Syphilis, a chronic infectious disease caused by Treponema pallidum infection, mainly manifests as skin and mucous membrane damage in the early stage, while in the late stage it may involve multiple important tissues and organs such as bones, cardiovascular and central nervous systems, leading to serious lesions. For women who are preparing for pregnancy and during pregnancy, it is very important to have a deep understanding of the knowledge related to syphilis during the perinatal period. The following is a detailed introduction for you.

PART 01 Tips for Preparing for Pregnancy

To reduce the risk of mother-to-child transmission, patients diagnosed with syphilis are advised to consider pregnancy only after completing standardized syphilis treatment and the titer has dropped significantly (such as RPR ≤ 1:4) and the condition has stabilized. If syphilis has not been completely cured or the titer has not reached the standard, contraception should be continued until the pregnancy conditions are met. At the same time, the patient's sexual partner also needs to be screened and treated simultaneously to avoid reinfection.

PART 02 Screening timing

All pregnant women should undergo serological screening for syphilis before pregnancy or at the first obstetric visit during pregnancy. The best time is the first obstetric visit within 3 months of early pregnancy so that problems can be detected as early as possible and appropriate measures can be taken.

PART 03 Treatment and follow-up of infected pregnant women

1. Follow-up of pregnant women

The treatment of pregnancy complicated with syphilis follows the principle of early and standardized treatment. After adequate and standardized treatment of early syphilis, the non-treponemal test antibody titer will drop by 2 dilutions in 3 months and 4 dilutions in 6 months. Among them, the non-treponemal test turns negative in 1 year for primary syphilis; it turns negative after 2 years for secondary syphilis; the non-treponemal test antibody titer decreases slowly after treatment for late syphilis, and about 50% of patients still have positive non-treponemal tests 2 years after treatment.

After treatment of syphilis during pregnancy, nontreponemal testing should be done monthly before delivery:

1. For patients with high antibody titers, if the non-treponemal antibody titer increases or does not decrease by 2 dilutions 3 months after treatment, treatment should be repeated.

2. After treatment, the non-treponemal test antibody titer of patients with low antibody titer usually does not decrease significantly. As long as the non-treponemal test antibody titer does not increase after treatment, re-treatment is generally not required.

2. Postpartum follow-up

Follow-up should be conducted every 3 months in the first year after delivery, and every 6 months thereafter for 3 years. If the infected pregnant woman is treated for neurosyphilis, cerebrospinal fluid testing should be performed 3 months after delivery, and then every 6 months thereafter, and once a year after a negative result for 3 years.

PART 04 Delivery Management

It should be made clear that syphilis is not an indication for cesarean section. The specific mode of delivery should be decided by a professional doctor after evaluation based on other conditions of the pregnant woman and fetus.

PART 05 Treatment and follow-up of exposed children

Children born to pregnant women with syphilis need to be closely followed up and undergo physical examinations, and undergo syphilis-related serological tests at 3, 6, 9, 12, 15, and 18 months of age until the serological test results of Treponema pallidum antigen turn negative. If the TPPA test for syphilis in children is still positive at 18 months of age, congenital syphilis can be diagnosed.

PART 06Breastfeeding

Syphilis cannot be transmitted through breast milk. If the mother has received standardized treatment and her nipples are not damaged, she can breastfeed.

PART 07 Contraceptive measures

Promoting the use of condoms is a relatively effective way to prevent the spread of syphilis. However, although condoms can reduce the risk of syphilis transmission, since the bacteria may exist in the scrotum, vagina, rectum and mouth, using condoms cannot completely prevent infection.

PART 08 Reproductive Management

Before planning to have another child, be sure to undergo syphilis screening to ensure that there is no active infection. If infection is found, treatment must be completed before pregnancy.

PART 09 Summary of key points

For syphilis, screening and treatment during pregnancy are key links. After standardized treatment, mothers can breastfeed if conditions are met.

PART 10 Common Misconceptions Clarification The view that "there is no need for reexamination after syphilis is cured" is wrong. Syphilis patients need to have their RPR titers checked regularly to ensure that there is no recurrence of the disease.

It is hoped that women who are preparing for pregnancy or are pregnant will pay attention to the knowledge related to syphilis, take active preventive and response measures, and protect their own and their fetus’ health.