31例妊娠梅毒诊疗分析

目的 探讨妊娠梅毒的临床表现、诊断治疗方法及预后.方法 回顾性分析31例妊娠梅毒的临床表现、诊断治疗及预后情况.结果 31例孕母均未见有皮疹及其他梅毒相关临床体征.10例妊娠梅毒在妊娠早期、晚期各进行水剂青霉素联合苄星青霉素治疗一个疗程后,所生新生儿均无临床症状,血清学滴度低于母亲或为阴性.红霉素治疗及妊娠晚期开始青霉素治疗的孕妇所生新生儿,72.2%(13/18)血清滴度高于母亲,可伴有临床表现.结论 青霉素早期治疗妊娠梅毒是防止发生先天梅毒的有效措施,可望获得良好的妊娠结局.     

苄星青霉素、头孢三嗪治疗早期梅毒效果观察

目的观察苄星青霉素、头孢三嗪治疗早期梅毒的临床效果。方法将130例早期梅毒患者按治疗药物不同分为三组,分别给予苄星青霉素（A组）、头孢三嗪（B组）及苄星青霉素联合头孢三嗪（C组）治疗。三组一般资料比较,P均〉0.05,有可比性。比较三组临床疗效及梅毒血清学试验（TRUST）平均转阴时间。结果三组中,所有一期梅毒患者硬下疳及二期梅毒患者皮损均在治疗后2周内消失,均未出现严重不良反应。C组1年临床治愈率明显高于A、B组,TRUST转阴时间明显早于A、B组（P〈0.05和0.01）。结论苄星青霉素联合头孢三嗪治疗早期梅毒临床效果较单药治疗满意。     

妊娠梅毒的孕期干预时机对妊娠结局的影响分析

目的探讨妊娠梅毒患者的不同干预治疗时机,对妊娠结局及新生儿先天梅毒的影响。方法收集2008年1月至2012年12月收治的妊娠梅毒孕妇,回顾性分析和比较不同干预治疗时机对妊娠梅毒患者的不良妊娠结局及新生儿先天梅毒的发生率。采用SPSS 11.5进行数据的统计分析。结果共调查妊娠梅毒孕妇127例,妊娠梅毒均经血清学检查确诊。根据患者孕期实施干预(长效青霉素治疗)时机的不同,分为A组(60例)早期规范干预组(孕20周),B组(41例)中期规范干预组(孕20-28周),C组(26例)未干预/不完整干预组。A+B组为规范干预组。不良妊娠结局总发生率A组为10.00%,B组为29.27%,C组为69.23%,差异有统计学意义(χB2=6.174,PB=0.013;χ2C=31.63,PC=0.000)。其中早产/低体重B组为26.83%,C组为50.00%,差异有统计学意义(χ2B=4.93,PB=0.026;χ2C=16.86,PC=0.000)。C组的不良妊娠结局高于规范干预的A+B组,差异有统计学意义(χ2=26.91,P=0.000);C组新生儿先天梅毒发生率为19.23%,A+B组为0.99%,差异有统计学意义(χ2=11.50,P=0.001)。快速血浆反应素球状卡片试验(RPR)滴度不同的妊娠梅毒患者,经规范干预后,规范干预组与未干预/不完整干预组的妊娠不良结局发生率差异有统计学意义(χ2高=13.01,P高=0.000;χ2低=7.65,P低=0.006),新生儿先天梅毒发生率差异也有统计学意义(χ2高=4.94,P高=0.026;P低=0.017)。结论早期规范治疗对改善妊娠梅毒患者的妊娠结局及降低先天梅毒发生率有着重要意义,不论患者RPR滴度高低,妊娠梅毒患者均应早期进行积极的规范治疗。     

妊娠合并甲状腺功能减退的筛查及其妊娠结局初步分析

目的：探讨妊娠期甲状腺功能减退症及甲状腺功能异常与不良妊娠结局的关系。方法选择2010年6月～2012年6月在首都医科大学平谷教学医院建册的妊娠20周前的孕妇2856例,应用直接化学发光法测定其促甲状腺激素、游离甲状腺素和抗甲状腺过氧化物酶抗体,并通过询问病史及体格检查获得甲状腺功能减退病例,根据确诊时间不同,将其随机分为孕前组（ A组）12例及孕后组81例,孕后组根据病情分为临床甲状腺功能减低13例（B组）、亚临床甲状腺功能减低52例（C组）、低甲状腺素血症16例（D组）,另选同期甲状腺功能正常、无其他合并症的孕妇300例作为对照组（ E组）,随访各组妊娠结局情况。结果 A组妊娠结局与E组比较无统计学差异（P＞0．05）,B、C、D组早产、妊娠期糖尿病以及产后出血、贫血、羊水少、胎膜早破、胎盘异常、脐带异常的发生率均高于E组（P均＜0．05）。结论孕前开展甲状腺功能减退的筛查,有利于改善甲状腺功能减退孕妇的母儿结局。     

药物、保守手术、根治手术治疗输卵管妊娠疗效比较

目的比较药物、保守手术、根治手术治疗输卵管妊娠的疗效。方法 480例输卵管妊娠患者,其中162例采用药物治疗（A组）,221例采用保守手术治疗（B组）,97例采用根治手术治疗（C组）。结果治疗后,A、B组输卵管通畅率分别为56.2%和97.3%（P〈0.05）;宫内妊娠率A、B、C组分别为42.8%、67.4%和46.4%,B组与A、C组相比P均〈0.05;再次异位妊娠率A、B、C组分别为10.5%、9.5%、8.2%,组间比较P均〉0.05。结论保守手术治疗输卵管妊娠的疗效优于药物治疗及根治手术。     

性病门诊的妊娠合并梅毒患者母婴阻断的临床研究

目的 探讨妊娠合并梅毒患者在妊娠不同孕周进行治疗后，其所生新生儿梅毒阻断率的不同。方法 对2001年11月至2005年11月期间，确诊妊娠合并梅毒患者进行回顾性临床分析，并通过对妊娠16周前后的孕妇用苄星青霉素治疗，对其新生儿在出生时和出生后3、6、9、12、18个月检测梅毒抗体，观察疗效。结果 16周前、后进行治疗的孕妇所生新生儿阻断率分别为86．1％和76．2％，两者差异有统计学意义（P〈0．05）。结论 对于妊娠合并梅毒的患者，早期进行青霉素足量治疗可以有效防止胎儿感染梅毒。故妊娠期妇女应该早期常规接受梅毒抗体检测，建议同时检查艾滋病病毒和性病。     

孕晚期B族链球菌感染情况对妊娠结局的影响

目的　研究孕晚期妇女B族链球菌（group B Streptococcus, GBS）感染情况对妊娠结局的影响。方法　采集2016年6月—2018年8月在北京积水潭医院产科进行产前检查的孕35～37周160例待产孕妇的阴道与肛周分泌物,常规用荧光定量PCR法和细菌培养法进行筛查,按照检测结果分为GBS阳性组和GBS阴性组,分析GBS感染情况对孕妇妊娠结局的影响。结果　160例孕晚期妇女GBS阳性者82例,阳性率51.25%（82/160）。2组在年龄、孕周、产次方面进行对比,差异均无统计学意义（P均＞0.05）。GBS阳性组产后出血率（40.24%）、胎膜早破率（20.73%）、宫内感染率（24.39%）均高于GBS阴性组,差异有统计学意义（P均＜0.05）。分离的82株GBS对青霉素G、头孢曲松、氨苄青霉素、利奈唑胺敏感率均为100%;对四环素、克拉霉素、万古霉素、左氧氟沙星、红霉素、克林霉素敏感率分别为7.31%、8.54%、82.93%、68.29%、71.95%、68.29%。结论　孕妇在孕晚期感染GBS将会增加产后出血,宫内感染,胎膜早破的发生率,对妊娠结局产生不良影响。孕妇在孕晚期进行GBS筛查是非常有必要的。     

提高妊娠合并梅毒产妇所分娩的新生儿苄星青霉素肌肉注射成功率及减少硬结发生率的方法研究

目的分析提高妊娠合并梅毒产妇所分娩的新生儿苄星青霉素肌肉注射成功率及减少硬结发生率的方法研究。方法随机选择2017年7月-2019年6月到我院生产的妊娠合并梅毒产妇所分娩的新生儿224例,以随机数字表法进行分组,对照组和观察组均为112例,对照组于左侧注射采用传统肌肉注射法注射苄星青霉素,观察组于右侧注射采用改进法注射苄星青霉素,分析观察新生儿的肌肉注射一次成功率、硬结发生率等相关情况。结果观察组和对照组的肌肉注射成功率分别为94.64%、52.68%,观察组显著高于对照组(P<0.05);观察组和对照组的硬结发生率分别为7.14%、77.67%,观察组显著优于对照组(P<0.05)。结论改进法能有效提高新生儿苄星青霉素肌肉注射一次成功率,降低硬结发生率,并减少药物浪费。     

梅毒感染孕产妇治疗时机与不良妊娠结局的关联性研究

目的 探讨梅毒感染孕产妇治疗时机对不良妊娠结局的影响。方法 收集2012年至2021年全国预防梅毒母婴传播管理信息系统中湖北地区报告的已分娩的梅毒感染孕产妇相关流行病学调查资料,根据孕产妇启动驱梅治疗时机分为早期治疗组、晚期治疗组和孕期未治疗组,采用χ2检验比较三组间孕产妇不良妊娠结局的发生率,运用Logistic回归模型,分析治疗时机对不良妊娠结局的影响。结果 共纳入4 859例梅毒感染孕产妇,早期治疗率46.41%(2 255例),晚期治疗率26.20%(1 273例),孕期未治疗率27.39%(1 331例)。早期治疗组、晚期治疗组和孕期未治疗组的总不良妊娠结局发生率依次为16.98%、21.76%和28.47%,死胎/死产的发生率分别为0.62%、1.02%和1.95%,新生儿死亡的发生率分别为0.27%、0.86%和2.40%,先天梅毒的发生率分别为0.89%、3.06%和6.54%,三组各项不良妊娠结局的发生率比较,差异有统计学意义（P均<0.05）。与早期治疗组相比,晚期治疗组发生总不良妊娠结局（a OR=1.39,95%CI:1.16～1.67）、新生儿死亡（a ...     

高龄孕妇妊娠晚期实施动态心电图检查的异常情况及妊娠结局分析

目的 探讨高龄孕妇妊娠晚期动态心电图检查结果对妊娠结局的影响。方法 纳入80例孕妇,2021年8月至2023年8月就诊,均行回顾性研究,将孕妇按照年龄进行分组,适龄组（<35岁）为40例,高龄组（≥35岁）为40例,对两组心电图异常检出率、心律失常类型和妊娠结局进行分析。结果 高龄组心电图异常检出率为55.00%,高于适龄组,差异有统计学意义（P<0.05）;高龄组心律失常以窦性心动过速为主,发生率为20.00%,明显高于适龄组,差异有统计学意义（P<0.05）;心电图异常患者中,高龄组不良妊娠结局发生率为72.73%,明显高于适龄组,差异有统计学意义（P<0.05）。结论 动态心电图可检出高龄孕妇妊娠晚期异常情况,可导致不良妊娠结局,应定期检查,及时干预。     

Treatment of maternal syphilis in rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss

OBJECTIVES: Despite few data, the treatment of syphilis in pregnant women using a single dose of benzathine penicillin is the standard of care in many resource-poor settings. We examined the effect of various doses of benzathine penicillin on pregnancy loss among women with a positive Rapid Plasma Reagin (RPR) test result in a rural South African district. METHODS: All pregnant women making their first antenatal care visit during pregnancy were screened for syphilis using the RPR test. Those testing positive were counselled to receive three weekly doses of benzathine penicillin, and received a partner notification card. Pregnancy outcomes were determined from facility records or home visits where necessary. RESULTS: Of 8917 women screened, 1043 (12%) had reactive syphilis serology; of those with titre data available, 30% had titres of 1:8 or greater. While 41% (n = 430) of women received all three doses as counselled, 30% (n = 312) received only one dose, and 20% (n = 207) did not return to the clinic to receive treatment. Among the 947 women with pregnancy outcome data available, there were 17 miscarriages and 48 perinatal deaths observed. There was a strong trend towards reduced risk of pregnancy loss among women receiving multiple doses of penicillin (adjusted OR for perinatal mortality for each additional dose received, 0.63; 95% CI, 0.48-0.84). CONCLUSIONS: While this association requires further investigation, these results suggest that there may be substantial benefit to providing multiple doses of benzathine penicillin to treat maternal syphilis in this setting.     

Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes

Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant women was recruited in Tanzania. Birth outcomes were compared among women treated for high-titer (n=133; rapid plasma reagin [RPR] titer > or = 1:8 and Treponema pallidum hemagglutination assay [TPHA]/fluorescent treponemal antibody [FTA] positive) and low-titer (n=249; RPR titer <1:8 and TPHA/FTA positive) active syphilis and 950 uninfected women. Stillbirth or low-birth-weight live births were observed in 2.3% and 6.3%, respectively, of women treated for high-titer active syphilis and in 2.5% and 9.2%, respectively, of seronegative women. There was no increased risk for adverse pregnancy outcome for women treated for high-titer active syphilis (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.4-1.4) or low-titer active syphilis (OR, 0.95; 95% CI, 0.6-1.5), compared with seronegative women. Single-dose treatment is effective in preventing adverse pregnancy outcomes attributable to maternal syphilis.     

Antenatal syphilis screening in sub-Saharan Africa: lessons learned from Tanzania

OBJECTIVES; To synthesise data from four recent studies in Tanzania examining maternal syphilis screening and its operational implementation in routine antenatal clinics (ANC), drawing lessons for strengthened antenatal services for the prevention of mother-to-child transmission (PMTCT) of HIV. METHODS: The impact of untreated maternal syphilis was examined in a retrospective cohort of 380 Tanzanian women. Effectiveness and cost-effectiveness of screening and single dose benzathine penicillin treatment were prospectively examined in 1688 pregnant women. Observation, interviews and facility audits were carried out in health facilities within nine districts to determine the operational reality of syphilis screening. RESULTS: Overall, 49% of women with untreated high titre syphilis experienced an adverse pregnancy outcome compared with 11% of uninfected women. Stillbirth and low birthweight rates among those treated for high- or low-titre syphilis were reduced to rates similar to those for uninfected women. The economic cost was $1.44 per woman screened and $10.56 per disability-adjusted life year saved. In the operational study, only 43% of 2256 ANC attenders observed were screened and only 61% of seroreactive women and 37% of their partners were treated. Adequate training, continuity of supplies, supervision and quality control are critical elements for strengthened antenatal services, but are frequently overlooked. CONCLUSIONS: Maternal syphilis has a severe impact on pregnancy outcome. Same-day screening and treatment strategies are clinically effective and highly cost-effective, but there are significant challenges to implementing syphilis screening programmes in sub-Saharan Africa. Current PMTCT interventions present an opportunity to reinforce and improve syphilis screening. Increasing PMTCT coverage will involve similar operational challenges to those faced by syphilis screening programmes.     

Congenital syphilis.

In the US and northern Europe, the prevalence of pregnant syphilitic women is estimated at .1-.6%, while in South Africa it was 7.6% in 1982. In 1978, there 108 cases in the US which increased to 268 reported cases in 1985. The increase of congenital syphilis (CS) by 25% from 1985 to 1988 was attributed to the spread of crack cocaine in the US. The rate was 10.5 cases/100,000 live births in the US during this period, a 21% increase. In contrast, in the Netherlands there were 2.5 cases/100,000 live births during 1982-85. Clinical symptoms appear 3 weeks after birth, but some are present at birth such as hepatosplenomegaly, bloated abdomen, cutaneous lesions, and nasal discharge turning into purulent rhinitis. Anemia occurs in 90% of children with CS. Generalized lymphadenopathy, splenomegaly with hepatomegaly, and syphilitic hepatitis may also occur. Syphilitic skeletal abnormalities include osteochondritis, periostitis, osteomyelitis, and osteitis. Meningovascular syphilis produces nervous system effects. CS complications include nephrotic syndrome and acute glomerulonephritis. Ocular abnormalities are caused by treponemes found in the cornea, sclera, uvea, retina and the optic nerve. Chorioretinitis and iridocyclitis are common ocular lesions. The pathogen Treponema pallidum can be diagnosed by dark field microscopy, by immunofluorescence, or by histopathological examination of silver-stained preparations. Pregnancy women with syphilis are treated with penicillin although failures have been reported after single or 2 or 3 in administrations of 2.4 MU benzathine penicillin and after giving tetracycline in 3rd trimester pregnancy. The CDC recommendation for treating infants with CS is iv 50,000 U/kg penicillin G every 8-12 hours for 10-14 days or im 50,000 U procaine penicillin once daily for 10-14 days. Single administration of 50,000 U/kg benzathine penicillin is recommended for newborn children whose mothers have been treated with erythromycin.     

Azithromycin vs. benzathine penicillin G for early syphilis: a meta-analysis of randomized clinical trials

The World Health Organization estimates that at least 12 million people are infected with syphilis in the world. Southeast Asia accounts for 5.8 million; Africa accounts for 3.5 million. There has been controversy in using the two kinds of antibiotics for early syphilis. A systematic review comparing these antibiotics could affect treatment guidelines. The aim of this study was to evaluate the efficacy and safety of azithromycin vs. penicillin G benzathine for early syphilis and a meta-analysis to compare these two kinds of antibiotics for early syphilis. Four randomized controlled trials met the inclusion criteria; 476 patients were evaluated for their cure rate. Cure rates were 95.0% (227/239) for azithromycin and 84.0% (199/237) for penicillin G benzathine. After pooling the data, the difference in efficacy was computed. Cure rate (OR=1.37), 95% CI (1.05, 1.77) and the risk difference for cure rate between the two drugs were statistically significant. Although the gastrointestinal adverse effect of azithromycin is five times more than the adverse effect of penicillin G benzathine, the differences are not significant. Azithromycin achieved a higher cure rate than penicillin G benzathine in a long follow-up.     

Azithromycin compared with penicillin G benzathine for treatment of incubating syphilis.

BACKGROUND: Preventive therapy is an important element of syphilis control efforts. No currently recommended, single-dose alternatives to penicillin G benzathine are available for treatment of incubating syphilis. OBJECTIVE: To evaluate the use of a single 1.0-g dose of azithromycin for treatment of persons recently exposed to sexual partners with infectious syphilis. DESIGN: Single-center, open-label, randomized pilot study to compare azithromycin with penicillin G benzathine therapy. Participants were evaluated serologically for 3 months. SETTING: Sexually transmitted disease clinic in Birmingham, Alabama. PARTICIPANTS: 96 participants who in the preceding 30 days had been exposed to partners with infectious syphilis through sexual intercourse. MEASUREMENTS: Syphilis prevention, as indicated by nonreactive serologic tests (rapid plasma reagin and fluorescent treponemal antibody-absorbed), throughout the 3-month follow-up. RESULTS: Among 96 participants enrolled, none of 40 evaluable persons in the azithromycin group and none of 23 evaluable persons in the penicillin group developed evidence of syphilis. Significantly more penicillin-treated participants (21 of 44 [48%]) than azithromycin-treated participants (12 of 52 [23%]) became nonevaluable during follow-up (P = 0.01). CONCLUSION: A single 1.0-g dose of azithromycin seems to be efficacious for prevention of syphilis in persons exposed to infected sexual partners.     

Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus.

OBJECTIVE: To evaluate the effect of ceftriaxone in treating latent syphilis or asymptomatic neurosyphilis in patients infected with the human immunodeficiency virus (HIV). DESIGN: Follow-up study of patients treated at two HIV-based clinics during 16 months from 1989 to 1991. PATIENTS: Patients were those in whom a clinical diagnosis of latent syphilis or asymptomatic neurosyphilis was made, who received all recommended doses of antimicrobial therapy, and who returned for follow-up visits for 6 or more months. RESULTS: Forty-three patients were treated with ceftriaxone, 1 to 2 g daily for 10 to 14 days. Thirteen underwent lumbar puncture before treatment; 7 (58%) had documented neurosyphilis (pleocytosis in 5, elevated protein levels in 6, VDRL reactive in cerebrospinal fluid [CSF] in 7), and 6 had documented latent syphilis (entirely normal CSF). The remaining 30 were said to have presumed latent syphilis. There was no relation between the diagnosis and the selected dosage of ceftriaxone. Response rates were similar in those who had documented neurosyphilis and documented or presumed latent syphilis. Overall, 28 patients (65%) responded to therapy, 5 (12%) were serofast, 9 (21%) had a serologic relapse, and 1 (2%) who experienced progression to symptomatic neurosyphilis was a therapeutic failure. Thirteen patients received benzathine penicillin for presumed latent syphilis; results were similar to those observed after ceftriaxone therapy, with 8 (62%) responders, 1 (8%) serofast, 2 (15%) relapses, and 2 (15%) failures. CD4 cell counts in responders were not different from those who failed to respond. CONCLUSIONS: Even in the absence of neurologic symptoms, half of the HIV-infected persons who have serologic evidence of syphilis may have neurosyphilis. Although ceftriaxone achieves high serum and CSF levels, 10 to 14 days of treatment with this drug were associated with a 23% failure rate in HIV-infected patients who had latent syphilis or asymptomatic neurosyphilis. Three doses of benzathine penicillin did not have a significantly higher relapse rate and may provide appropriate therapy, at least for documented latent syphilis in persons co-infected with HIV. Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients.     

Jarisch-Herxheimer reaction among syphilis patients in Rio de Janeiro, Brazil

The Jarisch-Herxheimer reaction (JHR) is a syndrome observed after antimicrobial treatment of some infectious diseases. The syndrome has clinical characteristics of an inflammatory reaction to antibiotic treatment. A prospective study of patients with a clinical and laboratory diagnosis of syphilis was conducted at a sexually transmitted diseases clinic in Rio de Janeiro, Brazil. Patients were treated with benzathine penicillin and observed for the JHR. A total of 115 patients were included in this study. Fifty-one patients (44%) had secondary syphilis; 37 (32%), primary; 26 (23%), latent; and one (1%), tertiary syphilis. Ten patients (9%) developed the JHR. All JHRs occurred in patients with secondary and latent syphilis. No patients experienced an allergic reaction to penicillin. The JHR occurred less frequently than in previous studies. It is important that health-care professionals recognize the clinical characteristics of the JHR so that it is not misinterpreted as an allergic reaction to penicillin.     

妊娠期不同阶段给予替比夫定阻断乙型肝炎病毒宫内母婴传播的研究

目的 探讨妊娠不同阶段给予替比夫定治疗阻断乙型肝炎病毒母婴传播的效果和安全性。方法 选择血清HBsAg阴性父亲,血清HBsAg和HBV DNA阳性孕妇180例,干预1组60例,在孕前口服替比夫定,直至HBV DNA阴性后受孕并继续服药至新生儿出生; 干预2组60例,在孕24 w时口服替比夫定至新生儿出生;对照组60例不进行抗病毒处理。观察婴儿0 w、24 w和48 w时血清HBsAg和HBV DNA阳性情况。结果 干预1组婴儿出生时、24 w、48 w血清HBsAg和HBV DNA阳性率均为0.0%,干预2组出生时、24 w、48 w时 HBV DNA阳性率为5.0%、3.3%、3.3%,两组有统计学差异（P<0.01）;对照组出生时、24 w、48 w血清HBV DNA阳性率为20.0%、18.3%、16.7%,与干预2组比有统计学差异（P<0.05）;干预组未发现与应用替比夫定相关的不良反应;三组新生儿胎龄、体质量、身长和Apgar评分比较无统计学差异（P>0.05）。结论 口服替比夫定至HBV DNA阴性时受孕可以完全阻断乙型肝炎病毒母婴宫内传播,且有较好的孕妇和新生儿安全性。     

Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial

OBJECTIVE: To demonstrate the impact on perinatal mortality of inadequate treatment for maternal syphilis despite adequate screening. METHOD: In 12 clinics providing antenatal care in Hlabisa, South Africa 1783 pregnant women were screened for syphilis at their first antenatal visit between June and October 1998. Pregnancy outcome was determined among those with syphilis. RESULTS: A total of 158 women were diagnosed with syphilis: prevalence 9% (95% CI 8-10%). Mean gestation at first antenatal visit was 24 weeks. Thirty women (19%) received no treatment and 96 (61%) received all three recommended doses of penicillin. Among those receiving at least one dose, mean delay to the first dose was 20 days. Among those fully treated mean delay to treatment completion was 34 days. Pregnancy outcome was known for 142 women (90%) and there were 17 perinatal deaths among 15 women (11%). Eleven of 43 women (26%) who received one or fewer doses of penicillin experienced a perinatal death whilst only four of 99 women (4%) who received two or more doses of penicillin did so (P = 0.0001). Protection from perinatal death increased with the number of doses of penicillin: linear modelling suggests that one dose reduced the risk by 41%, two doses by 65% and three doses by 79%, compared with no doses. A dose-specific, categorical model confirmed reduction in risk by 79% for all three doses. CONCLUSION: Despite effective screening, many pregnant women with syphilis remain inadequately treated, resulting in avoidable perinatal mortality. Delays in starting and finishing treatment, as well as incomplete treatment occur. Near-patient syphilis testing in the antenatal clinic with early treatment could improve treatment of syphilis and reduce perinatal mortality, and a randomized trial to test this is underway.