Blissful ignorance when managing pregnant women with syphilis and nonreactive nontreponemal tests?

摘要

The use of the reverse sequence syphilis algorithm has identified a population with serodiscordant test results: nonreactive nontreponemal tests and confirmed reactive treponemal tests. This is a heterogeneous population. Most individuals have treated syphilis resulting in a decline in nontreponemal antibody titers after therapy. Others have early infection (testing preceded the development of detectable antibodies or was affected by the prozone phenomenon), and subsequent nontreponemal tests are usually found to be reactive. Nontreponemal antibody titers may also decline over time even in the absence of therapy, so asymptomatic individuals with persistently nonreactive nontreponemal tests and no history of syphilis treatment may have late syphilis. In the antibiotic era, several important clinical and public health questions arise in individuals with serodiscordant test results without documented past syphilis treatment. What are the clinical risks of progression to tertiary syphilis? What are the public health risks of (a) sexual transmission and (b) vertical transmission from mother to infant?