二期梅毒的早期诊断及治疗探讨

目的 :探讨二期梅毒的早期诊断 ,正确治疗 ,减少误诊、误治。方法 :对经血清学检查 (USR和TPPA)确诊的 12 0例二期梅毒患者的临床特点及病程作了分析 ,并对 98例采用苄星青霉素 2 4 0万U ,分两侧肌注 ,每周 1次、共 3次 ;12例采用青霉素钠 80 0万U静滴 ,每日一次 ,共 10天 ;青霉素过敏者 10例采用红霉素 5 0 0mgqid× 15d为一个疗程。结果 :1、女性居多 ,占6 1 7%。2、临床皮疹呈斑疹型 4 8例 ,病程短 ,消退快 ,平均为 6天 :扁平湿疣 4 6例 ,掌跖部皮疹 76例 ,消退较慢 ,病程相对较长 ,平均 13天 ;呈银屑病样皮疹或脓疱样疹 18例 ,则消退最慢 ,病程相对最长 ,平均 2 2天。3、二期梅毒患者经治疗后 ,平均5 5个月 ,血清学USR转阴率为 10 0 %。结论 :根据病史、临床特点及血清学 (USR和TPPA)检查可早期诊断二期梅毒 ,减少误诊、漏诊。采用苄星青霉素治疗梅毒 ,过敏者采用红霉素 ,仍是首选有效的治疗方法。     

苄星青霉素与阿奇霉素驱梅治疗的效果比较

目的观察比较苄星青霉素与阿奇霉素驱梅治疗的临床效果。方法按照随机数表法分为两组,对照组35例,采用阿奇霉素治疗,观察组36例,采用苄星青霉素治疗。比较两组患者治疗3个月、6个月、9个月、12个月后的梅毒转阴率,及一期梅毒、二期梅毒的皮损开始消退时间、皮损愈合时间。结果观察组1年内TRUST全部阴转,对照组有2例未阴转,但两组患者在治疗3个月、6个月、9个月、12个月后的转阴率均无明显差异,(P 0.05),两组患者一期梅毒与二期梅毒的皮损开始消退时间与皮损愈合时间均无明显差异,(P 0.05)。结论在梅毒治疗中选择苄星青霉素治疗具有肯定的疗效,其中一期梅毒治疗效果可达100%,二期梅毒治疗效果较一期差,因此需确保治疗的早期性、规范性。阿奇霉素治疗近期疗效与苄星青霉素相当,可作为青霉素过敏患者的替代治疗方案。     

小儿获得性二期梅毒1例

患儿女,4岁。外阴、肛周皮损1月余,伴虫蚀样脱发半月余。皮肤科情况:外阴、肛周可见红色湿性斑块,肛周皮损表面覆灰白色薄膜及分泌物。RPR1:32(+),TPPA(+)。诊断:小儿获得性二期梅毒。予苄星青霉素肌内注射治疗后皮损基本消退。     

雅司样梅毒疹

报告1例以全身雅司样丘疹为主要表现的二期梅毒。患者女,47岁。全身散在斑丘疹1个月余。皮肤科检查:头部、颈部、躯干及四肢散在大小不一的圆形斑丘疹,直径5~20 mm,表面有血痂,周围有红晕,较易剥离,剥离后为湿润出血性糜烂面,基底潮红,轻微浸润,有轻压痛。快速血浆反应素试验(RPR)(+),滴度1∶2048,梅毒螺旋体颗粒凝集试验(TPPA)(+)。诊断:二期梅毒。治疗:经苄星青霉素治疗后皮损基本消退。     

梅毒并艾滋病1例

患者男,25岁。头皮、面部、躯干及四肢斑块并结节3个月。血清TRUST 1∶256(+),TPPA(+)。HIV抗体确诊试验(+)。CD4~+T淋巴细胞:172个/μL。左上臂皮损组织病理示:表皮轻度增生,真皮浅中层浆细胞、淋巴细胞及组织细胞呈苔藓样或结节状浸润。诊断:二期梅毒;艾滋病。予长效青霉素驱梅治疗和高效抗逆转录病毒治疗(HARRT)后,患者的皮损已消退。     

表现为泛发性湿疹的二期梅毒一例并文献复习

患者，女，68岁。表现为泛发性湿疹样损害伴瘙痒10余年，TP阳性，RPR 1∶128阳性，苄星青霉素治疗3周后皮损完全消退。该患者皮损有别于经典的梅毒皮疹，容易误诊，本文对其进行报道并复习相关文献。     

以多部位扁平湿疣为表现的二期梅毒1例

患者男,38岁。双侧腋窝、肛周及阴囊赘生物1月余。TRUST阳性1:64,梅毒螺旋体血凝试验(TPPA)阳性,HIV阴性。诊断:二期梅毒,扁平湿疣。予苄星青霉素240万u治疗,3周后皮损全部消退。     

误诊为阴囊湿疹的二期梅毒1例

患者男,23岁。阴囊红斑、鳞屑伴瘙痒1个月。初发皮损为阴囊暗红色浸润性红斑和片状鳞屑,自觉瘙痒,按阴囊湿疹治疗后皮疹增多,蔓延至阴茎,且瘙痒加剧。梅毒血清学试验:TPPA(+);RPR 1:64(+)。诊断:二期梅毒。予苄星青霉素驱梅治疗1周后皮损明显消退,瘙痒缓解。     

银屑病样二期梅毒误诊5例

银屑病样二期梅毒误诊５例胡晓佩①孙文桂①我科门诊在１９９５～１９９６年间，发现有５例误诊为银屑病的二期梅毒患者，现报告如下。临床资料：男３例，女２例，年龄２４～３５岁，病程２５～３２天。５例均有婚外性生活史。皮损特点：２例表现为胸、腹及臀部的扁平状丘...     

二期梅毒误诊为银屑病1例

患者男,46岁。颌下、颈部、躯干、四肢铜钱样红斑伴瘙痒2月。有冶游史,曾被误诊为"环状肉芽肿"、"银屑病"。查血清RPR1:16阳性,TPHA阳性。诊断:二期梅毒。予苄星青霉素240万U分两侧臀部肌注,1次/周,治疗3次后,皮损消退,瘙痒症状消失。     

Clinical Study on Syphilis in Abu Dhabi with Special Stress on the Unusual Presentation of the Disease

ABSTRACT: Seventy-nine cases of syphilis were the material of this study. Unusual presentations of primary syphilis were found in 42.5% of cases; explanations are given for these findings. Other aspects of the unusual presentations of the disease were studied with special stress on the occurrence of itching in the course of secondary syphilis. The authors emphasize that pruritis as a presenting symptom in the presence of skin lesion suggestive of syphilis should not blind the physician to the possibility that Treponema pallidum may be the etiologic agent.     

IgM-FTA test in syphilis in adults. Its relation to clinical findings.

IgM-FTA tests have been carried out on 209 sera from 169 patients with treated or untreated syphilis at various stages and on 128 sera from 109 patients, born in areas where yaws is or was prevalent, with treated or untreated latent treponemal disease. IgM anti-treponemal antibody was found in virtually all cases of untreated early or early latent syphilis but in only 23 per cent. of sera from patients with untreated late latent syphilis. After treatment the antibody usually disappeared within one year, but it persisted in a minority of patients, including some treated for late symptomatic or congenital syphilis. Except in isolated cases there was no clinical evidence to suggest continued disease activity, although a third of the patient in whom the antibody persisted for more than 2 years after treatment were noted to be homosexuals. The test may assist in differentiating untreated early latent from late latent syphilis.     

妊娠梅毒的孕期干预时机对妊娠结局的影响研究

目的:分析并探讨妊娠梅毒孕妇孕期干预时机对母婴妊娠结局的影响。方法:选取医院进行产检及分娩的孕妇254例,所有孕期发现梅毒后,均给予长效青霉素治疗。早期干预组给予240万U,臀部肌内注射,1次/周,3周/疗程。每疗程结束后复查,若转阴,则晚期再治疗1个疗程,若未转阴且RPR(快速血浆反应素环状卡片试验)滴度下降小于2倍比稀释度,则继续治疗1个疗程。对于中期干预者,在发现后治疗1个疗程,晚期治疗1个疗程。晚期干预者在发现后即治疗1个疗程。结果:早期干预组早产、低体重儿12例(10.00%),死胎0例,新生儿畸形0例,新生儿死亡0例,新生儿梅毒0例;中期干预组早产、低体重儿22例(26.83%),死胎2例(2.44%),新生儿畸形2例(2.44%),新生儿死亡0例,新生儿梅毒2例(2.44%);晚期干预组早产、低体重儿26例(50.00%),死胎8例(15.38%),新生儿畸形4例(7.69%),新生儿死亡4例(7.69%),新生儿梅毒10例(19.23%)。早期干预妊娠结局最优,且新生儿梅毒发生率最低(P0.05)。RPR滴度低组,妊娠结局明显优于滴度高组,且新生儿梅毒发生率低(P0.05)。结论:妊娠梅毒孕妇孕期早期干预有利于改善妊娠结局,降低新生儿先天梅毒发生率,临床上对疑似孕妇应尽早诊治。     

Clinical Survey of Syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with Special Reference to the Recent Clinical Manifestations and Evaluation of IgM Antibodies to Treponema pallidum

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA+IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.     

39例早期先天性梅毒的临床分析

目的了解先天性梅毒的流行病学特点、临床特征及其治疗预后情况,为先天性梅毒的防治提供参考。方法对2010—2014年住院治疗的先天性梅毒患儿的病历资料进行回顾性分析。结果①共39例资料完整的先天性梅毒患儿入选;②患儿母亲正规驱梅治疗5例、非正规驱梅治疗34例;③临床和体征主要表现为皮肤黏膜损害、肝损伤、血液系统损害、骨损害、心脏损害、中枢神经系统损害、发热、脾大;④患儿均予以青霉素治疗,未见青霉素不良反应;⑤症状体征消失的有11例、症状体征好转17例、无改善3例。结论先天性梅毒中以早期先天性梅毒最常见;早期先天性梅毒可以有皮肤黏膜、肝脏、血液系统、骨骼系统、中枢神经系统及心脏损害等多器官损害;青霉素是先天性梅毒治疗的首选药物,但早期先天性梅毒的预后值得关注。     

儿童梅毒11例临床分析

为探讨我国儿童梅毒的特点，对我院的11例儿童梅毒临床特点进行了分析。结果10例为先天性梅毒，1例为后天获得性梅毒。主要临床表现为皮肤损害10例，骨损害8例，肝脾肿大5例，贫血7例及血小板减少3例。临床分析提示，在我国儿童梅毒发病中先天性梅毒仍是主要的；日常生活中密切接触易感是儿童与成人的不同点；儿童梅毒临床症状具有多样性，对此在临床中应引起重视。     

早期显性梅毒治疗的预后研究

目的：探索影响早期显性梅毒预后的因素。方法：用前瞻性研究的方法对202例早期显性梅毒的预后因素进行分析。结果：患者的年龄、病程、梅毒的分期、伴有的系统疾患、神经系统症状与梅毒的预后呈负相关。采用四环素、红霉素、多西环素等药物治疗的患者，其预后明显差于用头孢曲松或青霉素治疗的患者。治疗结束后3个月血清快速血浆反应素试验(RPR)滴度下降2个滴定值或以上，6个月RPR滴度下降4个滴定值或以上与梅毒的预后呈正相关。多元回归分析显示：治疗药物、梅毒的分期及病程是影响梅毒预后的主要因素。结论：一期梅毒经正规治疗后随访期1年即可。治疗结束后3个月RPR滴度下降2个滴定值或以上，6个月RPR滴度下降4个滴定值或以上，可作为短期内决定是否进行重复治疗的指标。     

123例早期梅毒临床分析

目的观察早期梅毒的临床特点及疗效,为提高早期诊治水平提供科学依据。方法对123例早期梅毒患者的临床资料进行综合分析。结果本组病例中男性76例,女性47例。Ⅰ期梅毒53例,以外生殖器硬下疳为主;Ⅱ期梅毒67例,以掌跖暗红斑、扁平湿疣及玫瑰疹为主;潜伏梅毒3例,无皮疹。123例患者USR、Trust、TI'PA试验均为阳性(100%):使用苄星青霉素治疗梅毒血清试验阴转率达95.9%。结论早期梅毒临床表现多样性,易误诊。苄星青霉素是治疗早期梅毒的首选药物。     

An epidemiological study of syphilis incognito, an emerging public health problem in Greece

BACKGROUND: Syphilis incognito is a subtype of latent syphilis (early or late) characterized by no signs or symptoms of primary or secondary syphilis and diagnosed by positive serologic results for syphilis during routine screening. OBJECTIVE: To study the epidemiological characteristics, causes, and implications of syphilis incognito in Greece. PATIENTS AND METHODS: All new adult patients diagnosed as having syphilis in Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece, from 1989 through 1996 were studied prospectively and retrospectively (history, physical examination, serologic tests, cerebrospinal fluid examination, and imaging) to determine the stage of their disease. The epidemiological, clinical, and serologic characteristics of patients with syphilis incognito were recorded and analyzed. RESULTS: During the 8-year period, 711 new syphilis cases were detected; of these, 480 cases (67.5%) fulfilled the definition criteria of syphilis incognito. The male-female ratio was 1.8:1. Patients with syphilis incognito were most commonly heterosexual, had a median socioeconomic status, and were aged 20 to 39 years, and their conditions were diagnosed during routine screening for syphilis (prenatal care, hospital admission, or blood donation). However, the number of syphilis incognito cases appeared to decline during the period studied. CONCLUSIONS: The incidence of syphilis in Greece has decreased dramatically, following the trends in western Europe. The most common form of syphilis is syphilis incognito, affecting adults who are older and have a higher socioeconomic status than those in the past. Improved hygiene and wide use of antibiotics that minimize or abolish symptoms of early disease may have contributed to the frequency of syphilis incognito in recent years. Screening of asymptomatic persons, especially those at high risk, should continue and be reenforced to prevent the devastating consequences of unrecognized and untreated syphilis.     

Sexually Transmitted Diseases in Children

Sexually transmitted diseases (STDs) in children may be transmitted by sexual abuse, by accidental contact, or perinatally. Although only 2% to 10% of abused children become infected, childhood syphilis, gonorrhea, condylomata acuminata, and Chlamydia trachomatis must always be considered. We reviewed data from our hospital regarding the frequency, prevalence, routes of transmission, and clinical features of these infections. Ninety-five percent of acquired syphilis in children is transmitted by sexual abuse. The perpetrator is usually someone the child knows or trusts. Of our 21 patients under 14 years of age with acquired syphilis, most were 4 to 8 years old. Girls were infected twice as often as boys. Sexual contact was confirmed in 71.4%. A chancre sore was infrequent in children; condylomata lata was the most frequent cutaneous lesion (80.9%). In the last 10 years, 102 cases of congenital syphilis were diagnosed in our hospital. The main clinical findings were bone involvement (78.7%), hepatosplenomegaly (68.8%), cutaneous lesions (50.8%), and jaundice (15.1%). Gonorrhea was detected in only nine children. Vulvovaginitis was the most common clinical manifestation. Sexual transmission was documented in three patients. Accidental contact with their infected mother occurred in two sisters. Three newborns acquired the disease during delivery. The STDs in children are a worrisome problem. Evaluation for sexual abuse should be done in all cases. Prevention and treatment of adults are the main steps to prevent these infections in children.