2010—2020年北京市房山区梅毒防治效果分析

目的了解北京市房山区梅毒规划(2010—2020年)实施期间梅毒防治效果和各考核指标达标情况,为下一步制定有效的梅毒防治策略提供科学依据。方法根据《中国预防与控制梅毒规划(2010—2020年)》(以下简称《梅控规划》)终期评估的要求,通过专网、现场调查、APP答题等方式对涉及的16个指标进行收集,并将16个指标划分为梅毒防治保障措施的落实、防治工作开展和防治效果3个层面进行评估,同时将评估结果与终期评估标准进行比较。采用SPSS 18.0软件进行描述性统计分析。结果2010—2020年北京市房山区共报告梅毒病例3260例,年均报告发病率27.99/10万,年均增长0.08%,男女比例基本持平,以25岁年龄组病例数最多,历年病例均以隐性梅毒为主。保障措施与能力建设方面均达标;防治工作方面:感染梅毒的孕产妇所生婴幼儿接受规范诊疗服务的比例为50.00%,梅毒患者接受规范化治疗的比例86.11%,两指标未达标,其余均达标;防治效果中一期和二期梅毒年报告发病率增长幅度为3.80%,未达标,先天梅毒年报告发病率为9.25/10万活产数达到了《梅控规划》的工作要求。结论2010—2020年北京市房山区梅毒防治工作取得了一定成效,但部分指标仍未达标,应继续加强梅毒防治工作,尤其是需提高规范化诊疗的比例同时控制新发梅毒发病率。     

Seroprevalence and trends of transfusion transmissible infections among retrospective blood donors in Western Azerbaijan Regional Blood Transfusion Center,Iran: A ten-years evaluation

Transfusion transmissible infections (TTIs) have been a public health challenge for the accessibility, quality and safety of blood transfusion. The present study aimed to consider the prevalence and the trends of hepatitis B virus (HBV), hepatitis C virus (HCV), Human T-cell leukemia virus type 1 (HTLV-1), human immunodeficiency virus (HIV) and syphilis across the ten years among retrospective blood donors. A retrospective investigation of blood donors’ data covering the period from 22 May 2009 to 22 May 2019 was done. Data was accumulated and analyzed from Blood Transfusion Center records, pertaining to all donors who were screened for various TTIs using respective immunological techniques. Out of the 682,171 screened donors in the 2009–2019 study period, 2470 (0.36 %) were infected with at least one infectious agent. The overall prevalence of HBV, HCV, HTLV-1, HIV and syphilis were 1700 (0.25 %), 184 (0.027 %), 335 (0.05 %), 4 (0.0.05 %) and 247 (0.036 %), respectively. The study showed male dominated donor pool (96.79 %) with higher prevalence (0.34 %) of TTIs compared to female donors (0.02 %) with 3.21 % population. Despite the low prevalence of TTIs in our study, HBV, HCV, syphilis and HIV have remained a big threat to safe blood transfusion in Iran. Strict adherence to selection criteria, algorithm of donor screening, use of highly sensitive and specific methods for detection of TTIs, regular consultation and health education programs, prevention and sanitization strategies to reduce the risk of TTIs are recommended to reduce the risk of TTIs and ensure the safety of blood transfusion for recipient.     

梅毒螺旋体血行播散机制的研究进展

【摘要】 梅毒是由梅毒螺旋体进入循环系统进行血行播散导致的多系统损害，但目前其全身播散的具体机制尚未完全明确。基于国内外的研究进展，本文从梅毒螺旋体黏附与细胞外基质降解、细胞间连接和细胞骨架系统破坏、血管生成、炎症细胞浸润等多方面探讨梅毒螺旋体血行播散的机制，为进一步研究提供理论基础。     

Non-pathogenic Borrelia burgdorferi expressing Treponema pallidum TprK and Tp0435 antigens as a novel approach to evaluate syphilis vaccine candidates

Background

Syphilis is resurgent in many developed countries and still prevalent in developing nations. Current and future control campaigns would benefit from the development of a vaccine, but although promising vaccine candidates were identified among the putative surface-exposed integral outer membrane proteins of the syphilis spirochete, immunization experiments in the rabbit model using recombinant antigens have failed to fully protect animals upon infectious challenge. We speculated that such recombinant immunogens, purified under denaturing conditions from Escherichia coli prior to immunization might not necessarily harbor their original structure, and hypothesized that enhanced protection would result from performing similar immunization/challenge experiments with native antigens.

深圳市宝安区梅毒血清固定孕妇的筛查及规范性治疗对妊娠结局和新生儿影响

目的对深圳市宝安区梅毒血清固定的妊娠期孕妇的状况进行筛查及了解规范性治疗对妊娠结局和新生儿的影响。方法选取2015年1月至2017年12月深圳市宝安区医疗单位进行免费梅毒保健筛查的妊娠期孕妇作为观察对象。对妊娠期梅毒患者的数量及梅毒血清固定的人数比例进行分析。梅毒血清固定孕妇,根据第一疗程、第二疗程同时驱梅用药患者作为治疗组,而两疗程没有同时进行药物治疗或两疗程均没有驱梅用药的患者作为未治疗组,选取同期正常孕妇作为对照组,观察规范性治疗对妊娠结局和新生儿影响。结果 2015年1月至2017年12月深圳市宝安区梅毒筛查中,3年的梅毒确诊分别为204例、154例和195例;血清固定孕妇占比分别为5.39%、9.74%和3.07%;在血清固定组患者中不良结局妊娠上三组之间差异无统计学意义(P>0.05);梅毒血清固定患者中治疗组新生儿血清梅毒阳性率和不良事件发生率均显著低于未治疗组,差异具有统计学意义(均P<0.05)。结论本次研究结果显示,在梅毒血清固定患者中采取药物治疗对于提高新生儿的存活率、降低新生儿血清感染率和不良疾病发生率上均具有较好帮助,值得在梅毒血清型固定妊娠妇女中推荐应用。     

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center

IntroductionA resurgence of syphilis in Brazil has been reported in recent years.ObjectiveWith this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital.MethodsA retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected.ResultsA total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%).ConclusionThe frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.     

2008～2014年广州市梅毒流行现状及防治策略探讨

目的:为了解广州市贯彻实施《中国预防控制梅毒规划(2010~2020)》的成效,为下一步更好的控制梅毒提供指导。方法:从中国疾病预防控制中心传染病网络直报系统下载2008~2014年广州市医疗机构网络直报的广州市常住人口梅毒病例,SPSS软件分析广州市各类型梅毒基本特征。结果:2014年,广州市梅毒、早期显性梅毒、胎传梅毒、三期梅毒报告发病率分别为54.0/10万、9.1/10万、32.0/10万、1.0/10万,2008年以来分别年均下降2.1%、10.2%、32.5%、0.3%;而2014年隐性梅毒报告发病率为42.2/10万,报告病例数为6 305例,2008年以来分别年均增长0.04%、5.8%。在五种监测的性传播疾病(STD)中,梅毒报告发病率已经降为第二位。病例构成比表明:2014年,早期显性梅毒、胎传梅毒病例构成比分别为16.8%、0.8%,2008年以来年均分别下降8.2%、24.8%,而三期梅毒、隐性梅毒构成比分别为1.8%、80.6%,2008年以来年均分别上升1.8%、3.5%。60岁以上离退休老年梅毒患者逐年上升。结论:过去的6年间,以隐性梅毒为主的广州市梅毒流行上升势头得到遏制,梅毒总体发病率已经退居STDs中第二位,继续落实梅毒综合防治策略、强化以隐性梅毒为主的梅毒疫情报告管理是广州市当前梅毒防治工作的主要任务。     

Are nontreponemal tests suitable for monitoring syphilis treatment efficacy? Evidence from rabbit infection models

ObjectivesWe aimed to characterize kinetics of non-treponamal antibody titres during the natural course of syphilis and explore their roles in monitoring syphilis treatment efficacy.MethodsSixty New Zealand white male rabbits were challenged with Nichols or Amoy Treponema pallidum strains, and the rapid plasma reagin (RPR) test was performed to quantify non-treponemal antibody titres during the infection course. Viable T. pallidum in the challenged rabbits was assessed with rabbit infectivity tests.ResultsThe RPR titres of the Nichols or Amoy strain between no benzathine penicillin G (BPG) and BPG treatment subgroups displayed a similar trend: first ascending and then descending. Compared with baseline, the proportions of fourfold decline in RPR titres in the Nichols or Amoy group presented a similar result on days 30, 60 and 180 between the no BPG and BPG treatment subgroups (0%, 0/5; 80%, 4/5; 100%, 5/5; vs. 0%, 0/5; 80%, 4/5; 100%, 5/5; p 0.999; 0%, 0/5; 80%, 4/5; 80%, 4/5; vs. 40%, 2/5; 100%, 5/5; 100%, 5/5; p 0.098, respectively). Compared with the maximum baseline titre, the proportion of fourfold decline in PRR titre also showed a similar result in the two groups on days 30, 60 and 180 between the no BPG and the BPG treatment subgroups (0%, 0/5; 100%, 5/5; 100%, 5/5, vs. 40%, 2/5; 100%, 5/5; 100%, 5/5; p 0.129; 0%, 0/5; 100%, 5/5; 100%, 5/5, vs. 80%, 4/5; 100%, 5/5; 100%, 5/5; p 0.091, respectively. Moreover, regardless of whether the RPR titres presented a fourfold decline, viable T. pallidum could be detected in untreated rabbits' lymph nodes at 30, 60 and 180 days post infection, while viable T. pallidum was not detected in any of the treated rabbits' lymph nodes.ConclusionsThe RPR titre increased and then decreased (even became negative) during the natural course of syphilis, similar to that seen after BPG treatment. The RPR tetre is thus a questionable indicator of syphilis treatment efficacy.     

Retrospective comparison between non-treponemal and treponemal tests for screening of blood donors for syphilis and their correlation with donor history in a tertiary care teaching hospital

Background and objectivesTreponemal tests provide advantage of better detection during early, late and latent stages of syphilis with equal or higher sensitivity & specificity in comparison to non-treponemal tests. The objective of the present study was to analyse the level of concordance between treponemal and non-treponemal tests for donor screening and to correlate them with donor history.Materials and methodsRetrospective analysis of syphilis screening by treponemal (Chemiluminescence & TPHA) and non-treponemal tests (RPR) was done and donor history for high-risk behaviour and factors associated with false positivity were collected from post-donation counselling and collected data was coded and analysed.ResultsAmongst the 12,000 donors screened, reactivity rate by RPR, TPHA and Chemiluminescence was 0.45%, 0.8% and 1.17% respectively. There was discordance of 62% and 32% for reactive results by RPR and TPHA respectively when compared with Chemiluminescence. History of high-risk behaviour was present in ∼ 50% and 15% of donors with discordant results by RPR and TPHA respectively. Of 34 donors who were reactive only by Chemiluminescence and were followed up, 15% had history of high-risk behaviour and 56% had factors associated with false reactivity.ConclusionTreponemal tests showed high syphilis reactivity amongst blood donors as compared to non-treponemal tests most likely due to their ability to detect early, late and latent syphilis cases. This may confer added transfusion safety in centres dependent on replacement donors without NAT testing by identifying donors with high-risk history with negligible increase in discard rate due to false reactivity.