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.     

头孢曲松钠联合苄星青霉素治疗潜伏梅毒血清快速血浆反应素的转归

目的 观察头孢曲松钠联合苄星青霉素治疗潜伏梅毒患者血清快速血浆反应素（RPR）的转归.方法 88例潜伏梅毒患者被随机分为观察组45例（早期潜伏梅毒23例,晚期潜伏梅毒22例）和对照组43例（早期潜伏梅毒22例,晚期潜伏梅毒21例）.观察组采用头孢曲松钠2g/d,连用14d,休息1周后苄星青霉素240万U,1次/周,连续3次;对照组应用苄星青霉素240万U,1次/周,连续3次;治疗后的第3、6,9,12,18,24个月复查梅毒RPR试验和梅毒螺旋体血凝试验（TPPA）.结果 随访至治疗后的第24个月时,观察组中早期潜伏梅毒患者有16例血清RPR转阴,痊愈率为69.57％,晚期潜伏梅毒患者有6例血清RPR转阴,痊愈率27.27％;对照组中早期潜伏梅毒患者有8例血清RPR转阴,痊愈率为36.36％,晚期潜伏梅毒患者有2例血清RPR转阴,痊愈率为9.52％.2组中的早期潜伏梅毒痊愈率相比差异有统计学意义（P＜0.05）,晚期潜伏梅毒痊愈率相比差异无统计学意义（P＞0.05）.结论 头孢曲松钠联合苄星青霉素治疗早期潜伏梅毒的效果较单一使用苄星青霉素显著,表现在血清RPR阴转时间缩短,转阴率高,血清固定率降低,对晚期潜伏梅毒患者的治疗效果与单纯使用苄星青霉素没有差异.     

Clinical value of the Treponema pallidum haemagglutination test.

In 1,129 patients attending the Department for Sexually Transmitted Diseases, the serum was examined by three screening tests (VDRL slide, RPCF, and TPHA) and twelve cases of syphilis (1 per cent. of patients attenting the clinic) were discovered. Six of these patients were considered to have latent syphilis (5 acquired, 1 congenital) and were detected only by the TPHA; all six cases were confirmed by the FTA-ABS, The TPHA failed to detect three of the remaining six cases (2 primary and 1 very early, the latter in a contact of a patient with primary syphilis). All six cases were, however, detected by the VDRL. In seven cases, the TPHA was positive in the absence of other evidence of present or previous syphilis. In these cases the FTA-ABS was also negative. The clinical application of the TPHA test in the detection of syphilis is discussed.     

The use of immunoenzyme analysis for recording specific IgM antibodies in syphilis patients

Specific IgM antibodies were assayed in blood sera of 230 patients with various forms of syphilis and of 561 controls. Enzyme immunoassay (EIA) sensitivity has made up 95.8 percent for primary syphilis, 93.8 percent for secondary new, 78.3 percent for secondary recurrent, 35.4 percent for early latent, 37.5 percent for late latent, and 80 percent for unknown syphilis. False-positive reactions were recorded in 5.5 percent of cases and were as a rule seen in the sera from patients with diffuse diseases of connective tissue. IgM EIA has proved highly effective in testing the sera from patients with primary seronegative syphilis and from subjects who had sexual intercourse with patients suffering from contagious forms of syphilis.     

晚期隐性梅毒患者超声心动图检查结果分析

目的:了解晚期隐性梅毒患者心血管系统损害的临床特点。方法:对45例病期超过2年的晚期隐性梅毒患者进行彩色超声心动图检查,分析结果,并与20例健康者进行比较。结果:45例晚期隐性梅毒患者中,23例(51.11%)心脏彩色超声心动图有异常发现,对照组1例(5%)有异常发现,经比较两类人群心动图异常发现率有统计学差异,χ2=12.64,P<0.05。45例晚期隐性梅毒患者中,二尖瓣关闭不全13例,三尖瓣关闭不全12例,左房扩大11例,左室扩大1例,主动脉关闭不全7例,主动脉增宽10例,轻度肺动脉高压3例,轻度左室舒张功能不全7例,室间隔及左室前壁运动降低、少量心包积液、中度左室舒张功能不全、左室容量增大、左室射血分数降低1例。结论:晚期隐性梅毒患者心血管系统损害以二尖瓣关闭不全、三尖瓣关闭不全、左房扩大、主动脉关闭不全、主动脉增宽为主,超声心动图是诊断心血管梅毒的主要方法。     

2010-2019年山东省梅毒流行特征分析

目的：了解山东省梅毒流行特征及趋势,为梅毒防治措施的制定提供科学依据。方法：对2010-2019年山东省16个地级市报告的梅毒病例资料进行流行病学分析,描述梅毒报告病例的三间分布,计算发病率、构成比、年均增长率,采用χ2趋势检验分析梅毒的发病趋势。结果：山东省梅毒报告发病率由2010年6.15/105增至2019年20.24/105,呈逐年增长趋势（χ2=12475.40,P<0.01）,年均增长率为14.15%。其中,隐性梅毒占比增长最快,由2010年的31.98%增至2019年的74.28%。高发地区为鲁东半岛的威海市、青岛市及鲁南地区的枣庄市,年均报告发病率在20/105以上。各年女性报告病例数均多于男性,男女性别比为0.89∶1。从年龄分布来看,20~35岁人群梅毒报告病例数占比最多,占总病例数的39.41%;60~79岁人群报告发病率增速最快,年均增长率为22.82%。20类职业中,农民报告病例数最多,占43.94%。结论：山东省梅毒报告发病率呈较快增长,其中隐性梅毒增长尤为迅速。需加强梅毒筛查和防治,特别是高发地区及高发人群。     

Venereal disease among immigrant workers in Vienna.

Official physical examinations of migrant workers upon immigration are required before work permits are issued. The screening of 74,983 applicants during 1972 to 1974 revealed sera reactive to serological tests for syphilis in 0-8 per cent. (range 0-5 to 1-1 per cent.) of all persons concerned and fifteen cases of early syphilis. The incidence of recent infections among immigrants is lower than that reported among the inhabitants of Vienna. General statistics on the spread of venereal diseases among immigrant workers are not available after they start work. Some evidence is provided by those who had to be traced for compulsory examination because they had defaulted from treatment or follow-up, because they were suspected of clandestine prostitution, or because they were reported to be sources of infection. 257 (60-6 per cent.) of 414 individuals who were wanted for reasons of syphilis control could be located and eighteen (7 per cent.) of those who were examined had early infectious lesions.     

Misclassification of the stages of syphilis: implications for surveillance

SHORT SUMMARY: Syphilis cases were reviewed to see if reported stages met the Centers for Disease Control and Prevention case definition. Classification was excellent for primary and secondary and good for late latent, but half of early latent and unknown duration were misclassified. New surveillance definitions are suggested, comments requested. BACKGROUND: Uncertainty when staging latent syphilis should lead clinicians to call it late latent (requires more treatment) and disease investigators to call it early latent (priority for partner investigation). Accurate surveillance requires consistent case definitions. OBJECTIVE: Assess validity of reported syphilis stages. METHODS: Record reviews in 6 jurisdictions to determine if reported cases met the Centers for Disease Control and Prevention case definitions. RESULTS: Nine hundred seventy-three records from 6 jurisdictions in 2002 showed excellent agreement for reported primary (94.0%) and secondary (95.4%), good agreement for late latent (80.2%), and poor agreement for early latent (48.4%) and unknown duration (49.7%). Unknown duration (age < or =35 and nontreponemal test titer > or =32) was often misinterpreted to mean "not known." Early latent (within the past year, documented: seroconversion, fourfold titer increase, symptoms, or contact with an independently documented early syphilis case) was often misinterpreted to include patients with risky behavior, young age, or high nontreponemal test titers. CONCLUSIONS: The unknown duration stage should be dropped. Surveillance of latent syphilis would be more consistent if cases were reported as having high or low titers on nontreponemal test. Alternative approaches are solicited from readers.     

Immunological responses in late syphilis.

Thirty-one serum samples from 18 patients with clinically established late syphilis and 1319 from patients at other stages of the disease were fractionated by density gradient ultracentrifugation and examined for antilipoidal and antitreponemal antibodies of the IgM and IgG classes. Sera from the patients with late syphilis always showed persistent concentrations of antilipoidal IgM and IgG and of antitreponemal IgG but never yielded detectable concentrations of antitreponemal IgM. When treated, these patients' antibody titres did not decline. Patients with secondary or latent syphilis also showed this serological picture after treatment but only transiently; their antibody titres continued to decline in a way which clearly distinguished them from the cases of late syphilis. It is suggested that patients whose sera persist in showing the stable pattern described may develop late symptomatic syphilis.     

Impact of reverse sequence syphilis screening on new diagnoses of late latent syphilis in Edmonton, Canada

After the introduction of reverse sequence syphilis screening in Alberta, Canada, there was an increase in the diagnosis of late latent syphilis in individuals screening positive with the treponemal test; these cases required additional public health follow-up.     

治疗干预对不同妊期潜伏梅毒孕妇新生儿影响的研究

目的:探讨对不同妊娠时期的潜伏梅毒孕妇进行驱梅治疗后对其新生儿的影响。方法:对早、中、晚妊娠并发潜伏梅毒的50例孕妇分别进行驱梅治疗,于新生儿出生一个月内进行梅毒快速反应试验(RPR)、梅毒螺旋体颗粒凝集试验(TPPA)和梅毒IgM(TP-IgM)检测,比较新生儿先天性梅毒的发病状况,并与13例未经治疗的潜伏梅毒妊娠所生新生儿的检测结果相对照。结果:不同时期妊娠并发潜伏梅毒经驱梅治疗后,新生儿先天性梅毒的发生率分别为5.00%、14.29%、35.71%,而未经治疗的潜伏梅毒孕妇所生新生儿先天性梅毒的发生率为76.92%,差异有统计学意义(P<0.05)。结论:及早对孕妇进行梅毒血清学筛查并及时对潜伏梅毒孕妇进行驱梅治疗是降低新生儿先天性梅毒发病率的关键。     

2014—2019年中国梅毒流行趋势与特征分析

目的:分析2014—2019年中国梅毒流行趋势和特征,为制定防治对策提供依据。方法:应用描述性流行病学方法对2014—2019年中国梅毒报告病例数据进行"三间分布"分析。结果:2014—2019年,梅毒报告发病率由30.93/10万增长至38.37/10万,年均增长4.41%;其中一期与二期梅毒、胎传梅毒报告发病率年均...     

梅毒患者外周血单核细胞亚群的研究

目的 探讨未经治疗的一期、二期和隐性梅毒患者外周血单核细胞亚群的变化.方法 流式细胞仪检测58例未经治疗的梅毒患者(包括隐性梅毒36例,一期梅毒8例,二期梅毒14例)的外周血单核细胞CD14highSCD16-亚群和CD14+CD16+亚群.结果 与正常人对照组相比.梅毒患者CD14+CD16+单核细胞所占比例明显升高,所占总单核细胞比例为12.0%±5.0%,而CD14highCD16-Mo亚群明显降低.为88.0%±5.1%,二者差异均有统计学意义.隐性梅毒、一期梅毒、二期梅毒之间CD14highCD16-亚群和CD14+CD16+亚群差异无统计学意义.结论 未经治疗的梅毒患者外周血单核细胞亚群的变化可能与梅毒螺旋体的持续感染有关,与各临床分期相关性不明显.     

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.     

早期潜伏梅毒和晚期梅毒外周血淋巴细胞亚群检测

目的检测早期潜伏梅毒和晚期梅毒外周血淋巴细胞亚群,了解机体在梅毒无症状感染时淋巴细胞亚群的变化。方法应用流式细胞仪检测57名志愿者外周血CD3+、CD4+、CD8+和CD1+9淋巴细胞亚群,其中早期潜伏梅毒(ELS)14例,晚期梅毒(LS)24例,正常对照组19例。结果ELS、LS和正常对照三组人群CD3+、CD8+和CD1+9差异无统计学意义(P均>0.05),但CD4+和CD4+/CD8+差异有统计学意义(P<0.05),ELS组与LS组比较,差异也无统计学意义,但均与正常对照组差异有统计学意义(P<0.05)。结论ELS和LS组CD4+和CD4+/CD8+水平上升,但CD3+、CD8+和CD1+9水平正常。提示ELS和LS体液免疫无明显减弱,但细胞免疫增强,有利于消灭梅毒螺旋体。     

Evaluation of cerebrospinal fluid in asymptomatic late syphilis

To help determine the role of lumbar puncture in evaluation of patients with asymptomatic late syphilis, we reviewed results of cerebrospinal fluid (CSF) testing of 47 asymptomatic patients with syphilis. Syphilis was of unknown duration (n = 27) or known duration of greater than one year (n = 20), and all patients had reactive rapid plasma reagin (RPR) tests and reactive fluorescent treponemal antibody absorption tests. Thirty-two per cent of subjects had abnormal CSF findings; these included elevated protein in nine (19%) of 47 and pleocytosis in six (13%) of 47. In most cases, the etiology of these abnormalities was uncertain. Asymptomatic neurosyphilis, diagnosed on the basis of a reactive Venereal Disease Research Laboratory (VDRL; Atlanta, GA) test of CSF, was present in three (6%) of 47 patients. Of the eight patients with RPR titers of greater than or equal to 1:128, three (38%) had neurosyphilis. These results suggest that lumbar puncture is indicated for patients with asymptomatic late syphilis or syphilis of unknown duration.     

Epidemiology of reported syphilis among U.S. Navy and Marine Corps personnel, 1985-1987

The authors analyzed four hundred fifty-six cases of syphilis reported via a passive disease surveillance system in the Navy and Marine Corps during 1985-1987. The annual incidence of all reported cases significantly increased during this time from approximately 16 out of 100,000 in 1985 to 23 out of 100,000 in 1987. Much of this increase is attributed to concurrent increased rates of primary syphilis and late latent syphilis. Incidence rates for all stages of syphilis combined increased significantly among men and blacks during these years. Cumulatively, most reported patients were male (422, 96.1%), aged 20-24 years (204, 55.1%), E-3 (junior) enlisted pay grade (101, 30.1%), and black (217, 53.8%). Sexual exposures were reported most frequently from the eastern U.S. coast and from western Pacific countries.     

儿童获得性梅毒14例分析

目的 分析儿童获得性梅毒的临床表现及其治疗方法。方法 回顾分析2007年7月至2010年12月诊治的14例儿童获得性梅毒患者的临床资料。结果 14例患者中10例为二期梅毒,早、晚期潜伏梅毒各2例。14例患者均有与现症梅毒患者密切接触史或被成人梅毒患者口内咀嚼食物后喂养史。所有患者血清快速血浆反应素环状卡片试验（RPR）及梅毒螺旋体血凝试验（TPHA）均阳性。其皮损主要发生于口腔黏膜,躯干少见,表现为黏膜白斑和黏膜湿丘疹、皮肤脓疱等。7例患者被误诊为其他皮肤病。结论 儿童获得性梅毒临床常被误诊或忽视。有不典型皮疹、尤其是与活动性梅毒患者有密切接触者,应考虑儿童获得梅毒可能。     

1990年至1994年全国38个城市监测点梅毒流行病学调查报告

为了全面地了解我国梅毒发生、发展和分布的特点及流行的规律,为制订控制梅毒的对策提供科学依据,我们于1990～1994年对全国38个城市监测点用统一的方法、步骤和表格作了连续五年的梅毒发病情况的调查.总计发现梅毒病例5078例,占STD构成比为1.34%,平均年发病率为0.94/10万,平均年增长率为23.06%,男性平均年发病率为1.09/10万,女性平均年发病率为0.75/10万.我国目前流行的主要是早期梅毒,占94.70%,其中一期梅毒20.16%,二期梅毒46.51%,早期隐性梅毒28.10%;此外,三期梅毒为2.10%,先天梅毒为0.70%.以20～29岁和30～39岁年龄组发病率最高,分别为1.80/10万和1.56/10万.从职业分析以个体者、待业者、驾驶员发病率为最高.我国梅毒发病率较高的地区,北方是新疆、陕西、甘肃和天津,南方是福州、桂林、杭州、南宁和海口一些旅游城市,尤其是南方城市近年来呈明显上升之趋势.作者认为:必须继续进行对我国梅毒流行的监测,加强提高梅毒诊断技术和治疗方法,加强长效青霉素制剂的生产和供应,以保证梅毒防治工作的开展.