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。     

二期梅毒误诊为荨麻疹性血管炎1例

患者女,20岁,全身出现水肿性红斑伴痒10 d,加重4 d。拟诊"荨麻疹性血管炎",行梅毒血清学检查:TPPA(+),RPR(+) 1∶32;皮损组织病理示:角化过度,上皮突存在,棘层肥厚,基底膜完整,真皮浅层及小血管周围可见淋巴细胞及浆细胞浸润。诊断:二期梅毒。给予苄星青霉素240万U驱梅治疗,连用3周。患者皮损已消退,目前在随访中。     

智障的二期梅毒患者3例误诊分析

报告3例误诊的伴有智障的二期梅毒。例1 RPR 1:64(+),TPHA(+),例2 RPR 1:128(+),TPHA (+),例3 RPR 1:128(+),TPHA(+),均确诊为二期梅毒。予以苄星青霉素治疗4周,3个月复查皮损无复发,后随访RPR、TPHA均转阴。提示对某些智障患者就诊时,疑有不确定的皮损,宜做相应的实验室及性病实验室检查,以免漏诊及误诊。     

梅毒患者皮损中Th1/Th2细胞因子表达与RPR试验阴转的关系

目的 了解早期显性梅毒患者皮损中Th1/Th2型细胞因子的表达及其与患者RPR试验阴转的关系.方法 用ABC免疫组化检测30例早期显性梅毒患者皮损中Th1/Th2型细胞因子的表达,并于驱梅治疗结束后的第1,3,6,9,12个月随访这些患者的血清快速血浆反应素环状卡片试验(RPR)情况.结果 10例一期梅毒患者在随访期内血清RPR试验均转阴,皮损中有9例表达Th1/Th2型细胞因子,1例仅有Th1型细胞因子表达;20例二期显性梅毒患者在随访期内血清RPR试验有12例转阴,皮损中16例有Th1/Th2型细胞因子表达,4例仅有Th2型细胞因子表达;早期梅毒皮损Th1型细胞因子的表达与梅毒RPR试验阴转呈正相关,干扰素γ表达越高,血清RPR试验越容易转阴.结论 Th1型细胞因子的早期活化和持续存在在清除局部病原体的过程中起重要作用.     

环状皮损表现二期梅毒1例

报告1例以环状皮损为主要临床表现的二期梅毒。患者,男,阴茎、阴囊多个环状红色斑疹。梅毒血清学检查:快速血浆反应素实验(RPR)阳性,滴度1∶32;TPPA阳性。诊断为梅毒。4周规范治疗后皮损消退。     

环状皮损表现二期梅毒1例

报告1例以环状皮损为主要临床表现的二期梅毒。患者,男,阴茎、阴囊多个环状红色斑疹。梅毒血清学检查:快速血浆反应素实验(RPR)阳性,滴度1∶32;TPPA阳性。诊断为梅毒。4周规范治疗后皮损消退。     

误诊为寻常疣的二期梅毒一例

患者,女,42岁。双手掌多发斑丘疹45天。曾按寻常疣治疗效果不佳。皮损组织病理:表皮角化过度伴角化不全,棘层肥厚,真皮浅层可见大量淋巴细胞和浆细胞。实验室检查:TPPA(+),RPR 1∶64(+)。诊断:二期梅毒。予以苄星青霉素240万U治疗,每周1次,治疗3次皮损消退。     

播散性环状红斑表现的二期梅毒疹1例北大核心CSCD

患者女,30岁。全身皮肤出现环状红斑伴渗出半个月。皮肤科情况:右侧腋下、左侧胸前、外阴可见多个环形红斑,边缘隆起,表面糜烂、溃疡伴有渗出。梅毒螺旋体明胶凝集试验(TPPA)(+),快速血浆反应素实验(RPR)1:32(+)。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,共3周。治疗后皮损消退,随诊RPR滴度下降,目前仍在随诊中。     

二期梅毒误诊2例报道

目的:报告2例二期梅毒误诊病例,二期梅毒皮损多种多样,可有斑疹、丘疹、脓疱疹、斑块、结节等,常易误诊为一般的皮肤病而延误治疗。方法:2例患者查血快速血浆反应素环状卡片试验(RPR)均〉1∶8(+),梅毒螺旋体血凝试验(TPHA)(+)。结果:病理检查,表皮增生,真皮层可见密集混合性炎症细胞浸润,其中大量浆细胞。结论:诊断为二期梅毒。     

以局限性环状斑疹为主要表现的二期梅毒1例

患者女,58岁。双手背淡红色、淡褐色环形斑疹半年。曾被误诊为"皮炎"、"环状肉芽肿"、"体癣","环形红斑",予以上述疾病对症治疗均无效。皮损组织病理示:镜下可见表皮内水疱,无明显棘层细胞松解现象,真皮浅层及血管周围可见以淋巴细胞和浆细胞为主的炎性细胞浸润。皮损组织梅素螺旋体(TP)染色以及巢式聚合酶链反应(PCR)均为阴性;血梅毒螺旋体抗体(TPPA)(+),快速血浆反应素试验(RPR)1∶16。诊断为二期梅毒。予苄星青霉素240万U肌肉注射,3次/周,皮疹迅速消退,半年后随访RPR 1∶4.     

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。     

Pityriasis rosea and the need for a serologic test for syphilis

A rapid plasma reagin (RPR) test was performed in fifty patients with a clinical diagnosis of pityriasis rosea to determine the frequency of syphilis as the underlying cause of the eruption. In none of the fifty patients was syphilis the cause. Experience in diagnosing skin diseases, frequency of syphilis in the community served, and the characteristics of the individual eruption are important factors in the decision to perform an RPR test.     

Occurrence of congenital syphilis after maternal treatment with azithromycin during pregnancy

OBJECTIVE: To evaluate the efficacy of azithromycin in preventing congenital syphilis. METHOD: Five pregnant women with syphilis who were allergic to penicillin were given azithromycin, 1 g daily orally or intravenously, in different hospitals. The duration of the therapy ranged from 1 day to 10 days. A second course of therapy was provided at 28 weeks gestation. The babies were given a physical examination and blood test for serum rapid plasma reagin test (RPR), treponema pallidum hemagglutination test (TPHA), and fluorescent treponemal antibody adsorption test (FTA-ABS-19-sIgM) within three months after birth. RESULTS: Five infants born to these mothers developed skin rashes. Four of the infants had hepatomegaly and one showed osteochondritis. The tests RPR, TPHA, and FTA-ABS-19-sIgM were positive. The RPR titers varied from 1:64 to 1:256 and the babies were diagnosed with congenital syphilis. They were successfully treated with penicillin. CONCLUSIONS: Successful therapy for syphilis during pregnancy demands maternal care as well as prevention or cure of congenital infection. The failure of azithromycin in preventing congenital syphilis in our report suggests that azithromycin should not be recommended as an alternative in treating syphilitic pregnant women or fetal syphilis.     

Performance of the rapid plasma reagin and the rapid syphilis screening tests in the diagnosis of syphilis in field conditions in rural Africa

OBJECTIVES: To assess the rapid plasma reagin (RPR) test performance in the field and to evaluate a new rapid syphilis test (RST) as a primary screen for syphilis. METHODS: 1325 women of reproductive age from rural communities in the Gambia were tested for syphilis seropositivity using a RPR 18 mm circle card and a RST strip. Within 1 week a repeat RPR and a TPHA test were carried out using standard techniques in the laboratory. RESULTS: Comparing field tests to a diagnosis of "active" syphilis defined as laboratory RPR and TPHA positive, the RPR test was 77.5% sensitive and 94.1% specific; the RST was 75.0% sensitive and 95.2% specific. The RST was easier to use and interpret than the RPR test especially where field conditions were difficult. In this setting with a low prevalence of syphilis in the community (3%), the chance of someone with a positive test being confirmed as having serologically active syphilis was less than 50% for both tests. CONCLUSIONS: The appropriateness of syphilis screening using RPR testing in antenatal clinics and health centres should be questioned if there is a low prevalence in the population, conditions for testing are poor, and resources limited. There is still an urgent need for an appropriate rapid syphilis test for field use.     

A study evaluating ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy

OBJECTIVES: To evaluate the efficacy of ceftriaxone in pregnant women who were diagnosed with early syphilis. STUDY: Eleven women with a history of penicillin allergy, positive skin test, but prior history of safe usage of cephalosporins were included. Ceftriaxone (250 mg) was given intramuscularly once daily for 7 and 10 days to patients with primary and secondary syphilis, respectively. A second course of therapy was provided at 28 weeks' gestation. The rapid plasma reagin test (RPR) was measured before and after therapy. The blood of neonates was also tested at delivery and during the follow-up period. RESULTS: The serum RPR titers of 11 mothers decreased fourfold, 3 months after treatment. Ten patients developed negative RPR results. The serum RPR was negative at delivery or 6 months after delivery in all neonates. CONCLUSIONS: Ceftriaxone may be considered as an alternative for treatment of early syphilis in pregnancy.     

以梅毒疹和脱发为表现的幼儿获得性梅毒一例

患儿,男,3岁6个月.肛周、外生殖器处红褐色斑疹、斑丘疹1月余,虫蚀状脱发1周,无自觉症状,无性接触史.梅毒血清学检查:梅毒螺旋体颗粒凝集试验(TPPA)阳性,快速血浆反应素环状卡片试验(RPR)滴度为1:32.其父母、祖父母梅毒血清学试验阴性,外祖父母TPPA、RPR均阳性,滴度分别为1:16和1:64.诊断为幼儿获...     

Evaluation of a digital flocculation reader for the rapid plasma reagin test for the serological diagnosis of syphilis

We described the ASiManager-AT digital flocculation reader to demonstrate concordance between visual and digital readings of the rapid plasma reagin test for detection of antibodies in the serum of patients with syphilis. A qualitative and quantitative rapid plasma reagin was performed on each serum samples giving a concordance of 98.6% and 99.7%, respectively, for reactives and 100% for nonreactives.     

Painful red leg nodules and syphilis: a consideration in patients with erythema nodosum-like illness

An adolescent girl presented with the classical physical findings of painful red nodules on the legs; the lesions were suggestive of erythema nodosum. The usual underlying causes were explored and found to be absent. Because she was sexually active, the patient was also routinely screened for sexually transmitted diseases. A rapid plasma reagin test was performed and found to be strongly positive. The confirmatory fluorescent treponemal antibody test was also positive. A diagnosis of syphilis was made, and she was treated with benzathine penicillin G (2.4 X 10(6) units). This report is a reminder that when a patient is suspected of having erythema nodosum, the physician should check for syphilis as well as for tuberculosis, sarcoidosis, reaction to a drug, and streptococcal disease. Panniculitis can be an important clinical sign of secondary syphilis that should never be overlooked.     

Prenatal syphilis infection is a possible cause of preterm delivery among immigrant women from eastern Europe

OBJECTIVE: to evaluate the prevalence of maternal syphilis at delivery and neonatal syphilis infection in an Italian urban area, in connection with the increased flow of immigration. STUDY DESIGN: A prospective surveillance study was carried out in Bologna, Italy, from November 2000 to March 2006. All pregnant women were screened for syphilis at delivery. Infants born to seropositive mothers were enrolled in a prospective follow-up. RESULTS: During the study period 19,205 women gave birth to 19,548 infants. A total of 85 women were seropositive for syphilis at delivery. The overall syphilis seroprevalence in pregnant women was 0.44%, but it was 4.3% in women from eastern Europe and 5.8% in women from Central-South America. Ten women were first found positive at delivery, as they did not receive any prenatal care. Nine of these were from eastern Europe. All their infants were asymptomatic, but six had both reactive immunoglobulin (Ig)M western blot and rapid plasma reagin tests and were considered prenatally infected. Three of six were preterm (gestational age <37 weeks). CONCLUSIONS: In Italy, congenital syphilis infection is strictly related to immigration from eastern Europe. Although it is asymptomatic, it could cause premature delivery. Therefore, it is necessary to perform serological tests during the third trimester in mothers coming from endemic areas to adequately treat syphilis in pregnancy and prevent congenital infection. If the mother's test results are not available at delivery, it is necessary to investigate the newborn, especially if it is born prematurely.     

Evaluation of three serological tests manufactured in Belarus for the diagnosis of syphilis

The performance of three serological tests manufactured in Belarus for the diagnosis of syphilis, i.e. a microprecipitation reaction (MPR) and two enzyme-linked immunosorbent assays (ELISAs) were compared with internationally recognized assays, namely the rapid plasma reagin test and the Treponema pallidum passive particle agglutination assay (TPPA). Sera from 392 consecutive patients attending Brest (Belarus) regional dermatovenereological dispensaries were tested. The sensitivity of the MPR test was low (77.3%) compared with the rapid plasma reagin test, while the specificity was high (100%). In contrast, both Belarusian ELISAs performed well when compared with the TPPA (sensitivities of 99.2% and 100%, specificities of 98.7% and 99.0%, respectively). There is a clear need to improve the sensitivity of the existing Belarusian MPR test or to use a more sensitive screening test in order to improve diagnosis of the disease in Belarus.