1990年全国38个城市监测点梅毒流行病学调查报告

总给了1990年全国24个省(市)38个性病监测点梅毒流行病学调查资料.一年中,总计发现梅毒病人809例.平均年发病率为0.75/10万人、男性发病率(0.97/10万)明显高于女性(0.52/10万),新祖、陕西、甘肃和河北等省区的发病率较其他省区为高.本组梅毒病人多为性活跃年龄者,20-39岁年龄组患者占73.54%.对性和性行为的态度有明显改变.患者中初中以下文化程度占71.32%.早期梅毒占97.21%(787例),三期梅毒1.65%(l3例),先天梅毒1.14%(9例).     

Late syphilis mimicking a pseudolymphoma of the skin

After a period of declining incidence of syphilis in most of Western Europe until the late 1990s, reports about an increasing trend have been published recently. In contrast to the rising incidence of early syphilis, cases of late (tertiary) syphilis are rarely seen in developed countries. In this report, we describe a 54-year-old patient with infiltrated erythematous plaques on his forehead and neck that histologically revealed a dense lymphocytic cell infiltrate with numerous plasma cells. The serologic examination was characteristic of syphilis and in conjunction with the clinical presentation and the patient's history led to the diagnosis of tertiary syphilis. The diagnosis of this late stage of syphilis can be difficult as clinical pictures can be misleading. Peculiar skin lesions should always remind clinicians of this infectious disease which has still to be considered in differential diagnoses in dermatology.     

The clinical and serological characteristics of early congenital syphilis today. 2

Examinations of 207 children suffering from early congenital syphilis have revealed a lowered incidence of involvement of the bone system, liver, and spleen. Syphilitic rhinitis, chorioretinitis, and orchitis are less frequently recorded. Wassermann's test has been negative in 7.24 percent of patients.     

早期胎传梅毒15例回顾性分析

目的　探讨早期胎传梅毒的临床表现。方法　回顾性分析本院 1999年 5月～ 2 0 0 3年 3月收治的 15例早期胎传梅毒。结果　皮肤损害 15例 ,早产儿 8例 ,低体重儿 9例 ,贫血 12例 ,肝脾肿大 11例 ,骨损害 1例 ,鼻炎 4例 ,新生儿肺炎 4例。梅毒血清学检查 :TPPA阳性 15例 ,RPR阳性 14例。选用青霉素治疗 ,临床症状消失 5例 ,好转 8例 ,死亡 1例 ,放弃治疗 1例。发生吉海反应 2例。结论　典型皮肤损害可作为早期胎传梅毒诊断的主要依据 ;对不明原因的新生儿贫血应警惕胎传梅毒 ;治疗中可发生吉海反应应引起注意。     

Syphilis serologic prevalence monitoring among STD clinic clients: correlation with reported syphilis incidence, San Diego, CA, 1985-2004

OBJECTIVE: To describe the serologic test for syphilis (STS) prevalence among STD clinic clients, determine the correlation between STS prevalence trends and reported community-diagnosed primary and secondary (P&S) case incidence, and evaluate the usefulness of STS prevalence monitoring as a component of syphilis surveillance. STUDY: During the period 1985-2004, 21,4336 STS were done among STD clinic clients and a variety of STS prevalence measures were evaluated. RESULTS: From 1985-1991, 10.2% of STS were positive, which declined to 5.6% during 1992-2004. Overall, STS positivity (>or=1:8) and male positivity (>or=1:8) trends were correlated with reported community-diagnosed P&S case incidence and case incidence in men (r = 0.58 and r = 0.81, respectively). Male STS positivity (>or=1:8) began increasing in 2001, 1 year before the increase in syphilis incidence in men, which began in the latter half of 2002 and occurred mostly among men who have sex with men. CONCLUSION: In a syphilis outbreak in men who have sex with men, STS prevalence (>or=1:8) among male STD clinic clients was a useful measure of syphilis case incidence trends and may provide an early warning for a subsequent increase in community-diagnosed case incidence.     

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。     

Bone lesions in early syphilis detected by bone scintigraphy

We report a case of early syphilis with multiple bone lesions which all resolved after treatment with penicillin. We discuss why bone lesions may be more prevalent than generally believed and why 99m-Tc-MDP-bone scintigraphy is more sensitive than radiography in detecting syphilitic periostitis.     

Bone lesions in early syphilis detected by bone scintigraphy.

We report a case of early syphilis with multiple bone lesions which all resolved after treatment with penicillin. We discuss why bone lesions may be more prevalent than generally believed and why 99m-Tc-MDP-bone scintigraphy is more sensitive than radiography in detecting syphilitic periostitis.     

Recent declines in reported syphilis rates in eastern Europe and central Asia: are the epidemics over?

BACKGROUND: Since the early 1990s, major syphilis epidemics have occurred in the Newly Independent States (NIS) of the former Soviet Union. The new and rapidly changing societal and economic conditions in these countries challenge their traditional approaches to the control of sexually transmitted infections (STI). Nevertheless, following a steady increase until 1997, reported syphilis incidence has declined during the past 3 years in most parts of the region. We examine these trends against a background of ongoing changes in service delivery, care seeking behaviour, and case finding practices. METHODS: National syphilis surveillance data reported to the WHO Regional Office for Europe were compiled and analysed, and supplemented with information presented at recent expert meetings and with results from ongoing research. RESULTS: Since 1997, reported syphilis incidence either stabilised or declined in many locations in the NIS, but further increased in others, especially in rural areas. Congenital syphilis continued to increase in all countries, except Latvia. The proportion of self presenting cases versus cases detected through screening declined, and so did notifications of early compared with late forms of syphilis. Patients increasingly seek care in the private formal and informal healthcare sectors which hardly participate in case reporting. CONCLUSIONS: Recent declines in syphilis notifications in the NIS are at least partially a reflection of a reduced intensity of active case finding and of changes in reporting completeness because of a shift in service utilisation from the public to the private/informal sectors. Syphilis rates are still high, indicating that both public and private sectors have to respond more efficiently to the needs of many people at risk of STI. The collection of serial STI prevalence data is recommended to be able to validate trends in notifications.     

Congenital Syphilis,Case Report and Epidemiologic Features in Spain

Abstract: Congenital syphilis (CS) is a preventable disease. Nevertheless, since the year 2000, there has been an upward trend in incidence in Spain, similar to what has occured in other European countries. We present a case of early congenital syphilis showing the classical features of the disease, in which skin lesions gave the clue that led to the diagnosis.     

Venereal syphilis in tropical Africa.

A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin.     

Effect of highly active antiretroviral therapy on incidence of early syphilis in HIV-infected patients

OBJECTIVES: To evaluate the incidence of early syphilis based on time from initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients. STUDY DESIGN: Five hundred thirty-nine HIV-positive patients undergoing HAART were followed up to 4 years to identify early (primary or secondary) syphilis. Incidence rate trends according to time from HAART initiation were evaluated by Poisson regression after adjustment for calendar year. RESULTS: With median follow-up of 2.9 years, 56 (10.4%) patients experienced early syphilis, 17 (3.2%) with primary syphilis, and 39 (7.2%) with secondary syphilis. The overall incidence rate of early syphilis for 4 years after the start of HAART was 4.57 per 100 person-years (95% confidence interval, 3.45-5.93). The incidence rate of early syphilis significantly increased in proportion to the years after the start of HAART (3.4-6.1 per 100 person-year, P for trend <0.001). CONCLUSIONS: Early syphilis incidence in HIV-infected patients increased in proportion to HAART duration. The finding suggests that screening for syphilis in HIV-infected patients who initiate HAART should be encouraged with attention to the time passed since HAART initiation.     

Early syphilis and the skeletal system

Eleven patients with early syphilis were selected at the University Dermatology Clinik in Frankfurt/M, and bone scintigraphy was performed to check for bone lesions as sign of a systemic character of the disease. The 99mTc-methylene diphosphonate scintigrams were compared with those in a control group of 50 patients. Focal hot spots indicating early metabolic changes in bone were found in all 11 patients with early syphilis. The difference between the two groups was statistically significant. The most frequent sites of hot spots were the joints of the palmar and plantar first digits. Foci were also found at the tibial tuberosities. The results support the hypothesis that reactive focal osteitis is caused by penetrating treponemes in the very early stages of syphilis. Also, we can confirm the high sensitivity of bone scintigraphy for the early detection of metabolic changes in bone compared with conventional X-ray images.     

Pregnancy loss, infant death, and suffering: legacy of syphilis and gonorrhoea in Africa.

Africa in the 1980s appears to be facing problems associated with syphilis and gonorrhoea during pregnancy similar in severity and magnitude to those faced by the western world in the early 1900s. From a review of published reports, the prevalence of syphilis seroreactivity in pregnant women in many parts of Africa is at least 10%. Assuming this level of seroreactivity, we estimate that 5% to 8% of all pregnancies surviving past 12 weeks will have an adverse outcome caused by syphilis, such as spontaneous abortion, perinatal or infant death, or a living infant with syphilis. Our findings on gonorrhoea during pregnancy are almost as startling. The prevalence of gonorrhoea in pregnant women in many parts of Africa is at least 10% and it approaches 20% in some areas. The incidence of gonococcal ophthalmia neonatorum in neonates appears to be between 2% and 4%. We recommend commitment of health resources to initiatives to prevent and control sexually transmitted disease in Africa and additional research into the cost effectiveness of different prevention and control approaches.     

Venereal syphilis in tropical Africa.

A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin.     

不同阶段驱梅治疗的妊娠结局分析

目的探讨在不同阶段驱梅治疗后的妊娠结局,以及其对新生儿的影响。方法根据注射首剂青霉素时的孕期,将261例妊娠梅毒患者分为3组:早孕组(妊娠≤12周)92例,中孕组(妊娠13～28周)94例,晚孕组(妊娠≥29周)75例。各组均予以规范青霉素驱梅治疗,治疗结束后比较三组梅毒孕妇的妊娠结局、围产儿预后及先天性梅毒的发病率,同时根据孕妇血清快速血浆反应素环状卡片试验(RPR)滴度高低,分为RPR≤1:4组和RPR≥1:8组,观察血清RPR滴度与围产儿预后的关系。结果早孕组、中孕组和晚孕组三组梅毒孕妇的足月分娩率分别为92.83%,89.36%和53.33%;先天性梅毒发病率分别为2.17%,5.32%和28.00%。早孕组及中孕组梅毒孕妇的妊娠结局和围产儿预后均明显优于晚孕组,先天性梅毒发病率明显低于晚孕组。RPR≤1:4组159例,先天性梅毒发病率为1.26%;RPR≥1:8组102例,先天性梅毒发病率为25.49%,差异有显著性(P0.05)。结论妊娠合并梅毒时,首剂青霉素治疗早晚和其妊娠结局、围产儿预后及先天性梅毒发病率密切相关,早期进行正规青霉素治疗可以有效防止胎儿感染梅毒,且梅毒孕妇血清RPR滴度高低是影响其妊娠结局的重要因素。     

Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis,its differential diagnoses,management, and current recommendations

Syphilis is an ancient disease that has re‐emerged in the last decade. It is prevalent among men who have sex with men and has increased in incidence with certain ethnic groups. It usually presents as primary or secondary syphilis and can progress to tertiary syphilis if not treated. Primary syphilis will classically manifest as a single, painless ulcer with smooth, clean, and raised borders on the genitals or less often on the oral mucosa. Unusual primary syphilis cases have been reported and can be easily misdiagnosed with a resulting delay of treatment. Secondary syphilis is a systemic disease, wherein the treponemes have disseminated to various organ systems, typically presenting with characteristic mucocutaneous lesions. Tertiary syphilis has a higher rate of morbidity and mortality; as such, the aim of this article is to provide the readers with tools to recognize early syphilis and prevent its progression to late stages. In this review, we present a likely case of unusual primary syphilis mimicking herpes progenitalis as well as a compilation of all atypical cases of primary syphilis from 1973 to 2015. We will also review the differential diagnosis, management, and recommendations for each stage of syphilis.     

Early syphilis in the United States identified in corrections facilities, 1999-2002

BACKGROUND: Corrections facilities offer public health practitioners an opportunity to gain access to large numbers of persons at risk for syphilis and other sexually transmitted diseases. GOALS: The goals of this study were to estimate the number of early syphilis cases (primary, secondary, early latent) identified from corrections facilities from 1999 to 2002 and to determine characteristics of persons likely to be identified with syphilis in corrections facilities. STUDY DESIGN: We determined the proportion of cases identified from corrections facilities for the entire United States using case reports by state health departments to the Centers for Disease Control and Prevention (CDC). We calculated the proportion of cases identified in corrections facilities in the 30 counties with the largest number of cases in 2002 and determined the male-to-female syphilis rate ratios. RESULTS: From 1999 to 2002, there were 63,293 cases of early syphilis reported to the CDC, of which 61,691 (97.5%) had a known source of report. Of these, 7725 (12.5%) noted corrections facilities as the source of information. Among men, 4747 (13.0%) cases were from corrections and in women 2974 (11.8%) of cases were. We found that counties with a higher proportion of cases from corrections facilities were likely to have lower male-to-female rate ratios (r = -0.66, P <0.001). CONCLUSIONS: A substantial proportion of early syphilis cases is identified from corrections facilities. Among counties with the largest number of cases, a higher proportion of syphilis cases was identified from corrections facilities in counties with higher rates of heterosexually transmitted syphilis.     

Sífilis maligna: revisión sistemática de los casos publicados entre los años 2014-2018

Malignant syphilis (MS) is a rare manifestation of secondary syphilis which mainly occurs in immunocompromised individuals such as those coinfected with human immunodeficiency virus (HIV). However, recent reports have described MS in immunocompetent individuals. To describe the characteristics of individuals with MS and associated risk factors, a review of case reports published from 2014 to 2018 was conducted. Out of 45 published case reports, 33 cases (73%) occurred in HIV-positive individuals with majority having CD4 counts < 500 cells/mm³. Of the 12 cases (27%) in HIV-negative individuals, half had comorbidities such as diabetes mellitus, alcoholism, drug abuse, psoriasis, and hepatitis. The most frequent manifestation of MS was ulceronodular cutaneous lesions with central adherent crust, which affected the face, trunk, and limbs. Given the increasing number of MS regardless of the immune status, dermatologists and general practitioners should be vigilant to allow early diagnosis and treatment, hence reducing their morbidity.     

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.