Examination of the correlation between the manual and automated serological testing methods for syphilis

We evaluated the correlation between the conventional manual serological testing method for syphilis and a novel automated serological testing method and between six different reagents used in the automated method. Twenty-six serum samples, which were positive on non-treponemal manual serological testing, were obtained from 19 patients with early syphilis. The samples were manually analyzed using the non-treponemal serological test for syphilis kit and automatically analyzed using six different reagents approved by the Ministry of Health, Labor and Welfare in Japan. Statistically significant correlations were observed between most of the reagents used in the automated testing (r = 0.652-0.996, P < 0.001), except for one combination of the reagents. In the simple regression analysis, the slope of the simple regression line (range, 0.014-3.040) and some of the regression coefficients were not equal to 1.0. Therefore, it is recommended that when the automated serological testing method is used to test for syphilis, the same reagent should be consistently selected to evaluate the changes in antibody titers. Statistically significant correlations were also observed between the manual method and all the reagents used in the automated method (r = 0.682-0.811, P < 0.001). In this case, the regression coefficients ranged 0.375-6.270, and the simple regression line intercept ranged -71.926 to 4.184. The regression coefficient and the intercept between the manual method and some of the reagents used in the automated method were not similar to the values described in the documentation attached to the reagents used in this study.     

A rare presentation of congenital syphilis: Pemphigus syphiliticus in a newborn infant with extensive desquamation of the extremities

Congenital syphilis is an infection transmitted from mother to fetus and can present with early but variable cutaneous manifestations. In rare situations, a bullous eruption known as pemphigus syphiliticus may develop. We present an unusual case of broad desquamation of the extremities in a newborn infant who was found to have congenital syphilis. Pemphigus syphiliticus should be considered in the differential diagnosis of neonatal bullous eruptions and erosions.     

早期先天梅毒1例

报告1例以四肢弯曲痛为惟一症状的早期先天梅毒。患儿女，70d。四肢弯曲痛40d。未见明显皮损，全身浅表淋巴结未触及。实验室检查；快速血浆反应素试验（RPR）阳性，滴度1：128；梅素螺旋体血凝试验（TPHA）阳性。上、下肢X线摄片示；层状骨膜反应，双侧下肢见对称性骨质破坏。诊断：早期先天梅毒。经正规驱梅治疗后，症状消失，梅毒血清学试验阴转。     

梅毒螺旋体抗体在诊断新生儿梅毒中的应用和讨论

目的:探讨梅毒螺旋体(treponema pallidum,TP)抗体在诊断新生儿梅毒中的应用。方法:分别用甲苯胺红不加热血清试验(TRUST)、TP-ELISA和密螺旋体颗粒凝集实验(TPPA)法对84例确诊新生儿梅毒患者与100例健康新生儿血清进行检测。结果:三种检测梅毒螺旋体抗体方法的灵敏度分别为51.2%、98.8%和100%,相对而言,TRUST法不适合作为诊断新生儿梅毒的初筛试验。结论:TP-ELISA法灵敏度与特异性相对较高,操作简便易行,建议作为诊断新生儿梅毒的初筛试验;TPPA法由于操作繁琐复杂,可结合临床作为新生儿梅毒的确诊试验。     

梅毒的免疫学实验诊断进展

 梅毒被称为“伟大的模仿者”,其临床表现多样,病变部位广泛,单靠临床症状和体征诊断易造成漏诊或误诊,往往需要通过实验室确诊。梅毒螺旋体尚不能在体外进行长时间培养,病原体的形态学检查受样本取材等因素限制,灵敏度低。梅毒螺旋体感染后所产生的免疫反应成为确定梅毒螺旋体感染的重要依据。本文就传统免疫学试验在诊断梅毒方面的应用及新免疫学指标的进展作一综述,旨在为实验室结合自身条件及临床需求选择合适的梅毒免疫学检测方法提供依据。     

早期先天梅毒1例

报告1例早期先天梅毒。患儿女,70d。发热、背部及四肢起暗红色斑伴脱屑1周。患儿及其父母快速血浆反应素环状卡片试验RPR均阳性(1∶16),梅毒微粒凝集试验TPPA阳性。给予水剂青霉素G5万U/kg·d,连续用药14d全身皮疹完全消退。     

荧光定量PCR检测梅毒孕妇引产胎盘脐带组织中的梅毒螺旋体

目的：研究荧光定量PCR(FQ-PCR)检测梅毒孕妇引产胎盘脐带组织中的梅毒螺旋体，评估其在早期诊断先天梅毒中的作用。方法：采用荧光定量PCR技术检测13例梅毒孕妇引产胎盘脐带组织中的梅毒螺旋体DNA。结果：13例胎盘和脐带标本中6例(46．15％)荧光定量PCR检测阳性，6例阳性者中，4例未接受治疗，2例接受了治疗。结论：FQ-PCR可检出胎盘脐带组织中的梅毒螺旋体，可用于先天梅毒的早期诊断，干预治疗并不能完全阻断妊娠期间梅毒螺旋体的垂直传播。     

口服头孢克肟治疗早期显性梅毒疗效评价

目的:评价头孢克肟对早期显性梅毒的治疗效果.方法:以2018年5月至2020年4月本院性病门诊收治的60例早期梅毒患者作为研究对象.随机分为实验组和对照组.实验组口服头孢克肟治疗,每次100 mg,每日2次,连续15天;对照组给予苄星青霉素治疗,每次240万单位,分双侧臀部肌内注射,每周1次,共2次.比较分析两组患者的...     

IgM抗体诊断早期先天梅毒

我们用梅毒特异性19（s)IgM-TPPA抗体检测方法，对5例常规梅毒血清学方法RPR和TPPA两个试验均阳性的新生儿（其母亲已在怀孕时被确诊为不同病期梅毒）进行了检测。患儿中有3例19（s)IgM-TPPA阳性，另2例阴性。最终确诊3例新生儿为先天梅毒。特异性IgM检测应该作为新生儿和早期无症状先天梅毒确诊的实验诊断方法。加强婚前、孕前及早孕期的梅毒筛查和治疗，对控制先天梅毒的发生有重要意义。     

血清梅毒螺旋体IgM在先天梅毒诊断中的意义

目的探讨血清梅毒螺旋体IgM(TP-IgM)检测在先天梅毒诊断中的作用。方法回顾性分析了1215例初诊儿童的梅毒血清学检查结果,并与其临床资料作比较分析。结果梅毒血清学阳性率8.81%(107/1215),其中梅毒螺旋体IgM阳性率6.42%(78/1215)。107例梅毒血清学阳性患儿最后确诊为先天梅毒92例,TP-IgM阳性与先天梅毒确诊符合率为100%。结论血清梅毒螺旋体IgM是诊断婴幼儿先天梅毒有价值的梅毒血清学指标,对鉴别先天梅毒和被动梅毒血症有重要意义。     

梅毒螺旋体特异性抗体对梅毒早期诊断和治疗的评价

目的：为评价梅毒血清特异性抗体在梅毒早期诊断及治疗后的意义。方法：采用蛋白印迹法(Western blottinG,WB)、快速血浆反应素(RPR)试验、梅毒颗粒凝集试验(TPPA)3种方法．对67例梅毒及其中经治疗后随诊18～24个月的21例患者作血清检测。对5年来诊治的临床一期、二期梅毒血清抗体的变化进行分析。结果：20例一期梅毒WB检测出现不同抗体谱条带,其中均有相对分子质量为47000的条带,RPR试验及TPPA部分为阴性。经治疗后随诊18-24个月的21例梅毒患者．18个月内检测时WB9．52％阴转,24个月时28．57％阴转;TPPA阴转的情况同WB;RPR滴度随疗后时间的增加而逐渐下降．6个月内28．57％阴转,24个月85．71％阴转：结论：相对分子质量为47000、17000的条带对早期梅毒的诊断既敏感又特异：部分一期和二期梅毒患者在经过有效治疗后2年,梅毒抗体可以完全消失;RPR试验可用于梅毒治疗期间的疗效判定。     

Atypical manifestations of recent syphilis: study of 19 cases

BackgroundSyphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare.ObjectivesTo describe atypical penile manifestations in patients with early syphilis.MethodsThe present study reports patients who developed cord-like lesions on the penis.ResultsThe study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed.Study limitationsSmall number of patients included.ConclusionsIn view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.     

Sarcoid reactions in a patient with congenital syphilis

A case of sarcoid reactions in a patient with congenital syphilis was reported. The eruptions appeared on the upper extremities and disappeared within 10 days after biopsy. Histological findings were compatible with those of subcutaneous sarcoidosis. The patient also had so-called Hutchinson's teeth, rhagades of the lips, corneal scars and eighth nerve deafness.     

一例先天性梅毒患儿的护理体会

目的:通过对患儿的规范护理验证其效果。方法:严格执行消毒隔离制度,做好皮肤护理、家长心理护理、喂养指导及预防接种工作。结果:经治疗及护理该患儿好转出院。结论:在治疗过程中,规范护理、加强宣教十分必要。     

Multiple primary syphilis on the lip,nipple–areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti‐T. pallidum antibody

Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29‐year‐old man visited our hospital for skin lesions on his lower lip, nipple–areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut‐off index of 39.0. Histopathological examination of a nipple–areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti‐T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase.     

2021年美国CDC梅毒诊疗指南注意事项读解

梅毒是由梅毒螺旋体苍白亚种感染引起的一种性传播疾病.尽管正确使用抗生素可治愈梅毒,但由于梅毒临床表现多样、检测结果解读困难以及神经梅毒诊断困难,梅毒的管理仍面临挑战.因此,2021年美国CDC发布了最新的梅毒诊疗指南,本文主要解读梅毒不同检测方法、反向筛查策略、神经梅毒检测、妊娠梅毒、吉海反应及性伴管理等方面的注意事项...     

High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India

BACKGROUND: Recent syphilis outbreaks have raised concern regarding the potential enhancement of HIV transmission. The incidence of syphilis and its association with HIV-1 infection rates among a cohort of sexually transmitted infection (STI) clinic attendees was investigated. METHODS: 2732 HIV-1 seronegative patients attending three STI and one gynaecology clinic, were enrolled from 1993-2000 in an ongoing prospective cohort study of acute HIV-1 infection in Pune, India. At screening and quarterly follow up visits, participants underwent HIV-1 risk reduction counselling, risk behaviour assessment and HIV/STI screening that included testing for serological evidence of syphilis by RPR with TPHA confirmation. Patients with genital ulcers were screened with dark field microscopy. RESULTS: Among 2324 participants who were HIV-1 and RPR seronegative at baseline, 172 participants were found to have clinical or laboratory evidence of syphilis during follow up (5.4 per 100 person years, 95% CI 4.8 to 6.5 per 100 person years). Independent predictors of syphilis acquisition based on a Cox proportional hazards model included age less than 20 years, lack of formal education, earlier calendar year of follow up, and recent HIV-1 infection. Based on a median follow up time of 11 months, the incidence of HIV-1 was 5.8 per 100 person years (95% CI 5.0 to 6.6 per 100 person years). Using a Cox proportional hazards model to adjust for known HIV risk factors, the adjusted hazard ratio of HIV-1 infection associated with incident syphilis was 4.44 (95% CI 2.96 to 6.65; p<0.001). CONCLUSIONS: A high incidence rate of syphilis was observed among STI clinic attendees. The elevated risk of HIV-1 infection that was observed among participants with incident syphilis supports the hypothesis that syphilis enhances the sexual transmission of HIV-1 and highlights the importance of early diagnosis and treatment of syphilis.     

荧光PCR和蛋白免疫印迹技术在诊断新生儿先天梅毒中的意义

目的:探讨荧光PCR和蛋白免疫印迹技术在诊断新生儿先天梅毒中的运用。方法:对我院收治的50例先天梅毒患儿以及40例正常新生儿进行荧光PCR和蛋白免疫印迹技术在诊断新生儿先天梅毒的敏感度以及特异性研究。结果:荧光PCR其敏感度为98%,特异性为100%,明显高于蛋白免疫印迹的84%以及85%。两种方法比较具有统计学差异性(P<0.05)。结论:荧光PCR在诊断新生儿先天梅毒中较蛋白免疫印迹技术具有更好的敏感性以及特异性,值得在临床中推广。     

两种PCR方法检测隐性梅毒患者梅毒螺旋体DNA的初步比较

目的:比较两种PCR方法对隐性梅毒患者体内梅毒螺旋体DNA的检测效果。方法:分别用47-PCR和pol A-PCR检测40例隐性梅毒患者全血、血浆和血清的梅毒螺旋体47-kD蛋白和DNA聚合酶I基因片段,比较两种方法检测三种标本的阳性率以及两种方法区分早晚期隐性梅毒的阳性率。结果:采用47-PCR检测全血、血浆、血清的TP-DNA阳性率分别为30.0%、37.5%和20.0%,采用pol APCR检测全血、血浆、血清的TP-DNA阳性率分别为22.5%、27.5%和15.0%,两种方法检测结果差异无统计学意义(P值均>0.05);两种方法检测三种血标本的阳性率均为血浆>全血>血清,两种方法在三种标本中检测早、晚期隐性梅毒的阳性率均无统计学差异(P值均>0.05)。结论:47-PCR和pol APCR均可用于检测隐性梅毒患者体内梅毒螺旋体DNA,可辅助用于隐性梅毒的筛查和病情评估。     

A Case of Secondary Syphilis with Mucous Patches on the Hard Palate

A rare case of secondary syphilis showing mucous patches on the hard palate is reported. A 31-year-old male had two erosive patches which were slightly raised on his hard palate. A linear lesion was also present on the inside of his right alveolar process. Many red-brown macules on his abdomen and bilateral inguinal lymphadenopathy accompanied these symptoms. The serological tests for syphilis were positive: VDRL test 1:512, TPHA test 1:20,480, and IgM-FTA-ABS test 1:40. Immunohistochemical staining with rabbit monoclonal antibody to Treponema pallidum by the biotin-streptoavidin system detected treponemal organisms in the paraffin-embedded specimen from his mucous patch. A diagnosis of secondary syphilis was made, and he was given amoxicillin (AMPC) at 750 mg per day for 4 weeks. His eruptions, including the mucous patch, healed in a week.