妊娠梅毒母婴传播干预后先天梅毒发病情况分析

目的了解深圳市启动预防与控制梅毒母婴传播项目后,先天梅毒的发病情况,为先天梅毒的预防、诊断、治疗及随访管理提供参考依据。方法对宝安区妇幼保健院建档的疑似先天梅毒患儿的发病情况进行分析,对孕妇开展血清学筛查及确诊,根据19S-IgM-梅毒螺旋体明胶凝集试验(19S-IgM-TPPA)确诊先天梅毒,对疑似先天梅毒病例,根据随访结果进一步明确诊断。结果 2004-2009年共检测孕妇67 693例,孕妇梅毒阳性率0.59%;在310例疑似先天梅毒患儿中共确诊79例,发病率从2004年的431例/10万活产儿下降至2009年的127例/10万活产儿。结论 6年间孕妇梅毒的阳性率及先天梅毒的发病率均显著性下降。     

上海市1986～2001年梅毒实验室监测结果分析

目的 分析上海市1986～2001年性病门诊病例和部分社会人群梅毒感染情况，探索梅毒流行规律，发现高危人群，为有关部门开展性病防治工作提供决策依据。方法 收集和整理上海市1986～2001年的性病门诊病例和部分高危人群的血清学检查结果，结合梅毒确诊试验进行统计学处理。结果 1986～2001年共对20355人次做了梅毒确诊试验，包括梅毒暗视野检查、梅毒螺旋体血凝试验和荧光螺旋体抗体吸收试验，共发现梅毒阳性13518人次，年均阳性检出率为58．63％。其中男性检出率51．53％，女性检出率70．65％，女性明显高于男性。从1995年起，上海市每年梅毒阳性检出数呈逐年快速上升趋势，并出现先天梅毒和小儿梅毒增多现象。结论 上海市性病门诊病例中，梅毒检出数和检出率逐年升高，发病形势日趋严峻。     

Primary and secondary syphilis: a histopathological study

We present a study of biopsies taken from skin lesions of 44 patients presenting with primary or secondary syphilis. In most primary lesions erosion or, more often, ulceration was present, with a dense inflammatory infiltrate. In secondary syphilis a wide variety of histological changes was present. Blood vessels were frequently involved, with marked endothelial swelling and often proliferation. Treponemes were demonstrated with the Steiner staining method in all investigated cases of primary syphilis and in 71% of secondary syphilis cases. Treponemes were present throughout the dermis, particularly perivascularly, and in the dermal-epidermal junction zone. In two specimens of secondary syphilis treponemes were located predominantly in the epidermis, but there were always some microorganisms demonstrable in the dermis. The inflammatory infiltrate was often located in a perivascular coat-sleeve-like arrangement. In this study plasma cells and lymphocytes were present in all specimens of primary and secondary syphilis. Syphilitic lesions differed from yaws lesions mostly in the location of treponemes and the affection of blood vessels. In this histopathological study of early syphilis, treponemes did not show the epidermiotropic character of yaws, and blood vessel changes were more pronounced than in yaws. Unfortunately, due to the protean histopathological manifestations described in venereal syphilis and in yaws, these two treponemal diseases cannot always be differentiated on histological grounds alone.     

南京市2005-2010年法定报告的淋病和梅毒流行病学特征

目的了解近年来南京市淋病、梅毒发病的流行趋势及特点,为制定有效的防制对策提供科学依据。方法对南京市2005—2010年全国疾病监测信息报告管理系统中,淋病、梅毒的疫情资料进行描述性流行病学分析。结果近6年来,南京市淋病发病率逐年下降,从2005年的59.45/10万下降至2010年的14.63/10万;梅毒发病率逐年增长,从2005年的25.35/10万增长到2010年的37.83/10万。梅毒分期中,以早期(一、二期)显性梅毒为主,占73.27%;各年度梅毒病例的分期差异有统计学意义(P<0.0001)。淋病、梅毒的发病年龄均集中在20～49岁,分别占83.25%和72.37%。淋病各年龄组均是男性多于女性;梅毒小年龄组女性多于男性,大年龄组则是男性多于女性,差异有统计学意义。职业分布中两者均以工人、家务及待业和农民为主。结论应根据南京市淋病、梅毒的流行病学特征,采取针对性的预防措施,控制淋病、梅毒的发病率。由于梅毒与艾滋病之间的密切关系,使得控制梅毒的发病率对于控制艾滋病的流行具有重要意义。     

福建省三明市1989～1999年梅毒流行病学分析

目的了解和掌握三明市梅毒流行动态,为有关部门防治性病提供决策依据.方法对1989～1999年全市梅毒疫情资料进行整理分析.结果1989～1999年全市登记性病20236例,其中梅毒2322例,占同期性病数的11.47%.1989年首先报告3例,占性病总数的0.37%,1999年报告433例,占17.64%,呈逐年上升趋势.1992年以前每年报告在20例以下,1993年后呈跳跃式上升,1995年起每年报告在300例以上,并出现胎传梅毒、小儿梅毒和晚期隐性梅毒.男女性别比为1.301,年龄4天～67岁,职业以工人、个体及无业人员居多,占62.19%,已婚占77.09%,非婚性接触传染占70.20%.结论 11年来三明市梅毒流行呈逐年上升趋势,早期梅毒占多数,传染性强,如不采取有效措施,今后几年梅毒仍有可能在较高水平流行.     

梅毒螺旋体IgM抗体检测在梅毒诊断中的意义

目的 探讨检测血清梅毒螺旋体IgM抗体在梅毒诊断中的临床意义.方法 北京佑安医院性病门诊就诊者中已确诊为不同临床分期梅毒患者207例,治疗前采用免疫印迹法(TP-IgM-WB)检测血清中的IgM抗体同时进行快速血浆反应素环状卡片试验(RPR).患者规范治疗后,每3个月复查1次,1年后每半年复查1次,随访两年.首次RPR...     

1995-2009年十堰市梅毒流行病学特征分析

目的了解十堰市1995～2009年梅毒疫情的趋势和特点,为制定防治措施提供依据。方法对1995-2009年的疫情资料进行描述性统计分析。结果1995-2009年十堰市累计报告梅毒3477例,年均发病率6．90／10万,发病率呈逐年上升趋势。Ⅰ期梅毒1156例（占33．42％）,Ⅱ期梅毒806例（占23．30％）,Ⅲ期梅毒20例（占0．58％）,胎传梅毒130例（占3．76％）,隐性梅毒1347例（占38．94％）。患者中,男性病例1698例,女性病例1779例。发病以20～49岁为主,占67．44％;职业以农民（占17．75％）、工人（占16．59％）、家务及待业者（占12．42％）为主。地区分布,以十堰城区、丹江口市和房县为主,分别占60．68％、10．07％和9．84%。结论十堰市梅毒发病率较高,防治工作任务艰巨。     

New HIV cases attributable to syphilis in the USA: estimates from a simplified transmission model.

OBJECTIVE: Because syphilis can raise the likelihood of HIV transmission and acquisition, syphilis prevention in the USA has the potential benefit of reducing the number of new cases of HIV. We developed a simplified transmission model to estimate the annual number and cost of new, heterosexually-acquired HIV cases in the USA attributable to syphilis. DESIGN: We estimated the number of heterosexual, HIV serodiscordant partnerships in which syphilis was present in 1996. The model included the probability of transmission of HIV (with and without the presence of syphilis) and other parameters based on data from recent literature. Published direct costs (HIV treatment costs including antiretroviral therapy) and indirect costs (e.g., lost productivity) per case of HIV were used to estimate the annual cost of HIV cases attributable to syphilis. The potential savings in averted HIV costs related to syphilis were used to estimate the potential benefits of a syphilis elimination program. RESULTS: In 1996, an estimated 1082 new heterosexual cases of HIV in the USA could be attributed to syphilis. These cases represented direct costs of US$ 211 million and indirect costs of US$ 541 million; yielding US$ 752 million in total costs. Over 15 years, a syphilis elimination program could save over US$ 833 million (discounted at 3% annually) in averted direct medical costs of syphilis-related HIV infections. CONCLUSIONS: If the only benefit of syphilis elimination were to prevent new HIV cases attributable to syphilis, a national syphilis elimination program costing less than US$ 833 million would probably pay for itself.     

Persons with early syphilis identified through blood or plasma donation screening in the United States

The number of persons with early syphilis who donated blood between 1995 and 2000 in the United States was estimated using data collected in the National Electronic Telecommunication System for Surveillance (NETSS). To distinguish paid from volunteer donors, cases reported in 2000 were analyzed. For the 6 years, 22 primary, 81 secondary, and 413 early latent syphilis cases were identified through donation screening. In 2000, 69 cases of early syphilis were identified through donation screening in 16 states. In 6 states that reported 53 of these cases, 31 case subjects (58%) were volunteer donors and 22 (42%) were paid donors. Eighty-one percent of volunteer donors and 64% of paid donors reported no risk factors for syphilis. After adjustment for variation in NETSS use, it was estimated that, over the 6 years, approximately 1200 cases of early syphilis were detected nationally through donation screening, and 58% of the case subjects were volunteer donors.     

Risk factors of syphilis co-infection among HIV-infected men who have sex with men in Tel-Aviv,Israel

Syphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR?=?1.8 [1.2–2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR?=?2.2 [1.5–8.2]), especially with HIV-infected partner (OR?=?3.2 [1.1–7.9]).

In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.     

Field performance of a rapid point-of-care diagnostic test for antenatal syphilis screening in the Amazon region, Brazil

We evaluated an immunochromatographic point-of-care (POC) syphilis test in 712 pregnant women under field conditions in remote communities of the Amazon region (Brazil), and identified risk factors for syphilis. Women were screened by POC test using whole blood obtained by fingerprick, the fluorescent treponemal antibody absorption (FTA-Abs) test as the gold standard and the Venereal Diseases Research Laboratory (VDRL) test to determine test performance in active syphilis. Multivariate analysis was conducted to identify factors associated with syphilis infection. Among women, 2.2% had syphilis (positive FTA-Abs) and 0.8% active syphilis (FTA-Abs and VDRL positive). In all, 2.2% of samples were positive by the POC test. The sensitivity, specificity, positive and negative predictive values were 62.5% (95% confidence interval [CI]: 38.6-81.5), 99.1% (95% CI: 98.1-99.6), 62.5% (95% CI: 38.6-81.5) and 99.1% (95% CI: 98.1-99.6), respectively. The POC test identified 62.5% (10/16) of syphilis cases, 66.7% (4/6) of active syphilis cases and all high-titre syphilis cases (VDRL > 1:8). Older age was associated with syphilis infection. The rapid test performed moderately well as a screening tool for low-risk populations. This combined with on-site testing and same day treatment could expand antenatal syphilis screening programmes in distant communities characterized by difficult access to antenatal services and infrequent clinical follow-up visits.     

Patterns of HIV and syphilis infection in Northern Thailand 1998-2001

Northern Thailand has been the epicentre of a largely heterosexually transmitted HIV epidemic that has recently involved married women. In preparation for HIV-prevention trials, we investigated patterns of HIV and syphilis risk through annually measured HIV and syphilis prevalence among northern Thai, peri-urban, community-dwelling men (n=2564) and women (n=3907) aged 18-35 years between 1998 and 2001. Crude HIV and syphilis prevalence were 3.3% and 2.7% for men and 2.3% and 2.1% for women, respectively. In logistic regression models of HIV and syphilis, compared with married men/women, widowers and widows were at increased risk (odds ratio; 95% confidence interval) of syphilis (7.86; 1.56-39.6 and 3.3; 1.14-9.61, respectively) and HIV (12.68; 3.23-49.8 and 41.3; 24.3-70.3, respectively). The oldest women were at lower risk of HIV (0.43; 0.22-0.85). For men and women, those with syphilis were approximately three times more likely to have HIV. These unique population data illustrate evolving sex parity of HIV burden in northern Thailand.     

Syphilis surveillance in France, 2000-2003

This article describes syphilis trends, characteristics of patients from 2000 to 2003 in France and trends of the benzylpenicillin benzathine 2.4 million UI sales from 2001 to 2003. The ongoing surveillance system for syphilis case reporting since 2001 has been set up in volunteer settings, mostly public settings where STI treatment is offered. Clinical case reporting is complemented by sexual behavioural data based on a self-administered questionnaire. From 2000 to 2003, 1089 syphilis cases were reported in France, increasing from 37 cases in 2000 to 428 in 2003. Overall, 96% of syphilis cases were in men with a mean age of 36.5 years and 70% of whom were born in France. The proportion of syphilis cases with HIV co-infection decreased over time from 60% in 2000 to 33% in 2003. The most affected area by the syphilis epidemic is the Ile-de-France region, mainly the city of Paris. The greatest proportion of syphilis cases diagnosed in men who have sex with men (MSM) were in the Ile-de-France region, where they made up 87% of cases, compared with 75% in other regions. Among the patients who completed the self-administered questionnaire on sexual behaviour, 83% reported having casual sex partners in the 3 months prior to their syphilis diagnosis. Trends in the sales of benzylpenicillin benzathine 2.4 million UI in private pharmacies are similar to those observed in the surveillance system, and increased between 2001 and 2003. In conclusion, syphilis transmission is still ongoing in France in 2003 and the role of unprotected oral sex in the transmission of syphilis should be emphasised.     

Detection of Treponema pallidum sp pallidum DNA in latent syphilis

In this study, polymerase chain reaction (PCR) techniques were used to detect Treponema pallidum DNA in samples from patients with latent syphilis. Sixty-nine patients with latent syphilis and 18 with treated syphilis were included. Whole blood, plasma, sera and ear scrapings, totalling 235 samples from patients with latent syphilis, were obtained. Three PCR assays (47-PCR, polA-PCR and M-PCR assays) were performed. The 47-PCR yielded the highest number of positive samples -92/235 (39.1%), followed by M-PCR -90/235 (38.3%) and polA-PCR -73/235 (31.1%). Ear scrapings presented the highest number of positives (47/84 -56%), followed by plasma samples (36/84 -42.9%), whole blood (32/84 -38.1%) and sera (21/84 -25%). In conclusion, we have confirmed that T. pallidum can be found in blood of patients with latent syphilis. The 47-PCR technique was found to be the most sensitive, whereas ear lobe scrapings seem to be the best specimen for detection of T. pallidum DNA in latent syphilis.     

Study confirms the link between MSM and web. San Francisco officials use on-line interventions

When the number of early syphilis cases in San Francisco increased from 41 in 1998 to 495 in 2002, and more than two-thirds of these cases also were HIV-positive, health department officials decided that new prevention interventions were needed. The syphilis outbreak also was notable in how it mainly involved men who have sex with men (MSM) by 2002. In 1998, only 22% of the early syphilis cases involved MSM, whereas in 2002, 88% involved MSM. Investigators with the San Francisco Department of Public Health discovered that a significant majority of the MSM syphilis cases listed the Internet as venue for meeting sexual partners.     

Antenatal syphilis screening in sub-Saharan Africa: lessons learned from Tanzania

OBJECTIVES; To synthesise data from four recent studies in Tanzania examining maternal syphilis screening and its operational implementation in routine antenatal clinics (ANC), drawing lessons for strengthened antenatal services for the prevention of mother-to-child transmission (PMTCT) of HIV. METHODS: The impact of untreated maternal syphilis was examined in a retrospective cohort of 380 Tanzanian women. Effectiveness and cost-effectiveness of screening and single dose benzathine penicillin treatment were prospectively examined in 1688 pregnant women. Observation, interviews and facility audits were carried out in health facilities within nine districts to determine the operational reality of syphilis screening. RESULTS: Overall, 49% of women with untreated high titre syphilis experienced an adverse pregnancy outcome compared with 11% of uninfected women. Stillbirth and low birthweight rates among those treated for high- or low-titre syphilis were reduced to rates similar to those for uninfected women. The economic cost was $1.44 per woman screened and $10.56 per disability-adjusted life year saved. In the operational study, only 43% of 2256 ANC attenders observed were screened and only 61% of seroreactive women and 37% of their partners were treated. Adequate training, continuity of supplies, supervision and quality control are critical elements for strengthened antenatal services, but are frequently overlooked. CONCLUSIONS: Maternal syphilis has a severe impact on pregnancy outcome. Same-day screening and treatment strategies are clinically effective and highly cost-effective, but there are significant challenges to implementing syphilis screening programmes in sub-Saharan Africa. Current PMTCT interventions present an opportunity to reinforce and improve syphilis screening. Increasing PMTCT coverage will involve similar operational challenges to those faced by syphilis screening programmes.     

2000-2011年广州地区梅毒疫情报告结果分析

目的分析2000-2011年11年间广州地区梅毒疫情的形势,为制定梅毒防治措施提供依据。方法先后收集整理性病疫情网（2000-2003）及中国疾病预防控制疫情网（2004-2011）广州市梅毒疫情资料,分析各类型梅毒的年报告发病率及患者的人口特征现状。结果 2011年梅毒报告发病率为104.61/10万,较2000年上升1.51倍,其间Ⅰ期、II期梅毒发病率年均降低5.28%,而隐性梅毒、胎传梅毒、Ⅲ期梅毒年均分别增长21.56%、18.34%、35.59%。2011年的报告病例中,60.63%的病例来自临床术前检测、咨询门诊和专项调查等,而各医院性病门诊报告的病例数只占39.37%。低学历,低收入人群、60岁以上高龄及性活跃期年龄好发是当前梅毒患者的特征。结论广州地区梅毒疫情上升出现结构性特征,早期梅毒逐年下降,胎传梅毒、隐性梅毒和Ⅲ期梅毒逐年上升,加强梅毒筛查及疫情管理、阻断梅毒母婴传播、加强重点人群的健康教育,是当前梅毒控制的主要任务。     

2012年广州市网络直报梅毒准确性核查分析

目的调查分析广州市网络直报梅毒的诊断报告质量及其影响因素。方法从传染病直报系统下载广州市医疗机构2012年内报告的梅毒病例,分区整理并按照5∶2∶2∶1抽查隐性、一期、二期、三期/胎传梅毒,计算梅毒诊断的正确率及报告准确率;Logistic回归分析影响梅毒报告准确率的因素。结果共核查2402例梅毒病例。资料完整、纳入分析者2224例,梅毒诊断准确率为90.06%,报告准确率为45.37%,过度报告率为46.09%,分类误诊率为8.54%。各类梅毒诊断准确率位于34.38%~99.38%,差异有统计学意义(χ2=556.24,P0.01);胎传梅毒诊断准确率最低,隐性梅毒最高。而各类梅毒报告准确率位于14.58%~61.76%,其间差异有统计学意义(χ2=76.33,P0.01);胎传梅毒报告准确率最低,二期梅毒最高;而过度报告率隐性梅毒最高56.38%,胎传梅毒最低21.88%;分类误诊率胎传梅毒最高63.54%。Logistic回归结果显示,报告医疗机构开设有皮肤性病科、性病专科诊疗机构及皮肤性病科医生进行的梅毒疫情报告、诊疗期间开展梅毒快速血浆反应素试验(RPR)定性定量检测,有助于提高梅毒报告质量。结论广州市医疗机构报告的梅毒整体上诊断准确,但疫情报告准确率亟待提高,各类梅毒普遍存在过度报告,胎传梅毒误诊普遍。应进一步加强梅毒诊疗培训,医疗机构应加强院内梅毒报告工作的管理,优化梅毒诊断报告流程。     

天津市梅毒血清学检测能力验证对梅毒疫情的影响

目的通过分析2009-2010年梅毒流行趋势,并结合天津市梅毒血清学检测能力验证考核结果,探寻天津市梅毒疫情变化的影响因素,为制定梅毒疫情防治策略提供科学依据。方法随机选取4家医疗机构,收集其2009年第一季度到第三季度的梅毒阳性血清并进行梅毒血清学复验。制备并发放梅毒血清样本,各管辖的性病实验室的常规检测人员,按其实验室常规检测方法,在规定的时间内检测并将检测结果回报。采用SPSS 15.0软件对收集的检测结果与梅毒疫情数据进行统计分析。结果在随机抽取的4家医疗机构收集的血液样本中,性病实验室与确证中心实验室梅毒检测结果的符合率为77.43%(247/319)。性病门诊实验室梅毒血清学检测能力验证结果显示,合格率为97.30%(36/37),其中优秀占78.38%(29/37),良好占13.51%(5/37),合格占5.41%(2/37),不合格率为2.70%(1/37)。结论以梅毒血清学确证能力建设为抓手,可以在一定程度上减少梅毒疫情报告中的误报情况,从而展示天津市真实的梅毒发病情况,为进一步制定梅毒疫情控制方案提供真实数据。     

Syphilis Among Men Who Have Sex With Men (MSM) in Taiwan: Its Association With HIV Prevalence, Awareness of HIV Status, and Use of Antiretroviral Therapy

To understand how awareness of HIV-positivity and the use of antiretroviral therapy associated with syphilis infection, 361 MSM attending 16 Hong-Pa (drug-and-sex parties) in Taiwan were studied. The syphilis rate of individuals within their first 2 years after HIV diagnosis (awareness) was lower than that in individuals who had not been diagnosed HIV infection prior to Hong-Pa (unawareness) (Adj OR = 0.24, P < 0.05). Notably, there was a decrease in the beneficial effect of HIV-positive status awareness on syphilis prevention with an increase in time since notification. Moreover, antiretroviral therapy was not associated with a lower incidence of syphilis, and syphilis infection peaked during the treatment dropout period. In conclusion, the duration of a protective effect of knowing one’s HIV-positivity against syphilis infection was short, and the highest risk of syphilis infection was observed when patients discontinued antiretroviral therapy. Future research should examine the behavioral mechanisms involved in this prevention failure.