苄星青霉素、阿奇霉素治疗早期梅毒疗效观察

将120例早期梅毒患者，分为苄星青霉素、阿奇霉素加苄星青霉素及阿奇霉素治疗，观察比较3组的疗效。前两组患者在RPR转阴时问、冶愈率上无显著差异（P〉0．05），但是，前两组患者与第三组患者在RPR转阴时问、治愈率上有极显著性差异（P〈0．01）。苄星青霉素及阿奇霉素加苄星青霉素的疗效优于单用阿奇霉素，阿奇霉素单用失败率高。     

阿奇霉素治疗早期梅毒25例

青霉素是目前治疗梅毒最有效的药物 ,但部分病人对青霉素过敏。阿奇霉素是一种氮环内酯类抗生素 ,服用方便 ,不良反应少 ,作者收集 2 5例经阿奇霉素治疗并接受定期随访的早期梅毒患者 ,观察疗效 ,现报告如下。1　资料与方法1 1　临床资料　从 1998年 4月起 ,作者对 2 5例青霉素皮试阳性或自愿接受阿奇霉素治疗的早期梅素患者 ,既往未经驱梅治疗 ,予以阿奇霉素 (商品名希舒美 ,由辉端制药有限公司生产 )治疗。其中男性 15例 ,女性 10例 ;年龄 18～ 5 3岁 ;具有斑疹型梅毒疹 5例 ,掌跖型梅毒疹 8例 ,银屑病样丘疹型梅毒疹 4例 ,扁平湿疣 4例 ,…     

阿奇霉素治疗妊娠梅毒预防先天性梅毒的临床观察

目的对照苄星青霉素G,探讨阿奇霉素治疗妊娠梅毒、预防先天性梅毒的效果。方法根据妊娠期血清学检查确诊的96例梅毒孕妇,53例青霉素皮试阴性者进入苄星青霉素组,采用240万u肌肉注射,每周1次连续3周为1疗程,43例青霉素皮试阳性者进入阿奇霉素组,口服阿奇霉素1g/d,10天为1疗程。结果组间资料均衡、可比(P>0.05),先天性梅毒的发生率在苄星青霉素G组为3.77%,阿奇霉素组为4.65%,两组间疗效无统计学意义(P=0.765)。结论阿奇霉素治疗妊娠梅毒、预防先天性梅毒的效果与苄星青霉素G相同,对于青霉素皮试阳性的妊娠妇女可以作为青霉素的替代治疗药物。     

阿奇霉素单剂口服治疗早期梅毒的Meta分析

目的评价阿奇霉素单剂(2.0)口服治疗早期梅毒的有效性和安全性。方法应用国际Cochrane协作网系统评价方法对阿奇霉素治疗早期梅毒的随机对照试验(RCT)进行系统评价。计算机检索Cochrane临床对照试验资料库(2007年第2期),MEDLINE(1996-2007),EMBASE(1984-2007)和中文科技期刊数据库(1979-2007),纳入比较阿奇霉素2.0单剂口服与苄星青霉素(240万u,肌注,1次/周)治疗早期梅毒的RCT。由两名评价者独立提取资料并进行质量评估。试验数据的统计分析采用Cochrane协作网提供的RevMan 4.2软件。结果最终纳入了2个RCT并对其疗效进行了Meta分析,表明阿奇霉素2.0单剂口服治疗早期梅毒与对照组相比,疗效差异无显著性[OR 0.72,95%CI(0.47,1.11),P=0.23];均未报道阿奇霉素引起的严重系统性不良反应。结论现有临床证据表明,阿奇霉素2.0单剂口服治疗早期梅毒疗效相当于对照组并且具有较好的安全性。     

多西环素治疗早期梅毒血清固定疗效评价

目的:观察多西环素治疗早期梅毒血清固定的近期疗效.方法:对38例血清固定的早期梅毒患者随机分成3组,治疗组予以多西环素治疗,对照组予以苄星青霉素及阿奇霉素治疗.治疗后分别于3、6个月复查RPR,以RPR转阴为痊愈.结果:治疗6个月后,多西环素治疗组痊愈7例,有效3例,有效率78.57％;苄星青霉素组痊愈5例,有效3例,有效率61.23％;阿奇霉素组痊愈2例,有效2例,有效率36.36％.多西环素治疗组与阿奇霉素组间差异有统计学意义(x2=6.30,P＜0.05).结论:多西环素治疗早期梅毒血清固定有一定的优势,值得进一步研究.     

阿奇霉素对照苄星青霉素阻断梅毒母婴垂直传播的非劣效性研究

目的:以苄星青霉素G为阳性对照,对阿奇霉素阻断梅毒母婴垂直传播临床疗效进行非劣效性分析,寻找青霉素的替代方案。方法:完成临床观察的96例梅毒孕妇,青霉素皮试阴性的进入苄星青霉素G组(53例),青霉素皮试验阳性的进入阿奇霉素组(43例),随访妊娠梅毒孕妇的婴儿,以婴儿结局为参照,评价阿奇霉素对比苄星青霉素G的非劣效性。结果:组间资料均衡,非劣效性检验的界值取对照组的10%时,u=2.58,单侧P<0.05,阿奇霉素治疗妊娠梅毒、阻断梅毒垂直传播的有效率非劣效于苄星青霉素G。结论:阿奇霉素治疗妊娠梅毒阻断梅毒垂直传播非劣效于苄星青霉素G(P<0.05),可以作为苄星青霉素G治疗妊娠梅毒的替代治疗药物。     

阿奇霉素治疗早期梅毒22例疗效观察

1998年1月至1999年5月,我们采用阿奇霉素（希舒美）治疗对青霉素过敏的早期梅毒22例,获较满意的治疗效果,现报告如下：临床资料对青霉素过敏的早期梅毒22例（Ⅱ期海毒16例,潜伏海毒6例）,均为我所性病门诊女性患者,年龄21-48岁。Ⅱ期梅毒均有典型的临床症状。全部病例均经USR定性定量试验和TPHA确证。为比较疗效,在同一治疗时期内,随机抽样采用等星青霉素治疗的早期梅毒22例,作为对照组。治疗方法阿奇霉素治疗组,阿奇霉素500毫克,每日1农口服,连服10天。从开始治疗之日起,一个月进行第一次复诊。以后,第一年每3个月复查1次…     

苄星青霉素、阿奇霉素治疗早期梅毒的临床研究

目的：研究苄星青霉素与阿奇霉素治疗早期梅毒的临床疗效,统计分析两种方案的疗效差异。方法：将我院收治的早期梅毒患者分成两组,分别为苄星青霉素组和阿奇霉素组,每组各80例。治疗2周后统计两组的临床治愈率及皮疹消失时间;分别在用药后第3、6、12、24个月对所有患者进行快速血浆反应素试验（aea）检查,统计转阴率。结果：苄星青霉素组和阿奇霉素组的皮疹消失时间无显著性差异,2周后两组的临床治愈率无显著性差异（P〉0．05）;用药后第3、6、12、24个月两组患者间RPR阴性率无显著性差异（P〉0．05）,治疗24个月后RPR阴性率均高达95％以上。结论：阿奇霉素与苄星青霉素一样,对于早期梅毒具有很好的疗效。     

苄星青霉素与阿奇霉素驱梅治疗的效果比较

目的观察比较苄星青霉素与阿奇霉素驱梅治疗的临床效果。方法按照随机数表法分为两组,对照组35例,采用阿奇霉素治疗,观察组36例,采用苄星青霉素治疗。比较两组患者治疗3个月、6个月、9个月、12个月后的梅毒转阴率,及一期梅毒、二期梅毒的皮损开始消退时间、皮损愈合时间。结果观察组1年内TRUST全部阴转,对照组有2例未阴转,但两组患者在治疗3个月、6个月、9个月、12个月后的转阴率均无明显差异,(P 0.05),两组患者一期梅毒与二期梅毒的皮损开始消退时间与皮损愈合时间均无明显差异,(P 0.05)。结论在梅毒治疗中选择苄星青霉素治疗具有肯定的疗效,其中一期梅毒治疗效果可达100%,二期梅毒治疗效果较一期差,因此需确保治疗的早期性、规范性。阿奇霉素治疗近期疗效与苄星青霉素相当,可作为青霉素过敏患者的替代治疗方案。     

三种方法治疗早期梅毒的疗效比较研究

目的:研究三种方法治疗早期梅毒的疗效。方法:将近二年的118例早期梅毒患者随机分成三组,第一组采用苄星青霉素肌注,第二组采用头孢曲松静点+苄星青霉素肌注,第三组采用阿奇霉素静点+口服。结果:三种方法均具有较好效果,但疗效比较差异有显著性(P<0.05),头孢曲松+苄星青霉素组平均有效时间最短,治愈率最高达94.6%。结论:为尽快治愈早期梅毒,应选择敏感、高效的抗生素,头孢曲松及苄星青霉素为首选,青霉素过敏者可选用阿奇霉素治疗。     

4种常用驱梅药物治疗早期梅毒的疗效评价

梅毒是由梅毒螺旋体(TP)感染引起的一种慢性性传播疾病.近年来,由于其发病率的增加与广泛的传播,以及对人体造成的巨大危害性,梅毒治疗的有效性成为人们日益关注的问题.半个多世纪以来,青霉素一直是治疗梅毒的首选药物,然而随着对青霉素过敏的个体出现与其治疗局限性,以及对阿奇霉素耐药梅毒螺旋体出现后,寻求等效的替代方案成为治疗梅毒的重要手段.本文对青霉素、头孢曲松、米诺环素和阿奇霉素这4种临床常用的驱梅药物治疗早期霉毒的疗效评价进行综述.     

A randomized,comparative pilot study of azithromycin versus benzathine penicillin G for treatment of early syphilis

BACKGROUND: Penicillin is the only medication currently recommended for treatment of early syphilis in non-penicillin-allergic patients. Preliminary data suggest that azithromycin may be effective for syphilis therapy. STUDY DESIGN: This was a randomized, comparative pilot study of intramuscular injections of benzathine penicillin G and two oral azithromycin regimens for treatment of syphilis. METHODS: We randomly assigned patients with early syphilis to treatment with either intramuscular injections of 2.4 million units of benzathine penicillin G or azithromycin administered orally, either as a single 2.0-g dose or as two 2.0-g doses given 1 week apart. Serological response to therapy was evaluated at 3, 6, 9, and 12 months following therapy. Participants whose rapid plasma reagin (RPR) test became nonreactive or whose RPR titer decreased > or =2 dilutions were classified as responding to therapy. When serological tests did not show a response to therapy, the treatment was classified as a failure if RPR titers increased > or =2 dilutions. Nonresponders were those whose serologic titers remained within +/-1 dilution of the initial RPR titer. RESULTS: Cumulative response rates were as follows: benzathine penicillin G, 86% (12 of 14); azithromycin, 2.0-g single dose, 94% (16 of 17); and azithromycin, two 2.0-g doses given 1 week apart, 83% (24 of 29). Therapy failed for one patient treated with benzathine penicillin and one patient treated with the two-dose azithromycin regimen, whereas in six patients the clinical manifestations of infection resolved but there was no serological response. CONCLUSION: Oral therapy with 2.0 g of azithromycin as a single dose or as two doses 1 week apart is a promising alternative to therapy with benzathine penicillin G for syphilis and should be studied further.     

苄星青霉素与阿奇霉素治疗早期梅毒的临床对比研究

目的:探讨苄星青霉素和阿奇霉素治疗早期梅毒疗效比较,以期提高治疗水平。方法:按入院时住院号单双选取2010年9月至2015年9月116例早期梅毒患者为研究对象,分成两组,每组均为58例,分别予苄星青霉素和阿奇霉素治疗,观察治疗后在皮损愈合时间、甲苯胺红非加热血清试验(Toluidine red unheated serum test,TRUST)转阴率、T淋巴细胞亚群变化情况。结果:两组治疗后在平均皮损起效时间、平均皮损痊愈时间和治疗后1个月、3个月、6个月、9个月、12个月梅毒TRUST转阴率比较差异无统计学意义(P均>0.05);两组治疗后CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均明显改善,除CD8^+外均显著升高,CD8^+则显著下降,组内比较差异显著(P<0.05),但两组治疗后CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比较差异不显著(P均>0.05)。结论:苄星青霉素和阿奇霉素均是治疗早期梅毒良好药物,对青霉素过敏者可选择阿奇霉素。     

Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda

OBJECTIVE: The goal of this study was to assess azithromycin and/or benzathine penicillin for treatment of syphilis. METHODS: In a population-based study, participants with serologic syphilis (TRUST with TPHA confirmation) were offered 2.4 MU benzathine penicillin intramuscularly. Intervention arm participants received 1 g presumptive oral azithromycin. We assessed cure rates with penicillin or azithromycin given alone and in combination. Cure assessed after 10 months was defined as seroreversion or a 4-fold decrease in titer. The rate ratio (RR) of cure and 95% confidence intervals (95% CIs) were estimated by log binomial regression. RESULTS: Among 952 cases with syphilis, 18% received penicillin alone, 17% azithromycin only, and 65% dual treatment. The overall cure rate was 61%. Cure rates were lower in males compared with females (RR, 0.89; 95% CI, 0.80-0.99) and in subjects with initial titers > or =1:4 compared with < or =1:2 (RR, 0.77; 95% CI, 0.69-0.86). There was no significant differences in cure rates among HIV-positive and HIV-negative persons. With initial titers < or =1:2, there were no differences in cure rates by treatment regimen. However, with initial titers > or =1:4, significantly higher cure rates were observed with azithromycin alone (adjusted RR, 1.38; 95% CI, 0.97-1.96), and with dual treatment of azithromycin and benzathine penicillin (RR, 1.38; 95% CI, 1.03-1.87) compared with penicillin alone. CONCLUSION: Azithromycin alone or in combination with penicillin achieved higher cure rates than penicillin alone in cases with a high initial TRUST titer. In low-titer infections, the 3 drug combinations were equally effective. HIV status did not affect cure rates.     

Syphilis in adults

Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.     

The cost-effectiveness of single-dose azithromycin for treatment of incubating syphilis

BACKGROUND: Treatment of incubating syphilis with intramuscular benzathine penicillin in exposed sex partners is not always practical in the field, and exposed partners may not adhere to referrals for treatment at clinical facilities. The availability of a single-dose oral therapy could increase the number of partners treated and reduce future infections. GOAL: The goal of the study was to evaluate the cost-effectiveness of directly observed oral administration of azithromycin as an alternative to referral for treatment with benzathine penicillin. STUDY DESIGN: Using published probability and cost estimates, we constructed a decision-analysis model to compare the direct costs and effectiveness of field treatment with azithromycin (1-g single dose) versus referral for standard benzathine penicillin therapy. RESULTS: At public-sector pricing ($11.50 U.S. dollars), directly observed field treatment with azithromycin is cost-saving from both the program and healthcare system perspectives at efficacy levels as low as 75%. Azithromycin therapy is cost-saving at the wholesale price of $17.32 U.S. dollars (sachet formulation) when efficacy is at least 90%. The more expensive tablet formulation (average wholesale price of $27.89 U.S. dollars) is not cost-saving from a program perspective, but it remains cost-saving from a healthcare system perspective if efficacy rates are at least 90%. Azithromycin therapy (1-g single dose) will result in fewer cases of early syphilis among exposed partners, provided that the drug's efficacy is at least 87%. CONCLUSIONS: Azithromycin is a cost-effective alternative treatment for incubating syphilis in settings where standard intramuscular therapy is not practical.     

Syphilis in pregnancy

Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, non-immune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost effective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitized before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to effective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900's.     

Survival of treponemes after treatment: comments, clinical conclusions, and recommendations.

Treponemes may persist after treatment that has been accepted as effective; the reasons for this are discussed. Nevertheless, the epidemic of syphilis after the second world war was not followed by an epidemic of late syphilis, and the results of treatment with penicillin are excellent. Neurological signs may progress in some treated patients, and the standard doses of soluble penicillin and any dose of benzathine penicillin (even with added probenecid by mouth) cannot be relied on to achieve treponemicidal concentrations in the cerebrospinal fluid (CSF). There are no large scale studies of CSF findings after treatment of early syphilis with benzathine penicillin. Standard dosage, such as procaine penicillin G 600 000 international units (IU) by intramuscular injection for 10 days, is the treatment of choice for the patient suffering from uncomplicated early syphilis; this should be preferred to benzathine penicillin, which should only be used when standard treatment as above cannot be given. Treponemicidal concentrations of penicillin should be achieved in the CSF of patients suffering from neurosyphilis by schedules of probenecid by mouth and procaine penicillin by single daily intramuscular injections; treatment should last for 17 to 21 days. Benzathine penicillin should not be used for the treatment of patients suffering from neurosyphilis or from the iritis of late syphilis including that accompanying interstitial keratitis. Treatment for interstitial keratitis should initially be as for neurosyphilis, but in recurrent cases it may have to be prolonged to eradicate Treponema pallidum that is dividing slowly. Doxycycline 200 mg by mouth daily for 21 days provides a supervisable outpatient schedule for patients allergic to penicillin. Cephaloridine (and probably cefuroxime and the new cephalosporins) may be useful for patients who are allergic to penicillin but have not developed anaphylactic allergy. If erythromycin is used for treating syphilis in pregnant women who are allergic to penicillin, then the newborn babies should be treated with penicillin.