梅毒与HIV共感染

梅毒与HIV感染呈现特定人群聚集和共同增长的流行病学特点.近年来,二者的相互影响逐渐受到关注.梅毒可通过多种机制促进HIV的传播,与HIV的耐药变异及一过性的病毒载量增长可能存在相关性,但并未显著恶化HIV感染的预后.同时,HIV感染也可能改变梅毒的临床表现及血清试验结果,并导致梅毒的治疗失败和复发,然而,合并HIV感染的梅毒治疗方案仍存在争议.因此,有必要对梅毒与HIV共感染的免疫学机制开展深入研究,从而为进一步理解二者的致病机制及制定更加有效的防治措施奠定基础.     

梅毒及其与HIV合并感染的免疫机制研究

梅毒不同的临床表现多取决于细胞免疫的强度和持续时间,巨噬细胞、CD4+T淋巴细胞、CD8+T淋巴细胞、自然杀伤细胞均在梅毒感染的细胞免疫中起重要作用.而与HIV合并感染更是增加了其免疫机制的复杂性和临床表现的多形性.在与HIV合并感染的二期梅毒中,Th1、Th17型细胞免疫增强,而Th2型细胞免疫的改变目前尚不确切.梅毒与HIV合并感染时两者的免疫机制、病程以及疗效均可能发生影响,因此,有必要进行梅毒患者的HIV筛查和HIV感染者的梅毒筛查,以便获得及时有效的治疗.     

苄星青霉素治疗梅毒合并HIV感染的疗效评价

目的:比较苄星青霉素治疗合并HIV感染的梅毒和非合并HIV感染梅毒的疗效。方法:对来自VCT门诊男男人群合并HIV感染的梅毒患者(A组31例)和非合并HIV感染的梅毒患者(B组64例)均给予苄星青霉素240万U肌肉注射,每周1次,共3次,分别于治疗后的第3、6、9、12个月门诊随诊,比较两组患者的临床及血清学疗效。结果:治疗后的第3、6、9、12个月A组总有效率分别为80.65%、83.87%、82.14%和85.19%,B组分别为81.25%、83.61%、86.89%和91.67%,两组差异均无统计学意义(P0.05)。结论:苄星青霉素治疗男男性行为人群中HIV合并梅毒感染和单纯梅毒感染的疗效相当。     

梅毒与HIV共感染

梅毒与HIV感染呈现特定人群聚集和共同增长的流行病学特点。近年来,二者的相互影响逐渐受到关注。梅毒可通过多种机制促进HIV的传播,与HIV的耐药变异及一过性的病毒载量增长可能存在相关性,但并未显著恶化HIV感染的预后。同时,HIV感染也可能改变梅毒的临床表现及血清试验结果,并导致梅毒的治疗失败和复发,然而,合并HIV感染的梅毒治疗方案仍存在争议。因此,有必要对梅毒与HIV共感染的免疫学机制开展深入研究,从而为进一步理解二者的致病机制及制定更加有效的防治措施奠定基础。     

血清RPR滴度与神经梅毒相关性分析

目的:确定梅毒患者血清RPR滴度神经梅毒的相关性。方法:2013年6月至2016年6月就诊的360例梅毒患者(合并HIV感染120例)行腰椎穿刺及神经梅毒相关检查。结果:240例非HIV感染患者中,神经梅毒确诊或疑似病例68例,阳性率28.33%。120例HIV感染患者中,神经梅毒确诊或疑似病例61例,阳性率50.83%。HIV感染组中血RPR滴度对数为1∶1,1∶2,1∶4,1∶8,1∶16,1∶32的患者中神经梅毒阳性率分别为0%,33.33%,40%,75%,75%,66.67%,非HIV感染组分别为10%,15.38%,32.14%,35.71%,50%,50%,两组中神经梅毒阳性率与血清滴度均呈线性相关(P0.05)。结论:神经梅毒与血清RPR滴度相关,滴度越高,神经梅毒可能性越大。     

梅毒合并HIV感染的临床特点及研究进展

梅毒与HIV感染同属性传播疾病,两者感染相互影响。梅毒可以促进HIV的传播,同时HIV可以改变梅毒的临床表现及自然进程,影响梅毒的血清学试验结果,增加了梅毒的诊疗困难。本文总结梅毒合并HIV感染的流行病学、临床特征、诊断及治疗,使医务人员进一步了解两者合并感染的特点。     

43例HIV合并梅毒感染临床及脑脊液分析

目的：分析HIV合并梅毒的临床表现及实验室特征。方法：回顾性分析2014年3月至2017年7月在我院皮肤科进行腰穿的HIV合并梅毒感染的43例患者的人口学特点、临床表现及实验室检查。结果：43例患者中男39例,女4例,中位年龄为31.5岁。有3例（7.0%）符合神经梅毒诊断（脑脊液表现为白细胞≥20/μL并伴有脑脊液RPR阳性）。这3例患者均为二期梅毒,临床表现均为眼部症状,CD4均＜350个/μL,血清RPR均≥1:32。结论：在HIV合并梅毒感染时,神经梅毒尤其好发于血清RPR≥1:32,CD4＜350个/μL的二期梅毒患者。     

同时合并梅毒、生殖器疱疹的艾滋病1例

目的：报道1例合并梅毒、生殖器疱疹的艾滋病（AIDS）并初步探讨误诊、漏诊原因。方法：回顾分析2007年4月我科住院的1例合并梅毒、生殖器疱疹的AIDS患者的病史、临床表现、实验室检查及治疗情况，并复习相关文献。结果：根据患者冶游史，有生殖器水疱及无痛性溃疡，梅毒血清试验及HIV确证试验阳性，可确诊为AIDS合并梅毒及生殖器疱疹；但临床表现不典型、血清学有假阴性。结论：既往有冶游史、临床表现可疑，梅毒初筛阴性的患者，要注意行梅毒确证试验及HIV相关检查，以减少梅毒、HIV感染的误诊、漏诊率。     

神经梅毒合并HIV感染6例分析

目的探讨神经梅毒合并HIV感染的临床表现及转归。方法对北京地坛医院收治的6例神经梅毒合并HIV感染者的性别、好发人群、临床表现、实验室检查、诊断方法、治疗经过及转归进行回顾性分析。结果 6例神经梅毒合并HIV感染的患者,5例为男性同性恋者。除1例因青霉素过敏而失访外,其他5例患者对青霉素治疗均反应良好。结论男性同性恋人群是梅毒和HIV共感染的高危人群,临床表现多样,可以迅速进展到神经梅毒,且极易被误诊。临床上主要依靠梅毒血清学试验、脑脊液检查、影像学检查和全面细致的查体进行诊断。目前青霉素仍为首选治疗药物。     

HIV/AIDS合并神经梅毒患者临床特征及预后分析

目的 分析HIV/AIDS合并神经梅毒患者的临床特征，为HIV/AIDS合并神经梅毒(NS)的诊治工作提供参考。方法 本研究对2017年1月—2021年12月重庆市公共卫生医疗救治中心收治的HIV/AIDS合并神经梅毒人群的临床资料进行回顾性分析，按照是否合并神经系统症状和体征进行分组，比较有症状组和无症状组的年龄、性别、感染途径、是否接受高效抗逆转录病毒治疗(highly active anti-retroviral therapy, HAART)、CD4、HIV RNA、血清梅毒RPR滴度、脑脊液检查及其临床转归等是否存在差异。结果 本研究共纳入86例HIV合并神经梅毒患者，有症状组70例，无症状组16例，平均年龄(37.63±1.36)岁，男84例(97.67%)。42例(48.84%)患者已接受HAART,54例(62.79%)CD4<200个/μL,60例(69.77%)HIV RNA>1 000 CPs/mL,感染途径以同性性行为感染为主(56.98%)。两组在年龄、同性性行为、异性性行为差异有统计学意义(P<0.05)。两组脑脊液总蛋白、脑脊液HIV R...     

Leukocytoclastic vasculitis: another condition that mimics syphilis

Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented.     

Syphilis among HIV-infected mothers and their infants in Texas from 1988 to 1994

BACKGROUND: Syphilis was investigated in a group of HIV-infected women and their infants. GOAL: To assess syphilis morbidity among HIV-infected women and their infants. Among women with syphilis during pregnancy, the risks for delivering an infant with congenital syphilis were assessed. STUDY DESIGN: Through the Pediatric Spectrum of HIV Disease project, Texas infants born to HIV-infected women were identified. After the infants were matched with their mothers, it was determined which had been reported as syphilis cases. RESULTS: In this study 18% of the HIV-infected mothers were reported as syphilis cases, most during pregnancy. Half of these mothers delivered infants (n = 49) with congenital syphilis. Inadequate prenatal care was the only significant risk for delivering an infant with congenital syphilis. The congenital syphilis rate among Texas infants of HIV-infected mothers was 48.8 per 1,000 live births. CONCLUSION: The congenital syphilis rate among Texas infants born to HIV-infected mothers was almost 50 times that of the general population.     

Syphilis and HIV infection

The management of an HIV-infected patient with syphilis is an evolving and difficult area of clinical medicine. Many such patients initially present with dermatologic problems, and the practicing dermatologist must be alert to the variety of presentations syphilis may take in these patients. The role of biopsy with immunofluorescent or Warthin-Starry silver staining is often crucial in correctly diagnosing confusing cases. The treatment of early syphilis in HIV-infected patients may need to be more intensive than has previously been recommended, because the immunosuppression induced by HIV can accelerate the pace of the infection and increase the risk of progression to neurosyphilis. After treatment, careful and frequent follow-up is essential so that the often irreversible consequences of late syphilis can be avoided.     

MALIGNANT SYPHILIS (LUES MALIGNA) AND CONCURRENT INFECTION WITH HIV

Background. During the past 2 1/2 years we observed six patients who had a reactive serology for syphilis, of which four developed widespread noduloulcerative and two vesiculonecrotic lesions. The purpose was to report the occurrence of lues maligna, a rare form of secondary syphilis, in five patients infected with the human immunodeficiency virus (HIV) and in one patient with risk factors for infection. Methods. Tzanck preparations, viral cultures, and skin biopsies were performed to evaluate the etiology of the lesions. Results. Syphilis serology titers ranged from 1:32 to 1:128 and in one instance was as low as 1:8. Such titers can also be found in patients with the latent form of syphilis. Therefore, confirmation of the clinical diagnosis of lues maligna was dependent on skin biopsies that were compatible with secondary syphilis and negative viral studies that excluded varicella, disseminated varicella-zoster or herpes simplex. Lues maligna takes an aggressive course in HIV-infected patients since four of the patients required hospitalization and the two patients who refused to complete treatment, subsequently developed more severe skin and constitutional symptoms. Conclusions. HIV-infected patients are at risk for developing lues maligna. Despite its malignant presentation, lues maligna lesions respond rapidly to treatment with penicillin. Secondary syphilis should be added to the list of diseases known to be more aggressive in HIV-infected patients.     

快速乳胶试验检测梅毒螺旋体抗体

目的：评价快速乳胶试验检测梅毒螺旋体抗体的可行性。方法：采用快速乳胶试验和TPPA平行检测50例梅毒患者血清和30例对照组血清的梅毒螺旋体抗体(TP—Ab)。结果：50例梅毒患者血清中，快速乳胶试验阳性47例，阴性3例；30例对照组血清快速乳胶试验阳性1例，阴性29例；以TPPA结果为标准，快速乳胶试验的敏感性为94．0％(47／50)，特异性为96．7％(29／30)。结论：快速乳胶试验检测TP—Ab具有一定的敏感性和特异性，操作简单，快捷。     

Syphilis and human immunodeficiency virus (HIV)-1 coinfection: influence on CD4 T-cell count, HIV-1 viral load, and treatment response

OBJECTIVES: To assess the effect of human immunodeficiency virus (HIV)-1 and syphilis coinfection on HIV-ribonucleic acid (RNA) viral load, CD4 cell count, and the response in rapid plasmin reagin (RPR) to treatment of the syphilis infection. STUDY DESIGN: Cases of syphilis diagnosed during 1 year in HIV-infected patients in Copenhagen were included. HIV-RNA, CD4 cell counts, and RPR-serology were measured before, during, and after syphilis. RESULTS: Forty-one patients were included. CD4 cell count decreased significantly during infection in patients with primary and secondary stages of syphilis (mean 106 cells/mm, P = 0.03). Treatment of syphilis was associated with an increase in the CD4 cell count and a decrease in HIV-RNA in the overall group (mean 66 cells/mm and -0.261 RNA log10 copies/ml, P = 0.02 and 0.04). The serological response rates for 15 patients treated with penicillin and 25 treated with doxycycline were the same. CONCLUSION: Syphilis was associated with a decrease in CD4 cell counts and an increase in HIV-RNA levels that both improved after treatment of syphilis.     

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.     

梅毒血清固定患者血清IL-10和IL-12水平及其关系研究

目的:比较健康者、梅毒未治疗、梅毒治疗后转阴以及梅毒血清固定患者的血清IL-10和IL-12水平,并分析梅毒血清固定患者血清IL-12、IL-10水平之间的关系。方法:纳入健康者、梅毒未治疗、梅毒治疗后转阴以及梅毒血清固定患者各20例,检测并比较各组的血清IL-12、IL-10水平,并对梅毒血清固定患者血清IL-12、IL-10水平相关性进行分析。结果:对各组的IL-10水平进行检测和比较,各组间比较差异具有统计学意义(P0.05)。对各组的IL-12水平进行检测和比较,各组间比较差异不具有统计学意义(均P0.05)。对20例梅毒血清固定患者血清IL-12、IL-10水平之间的关系进行分析,可得二者之间无显著相关性(r=0.423,P0.05)。结论:梅毒血清固定患者体内会出现免疫失衡,细胞免疫受到抑制,进而导致梅毒螺旋体逃脱机体免疫监视发生残存,是导致血清固定的重要因素之一。     

HIV and syphilis: when to perform a lumbar puncture

OBJECTIVES: The objectives of this study were to determine predictive factors for neurosyphilis in HIV-infected patients with syphilis and optimize the use of lumbar puncture. STUDY DESIGN: The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood cells count > or =20/microL, and/or a reactive cerebrospinal fluid-Venereal Disease Research Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index. RESULTS: Twenty-six of 112 had neurosyphilis. Neurologic manifestations and serum rapid plasma reagin (RPR) were associated with neurosyphilis (P = 0.036, P = 0.018, respectively). In multivariate analysis, log(2)RPR was still associated with neurosyphilis (P = 0.005). In patients without neurologic manifestations, the risk of neurosyphilis increases gradually with log(2)RPR. A serum RPR of 1/32 seems to be the best cutoff point to decide the performance or not of a lumbar puncture (sensitivity 100%, specificity 40%). CONCLUSION: In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR > or =1/32.