苄星青霉素与普鲁卡因青霉素治疗早期梅毒的疗效比较

目的：比较苄星青霉素和普鲁卡因青霉素对早期梅毒的疗效。方法：选取确诊的早期梅毒患261例随机分组，甲组193例用苄星青霉素，乙组68例用普鲁卡因青霉素，均按卫生部推荐的方案进行治疗，分别在治疗后第3、6、9、12个月观察并用χ^2检验进行疗效比较。结果：12个月时两组的RPR阴转率分别是89．1％和85．3％，RPR滴度下降的几何均数分别为6.7和8．2,治疗后第3、6、9、12个月的RPR滴度及转阴率比较无统计学上的差异性（χ^2值分别为0.13和0.12,P均＞0．05）。结论：两种青霉素治疗早期梅毒的效果无差异。     

三种方法治疗获得性早期梅毒的临床疗效分析

目的：观察三种方法治疗获得早期梅素的疗效。方法：将７６例患分为三组,分别用苄星青霉素（４７例）、普鲁卡因青霉素（１８例）及阿奇霉素（１１例）治疗,观察其临床疗效,并随访追踪疗后１年及２年,非梅毒螺旋体抗原血清学试验（ＲＰＲ／ＵＳＲ）阴转情况;结果：三组的治愈率分别为９３．６２％、８８．８９％、８１．８２％。ＲＰＲ／ＵＳＲ１年阴转率三组分别为９３．６２％、８８．８９％、１００％;２年的阴转率三组均     

Neurosyphilis after treatment of latent syphilis with benzathine penicillin.

Two patients developed neurosyphilis after treatment of latent syphilis with intramuscular benzathine penicillin. The cases confirm recent investigations that show that neither benzathine penicillin nor procaine penicillin in the standard doses results in treponemicidal concentrations of penicillin in cerebrospinal fluid. Neurosyphilis can be treated effectively by intravenous benzylpenicillin infusions of 18 to 21.6 g daily for 15 days.     

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.     

An IgM capture enzyme linked immunosorbent assay to detect IgM antibodies to treponemes in patients with syphilis.

A new IgM capture enzyme linked immunosorbent assay (ELISA) was compared with the 19S(IgM) fluorescent treponemal antibody absorption (19S(IgM)FTA-ABS) test for detecting IgM antibodies to treponemes. Serum samples from 180 people, 109 with various stages of untreated syphilis, 45 with treated syphilis, and 26 non-infected, were investigated. In all diagnostic groups of syphilis the reactivity of the IgM capture ELISA was similar to that of the 19S(IgM)FTA-ABS test except in untreated neurosyphilis, for which the IgM capture ELISA was significantly less sensitive. The IgM capture ELISA was very sensitive in congenital (100%, 5/5) and primary (82%, 18/22) syphilis, but less sensitive in secondary (60%, 12/20), latent (53%, 16/30), neurosyphilis (34%, 11/32), and treated (11%, 5/45) syphilis. False positive IgM capture ELISA results were not found in five people who gave false positive Venereal Disease Research Laboratory (VDRL) reactions or in 21 neonates born to mothers adequately treated for syphilis before or during pregnancy. This indicated that the IgM capture ELISA was very specific. The course of antitreponemal IgM reactivity after treatment of early infectious syphilis was followed up in six patients. The quantity of IgM antibody declined in nearly all patients after treatment, but still remained detectable in five patients up to six months after treatment. In contrast, non-treponemal antibodies measured by the VDRL test disappeared in four out of six patients within five months from starting treatment. In conclusion, the IgM capture ELISA may be useful for easy and sensitive detection of IgM antibodies to treponemes in patients with congenital and primary syphilis. A positive test result in these cases indicates that patients should receive treatment if they have not been treated recently. The test is not, however, recommended to replace the VDRL test to monitor patients treated for syphilis.     

头孢曲松治疗早期梅毒血清固定近期疗效观察

目的 :　了解头孢曲松对早期梅毒血清固定的治疗价值。方法 :　 4 7例出现血清固定的早期梅毒患者随机分成两组。治疗组 2 4例 ,以头孢曲松 1.0静脉滴注 ,qd×15复治 ;对照组以苄星青霉素 2 4 0万U肌注qw× 3复治。复治后第 3、6个月均复查RPR。以RPR转阴为痊愈 ,RPR下降 2个或 2个以上滴度为有效 ,RPR下降不到 2个滴度为无效判定结果。结果 :　复治 6个月后 ,治疗组痊愈 2 3例 ,有效 1例 ,痊愈率为 95 .83% ;对照组痊愈 17例 ,有效 4例 ,痊愈率为 79.92 % ,两者差异有统计学意义 (χ2 =4 .4 5 2 ,P <0 .0 5 )。结论 :　治疗早期梅毒血清固定 ,头孢曲松优于苄星青霉素 ,机理可能缘于两者对血脑屏障通透性的差异     

Results of the treatment of neurosyphilis and seroresistant latent syphilis by intravenous administration of potassium salt of penicillin G

Potassium penicillin G was administered intravenously 4 times daily in doses of 6 million u for 10 days to 49 patients, 36 with central nervous system syphilis and 13 with latent seroresistant syphilis. Forty six patients were followed up after treatment. In 16 patients with central nervous system syphilis treated by this method another cerebrospinal fluid examination was done. Cerebrospinal fluid changes regressed completely in 13 patients, in three cases the improvement was incomplete. The titres of VDRL and FTA tests decreased in 23 patients with central nervous system syphilis and in 11 with latent seroresistant syphilis. In eight patients treated by this method seroresistance persisted and in four cases the titre fluctuated. The results of the study demonstrate the effectiveness and advantages of the treatment of central nervous system syphilis and latent seroresistant syphilis with crystalline penicillin administered intravenously.     

Micro-TPHA test in the routine serodiagnosis of syphilis

Sera from untreated primary, secondary and latent syphilis and treated syphilis were tested with a new micro-Treponema pallidum haemagglutination assay (micro-TPHA, Syfhatect, Wellcome Diagnostics, U.K) compared with the standard VDRL slide test. Serum titers of 1:8 and above were considered positive on the VDRL, and those 1:20 and above were taken as positive on the micro-TPHA. All patients with secondary syphilis were positive with both tests. 65.5% of cases of primary syphilis were positive with VDRL, compared to 78.8% with micro-TPHA. For latent syphilis, 87.5% were positive with VDRL, and 100% were positive with micro-TPHA. Of 25 patients with treated syphilis and reactive VDRL sera, all were also positive with micro-TPHA. Of 76 persons with treated syphilis who were no longer reactive on VDRL, 91% had positive micro-TPHA tests. The micro-TPHA test is so sensitive that it cannot be used to evaluate response to treatment in the sense that a VDRL test will become negative.     

早期梅毒治疗前后血清学分析

用苄星青霉素治疗了２１０例早期梅毒，对其治疗效果及治疗前后的血清学结果进行了分析，结果发现：治疗前ＲＰＲ与ＴＰＨＡ滴度呈正相关，ＴＰＨＡ滴度的高低对治疗效果无影响。二期梅毒患者ＴＰＨＡ与ＲＰＲ两项滴度均高于一期梅毒及潜伏梅毒。     

Quantitative evaluation of the FTA-ABS-IgM and VDRL test in treated and untreated syphilis.

Observations made on fluorescent treponemal antibody absorption (FTA-ABS) immunoglobulin M (IgM) titres in patients with untreated early syphilis showed non-reactive or weakly reactive results in patients with primary (one of five cases) and secondary (two of 16 cases) lesions. In patients with primary (19.5%) and secondary (15%) syphilis sera remained reactive with increased titres for more than one year after treatment. The respective figures in the results of the Venereal Disease Research Laboratory (VDRL) test were zero in primary and 20% in secondary syphilis. The non-reactive FTA-ABS IgM results may possibly be explained by competitive inhibition of IgM by immunoglobulin G (IgG). The persistence of reactivity in a comparable percentage has been observed by other investigators (Grin et al., 1974; Wilkinson and Rodin, 1976). The current results therefore suggest that FTA-ABS IgM titres are less reliable for assessing the effect of treatment than the course of the VDRL titres. The phenomenon of a decrease in FTA-ABS IgM titres soon after treatment with a later rise before final non-reactivity is a matter for further investigation.     

The course of early syphilis in morphine base-dependent rabbits

Eleven rabbits made dependent on morphine base were observed which were infected with syphilis studying the clinical and serological course of the infection. The control group comprised five non-dependent rabbits infected with syphilis. After 30 days from the infection all animals were given procaine penicillin in daily doses of 75,000 mu/kg. The treatment was carried on for 20 days. In all animals the following serological tests: VDRL, IgG, FTA, TPHA, and TPI were done before the treatment and 1, 3, 6, and 12 months after it. Ulcerations at the site of injection of Nichols strain of spirochetae in all morphinedependent rabbits developed earlier (5-6 days after infection) than in controls (9-10 days), were much larger and persisted longer, while the antibody titres were lower, as a rule, in the morphine-dependent animals. The results presented justify the conclusion that the clinical and serological course of the early stages of syphilis is different in the morphine-dependent animals when compared with controls.     

Quantitative evaluation of the FTA-ABS-IgM and VDRL test in treated and untreated syphilis.

Observations made on fluorescent treponemal antibody absorption (FTA-ABS) immunoglobulin M (IgM) titres in patients with untreated early syphilis showed non-reactive or weakly reactive results in patients with primary (one of five cases) and secondary (two of 16 cases) lesions. In patients with primary (19.5%) and secondary (15%) syphilis sera remained reactive with increased titres for more than one year after treatment. The respective figures in the results of the Venereal Disease Research Laboratory (VDRL) test were zero in primary and 20% in secondary syphilis. The non-reactive FTA-ABS IgM results may possibly be explained by competitive inhibition of IgM by immunoglobulin G (IgG). The persistence of reactivity in a comparable percentage has been observed by other investigators (Grin et al., 1974; Wilkinson and Rodin, 1976). The current results therefore suggest that FTA-ABS IgM titres are less reliable for assessing the effect of treatment than the course of the VDRL titres. The phenomenon of a decrease in FTA-ABS IgM titres soon after treatment with a later rise before final non-reactivity is a matter for further investigation.     

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.     

Clinical Survey of Syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with Special Reference to the Recent Clinical Manifestations and Evaluation of IgM Antibodies to Treponema pallidum

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA+IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.     

Malignant syphilis in a patient with acquired human immunodeficiency virus (HIV) infection

Malignant syphilis is an uncommon variant of syphilis, most often (but not always) found in immunosuppressed individuals. This report describes the case of a 57-year-old man, infected with the acquired human immunodeficiency virus (HIV), with a generalized picture of erythematous-squamous papules that rapidly progressed to painful and ulcerated plaques and nodules, some covered with a black rupioid crust. The analytical study performed revealed positive VDRL (Venereal Disease Research Laboratory) and RPR (Rapid Plasma Reagin). The skin biopsy was nonspecific; however, the immunohistochemical analysis disclosed the presence of spirochetes. The patient was then treated with benzathine penicillin G 2.4 MU once a week IM for three weeks, with progressive resolution of the lesions. Considering its rarity, this atypical form of syphilis that needs to be known to better recognize its clinical presentation and provide more prompt treatment to patients.     

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。     

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。     

苄星青霉素联合头孢曲松对早期梅毒血清快速血浆反应素环状卡片试验/甲苯胺红不加热血清试验结果影响的Meta分析

【摘要】 目的 系统评价苄星青霉素联合头孢曲松治疗早期梅毒对血清快速血浆反应素环状卡片试验/甲苯胺红不加热血清试验（RPR/TRUST）转阴率的疗效。方法 检索PubMed、Web of science、Embase、Cochrane、中国知网、万方、维普数据库中关于苄星青霉素联合头孢曲松治疗早期梅毒的病例对照研究。使用Newcastle-Ottawa量表（NOS）评估纳入研究文献的质量,使用RevMan5.3软件分析患者RPR/TRUST转阴率。结果 共纳入14个病例对照研究1 160例梅毒患者,联合组585例,单用组575例。结果显示,联合组血清RPR/TRUST转阴率明显高于单用组［OR = 3.70,95% CI（2.71,5.06）,P < 0.001］。按随访时间进行亚组分析,联合治疗组在治疗后3个月［OR = 3.68,95% CI（2.26,5.98）,P < 0.001］、6个月［OR = 3.11,95% CI（2.26,4.27）,P < 0.001］及12个月时［OR = 4.35,95% CI（2.81,6.73）,P < 0.001］RPR/TRUST转阴率均高于单用组。结论 与苄星青霉素相比,苄星青霉素联合头孢曲松治疗早期梅毒能更有效地促进血清RPR/TRUST转阴。     

Treatment of neurosyphilis with chloramphenicol. A case report.

Although penicillin is the drug of choice in syphilis, treatment failures with benzathine and procaine penicillin have occurred in neurosyphilis. Patients allergic to penicillin have traditionally been treated with tetracycline but, since this drug diffuses poorly into the cerebrospinal fluid, its use in neurosyphilis is uncertain. In the case reported here, a penicillin allergic patient with general paresis of the insane was successfully treated with chloramphenicol. This drug has been used in the treatment of syphilis and achieves high concentrations in the cerebrospinal fluid. Thus chloramphenicol may be a more appropriate agent than tetracycline in treating patients with neurosyphilis who are allergic to penicillin.