梅毒患者病程中宿主的免疫学变化

目的 探讨梅毒螺旋体(TP)感染的不同病程与宿主免疫学变化的关系。方法 采用ELISA法分别检测一期和二期梅毒患者血清抗TP抗体的滴度(用活动指数AI表示)。MTT比色法测定一期和二期梅毒患者血清对脐带血淋巴细胞增殖反应的影响(用刺激指数SI表示)。ABC-ELLSA法分别检测一期和二期梅毒患者血清中细胞因子IL-2、IL-4含量。结果 二期梅毒患者抗TP抗体的活动指数(AI)显著高于一期梅毒(t=3.92,P<0.01)。一期和二期梅毒血清对脐带血淋巴细胞增殖反应的刺激指数SI显著低于无血清含PHA组(q₁=12.99,P₁<0.01。q₂=12.04,P₂<0.01),且二期梅毒血清SI亦显著低于一期梅毒(q=7.18,P<0.01)。一期梅毒血清中IL-2含量明显高于二期梅毒(t=3.50,P<0.05),IL-4含量与二期梅毒差异无显著性(t=1.31,P>0.05)。结论 抗TP抗体随着梅毒病程由一期向二期进展其滴度越来越高,但与体液免疫有关的细胞因子IL-4没有发生显著性变化;宿主感染梅毒螺旋体后,其细胞免疫功能受到明显抑制,且随着病程由一期向二期进展,其抑制现象越来越显著。     

452例梅毒患者的临床分析

目的:了解梅毒的发病及临床特点,以探求及早控制本病的措施。方法:对本院1997年1月-2002 年12月间的452例梅毒患者的临床资料进行整理和临床分析。结果:452例梅毒中一期梅毒174例,占38.5%, 二期梅毒198例,占43.8%,一、二期梅毒共存者6例,占1.3%。潜伏期(隐性)梅毒74例,占16.4%。结论:正规足量的驱梅药物治疗,一期梅毒治愈恢复明显快于二期梅毒。     

133例早期潜伏梅毒的临床与血清学分析

目的：了解潜伏梅毒与显性梅毒在临床和血清学方面的异同。方法：对133例早期潜伏梅毒进行了临床特点和血清学分析。结果：早期潜伏梅毒女性患者的比例明显高于显性梅毒,梅毒患者中潜伏梅毒的构成比和女性潜伏梅毒患者比例都有逐年增加的趋势,有46．6％的潜伏梅毒患者由于性伴患梅毒而被发现,有24．8％的患者有疑似早期梅毒的病史,潜伏梅毒患者治疗前的血清TRUST平均滴度明显低于显性梅毒患者,但下降较慢。结论：提示应及时筛查和治疗潜伏梅毒患者。     

佛山市2004-2013年梅毒流行病学分析

目的：了解佛山市2004-2013年梅毒流行病学特点,为制定防治策略提供科学依据。方法：采用Microsoft Excel 2010及SPSS15.0对2004-2013年佛山市梅毒疫情资料进行描述性流行病学分析。结果：2004-2013年佛山市累计报告梅毒病例47 632例,其中后天梅毒45 458例,年均报告发病率为64.94/10万,年报告发病率缓慢上升,2012年达到高峰;Ⅰ＋Ⅱ期梅毒年报告发病率曲线平缓;隐性梅毒年报告发病率与后天梅毒报告发病率变化基本一致;近十年胎传梅毒共报告2 174例,年均报告发病率为217.4/10万活产数,2004至2007年报告发病率呈上升趋势,2007年后呈波动下降趋势;年龄组别报告病例数最多的是30-39岁年龄组;报告病例数居前三位的职业分别是工人、家务及待业、农民;顺德区和南海区病例数最多。结论：青壮年是梅毒重点防治人群,但老年人群也不容忽视;要加强孕期妇女的梅毒筛查,减少胎传梅毒的发生;同时应加强梅毒监测,继续开展有效的干预措施控制我市梅毒的流行。     

Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis,its differential diagnoses,management, and current recommendations

Syphilis is an ancient disease that has re‐emerged in the last decade. It is prevalent among men who have sex with men and has increased in incidence with certain ethnic groups. It usually presents as primary or secondary syphilis and can progress to tertiary syphilis if not treated. Primary syphilis will classically manifest as a single, painless ulcer with smooth, clean, and raised borders on the genitals or less often on the oral mucosa. Unusual primary syphilis cases have been reported and can be easily misdiagnosed with a resulting delay of treatment. Secondary syphilis is a systemic disease, wherein the treponemes have disseminated to various organ systems, typically presenting with characteristic mucocutaneous lesions. Tertiary syphilis has a higher rate of morbidity and mortality; as such, the aim of this article is to provide the readers with tools to recognize early syphilis and prevent its progression to late stages. In this review, we present a likely case of unusual primary syphilis mimicking herpes progenitalis as well as a compilation of all atypical cases of primary syphilis from 1973 to 2015. We will also review the differential diagnosis, management, and recommendations for each stage of syphilis.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

妊娠梅毒与胎传梅毒

近年来妊娠梅毒和胎传梅毒的发病率呈上升趋势。感染梅毒螺旋体后，由于免疫反应及细胞因子水平随病期的进展而变化，导致不同的妊娠结局，包括胚胎死亡、流产、早产或娩出胎传梅毒患儿；妊娠期间机体免疫反应状态的改变也会影响母体及胎传梅毒的自然病程。因此，进一步了解妊娠与梅毒的相互影响，揭示妊娠梅毒和胎传梅毒发生发展的规律，对于有效地控制梅毒的母婴传播，预防梅毒导致的不良妊娠结局，降低胎传梅毒的发病率具有重要意义。     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

胎传梅毒的研究进展

近年来随着梅毒发病率的增长,胎传梅毒的发病率也在不断增加.孕妇缺乏梅毒血清学筛查及梅毒孕妇不正规的治疗是导致胎传梅毒发生的主要因素.胎传梅毒在临床特点、诊断和治疗等多方面与后天梅毒有所不同.临床上大多数胎传梅毒患儿在出生时并无临床症状,对无症状的患儿仅依据快速血浆反应素环状卡片试验和梅毒孕妇性病研究实验室试验的阳性结果诊断胎传梅毒易造成误诊、漏诊.因此,临床上对出生时无症状的胎传梅毒患儿应提高警惕.     

An epidemiological study of syphilis incognito, an emerging public health problem in Greece

BACKGROUND: Syphilis incognito is a subtype of latent syphilis (early or late) characterized by no signs or symptoms of primary or secondary syphilis and diagnosed by positive serologic results for syphilis during routine screening. OBJECTIVE: To study the epidemiological characteristics, causes, and implications of syphilis incognito in Greece. PATIENTS AND METHODS: All new adult patients diagnosed as having syphilis in Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece, from 1989 through 1996 were studied prospectively and retrospectively (history, physical examination, serologic tests, cerebrospinal fluid examination, and imaging) to determine the stage of their disease. The epidemiological, clinical, and serologic characteristics of patients with syphilis incognito were recorded and analyzed. RESULTS: During the 8-year period, 711 new syphilis cases were detected; of these, 480 cases (67.5%) fulfilled the definition criteria of syphilis incognito. The male-female ratio was 1.8:1. Patients with syphilis incognito were most commonly heterosexual, had a median socioeconomic status, and were aged 20 to 39 years, and their conditions were diagnosed during routine screening for syphilis (prenatal care, hospital admission, or blood donation). However, the number of syphilis incognito cases appeared to decline during the period studied. CONCLUSIONS: The incidence of syphilis in Greece has decreased dramatically, following the trends in western Europe. The most common form of syphilis is syphilis incognito, affecting adults who are older and have a higher socioeconomic status than those in the past. Improved hygiene and wide use of antibiotics that minimize or abolish symptoms of early disease may have contributed to the frequency of syphilis incognito in recent years. Screening of asymptomatic persons, especially those at high risk, should continue and be reenforced to prevent the devastating consequences of unrecognized and untreated syphilis.     

梅毒母婴传播的研究进展

母婴传播是梅毒传播的重要途径,妊娠任何时期都可能发生梅毒的母婴传播.梅毒的母婴传播可以导致许多不良的妊娠后果,严重影响母婴健康,是一项严重的公共卫生和社会问题.梅毒的母婴传播与孕妇梅毒的分期、妊娠时期及是否治疗有关,特别是早期梅毒的母婴传播风险较高.随着梅毒发病率的增长,梅毒母婴传播的防控变得愈加重要,妊娠期梅毒的筛查和早期治疗可有效的阻断梅毒母婴传播.因此,了解梅毒母婴传播的流行病学、传播途径与传播风险及其影响因素等无疑会对其防控提供一个较好的指导途径.     

The syphilis epidemic in Connecticut: relationship to drug use and prostitution

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.     

梅毒194例夫妻间发病情况分析

目的了解梅毒在夫妻间的发病情况,探讨近年来梅毒发病率不断升高的原因。方法对194例首诊为梅毒的患者及其配偶的临床资料进行分析。结果有114对夫妻同患梅毒,占58.76%。其中男性首诊患者49例,主要为一期梅毒,女性首诊患者65例,主要为二期梅毒,另有4例妊娠梅毒。114对夫妻同患梅毒的患者中,在一方首诊为梅毒后,有86例的配偶同时追访被诊断为梅毒,其余28例在1～2个月后才被确诊。配偶被追访而诊断的梅毒患者中主要为潜伏梅毒,占69.30%(79/114)。结论夫妻同患梅毒比例较高,潜伏梅毒发生率较高,提高性伴通知确切性和孕前梅毒筛查是降低梅毒发生和提高生殖健康水平必要和有效的方法。     

儿童梅毒11例临床分析

为探讨我国儿童梅毒的特点，对我院的11例儿童梅毒临床特点进行了分析。结果10例为先天性梅毒，1例为后天获得性梅毒。主要临床表现为皮肤损害10例，骨损害8例，肝脾肿大5例，贫血7例及血小板减少3例。临床分析提示，在我国儿童梅毒发病中先天性梅毒仍是主要的；日常生活中密切接触易感是儿童与成人的不同点；儿童梅毒临床症状具有多样性，对此在临床中应引起重视。     

2012-2018年宁波市鄞州区HIV阳性患者梅毒感染及影响转归的相关因素

目的：了解HIV阳性患者梅毒感染情况及影响转归的相关因素。方法：收集2012-2018年间在我院皮肤性病门诊就诊的HIV感染阳性并行梅毒检测患者的资料,分析梅毒患病感染情况及治疗转归效果。结果：480例HIV阳性患者中梅毒感染率为25%,多因素logistic回归结果显示本组患者梅毒感染的危险因素为年龄在21~30岁之间、同性传播、性伴人数大于2、有不安全注射史及未接受HAART治疗;多因素Cox回归结果显示性伴人数大于2人、有不安全注射史、未接受HAART治疗、CD4+T细胞数量,梅毒患病时的TRUST初始滴度和临床用药选择则是梅毒转归的危险因素。结论：HIV阳性患者中梅毒感染率高,影响转归的因素包括性伴人数、不安全注射史、未接受HAART治疗等。     

妊娠合并梅毒临床病例分析

目的：总结妊娠合并梅毒病例的临床特点及产前梅毒筛查情况，研究梅毒治疗时间对妊娠结果的影响。方法：对我院1998年4月—2002年4月间妊娠合并梅毒的病例进行回顾性分析。结果：妊娠合并梅毒病例30例，占住院分娩病例总数的0．49％。潜伏梅毒病25例，占83．3％；Ⅰ期梅毒、Ⅱ期梅毒及妊娠前驱梅治疗后血清固定的病例各占3．3％、6．7％、6．7％。晚期妊娠发现梅毒病例中，死胎或畸胎6例，先天性梅毒婴儿3例，远多于妊娠早期及中期发现梅毒的病例。结论：妊娠合并梅毒病例的临床表现以潜伏梅毒为主。治疗梅毒的时间对妊娠结局有一定影响。     

The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity

Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. Although there has been a significant reduction of tertiary disease and recognition of facilitative interactions with human immunodeficiency virus infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed-type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and, more importantly, activation of macrophages by sensitized CD4 T cells. The Bacillus Calmette-Guerin vaccination can enhance DTH and has been shown to produce a low, but measurable, beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.     

Congenital syphilis and fluorescent treponemal antibody test reactivity after the age of 1 year.

BACKGROUND: Many believe that a persistently reactive fluorescent treponemal antibody absorption (FTA-ABS) is manifested with congenital syphilis after the age of 1 year, that it is useful in the retrospective diagnosis of children with congenital syphilis, and that it can be used to confirm other treponemal tests. GOAL: To determine whether a reactive FTA-ABS after the age of 12 months is indicative of congenital syphilis. STUDY DESIGN: Prospective outpatient follow-up evaluation until at least the age of 12 months was conducted for 194 babies born to mothers with reactive syphilis serology at delivery, and for two additional children with congenital syphilis diagnosed when they were younger than 1 year (total, 196 children). RESULTS: In the study group, 54 children had reactive FTA-ABS (reactors) until the age of at least 12 months or more, and 142 children had nonreactive FTA-ABS (nonreactors) at the age of 12 months or more. Of the 54 reactors, 17 (31%) had evidence of congenital syphilis at birth, whereas evidence of congenital syphilis was seen in 14 of the 142 (10%) nonreactors (P = 0.0002). At 15 months, nonreactive FTA-ABS developed in six reactors, and eventually in 15 of 44 reactors (34%) tested. CONCLUSIONS: A reactive FTA-ABS may be seen at 12 months in children with and without evidence of congenital syphilis at birth. Not all children with congenital syphilis will manifest reactive FTA-ABS at 12 months, and FTA-ABS reactivity wanes with time.     

早期隐性梅毒患者细胞免疫变化

目的研究早期隐性梅毒患者细胞免疫变化。方法采用流式细胞仪分别检测12例早期隐性梅毒患者(A组)、12例二期梅毒患者(B组)外周血T淋巴细胞亚群,ELISA法分别检测两组血清白细胞介素12(IL12)水平。结果两组外周血CD4+T细胞数、CD4/CD8比值均低于正常对照组(P均<0.01),两组血清IL12水平均高于正常对照组(P均<0.01)。A组外周血CD4+T细胞数、CD4/CD8比值、血清IL12水平均低于B组(P均<0.01)。A组外周血CD8+T细胞数高于B组(P<0.01)。结论早期隐性梅毒患者存在较二期梅毒患者更显著细胞免疫低下现象。