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。     

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.     

河北省HIV-1感染者合并梅毒感染状况调查

目的了解河北省艾滋病病毒(HIV)感染者中梅毒的感染状况。方法采集HIV-1感染者的抗凝全血样品,进行梅毒快速血浆反应素试验(RPR)和梅毒螺旋体颗粒凝集试验(TPPA)。结果 147例HIV-1感染者中累计梅毒感染率为26.53%(39/147),其中既往梅毒感染率11.56%(17/147),现症梅毒感染率14.97%(22/147)。HIV合并梅毒感染,在性别之间梅毒感染率差异有统计学意义(P<0.05),男性高于女性;在婚姻状态方面累计梅毒感染率差异有统计学意义(P<0.05),在离异组较高。结论 HIV感染人群中有较高的梅毒感染率。     

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.     

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.     

Malignant syphilis in an HIV-infected patient

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection may change the classic clinical course of syphilis and increase the incidence of a subtype of secondary syphilis named malignant syphilis. A homosexual patient with HIV infection consulted us about a one-month history of general malaise and widespread cutaneous ulcerative lesions, some with thick hemorrhagic crusts. Serology for syphilis was positive at high titers. Based on clinical, histological and serological findings, a diagnosis of malignant syphilis was made and the patient started treatment with penicillin G benzathine with progressive resolution of lesions. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous lesions.     

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。     

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。     

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。     

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。     

上海市某医院性病门诊梅毒患者就诊延迟行为影响因素研究

目的：了解性病门诊梅毒患者的就诊延迟行为影响因素,为梅毒控制策略提供依据。方法：以某院性病门诊梅毒患者作为研究对象,通过问卷调查了解调查对象基本情况和求医行为特征,分析影响延迟就诊行为的影响因素。结果：共调查206例梅毒患者,平均年龄(50.38±14.61)岁;57例（27.7%）出现症状就诊,40例（19.4%）因发生过高危性行为来就诊;患者中以隐性梅毒患者为主（132例,64.1%）,性病艾滋病核心知识总体知晓率为39.8%,平均就诊延迟时间为40.4天。多因素分析结果显示,核心知识知晓患者平均延迟就诊时间为22.79天,短于不知晓患者（52.07天）,差异有统计学意义（P<0.05）;一期梅毒、二期梅毒平均延迟就诊时间（14.3和17.2天）短于隐性梅毒（54.2天）。结论：核心知识知晓情况和梅毒分期是患者就诊延迟的主要影响因素。     

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。     

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.     

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.     

Active syphilis in HIV infection: a multicentre retrospective survey. The German AIDS Study Group (GASG).

OBJECTIVE: To study syphilis in HIV infection focusing on immunocompromised patients with an atypical or aggressive clinical course of syphilis, inappropriate serological reactions or an unreliable response to therapy. STUDY DESIGN: A multicentre retrospective chart review using a standardised questionnaire for all patients with active syphilis. SETTINGS: Thirteen dermatological and medical centres throughout Germany, all members of the German AIDS Study Group (GASG). PATIENTS: Clinical data of 11,368 HIV infected patients have been analysed for cases of active syphilis requiring treatment. Asymptotic patients with reactive serological parameters indicating latent syphilis without a need for treatment were excluded. RESULTS: Active syphilis was reported in 151 of 11,368 HIV infected patients (1.33%, range per centre 0.3%-5.1%). Most of the 151 syphilis patients were male (93%) and belonged to the homosexual or bisexual exposure category for HIV infection (79%); another 6% were iv drug users. Among the 151 syphilis patients primary syphilis was diagnosed in 17.2%, maculopapular secondary syphilis in 29.1%, ulcerating secondary syphilis in 7.3%, neurosyphilis in 16.6% and latent seropositive syphilis without clinical symptoms but serological abnormalities indicating active syphilis in 25.2%. A history of prior treatments for syphilis was reported in 50%. At the time of syphilis diagnosis 26.5% of the patients were in CDC stage II, 33.8% in stage III and 24.5% in stage IV of HIV disease (CDC classification 1987). CD4 cell count was lowest in those with ulcerating secondary syphilis (mean 307, SD 140/microliters) and neurosyphilis (351, SD 235/ microliters). The highest CD4 count was found in patients with early primary and early secondary syphilis (444, SD 163/microliters and 470, SD 355/microliters). Inappropriate serological response to syphilis infection was found in 81 of 151 patients (54%). Remarkable findings were false negative VDRL titres (11 patients with non primary syphilis), false negative TPHA (1) or 19S-IgM-FTA-ABS-tests (16), and strongly reactive VDRL (> or = 512, 8) or TPHA titres (> or = 10 240, 47). Treatment failures were reported in at least 6 of 151 cases (4%). CONCLUSIONS: Atypical clinical and serological courses of syphilis were observed in HIV infected patients. Ulcerating secondary syphilis with general symptoms ("malignant syphilis") was 60 times more frequent than in historic syphilis series. Neurosyphilis was found in one sixth of those with active syphilis. Therefore lumbar puncture should be considered a routine in coinfections with HIV and syphilis. Treatment efficacy should be monitored carefully.     

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。     

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.     

Importance of specific IgM antibodies in 116 patients with various stages of syphilis.

We tested 222 serum samples obtained from 51 patients presenting with syphilis, before and after treatment; 117 from 65 patients with a history of syphilis (114) or yaws (3); 77 from 71 patients with no evidence of syphilis; and 1117 serologically negative serum samples. Our tests included the IgM fluorescent treponemal antibody absorbed (IgM-FTA-ABS) and solid phase haemadsorption assay (SPHA) techniques. According to the stage of development of syphilis, IgM antibodies were found in 83-100% of the serum samples. This permitted a precise diagnosis to be made and cure assessed. As IgM antibodies were absent in serum from patients with healed syphilis, resolved syphilis could be distinguished from developing syphilis. The sensitivity (92%) of the IgM-FTA-ABS test was comparable with that of the SPHA (96%), but the SPHA was more specific (97.4%) than the IgM-FTA-ABS test (89.61%).     

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.     

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.