Transmission of Syphilis by Solid Organ Transplantation

Two organ recipients developed serologic evidence of syphilis infection after renal transplantation from a common deceased donor with a history of treated syphilis. Testing of donor serum for syphilis, which occurred after transplantation, gave results interpreted as consistent with past infection. However, subsequent serologic results in the recipients suggested transmission of infection at transplantation due to active infection of the donor. This may be explained by recent donor re-infection in view of the current syphilis epidemic in the United Kingdom. An initial error in the treatment of recipients further served to highlight unfamiliarity in managing this resurgent infection in the context of organ transplantation.     

Specific and sensitive diagnosis of syphilis using a real-time PCR for Treponema pallidum

A real-time PCR assay with a Taqman probe was developed that targeted the polA gene of Treponema pallidum. The test was validated using an analytical panel (n = 140) and a clinical panel of genital samples (n = 112) from patients attending a sexually transmitted infections clinic. High sensitivities and specificities of 94-100% were achieved using two real-time PCR platforms, the Rotor-Gene and the iCycler. The assay can be completed within 2 h, enabling reporting in <8 h. This fast and robust assay is suitable for implementation in routine laboratories for diagnosing primary syphilis.     

Trancranial Doppler Monitoring of Response to Therapy for Meningovascular Syphilis

Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10-day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.     

烟台口岸74例梅毒感染者检测结果分析

目的了解烟台口岸出入境人群梅毒感染的流行分布状况和趋势,确定重点监测对象,为口岸传染病监测和预防控制提供依据。方法对受检者血清样本采用甲苯胺红不加热血清试验（TRUST）和梅毒螺旋体抗体血凝实验法（TPPA）进行梅毒血清学检测。结果在检测对象中检出的74例梅毒感染者,梅毒感染率为0.20%,男女感染者无显著性差异（P〉0.05）,介于21-50岁的中青年感染者构成比为78.39%,入境人员梅毒感染率较往年显著增高。传播途径依然以性传播为主,临床表现不明显,感染以潜伏梅毒居多。结论做好传染病监测的同时,应积极做好性传播疾病的防治宣传工作和咨询工作,加强对远洋船员、劳务人员等高危人群的行为干预,做好入境人员的疾病监测和监管,提高出入境人员的防病意识,降低梅毒感染率。     

2011—2019年不同时期荆州市一二期梅毒时空特征对比分析

目的 分析荆州市不同时期一二期梅毒的时空分布变化情况,为合理配置卫生资源提供参考。方法 收集2011—2019年荆州市一二期梅毒疫情资料,根据发病率高低,将荆州市一二期梅毒疫情分为2011—2013年（高）、2014—2016年（中）、2017—2019年（低）3个时期,采取趋势面、空间自相关和时空扫描分析3个时期一二期梅毒在时空上的变化趋势。结果 2011—2019年,荆州市累计报告一二期梅毒4 715例,年均发病率为9.19/10万,发病率呈下降趋势（P<0.01）。趋势面分析得出荆州市一二期梅毒的高发区域逐步从西北部（2011—2013年）向中部转移（2017—2019年）。全局空间自相关分析显示,荆州市一二期梅毒发病率在2011—2013年、2014—2016年呈正相关,且有空间聚集性（Moran’s I=0.333 6、0.210 5,均P<0.01）。局部空间自相关分析显示,一二期梅毒高值聚集区2011—2013年主要集中在公安县、荆州区、沙市区、江陵县的部分乡镇（P<0.05）,2014—2016年主要集中在荆州区、沙市区、监利县的部分乡镇（P<0.05）,2017—2019年主要集中在监利县、沙市区的部分乡镇（P<0.05）。时空扫描结果显示,主聚集区在公安县、江陵县,共24个乡镇（街道）,聚集时间为2011年4月11日至2011年8月15日（RR=4.14,LLR=93.55）。结论 3个时期荆州市一二期梅毒均存在空间聚集性,高发区域逐步缩小,2017—2019年监利县、沙市区的部分乡镇为疫情高发地区,应加强对该地区的防控工作。     

内蒙古4盟市后天梅毒报告病例数据质量调查

目的　了解内蒙古自治区梅毒报告病例数据的质量,发现存在的问题,提出改进措施。方法　选取2018年7月1日—2019年6月30日内蒙古自治区4个盟市的30家医疗机构的895例后天梅毒报告病例进行调查,包括核对传染病报告卡、临床和实验室原始资料等,评价其信息质量指标和诊断质量指标。结果　4个盟市的报卡填写完整率、正确率、信息录入正确率、病例报告及时率、过度报告率、重复报告率分别为97.65%、92.63%、89.16%、91.06%、13.85%、3.46%。不同盟市的报告卡的填写正确率、病例报告及时率、过度报告率和重复报告率的差异均有统计学意义（P均＜0.05）。后天梅毒病例诊断正确率为66.93%,不同地区间差异有统计学意义（χ2=45.963,P=0.000）。不同地区间一期梅毒分期正确率、隐性梅毒分类正确率的差异均有统计学意义（P均＜0.05）。皮肤性病科、非皮肤性病科报告病例正确率分别为74.90%、57.63%,差异有统计学意义（χ2=29.967,P=0.000）。结论　内蒙古自治区梅毒疫情报告质量参差不齐,梅毒诊断正确率、分期正确率低,影响梅毒发病率与发病趋势的分析,须加强梅毒报告、诊断标准的培训,切实提高病例数据的质量。     

Sexually transmitted diseases in Bauchi,Nigeria

Sexually transmitted diseases pose a health threat to families, society and the nation but there is no report of these diseases to help health planners in Bauchi. Medical records were examined from 1983 to 1988 in two major health institutions, the University Medical Centre and the Specialist Hospital to determine the extent and types of these diseases in Bauchi.

Urethritis, syphilis, candidiasis, pelvic inflammatory diseases, trichomoniasis were very common. Gonorrhoea was the least reported disease.

The cases of syphilis reported at the Specialist Hospital nearly doubled from 111 in 1983 to 214 in 1988, urethritis increased from 141 to 232. In the University Medical Centre, all reported cases of sexually transmitted diseases decreased from 1983 to 1988.

Data analysis of cases common to the Specialist Hospital and the University Medical Centre gave no significant difference between the institutions at the 95% level of confidence.     

阿奇霉素治疗早期梅毒患者血清学变化的分析

目的观察阿奇霉素在早期梅毒治疗中的疗效并探讨免疫印迹法(WB)在梅毒血清学诊断中的意义。方法对确诊为早期梅毒的26例患者采用阿奇霉素500 mg/d,1次/d,连续10 d空腹口服治疗。治疗后3个月、6个月、1年、2年随访并做快速血浆反应素(RPR)、梅毒颗粒凝集实验(TPPA)、WB血清学检查。结果治疗3个月后26例临床症状明显消失或消退,RPR 17例(65.4%)阴转,WB 3例(11.5%)阴转;6个月后RPR 25例(96.2%)阴转,WB 3例(11.5%)阴转;1年后RPR 26例(100%)阴转,WB 4例(15.4%)阴转;2年后RPR 26例(100%)阴转,WB 10例(38.6%)阴转。结论RPR在短时间内转阴率高,阿奇霉素治疗早期梅毒疗效肯定。免疫印迹法在梅毒的早期诊断中具有高度特异性和敏感性,可以作为早期梅毒的确诊方法。     

An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report

Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.     

梅毒在口腔黏膜表现的临床分析——附8例报告

目的:分析梅毒在口腔黏膜的临床表现。方法:总结8例以口腔梅黏膜病损为首发症状的梅毒患者的临床特征,并结合相关文献进行临床分析。结果:8例梅毒患者中7例表现为梅毒黏膜斑,好发部位为下唇;3例表现为梅毒性黏膜炎。1例在一期梅毒时期被误诊为复发性口疮。1例儿童因父母双方均为梅毒患者而间接感染结论:梅毒在口腔的首发症状以梅毒黏膜斑最为常见。口腔医生应掌握梅毒的口腔病损,并及时对患者家属进行梅毒筛查,以免误诊,漏诊。