Brown S T
J Am Vener Dis Assoc. 1976 Dec;3(2 Pt 2):172-6.
Reactions related to treatment of syphilis may be due to treponemal infection, therapy, or to the interaction of these. In this review I discuss the Jarisch-Herxheimer (J-H) reaction and the therapeutic paradox. Antibiotic side effects are not unique among patients treated for syphilis; therefore, readers are referred elsewhere for reviews of major antibiotic side effects. J-H reactions are acute, transient episodes with manifestations occurring both systemically and at local sites of treponemal concentration. These reactions are related to the rapid destruction of treponemes by various therapeutic agents. In this review, I suggest that J-H reactions may be significant only in syphilitic paresis, pregnancy complicated by syphilis, and when local inflammation can cause serious functional compromise, as with second or eighth cranial nerve involvement. Many workers use prednisone in conjunction with penicillin in some or all of these situations. However, the efficacy of corticosteroids has not been evaluated for such problems in clinical trials. Therefore, the use of prednisone can be supported only in very selected situations and for short duration (ie, 2 days). Therapeutic paradox, which is clinical worsening despite cure of infection, is said to result from scar formation after rapid treponemal destruction by therapeutic agents. The therapeutic paradox does not appear of great significance. Futhermore, no methods to prevent such reactions are generally advocated.
与梅毒治疗相关的反应可能归因于梅毒螺旋体感染、治疗手段或二者的相互作用。在本综述中，我将讨论吉海反应（J-H反应）和治疗矛盾。抗生素副作用在梅毒治疗患者中并非独有；因此，主要抗生素副作用的综述请读者参考其他资料。J-H反应是急性、短暂的发作，全身和梅毒螺旋体集中的局部部位均有表现。这些反应与各种治疗药物导致的梅毒螺旋体快速破坏有关。在本综述中，我认为J-H反应可能仅在梅毒性轻瘫、合并梅毒的妊娠以及局部炎症可导致严重功能损害（如累及第二或第八颅神经）时才具有重要意义。许多工作人员在部分或所有这些情况下会将泼尼松与青霉素联合使用。然而，临床试验中尚未评估皮质类固醇对这些问题的疗效。因此，仅在非常特定的情况下且短期（即2天）使用泼尼松才是合理的。治疗矛盾是指尽管感染已治愈，但临床症状却恶化，据说这是治疗药物使梅毒螺旋体快速破坏后瘢痕形成所致。治疗矛盾似乎并不十分重要。此外，一般不主张采取预防此类反应的方法。
