Nnoruka E N, Ezeoke A C J
Department of Dermatology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Trop Med Int Health. 2005 Jan;10(1):58-64. doi: 10.1111/j.1365-3156.2004.01344.x.
To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period.
Descriptive, cross-sectional, hospital-based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark-field microscopy were undertaken to confirm diagnosis where serologic (non-treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x-ray, mantoux and purified protein derivative (PPD) status taken.
Thirty-one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months +/- 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD)--particularly genital ulcers--while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non-reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections.
Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.
记录12个月期间合并感染HIV患者的梅毒表现。
对2000年7月至2001年6月期间在尼日利亚大学教学医院埃努古分校皮肤科就诊的所有成年梅毒合并HIV感染患者进行描述性横断面医院研究。使用标准化问卷记录年龄、性别、婚姻状况、职业和HIV感染的危险因素；皮疹/溃疡的初始发病部位、病程、黏膜、毛发和指甲的任何伴随病变以及每位患者就诊前接受的治疗。检查皮肤科医生记录病变的形态分布、黏膜表面（结膜、外阴和直肠）检查以及与HIV相关的伴随疾病。在梅毒血清学（非梅毒螺旋体和梅毒螺旋体特异性）检测结果与临床怀疑不一致时，进行病变活检和暗视野显微镜检查以确诊。每位患者均进行常规胸部X光检查、结核菌素试验和纯化蛋白衍生物（PPD）状态检查。
研究期间共诊治31例合并梅毒和HIV的患者（21例男性）。一期梅毒9例（29%），二期梅毒20例（64.5%），潜伏梅毒2例（6.5%）。未观察到神经梅毒。这些合并HIV患者的梅毒患病率为2.1%。梅毒的平均病程为3.9个月±1.4个月，最受关注的病变主要发生在生殖器部位。龟头受累10例（32.3%），阴茎体7例（22.6%），口腔5例（16.1%），直肠6例（19.4%），外阴3例（0.9%）。9例（29.1%）患者有一期梅毒硬下疳病史，19例（61.3%）有性传播疾病（STD）既往史——尤其是生殖器溃疡——而3例（9.7%）无法回忆起任何STD既往史。18例（59.3%）有不安全性行为史，16例（51.7%）有多个性伴侣，4例（13.3%）有口交史，1例（3.3%）有肛交史；无人承认是双性恋。其他HIV传播的相关危险因素包括3例（9.7%）在5年内有输血史和2例（6.5%）有静脉吸毒史。一些患者有多种可能的暴露源情况。17例（48.4%）患者血清学检测呈弱阳性，9例（29%）呈强阳性，5例（16.1%）呈阴性。3例患者出现前带现象。治疗采用目前在没有性传播感染病因诊断设施的初级保健中心提倡使用的综合征治疗方法。
我们的梅毒合并HIV/AIDS病例有不寻常的表现，由于总体健康水平较低，与西方文献中描述的病例相比，对治疗反应更慢且死亡更早。
