Farhi David, Dupin Nicolas
Cabinet de dermatologie-vénéréologie, 75013 Paris.
Rev Prat. 2010 Apr 20;60(4):525-30.
Since the turn of the millennium, the incidence of syphilis is on the rise in France and in other developed countries. The majority of syphilis cases currently occur in men having sex with men and half of the cases occur in HIV-positive patients. Multiple partners and non protected intercourses are frequently reported. About 80% of syphilis recently diagnosed in France are symptomatic and correspond to primary or secondary syphilis. The other potential circumstances of diagnosis of syphilis include the presence of risk factors, an intercourse with an infected partner, the serological follow-up of a previous syphilis and a systematic screening during pregnancy. Clinical features are mainly represented by skin and mucosal lesions. However, extra-cutaneous involvement and biological abnormalities are quite frequent during secondary syphilis especially ophthalmic complications which are source of sequelae due to the delay for diagnosis. In the post-HAART era, it seems that clinical presentation and serological response after treatment is similar in HIV infected patients in comparison to HIV uninfected patients and that patients with early syphilis shoud be treated with one dose of benzathine penicillin G while the unique treatment for neurosyphilis is intravenous penicilline G.
自千禧年之交以来，法国及其他发达国家梅毒的发病率呈上升趋势。目前，大多数梅毒病例发生在男男性行为者中，且一半的病例发生在艾滋病毒阳性患者身上。经常有多个性伴侣和无保护性行为的报告。在法国，最近诊断出的梅毒病例中约80%有症状，且对应一期或二期梅毒。梅毒诊断的其他潜在情况包括存在危险因素、与感染伴侣发生性行为、对既往梅毒进行血清学随访以及孕期系统筛查。临床特征主要表现为皮肤和黏膜病变。然而，二期梅毒期间皮肤外受累和生物学异常相当常见，尤其是眼部并发症，由于诊断延迟会导致后遗症。在高效抗逆转录病毒治疗（HAART）时代之后，与未感染艾滋病毒的患者相比，感染艾滋病毒的患者治疗后的临床表现和血清学反应似乎相似，早期梅毒患者应接受一剂苄星青霉素G治疗，而神经梅毒的唯一治疗方法是静脉注射青霉素G。
