Clinic for Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
AIDS. 2010 Jul 31;24(12):1907-16. doi: 10.1097/QAD.0b013e32833bfe21.
Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis.
Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form.
Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:>or=32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer.
Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.
2004 年，瑞士艾滋病毒队列研究（SHCS）重新引入了每年进行梅毒检测。我们前瞻性地研究了梅毒的发生、危险因素、临床表现、诊断方法和治疗。
在 33 个月的时间内，使用 SHCS 数据库和额外的结构化病例报告表研究了梅毒螺旋体血凝试验阳性测试结果的参与者。
在 7244 名队列参与者中，909 人（12.5%）梅毒血清学检测阳性。其中，633 人以前接受过治疗，在检测时没有当前的梅毒体征或症状。在 218 名新发现未经治疗的梅毒患者中，20%的患者仅报告生殖器-口腔接触为唯一的危险行为，60%的患者无症状。新发现的梅毒在男男性接触者（MSM）中更为常见[调整后的优势比（OR）2.8，P < 0.001]，在报告偶然性伴侣的人群中（调整后的 OR 2.8，P < 0.001）和年龄较小的 MSM 中更为常见（P = 0.05）。仅进行了 35%的推荐的脑脊液（CSF）检查。在 4 名无神经系统症状的患者中诊断出神经梅毒；他们的所有性病研究实验室（VDRL）滴度均为 1:>或=32。91%的患者对治疗有反应，VDRL 滴度至少下降了 4 倍。
梅毒仍然是 SHCS 中的一个重要合并感染， justifies 重新引入常规筛查。生殖器-口腔接触是一种重要的传播途径，年轻的 MSM 感染梅毒的风险很高。目前，通过 CSF 分析排除神经梅毒的指南在临床实践中并未得到一致遵循。在联合抗逆转录病毒治疗时代，血清学治疗反应超过 90%。
