Musher D M, Hamill R J, Baughn R E
Veterans Affairs Medical Center, Houston, Texas.
Ann Intern Med. 1990 Dec 1;113(11):872-81. doi: 10.7326/0003-4819-113-11-872.
To evaluate evidence that concurrent infection with human immunodeficiency virus (HIV) alters both the natural history of syphilis (by increasing the frequency of early neurosyphilis) and the response to penicillin.
Review of major works on syphilis in the English language and files maintained since 1971, supplemented by a systematic search using Index Medicus and MEDLARS.
The works mentioned above were critically reviewed for information on early neurosyphilis and, where relevant, HIV infection.
The central nervous system is regularly involved in early syphilis. Standard recommended doses of benzathine penicillin provide cerebrospinal fluid levels that are probably at the borderline of efficacy, and cure relies on treatment and an adequate host immune response. Early neurosyphilis, appearing within 2 years of onset of infection with Treponema pallidum, was uncommon in the prepenicillin era and usually occurred after inadequate therapy. This complication was exceedingly rare in the first three decades of penicillin use. In contrast, in the past decade, 40 patients with HIV infection have been reported to have asymptomatic neurosyphilis, or syphilitic meningitis, cranial nerve abnormalities (predominantly in cranial nerves II and VIII), or cerebrovascular accidents, singly or together. In 40% of cases, HIV infection was first diagnosed when neurologic symptoms appeared. Of the 38 patients for whom information was available, 18 had the acquired immunodeficiency syndrome (AIDS), 7 had AIDS-related complex, and 13 had antibody to HIV. Sixteen had previously been treated for syphilis, of whom 5 (31%) had received benzathine penicillin within the previous 6 months. Preliminary data also suggest that skin lesions and VDRL (Venereal Disease Research Laboratory) antibody in HIV-infected patients with secondary syphilis respond more slowly to conventional penicillin therapy.
Intensive therapy and follow-up observation is indicated for early syphilis in HIV-infected subjects. Novel approaches to treatment deserve systematic evaluation.
评估人类免疫缺陷病毒（HIV）合并感染是否会改变梅毒的自然病程（通过增加早期神经梅毒的发生率）以及对青霉素的反应。
回顾自1971年以来保存的英文梅毒主要著作及档案，并使用《医学索引》和医学文献分析和检索系统（MEDLARS）进行系统检索作为补充。
对上述著作进行严格审查，以获取有关早期神经梅毒以及相关HIV感染的信息。
中枢神经系统常受累于早期梅毒。苄星青霉素的标准推荐剂量所提供的脑脊液水平可能处于疗效临界值，治愈依赖于治疗和充分的宿主免疫反应。早期神经梅毒出现在感染梅毒螺旋体后2年内，在青霉素时代之前并不常见，且通常发生在治疗不充分之后。在青霉素使用的头三十年中，这种并发症极其罕见。相比之下，在过去十年中，已有报道称40例HIV感染患者出现无症状神经梅毒、梅毒脑膜炎、脑神经异常（主要累及脑神经II和VIII）或脑血管意外，单独或合并出现。在40%的病例中，神经系统症状出现时首次诊断出HIV感染。在可获取信息的38例患者中，18例患有获得性免疫缺陷综合征（AIDS），7例患有AIDS相关综合征，13例有HIV抗体。16例患者先前曾接受过梅毒治疗，其中5例（31%）在过去6个月内接受过苄星青霉素治疗。初步数据还表明，HIV感染合并二期梅毒患者的皮肤损害和性病研究实验室（VDRL）抗体对传统青霉素治疗的反应更为缓慢。
对于HIV感染的早期梅毒患者，应进行强化治疗和随访观察。新的治疗方法值得进行系统评估。
