Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, CH-8091 Zürich, Switzerland.
Clin Infect Dis. 2012 Dec;55(12):1615-22. doi: 10.1093/cid/cis757. Epub 2012 Sep 5.
Serology is the mainstay for syphilis diagnosis and treatment monitoring. We investigated serological response to treatment of syphilis according to disease stage and HIV status.
A retrospective cohort study of 264 patients with syphilis was conducted, including 90 primary, 133 secondary, 33 latent, and 8 tertiary syphilis cases. Response to treatment as measured by the Venereal Disease Research Laboratory (VDRL) test and a specific IgM (immunoglobulin M) capture enzyme-linked immunosorbent assay (ELISA; Pathozyme-IgM) was assessed by Cox regression analysis.
Forty-two percent of primary syphilis patients had a negative VDRL test at their diagnosis. Three months after treatment, 85%-100% of primary syphilis patients had reached the VDRL endpoint, compared with 76%-89% of patients with secondary syphilis and 44%-79% with latent syphilis. In the overall multivariate Cox regression analysis, serological response to treatment was not influenced by human immunodeficiency virus (HIV) infection and reinfection. However, within primary syphilis, HIV patients with a CD4 count of <500 cells/μL had a slower treatment response (P = .012). Compared with primary syphilis, secondary and latent syphilis showed a slower serological response of VDRL (P = .092 and P < .001) and Pathozyme-IgM tests (P < .001 and P = .012).
The VDRL should not be recommended as a screening test owing to lack of sensitivity. The syphilis disease stage significantly influences treatment response whereas HIV coinfection only within primary syphilis has an impact. VDRL test titers should decline at least 4-fold within 3-6 months after therapy for primary or secondary syphilis, and within 12-24 months for latent syphilis. IgM ELISA might be a supplement for diagnosis and treatment monitoring.
血清学是梅毒诊断和治疗监测的主要方法。我们根据疾病阶段和 HIV 状况研究了梅毒治疗后的血清学反应。
对 264 例梅毒患者进行了回顾性队列研究，包括 90 例原发性、133 例二期、33 例潜伏性和 8 例三期梅毒病例。采用 Cox 回归分析评估性病研究实验室（VDRL）检测和特异性 IgM（免疫球蛋白 M）捕获酶联免疫吸附试验（ELISA；Pathozyme-IgM）的治疗反应。
42%的原发性梅毒患者在诊断时 VDRL 检测为阴性。治疗 3 个月后，85%-100%的原发性梅毒患者达到了 VDRL 终点，而二期梅毒患者为 76%-89%，潜伏性梅毒患者为 44%-79%。在多变量 Cox 回归分析中，血清学治疗反应不受人类免疫缺陷病毒（HIV）感染和再感染的影响。然而，在原发性梅毒中，CD4 计数<500 个/μL 的 HIV 患者治疗反应较慢（P =.012）。与原发性梅毒相比，二期和潜伏性梅毒的 VDRL（P =.092 和 P <.001）和 Pathozyme-IgM 检测（P <.001 和 P =.012）的血清学反应较慢。
由于缺乏敏感性，VDRL 不建议作为筛查试验。梅毒疾病阶段显著影响治疗反应，而 HIV 感染仅在原发性梅毒中具有影响。原发性或二期梅毒治疗后 3-6 个月内，VDRL 滴度应至少下降 4 倍，潜伏性梅毒应下降 12-24 个月。IgM ELISA 可能是诊断和治疗监测的补充。
