Lefebvre M, Biron C, Guillouzouic A, Juvin M E, Masseau A, Néel A, Grossi O, Boutoille D
Service de maladies infectieuses et tropicales, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Rev Med Interne. 2013 Sep;34(9):522-7. doi: 10.1016/j.revmed.2013.02.010. Epub 2013 Aug 12.
Syphilis infection increase has been observed since the early 2000s. The medical records of patients hospitalized for syphilis at the tertiary care hospital of Nantes between 2000 and 2010 were retrospectively reviewed.
Cases were selected on the basis of serological database of the laboratory of bacteriology and extraction from the PMIS. Syphilis cases were defined by both positive TPHA and VDRL tests.
The number of positive serology testing was increased eightfold within ten years. Among the 36 patients with syphilis hospitalized cases, 97% were male, aged 17 to 75 years. Eighteen were HIV-infected patients. Among them, 94% were homosexuals and 67% had a history of sexually transmitted infections. The mean time between symptoms and diagnosis was significantly higher in non HIV-infected patients. Clinical forms of syphilis were cutaneomucous secondary syphilis with frequent systemic symptoms for 33%, neurosyphilis, including frequent uveitis for 50%, and gummatous tertiary syphilis involving bones for one patient. Secondary syphilis cases were treated with one to three doses of benzathine penicillin G. Late syphilis and cases of neurosyphilis were treated with penicillin G or ceftriaxone. Neurosensory sequelae accounted for 39% neurosyphilis cases.
This study highlights the incidence increase of syphilis cases in France, frequent poor prognosis of neurosyphilis cases, and diagnosis difficulties, particularly in non HIV-infected patients. This emphasizes the broader use of syphilis serology for compatible medical situations.
自21世纪初以来，梅毒感染率呈上升趋势。对2000年至2010年期间在南特三级护理医院因梅毒住院的患者病历进行回顾性研究。
根据细菌学实验室的血清学数据库进行病例筛选，并从医院信息系统中提取数据。梅毒病例定义为梅毒螺旋体血细胞凝集试验（TPHA）和性病研究实验室试验（VDRL）均呈阳性。
十年内血清学检测阳性数量增加了八倍。在36例梅毒住院病例中，97%为男性，年龄在17至75岁之间。18例为艾滋病毒感染患者。其中，94%为同性恋者，67%有性传播感染史。非艾滋病毒感染患者症状出现至诊断的平均时间显著更长。梅毒的临床类型包括：33%为有频繁全身症状的皮肤黏膜二期梅毒，50%为神经梅毒（包括频繁的葡萄膜炎），1例为累及骨骼的树胶肿性三期梅毒。二期梅毒病例采用一至三剂苄星青霉素G治疗。晚期梅毒和神经梅毒病例采用青霉素G或头孢曲松治疗。神经感觉后遗症占神经梅毒病例的39%。
本研究强调了法国梅毒病例发病率的上升、神经梅毒病例常见的不良预后以及诊断困难，尤其是在非艾滋病毒感染患者中。这强调了在符合条件的医疗情况下更广泛地使用梅毒血清学检测。
