Teo S Y, Morris G, Fairley I
York Teaching Hospital NHS Foundation Trust, UK.
Int J STD AIDS. 2013 May;24(5):415-8. doi: 10.1177/0956462412472833.
We present the case of a 47-year-old man who attended a genitourinary (GU) medicine clinic with posthitis and a painless testicular mass on examination. Initial ultrasound revealed a 2-cm well-defined hypoechoic mass within the right testis and he was referred to urology on suspicion of malignancy. Subsequent syphilis serology was positive and the penile lesion and testicular mass were felt to be consistent with syphilis. After liaising with the urology department, and in view of negative tumour markers (lactate dehydrogenase, alfa-fetoprotein and human chorionic gonadotrophin) and known penicillin allergy, he was managed conservatively with four weeks of oral doxycycline. Follow-up ultrasound scans revealed adequate response of the testicular mass, with the last scan, performed at 10 months post-treatment, showing complete resolution. This is the first documented case of conservative management of a testicular syphilitic lesion using antibiotics alone with testicular sparing.
我们报告了一例47岁男性病例，该患者前往泌尿生殖医学诊所就诊，检查发现患有阴茎头炎且睾丸有一无痛性肿块。初始超声检查显示右侧睾丸内有一个2厘米边界清晰的低回声肿块，因怀疑为恶性肿瘤，他被转诊至泌尿外科。随后梅毒血清学检查呈阳性，阴茎病变和睾丸肿块被认为与梅毒相符。在与泌尿外科沟通后，鉴于肿瘤标志物（乳酸脱氢酶、甲胎蛋白和人绒毛膜促性腺激素）呈阴性且已知患者对青霉素过敏，对他进行了为期四周的口服强力霉素保守治疗。后续超声扫描显示睾丸肿块有充分反应，在治疗后10个月进行的最后一次扫描显示肿块完全消退。这是首例仅使用抗生素对睾丸梅毒病变进行保守治疗并保留睾丸的文献记载病例。
