Department of Sexual Health and HIV, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK.
Department of Infectious Diseases, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK.
Sex Transm Infect. 2018 Aug;94(5):337-339. doi: 10.1136/sextrans-2016-052938. Epub 2017 Feb 14.
To determine the prevalence of asymptomatic neurosyphilis (ANS) in HIV-positive individuals after treatment of early syphilis with single-dose benzathine penicillin G (BPG) or oral antibiotic alternatives.
Patients at high risk of neurosyphilis (defined by serum rapid plasma reagin (RPR) titre ≥1:32 and/or peripheral blood CD4 lymphocyte count ≤350/μL) underwent lumbar puncture (LP) at a median time of 8.2 months post treatment. ANS was diagnosed by a reactive cerebrospinal fluid (CSF) RPR test or CSF white blood cells (WBC) >20/μL plus a reactive CSF particle agglutination (TPPA) ≥1:640.
Of 133 eligible patients, all were men who have sex with men. Of these, 64 consented to LP. Full CSF results were available for 59 patients. Inclusion criteria were serum RPR (21/59), CD4 count (22/59) and combined RPR and CD4 (16/59). The LP patients were white British (82%), median age 40. Syphilis stages were primary (17%) secondary (43%) and early latent (41%). Syphilis was treated with BPG (47/59), doxycycline 100 mg two times per day for 14 days (10/59) and for 21 days (1/59). Azithromycin 500 mg one time per day for 10 days was given to 1/59. At the time of LP, 100% of patients had achieved serological cure, and 66% were taking antiretroviral treatment. Only 1/59 was diagnosed with ANS. The CSF showed: RPR non-reactive (59/59); TPPA non-reactive in 54/59; WBC ≤5/μL in 51/59.
Although the number of patients in our study is modest, single-dose BPG appears to be highly effective even in patients at high risk of neurosyphilis.
确定早期梅毒经单剂量苄星青霉素 G（BPG）或口服抗生素替代治疗后，HIV 阳性个体中无症状神经梅毒（ANS）的患病率。
高危神经梅毒患者（定义为血清快速血浆反应素（RPR）滴度≥1:32 和/或外周血 CD4 淋巴细胞计数≤350/μL）在治疗后中位数时间 8.2 个月行腰椎穿刺（LP）。通过脑脊液（CSF）RPR 试验阳性或 CSF 白细胞（WBC）>20/μL 加 CSF 密螺旋体颗粒凝集（TPPA）≥1:640 诊断 ANS。
在 133 名符合条件的患者中，均为男男性行为者。其中 64 名同意行 LP。59 名患者的 CSF 结果完整。包括血清 RPR（21/59）、CD4 计数（22/59）和联合 RPR 和 CD4（16/59）。LP 患者为白种英国人（82%），中位年龄为 40 岁。梅毒分期为一期（17%）、二期（43%）和早期潜伏（41%）。BPG（47/59）、多西环素 100mg 每日两次共 14 天（10/59）和 21 天（1/59）、阿奇霉素 500mg 每日一次共 10 天治疗梅毒。LP 时，100%的患者达到血清学治愈，66%的患者正在接受抗逆转录病毒治疗。仅有 1/59 被诊断为 ANS。CSF 显示：RPR 无反应（59/59）；TPPA 无反应 54/59；WBC≤5/μL 51/59。
尽管我们研究中的患者数量有限，但单剂量 BPG 似乎即使在高危神经梅毒患者中也非常有效。
