Hobbs Emily, Vera Jaime H, Marks Michael, Barritt Andrew William, Ridha Basil H, Lawrence David
Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
Lawson Unit, Royal Sussex County Hospital, Brighton, UK.
Pract Neurol. 2018 Jun;18(3):211-218. doi: 10.1136/practneurol-2017-001754. Epub 2018 Feb 24.
Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.
梅毒在英国是一种再度流行的性传播感染疾病，在感染艾滋病毒的患者中诊断比例过高，尤其是在男男性行为者中。梅毒在艾滋病毒感染者中的表现似乎有所不同，特别是在那些严重免疫抑制的患者中。在合并感染艾滋病毒的情况下，进展为神经梅毒更为常见，而且可能无症状，通常持续数年。神经梅毒的表现各不相同，但可能包括脑膜炎、脑膜血管病、全身麻痹和脊髓痨。对于何时进行腰椎穿刺存在争议，而且目前的金标准诊断方法敏感性不足。我们建议采用务实的方法进行腰椎穿刺、解读检查结果并决定何时考虑使用能穿透神经的抗生素方案进行治疗。
