Pastuszczak Maciej, Kotnis-Gąska Agnieszka, Jakubowicz Bernadetta, Martyka Iwona, Bociaga-Jasik Monika, Wojas-Pelc Anna
1 Department of Dermatology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
2 St John Paul II Hospital, Cracow, Poland.
Int J STD AIDS. 2018 Aug;29(9):890-894. doi: 10.1177/0956462418762849. Epub 2018 Apr 8.
Until now only non-treponemal tests (e.g. rapid plasma reagin [RPR]) have been used to monitor syphilis activity (e.g. distinguishing between treated, untreated and repeat disease) and efficacy of treatment. However, they usually require manual operation and are less specific than treponemal tests. The aim of the current study was to evaluate the use of the antitreponemal IgM testing in the diagnosis of early and repeat syphilis in HIV-infected and non-infected patients. One hundred and seventeen patients with early syphilis were included in this prospective study. RPR and anti- Treponema pallidum-IgM (TP-IgM) tests were conducted at onset and at three-month intervals during 24-month follow-up after initial treatment. In 31 of 117 syphilitic patients the co-occurrence of HIV infection was diagnosed. A positive TP-IgM test was present in 78.6% of patients with newly-diagnosed primary syphilis, 95.8% with secondary and 57.9% with early latent syphilis, but only in 38.5% patients with syphilis reinfection. There was a significant correlation between primary and secondary syphilis, higher baseline RPR titre and the pre-treatment IgM test reactivity. Regardless of the syphilis stage, HIV-seropositive individuals were more frequently positive for TP-IgM, both during the first onset of the disease (90.3%), and reinfection (71.4%), as compared to the HIV-seronegative group (71.4% and 0%, respectively, P < 0.03). TP-IgM seroreversion was observed in 115 out of 117 patients studied (98.3%) during follow-up (mean time to seroreversion 6.9 months). The time to TP-IgM seroreversion after treatment was significantly shorter in patients with early symptomatic syphilis (mean 4.9 months) when compared to early latent syphilis (7.7 months, P < 0.05). A negative TP-IgM test was found in approximately 20% and 40% of individuals with primary and early latent syphilis, respectively. The value of IgM testing in the diagnosis of syphilis reinfection is doubtful.
到目前为止，仅使用非梅毒螺旋体检测（如快速血浆反应素试验[RPR]）来监测梅毒活动情况（如区分已治疗、未治疗和复发性疾病）及治疗效果。然而，它们通常需要手工操作，且特异性低于梅毒螺旋体检测。本研究的目的是评估抗梅毒螺旋体IgM检测在诊断HIV感染和未感染患者的早期及复发性梅毒中的应用。117例早期梅毒患者纳入了这项前瞻性研究。在初始治疗后的24个月随访期间，发病时及每隔三个月进行RPR和抗梅毒螺旋体IgM（TP-IgM）检测。117例梅毒患者中有31例被诊断合并HIV感染。新诊断的一期梅毒患者中78.6%的TP-IgM检测呈阳性，二期梅毒患者中为95.8%，早期潜伏梅毒患者中为57.9%，但梅毒再感染患者中仅38.5%呈阳性。一期和二期梅毒、较高的基线RPR滴度与治疗前IgM检测反应性之间存在显著相关性。无论梅毒处于何阶段，与HIV血清阴性组相比，HIV血清阳性个体在疾病首次发作时（90.3%）和再感染时（71.4%）TP-IgM检测呈阳性的频率更高（分别为71.4%和0%，P < 0.03）。在研究的117例患者中有115例（98.3%）在随访期间观察到TP-IgM血清学转阴（血清学转阴的平均时间为6.9个月）。与早期潜伏梅毒（7.7个月，P < 0.05）相比，有症状的早期梅毒患者治疗后TP-IgM血清学转阴时间显著更短（平均4.9个月）。一期和早期潜伏梅毒患者中分别约20%和40%的个体TP-IgM检测呈阴性。IgM检测在梅毒再感染诊断中的价值存疑。
