Ricco Jason, Westby Andrea
University of Minnesota Medical School, Minneapolis, MN, USA.
Am Fam Physician. 2020 Jul 15;102(2):91-98.
Rates of primary, secondary, and congenital syphilis are increasing in the United States, and reversing this trend requires renewed vigilance on the part of family physicians to assist public health agencies in the early detection of outbreaks. Prompt diagnosis of syphilis can be challenging, and not all infected patients have common manifestations, such as a genital chancre or exanthem. The U.S. Preventive Services Task Force recommends screening for syphilis in all patients at increased risk, particularly those who reside in high-prevalence areas, sexually active people with HIV infection, and men who have sex with men. Other groups at increased risk include males 29 years or younger and people with a history of incarceration or sex work. All pregnant women should be screened for syphilis at the first prenatal visit, and those at increased risk should be screened throughout the pregnancy. The Centers for Disease Control and Prevention recommends the traditional screening algorithm for most U.S. populations. Penicillin is the preferred treatment across all stages of syphilis, although limited research suggests a possible role for other antibiotics in penicillin-allergic patients with primary or secondary syphilis. Pregnant women with syphilis who are allergic to penicillin should undergo penicillin desensitization before treatment.
在美国，一期、二期和先天性梅毒的发病率正在上升，要扭转这一趋势，家庭医生需要重新提高警惕，协助公共卫生机构尽早发现疫情。梅毒的及时诊断可能具有挑战性，并非所有感染患者都有常见表现，如生殖器溃疡或皮疹。美国预防医学工作组建议对所有高危患者进行梅毒筛查，特别是那些居住在高流行地区的人、感染艾滋病毒的性活跃人群以及男男性行为者。其他高危人群包括29岁及以下的男性以及有监禁或性工作史的人。所有孕妇在首次产前检查时都应进行梅毒筛查，高危孕妇在整个孕期都应进行筛查。疾病控制与预防中心建议对大多数美国人群采用传统的筛查算法。青霉素是梅毒各阶段的首选治疗药物，尽管有限的研究表明，对于对青霉素过敏的一期或二期梅毒患者，其他抗生素可能也有作用。对青霉素过敏的梅毒孕妇在治疗前应进行青霉素脱敏。
