244 例原发性梅毒男性患者的临床和实验室特征：一项为期 5 年的单中心回顾性研究。

Clinical and laboratory features of 244 men with primary syphilis: a 5-year single-centre retrospective study.

机构信息

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

出版信息

Sex Transm Infect. 2021 Nov;97(7):479-484. doi: 10.1136/sextrans-2020-054705. Epub 2021 Jan 11.

DOI:10.1136/sextrans-2020-054705

PMID:33431607

Abstract

BACKGROUND

Syphilis incidence has exponentially increased in recent decades, particularly among men who have sex with men (MSM). Primary syphilis is characterised by a chancre appearing at the site of (TP) inoculation. Atypical morphological variants of syphilitic chancre are frequent. Clinical suspicion must be confirmed either by the demonstration of TP within the lesion through direct tests, such as dark field microscopy (DFM) or nucleic acid amplification technique (TP-NAAT), or by serological tests.

OBJECTIVES

To analyse the clinical features, the sexual behaviour and the role of diagnostic tests in a cohort of men with primary syphilis in Milan.

METHODS

Epidemiological, clinical and laboratory data of male patients with primary syphilis seen at the STI Center of the University of Milan between 2015 and 2019 were retrospectively evaluated. Diagnosis was confirmed by at least one positive diagnostic test of either DFM, TP-NAAT or serology.

RESULTS

Among a total of 244 patients, 160 (65.6%) were MSM and 32 (13.1%) were living with HIV. One hundred twenty-four (50.8%) patients had a clinically atypical chancre. Chancres were exclusively extragenital in 30 (12.3%) patients, with MSM being more commonly affected (MSM vs heterosexuals: 16.3% vs 4.8%, respectively; p=0.012), and anal region the most frequently involved site. Chancres were multiple in 68/242 (28.1%) patients and morphologically atypical in 76/244 (31.1%). Diagnosis was obtained by (1) both serology and direct methods in 158/244 patients (64.7%), (2) serology solely in 47/244 (19.3%) and (3) direct methods solely in 39/244 (16%). DFM yielded positive results in 83/139 (59.7%) patients, while TP-NAAT gave positive results in 114/121 (94.2%) patients.

CONCLUSIONS

Patients with primary syphilis frequently present with morphologically atypical chancres. Furthermore, MSM commonly exhibit extragenital involvement. A combined diagnostic approach including both direct and indirect tests is needed.

摘要

背景

梅毒发病率在最近几十年呈指数级增长，尤其是在男男性行为者（MSM）中。一期梅毒的特征是在（TP）接种部位出现下疳。梅毒下疳的非典型形态变异很常见。临床怀疑必须通过直接检测（如暗场显微镜检查（DFM）或核酸扩增技术（TP-NAAT））或血清学检测来证实 TP 存在于病变内来确认。

目的

分析米兰一组原发性梅毒男性患者的临床特征、性行为以及诊断检测的作用。

方法

回顾性评估 2015 年至 2019 年间在米兰大学性传播感染中心就诊的原发性梅毒男性患者的流行病学、临床和实验室数据。诊断通过至少一项 DFM、TP-NAAT 或血清学的阳性诊断检测来确认。

结果

在总共 244 名患者中，160 名（65.6%）为 MSM，32 名（13.1%）为 HIV 感染者。124 名（50.8%）患者有临床表现不典型的下疳。30 名（12.3%）患者的下疳仅为外生殖器，MSM 更常见（MSM 与异性恋者：16.3% 与 4.8%，分别；p=0.012），肛门区域是最常受累的部位。242 名患者中有 68 名（28.1%）下疳为多发性，244 名患者中有 76 名（31.1%）下疳形态不典型。244 名患者中的（1）158 名（64.7%）通过血清学和直接方法获得诊断，（2）47 名（19.3%）仅通过血清学获得诊断，（3）39 名（16%）仅通过直接方法获得诊断。83 名患者（59.7%）的 DFM 检测结果阳性，114 名患者（94.2%）的 TP-NAAT 检测结果阳性。