School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
Department of Dermatology, Veterans Affairs Medical Center, State University of New York Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA.
Am J Clin Dermatol. 2023 Mar;24(2):287-297. doi: 10.1007/s40257-022-00755-3. Epub 2023 Jan 23.
The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.
梅毒的发病率自 2000 年以来一直在美国上升。值得注意的是，2019 年冠状病毒病大流行对包括梅毒和先天性梅毒在内的性传播疾病传播的公共卫生工作产生了负面影响。梅毒的临床表现主要为黏膜皮肤损害，因此皮肤科医生能够识别这种疾病的多种表现。一期梅毒的特征通常为无痛性一过性硬下疳，最常发生在生殖器部位。二期梅毒的临床表现通常为全身症状，同时伴有黏膜皮肤疹，存在多种表现形式。尽管在有效青霉素治疗时代，梅毒的晚期临床表现较为少见，但也有相关描述。除了通过体格检查识别梅毒外，还可以使用几种诊断工具来确认感染。可以直接使用组织病理学染色、暗场显微镜检查、直接荧光抗体和聚合酶链反应检测来检测苍白密螺旋体螺旋体。本文还包括一张详细描述梅毒组织病理学特征的表格。血清学检测，非密螺旋体和密螺旋体检测，是筛查和诊断梅毒感染的首选方法。存在两种血清学检测算法，以帮助临床医生诊断阳性梅毒感染。确定梅毒感染的正确阶段需要结合血清学检测结果、患者病史和体格检查结果。根据当前疾病预防控制中心的病例定义和治疗指南，本文提出了一种管理算法。青霉素仍然是治疗梅毒的首选药物，尽管在某些具体情况下可以选择替代疗法。梅毒在每个州都是一种应报告的疾病，应根据各州的具体要求，按照感染阶段进行报告。筛查建议主要基于性接触中遇到的风险。同样，性伴侣管理包括评估和治疗接触到诊断为感染性梅毒阶段的人的患者。建议密切临床随访和重复检测，以确保对治疗有适当的反应。本指南将讨论梅毒的当前流行病学，并重点讨论诊断和管理的实践方面，包括公共卫生报告。
