Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Rev. 2024 Jul 1;45(7):373-380. doi: 10.1542/pir.2023-006309.
Nearly half of all sexually transmitted infections occur in adolescents and young adults. Among them, syphilis infections are on the rise in the United States. Sexually active adolescents, especially those who do not use condoms consistently or are men who have sex with men, are at particular risk for syphilis infection. With the rise in acquired syphilis infections, the incidence of congenital syphilis has also increased. Syphilis can have a variety of presentations based on infectious stage and central nervous system involvement. Careful physical examination and history can elicit the diagnosis. Screening with a nontreponemal test followed by treponemal testing can confirm the diagnosis, and staging is determined clinically. Testing for all sexually transmitted infections should be pursued because coinfections are common. Penicillin is the first-line treatment for syphilis, and duration of therapy depends on the presence of neurologic symptoms; all infants with possible congenital syphilis should receive treatment. Posttreatment monitoring is essential to confirm successful eradication of syphilis. All sexually active, at-risk patients, including pregnant persons, should be screened for syphilis, and those diagnosed as having syphilis should be counseled on disclosure to partners. Although not often found in a pediatric population, with the increasing incidence of syphilis infections in the United States, pediatric providers should have a low threshold for syphilis screening in adolescents and a high index of suspicion for congenital syphilis in infants.
近一半的性传播感染发生在青少年和年轻人中。其中，美国的梅毒感染呈上升趋势。性活跃的青少年，特别是那些不经常使用避孕套或与男性发生性关系的人，特别容易感染梅毒。随着获得性梅毒感染的增加，先天性梅毒的发病率也有所上升。根据感染阶段和中枢神经系统受累情况，梅毒可呈现多种表现。仔细的体格检查和病史可以引出诊断。非梅毒螺旋体试验筛查后进行梅毒螺旋体试验可以确诊，并根据临床情况进行分期。应进行所有性传播感染的检测，因为合并感染很常见。青霉素是治疗梅毒的一线药物，治疗时间取决于是否存在神经系统症状；所有疑似先天性梅毒的婴儿都应接受治疗。治疗后监测对于确认梅毒的成功根除至关重要。所有有性行为、有感染风险的患者，包括孕妇，都应接受梅毒筛查，对于确诊梅毒的患者，应告知其向性伴侣披露病情。虽然在儿科人群中并不常见，但随着美国梅毒感染率的上升，儿科医生在青少年中梅毒筛查的门槛应该降低，对先天性梅毒的怀疑指数应该升高。
