Willcox R R
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patients are rendered non-infectious within hours, sero-reversal to tests with lipid antigens occurs within months and insignificant numbers of patients with cardiovascular or neurosyphilis are found among those who have received adequate treatment. On the other hand, seropositivity to tests with treponemal antigens may persist, sometimes indefinitely, and reinfections are, today, by no means uncommon. The physician also has a responsibility to persuade the patient with early infectious syphilis to induce the person who was the source of the infection and subsequent sexual partners to undergo examination and treatment.In late syphilis, no treatment can repair structural damage that has already occurred, e.g., severed neurons in the nervous system or loss of elastic tissue in the aortic wall, and clinical progression may occur in spite of treatment. Nevertheless, penicillin provides the basis of therapy.Early congenital syphilis, like the acquired infection, responds well to penicillin. However, because benzathine penicillin penetrates poorly into the cerebrospinal fluid much higher doses of procaine penicillin are now recommended, or alternatively the use of crystalline penicillin G.A recent WHO Scientific Group on Treponemal Infections has made new recommendations concerning the treatment of syphilis and these will be considered by the next WHO Expert Committee on Venereal Diseases, Treponematoses and Neisseria infections. Some of these recommendations are outlined in this article.
患者在数小时内即不再具有传染性，数月内梅毒血清试验（针对脂质抗原）转为阴性，在接受充分治疗的患者中，发生心血管梅毒或神经梅毒的人数极少。另一方面，梅毒螺旋体抗原试验的血清阳性反应可能持续存在，有时甚至会无限期持续，而且如今再次感染绝非罕见。医生还有责任劝说患有早期传染性梅毒的患者促使感染源及随后的性伴侣接受检查和治疗。
在晚期梅毒中，任何治疗都无法修复已经发生的结构性损害，例如神经系统中神经元的断裂或主动脉壁弹性组织的丧失，而且即便接受治疗，临床病情仍可能进展。尽管如此，青霉素仍是治疗的基础。
早期先天性梅毒，与后天性感染一样，对青霉素反应良好。然而，由于苄星青霉素难以穿透脑脊液，目前推荐使用更高剂量的普鲁卡因青霉素，或者使用青霉素G结晶。
世界卫生组织梅毒感染科学小组最近就梅毒治疗提出了新的建议，下一届世界卫生组织性病、密螺旋体病和奈瑟菌感染专家委员会将对这些建议进行审议。本文概述了其中一些建议。
