McCabe E, Jaffe L R, Diaz A
Division of Adolescent Medicine, Staten Island University Hospital, NY 10305.
Pediatrics. 1993 Nov;92(5):695-8.
The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection among inner-city, minority group adolescents.
From August 1989 through June 1990, serum from all positive serologic tests for syphilis, obtained from patients attending a comprehensive adolescent health center in an acquired immunodeficiency syndrome epicenter and its two school-based clinics, were frozen without patient identifiers and were subsequently screened for HIV by enzyme-linked immunosorbent assay with confirmatory Western blot for positives. In addition, a retrospective chart review was performed for all patients with a positive serologic test for syphilis during the study period.
Of the 59 specimens with a positive syphilis serologic test, 9 (15.3%) were HIV seropositive. Of the patients with syphilis, 57.4% were black and 42.6% were Hispanic; 16.4% were male (mean age 18.1) and 83.6% were female (mean age 17.8). Only 1 subject (female) was an injection drug user; 4 of the male subjects self-identified as having had sex with other males. Of the subjects, 27.8% had primary, 19.7% had secondary, and 52.5% had latent syphilis at the time of diagnosis. A prior or concurrent sexually transmitted disease was present in 90% of the males and 80% of the females; gonorrhea was the most prevalent sexually transmitted disease in the males (89%) and chlamydia was most prevalent in the females (35%). A history of chancroid and/or herpes was present in 16.4% of the subjects.
It is concluded that the diagnosis of syphilis in an adolescent is a risk factor for HIV infection. All sexually active adolescents should be routinely screened for syphilis, regardless of sexual practices. Those with syphilis should be specifically counseled about their increased risk for HIV infection and the importance of consistent condom use, and they should be referred for formal HIV pretest counseling.
本研究旨在评估市中心少数族裔青少年中梅毒与人类免疫缺陷病毒（HIV）感染之间的关系。
从1989年8月至1990年6月，采集了一所位于获得性免疫缺陷综合征高发区的综合青少年健康中心及其两家校内诊所的梅毒血清学检测呈阳性患者的血清，在去除患者标识后冷冻保存，随后通过酶联免疫吸附测定法进行HIV筛查，阳性结果采用免疫印迹法确认。此外，对研究期间梅毒血清学检测呈阳性的所有患者进行了回顾性病历审查。
在59份梅毒血清学检测呈阳性的标本中，9份（15.3%）HIV血清学检测呈阳性。梅毒患者中，57.4%为黑人，42.6%为西班牙裔；16.4%为男性（平均年龄18.1岁），83.6%为女性（平均年龄17.8岁）。仅1名受试者（女性）为注射吸毒者；4名男性受试者自述与其他男性发生过性行为。在诊断时，27.8%的受试者为一期梅毒，19.7%为二期梅毒，52.5%为潜伏梅毒。90%的男性和80%的女性有既往或同时感染性传播疾病的情况；淋病是男性中最常见的性传播疾病（89%），衣原体感染是女性中最常见的性传播疾病（35%）。16.4%的受试者有软下疳和/或疱疹病史。
得出结论，青少年梅毒诊断是HIV感染的一个危险因素。所有性活跃的青少年都应常规筛查梅毒，无论其性行为方式如何。梅毒患者应接受关于其HIV感染风险增加以及坚持使用避孕套重要性的专门咨询，并应被转介接受正式的HIV检测前咨询。
