Syphilis infection
小结
定义
Syphilis is a sexually transmitted infection caused by the spirochetal bacterium Treponema pallidum, subspecies pallidum. It is found only in human hosts. Infection is typically acquired through direct person-to-person sexual contact with an individual who has early (primary or secondary) syphilis.[1] Most sexual transmission of syphilis probably occurs from direct contact with syphilitic lesions on the genitals or mucous membranes. Transmission from mother to fetus during pregnancy causes congenital infection.[1] Syphilis has often been described as the great imitator because many of the symptoms and signs are difficult to distinguish from other diseases.[2][Figure caption and citation for the preceding image starts]: Electron micrograph of Treponema pallidum on cultures of cotton-tail rabbit epithelium cellsCDC/Dr David Cox; used with permission [Citation ends].
病史和体格检查
关键诊断因素
- anogenital ulcer
- lymphadenopathy
- diffuse rash
- constitutional symptoms
- fatigue
- rhinitis (congenital syphilis)
- hepatosplenomegaly (congenital syphilis)
- patchy alopecia
- condylomata lata
- memory impairment, altered mood, confusion, or dementia
- visual changes
- Argyll-Robertson pupils
- loss of sense of vibration, proprioception, and position sense
- ataxia
- loss of anal and bladder sphincter control
- positive Romberg sign
- diastolic murmur
- rubbery lesions/nodules with a necrotic center
- miscarriage, stillbirth, or neonatal death (congenital syphilis)
- premature labor and intrauterine growth retardation (congenital syphilis)
- neonatal skin rash (congenital syphilis)
- tibial bowing (congenital syphilis)
- craniofacial malformation (congenital syphilis)
- tooth abnormalities (congenital syphilis)
- necrotizing funisitis (congenital syphilis)
其他诊断因素
- mouth ulcer
- asymptomatic with positive serology (latent syphilis)
- tremor
- headache
- meningismus
- eye pain
- hearing loss
- seizures
- peripheral edema
- jaundice
- peripheral neuropathy
- areflexia
- angina
- dyspnea
- organomegaly
- skin or visceral organ perforation or collapse of structure
- neonatal neurologic abnormalities (congenital syphilis)
危险因素
- sexual contact with an infected person
- men who have sex with men (MSM)
- illicit drug use
- commercial sex workers
- multiple sexual partners
- people with HIV or other STIs
- syphilis during pregnancy (risk for congenital syphilis)
诊断性检查
首要检查
- dark-field microscopy of swab from lesion
- serum treponemal enzyme immunoassay (EIA)
- chemiluminescence immunoassay (CLIA)
- serum Treponema pallidum particle agglutination (TPPA)
- serum Treponema pallidum hemagglutination (TPHA)
- serum Treponema pallidum latex agglutination (TPLA)
- serum fluorescent treponemal antibody absorption (FTA-ABS) test
- immunocapture assay
- line immunoassay (LIA) serologic test
- serum rapid plasma reagin (RPR) test
- serum Venereal Disease Research Laboratory (VDRL) test
需考虑的检查
- lumbar puncture, cerebrospinal fluid (CSF) analysis
- CXR
- echocardiogram
- CT brain
- MRI brain
- HIV test
- fetal ultrasound scan
- CBC
- long-bone x-rays
- liver function tests (aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase) and bilirubin
- auditory brainstem response
- audiometry
- fetal skeletal survey
新兴检查
- Treponema pallidum polymerase chain reaction (PCR) (sample taken directly from ulcerative lesions)
- point of care (POC) testing with either treponemal or combination treponemal/nontreponemal antibody
治疗流程
adults with suspected early infection or sexual contacts of patients with confirmed infection
adults without neurosyphilis
adults with neurosyphilis
congenital syphilis
撰稿人
作者
Juan C. Salazar, MD, MPH, FAAP
Professor and Chair
Department of Pediatrics
University of Connecticut School of Medicine
Physician in Chief
Connecticut Children’s
Hartford
CT
Раскрытие информации
JCS has received NIH funding for syphilis research. JCS has been invited to speak about syphilis and congenital syphilis at various international conferences. He has been the principal author, corresponding author and/or co-author of several papers in the field of syphilis vaccine development, syphilis molecular epidemiology, and syphilis pathogenesis. JCS is the author of references cited in this topic.
Выражение благодарностей
Dr Juan C. Salazar would like to gratefully acknowledge Adriana R. Cruz, Jairo M. Montezuma-Rusca, Nicholas Bennett, Patrick French, and Nooshin Barmania, previous contributors to this topic. We would also like to acknowledge our infectious diseases expert panel member, Dr Elisabeth Adderson, for her contribution to this topic.
Раскрытие информации
PF is an author of a reference cited in this topic. EA, ARC, JMMR, NB, and NB declare that they have no competing interests.
Рецензенты
Robert A. Larsen, MD
Associate Professor of Medicine
University of Southern California
Keck School of Medicine
Los Angeles
CA
Раскрытие информации
RAL declares that he has no competing interests.
William Rodriguez, MD
Assistant Professor of Medicine
Harvard Medical School
Director of Research
Global Health Delivery Project
Harvard School of Public Health
Boston
MA
Раскрытие информации
WR declares that he has no competing interests.
Jennifer Handforth, MB ChB, MRCPCH, DTM&H
Consultant Paediatrician
Croydon University Hospital
Croydon
UK
Раскрытие информации
JH declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sex Health. 2015 Apr;12(2):103-9.Полный текст Аннотация
Kingston M, Apea V, Evans C, et al. BASHH UK guidelines for the management of syphilis 2024. Int J STD AIDS. 2024 Dec;35(14):1142-60.Полный текст Аннотация
World Health Organization. Guidelines for the treatment of Treponema pallidum (syphilis). 2016 [internet publication].Полный текст
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Полный текст Аннотация
World Health Organization. WHO guideline on syphilis screening and treatment for pregnant women. 2017 [internet publication].Полный текст
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Genital herpes
- Chancroid
- Primary HIV infection
Больше ОтличияРекомендации
- BASHH UK guidelines for the management of syphilis in pregnancy and children 2024
- BASHH UK guidelines on the management of syphilis 2024
Больше РекомендацииЛифлеты для пациента
Syphilis: what is it?
Syphilis: how is it diagnosed and treated?
Больше Лифлеты для пациентаVideos
Diagnostic lumbar puncture in adults: animated demonstration
Venepuncture and phlebotomy: animated demonstration
Больше Видео
Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice
Использование этого контента попадает под действие нашего заявления об отказе от ответственности