梅毒治疗的系统回顾及进展  

Review and progress on the treatment of syphilis

作　　者：贾亚利[1] 刘珏[1] 蔡莺莲[1] 吴黎明[1] 

机构地区：[1]杭州市第一人民医院皮肤科,杭州310002

出　　处：《中国性科学》2016年第6期93-96,共4页Chinese Journal of Human Sexuality

摘　　要：梅毒在近十余年发病率有逐年上升的趋势,特别是新出现了一些病患发生在男男性伴之间,成为一个新的社会问题。而梅毒的治疗在临床上已经相对规范和稳定。但是近几年出现了一些新的问题,例如：梅毒血清固定状态、合并艾滋病感染、孕妇梅毒、神经梅毒等特定人群。青霉素是治疗梅毒各个阶段的首选药物,但是本文也提出了不同的治疗方案建议。早期梅毒包括一、二期梅毒和早期潜伏梅毒的治疗方案BPG（苄星青霉素）240万单位,单次剂量肌肉注射。晚期和晚期潜伏梅毒采用BPG 240万单位一次三周连续给药共720万单位。血清固定的患者不会从再次治疗中受益。多西环素和头孢曲松也是治疗早期梅毒的有效药物。由于潜在的耐药性,阿奇霉素不应该被推荐治疗,除非所有的其他药物不可用。治疗的随访也是有必要的。治疗神经梅毒用水剂青霉素,通过持续输注1800万-2400万单位每日共持续10-14d。不幸的是,支持这一治疗方案的数据是推测出CSF（脑脊液）中的药物浓度而不是临床疗效。HIV感染者对比未合并感染者,需要加倍的注射疗程。怀孕妇女首选青霉素治疗,如果青霉素过敏尽量能够脱敏。The incidence of syphilis in the last ten years keeps increasing. Particularly,the new cases emerging among men who have sex with men（ MSM） have become a new social problem. Although in clinical practice,treatment of syphilis has been relatively standardized and stable,in recent years,there are still new challenges such as syphilis serofast state,concomitant HIV infection,pregnant women syphilis infection,neurosyphilis and other specific patient groups. Penicillin is the treatment of choice for all stages of syphilis,but this article also proposed other treatment options. Early syphilis including primary and secondary syphilis and early latent syphilis could be treated with benzathine penicillin（ BPG） 240 million units,single dose intramuscular injection. Late and late latent syphilis could be administered with BPG240 million units per week,for three weeks a total of 7. 2 million units. Serofast patients would not benefit from re- treatment. Doxycycline and ceftriaxone is effective for early syphilis. Because of potential drug resistance,azithromycin therapy should not be recommended unless all other medications are not available. Treatment follow- up is necessary. Aqueous penicillin is used to treat neurosyphilis,continuous infusion from 18 million to 24 million units daily for 10- 14 days. Unfortunately,data to support this treatment regimen is presumed drug concentration in CSF（ cerebrospinal fluid） instead of clinical efficacy. For patients with coinfected HIV,a doubled injection treatment is required. Penicillin is the treatment of choice for pregnant women,with allergy desensitization in those who are allergic to penicillin.

关 键 词：梅毒 治疗 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]