以阴道出血为首发症状的宫颈硬下疳1例  

A Case of Cervical Ulcerating Sclerosis with Vaginal Bleeding as Intial Symptom

作　　者：谭艳平 龚存林 高捷敏[1] 付宾[1] 

机构地区：[1]江西省妇幼保健院皮肤性病科,江西南昌330006

出　　处：《中国皮肤性病学杂志》2018年第2期185-186,共2页The Chinese Journal of Dermatovenereology

摘　　要：患者女,26岁。阴道不规则流血2周。查体:宫颈可见一鹌鹑蛋大小溃疡面,表面渗血;双侧腹股沟无淋巴结肿大;躯干、四肢未见红斑和脱屑。实验室检查:TPPA(+),TRUST 1∶64(+);TP-IgM(+);HIV抗体阴性;HSV-ⅠIgG(+),HSV-ⅡIgG(+),HSV-ⅠIgM(-),HSV-ⅡIgM(-);HSV-ⅡPCR(分泌物)阴性;宫颈溃疡表面分泌物暗视野检查梅毒苍白螺旋体(+);电子阴道镜组织病理检查示:考虑黏膜炎症性改变。诊断:一期梅毒,宫颈硬下疳。予以苄星青霉素240万U分两侧臀部肌注,1次/周,连用2次,皮损4周后消退,复查TP-IgM转阴。定期复查6个月时,TRUST转阴,目前随访中。A 26 years female, presented with vaginal bleeding 2 weeks.Examination showed that there was a painless ulcers on the cervical,quail egg sized, and most of them had blood oozing.Enlarged lymph nodes were not found on the two sides of groins, and no erythema and desquamation were found on torso and limbs either.Laboratory tests had results as follow： TPPA（＋）, TRUST 1：64（＋）; TP-IgM（＋）; HIV（-）; HSV-Ⅰ IgG（＋）, HSV-Ⅱ IgG（＋）, HSV-Ⅰ IgM（-）, HSV-Ⅱ IgM（-）; HSV-Ⅱ PCR（-）.Using TP-darkfield microscopic found TP in the secretions of Cervical ulcer; biopsy under electronic colposcope indicated the change of mucosal inflammatory.Therefore, the diagnosis is primary syphilis and cervical ulcerating sclerosis.Benzathine penicillin G 2.4 MU injections were given to each buttock once a week for 2 weeks.After 4 weeks chancres disappear, and TP-IgM was reviewed to be overcast.After 6 months TRUST overcast.A diagnosis of rectum ulcerating sclerosis was established.

关 键 词：阴道流血 宫颈 硬下疳 一期梅毒 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]