摘要 目的： 分析早期梅毒的临床特点，评价梅毒实验室诊断技术。方法： 总结 51 例早期梅毒的临床表现，对RPR、 FTA-ABS、蛋白印迹法以及PCR等多种诊断方法进行评价。结果： 一期梅毒较少，多表现为不典型下疳，女性患者易于漏诊；二期梅毒较多，临床表现多种多样但皮疹常以阴部为主，掌跖暗红色斑疹、肛周扁平湿疣也较为常见。在实验诊断方面，RPR对本组病例的敏感性为 73.2%， FTA-ABS为94.1%，蛋白印迹法为 100%。结论： 以阴部为主的多形性皮疹、掌跖暗红色斑诊、肛周扁平湿疣是临床梅毒的特征性皮损；RPR假阴性率较高，对初诊患者应尽可能做梅毒螺旋体抗原特异性试验如FTA-ABS。

Clinical analysis and laboratory evaluation on 51 cases of early syphilis

Liu Wei, Zhao Qingli, Li Jianbiao， Cai Ruikang (Department of Dermatology, The General Hospital of Air Force, Beijing 100036)

Abstract Objective: Analyze clinical manifestation of early syphilis and evaluate the laboratory techniques of diagnosis. Methods: 51 cases of early syphilis were summarized, RPR, FTA-ABS, Western-blot and PCR techniques were compared in the diagnosis. Results: Primary syphilis, 6 of 51 cases (11.8%), often appear an atypical chancres or irregular ulcers at genital organ, which may be easily lost from early diagnosis in female patients. Most of the patients reported in this paper were grouped as secondary syphilis (74.5%), the clinical characteristic lesions of which, important for differential diagnosis, are multiform syphilides concentrated around genital area, dark-red macules at palm and sole sites, and perianus condyloma flat. Several laboratory techniques were evaluated in the diagnosis of those patients. RPP as a screening method showed a low sensitivity (73.2%), FTA-ABS as a confirmation test is widely used at present, high quality of the antigen smear is the crucial point of a success experiment. Western-blot and PCR techniques are highly sensitive methods but still under researching and developing, more clinical data should be accumulated to testify the efficiency of the techniques. Conclusion: secondary syphilis is the major clinical type at present; specific test to the antigen of treponema padium such as FTA-ABS is the first choice in the laboratory diagnosis of syphilis.

Key words Syphilis; Sexually transmitted disease; Laboratory diagnosis

梅毒发病率在性传播疾病中占第四位 ......