The Clinical Research On Sero-resistance Of Syphilis

BackgroundSyphilis is one of the most important diseases in human history. So far it has been a big influence on public health all over the world. With the climbing of the incidence rate of syphilis, more and more patients'blood tests don't turn negative after the treatment. This serologic phenomenon is called sero-resisitance. Thus, this problem is getting more and more attention. The reason why some patients might have sero-resistance after the treatment remains unknown.ObjectiveCollecting the sero-resistant patients to perform the lumber puncture, test their cerebrospinal fluid to see if they have neurosyphilis. Request those patients'clinical, serum tests and epidemiology history. Calculate the incidence rate of neurosyphilis in sero-resistant patients and discuss the possible influence factors of neurosyphilis such as treatment, stage of syphilis and PRP titers.MethodsCollecting the syphilitic patients admitted in dermatology department of Huashan Hospital from November 2008 to February 2010 who met the criteria as follows:A) Positive for both serum TPPA and RPR test, negative for HIV test. B) Serum RPR test keeps positive for six month after treatment for early stage syphilis or positive for 12 month for late stage syphilis. C) Exclude other connective tissue diseases, pregnancy or infection diseases such as leprosy and hepatitis. Perform lumber puncture for those patients and test their cerebrospinal fluids for routine, biochemisty, VDRL, TPPA, RPR and IgG index analysis. Request their clinical and epidemiology history for syphilis.ResultsThere are totally 63 patients included, the sex proportion(male vs female) is 1:2. Among them, there are 8 patients who are diagnosed for neurosyphilis. The incidence rate of neurosyphilis is 12.70%. The sex proportion(male vs female)is 7:1. There are 5 primary syphilis, among them,3 are diagnosed with NS. There are 10 secondary syphilis, among them,1 is diagnosed with NS. There are 48 latent stage syphilis,among them,4 are diagnosed with NS. NS is more common in the primary stage syphilis.23 patients were treated with penicillin regularly,13 patients were treated with ceftriaxone,3 patients were treated with macrolides and 3 patients offered no information about their treatment. There is no statistic difference among the treatments of patients who developed into NS. The serum RPR titers are important to the occurance of neurosyphilis. The patients with serum RPR≥1:32 are more likely to have neurosyphilis than the ones with serum RPR<1:32.ConclusionsThe occurance rate of neurosyphilis in the sero-resistance syphilitic patients is 12.70%. NS is more common in the primary stage than second stag and latent syphilis. There is no statistic difference between the treatments of syphilis that eventually developed into neurosyphilis. However, the patients with serum RPR≥1:32 are more likely to have neurosyphilis than the ones with serum RPR<1:32.