日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

Online ISSN: 2434-2505 Print ISSN: 0917-0324
日本性感染症学会 Japanese Society for Sexually Transmitted Infections
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society for Sexually Transmitted Infections Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Japanese Journal of Sexually Transmitted Infections 30(1): 1-6 (2019)
doi:10.24775/jjsti.O-2019-0008

原著原著

当院で診療した梅毒症例の発生動向と診断状況に関する検討Clinical analysis of trends and diagnosis of patients with syphilis treated in The Jikei University Katsushika Medical Center

1東京慈恵会医科大学葛飾医療センター感染制御部Department of Infectious Disease and Infection Control, The Jikei University Katsushika Medical Center

2東京慈恵会医科大学葛飾医療センター中央検査部Department of Central Clinical Laboratory, The Jikei University Katsushika Medical Center

3東京慈恵会医科大学葛飾医療センター泌尿器科Department of Urology, The Jikei University Katsushika Medical Center

受付日:2019年4月1日Received: April 1, 2019
受理日:2019年7月18日Accepted: July 18, 2019
発行日:2019年10月11日Published: October 11, 2019
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2012~2017年に当院で診療した活動性梅毒64例の発生動向と診断状況を調べ、総合病院での梅毒診療の現状を検討した。顕性梅毒は43例で初診時の診療科は内科、皮膚科で半数以上を占めたが、多彩な症状から多くの診療科に受診していた。他疾患が疑われ診断に苦慮した例が4例、RPR 16 R.U.未満で臨床症状、TPLA陽性から診断された早期顕性梅毒例が7例にみられた。無症候性梅毒は21例で、推定感染経路では男性異性間、女性が全国調査に比べ高い傾向があり、多くが侵襲的処置前、入院時等での感染症スクリーニング検査が契機で診断された。定性検査陽性判明時に定量検査が行われず診断が遅れた例が2例あり、定性結果の見落としが原因と推定された。臨床医は積極的に梅毒抗体検査を行い臨床所見と併せて総合的に判断すること、梅毒抗体定性検査陽性の際は必ず定量検査を行い、定量検査の実施漏れを防ぐ対策が必要であると考えられた。

We retrospectively investigated the clinical analysis of trends and diagnosis of 64 patients with active syphilis treated in The Jikei University Katsushika Medical Center from 2012 to 2017.

A total of 43 patients were diagnosed with symptomatic syphilis. When these patients visited our hospital for the first time, more than 50% of them consulted the internal medicine and dermatology department. However, they were assessed by other medical departments due to the complexity of their symptoms. Four cases were difficult to diagnose because of other suspected diseases. Seven cases were diagnosed as early symptomatic syphilis with clinical symptoms and positive treponemal and low nontreponemal test results.

Furthermore, 21 patients were diagnosed with asymptomatic syphilis. The proportion of asymptomatic syphilis was high among men who have experienced sexual intercourse with women and vice versa. Many cases were diagnosed using infectious disease screening performed prior to invasive procedures or upon admission. However, two cases experienced delayed diagnosis due to a lapse in qualitative test results.

Clinicians should conduct the syphilis test and comprehensive judgment of the clinical findings and always perform a quantitative test if the qualitative test is positive.

Key words: syphilis; symptomatic syphilis; asymptomatic syphilis; rapid plasma regain; Treponema pallidum latex agglutination

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