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Hope for new antibiotics for syphilis treatment

机译：希望新抗生素进行梅毒治疗

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Syphilis is a multi-stage disease caused by infection with Treponema pallidum subspecies pallidum (T. pallidum). Syphilis is usually transmitted by contact with an infected sexual partner or by passage from an infected pregnant woman to her fetus (congenital syphilis). Globally, an estimated six million new cases of syphilis occur each year in persons aged 15 49 years. In 2016, 661,000 cases of congenital syphilis resulted in over 200,000 fetal and neonatal deaths [1]. Because there is no vaccine to prevent syphilis, early diagnosis and treatment of infected persons and their contacts are key to syphilis control. In the pre-antibiotic era, syphilis patients were treated with arsenicals, toxic compounds that required prolonged therapy that often led to treatment failure. A major breakthrough occurred in 1943 when Mahoney and colleagues reported that penicillin could cure syphilis [2]. Although their initial studies were performed in rabbits because T. pallidum was not yet cultivable, it quickly became apparent that penicillin was effective for treatment of patients with early and late syphilis, pregnant women with syphilis and infants with congenital syphilis. Within a few years, widespread use of penicillin, in conjunction with sex education and improved diagnostic tests, resulted in dramatic decreases in the incidence of syphilis. However, syphilis re-emerged becoming an endemic disease with periodic fluctuations and sporadic outbreaks [2,3]. Fortunately, T. pallidum has remained susceptible to penicillin, which is still the preferred treatment for all stages of syphilis [4]. A single intramuscular (IM) injection of 2￠4 million units (MU) of benzathine penicillin G (BPG) is recommended for early syphilis, while an IM injection of 2￠4 MU of BPG given once weekly for three weeks is recommended for late syphilis. Because BPG does not achieve a sufficient concentration in cerebrospinal fluid (CSF), aqueous penicillin G (18 24 MU per day) given intravenously (IV) for 10 14 days is the recommended treatment for neurosyphilis. There are no proven alternatives to BPG for pregnant women with syphilis. Those who are penicillin-allergic must be desensitized and treated with BPG.
机译：梅毒是一种由Treponema Pallidum亚种植体（T.Pallidum）感染引起的多阶段疾病。梅毒通常通过与受感染的性伴侣的接触或通过从受感染的孕妇通往她的胎儿（先天性梅毒）来传播。在全球范围内，每年在15岁49岁的人中每年估计六百万的梅毒病例。 2016年，661,000例先天性梅毒患者导致200,000多种胎儿和新生儿死亡[1]。由于没有疫苗来防止梅毒，感染者的早期诊断和治疗以及梅毒控制的关键。在抗生素前的时代，梅毒患者用砷治疗，毒性化合物，需要延长治疗，这些疗法往往导致治疗失败。当Mahoney及其同事报告青霉素可以治愈梅毒[2]时，1943年发生了重大突破[2]。虽然他们的初步研究是在兔子中进行的，因为T.Pallidum尚未耕种，但它很快就显而易见的是，青霉素对于治疗早期和晚期梅毒患者，孕妇患有梅毒和先天性梅毒的婴儿。在几年内，共同使用青霉素，与性教育和改善的诊断测试一起导致梅毒发生率显着降低。然而，梅毒重新出现成为具有周期性波动和散发性爆发的地方病[2,3]。幸运的是，T.Pallidum仍然易于青霉素，这仍然是梅毒所有阶段的优选治疗[4]。早期梅毒建议使用单一的肌内（IM）注射2¢400万单位（MU）苯甲苯胺蛋白G（BPG），同时推荐每周给予每周3周的2¢4亩BPG的IM注入三周梅毒。因为BPG在脑脊液（CSF）中没有达到足够的浓度，所以静脉内（IV）给予的青霉素G（每天18小时）10 14天是神经孢菌素的推荐治疗。对于梅毒孕妇的BPG没有证明替代品。那些是青霉素 - 过敏的人必须用BPG脱敏和治疗。

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    《EBioMedicine》 |2021年第a期|共2页
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    Lola V. Stamm;

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