Abstract：
Syphilis -the \"great simulator\" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won\'t be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
摘要：
梅毒-经典性病学家的“伟大模拟器”-尽管得到了充分的治疗，但仍在西方国家重新出现；已经确定了几个促成因素，包括性行为的改变,这将不是本文的主题。2021年，西班牙共报告了6613例新的梅毒病例，代表13.9x10万居民(90.5%，men).自2000年以来，费率逐步上升。梅毒的临床表现是异质性的。虽然软下体,梅毒玫瑰和梅毒指甲是典型的病变，可以存在其他形式的疾病，例如非溃疡性原发性病变，如Follmann龟头炎，在口腔中，片状继发性舌部病变，或者上颚和悬垂上的急斑，在许多其他人中。关于诊断，分子测定，如PCR已经取代了溃疡性病变的暗视野显微镜，而自动螺旋体测试(EIA，CLIA）正在用于血清学测试，以及用于确认和随访目的的经典测试(如RPR和HAART)。这些测试的解释应在患者的流行病学和临床背景下进行评估。对于患有梅毒的任何人，都应要求进行HIV血清学和STI筛查。接受治疗的患者的随访对于确保愈合和检测再感染很重要。对治疗的血清学反应应使用相同的非螺旋体试验（RPR/VDRL）进行评估；3-，6-，12-，24个月的随访是艾滋病毒感染者（PLHIV）的常见做法。性接触应酌情评估和处理。建议在怀孕的头三个月内对孕妇进行筛查。20周后流产的孕妇都应该接受梅毒检测。所有形式的梅毒的治疗选择，包括孕妇和艾滋病毒感染者，是青霉素。由于潜在的耐药性，大环内酯类药物是不明智的。
