如果梅毒未被治療，梅毒螺旋體進入血液並散播至全身，病患會出現二期梅毒症狀， ... 再者，臨床觀察研究也發現，治療失敗的機會增加，不過這些治療失敗的梅毒 ...☆網路內科繼續教育☆有效期間：民國102年07月01日至102年07月30日止  CaseDiscussion[PresentationofCase]       A24-year-oldmanwasseenbecauseofpainattheanalandperianalregionsforoneweekormore.Hehadbeenotherwisewellexceptforaprevioushistoryofsyphilisthatwastreatedwithbenzathinepenicillinadministeredintramuscularlywithintolerablepainandfainting.Hehadunprotectedoralandanalsexthreeweeksbeforethisevaluation.Hedidnothaveafever,rash,ororalulcer.Onexamination,thepatientappearedinnodistress,withoutfever,andtheconsciousnesswasclear.Therewasnoneckstiffnessorregionallymphadenopathy.ExaminationsoftheHeart,lung,andabdomenwereunremarkable.Therewerenumerouselevatedskinlesionswithwetsurfaceattheperianalregion(figure1A)andscrotum(figure1B).Rectalexaminationwasnotcompletedbecauseofseveretenderness.Swabspecimensoftheperianalandanalregionswereobtainedforviralisolation,polymerase-chain-reaction(PCR)assayfordetectionofTreponemapallidum;aurinespecimenwascollectedfordetectionofNeisseriaegonorrhoeaeandChlamydiatrachomatisusingPCRassaysattheTaiwanCentersforDiseaseControl;andabloodspecimenwasobtainedforserologicaltestsforsyphilisandHIVaftercounseling.Valacycloviratadailydoseof100mgtwicedailywasstartedandhewasseenaweeklater.       Oneweeklater,thesymptomsdidnotimproveandperianalandanalpaincontinued.Rapidplasmareagen(RPR)titerwas1:1024andatestforT.pallidumhemagglutination(TPHA)wasreportedpositive.TheviralcultureandPCRforC.trachomatisandN.gonorrhoeaeshowednegativeresults,whilethePCRassayforT.pallidumwaspositive.TheT.pallidumstraindidnotharborA2058orA2059mutationof23sRNAthatmayconferresistancetomacrolides.AntibodyforHIVwastestedpositive,andHIVinfectionwassubsequentlyconfirmedbyWesternblot.AdiagnosisofHIVinfectionwasmadeinthispatientswhopresentedwithprimaryandsecondarysyphiliswithcondylomalatum.Afterreviewofhisprevioustreatmenthistory,asingle,2-gdoseofazithromycinwasadministeredunderthedirectobservationofthecasemanager.       Oneweeklater,theperianal