梅毒是由梅毒螺旋体梅毒亚种引起的性传播感染。[3] 梅毒的体征和症状因所处的四个阶段而异 (基本的, 中学, 潜, 和第三级).[1] 初级阶段通常表现为单一下疳 (一间公司, 无痛的, non-itchy skin ulceration usually between 1 cm and 2 cm in diameter) though there may be multiple sores.[1] In secondary syphilis, a diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet.[1] There may also be sores in the mouth or vagina.[1] In latent syphilis, which can last for years, there are few or no symptoms.[1] In tertiary syphilis, there are gummas (soft, non-cancerous growths), neurological problems, or heart symptoms.[2] Syphilis has been known as “the great imitator” as it may cause symptoms similar to many other diseases.[1][2]
Syphilis is most commonly spread through sexual activity.[1] It may also be transmitted from mother to baby during pregnancy or at birth, resulting in congenital syphilis.[1][6] Other diseases caused by Treponema bacteria include yaws (T. pallidum subspecies pertenue), pinta (T. carateum), and nonvenereal endemic syphilis (T. pallidum subspecies endemicum).[2] These three diseases are not typically sexually transmitted.[7] Diagnosis is usually made by using blood tests; the bacteria can also be detected using dark field microscopy.[1] The Centers for Disease Control and Prevention (U.S.) recommend all pregnant women be tested.[1]
The risk of sexual transmission of syphilis can be reduced by using a latex or polyurethane condom.[1] Syphilis can be effectively treated with antibiotics.[3] 大多数情况下，首选抗生素是注射到肌肉中的苄星青霉素。[3] 对于那些有严重青霉素过敏的人, 可以使用多西环素或四环素。[3] 对于神经梅毒患者, 建议静脉注射苄青霉素或头孢曲松。[3] 在治疗期间，人们可能会发烧, 头痛, 和肌肉疼痛, 这种反应被称为贾里施-赫克斯海默反应。[3]
在 2015, 关于 45.4 百万人感染梅毒,[4] 新增病例六百万。[8] 期间 2015, 它引起了关于 107,000 死亡人数, 从下 202,000 在 1990.[5][9] 20 世纪 40 年代随着青霉素的出现而急剧下降, 自世纪之交以来，许多国家的感染率有所上升, 通常与人类免疫缺陷病毒联合使用 (艾滋病病毒).[2][10] 据信，这部分是由于乱交现象的增加, 卖淫, 男男性行为者中安全套的使用和不安全性行为的减少。[11][12][13]
体征和症状
梅毒可以展示 在四个不同阶段之一: 基本的, 中学, 潜, 和第三级,[2] 并且还可能发生先天地.[14] 它被称为 “the great imitator” 经过威廉·奥斯勒爵士 由于其多样化的演示.[2][15][16]
基本的
基本的硬下疳 阴茎感染部位梅毒
一期梅毒通常是通过与另一个人的感染性病变直接发生性接触而获得的.[17] 接触后大约 2-6 周 (范围为 10-90 天) 皮肤损伤, 称为硬下疳, 出现在现场，其中含有传染性螺旋体.[18][19] 这是经典的(40% 的时间) 一个单一的, 公司, 无痛的, 不痒皮肤溃烂 底部干净，边缘锐利，尺寸约为 0.3–3.0 厘米.[2] 病变几乎可以呈现任何形式.[20] 以经典形式, 它是从一个演变而来的macule to apapule and finally to anerosion 或者ulcer.[20] Occasionally, multiple lesions may be present (~40%),[2] with multiple lesions being more common when coinfected with HIV.[20] Lesions may be painful or tender (30%), and they may occur in places other than the genitals (2–7%).[20] The most common location in women is thecervix (44%), 这penis in heterosexual men (99%), 和anally 和rectally 在men who have sex with men (34%).[20] Lymph node enlargement frequently(80%) occurs around the area of infection,[2] occurring seven to 10 days after chancre formation.[20] 这lesion may persist for three to six weeks if left untreated.[2]
Secondary
Typical presentation of secondary syphilis with a rash on the palms of the handsReddishpapules 和nodules over much of the body due to secondary syphilis
Secondary syphilis occurs approximately four to ten weeks after the primary infection.[2] 虽然继发性疾病以其多种不同的表现方式而闻名, 最常见的症状包括皮肤, 粘膜, 和淋巴结.[21] 可能存在对称, 红粉色, 不痒皮疹 躯干和四肢, 包括手掌和脚底.[2][22] 皮疹可能会变成斑丘疹 或者脓疱型.[2] 它可能会形成扁平状, 广阔, 发白的, 粘膜上出现疣样病变, 作为。。而被知道广泛的尖锐湿疣.[2] 所有这些病变都含有细菌并且具有传染性.[2] 其他症状可能包括发烧, 咽喉痛, 不适, 减肥, 脱发, 和头痛.[2] 罕见的表现包括肝脏炎症, 肾 疾病, 关节炎症, 骨膜炎, 视神经炎症, 葡萄膜炎, 和间质性角膜炎.[2][23] 急性症状通常在三到六周后消失;[23] 关于 25% 的人可能会出现继发症状复发.[21][24] 许多患有二期梅毒的人 (40–85% 的女性, 20–65% of men) do not report previously having had the classical chancre of primary syphilis.[21]
Latent
Latent syphilis is defined as havingserologic proof of infection without symptoms of disease.[17] It develops after secondary syphilis and is divided into early latent and late latent stages.[25] Early latent syphilis is defined by theWorld Health Organization as less than 2 years after original infection.[25] Early latent syphilis is infectious as up to 25% of people can develop a recurrent secondary infection (during which spirochetes are actively replicating and are infectious).[25] Two years after the original infection the person will enter late latent syphilis and is not as infectious as the early phase.[23][26] The latent phase of syphilis can last many years after which, without treatment, approximately 15-40% of people can develop tertiary syphilis.[27]
Tertiary
Model of a head of a person with tertiary (gummatous) syphilis, Musée de l’Homme, 巴黎
Tertiary syphilis may occur approximately 3 到 15 years after the initial infection, and may be divided into three different forms: gummatous syphilis (15%), lateneurosyphilis (6.5%), and cardiovascular syphilis (10%).[2][23] Without treatment, a third of infected people develop tertiary disease.[23] People with tertiary syphilis are not infectious.[2]
Gummatous syphilis or latebenign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years.[2] This stage is characterized by the formation of chronicgummas, which are soft, tumor-like balls of inflammation which may vary considerably in size.[2] They typically affect the skin, 骨, and liver, but can occur anywhere.[2]
Cardiovascular syphilis usually occurs 10–30 years after the initial infection.[2] The most common complication issyphilitic aortitis, which may result inaortic aneurysm formation.[2]
Neurosyphilis refers to an infection involving thecentral nervous system. Involvement of the central nervous system in syphilis (either asymptomatic or symptomatic) can occur at any stage of the infection.[19] It may occur early, being either asymptomatic or in the form of syphilitic脑膜炎, or late as meningovascular syphilis, general paresis, 或者tabes dorsalis.[2]
Meningovascular syphilis involves inflammation of the small and medium arteries of the central nervous system. It can present between 1–10 years after the initial infection. Meningovascular syphilis is characterized by stroke, cranial nerve palsis andspinal cord inflammation.[28] Late symptomatic neurosyphilis can develop decades after the original infection and includes 2 types; general paresis and tabes dorsalis. General paresis presents with dementia, personality changes, delusions, seizures, psychosis and depression.[28] Tabes dorsalis is characterized by gait instability, sharp pains in the trunk and limbs, impaired positional sensation of the limbs as well as having a positiveRomberg’s sign.[28] Both tabes dorsalis and general paresis may present withArgyll Robertson pupil which are pupils that constrict when the person focuses on near objects (accommodation reflex) but do not constrict when exposed to bright light (pupillary reflex).
Congenital
Main article: Congenital syphilis
Congenital syphilis is that which is transmitted during pregnancy or during birth.[6] Two-thirds of syphilitic infants are born without symptoms.[6] Common symptoms that develop over the first couple of years of life includeenlargement of the liver and spleen (70%), 皮疹 (70%), 发烧 (40%), neurosyphilis (20%), 和lung inflammation (20%).[6] If untreated, late congenital syphilis may occur in 40%, includingsaddle nose deformation, Higouménakis’ sign, saber shin, 或者Clutton’s joints among others.[6] Infection during pregnancy is also associated withmiscarriage.[29] The three main dental defects in congenital syphilis areHutchinson’s incisors (screwdriver shaped incisors), Moon’s molars or bud molars, and Fournier’s molars ormulberry molars (molars with abnormal occlusal anatomy resembling amulberry).[30]
Cause
Bacteriology
Histopathology 的Treponema pallidumspirochetes using a modifiedSteiner silver stainMain article: Treponema pallidum
Treponema pallidum subspecies pallidum is a spiral-shaped, Gram-negative, highly mobile bacterium.[10][20] Three other human diseases are caused by relatedTreponema pallidum subspecies, includingyaws (subspeciespertenue), pinta (subspeciescarateum) 和bejel (subspeciesendemicum).[2] Unlike subspeciespallidum, they do not cause neurological disease.[6] Humans are the only knownnatural reservoir for subspeciespallidum.[14] It is unable to survive more than a few days without ahost.[20] This is due to its small genome (1.14Mbp) failing to encode the metabolic pathways necessary to make most of its macronutrients.[20] It has a slowdoubling time of greater than 30 hours.[20] The bacterium is known for its ability to evade the immune system and its invasiveness.[31]
Transmission
Syphilis is transmitted primarily by sexual contact or duringpregnancy from a mother to her baby; the spirochete is able to pass through intact mucous membranes or compromised skin.[2][14] It is thus transmissible bykissing near a lesion, as well asoral, vaginal, 和anal sex.[2][32] Approximately 30% 到 60% of those exposed to primary or secondary syphilis will get the disease.[23] Itsinfectivity 一个例子是，一个人接种过的 仅与 57 生物体具有 50% 被感染的机会.[20] 美国新增病例最多 (60%) 发生于男男性行为者; 并且在这个人群中 20% 梅毒病例仅由口交引起.[2][32] 梅毒可以通过以下途径传播血液制品, 但由于筛查，风险较低献血 在很多国家.[2] 传播风险来自共用针头 似乎受到限制.[2]
一般不可能通过马桶座圈感染梅毒, 日常活动, 热水浴缸, 或共用餐具或衣服.[33] 这主要是因为细菌在体外很快就会死亡, 进行传输物体 极其困难.[34]
诊断
这张海报承认梅毒的社会耻辱, 同时敦促那些可能患有这种疾病的人进行检测 (大约 1936).Micrograph of secondary syphilis skin lesions. (A/B) H&E stain of SS lesions. (C/D) IHC staining reveals abundant spirochetes embedded within a mixed cellular inflammatory infiltrate (shown in the red box) in the papillary dermis. The blue arrow points to a tissue histiocyte and the read arrows to two dermal lymphocytes.[35]
Syphilis is difficult to diagnose clinically during early infection.[20] Confirmation is either viablood tests or direct visual inspection usingdark field microscopy.[2][36] Blood tests are more commonly used, as they are easier to perform.[2] Diagnostic tests are unable to distinguish between the stages of the disease.[37]
Blood tests
Blood tests are divided intonontreponemal and treponemal tests.[20]
Nontreponemal tests are used initially, and includevenereal disease research laboratory (VDRL) 和rapid plasma reagin (RPR) tests.False positives on the nontreponemal tests can occur with some viral infections, 例如varicella (chickenpox) 和measles. False positives can also occur withlymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, 和pregnancy.[17]
Because of the possibility of false positives with nontreponemal tests, confirmation is required with a treponemal test, 例如treponemal pallidum particle agglutination (TPHA) 或者fluorescent treponemal antibody absorption test (FTA-Abs).[2] Treponemal antibody tests usually become positive two to five weeks after the initial infection.[20] Neurosyphilis is diagnosed by finding high numbers ofleukocytes (predominatelylymphocytes) and high protein levels in thecerebrospinal fluid in the setting of a known syphilis infection.[2][17]
Direct testing
Dark field microscopy 的serous fluid from a chancre may be used to make an immediate diagnosis.[20] Hospitals do not always have equipment or experienced staff members, and testing must be done within 10 minutes of acquiring the sample.[20] Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody (DFA) 和polymerase chain reaction (聚合酶链式反应) tests.[20] DFA usesantibodies tagged withfluorescein, which attach to specific syphilis proteins, while PCR uses techniques to detect the presence of specific syphilisgenes.[20] These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis.[20]
Prevention
Vaccine
As of 2018, there is novaccine effective for prevention.[14] Several vaccines based on treponemal proteins reduce lesion development in ananimal model but research continues.[38][39]
Sex
Condom use reduces the likelihood of transmission during sex, but does not completely eliminate the risk.[40] 这Centers for Disease Control and Prevention (CDC) states, “Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.[41] 然而, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom.”[42]
Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis. The CDC states, “The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutuallymonogamous relationship with a partner who has been tested and is known to be uninfected.”[42]
Congenital disease
Portrait of Mr. J. Kay, affected with what is now believed to have been congenital syphilis c. 1820[43]
Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected.[44] 这United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women,[45] while theWorld Health Organization (WHO) recommends all women be tested at their first antenatal visit and again in thethird trimester.[46][47] If they are positive, it is recommended their partners also be treated.[46] Congenital syphilis is still common in the developing world, as many women do not receiveantenatal care at all, and the antenatal care others receive does not include screening.[44][48] It still occasionally occurs in the developed world, as those most likely to acquire syphilis are least likely to receive care during pregnancy.[44] Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries.[46] Point-of-care testing to detect syphilis appeared to be reliable although more research is needed to assess its effectiveness and into improving outcomes in mothers and babies.[49]
Screening
The CDC recommends that sexually active men who have sex with men be tested at least yearly.[50] The USPSTF also recommends screening among those at high risk.[51]
Syphilis is anotifiable disease 在很多国家, including Canada,[52] 这European Union,[53] and the United States.[54] This means health care providers are required to notifypublic health authorities, which will then ideally providepartner notification to the person’s partners.[55] Physicians may also encourage patients to send their partners to seek care.[56] Several strategies have been found to improve follow-up for STI testing, including email and text messaging of reminders for appointments.[57]
治疗
Early infections
The first-line treatment for uncomplicated syphilis (primary or secondary stages) remains a single dose ofintramuscular benzathine benzylpenicillin.[58] Doxycycline 和tetracycline are alternative choices for those allergic to penicillin; due to the risk ofbirth defects, these are not recommended for pregnant women.[58] Resistance 到macrolides, rifampicin, 和clindamycin is often present.[14] Ceftriaxone, a third-generationcephalosporin antibiotic, may be as effective as penicillin-based treatment.[2] It is recommended that a treated person avoid sex until the sores are healed.[33]
Late infections
For neurosyphilis, due to the poor penetration of benzathine penicillin into thecentral nervous system, those affected are given large doses ofintravenous penicillin G for a minimum of 10 天.[2][14] If a person is allergic to penicillin, ceftriaxone may be used or penicillin desensitization attempted.[2] Other late presentations may be treated with once-weekly intramuscular benzathine penicillin for three weeks.[2] Treatment at this stage solely limits further progression of the disease and has a limited effect on damage which has already occurred.[2] Serologic cure can be measured when the non-treponemal titers decline by a factor of 4 or more in 6–12 months in early syphilis or 12–24 months in late syphilis.[19]
Jarisch–Herxheimer reaction
Jarisch–Herxheimer reaction in a person with syphilis and human immunodeficiency virus[59]
One of the potential side effects of treatment is theJarisch–Herxheimer reaction.[2] It frequently starts within one hour and lasts for 24 小时, with symptoms of fever, muscle pains, 头痛, and afast heart rate.[2] It is caused bycytokines released by the immune system in response tolipoproteins released from rupturing syphilis bacteria.[60]
Pregnancy
Penicillin is an effective treatment for syphilis in pregnancy[61] but there is no agreement on which dose or route of delivery is most effective.[62]
流行病学
Main article: Epidemiology of syphilisSyphilis deaths per million persons in 2012 0–0 1–1 2–3 4–10 11–19 20–28 29–57 58–138Age-standardizeddisability adjusted life years from syphilis per 100,000 inhabitants in 2004[63]
| no data<35 35–70 70–105 105–140 140–175 175–210 | 210–245 245–280 280–315 315–350 350–500>500 |
在 2012, 关于 0.5% of adults were infected with syphilis, with 6 million new cases.[8] 在 1999, it is believed to have infected 12 million additional people, with greater than 90% of cases in thedeveloping world.[14] It affects between 700,000 and 1.6 million pregnancies a year, resulting inspontaneous abortions, stillbirths, and congenital syphilis.[6] 期间 2015, 它引起了关于 107,000 死亡人数, 从下 202,000 在 1990.[5][9] 在sub-Saharan Africa, syphilis contributes to approximately 20% 的perinatal deaths.[6] Rates are proportionally higher amongintravenous drug users, those who are infected with艾滋病病毒, and men who have sex with men.[11][12][13] In the United States about 55,400 people are newly infected each year.[64] In the United States as of 2020, rates of syphilis have increased by more than threefold; 在 2018 approximately 86% of all cases of syphilis in the United States were in men.[19] African Americans accounted for almost half of all cases in 2010.[65] As of 2014, syphilis infections continue to increase in the United States.[66][67]
Syphilis was very common in Europe during the 18th and 19th centuries.[10] Flaubert found it universal among nineteenth-century Egyptian prostitutes.[68] In the developed world during the early 20th century, infections declined rapidly with the widespread use ofantibiotics, until the 1980s and 1990s.[10] 自从 2000, rates of syphilis have been increasing in the US, Canada, the UK, Australia and Europe, primarily among men who have sex with men.[14] Rates of syphilis among US women have remained stable during this time, while rates among UK women have increased, but at a rate less than that of men.[69] Increased rates among heterosexuals have occurred in China and Russia since the 1990s.[14] This has been attributed to unsafe sexual practices, such as sexual promiscuity, 卖淫, and decreasing use of barrier protection.[14][69][70]
Left untreated, it has a mortality rate of 8% 到 58%, with a greater death rate among males.[2] The symptoms of syphilis have become less severe over the 19th and 20th centuries, in part due to widespread availability of effective treatment, and partly due tovirulence of the bacteria.[21] With early treatment, few complications result.[20] Syphilis increases the risk of HIV transmission by two to five times, and coinfection is common (30–60% in some urban centers).[2][14] In 2015,Cuba became the first country to eliminate mother-to-child transmission of syphilis.[71]
历史
Main article: History of syphilisPortrait ofGerard de Lairesse 经过Rembrandt van Rijn, circa 1665–67, oil on canvas. De Lairesse, himself a painter and art theorist, had congenital syphilis that deformed his face and eventually blinded him.[72]
The origin of syphilis is disputed.[2] Syphilis was present in the Americas before European contact,[73] and it may have been carried from the Americas to Europe by the returning crewmen fromChristopher Columbus‘s voyage to theAmericas, or it may have existed in Europe previously but gone unrecognized until shortly after Columbus’s return.[37][74] These are theColumbian 和pre-Columbian hypotheses, 分别, with theColumbian hypothesis better supported by the evidence.[37][75][76] 然而, findings fromphylogenetic science suggest that is, in fact, ANew World 疾病.[77]
The first written records of an outbreak of syphilis in Europe occurred in 1494 或者 1495 在那不勒斯, 意大利, during a French invasion (Italian War of 1494–98).[10][37] Since it was claimed to have been spread by French troops, it was initially called the “French disease” by the people of Naples.[78] 在 1530, the pastoral name “syphilis” (the name of a character) was first used by the Italian physician and poetGirolamo Fracastoro as the title of hisLatin poem indactylic hexameter describing the ravages of the disease in Italy.[79][80] It was also called the “Great Pox”.[81][82]
In the 16th through 19th centuries, syphilis was one of the largest public health burdens inprevalence, symptoms, and disability,[83]:208–209[84] although records of its true prevalence were generally not kept because of the fearsome and sordid status ofsexually transmitted diseases in those centuries.[83]:208–209 According to a 2020 study, 多于 20% of individual in the age range 15–34 years in late 18th century London were treated for syphilis.[85] At the time thecausative agent was unknown but it was well known that it was spread sexually and also often from mother to child. Its association with sex, especiallysexual promiscuity 和卖淫, made it an object of fear and revulsion and a taboo. The magnitude of its morbidity and mortality in those centuries reflected that, unlike today, there was no adequate understanding of itspathogenesis and no truly effective treatments. Its damage was caused not so much by great sickness or death early in the course of the disease but rather by its gruesome effects decades after infection as it progressed toneurosyphilis 和tabes dorsalis. Mercury compounds and isolation were commonly used, with treatments often worse than the disease.[81]
The causative organism, Treponema pallidum, was first identified byFritz Schaudinn 和Erich Hoffmann, 在 1905.[86] The first effective treatment for syphilis wasArsphenamine, discovered bySahachiro Hata 在 1909, during a survey of hundreds of newly synthesized organicarsenical compounds led byPaul Ehrlich. It was manufactured and marketed from 1910 under the trade nameSalvarsan 经过Hoechst AG.[87] 这organoarsenic compound 是第一个现代的化疗剂.
20世纪期间, 既微生物学 和药理 大大进步, syphilis, 像许多其他传染病一样, 不再是一个可怕的、毁容的谜团，而是一个可以控制的负担, 至少在发达国家 在那些有能力支付及时诊断和治疗费用的人群中. 青霉素被发现于 1928, 以及治疗的有效性青霉素 已在试验中得到证实 1943,[81] 那时它成为主要治疗方法.[88]
许多著名的历史人物, including弗朗茨·舒伯特, 阿瑟·叔本华, 爱德华·马奈,[10] 查尔斯·波德莱尔,[89] 和居伊·德·莫泊桑 被认为患有这种疾病.[90] 弗雷德雷西尼采 长期以来人们相信他是因为以下原因而发疯的三期梅毒, 但这一诊断最近受到质疑.[91]
艺术与文学
也可以看看: 梅毒病例清单An early medical illustration of people with syphilis, Vienna, 1498
The earliest known depiction of an individual with syphilis isAlbrecht Dürer‘sSyphilitic Man, a woodcut believed to represent aLandsknecht, a Northern Europeanmercenary.[92] The myth of thefemme fatale 或者 “poison women” of the 19th century is believed to be partly derived from the devastation of syphilis, with classic examples in literature includingJohn Keats‘ “La Belle Dame sans Merci“.[93][94]
The Flemish artistStradanus designed a print calledPreparation and Use of Guayaco for Treating Syphilis, a scene of a wealthy man receiving treatment for syphilis with the tropical woodguaiacum sometime around 1590.[95]
Tuskegee and Guatemala studies
也可以看看: Tuskegee syphilis experiment 和Guatemala syphilis experimentAWork Projects Administration poster about syphilis c. 1940
这 “Tuskegee Study of Untreated Syphilis in the Negro Male” was an infamous, unethical and racistclinical study conducted between 1932 和 1972 by theU.S. Public Health Service.[96][97] Whereas the purpose of this study was to observe thenatural history of untreated syphilis; the African-American men in the study were told they were receiving free treatment for “bad blood” from the United States government.[98]
The Public Health Service started working on this study in 1932 in collaboration withTuskegee University, Ahistorically black college in Alabama. Researchers enrolled 600 poor, African-Americansharecroppers fromMacon County, Alabama in the study. Of these men, 399 had contracted syphilis before the study began, 和 201 did not have the disease.[97] Medical care, hot meals and free burial insurance were given to those who participated. The men were told that the study would last six months, but in the end it continued for 40 年.[97] After funding for treatment was lost, the study was continued without informing the men that they were only being studied and would not be treated. Facing insufficient participation, the Macon County Health Department nevertheless wrote to subjects to offer them a “last chance” to get a special “治疗”, which was not a treatment at all, but a spinal tap administered exclusively for diagnostic purposes.[96] None of the men infected were ever told that they had the disease, and none were treated with青霉素 even after the antibiotic had been proven to successfully treat syphilis. According to theCenters for Disease Control, the men were told they were being treated for “bad blood”—a colloquialism describing various conditions such as fatigue, 贫血 and syphilis—which was a leading cause of death among southern African-American men.[97]
The 40-year study became a textbook example of poormedical ethics because researchers had knowingly withheld treatment with青霉素 and because the subjects had been misled concerning the purposes of the study. The revelation in 1972 of these study failures by awhistleblower, Peter Buxtun, led to major changes in U.S. law and regulation on the protection of participants in clinical studies. Now studies requireinformed consent,[99] communication of诊断, and accurate reporting of test results.[100]Preparation and Use of Guayaco for Treating Syphilis, afterStradanus, 1590
Similar experiments were carried out inGuatemala from 1946 到 1948. It was done during the administration of American PresidentHarry S. Truman and Guatemalan PresidentJuan José Arévalo with the cooperation of some Guatemalan health ministries and officials.[101] Doctors infected soldiers, prostitutes, prisoners andmental patients with syphilis and othersexually transmitted diseases, without theinformed consent of the subjects, and treated most subjects withantibiotics. The experiment resulted in at least 83 死亡人数.[102][103] In October 2010, 美国. formally apologized to Guatemala for the ethical violations that took place. Secretary of StateHillary Clinton and Health and Human Services SecretaryKathleen Sebelius stated “Although these events occurred more than 64 几年前, we are outraged that such reprehensible research could have occurred under the guise of public health. We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices.”[104] The experiments were led by physicianJohn Charles Cutler who also participated in the late stages of the Tuskegee syphilis experiment.[105]
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