[申覆] 醫學三 62
陳先生今年 70 歲，身體仍十分健康，並沒有任何疾病與不適。在今年的健康檢查中，意
外發現有關梅毒（syphilis）感染的血清學檢查結果如下：VDRL（Venereal Disease
Research Laboratory）test, non-reactive; TPHA（Treponema pallidum
hemagglutination）test, 1:2560。下列處置何者正確？
猨(A) 此為 early latent syphilis，應接受治療
獏(B) 此為 secondary syphilis，應接受治療
獱(C) 隔一個月追蹤 TPHA titer，若 titer 未下降即給予治療
斅(D) 不需治療
答案: D
建議答案: 送分
申覆理由:
根據Sexually Transmitted Diseases Treatment Guidelines, 2010
Morbidity and Mortality Weekly Report
Department of health and human services
Centers for Disease Control and Prevention
如果病人TPHA為positive, 而nontreponemal test(VDRL)為negative, 之後應該在做一個
different treponemal test (preferably one based on different antigens than
the original test, 以下稱第二個TPHA) 確認. 假如第二個TPHA為positive, 病人可能
之前有治療過, 如沒有sexual history re-exposure, 就不需要治療. 但假如之前沒有治
療過, 就應該給予治療. 而假如第二個TPHA為negative, 就不須再做評估或治療.
因此這個病人應該再接受另外一種treponemal test以評估病人狀況. 因為沒有選項符合
, 故建議送分.
參考資料：
Sexually Transmitted Diseases Treatment Guidelines, 2010
Morbidity and Mortality Weekly Report
Department of health and human services
Centers for Disease Control and Prevention
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