182.3 🩺 內科專科考前版

182.3.0.1 1️⃣ Azithromycin Resistance Concern

• 2018 PNG cluster: azithro-R T. pallidum subsp. pertenue isolates
• 23S rRNA mutation
• Monitor in mass treatment programs
• PCG G IM remains effective
• Need backup strategies

182.3.0.2 2️⃣ Serology Challenge in Endemic Areas

• VDRL/RPR + treponemal both + 可能 due past endemic treponematosis (not active syphilis)
• 鑑別 difficult — clinical context, age of seroconversion, sexual history
• PCR can distinguish if available
• Public health implications: don’t over-treat presumed syphilis

182.3.0.3 3️⃣ Travel Medicine

• Returnee from endemic area with chronic skin lesion + bone pain → consider
• Send PCR if available (specialized lab — CDC, Pasteur)
• Rare in returnees due brief exposure

182.3.0.4 4️⃣ 健保 / Taiwan

• Endemic treponematoses very rare in Taiwan
• Travel medicine + ID consult
• 健保 azithromycin / PCN covered

182.3.0.5 5️⃣ Comparison: Syphilis vs Endemic Treponematoses

Feature	Syphilis	Yaws	Bejel	Pinta
Pathogen	T. p. pallidum	T. p. pertenue	T. p. endemicum	T. carateum
Transmission	Sexual + vertical	Skin contact	Oral contact	Skin contact
Age	Adults	Kids	Kids	All ages
CV/Neuro	YES	NO	NO	NO
Visceral	YES	Bone only	Bone, palate	Skin only
Geography	Global	Tropics	Dry tropics	C/S America
Vertical	YES	NO	NO	NO
Treatment	PCN G	Azithro/PCN	Azithro/PCN	Azithro/PCN

---