Syphilis is a chronic infectious disease caused by Treponema pallidum (TP), which is transmitted mainly through sexual contact and blood. TP can invade almost all organs of the body, so the clinical manifestations of syphilis are extremely complicated, and can cause miscarriage, premature birth, stillbirth and fetal syphilis through placental transmission, which is extremely dangerous.
Commonly used anti-syphilis drugs
1. penicillin: the first choice, serum concentration of 0.03 IU/ml can kill TP, but the serum concentration must be stable for more than 10 days to completely remove TP from the body. commonly used benzathine penicillin G, procaine aqueous penicillin G, aqueous penicillin G, cardiovascular syphilis without benzathine penicillin G.
2. Ceftriaxone sodium: In recent years, it has been confirmed to be a highly effective anti-TP drug, which can be used as an alternative treatment drug of preference for penicillin allergic patients.
3. Tetracyclines and erythromycin: less effective than penicillin, usually used as an alternative treatment drug for penicillin allergic patients.
Choice of treatment options
1. Early syphilis: benzathine penicillin G 2.4 million U, divided into two sides of the buttocks intramuscular injection, 1 time / week, 2~3 times in a row; or procaine penicillin G 800,000 U / d intramuscular injection, 10~15 days in a row. For penicillin allergy, ceftriaxone sodium 1.0g/d IV for 10~14 days, or oral tetracyclines (tetracycline 2.Og/d; doxycycline 200mg/d; minocycline 200mg/d) for 15 days; or oral erythromycin (erythromycin 2.0g/d) for 15 days.
2. Late syphilis: benzathine penicillin C 2.4 million U, divided into two sides of the buttocks intramuscular injection, 1 time / week, 3 ~ 4 times in a row; or procaine penicillin C 800,000 U / d intramuscular injection, 20 days in a row. For penicillin allergy, tetracycline or erythromycin can be used for 30 days at the same dose as above.
3. Cardiovascular syphilis: should be hospitalized, and for those with complications of heart failure, heart failure should be controlled and then treated with anthelmintic therapy. To avoid Gee-Hay reaction, oral prednisone (20mg/d in 2 doses) should be started 1 day prior to anthemic therapy for 3 days. The first choice of aqueous penicillin G intramuscular injection, the dose of day 1 100,000 U, day 2 200,000 U (divided into 2 times), day 3 400,000 U (divided into 2 times); day 4 onwards intramuscular injection procaine penicillin G 800,000 U / (15 consecutive days as a course of treatment, a total of 2 courses of treatment, the interval between courses of treatment 2 weeks. The treatment of penicillin allergy is the same as above.
4. Neurosyphilis: should be hospitalized and oral prednisone (as above) should be given to avoid Ji Yi Hai reaction. The first choice is aqueous penicillin G 12~24 million U/d in 4~6 doses for 10~14 days, followed by benzathine penicillin G 2.4 million U intramuscular injection, 1 time/week, 3 times in a row; or procaine penicillin G 2.4 million U/d intramuscular injection Simultaneous oral propofol (2.Og/d in 4 doses) for 10~14 days, followed by benzathine penicillin G 2.4 million U intramuscular injection, 1 time/week, 3 times in a row. 1 time/week, 3 times in a row. The treatment of penicillin allergy is the same as above.
5. Pregnancy syphilis: according to the stage of syphilis of pregnant women, the corresponding program is used for treatment, the usage and dosage are the same as other syphilis patients in the same period, but the first 3 months of pregnancy and the last 3 months of pregnancy are each treated with 1 course of treatment. For penicillin allergy, erythromycin is used for oral administration.
Congenital syphilis
1. Early congenital syphilis: for those with abnormal cerebrospinal fluid, use aqueous penicillin G 100,000~150,000 U/(kg・d) in 2~3 doses for 10~14 days; or procaine penicillin G 50,000 U, (kg・d) intramuscularly for 10~14 days. For those with normal cerebrospinal fluid, benzathine penicillin G 50,000 U/(kg・d) intramuscular injection was used). Those who are not in a position to check the cerebrospinal fluid should be treated according to the protocol for those with abnormal cerebrospinal fluid.
2. Late congenital syphilis: aqueous penicillin G 200,000~300,000 U/(kg・d) in 4~6 doses for 10~14 days; or procaine penicillin G 50,000 U/(kg・d) intramuscularly for 10~14 days as a course of treatment, available for 1~2 courses. The penicillin dose for older children should not exceed the dose for adult patients at the same time. For penicillin allergy, use erythromycin, 10~15mg/(kg・d), divided into 4 oral doses for 30 consecutive days.