Syphilis
Syphilis can be divided into congenital syphilis and acquired syphilis according to the route of transmission, and acquired syphilis can be divided into early syphilis and late syphilis, early syphilis including stage I syphilis, stage II syphilis, and early latent syphilis (infection period <2 years); late syphilis including (gum disease, cardiovascular syphilis, neurosyphilis) and late latent syphilis. Congenital syphilis is subdivided into early congenital syphilis, late congenital syphilis and latent congenital syphilis according to the age of onset (defined as 2 years) and the presence or absence of clinical manifestations.
Clinical manifestations
Stage I syphilis
1. Hard chancre: mostly occurs 2-4 weeks after sexual intercourse, mostly on the prepuce, coronal groove, tether and glans of the penis in males, and commonly on the hepatophore and rectum in homosexual males; in females, mostly on the labia majora and minora or cervix, and a few on the lips and pharynx. The typical manifestations of hard chancre are.
1. a single ulcer;
2. round or ovoid in shape, 1-2cm in diameter, slightly elevated at the border of clearance, flesh-red in color, clean surface, and a small amount of exudate;
3. cartilage-like hardness on palpation;
It is not consciously painful to the touch; 5. It may resolve spontaneously within 3-8 weeks without treatment. The hard chancre may also be atypical, such as multiple ulcers, deep ulcers, self-induced pain, and diffuse redness and oozing of the glans penis.
The lymph nodes are characterized by a number of different sizes, hard and elastic, non-adhesive and movable, non-fusing, no pain and tenderness, no redness and swelling, and no septic ulcers.
Stage II syphilis
Syphilis occurs 7-10 weeks after infection or 6-8 weeks after the appearance of hard chancre. There are systemic manifestations, including skin and mucous membrane damage, generalized lymph node enlargement, hair loss, and joint, eye, and neurological lesions. Skin lesions: mainly rashes (maculopapular rash, maculopapular rash, papulosquamous syphilis rash, follicular rash, yaws rash, pustular rash, etc.) and flat warts (formed by fusion of flat wet papules, slightly above the epidermis, with moist vesicular surface) in the genital area outside the hepatic portal.
Syphilitic alopecia: small, scattered patches of alopecia, worm-like, occurring mainly on the temporal and posterior occipital areas. Mucosal damage: mucosal patches on the inner side of the lips and cheeks (mucosal redness and erosion, covered with grayish exudate). Bone damage: osteochondritis and arthritis may occur. Pain in the long bones and large joints of the extremities occurs, which is worse at night and at rest and lighter during the day and during activity. Ocular syphilis: Rarely, iritis, iridocyclitis, chorioretinitis, optic neuritis and retinitis may occur.
Stage III syphilis (late syphilis).
About 30-40% of untreated syphilis patients may progress to advanced syphilis after 2 years, with dendritic syphilis, cardiovascular syphilis and neurosyphilis. Skin and mucosal damage is mainly dendritic swelling (subcutaneous nodules with central softening and ulceration, excluding dendritic or bloody pus), and nodular syphilis rash (multiple small subcutaneous nodules). Osteoarthritis syphilis can be osteochondritis or osteodendritic osteitis. Bone death and skin ulcers may develop.
Cardiovascular syphilis mostly occurs 10-30 years after infection, with syphilis simple aortitis (aortic dilatation, self-induced discomfort or pain behind the sternum, or paroxysmal dyspnea), syphilitic aortic atresia (blood cannot be effectively output, causing the heart to expand, with increased pulse pressure, watery veins, and in severe cases, congestive heart failure, leading to death), syphilitic aortic aneurysm (commonly in the ascending aorta The aneurysm may produce compression or even augmentation of the sternum, compressing the surrounding organs together with corresponding symptoms and signs, and may cause death if the hemangioma suddenly ruptures).
Neurosyphilis can be seen in all stages of syphilis. Neurosyphilis can be divided into three categories: asymptomatic neurosyphilis, meningeal vascular syphilis (involving the meninges, cerebral vessels and spinal cord, which can present with symptoms of increased intracranial pressure and cranial nerve paralysis: headache, vomiting, visual disturbances, sensory abnormalities, muscle atrophy of the extremities, loss of sensation in the extremities and trunk) and parenchymal syphilis (involving the brain parenchyma, which can present with dementia, optic nerve atrophy, etc.).
Latent syphilis: history of infection, but no clinical symptoms, positive syphilis serology test, no other diseases that can cause positive syphilis serology test, normal cerebrospinal fluid examination. Early latent syphilis is considered within 2 years of infection and late latent syphilis after 2 years. If the disease is of unknown duration it should be treated as late latent syphilis.
Congenital syphilis (fetal syphilis).
Early congenital syphilis: Onset within 2 years after birth. The child may be thin, hypothermic, anemic, hepatosplenomegaly, and superficial lymph node enlargement. The main manifestations are: nasal congestion (rhinitis with purulent or bloody discharge and difficulty in breastfeeding); palmoplantar maculopathy; splenomegaly; pseudoparalysis (osteochondritis of the long bones, causing pain, swelling and immobility of the limbs. The slightest tugging on the limbs causes crying); cutaneous syphilis rash (red-copper colored macules and papular scaly lesions on the palmoplantar, external genitalia, buttocks and lower half of the face, or flat warts)
Late congenital syphilis: occurs after the age of 2 years, often between 7-15 years. Manifestations are: deformities: left over from earlier lesions that are no longer active but characteristic. These include a rounded forehead, peyote shins, yawnsen teeth, mulberry teeth, saddle nose, radiolucent chalazion scar around the cavity, sternoclavicular joint bony hypertrophy, and retinitis. Still have clinical manifestations due to active damage: cerebrospinal fluid abnormalities, neurosyphilis, interstitial keratitis, deafness, hepatosplenomegaly joint effusion, osteochondritis, skin mucosal damage.
Laboratory tests
Dark-field microscopic examination: Take sclerosing chancre, flat warts, skin papules, mucosal spots or amniotic fluid for dark-field microscopic examination, finding syphilis spirochetes with typical morphology and characteristic movement pattern is considered positive and has confirmatory value.
Serological tests: non-syphilis spirochete antigen test: detect anti-cardiolipin antigen antibodies in the serum, including VDRL (venereal disease research laboratory test), unheated serum reactin test (USR), rapid plasma reactin test (RPR), such tests can be used for screening, but also as a quantitative test for efficacy evaluation.
Syphilis spirochete antigen test: including syphilis spirochete hemagglutination test (TPHA), syphilis spirochete particle agglutination test (TPPA), fluorescent spirochete antibody absorption test (FTA-ABS), which has high sensitivity and specificity and can be used as a confirmatory diagnosis, but not as an indicator for observing the efficacy of treatment. For neurosyphilis, in addition to a positive peripheral blood syphilis serology test, there should be evidence of abnormal cerebrospinal fluid examination (wbc ≥ 10*106/L, protein amount > 500 mg/L) or a positive cerebrospinal fluid syphilis serology test (VDRL or FTA-ABS).
Treatment options.
Early syphilis (including stage I, II VII syphilis and early latent syphilis): penicillin (benzathine penicillin G 2.4 million U, intramuscularly on both sides of the buttocks, once a week for 2-3 times; or procaine penicillin G 800,000 U, intramuscularly once a day for 10-15 days, for a total of 8-12 million U). Penicillin allergy can be treated with the following alternative regimen: tetracycline 500 mg orally twice daily for 15 days, or erythromycin 500 mg orally four times daily for 15 days.