Syphilis (syphilis) is a chronic, systemic sexually transmitted disease caused by the pale spirochete. It can be divided into acquired syphilis and fetal syphilis (congenital syphilis). Acquired syphilis is further divided into early and late syphilis. Early syphilis refers to infection with the syphilis spirochete within 2 years, including stage I, stage II and early recessive syphilis, and stage I and II syphilis can also overlap. Late syphilis has a duration of more than 2 years and includes stage III syphilis, cardiovascular syphilis, and late recessive syphilis. Neurosyphilis can occur in both the early and late stages of syphilis. Fetal syphilis is further divided into early stage (onset within 2 years after birth) and late stage (onset after 2 years of birth).
Diagnosis
1.Phase I syphilis.
(1) Epidemiological history: history of unsafe sex, multiple sexual partners or sexual partner infection.
(2) Clinical manifestations.
(1) Hard chancre: incubation period is usually 2 to 4 weeks. It is often single, but can also be multiple. The first nodule is a corn-sized nodule above the skin surface, and later develops into a round or oval shallow ulcer with a diameter of about 1 to 2 cm. The nodules are typically well-defined, with slightly elevated margins and a flat, clean wound surface. Most often seen in the external genital area.
(2) Enlarged inguinal or affected proximal lymph nodes: may be unilateral or bilateral, painless, isolated from each other without adhesions, medium in quality, not septic and ruptured, no redness, swelling or heat on their surface skin.
(3) Laboratory examination.
(1) Using dark field microscopy or silver-plated staining microscopy to take the exudate of sclerosing chancre damage or lymph node puncture fluid, syphilis spirochetes can be detected, but the detection rate is low.
② Positive serological test for non-syphilis spirochetes. If the infection is less than 2-3 weeks, the test may be negative and should be rechecked after 4 weeks of infection; ③Serological test for syphilis spirochetes is positive and may be negative at very early stage.
(4) Diagnostic classification.
(① suspected cases: should be consistent with both clinical manifestations and laboratory tests in ②, may or may not have epidemiological history; or consistent with both clinical manifestations and laboratory tests in ③, may or may not have epidemiological history.
② confirmed cases: should meet both the requirements of suspected cases and laboratory tests in ①, or both the requirements of suspected cases and both types of syphilis serological tests are positive.
2, phase II syphilis.
(1) Epidemiological history: history of unsafe sex, multiple sexual partners or sexual partner infection, or history of blood transfusion (the blood donor is an early syphilis patient).
(2) Clinical manifestations: There may be a history of stage I syphilis (often appearing 4-6 weeks after the onset of hard chancre), and the disease period is within 2 years.
(1) Skin and mucous membrane damage: The types of lesions are diverse, including macules, maculopapular rash, papules, scaly lesions, follicular rash and pustular rash, etc. They are distributed on the trunk and extremities, and are often generalized and symmetrical. Dark erythematous and desquamative macules on the palms and plantars, and eczema or flat warts on the vulva and perianal area are the characteristic damages. The rash is usually not pruritic. Oral mucosal plaques and worm-like alopecia may occur. (i) The number of second-stage recurrent syphilis lesions is small and the lesions are peculiarly morphologic, often annular or bow-shaped or arcuate.
(ii) Superficial lymph nodes may be enlarged throughout the body.
(3) Syphilitic bone and joint, eye, visceral and neurological damage may occur.
(3) Laboratory tests.
① dark-field microscopy or silver-plated staining microscopy method, take the second-stage skin lesions, especially flat warts, wet papules, town to find syphilis spirochetes. el cavity mucosal spots because it is not easy to identify with other spirochetes in the oral cavity, so do not use this method of examination.
② positive non-syphilis spirochete serological test; ③ positive syphilis spirochete serological test.
(4) diagnostic classification: ① suspected cases should be consistent with both clinical manifestations and laboratory tests in ②, with or without epidemiological history.
② confirmed cases should meet both the requirements of suspected cases and laboratory tests in ①, or both the requirements of suspected cases and both types of syphilis serological tests are positive.
3, stage III syphilis.
(1) Epidemiological history: history of unsafe sex, multiple sexual partners or sexual partner infection, or history of blood transfusion.
(2) Clinical manifestations: there may be a history of stage I or II syphilis, and the duration of the disease is more than 2 years.
①Late syphilis.
a. Skin and mucous membrane damage: nodular syphilis rash on the head, face and extremities, subarticular nodules near large joints, dendritic swelling of the skin, mouth and tongue and throat, mucous membrane dendritic swelling of the palate and nasal septum may lead to perforation of the palate and septum and saddle nose.
b. bone syphilis, ocular syphilis, other visceral syphilis involving the respiratory tract, gastrointestinal tract, liver and spleen, genitourinary system, endocrine glands and skeletal muscles.
②Cardiovascular syphilis, simple aortitis, aortic valve atresia insufficiency, aortic aneurysm, etc. may occur.
(3) Laboratory tests.
① positive serological test for non-syphilis spirochetes, very few advanced syphilis can be negative.
(2) Positive syphilis spirochete serological test.
(4) Diagnostic classification.
① suspected cases should be consistent with both clinical manifestations and laboratory tests in ①, may or may not have an epidemiological history.
② confirmed cases should meet the requirements of both suspected cases and positive serological tests for both types of syphilis.
4, neurosyphilis.
(1) epidemiological history: a history of unsafe sex, multiple sexual partners or sexual partner infection, or a history of blood transfusion.
(2) Clinical manifestations.
(1) Asymptomatic neurosyphilis: no obvious neurological symptoms and signs.
(ii) Meningeal neurosyphilis: manifested as fever, headache, nausea, vomiting, cervical ankylosis, optic papillomegaly, etc.
(iii) meningeal vascular syphilis: manifestations of occlusive cerebrovascular syndrome, such as hemiplegia, paraplegia, aphasia, epileptiform seizures, etc.
(iv) cerebral parenchymal syphilis: psychiatric symptoms may appear, manifesting as paralytic dementia, inattention, mood changes, delusions, and diminished intelligence, judgment and memory, personality changes, etc.; neurological symptoms may appear, manifesting as tremor, speech and writing disorders, ataxia, muscle weakness, seizures, tetraplegia and incontinence, etc. If the spinal cord is damaged by syphilis spirochetes, the disease is called spinal consumption. Lightning-like pain, abnormal sensation, tactile pain and temperature perception disorders, hyperalgesia and loss of deep sensation, position and vibration perception disorders, etc. may occur.
(3) Laboratory tests.
(1) Positive non-syphilis spirochete serological test, very few advanced patients may be negative.
(ii) Positive serological test for syphilis spirochetes.
③ Cerebrospinal fluid examination: white blood cell count ≥ 5 × 106 several, protein amount > 500 mg/L, and no other causes of abnormalities. Positive cerebrospinal fluid fluorescent spirochete antibody absorption test (FrA-ABS) and/or venereal disease research laboratory (VDRL) test. In the absence of conditions for FFA-ABS and VDRL, the syphilis spirochete gelatin agglutination test (TPPA) and rapid plasma reactin ring card test (RPR)/toluidine red unheated serological test (TRUST) may be used instead.
(4) Diagnostic classification.
(i) suspected cases: should be consistent with both clinical manifestations, laboratory tests ①, ② and ③ in the routine examination of cerebrospinal fluid abnormalities (excluding other causes of abnormalities), and may or may not have an epidemiological history.
② confirmed cases: should meet both the requirements of suspected cases and laboratory tests ③ in the cerebrospinal fluid syphilis serology test positive.