Syphilis is a chronic, systemic sexually transmitted disease caused by the syphilis spirochete. It is mainly transmitted through the sexual route and can be clinically manifested as stage I syphilis, stage II syphilis, stage III syphilis, latent syphilis and congenital syphilis (fetal syphilis). It is a disease listed in the Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases as a category B disease.
Clinical symptoms
1.Acquired dominant syphilis
(1) The hallmark feature of stage I syphilis is hard chancre. The most common sites are penis, glans, coronal sulcus, foreskin, urethra; labia, clitoris, cervix; anus and anal canal. Occasionally, it can be found on the lips, tongue and breasts. (1) Hard chancre is characterized as appearing 7 to 60 days after infection with syphilis spirochetes, with cartilage-like hardness when touched, lasting 4 to 6 weeks, and can heal spontaneously. The swollen lymph nodes are of different sizes and painless.
(2) Stage II syphilis is characterized by syphilis rash (rose rash) and cutaneous syphilis rash: it occurs in 80% to 95% of patients. It is characterized by a variety of rash types and recurrence, widespread and symmetrical, painless, leaving no traces after healing, and fading rapidly with anthelmintic treatment.
(3) The main manifestations of stage III syphilis are ① Skin and mucous membrane damage nodular syphilis rash occurs on the scalp, scapula, back and the extensor side of the limbs. Gum-like swelling often occurs in the calf, as a deep ulcer formation; when it occurs in the upper forehead, tissue necrosis, perforation; occurs in the nasal diaphragm, then bone destruction, the formation of saddle nose. ②Proximal joint nodules are slowly growing subcutaneous fibrous nodules of syphilitic fibromas, symmetrical, variable in size, non-inflammatory, painless, and self-resolving. ③Cardiovascular syphilis mainly invades the aortic arch area and causes syphilitic heart disease. The incidence of neurosyphilis is about 10%, which can occur in the early stage of infection or several years or ten years later. Syphilitic meningitis, cerebrovascular syphilis, meningeal dendritic swelling, and paralytic dementia can occur without symptoms. Meningeal dendritic swelling is a lesion involving the subcortex of one cerebral hemisphere.
2.Acquired latent syphilis
Acquired syphilis spirochete infection does not form dominant syphilis and presents asymptomatic manifestation, positive syphilis serologic test and normal cerebrospinal fluid examination, called recessive (latent) syphilis.
3.Gestational syphilis
Gestational syphilis is a dominant or recessive syphilis that occurs during pregnancy. In gestational syphilis, the syphilis spirochete can be transmitted to the fetus through the placenta or umbilical vein, resulting in congenital syphilis in the baby born later. Only a few pregnant women can have healthy children.
4.Congenital dominant syphilis
(1) Children with early congenital syphilis are born thin and small, and symptoms appear 3 weeks after birth, with enlarged lymph nodes all over the body, without adhesions, painless and hard. Most of them have syphilitic rhinitis. Skin lesions appear about 6 weeks after birth as blistering-herpetic lesions (also called syphilitic aspergillosis) or maculopapular or papular scaly lesions. Thrombocytopenia and anemia may be present. Neurosyphilis may occur. However, hard chancre does not occur.
(2) Late congenital syphilis occurs after 2 years of age. Saddle nose etc. may appear, but is not active. Keratitis, neurological deafness, abnormal neurological manifestations, cerebrospinal fluid changes, hepatosplenomegaly, nasal or jaw dendrites, joint effusion, osteochondritis, dactylitis, and skin mucosal damage may also occur.
Sources of infection and means of transmission
Syphilis is prevalent worldwide, and according to WHO estimates, there are about 12 million new cases worldwide each year, mainly in South Asia, Southeast Asia and sub-Saharan Africa. Syphilis has been growing rapidly in China in recent years and has become the STD with the highest number of reported cases. The skin and mucous membranes of syphilis patients contain syphilis spirochetes, and people who do not have the disease can get the disease if there is a slight break in the skin or mucous membranes during sexual contact with syphilis patients. Rarely, the disease can be transmitted through blood transfusions or routes. Acquired syphilis (acquired) early syphilis patients are the source of infection, more than 95% is transmitted through risky or unprotected sex, a few through kissing, blood transfusions, contaminated clothing, etc. Fetal syphilis is transmitted by pregnant women with syphilis, and the chance of transmission to the fetus is quite high if the pregnant women with first and second stage and early latent syphilis.
1. Source of infection
Syphilis is a unique human disease, and patients with overt and covert syphilis are the source of infection. The skin lesions of people infected with syphilis and their secretions and blood contain syphilis spirochetes. Syphilis is most contagious in the first 2 years of infection, while sexual transmission decreases significantly after 4 years. The syphilis spirochete can be transmitted to the fetus through the placenta, and there is a high risk of transmission to the fetus from a pregnant woman with early syphilis.
2.The way of transmission
Sexual contact is the main way of transmission of syphilis, accounting for more than 95%. The early stage of syphilis infection is the most infectious. With the prolongation of the disease, the infectiousness becomes less and less, and it is generally believed that the infectiousness of sexual contact is very weak more than 4 years after infection.
Pregnant women with syphilis can be transmitted to the fetus through the placenta, causing intrauterine infection in the fetus, which can lead to miscarriage, premature birth, stillbirth or delivery of fetal syphilis children. It is generally believed that the earlier the stage of syphilis in a pregnant woman, the greater the chance of infection of the fetus.
Treatment
1.Treatment principles
Emphasize early diagnosis, early treatment, regular course of treatment and sufficient dose. Regular clinical and laboratory follow-up after treatment. Sexual partners should be investigated and treated together. Early syphilis can be clinically cured by thorough treatment, eliminating infectiousness. Late syphilis treatment can eliminate inflammation in the tissue, but the damaged tissue is difficult to repair.
Penicillin is the drug of choice for different stages of syphilis. For those who are allergic to penicillin, drugs such as doxycycline and tetracycline can be chosen. The serum should be rechecked every 3 months for the first year after syphilis treatment, and every 6 months for 3 years afterwards. Neurosyphilis and cardiovascular syphilis should be followed up for life.
2.Early syphilis (including stage I and II syphilis and early latent syphilis)
(1) Penicillin therapy
(2) Allergic to penicillin
3.Late syphilis (including three stages of skin, mucous membrane, bone syphilis, late latent syphilis) and second stage recurrent syphilis
(1) Penicillin therapy
(2) Allergic to penicillin
4.Neurosyphilis
should be hospitalized for treatment.
(1) Aqueous penicillin G
(2) Procaine penicillin G After the above treatment, then connect with benzathine penicillin G.
5.Syphilis during pregnancy
The treatment should be given according to the syphilis treatment protocol of the corresponding disease stage, and a course of treatment should be applied in the first 3 months of pregnancy; a course of treatment should be applied in the last 3 months of pregnancy.
6.Fetal syphilis (congenital syphilis)
Early congenital syphilis (within 2 years of age) with abnormal cerebrospinal fluid: treatment with aqueous penicillin G or procaine penicillin G, specific dose as prescribed by the doctor. If there is no condition to check the cerebrospinal fluid, it can be treated as those with abnormal cerebrospinal fluid.
7. Treatment of syphilis in pregnant women
Married women with a history of syphilis must undergo a comprehensive syphilis examination before pregnancy. Women who have had an unclean sex life or have been infected with syphilis should preferably go to a regular hospital for a comprehensive syphilis test before they plan to get pregnant. For those married women whose syphilis treatment is completed and whose syphilis symptoms are not obvious should also be sure that the syphilis is cured before they can get pregnant.
8, syphilis treatment in the Jihai reaction
Fever, headache, arthralgia, nausea, vomiting, and intensification of syphilis rash may occur within a few hours after the first dose of syphilis treatment, which is called Jihai reaction. The symptoms will mostly resolve within 24 hours. To prevent the occurrence of Jihai reaction, small doses of hormone penicillin are usually given to reduce the fever of Jihai reaction.
9.Dietary precautions
Avoid eating spicy and stimulating food after syphilis, quit smoking and alcohol, and drink more water appropriately to facilitate the elimination of toxins from the body.
After treatment (prognosis)
The RPR is a non-specific syphilis serological test, which is often used to determine the efficacy of treatment. The TPPA (syphilis spirochete agglutination test) detects specific syphilis spirochete antibodies in the serum, and once the test is positive, it usually remains positive for life, regardless of treatment or disease activity.
After regular treatment, the RPR should be retested every three months, and after six months, the RPR should be retested every six months and followed up for two years to compare the current RPR titer with the previous ones. A fourfold or more decrease in titers 3 to 6 months after treatment indicates that the treatment is effective. The titer may continue to decrease or even turn negative. If the results of three to four consecutive tests are negative, the patient is considered to be clinically cured of syphilis.
There are generally three possible changes in the serologic response of a patient with syphilis after anti-syphilis treatment.
1. seronegative.
2. A decrease in serum titer without a negative change, or serum resistance.
3, turn negative and then become positive, or continue to decline in the process of rising again, indicating a relapse or reinfection.
When the seropositivity is still maintained after 12 months of regular anti-syphilis treatment for phase I syphilis and 24 months for phase II syphilis, it is clinically called serum resistance or serum fixation, which may occur because of factors such as potential active lesions still in the body, decreased immunity of the patient, insufficient dose of anti-syphilis treatment or drug resistance, etc., and there are also unidentified causes. In this case, it is important to insist on an active search for the cause and not to give up any feasible efforts.
Prevention
Avoid unsafe sexual practices: Early syphilis patients are highly contagious, and late syphilis, although gradually less contagious, should be carefully protected. In addition, the patient’s underwear and towels are washed separately and disinfected by boiling in a timely manner, and they are not bathed in the same tub with others.