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Abstract: This patient was diagnosed with syphilis after a preoperative examination that unexpectedly suggested the presence of syphilis. The patient was immediately admitted to our department for treatment. Through symptomatic intravenous infusion and outpatient review 4 months after discharge, we learned that the patient’s condition is now stable and there is no sign of recurrence.
Basic information】Female, 27 years old
Type of disease】Chronic infectious disease (syphilis)
Hospital】Eastern War Zone General Hospital
Time of consultation】September 2019
Treatment plan】Intravenous infusion (Ceftriaxone sodium for injection)
Treatment period】2 weeks, rechecked 4 months after discharge
Treatment effect】No sign of recurrence
I. Initial consultation
Two weeks ago, when Ms. Zhu underwent preoperative examination, her viral test results indicated syphilis (+).
However, during the post-operative recovery period, the patient accidentally found a hard chancre in her vagina while taking a shower. After carefully asking about the patient’s current medical history and daily condition, we learned that the patient is usually healthy and has no history of hypertension, diabetes, or coronary heart disease. The patient’s body examination showed that there was no yellowing of the skin or rash, no pressure pain or rebound pain in the abdomen, no percussion pain in the liver area, no edema in both lower limbs, and only a hard chancre node was visible in the vagina. After combining the patient’s examination results, current medical history and physical examination results, the patient was admitted to the outpatient clinic with “syphilis”.
Treatment
After the patient was admitted to the hospital, in order to clarify the diagnosis of syphilis, the patient was then arranged for routine examination and syphilis specialist examination, and the result of toluidine red non-heating serum test for syphilis was strongly positive, and the final test result was stage II syphilis. Because the patient had high-risk sexual behavior and was also fertile, the patient needed to be checked for conception and for other STDs. The test suggested that the patient was not pregnant and not infected with HIV, and that standard anti-infective treatment for syphilis could be administered. However, since the patient was allergic to penicillin, the treatment plan was modified to intravenous infusion of ceftriaxone sodium for injection after communication with the patient, who not only indicated that he would actively cooperate with the treatment, but also indicated that his sexual partner would also come to the hospital for treatment.
III. Treatment effect
After 2 weeks of treatment, the patient’s condition was fine and there were no adverse reactions. The repeat syphilis toluidine red non-heating serum test indicated a decrease in titer, and physical examination showed that the patient’s skin was free of yellow staining and rash, and the vaginal hard chancre had shrunk and flattened compared with that before treatment. Four months after the patient was discharged from the hospital, she returned to the outpatient clinic for a follow-up examination, which showed that the syphilis toluidine red non-heated serologic test was negative and the vaginal chancre had shrunk and flattened, and there was no sign of recurrence so far.
IV. Notes
I am glad to see that the patient’s symptoms are gradually reduced, but in order to prevent the patient’s disease from recurring, we still need to remind the patient to pay attention to some matters in daily life: 1.
1, during the treatment process, patients should pay attention to the prohibition of intercourse, so as not to lead to aggravation of the disease, or infected to sexual partners.
2. Patients can be properly isolated from their family members during the illness and remind them to avoid contact with the patient’s pollutants, including intimate clothing and toothbrushes, to prevent cross-infection. In addition, intimate clothing, towels, bath towels and other items need to be washed separately and disinfected, and avoid sharing with others.
3, daily diet to ensure the need to ensure nutritional intake, pay attention to the combination of work and rest, can be appropriate to carry out the necessary functional exercise, in order to maintain a good state of mind, but also to improve their own body immunity, help to alleviate the disease.
V. Personal insight
Syphilis is a chronic sexually transmitted disease, often transmitted through sexual intercourse, but because the symptoms of early syphilis are not obvious, most patients are found when the symptoms are aggravated, or during preoperative examination or physical examination, which is the case of the patient in this case. The patient’s emotions should be taken into account because of the strong mental and psychological impact of the test.
In addition, although the test has a high sensitivity, as doctors, we still cannot exclude the possibility of false positives, so the diagnosis of syphilis should not be overly dependent on the test report, but should be combined with the patient’s symptoms and the presence of high-risk conditions to make a comprehensive decision.