1.What is syphilis? Syphilis is a chronic sexually transmitted disease caused by the pale spirochete, with an incubation period of 9 to 90 days and an average of 3 weeks. Syphilis spirochete is a very fragile pathogen, like cold and fear of heat, leaving the body is not easy to survive. However, the syphilis pathogen can invade multiple organs of the body, showing multiple signs and symptoms throughout the body. On the other hand, syphilis can be asymptomatic for many years, called latent syphilis. 2.How is syphilis infected and transmitted? ①Sexual contact transmission: This transmission route accounts for about 95%. Syphilis spirochetes invade the body from minor mucosal breaks and are present in large quantities in the skin, mucous membranes, saliva, breast milk, semen, urine, therefore, either sexual intercourse, anal sex or oral sex can be infected. Untreated patients are the most infectious at the beginning of the infection, and the infectiousness will decrease as the disease period increases. ②Mother-to-child transmission: Pregnant women with syphilis can transmit the pathogen to the fetus through the placenta and congenital syphilis can occur. ③Other ways: such as blood, kissing, breastfeeding, contact with infected patients’ articles, etc. 3.What are the manifestations of syphilis? There are many clinical symptoms of syphilis, which can be clinically divided into three stages, and the clinical manifestations of each of the three stages have their own characteristics. (1) Stage I syphilis: The main manifestations are hard chancre and enlargement of nearby lymph nodes, which usually appear 2 to 4 weeks after unclean sexual intercourse. The hard chancre most often appears in the coronal groove of the penis, glans, prepuce and tether, and can also occur on the lips, throat, tongue, breasts, fingers, and even the anus and rectum. The hard chancre starts as a dark red patchy rash that expands and bulges into a papule in 2 to 3 days and forms a vesicle or shallow ulcer of 1 to 2 cm, with a small amount of plasma exudate on its surface, containing a large number of syphilis spirochetes, which is highly contagious. A few days to a week after the appearance of the hard chancre, the inguinal lymph nodes become enlarged. The hard chancre usually disappears spontaneously within 3 to 8 weeks if untreated, leaving no trace or only mild atrophy and pigmentation, while the swollen lymph nodes can last for several months. (2) Stage II syphilis: Syphilis rash is the main feature, the rash is widely distributed and symmetrical, and there are generally no conscious symptoms. It usually occurs 7 to 10 weeks after infection or 6 to 8 weeks after the appearance of hard chancre. In the early stage, flu-like symptoms such as vomiting, generalized lymph node enlargement, fever, headache, etc. may appear. If itching and painful itching in the anus and vulva occur, it often suggests the presence of lichen planus. Second, about 10% of patients may develop hair loss. Then, as the disease progresses, skin and mucous membrane damage, bone pain, eye inflammation, and nerve destruction symptoms (such as headache, hemiplegia, and aphasia) gradually appear. (3) Stage III syphilis: Also known as late syphilis, the skin lesions caused by it often form a small number of hard nodes with a large diameter, of which dendritic swelling is the typical manifestation, most of which appear 3 to 4 years after infection, and is the main cause of syphilis disability and death. Other symptoms are similar to those of stage II syphilis. 4.How to diagnose syphilis? ①History: unclean sexual intercourse or history of syphilis infection in spouse, history of indirect infection or chance of mother-to-child transmission. ②The above-mentioned typical clinical manifestations. ③ Non-syphilis spirochete test (such as RPR) specific syphilis spirochete test (such as TPHA), etc. If RPR or TPHA is positive, it indicates the possible presence of syphilis infection and should be further examined, such as taking part of the exudate from vulvar ulcers to test for syphilis spirochetes under the microscope. However, positive RPR and TPHA may occur in many diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and liver cirrhosis. Likewise, a negative RPR and TPHA does not necessarily rule out syphilis. This is because early syphilis sometimes does not have any positive results. Therefore, those who suspect syphilis should be tested 4 weeks after the first test
The test should be repeated again. Some syphilis patients should also undergo cerebrospinal fluid examination to rule out neurosyphilis, especially asymptomatic neurosyphilis. 5.How is syphilis treated? The main treatment is medication. Penicillin is the main drug used to treat syphilis. Syphilis spirochetes are very sensitive to penicillin. If the patient is allergic to penicillin, tetracycline, erythromycin, doxycycline or third generation cephalosporin can be used. As the cardiovascular system and nervous system are often invaded in stage III syphilis, the disability and death rate is high, therefore, syphilis emphasizes early diagnosis, early treatment and regular treatment.