What is syphilis?
Syphilis is a systemic chronic sexually transmitted disease caused by the syphilis spirochete. Except for congenital syphilis, the majority of patients are infected through sexual contact.
What is the pathogen of syphilis? What are the characteristics?
The pathogenic microorganism that causes syphilis is called Syphilis pallidum, also known as the syphilis spirochete. This microorganism is about 6-15 microns long and 0.15 microns wide, has 4-16 spirals, is active, and has three types of movement.
① Rotating forward around its own long axis;
②The whole body bends like a snake movement;
(3) stretching the distance of its rotation circle and move. Syphilis spirochetes are mainly found in the vesicular surface of hard chancre, flat warts and mucosal spots, cerebrospinal fluid of neurosyphilis patients, viscera of fetal syphilis, milk, saliva, semen and urine of syphilis patients.
The syphilis spirochete is highly infectious through direct human-to-human contact, but it is outside the human body and is weakly adaptable to various external conditions; heating, cooling, drying, etc. can cause it to die quickly. General chemical disinfectants can also kill them very quickly, and it is usually considered that outside the body, 1 to 2 hours to die.
Syphilis spirochetes are not visible under the general microscope, and the general staining method (Gram stain) also see the visible color, and can only be seen with a dark field microscope or by silver staining or fluorescent antibody method of examination.
How is syphilis transmitted?
Syphilis can be transmitted in the following ways.
Syphilis that is contracted by direct sexual contact (including genital-genital, anal-genital, oral-genital, etc.) or indirectly by other means is called acquired syphilis or acquired syphilis.
1, direct contact infection Syphilis spirochetes can penetrate the normal mucous membrane and epidermis of the tiny damage into the body. The majority of patients are infected through different ways of sexual contact, a few can be infected by kissing, hugging, breastfeeding, touching, oral sex, blood transfusion, etc..
Doctors, nurses, midwives can be infected by direct contact with the lesion (formal operation should be gloved) called innocent syphilis.
2.Indirect contact transmission Very few people may be infected through utensils with syphilis spirochetes, including clothing (underwear, underpants), bedding, towels, razors, cigarettes, eating utensils, toys, breastfeeding bottles, toilets, medical equipment, etc. and be infected. It must be noted that indirect contact transmission is theoretically possible, but in practice it is extremely rare clinically.
In pregnant women with syphilis, the syphilis spirochete in the body can pass through the placenta and infect the fetus with syphilis by the blood through the umbilical cord, called congenital syphilis.
The incidence of fetal syphilis in mothers with early syphilis is higher than that of late syphilis. If an untreated mother has had syphilis for more than 4 years, the likelihood of transmission through sexual contact is small, but it is still possible for the fetus to become infected with syphilis during pregnancy.
How is syphilis staged?
Syphilis clinicians divide syphilis into early syphilis (those who have had the disease for less than two years) and late syphilis (those who have had the disease for more than two years) from the time of onset.
Early syphilis is divided into stage I syphilis (hard chancre), stage II syphilis (syphilis spirochetes pass through the local area and enter the bloodstream to the whole body), and early latent syphilis. Late syphilis, also known as stage III syphilis, damages tissues and organs throughout the body, including the skin, mucous membranes, bone, heart, liver, nerves, and eyes. There is also a type of latent syphilis (no clinical symptoms, but the lab test is positive).
What is hard chancre? Does it have any characteristics?
After the infection of syphilis spirochete, about 2~4 weeks of incubation period (the first incubation period), red to dark red pea-sized nodules will occur at the place where the spirochete first invades, slightly raised on the surface of skin or mucous membrane, called the initial nodules. The nodules soon become eroded and form a shallow ulcer, which is called a hard chancre. The following are the characteristics of chancre.
(1) Most patients have only one noma (single). However, in recent years, due to changes in sexual behavior, there has been an increase in multiple chancre;
(2) The chancre is a shallow ulcer with clear margins and a slightly raised peripheral dike, ranging from a few millimeters to 2 cm in diameter;
The surface of the ulcer is clean and free of pus, and there is only a plasma or thick fibrous membrane, which is not easily removed;
④The surface of the ulcer has a large number of syphilis spirochetes, which is highly infectious;
⑤ The ulcer is hard to touch, like cartilage-like hardness;
(6) The ulcer is painless or only mildly painful to the touch;
The ulcers can heal on their own within a few weeks (about 3-8 weeks) without scarring or mild atrophic scars if not treated.
In men, the chancre is found in the coronal groove, glans, circumcision, inner foreskin, and sometimes in the scrotum and urethra; in women, it is found in the labia majora, labia minora, labial ties, clitoris, vaginal opening, and sometimes in the cervix and vagina. The external genital chancre is found on the lips, tongue, cheeks, throat, gums, upper jaw, anus and its vicinity, rectum, groin, pubic mound, breast, nipple, armpit, pustule, and fingers of women. In recent years, there has been a significant increase in extragenital chancre.
What is the earliest appropriate time to have a blood test for syphilis?
When the hard chancre appears 2 weeks later, the syphilis serologic reaction begins to show a positive reaction. When 7 to 8 weeks have passed, all patients have a positive serologic reaction. Therefore, the earliest time to have a blood test for suspected syphilis is 1 month after sexual contact, and the highest rate of positive blood test is around 3 months.
What is the skin rash of stage II syphilis like?
Precursory symptoms Before the onset of the rash, there is often a low fever, headache, bone pain, neuralgia, limb pain and other flu-like manifestations, lasting about 3 to 5 days, and then gradually fade after the rash appears.
Skin damage.
The rash, also known as rose rash or rose rash, accounts for 70-80% of the second-stage syphilis rash, round, oval, more numerous, symmetrical distribution, isolated and scattered, about 0.5-1 cm in diameter, light red to dark rose color, no conscious symptoms or mild itching. The rash often starts on the trunk, then spreads to the abdomen and inner flanks of the limbs, and finally is symmetrically distributed throughout the body. A deep red macular rash (ham colored rash) on the palmoplantar area, which may be mildly desquamated, is characteristic for the diagnosis of stage II syphilis. After a few days, weeks, or even months, the rash may disappear without leaving a trace or with temporary hyperpigmentation and a small amount of scaling. Sometimes the rash may become a maculopapular rash.
Can I get bumps on my skin with stage 2 syphilis?
Yes, of course. The papules on the skin of second-stage syphilis occur after the second-stage maculopapular rash, about 3 weeks later. They appear on the face, trunk, vulva, and flexors of the extremities as green bean to nail-sized infiltrating papules, red, copper-red, or dark red, with a smooth or scaly surface. Papular syphilis rash is more variable, small occurrence of follicular mouth, called follicular syphilis rash, but also can have psoriasis-like, mossy, annular cockle-shaped, etc.
Can pustules occur on the skin of second-stage syphilis?
Pustular eruptions are a special type of syphilitic papules.
Pustular syphilis rash occurs mostly in weak and poorly nourished individuals, and pustular damage is less common than plaque and papules. It is often found on the trunk, extremities and face. The size and shape of the pustules vary greatly and are various, and can be pustular, acne-like, pox-like, deep pustular, oyster-shell-like, etc.
What is stage II syphilis mucocutaneous plaque?
Stage II mucosal plaques are found on the oral mucosa, labia minora, vaginal mucosa, and cervix, starting with erythema, followed by surface erosion, milky white, and well-defined borders, with a large number of syphilis spirochetes on the surface, which are highly contagious.
What are flat warts of syphilis?
Lichen planus is a specific type of syphilis papular lesion, which is a flat elevation protruding from the mucosal surface, grayish white, red to dark red, usually found in warm, moist skin folds or at the intersection of skin and mucosa, such as the vulva, around the anus, corner of the mouth, armpit and under the breast. This kind of lesion is soft, can be fused into myxoid or cauliflower-shaped, can also be lobulated, the surface may have vesicles or covered with plasma secretions and white film, containing syphilis spirochetes, infectious.
Can I lose my hair in second-stage syphilis?
Syphilitic alopecia, also known as syphilitic alopecia, is the second-stage syphilis patients hair, eyebrows, beard and other hairs irregularly one piece of hair loss, but also the hair stem can be broken at different heights; in the head, hair loss is often worm-like, also known as syphilitic worm-like alopecia, which may be due to syphilis infiltration of hair follicles, or sympathetic nerve invasion.
Can white spots grow on the skin of second-stage syphilis?
Syphilitic white spots occur mostly in women, and within a few months after the appearance of the second-stage syphilis rash, hypopigmented spots appear on the back and side of the neck, and also on the base of diffuse pigmentation deepening, scattered pigment loss spots with indistinct borders, mostly nail-sized. The white spots can last for several months, and even anti-Me treatment cannot make the white spots fade. This white spot is also called cervical leukoderma.
What is the damage to the nail in stage II syphilis?
Stage II syphilis damage to the nail is syphilitic nail beditis or syphilitic nail fungus. These two lesions can cause curved hypertrophy of the nail plate, surface unevenness and inflammation of the nail groove; other diseases may be local inflammation caused by spirochetes or the effects of systemic disease caused by syphilis.
What is the bone damage in stage II syphilis?
Bone damage includes osteochondritis, osteitis and osteomyelitis; arthritis includes arthritis, bursitis and tenosynovitis. All of the conscious symptoms have persistent tonal pain, which is lighter during the day and during activity and heavier at night and at rest, with no redness or congestion on the surface and no increase in skin. Osteochondritis and osteochondritis are mostly seen in the long bones. Arthritis is mostly in the elbow or knee. Syphilitic osteochondritis often occurs in the long bones, especially the tibia, with hypertrophy of the periosteum and marked pressure pain, most painful at night. Bone and joint damage may increase in response to initial anti-syphilis treatment, but gradually subsides after 1 to 2 days. Proximal joint nodules are most often seen near larger joints, approximately 0.5 cm in diameter, with no surface inflammation or tenderness.
What is the ocular disease of stage II syphilis?
There are few cases of ocular damage in stage II syphilis, including iritis, iridocyclitis, chorioretinitis, optic neuritis, optic retinitis, etc. Rarely, there is syphilitic conjunctivitis, keratitis, etc., which can even affect vision.
Can stage II syphilis damage the nerves?
Stage II syphilis can damage the nervous system, one type is called occult neurosyphilis or asymptomatic neurosyphilis, which only has abnormal changes in the cerebrospinal fluid without clinical symptoms; the other type is overt neurosyphilis, which not only has abnormal changes in the cerebrospinal fluid, but also has obvious clinical symptoms, including meningitis, cerebrovascular syphilis, meningeal vascular syphilis, etc.
Can there be other organ damage in stage II syphilis?
Swollen superficial lymph nodes throughout the body, usually the size of a soybean to a fava bean, are painless, and in clinical examination, swollen lymph nodes on the talus are more meaningful. This type of lymph node enlargement is also known as syphilitic polymphadenitis.
Rarely, syphilitic hepatitis, syphilitic nephritis, and syphilitic splenomegaly are also seen.
What are the skin lesions of advanced syphilis?
Nodular syphilis rash is a subcutaneous nodule, often arranged in the shape of a ring, arc or snake, bean, bean or even larger, brownish red to coppery red, hard, common in the forehead, buttocks, limbs, etc., may disappear on its own, or may break down to form ulcers, and finally leave atrophic scars. Dendritic nodules are hard subcutaneous nodules that gradually increase in size, become hard and round, and finally soften, break down, and become necrotic, forming deep ulcers with sharp edges, with coffee-colored dendritic secretions flowing out, and with lipid-like purulent secretions at the bottom of the ulcers; they occur on the extensor side of the extremities, forehead, sternum, lower legs, buttocks, etc. The damage is small in number, asymmetric, or isolated and solitary.
Proximal joint nodules are subcutaneous nodules occurring near large joints such as the hip, elbow, knee and sciatic joints, symmetrical, hard, slightly painful, slow to develop, do not break down, and gradually subside after treatment.
What is the mucosal damage in advanced syphilis?
Mucosal damage is a dendritic swelling occurring at the mucosa (upper jaw, nasal septum, pharynx, etc.), which can cause perforation, saddle nose, difficulty in breathing and hoarseness due to rupture and discharge of dead bone.
What is the cardiovascular damage of advanced syphilis?
Cardiovascular damage: syphilis spirochetes invade the cardiovascular system at the early stage of infection, but most of the cardiovascular clinical symptoms occur more than 10 years after the initial infection, and patients are mostly over 35 years old, and about 10-12% of the clinical, cardiovascular syphilis occurs. The incidence of aortitis with early adequate treatment is 0.4%, and the incidence of aortitis without early adequate treatment is 17.5%, with an autopsy incidence of up to 70%-80%, and a male to female ratio of about 2-5:1. simple aortitis: generally no obvious clinical symptoms, and the signs are not prominent; if the lesion is in the ascending aorta, the second heart sound in the aortic valve area is hyperactive, a low soft systolic murmur may be heard, and there is occasional retrosternal discomfort or paroxysmal dyspnea.
Radiographs may show dilated aorta. Aortic atresia insufficiency: It accounts for about 30-45% of syphilitic cardiovascular lesions and often occurs in combination with syphilitic aortic aneurysm. The symptoms are mild only, palpitations, severe angina attacks, low diastolic blood pressure, increased pulse pressure, watery pulse, and even congestive heart failure leading to death. Aortic aneurysm: the incidence accounts for about 20% of syphilitic cardiovascular lesions, divided into aortic sinus aneurysm, ascending aortic aneurysm, aortic arch aneurysm; X-ray can be detected as a pulsating shadow, and in severe cases the aneurysm ruptures, which can lead to the patient’s death soon. Coronary artery orifice stenosis: 90% of this disease is associated with syphilitic aortic valve atresia insufficiency. It causes angina-like attacks, but is not effective against nitrites, and may also have arrhythmias and progressive heart failure. Myocardial dendritic swelling: rare, can vary depending on the location of the dendritic swelling, causing progressive heart failure.
What is the neurological damage in advanced syphilis?
There are four types of neurological damage: asymptomatic neurosyphilis, meningeal vascular syphilis, spinal cord consumption, and paralytic dementia. Of course, sometimes these types overlap with each other; in addition, in recent years antibiotics, especially penicillin, have been widely used in many diseases, and the neurosyphilis damage of each type has become atypical and should be brought to the attention of clinicians.
Asymptomatic neurosyphilis: no signs and symptoms of neurological disease, positive cerebrospinal fluid syphilis seropositivity, may or may not have syphilis manifestations in other organs or systems. Meningeal vascular syphilis: acute or subacute aseptic cerebrospinal meningitis may appear after stage I syphilis, usually within 1 year of infection, and may cause unilateral or bilateral cranial nerve palsies, and about 10% of patients develop a stage II syphilis rash along with meningitis.
Cerebrovascular syphilis often manifests as endarteritis and perivasculitis, causing cerebrovascular thrombosis and infarction, with typical signs and symptoms of cerebrovascular accidents, usually within 5-10 years of infection, mostly in men, often combined with aseptic meningitis. Spinal meningeal vascular syphilis is more common, affecting the cerebrospinal cord, with thoracic radicular pain, muscle atrophy in the extremities, sensory loss, sensory abnormalities, and sphincter dysfunction.
Focal meningeal syphilis is rare, as the meninges have syphilitic dendritic swelling formation, with the same symptoms as brain tumors. Spinal consumption: This is a chronic progressive disease involving the posterior columns and roots of the spinal cord with lightning-like pain, abnormal sensation in the lower extremities, diminished and absent tendon reflexes, visceral crisis (stomach, intestines and rectum), impaired tenderness and temperature perception, diminished and absent deep sensation, and progressive ataxia. Spinal consumption occurs 10 to 30 years after infection with syphilis and is generally more common in men.
About 30-40% of patients have a negative serum VDRL test and 10%-20% have normal cerebrospinal fluid, but almost all have a positive serum FTA-ABS test. Spinal cord consumption is now rare due to improved treatment and detection, but in the past, 10% of newly diagnosed advanced syphilis and 40% of those with neurosyphilis symptoms had spinal cord consumption in Denmark in the 10 years from 1961 to 1970. Paralytic dementia: This is a progressive loss of cerebral cortical function caused by chronic meningitis.
It usually develops 10 to 20 years after infection. The pathology is characterized by a chronic inflammatory reaction of the perivascular and meninges with meningeal thickening, granular ventriculitis, parenchymal degeneration of the cerebral cortex, and spirochetes within the lesioned tissue.
In the mental area, there are agitation, fatigue, headache, amnesia and personality changes, later memory impairment, errors in judgment, lack of discrimination, mental confusion, depression or complacency, and even fantasy, etc. In the mental area, there are tremors, especially of the lips, tongue and hands, Arodian pupils (loss of response to light, presence of regulatory response), stuttering and slurred pronunciation, seizures, tetraplegia and incontinence. The serum VDRL test is often positive, and the FTA-ABS test is mostly positive.
What are the other systemic damages of advanced syphilis?
Deep dendritic swelling it occurs in muscles, periosteum, lymph nodes, internal organs, and almost everywhere in the body can be avoided.
Bone syphilis is more common with osteochondritis, which often affects long bones, and bone dendritis, which affects flat bones such as the skull.
Ocular syphilis can occur iridocyclitis, retinitis, keratitis. In the late stage, there is also optic nerve atrophy.