A sexually transmitted disease caused by the syphilis spirochete. It can attack all organs of the body and produce a wide variety of signs and symptoms throughout the body.
Transmission routes
(1) Sexual contact: This is the most important route of transmission.
(2) Fetal transmission (mother-to-child transmission).
(3) Other: having used or been in contact with the blood or body fluids of syphilis patients, or objects containing the blood or body fluids of patients. In general, this route of transmission is rare nowadays.
Syphilis Stages
Early syphilis is defined as syphilis that is less than 2 years old, including stage 1 syphilis (hard chancre), stage 2 syphilis and early latent syphilis. Syphilis that is older than 2 years is considered late syphilis.
Clinical manifestations
Incubation period: 2-4 weeks.
(1) Stage I syphilis
Typical manifestations of hard chancre: shallow ulcers or erosive surfaces in the genital area, painless, cartilage-like hardness, usually one (may be more than one), which may disappear within 3-8 weeks without treatment and leave no trace after disappearance. It may be accompanied by enlargement of inguinal lymph nodes.
It is important to pay attention to the atypical manifestations of hard chancre, which should be combined with medical history and examination results to clarify the diagnosis.
(2) Stage II syphilis
The rash of stage II syphilis is diverse, typically coppery-red or rose-colored with collar-like scales and no obvious itching or other conscious symptoms. Because the rash is similar to many other skin diseases, it is difficult to make a diagnosis, so it needs to be combined with medical history and examination results to make a clear diagnosis.
Other: mucosal symptoms, bone and joint symptoms, eye symptoms, etc.
(3) Stage III (advanced) syphilis
Advanced cardiovascular syphilis, advanced neurosyphilis, etc.
Diagnosis
(1) History of STD or contact history.
(2) Clinical symptoms: hard chancre, skin rash, corresponding visceral involvement symptoms.
(3) Laboratory tests: dark field examination, non-syphilis spirochete test (RPR or USR, VDRL), syphilis spirochete test (TPPA or TPHA, FTA-ABS), cerebrospinal fluid examination.
A diagnosis of syphilis is made when both the non-syphilis spirochete test and the syphilis spirochete test are positive at the same time. For example, RPR and TPPA are positive at the same time.
Abnormal cerebrospinal fluid examination, including elevated white blood cells, abnormal protein and positive VDRL, is diagnostic of neurosyphilis.
Titer changes in the non-syphilis spirochete test are used to observe the efficacy of treatment.
Treatment
(1) Drug selection: penicillins are preferred (including penicillin, benzathine penicillin, and procaine penicillin). For penicillin allergy, ceftriaxone, tetracyclines (doxycycline, tetracycline), azithromycin are used.
(2) Course of treatment: Select the above drugs for treatment, for example, the following
Early syphilis, give benzathine penicillin injection, 2.4 million U, intramuscular injection (divided into two sides of the buttocks), once a week, a total of 2-3 times. If allergic to penicillin, give doxycycline orally, 0.1g, 2 times/day, for 14 days.
For advanced syphilis, give benzathine penicillin injection, 2.4 million U, intramuscularly (divided into two sides of the buttocks), once a week, 3-4 times in total. If allergic to penicillin, give Doxycycline oral, 0.1g, 2 times/day, for 28 days.
Neurosyphilis: penicillin injection, 18-24 million U/day every 4-6 hours for 14 days, followed by benzathine penicillin injection, 2.4 million U, intramuscularly (divided into two sides of the buttocks), once a week for 3 times. For penicillin allergy, it is recommended to give ceftriaxone injection, 2.0g/day for 10-14 days.
(3) Repeat treatment is required in the following cases: titer of non-syphilis spirochete antigen serologic test such as RPR rises more than 4 times; initially high titer, after 12-24 months of treatment, the titer does not drop more than 4 times; signs and symptoms of syphilis progression or reinfection.
Repeat treatment regimen: benzathine penicillin injection, 2.4 million U, intramuscularly (divided into two sides of the buttocks), once a week for 3 times.
Follow-up and review: follow-up and repeat non-syphilis spirochete antigen serologic tests every 3-6 months to observe titer changes. Total 2-3 years.
Treatment precautions
(1) It is important to also check to exclude the combination of other STDs such as condyloma acuminatum, AIDS, gonorrhea, etc.
(2) Sexual partners and spouses should be examined and treated.
(3) Follow up regularly during and after treatment as ordered by the doctor.
(4) After treatment, the titer of non-syphilis spirochete test such as RPR will gradually decrease to negative, and syphilis spirochete test can be negative or persistently positive.
(5) There is serologic relapse (such as RPR negative followed by positive, or titer rising more than 4 times), serum fixation (such as RPR long-term persistent low titer positive), cerebrospinal fluid examination should be done to clarify whether it is neurosyphilis.
(6) Different hospitals and laboratories may have differences in the titer of non-syphilis spirochete experiments due to different reagents and operations, so the results of the same regular hospital should be used as the standard to judge the efficacy and whether there is a relapse, etc.