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Abstract: The patient, a 23-year-old girl, reported that she was found to be positive for syphilis during a blood test 1 day ago, but she did not have any symptoms of discomfort in the usual way. After detailed questioning, it was learned that the patient had high-risk sexual behavior, and a blood test was performed to clarify the diagnosis of syphilis. Therefore, the patient was treated with intramuscular injection of benzathine penicillin according to the syphilis treatment guideline, and was eventually cured, and no significant recurrence was seen during the 2 years of follow-up.
Basic information】Female, 23 years old
Disease Type】Syphilis
Hospital】Eastern War Zone General Hospital
Date of consultation】August 2018
Treatment plan] Intramuscular injection (benzathine penicillin for injection)
Treatment period】3 weeks
Treatment effect】Stable condition
I. Initial consultation
A young female patient came to the clinic with an anxious face and reported that 1 day ago, during a physical examination, her blood was drawn and found to be positive for syphilis, but she usually did not have any uncomfortable symptoms, so she came to the clinic in order to confirm the diagnosis and carry out treatment. After further communication with the patient, it was learned that the patient had a history of high-risk sexual contact within 2 months, and that an ulcer appeared in the vulva area 1 month ago, but was not taken seriously and the ulcer healed after a period of time. Based on the patient’s medical history, the patient was initially diagnosed with syphilis, and relevant tests were given to clarify the diagnosis, which showed positive antibodies to syphilis spirochetes and clarified the diagnosis of syphilis.
II. Treatment process
After the diagnosis was confirmed, the patient was given a detailed specialist examination, and it was found that there were more scattered light red macules all over the patient’s body, which did not fuse with each other, but were not painful or itchy, so the patient did not have any uncomfortable symptoms. At the same time, in combination with the patient’s symptoms of the previous month, i.e. the appearance of ulcers in the vulva area, and the positive blood sample for syphilis spirochete antibodies with a titer of 1:2, the patient was diagnosed with stage II syphilis. Therefore, according to the syphilis treatment guidelines, the patient was given benzathine penicillin for injection, and at the same time, the patient was given penicillin skin test, and after excluding the patient’s penicillin allergy, the application of benzathine penicillin for injection intramuscularly was chosen for 6 months of continuous treatment.
III. Treatment effect
Since the treatment of syphilis has clear treatment guidelines, and the patient actively cooperated with the treatment, the patient’s condition was more stable. After 3 months of treatment with long-acting penicillin, i.e. benzathine penicillin for injection, the result of toluidine red unheated serum test was still positive, but compared with the previous one, it was reduced to 1:8. After the 6th month of treatment, the result of toluidine red unheated serum test was reviewed and the patient’s result had turned negative, indicating that the previous treatment plan was correct and the patient’s treatment effect was good, but since the disease is easy to recur, the patient was advised to However, since the disease is prone to recurrence, the patient was advised to have regular follow-ups within 2 years to prevent recurrence. Up to now, the patient has been followed up for 2 years without any recurrence and has reached the point of cure.
IV. Notes
We are glad that the patient has been cured after active treatment. However, since the disease is often prone to recurrence, the patient still needs to pay attention to the following points in daily life.
1, because the transmission route of syphilis is sexually transmitted, so the patient’s sexual partners also need to be examined in a timely manner, and if syphilis is diagnosed, it needs to be treated in a timely manner. After a clear diagnosis, treatment plans should be developed as soon as possible, penicillin is the drug of choice, penicillin allergy can be used doxycycline, erythromycin, azithromycin.
2, patients in the process of treatment of syphilis, need to pay attention to observe whether there is chills, fever, headache, dizziness, rapid breathing and tachycardia and other reactions, if there is a need to promptly consult a doctor. At the same time, regular follow-up is needed after the cure, with a review every 3 months in the first year and every 6 months in the second year. If the results are negative for 2-3 consecutive years, the follow-up can be terminated.
3, in daily life, pay attention to separate from other people’s clothes alone, avoid contact with daily public items at the skin lesion site, and go to the hospital for treatment as early as possible. During the treatment period, avoid drinking alcohol, eating seafood, beef, and spicy and stimulating foods such as chili, and also strictly prohibit intercourse during the treatment period.
V. Personal insight
Syphilis is more common in clinical practice and requires prompt medical attention. In this case, the patient was in the early stage of syphilis at the time of consultation and did not have other co-infections, and the result was good after regular treatment. The treatment of syphilis is generally not complicated, the drugs used are also more common, through active treatment, generally can achieve better results.
High-risk sexual contact is generally an important factor in developing syphilis, and people who have had a history of unclean sex and typical suspicious symptoms, such as ulcers on the vulva, need to go to the hospital in time for blood tests. Therefore, if you want to prevent the occurrence of syphilis, you should be clean in daily life, avoid high-risk sexual behavior, and promote the use of condoms to block the spread of the disease.