Stage II Syphilis
Syphilis is characterized by a stage II syphilis rash with systemic symptoms, usually occurring after a period of asymptomatic disease after the hard chancre has subsided, and the TP spreads with the bloodstream, causing multi-site damage and multiple lesions. It invades the skin, mucous membranes, bones, internal organs, cardiovascular and nervous systems. When syphilis enters stage II, the syphilis serology test is almost 100% positive. Systemic symptoms occur before the appearance of the rash, fever, headache, bone and joint pain, hepatosplenomegaly, and lymph node enlargement. The incidence is about 25% in males and 50% in females. 3 to 5 days to improve. The syphilis rash then appears and is characterized by recurrent occurrence.
(1) Cutaneous syphilis rash occurs in 80% to 95% of patients. It is characterized by a variety of rash patterns and recurrence, widespread and symmetrical, painless and non-itchy, mostly without scarring after healing, and fading rapidly with anthelmintic treatment. The main rash types are maculopapular, papular, pustular syphilis rash and flat warts, palmoplantar syphilis rash, etc.
② Recurrent syphilis rash After the initial syphilis rash subsides on its own, about 20% of patients with second-stage syphilis recur within a year, with cyclopoid papules being the most common.
Mucosal damage About 50% of patients develop mucosal damage. They occur in the lips, mouth, tonsils and throat, and are mucosal plaques or mucositis with exudates, or grayish white membranes and mucosal redness.
④ Syphilitic alopecia Approximately 10% of patients. It is mostly sparse with unclear borders, like worm-like; a few are diffuse.
⑤ Bone and joint damage Periostitis, osteitis, osteomyelitis and arthritis. With pain.
(vi) Stage II ocular syphilis Syphilitic iritis, iridocyclitis, chorioretinitis, retinitis, etc. Often bilateral.
(7) Stage II neurosyphilis Mostly no obvious symptoms, abnormal cerebrospinal fluid, positive cerebrospinal fluid RPR. May have meningitis or meningeal vascular symptoms.
(8) Generalized superficial lymph node enlargement
(3) Stage III syphilis 1/3 of untreated overt TP infections occur in stage III syphilis. Among them, 15% are benign late syphilis and 15%-20% are severe late syphilis.
The nodular syphilis rash occurs on the scalp, scapula, back, and extensor surfaces of the extremities. Dendritic swelling often occurs in the calf, as deep ulcer formation, atrophy-like scar; when it occurs in the upper forehead, tissue necrosis, perforation; in the nasal diaphragm, then bone destruction, the formation of saddle nose; tongue for the penetrating ulcer; vaginal damage for the appearance of ulcers, can form a vesicovaginal leak or rectovaginal leak, etc..
②Proximal joint nodules are slowly growing subcutaneous fibrous nodules of syphilitic fibromas, symmetrical, variable in size, hard, inactive, non-ruptured, normal epidermis, non-inflammatory, painless, and self-resolving.
Cardiovascular syphilis mainly invades the aortic arch and can lead to aortic valve atresia and syphilitic heart disease.
The incidence of neurosyphilis is about 10%, which can occur in the early stage of infection or several years or ten years later. Syphilitic meningitis, cerebrovascular syphilis, meningeal dendritic swelling, and paralytic dementia can occur without symptoms. Meningeal dendritic swelling is a lesion involving the subcortex of one cerebral hemisphere, which results in increased intracranial pressure, headache, and localized pressure symptoms in the brain. Parenchymal syphilis is a substantial lesion of the brain or spinal cord, the former forming paralytic dementia, the latter showing degenerative changes in the posterior roots and cords of the spinal cord, with a variety of symptoms such as sensory abnormalities and ataxia, i.e., spinal consumption.
Treatment
1.Treatment principles
Emphasize early diagnosis, early treatment, regular course of treatment and adequate dose. Regular clinical and laboratory follow-up after treatment. Sexual partners should be investigated and treated together. Early syphilis can be clinically cured by thorough treatment, eliminating infectiousness. Late syphilis treatment can eliminate inflammation in the tissues, but the damaged tissues are difficult to repair.
Penicillin, such as aqueous penicillin, procaine penicillin, benzathine penicillin, etc. are the drugs of choice for different stages of syphilis. Tetracycline and erythromycin can be chosen for those who are allergic to penicillin. Some patients may have a reaction to penicillin at the beginning of penicillin treatment, which can be prevented by starting with small doses or using other drugs. The serum should be rechecked every 3 months for the first year after syphilis treatment, and every 6 months for 3 years afterwards. Neurosyphilis and cardiovascular syphilis should be followed up for life.
2.Early syphilis (including Phase I, Phase II syphilis and early latent syphilis)
(1)Penicillin therapy
Benzathine penicillin G (long-acting cillin), intramuscular injection in both sides of the buttocks, once a week, 2-3 times. Procaine penicillin G, intramuscular injection, for 10-15 consecutive days, total 8-12 million u.
(2) Allergic to penicillin Tetracycline hydrochloride, orally for 15 days. Strongylin, for 15 days.
3.Late syphilis (including three stages of skin, mucous membrane, bone syphilis, late latent syphilis) and second stage recurrent syphilis
(1) Penicillin Benzathine penicillin G, 1 time/week, intramuscular injection, 3 times in total. Procaine penicillin G, intramuscular injection for 20 days. Treatment may be repeated once after an interval of 2 weeks.
(2) Allergic to penicillin Tetracycline hydrochloride, orally for 30 days. Strongylin, for 30 days.
4.Neurosyphilis
Should be hospitalized. To avoid the reaction of Jihai in treatment, take prednisone orally one day before penicillin injection, 1 time/day for 3 days.
(1) Aqueous penicillin G IV drip for 14 days.
(2) Procaine penicillin G intramuscularly with oral propofol for 10 to 14 days.
After the above treatment, then connect with benzathine penicillin G, 1 time/week, intramuscularly for 3 weeks.