Syphilis is a sexually transmitted disease caused by Helminthosporium pallidum, which has a chronic course and can affect the skin, mucous membranes, and various tissues and organs of the body, with a variety of clinical manifestations. Among the sexually transmitted diseases, the number of syphilis patients is low, but because of its long course and great danger, it should be taken seriously.
[Pathogen]
Syphilis spirochetes are small and slender spiral microorganisms with 6-12 spirals. Syphilis spirochetes do not easily survive in a dry environment in vitro, and are easily killed by boiling, soapy water and general disinfectants such as carbolic acid and alcohol. [Transmission route]
Syphilis is mainly transmitted through sexual contact, untreated syphilis patients are more infectious within a year after infection, later, with the prolongation of the disease, the infectiousness gradually decreases, pregnant women with syphilis can infect the fetus through the placenta, generally believed to occur after the fourth month of pregnancy, syphilis can occasionally be infected through contact with the daily products used by the patient, in addition, blood transfusion can also lead to infection.
[Course and stages of syphilis]
After infection with syphilis spirochetes, after 2-4 weeks of incubation period, hard chancre occurs at the invasion site, which is the first stage of syphilis. 6-8 weeks after hard chancre occurs, as the spirochetes enter the blood circulation through the lymph and spread to all parts of the body, skin mucous membrane into the systemic symptoms, which is the second stage of syphilis, if not treated, the symptoms can disappear on their own, and the disease enters the latent state, which is called early latent syphilis or occult syphilis. But after 5-10 years or more, the lesion can be active and appear skin mucosa, cardiovascular, neurological and other multi-organ damage, known as stage III syphilis, some patients can always do not appear symptoms, only in the blood test presents syphilis seropositive, known as late-stage latent syphilis.
1, acquired syphilis (acquired syphilis) “1) early syphilis: within 2 years of the disease is more infectious, including a period, two and early latent syphilis.
2) late syphilis: disease period of more than 2 years, less infectious, including three syphilis and late latent syphilis.
2, congenital syphilis (fetal syphilis) pregnant mother with syphilis, untreated, syphilis spirochete; through the blood exercise fetal infection, often with more serious visceral damage, the mortality rate is higher.
1) Early congenital syphilis: age less than 2 years, such as early congenital syphilis and early latent syphilis.
2) Late congenital syphilis: age older than 2 years, such as late congenital syphilis and late latent syphilis.
[Clinical manifestations and diagnostic points].
Stage I syphilis (hard chancre) Stage II syphilis (showing stage II syphilis rash and flat warts) 1. Stage I syphilis (hard chancre) 1) History of unclean sexual intercourse, prostitution, spousal infection or homosexuality.
2)The incubation period is 2-4 weeks.
3) The main manifestation is hard chancre, often single, painless and itchy, clear boundary, 1-2Cm in diameter, cartilage-like hardness when touched, the surface can be erosion or shallow ulcer, and there is a large number of syphilis spirochetes in the exudate.
4) It often occurs in the external genital area, such as the coronal groove, glans, tether and foreskin in men, labia majora, labia minora and cervix in women, and in the perianal area and rectum in male homosexuals, and occasionally in the lips and pharynx.
5) Local lymph nodes are enlarged, unilaterally or bilaterally.
6) Subsclerosis can disappear naturally without treatment within 3-8 weeks, leaving no trace or only a mild atrophic scar.
7) Smear of secretion for dark field microscopic examination, most active spirochetes are visible. Syphilis blood semen test: early negative for hard chancre, positive result in most patients after 7-8 weeks.
2) Stage II syphilis 1) Mostly develops 8-10 weeks after the initial infection or 6-8 weeks after the appearance of hard chancre.
2) The main manifestations are skin and mucous membrane damage, bone and joint damage such as periostitis and arthralgia, eye damage such as iritis and optic neuritis, and occasionally nerve damage such as meningitis.
3) The rash has various forms, such as macular rash, maculopapular rash, papular rash, pustular rash, scaly lesions, etc. It is often generalized and symmetrically distributed. The brownish-copper desquamative maculopapular rash on the palmoplantar area is characteristic.
4) Mucosal damage can be seen in the oral cavity, pharynx, larynx, genital mucosa, as redness and erosion, in the perianal area, around the external genitalia can occur flat warts, mucosal damage with a large number of syphilis spirochetes.
5)Worm-like alopecia is seen on the scalp and is common in the temporal part of the hair.
6) Superficial lymph node enlargement all over the body.
7) The smear of mucosal damage and flat warts is examined by dark field microscopy and most of the active spirochetes are seen.
Phase II recurrent syphilis: Phase II syphilis untreated or incompletely treated Si, when the patient’s resistance decreases, Phase II damage reappears after fading, known as Phase II recurrent syphilis, if not treated, can be repeated many times, this rash is basically the same as Phase II syphilis rash, but its number is reduced, the distribution is limited.
3, three syphilis (late syphilis) 1) unclean sexual life or spousal infection history, early syphilis history may or may not.
2) skin mucosal syphilis nodular syphilis rash: common in the forehead, extremities and scapulae, etc., for most subcutaneous small nodular cut, arranged in a circular pattern, can naturally fade, leaving atrophic spots.
Dendritic swelling: initially small subcutaneous nodules, gradually increasing in size and adhering to the skin, forming an infiltrative plaque, the center of which breaks down to form an ulcer, usually on the head, face and lower legs. When invading the palate and nasal septum mucosa, it can cause nasal septum perforation and saddle nose.
3) Cardiovascular syphilis: It occurs more than 10-20 years after infection and can cause syphilitic aortitis, aortic valve atresia, aortic aneurysm, etc.
4) Neurosyphilis: occurs 5-15 years after infection and can cause syphilitic meningitis, spinal cord consumption and paralytic dementia, etc. There can also be abnormal changes in the cerebrospinal fluid without neurological symptoms.
5) Other organs: such as bones, eyes, respiratory, digestive and urinary systems can be invaded.
6) Most of the syphilis serologic tests are positive, but a few can be negative. Cerebrospinal fluid leukocytosis, abnormal biochemical examination, positive syphilis antibody test.
4, latent syphilis has a history of infection, untreated or inadequate treatment, no clinical symptoms and signs, but positive syphilis seropositivity, except for other diseases that can cause positive syphilis seropositivity, cerebrospinal fluid examination negative, can be diagnosed as latent syphilis, the disease period of less than 2 years is called early latent syphilis, more than 2 years is called late latent syphilis.
5, early congenital syphilis 1) the birth mother has syphilis.
2) Clinical symptoms appear mostly in the first 3 weeks after birth.
3) Early manifestation of rhinitis, pharyngitis symptoms, due to nasal congestion can cause difficulties in breastfeeding.
4) Skin manifestations are diverse, such as maculopapular scaly damage, blistering and maculopapular and maculopapular damage, flat warts-like damage, corners of the mouth, perianal may occur linear chaparral damage, dry and wrinkled skin like the elderly, may be accompanied by hair loss, nail fungus, nail bed inflammation. There are mucosal spots in the oral cavity.
5) The child is thin and small, superficial lymphatic lines are enlarged, liver and spleen are also enlarged, often with osteochondritis and osteochondritis.
6)The secretions of skin and mucous membrane damage, nasal secretions, and cord blood smear for dark field microscopy can see spirochetes, and positive syphilis serologic test.
6. Late congenital syphilis occurs mostly in children and adolescence, and children with syphilitic teeth (semilunar incisors), substantial keratitis and triad of neurogenic deafness are characteristic. Skin and mucous membrane damage is similar to that of acquired tertiary syphilis, and active damage such as osteochondritis and hepatosplenomegaly may also occur.
7, congenital latent syphilis congenital syphilis without treatment, no clinical symptoms, syphilis seropositive called congenital latent syphilis.
[Syphilis serologic test]
1, non-syphilis spirochete antigen serologic test: heart phospholipid as antigen, check the anti-cardiolipin antibodies in the serum, that is, reactive element, belonging to this category of tests VDRL test, UST test and RPR test, these tests are simple, easy to promote, is a routine test commonly used in clinical practice, can also be used in large-scale census, in addition, these tests can be quantitative determination, can be used to observe the efficacy, determine However, it should be noted that because the antigens used in the test are non-specific, false-positive results can easily occur, and false-positive results can occur in some infectious diseases such as viral hepatitis, measles, upper respiratory tract infections, active tuberculosis, and autoimmune diseases, but the titer of the serum reaction is low and the duration is generally short.
2, syphilis spirochete-specific antigen serologic test: live or dead syphilis spirochetes or their components to measure anti-spirochete antibodies, belonging to this category of tests are fluorescent spirochete uptake test; syphilis spirochete hemagglutination test: the specificity of these tests is strong, can be used as a confirmatory test, but can not be used to observe the effectiveness of treatment, to determine the recurrence and reinfection.
[Treatment]
Principle: Once diagnosed, early, adequate and regular drug treatment should be given, with regular follow-up after treatment.
There should be no sexual intercourse during treatment. Sexual partners should be treated at the same time.
Treatment options.
1) Early syphilis (Phase I, Phase II, early latent syphilis) 1) Cytotoxic procaine penicillin G: 800,000 units, once daily intramuscular injection, for 10-15 days, a total of 8-12 million units benzathine penicillin G (long-acting cillin): 2.4 million units, divided into two measurements hip intramuscular injection, once a week, a total of 2-3 times.
2) Erythromycin for those allergic to penicillin: 500mg/day, for 30 days.
Strongylin: 100mg twice daily orally for 30 days.
2. Late syphilis (including stage III syphilis, stage II recurrent syphilis and late latent syphilis) 1) Penicillin procaine penicillin G: 800,000 units, once daily intramuscular injection for 15 days, total 12 million units. Give a second course at 2-week intervals, total 24 million units. Benzathine penicillin G: 2.4 million units, weekly – intramuscular injection for a total of 3 times.
2) Tetracycline for penicillin allergy: 500mg 4 times daily, orally for 30 consecutive days Erythromycin: the dose and course of treatment is the same as tetracycline.
3, cardiovascular syphilis see the treatment of late syphilis, if necessary, the number of courses can be increased, but do not apply benzylpenicillin G.
Individual patients in the treatment may occur Jihai reaction is due to the application of penicillin after the death of a large number of syphilis spirochetes, the release of heterogeneous protein, generally occurs in the first injection of penicillin 3-12 hours after the manifestation of flu-like symptoms and temporary aggravation of the original syphilis damage, this phenomenon occurs, can be oral aspirin O, 6 grams, 4 times a day, generally 1-2 days disappeared. For neurosyphilis and cardiovascular syphilis, oral prednisone 5mg can be given 4 times a day for 3 days before the injection, which can play a preventive role.
[Prevention and precautions]
1, abide by the moral code, strictly prohibit promiscuity, avoid impure sexual behavior.
2, early syphilis is prohibited before the cure of sexual life, female syphilis Si should avoid pregnancy before complete cure.
3, within 3 months where contact with infectious syphilis sexual couples should be examined, if necessary, according to the early syphilis for treatment.
4.Suspicious symptoms of syphilis should go to the regular hospital’s STD specialist for early diagnosis and treatment, once the diagnosis is clear, need to fully cooperate with the doctor, thorough treatment.
5, early syphilis treatment, should be regular follow-up 2-3 years, the first year every 3 months, the second year every 6 months, the third year at the end of each examination, such as all normal can stop observation.