Syphilis (Syphilis) is a chronic contact infection. The causative agent of syphilis is Treponema pallidum, a spirochete that is severely pathogenic to humans and can invade any organ and produce a variety of symptoms. Syphilis spirochetes only infect humans, so syphilis is the only source of infection. The route of infection, acquired syphilis mainly through sexual intercourse, a few can be transmitted through kissing, but also occasionally through the placenta to the fetus and cause disease. Syphilis patients who do not get treatment are the most infectious within one year after infection, and the longer the disease period, the less infectious. After four years of infection, the infection is generally no longer contagious through sexual contact, but can still be transmitted fetus.
It is generally believed that syphilis originated in the Americas. Columbus’s sailors in North America in 1493 contracted syphilis and brought it back to Spain, and it soon became prevalent in Europe. Later, it spread to Asia and other parts of the world during interactions. According to the World Health Organization, the world syphilis prevalence rate declined significantly in the late 1940s, rose again in the 1960s, declined slightly in the 1970s, but has increased again in the last decade. It is estimated that there are 3 million new cases worldwide each year, and the United States is even more pronounced, with an annual increase of 10-15% in incidence. Syphilis was first discovered and documented in Guangdong in 1505, when it was called syphilis, and spread throughout the country from the south to the north, with a high incidence before 1949, when it was the top five STDs. At that time, the incidence rate of some ethnic minorities was as high as 48%. Individual tribes almost suffered from the extinction of their clans. After the founding of New China, a series of active prevention and control measures were taken, and syphilis was basically eliminated in 1959. In recent years, syphilis has resurfaced, and many syphilis patients have been found in various places. In Guangzhou, there were 50 cases from 1984 to 1988, and before 1993, there were no more than 40 cases of syphilis reported each year; in 1993, there were more than 40 cases; in 1994, there were 159 cases; in 1995, there were 461 cases; in the first half of 1996, there were 352 cases, which was 76.36% of the total number of cases in 1995. According to the report of STD control center, 1870 cases of syphilis were reported nationwide in 1991, 1997 cases in 1992, 2016 cases in 1993, 4591 cases in 1994, 11336 cases in 1995, and the incidence rate of syphilis was 0.81/100,000 in 1993, increased to l.72/100,000 in 1994, and increased to 3.91/100,000 in 1995. The average increase in the last three years was 137.13%. The number of syphilis cases reported in Fujian Province has exceeded that of Xinjiang, which has been in first place for many years. Syphilis is the most serious venereal disease that harms individuals, families and society, so it should be fully understood and actively prevented, do not take it lightly.
I. Acquired syphilis
Early syphilis and late syphilis. Early syphilis is within two years after the infection, including stage I syphilis and stage II syphilis, and late syphilis is more than two years after the infection, that is, three syphilis.
1.Phase I syphilis
It occurs 3 weeks after infection (between 10-30 days). The main damage is the hard chancre, which is the place where the syphilis spirochete first invades and multiplies. The typical chancre is a painless red nodule that is as hard as cartilage when touched, with a clean base and a vesicular surface covered with a little exudate or a thin crust, with neat edges. The number of lesions is mostly single, but can be multiple. The lesions tend to occur on the external genitalia. In men, the lesions occur on the foreskin, coronal sulcus, glans or tether of the penis. In homosexual men, the lesions often occur in the anorectal area. In females, it occurs in the labia majora and also in the cervix. The chancre can occur on the lips, jaw and tongue, as well as on the eyelids, fingers and breasts. The chancre contains a large number of syphilis spirochetes and is often accompanied by swollen local lymph nodes. The chancre will disappear on its own after 2-6 weeks without treatment and will not leave a scar.
2. Second stage syphilis
In patients with untreated syphilis, stage II syphilis usually occurs 6 weeks to 6 months after infection. The syphilis spirochetes in the hard chancre of stage I syphilis are spread throughout the body through the blood circulation after reaching the lymph nodes via the lymphatic vessels. In the early stage, there may be fever, fatigue, headache, sore throat, muscle pain, joint pain, anorexia and other systemic symptoms. More than half of the patients have generalized lymph node enlargement, and occasionally liver and spleen enlargement. The blood picture may include leukocytosis, anemia and elevated sedimentation. About 70% of patients have a skin rash called syphilis rash. The syphilis rash can have many different manifestations and is generally symmetrical and widespread without itching.
(1) Mottled syphilis rash (rose rash)
This is the first syphilis rash that appears as a red, brown or pigmented rose rash, mostly starting on the trunk. Later, it develops on the extremities, palms and soles of the feet. The erythema is round and basically symmetrical on the palms of the hands and soles of the feet. This is the reason why syphilis is commonly known as “prune sores”.
(2) Papular syphilis rash
This is due to the development of the disease, some spots can thicken into papules. It occurs on the trunk, buttocks, calves, palms, soles and face. It can manifest as maculopapular, papular, papulosquamous, annular, psoriasis-like damage.
(3) flat warts
This is a papule that occurs in the external genital area, around the anus and other skin folds and moist areas. The damage is smooth, thick, flat, flat, and covered with a gray film containing a large number of syphilis spirochetes. The flat warts are more contagious than other second stage syphilis rashes.
(4) Mucosal spots
About 30% of patients have oral mucosal damage, the surface of the damage is covered with gray film, containing a large number of syphilis spirochetes.
The course of second-stage syphilis can occur in the form of flaky or diffuse hair loss. The hair loss is usually self-healing. Stage II syphilis sometimes threatens organs such as the nervous system, bones, or eyes.
The signs and symptoms of stage II syphilis are: it usually lasts for a few weeks and then subsides on its own, and if it is not treated, it can often recur within l – 2 years.
3.Stage III syphilis
Appears more than two years after infection. The main types are as follows.
(1) Late stage benign syphilis: the basic damage is dendritic swelling, which may be caused by an inflammatory response to syphilis spirochete antigen, and its pathogenesis is still not well understood. Microscopically, the active damage is a granulomatous lesion and the old damage is extensive fibrosis. Syphilis spirochetes are generally not found within the dendritic swelling. This inflammatory disease can invade any organ, but most commonly invades the skin and bone. Skin lesions manifest as dermal or subcutaneous nodules, ulcerative nodules and dendritic swellings. The nodules often occur on the face, trunk, and extremities, are asymmetrically distributed in clusters, are painless, and progress slowly with gradual ulceration. The ulcers generally heal slowly from the center, leaving a scar. Cutaneous dendritic swellings are single hard nodules that gradually increase in size to form infiltrative masses and collapse to form ulcers, with some areas of the disease healing spontaneously leaving scar formation. If the oral mucosa and nasal mucosa are involved, it can lead to perforation of the nasal septum and soft and hard palate, and the skeletal damage mainly includes osteochondritis, bone dendritic swelling, etc.
(2) Cardiovascular syphilis: aortitis, aortic valve atresia, aortic aneurysm, etc. may occur.
(3) neurosyphilis: spinal consumption, paralytic dementia, optic nerve atrophy, etc.
(2) Congenital syphilis
Congenital syphilis is transmitted from the mother to the fetus through the placenta, often causing premature birth and stillbirth.
(1) Early congenital syphilis
The symptoms occur within two years of age. The main manifestations include rhinitis, in addition to pharyngitis, wasting, insomnia, enlarged lymph nodes and liver and spleen, osteochondritis, and pseudo-paralysis. Skin and mucous membrane damage may include papulosquamous or scarring rash, flat warts, mucosal plaques, etc.
(2) Late congenital syphilis
Symptoms occur in those who are more than two years old. The manifestations include substantial keratitis, saddle nose, saber tibia, syphilitic teeth (Hutchinson), and neurogenic deafness. Others are generally similar to stage III acquired syphilis.
(3) Latent syphilis (occult syphilis)
In untreated stage II syphilis, the signs and symptoms often subside naturally and enter the asymptomatic phase, called the latent phase. If not treated, patients can relapse, usually within two years. Patients within two years are called early latent syphilis. Patients who have had syphilis for more than two years are called late latent syphilis. Late-stage latent syphilis rarely recurs, but can still be transmitted fetus to pregnant women. Latent syphilis is asymptomatic except for positive seropositivity.