Syphilis treatment is now mainly based on Western medicine, since penicillin is used to treat syphilis with miraculous results, Chinese medicine is basically not used as the main medical means, but only to play an auxiliary role, then the following is a brief introduction to the different stages of syphilis treatment with Western medicine.
A, early syphilis (including a, two syphilis and early latent syphilis)
1, penicillin therapy
(1) Benzathine penicillin G (long-acting cillin) 2.4 million u, divided into two sides of the buttock muscle injection, once a week, a total of 3 to 6 times.
(2) Procaine penicillin G 800,000u/day, intramuscular injection, for 10-15 days, total 8-12 million u.
2.Allergic to penicillin
(1) Tetracycline hydrochloride 500mg, 4 times/day, orally, for 15 days.
(2) Doxycycline 100mg, 2 times/day for 15 days.
Second, stage III syphilis (including stage III skin, mucous membrane, bone syphilis, late latent syphilis) and stage II recurrent syphilis.
1.Penicillin
(1) Benzathine penicillin G 2.4 million u, 1 time/week, intramuscular injection, 3 times in total.
(2) Procaine penicillin G 800,000u/day, intramuscular injection, for 20 days.
2.Allergic to penicillin
(1) Tetracycline hydrochloride 500mg, 4 times/day, orally for 30 days.
(2) Doxycycline 100mg, 2 times/day for 30 days.
Syphilitic cardiovascular disease
Should be hospitalized, if there is heart failure, firstly treat heart failure, when the heart function is compensated, inject penicillin from small dose, such as aqueous penicillin G, 100,000u on the first day, 1 time/day, intramuscular injection. On the second day, 100,000 u, 2 times/day, intramuscular injection, and on the third day, 200,000 u, 2 times/day, intramuscular injection. From the 4th day onwards, treat as follows (to avoid Jihai’s reaction, oral prednisone 20mg/dose, 1 time/day, for 3 days before penicillin injection).
1.Procaine penicillin G 80u/day, intramuscular injection, 15 consecutive days as a course of treatment, two courses of treatment, 2 weeks off between courses.
2.Tetracycline 500mg, 4 times/day for 30 days.
IV. Neurosyphilis
Should be hospitalized, in order to avoid Jihai’s reaction in treatment, take prednisone orally one day before penicillin injection, 20mg each time, 1 time/day for 3 days.
1.Aqueous penicillin G, 12 million u per day, intravenous drip (2 million u every 4 hours) for 14 days.
2.Procaine penicillin G, 1.2 million u per day, intramuscular injection, together with oral propoxur 0.5g each time, 4 times/day, for 10-14 days. If necessary, use benzathine penicillin G, 2.4 million u, 1 time/week, intramuscular injection for 3 weeks.
V. Syphilis combined with pregnancy
1. Procaine penicillin G, 800,000 u/day, intramuscular injection for 10 days. Inject one course of treatment in the first 3 months of pregnancy and one course of treatment in the last 3 months of pregnancy.
2. For those who are allergic to penicillin, treat with erythromycin, 500mg each time, 4 times/day, for 15 days in a row for early remorse and 30 days in a row for second stage relapse and late syphilis. One course of treatment is given in the first 3 months of pregnancy and one in the last 3 months of pregnancy (tetracycline is prohibited). However, the infant born should be treated with penicillin.
Congenital syphilis
1. Early congenital syphilis (within 2 years of age) with abnormal cerebrospinal fluid.
(1) Aqueous penicillin G, 50,000 u/kg body weight, intravenous drip in 2 times daily for 10-14 days.
(2) Procaine penicillin G, 50,000 u/kg body weight daily, intramuscularly for 10-14 days.
For normal cerebrospinal fluid.
Benzathine penicillin G, 50,000 u/kg body weight, one injection (divided into both gluteal muscles). If there is no condition to check the cerebrospinal fluid, it can be treated according to the abnormal cerebrospinal fluid.
2.Late congenital syphilis (above 2 years old)
Procaine penicillin G, 50,000 u/kg body weight per day, intramuscular injection, 10 consecutive days as a course of treatment (no more than the adult dose).
Tetracycline is contraindicated in children under 8 years of age.
Congenital syphilis allergic to penicillin can be treated with erythromycin, 7.5-12.5 mg/kg body weight daily, divided into 4 doses for 30 days.
Syphilis treatment should be noted that the diagnosis of syphilis must be clear, the earlier the treatment the better the effect, the dose must be sufficient, the course of treatment must be regular, and the treatment should be followed up and observed. The source of infection and the sexual couple or sexual contacts should be examined and treated with syphilis treatment at the same time.
Syphilis treatment matters for pregnant women
1, married women with a history of syphilis must undergo a comprehensive syphilis examination before pregnancy
Women who have had an unclean sex life or have been infected with syphilis should go to a regular hospital for a comprehensive syphilis test before they plan to get pregnant, and for those married women whose syphilis treatment is complete and whose syphilis symptoms are not obvious, they should also be sure that their syphilis is completely cured before they can get pregnant.
The syphilis test should include a syphilis serum screening test (such as the VSR or RPR test), a syphilis test, and the FTAABS or TPHA test, any positive result of which will require the use of medications such as gonorrhea to continue the syphilis treatment.
If a pregnant woman with syphilis still has a negative test result in the third month of pregnancy, she needs to be treated again; if the serological test is positive in the last three months of pregnancy, she needs to be treated completely for syphilis.
2.Treatment of syphilis infection during pregnancy in healthy pregnant women
If a healthy pregnant woman is infected with syphilis during pregnancy, the serological test result may be negative at that time, and she must be given timely treatment of syphilis in the last three months of pregnancy.
Treatment
Nowadays, syphilis serology tests are usually used to determine the efficacy of syphilis, and RPR (Rapid Plasma Reactive Hormone Ring Card Test) and TPHA (Syphilis Spirochete Haemagglutination Test) are more commonly used in major hospitals.
TPHA is a non-specific syphilis serological test, commonly used for early diagnosis of syphilis, but is not sensitive to latent syphilis, neurosyphilis. TPHA detects specific syphilis spirochete antibodies in the serum, has a high sensitivity and specificity. Once the test is positive, it usually remains positive for life, regardless of treatment or disease activity, and its titer changes are not related to syphilis activity, so it cannot be used as an indicator to evaluate the efficacy of treatment or to determine recurrence or reinfection, but only as a confirmation test for syphilis.
For those who are diagnosed with syphilis, it is best to do a quantitative test before treatment. A decrease in titer can only be determined when the difference between the two quantitative tests is more than 2 dilutions. After regular treatment, syphilis patients should have their RPR titers rechecked once a month for the first three months, and then every three months for the next year, and every three months or every six months for the second year, in order to observe and compare the changes in RPR titers between the current and the previous ones. Therefore, the follow-up observation of syphilis patients after treatment is usually over a period of two years. If the titer of RPR of each test shows a decreasing trend, it means that the anti-syphilis treatment is effective. If the results of three to four consecutive tests are negative, the patient is considered to be cured of syphilis.
There are generally three possible changes in the serologic response of a patient with syphilis after anti-syphilis treatment.
(1) seronegativity.
(2) Decrease in serum titer without a negative change, or serum resistance.
(3) Serologic response indicating relapse.
The rate of seronegativity may vary between stages of syphilis treated with different drugs. Early syphilis treated with any anti-syphilis drug has a high seroconversion rate, usually up to 70%-95% within 1 year, with some reports up to 100%. When seropositivity is maintained 6 months after regular anti-syphilis treatment for early syphilis or 12 months after regular anti-syphilis treatment for late syphilis, it is clinically referred to as seroresistance or serofixation, which may be related to the presence of potentially active lesions in the body, persistent immunity of the patient, insufficient dose of anti-syphilis treatment or drug resistance. Substantial neurosyphilis of stage III syphilis (e.g., spinal consumption, paralytic dementia) still occurs in 50%-80% of patients with serum resistance even after long-term regular anti-syphilis treatment. Early diagnosis, early treatment, and a full course of therapy are the best means of avoiding the development of serum resistance.
If a patient with syphilis receives an insufficient amount of anti-syphilis treatment, the seropositivity can turn positive again soon after a temporary negative change, or the titer can increase fourfold (e.g., from 1:2 to 1:8), which is called “seropositivity relapse”, thus it can be seen that there is a close relationship between regular and adequate anti-syphilis treatment and seropositivity relapse.
In summary, the treatment of syphilis should be regular and adequate at an early stage, and the efficacy of anti-syphilis treatment can be observed by comparing the RPR titers before and after.
Syphilis Chinese medicine treatment.
1, a syphilis of liver damp heat evidence
The main evidence is that it is mostly seen in the first stage of syphilis, the external genital chancre sores are hard and moist, or accompanied by cross-craft, the plum sores are mostly in the lower limbs, abdomen and pubic area, and the mouth is bitter and dry, the urine is yellow and red, the stool is constipated, the tongue is red, the coating is yellow and greasy, the pulse is stringent and smooth.
The treatment is based on clearing heat and dampness, detoxifying and expelling plum.
The formula]: gentian diarrhea liver soup plus reduction: gentian herb, gardenia, scutellaria, Chai Hu, raw earth, zedoary, angelica, carthamus tinctorius, mouton, jinyinhua, Tu Fu Ling, tiger scepter, licorice, etc.
2, the second stage of syphilis of blood heat contains poison evidence
Main Evidence】More often seen in the second stage of syphilis, the perimeter of the plum sores, such as rose, not painful, or see papules, pustules, scales, and dry mouth and throat, mouth and tongue sores, constipation, red and vivid tongue, thin yellow moss or less moss, smooth pulse or fine count.
Treatment】Treatment is based on cooling the blood and detoxifying the toxin, removing heat and dispersing blood stasis.
The formula is based on Qing Ying Tang with Peach and Red Four Things Tang with addition and subtraction: water hyacinth powder, Sheng Di, Xuan Shen, Bamboo Leaf Heart, Jin Yin Hua, Lian Lian, Huang Lian, Dan Shen, Mai Dong, Tao Ren, Red Flower, Paeonia, Chuan Xiong, Licorice, etc.
3.Spinal cord consumption of stage III syphilis with liver and kidney deficiency
The main evidence] is seen in the third stage syphilis spinal cord consumption, the disease can reach several decades, gradually two feet paralysis or impotence can not, skin numbness or insect itching, tendons and bones pain, waist and knee soreness, urinary difficulties, light tongue, thin white moss, sunken and weak pulse.
The treatment is based on nourishing the liver and kidney, filling the marrow and quenching the wind.
The formula is to use Dihuang Drinking Zi plus reduction: Dihuang, Bacopa monniera, Cornu Cervi Pantotrichum, Cistanches, Radix et Rhizoma, Poria, Yuan Zhi, Calamus, Mai Dong, Wu Wei Zi, Dendrobium, Peppermint, Ginger, Dates, etc.
4, plum knot poisoning of poison knot tendons and bones evidence
[Main Evidence] It is seen in Yangmei nodule poisoning, the disease for a long time, in the limbs, head and face, nasopharynx appear gum swelling, accompanied by joint, bone and tendon pain, walking inconvenience, muscle wasting, pain at night, the tongue is dark, coating thin white or gray or yellow, pulse sinking fine astringent.
Treatment】Treatment is based on activating the blood to detoxify the blood, promoting the circulation and relieving pain.
The formula is based on five tigers with addition and subtraction: five lingzhi, wood turtle seed, piercing nail, dahurian dahurica, rhubarb, scorpion, silkworm, centipede, and spotted cucumber.
5, cardiovascular syphilis of heart and kidney deficiency evidence
Main Evidence】See patients with cardiovascular syphilis, with panic and shortness of breath, fatigue, swelling of the lower limbs, blue and purple lips and nails, soreness and weakness of the waist and knees, shortness of breath when moving, pale tongue with teeth marks, thin white and moist coating, sunken and weak pulse or knotted generation.
Treatment】Treatment is based on nourishing the heart and tonifying the kidneys, dispelling blood stasis and promoting Yang.
The treatment is based on nourishing the heart, tonifying the kidney, eliminating blood stasis and promoting Yang.