As everyone's lives continue to open up, many people have become more open to sex. As a result, syphilis, a sexually transmitted disease, has gradually become a major killer of male health. Syphilis is a chronic infectious disease. "It is caused by Treponema pallidum, which has a long course of disease after becoming ill, with early invasion of the genitals and skin, and late invasion of various organs of the body, with a variety of symptoms and signs. It can be transmitted to each other through sexual behavior, and can be transmitted from mother to fetus, endangering the next generation.". Very few patients are infected by kissing, breastfeeding, or receiving daily necessities that may cause infectious damage to the patient. It is listed as a Class B disease under the "Law of the People's Republic of China on the Prevention and Control of Infectious Diseases".
Main transmission routes of syphilis
(1) Sexual transmission
This is the main route of transmission, accounting for 95%. Due to the large amount of Treponema pallidum on the surface of the skin and mucous membrane, it can be transmitted through minimal damage through sexual contact.
(2) Fetal transmission
Pregnant women with syphilis can transmit syphilis to their fetus through the placenta, usually after 4-6 months of pregnancy. The shorter the course of syphilis in pregnant women, the greater the chance of infection to the fetus, while the longer the course of syphilis, the less infectious it is to the fetus.
(3) Blood transfusion
"If a blood donor has Treponema pallidum in their blood, once injected into the recipient's body, it can lead to infection. Such patients do not develop the symptoms of primary syphilis, but directly develop secondary syphilis.".
(4) Indirect contact infection
Treponema pallidum is abundant in the skin, mucous membranes, and secretions of syphilis patients, especially early syphilis patients. The clothing of these patients is often contaminated as a source of infection.
(5) Iatrogenic infection
During the process of examining, diagnosing, or treating syphilis patients in a hospital, medical devices, beds, and sheets contaminated with syphilis spirochetes can be transmitted to other patients without being disinfected or sterilized. There are also cases where certain professions such as midwives, medical personnel, and laboratory personnel do not take appropriate protective measures when inspecting, treating, or treating specimens of syphilis patients, and inadvertently transmit them to medical personnel themselves.
(6) Birth canal infection
"Hard chancre often occurs at abrasions on the head or shoulder in newborns. It is caused by damage to the fetus as it passes through the birth canal, and is different from fetal syphilis.".
Clinical manifestations of syphilis
Incubation period
The incubation period for syphilis is approximately 9 to 90 days. When a patient is infected with syphilis, the clinical serum reaction at this time is positive, and the symptoms temporarily subside.
Phase I syphilis
It occurred 3 weeks after infection. A hard, painless round nodule appears at the site of the infection. "Beginning to flush and become moist, gradually ulcerating and erosive, forming ulcers, known as stage 1 syphilitic chancre, is the initial invasion and reproduction of Treponema pallidum, often occurring in the external genitalia.". Men are more likely to develop on the foreskin, coronal sulcus, glans, or frenulum of the penis. Homosexual men often occur in the anorectal region. In women, it often occurs in the inner parts of the labia and labia, and can also occur in the cervix. At the same time, bilateral inguinal lymph nodes were enlarged, but not painful. "In people infected by kissing, chancre can occur in areas such as the lips, jaw, and tongue, as well as in areas such as the eyelids, fingers, and breasts. Sometimes, before the chancre heals, it can be accompanied by other sexually transmitted diseases, such as gonococcal dermatitis.". There are many treponema pallidum in the hard chancre of primary syphilis, often accompanied by local lymph node enlargement, which is highly infectious. Hard chancre subsides without leaving scars after lasting for 2-6 weeks. However, due to the relatively concealed and asymptomatic location of female chancre, it is often overlooked and increases the chance of transmission. "If primary syphilis is not treated or not treated properly, the spirochete spreads through the bloodstream and lymph nodes throughout the body, and develops into secondary syphilis after a few weeks.".
Secondary syphilis
Patients who do not receive treatment generally develop secondary syphilis from 6 weeks to 6 months after infection. "It is caused by the spread of syphilis spirochetes in primary syphilitic chancre through the lymphatic vessels to the lymph nodes and through the blood circulation throughout the body.". Early symptoms can include 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, occasionally liver and spleen enlargement. The blood picture may include increased white blood cells, anemia, and elevated erythrocyte sedimentation rate. During the course of secondary syphilis, flaky or diffuse hair loss can occur, and generally hair loss can heal itself. Secondary syphilis can sometimes endanger organs such as the nervous system, bones, or eyes. If not treated, it can often recur within 1-2 years, at which time it is highly infectious and can naturally improve to latent syphilis. About 70% of patients present with a rash called syphilid. Syphilis rash can have various manifestations, generally distributed symmetrically and widely, without itching.
Secondary syphilis
1. "Zebra type syphilid: This is the initial appearance of a syphilid rash, which is a red, brown, or pigmented rosette rash that usually begins on the trunk.". Later, it developed to the limbs, palms, and soles of the feet. The erythema is circular and distributed symmetrically on the palm and sole of the foot. This is why syphilis is commonly known as "red bayberry sore".
2. Papillar syphilid: This is due to the progression of the disease, and some macular lesions can thicken and develop into papules. It is commonly found in the trunk, buttocks, calves, palms, soles of feet, and face. May manifest as maculopapules, papules, papules, scaly, annular, psoriasis like lesions.
3. Flat condyloma: This is a papule that occurs in the outer genital region, around the anus, and other skin folds and wet areas. The damage manifested as smooth, thick, flat, and flat, with a gray film covering the surface and a large amount of Treponema pallidum inside. Condyloma plana is more infectious than other secondary syphilitic eruptions.
4. About 30% of patients have oral mucosal lesions called mucosal plaques. The damaged surface is covered with a gray film containing a large amount of Treponema pallidum.
Stage III syphilis
Appears more than two years after infection. There are mainly the following types:
1. Advanced benign syphilis. The basic damage is gum swelling, which may be caused by an inflammatory reaction to Treponema pallidum antigen. The pathogenesis is still unclear. Microscopically, the active lesions are granulomatous lesions, while the old lesions are extensive fibrosis. Treponema pallidum is generally not found within the gummy swelling. This type of inflammation can invade any organ, but the most common is the skin and bone. Skin lesions manifest as dermal or subcutaneous nodules, ulcerative nodules, and gummy swelling. Nodules often occur in the face, trunk, and limbs, presenting a cluster distribution asymmetry, painless, slow progression, and progressive ulceration. The ulcer generally slowly heals from the center, leaving a scar. Gum swelling in the skin presents as a single induration, gradually increasing into an infiltrating mass, forming ulcers after collapse, and leaving scars in some areas during the course of the disease. If oral and nasal mucosa are involved, it can lead to perforation of the nasal septum and soft and hard palate. Bone damage mainly includes periostitis, bone gumma, and so on.
2. Cardiovascular syphilis. It can include arteritis, aortic valve insufficiency, aortic aneurysm, etc.
3. Neurosyphilis. There may be tuberculosis, paralytic dementia, and optic atrophy.
4. The degree of harm increases and the mortality rate of disability increases.
Treatment of syphilis
1、 Therapeutic drugs
(1) Penicillins are the preferred highly effective anti syphilis drugs with a serum concentration of 0.03µ "G/ml can kill Treponema pallidum, and should last for more than 2 weeks. Commonly used are benzylpenicillin, procaine penicillin, and aqueous penicillin.".
(2) Ceftriaxone sodium has been reported to treat syphilis and has achieved good short-term efficacy, but there is no definite experience in the dose, course of treatment, and long-term efficacy.
(3) Tetracyclines and erythromycin are less effective than penicillin and are commonly used as alternative therapies for people with penicillin allergy. The commonly used tetracyclines include tetracycline, doxycycline, and minocycline, which are prohibited for pregnant women and children. Erythromycin commonly used include erythromycin and azithromycin, and pregnant women should be cautious in using azithromycin.
2、 Early syphilis (including primary, secondary, and early latent syphilis)
(1) Penicillin
1. Benzathine penicillin G2400000 U, intramuscularly injected on both sides of the buttocks, once per week, a total of 2-3 times.
2. Procaine penicillin G800000 U, once a day, intramuscularly injected for 10-15 consecutive days, with a total amount of 8-12 million U.
(2) People who are allergic to penicillin
1. Tetracycline Hydrochloride Tetracycline Hydrochloride 500mg, 4 times per day, for 15 days; Or doxycycline 100mg, twice a day, for 15 days; Or minocycline 100mg, twice a day, for 15 days.
2. The usage of erythromycin is the same as tetracycline hydrochloride; Or azithromycin 500mg for 10 consecutive days.
3. Ceftriaxone sodium 1.0g, intravenous drip or intramuscular injection, once a day, for 10 consecutive days.
3、 Advanced syphilis (including tertiary syphilis, late latent syphilis, and secondary recurrent syphilis)
(1) Penicillin
1. Benzathine penicillin G2.4 million U was intramuscularly injected into both buttocks, once per week, a total of 3 times, with a total amount of 7.2 million U.
2. Procaine penicillin G800000 U, once a day, intramuscular injection, continuous for 20 days as a course of treatment. The second course of treatment can also be carried out after 2 weeks depending on the situation.
(2) People who are allergic to penicillin
1. Tetracycline hydrochloride, 500 mg, 4 times a day, for 30 days; Or doxycycline 100mg, twice a day, for 30 days; Or minocycline 100mg, twice a day, for 30 days.
2. The use of erythromycin is the same as that of tetracycline.