Syphilis

Introduction to syphilis Syphilis is a chronic sexually transmitted disease caused by the pallidum, Treponema pallidum. It can invade skin, mucous membranes and many other tissues and organs. It can have a variety of clinical manifestations, and sometimes it is asymptomatic latent state. Pathogens can transmit fetal syphilis through the placenta to the fetus. The vast majority are transmitted through sexual channels, clinically can be expressed as primary syphilis, secondary syphilis, tertiary syphilis and latent syphilis. It is listed in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases. basic knowledge The proportion of illness: 0.008% Susceptible people: good for young men and women Mode of transmission: sexual transmission, blood transmission, contact, transmission, vertical transmission Complications: aortic regurgitation myocardial infarction aortic aneurysm sudden death neurosyphilis

Cause of syphilis

P. pallidum infection (40%):

Treponema pallidum, also known as the pale spiral, was discovered in 1905. In taxonomy, it belongs to the genus Spirulina, Treponema, and Treponema. The cells are slender, with 6--12 spirals arranged evenly, 5--20 inches long, with an average length of 6-10 diameters of 0.15 inches. The movement is slow and regular, and the dyes commonly used in the laboratory are not easy to color. The cells were observed under a dark field microscope or a phase contrast microscope. In vitro artificial culture is difficult, and the spirochetes can be obtained by inoculating rabbit testicles.

Infectious immunity (20%):

Infectious immunity is produced after immunological infection. Specific IgM antibodies are produced 2 weeks after infection. This type of antibody cannot pass through the placenta; specific IgG antibodies appear 4 weeks after infection and can pass through the placenta. A fully cured early syphilis can be reinfected. In addition, TP destroys human tissue, causes tissue to release an antigenic cardiolipase, stimulates the body to produce responsive hormone, and can be detected by RPR, USR, VDRL, etc., after 5-7 weeks after infection with TP or after hard sac 2--3 turnover positive.

Human resistance (25%):

Resistant people have low viability in vitro, lose infectivity at 40 °C, die at 56 °C for 3 - 5 minutes, boil immediately; wet living supplies can survive for hours, not dry. Sensitive to soapy water and commonly used disinfectants (70% alcohol, 0.1% sulphuric acid, 0,1% liters of mercury, etc.), resistant to low temperatures. Therefore, wet living articles are easy to carry germs that cause syphilis.

Pathogenesis

After entering the human body from intact mucosa and bruised skin, Treponema pallidum invades nearby lymph nodes in a few hours, and spreads throughout the body through 2-3 days. Therefore, systemic infection and metastatic lesions have occurred before the appearance of hard chancre. Therefore, the patients in the incubation period or the blood of the early syphilis patients are contagious. The length of the incubation period is inversely proportional to the number of pathogens inoculated. Generally speaking, the number of spirochetes per gram of tissue is at least 107, and clinical lesions will appear. If intradermal injection of 106 spirochetes, lesions often occur within 72 hours. Vaccination for volunteers, half of the infection (ID50) of the disease is calculated to be 57 pathogens, and an average of 500-1000 infected pathogens can cause disease. Experimental vaccination of humans and rabbits showed that the time from inoculation to the appearance of primary lesions rarely exceeded 6 months, and a treatment with a lower than cure amount during this incubation period could delay the occurrence of hard chancre, but whether it can reduce systemic disease The final development is not yet certain.

After syphilis invades the human body, after a 2-3 week incubation period (called the first incubation period), skin damage occurs (typical damage is hard chancre). This is a stage syphilis. After skin damage occurs, the body produces antibodies. The experimental syphilis study from rabbits proves that the initial histological feature of syphilis is mononuclear cell infiltration. On the sixth day of infection, lymphocytic infiltration occurs, reaching a peak at 13 days. The macrophages appear, and the lymphocytes infiltrated in the lesions are mainly T cells. At this time, Treponema pallidum is found in the epithelial cell gap in the hard sac, and in the invagination or phagocytosis of epithelial cells, or fibroblasts and plasma. Cells, between small capillary endothelial cells and between lymphatic vessels and regional lymph nodes. Due to the action of immunity, Treponema pallidum was rapidly eliminated from the lesion. After the 24th day of infection, the presence of Treponema pallidum was not detected by immunofluorescence. Most of the spirochetes are killed, the hard chancre is naturally disappeared, and enters the asymptomatic incubation period, which is the first stage of latent syphilis. In the past, latent syphilis was mainly detected by serum test, and now the application of genetic diagnosis can be detected quickly and accurately.

The unkilled spirochetes still multiply in the body. After about 6-8 weeks, a large number of spirochetes enter the blood circulation and spread to the whole body. Causes early stage syphilis, skin and mucous membranes, bones, eyes and other organs and nervous system damage. The second-stage syphilis spirochete can be seen in many tissues, such as rash, lymph nodes, aqueous humor in the eyeball and cerebrospinal fluid. With the establishment of the body's immune response, a large number of antibodies are produced, and most of the spirochetes are killed. The second-stage early-onset syphilis also disappears naturally, and then enters the latent state. This is called the second-stage latent syphilis. At this time, although the clinical is asymptomatic, the remaining spirochetes have the opportunity to reproduce. When the body's resistance declines, the spirochete enters the blood circulation again, and the second stage of recurrent syphilis occurs. Before the advent of antibiotics, one or more systemic or local skin and mucous membrane recurrences can be experienced, and 90% of relapses are in the first year after onset. Later, with the growth and decline of the body's immunity, the disease activity and latency alternate. When the body's immunity is enhanced, the spiral is made into a granular shape or a spherical shape. When the immunity declines, the spirochete invades some parts of the body and relapses. This is repeated, and about 30%-40% of the patients enter the late stage syphilis after 2 years.

In the late syphilis, a typical gum-like swelling occurs. If there is no symptom, the chest, cardiovascular fluoroscopy and cerebrospinal fluid examination are negative, and only the syphilis serum test is positive. At this time, the PCR test is also positive, which is called late late syphilis. . Late syphilis often invades the skin, mucous membranes, bones, cardiovascular, and nervous system. There are also some patients with syphilis serum titer decreased, and finally turned negative, PCR detection was negative, and naturally healed.

The above is a typical change without any treatment, but due to the difference of immune and treatment, the clinical manifestations are quite different, some patients can lurk for life, some have only one stage of performance without second stage symptoms, or only three stages Syphilis symptoms.

Pathological change

The basic lesions of syphilis are mainly 1 endovascular inflammation, swelling and proliferation of endothelial cells; 2 perivascular inflammation, a large number of lymphocytes and plasma cells infiltration. In addition to the above changes, late syphilis has epithelial-like cells and giant cells granulomatous infiltration, sometimes necrosis.

First, hard chancre: invasive lesions around the blood vessels, mainly seen in lymphocytes, including CD8 + and CD4 + cells, plasma cells and tissue cells, accompanied by capillary endothelium hyperplasia, followed by small blood vessel occlusion. In addition, Treponema pallidum is found in the epithelial cell space in the sputum, in capillaries, and around lymphatic vessels and local lymph nodes.

Second and second stage syphilis rash; characterized by hyperkeratosis of the epidermis, neutral polymorphonuclear leukocytes invade the dermal papilla, and mononuclear cells, plasma cells and lymphocytes infiltrate around the deep blood vessels of the dermis.

Third, flat wet warts: early epidermal hyperplasia, late central tissue necrosis, nipple extension, inflammatory infiltration of the dermis. There is obvious plasma cell infiltration around the blood vessels, which is cuff-like arrangement, capillary proliferation, and edema inside and outside the epidermal cells. Stained syphilis was found in about 1/3 of cases of flat wet sputum by silver staining, mainly in the epidermis, and a few were located around the superficial blood vessels.

Stage IV and III syphilis: mainly granulomatous lesions, vascular changes are milder than the second stage, granuloma composed of epithelioid cells and macrophages, cheese-like necrosis in the middle, and a large amount of lymphocytes and plasma cells infiltrating around. There are some fibroblasts and tissue cells, and vascular endothelial cells often have hyperplastic swelling and even blockage of the lumen.

5. The difference between nodular syphilis and gum swelling lies in the extent and depth of the lesion. Nodular syphilis granuloma is confined to the dermis, mildew or lack of caseous necrosis, large blood vessels are not tired; gums have extensive lesions, which can affect the subcutaneous, cheese-like necrosis, and large blood vessels are often involved.

Syphilis prevention

As with other infectious diseases, we should first strengthen health publicity and education, and oppose unfair sexual behavior. Secondly, the following preventive measures should be taken:

(1) All suspected patients should be examined and tested for syphilis serum in order to detect new patients early and treat them promptly.

(2) Patients with syphilis must be forced to undergo isolation treatment. The patient's clothing and supplies, such as towels, clothes, razors, tableware, bedding, etc., should be strictly disinfected under the guidance of medical personnel to eliminate the source of infection.

(3) Tracking the patient's sexual partners, including patient self-reports and medical personnel visits, finding all sexual contact persons, conducting preventive examinations, tracking observations and performing necessary treatments. The spouse is absolutely forbidden to have sex before the cure.

(4) For pregnant women with suspected syphilis, preventive treatment should be given in time to prevent the infection of syphilis to the fetus; unmarried men and women patients can not get married without being cured.

Syphilis complications Complications aortic regurgitation myocardial infarction aortic aneurysm sudden death neurosyphilis

It is more destructive to the organization, can be life-threatening in severe cases, can invade the central nervous system, cardiovascular system and skeletal system, cause damage to tissues and organs, loss of function, leading to disability or death.

1. Mucosal lesions are easy to develop into chronic interstitial glossitis, which is a kind of precancerous lesion and should be strictly observed.

2. Cardiovascular lesions may have simple aortitis, aortic regurgitation, myocardial infarction, aortic aneurysm or sudden death.

3. The onset of neurosyphilis is slow, and meningitis can occur, which can cause sputum and sputum.

Symptoms of syphilis common symptoms syphilis liver mucosa rash herpes nose tip up saddle-like sore throat syphilis infection pigmentation body discomfort plague syphilitic hair loss

First, acquired syphilis

(1) Primary syphilis

The incubation period averages 3-4 weeks. The typical damage is Hard Chancre (Ulcus Durum). A red papule or induration begins to appear in the invagination site of the spirochete. Later, it appears as erosion, forming a shallow ulcer, which is hard and painless. Garden shape or elliptical shape, clear boundary, neat edges, ridge-like bulge, dark red infiltration around the perimeter, characteristic cartilage-like hardness, flat base, no pus, surface with fibrin-like film, difficult to remove, such as Slightly squeezed, there may be a small amount of serous exudate, containing a large number of syphilis, an important source of infection, hard sputum mostly single, there are also 2-3, more than the typical hard squat, but if it occurs in the original The erosion, laceration or erosive herpes or balanitis, the hard squat appears the same shape as the original damage, in this case should be tested for syphilis, hard sputum due to sexual intercourse infection, so damage occurs In the genital area and sexual contact, males are mostly in the glans, coronal sulcus and ligament, in the inner sheath of the foreskin or penis, root of the penis, urethra or urethra, the latter is easily misdiagnosed, Hard chancre often combined with foreskin edema, some patients may have lymphangitis in the back of the penis, showing a hard line damage, female hard chancre is more common in the size of the labia, clitoris, urethra, vaginal discharge, especially in the cervix, easy to miss diagnosis The genital genital sputum is more common in the lips, tongue, tonsils, fingers (health care personnel can also be infected with finger squats), breasts, eyelids, outer ears, in recent years, anus and rectum hard squats are not uncommon, such hard squats are often accompanied There are severe pain, difficulty in defecation, and easy bleeding. It is easy to be misdiagnosed as rectal cancer in the rectum. It is often atypical under the genital sputum. It should be tested for syphilis and genetic diagnosis. The hard squat has the following characteristics:

1 damage is often a single;

2 cartilage hardness;

3 does not hurt;

4 The damaged surface is clean.

After a week of hard chancre, the nearby lymph nodes are swollen, characterized by no pain, no redness and swelling of the skin surface, no adhesion to surrounding tissues, no ulceration, called painless transverse sputum (painless lymphadenitis), hard sputum if not Treatment, after 3-4 weeks can be self-healing, can be quickly healed after effective treatment, leaving a shallow atrophic scar, 2-3 weeks after the occurrence of hard chancre, syphilis serum reaction began to be positive, the first stage syphilis in addition to hard sputum A small number of patients can still have hard and edema in the labia majora, foreskin or scrotum, just like the skin, called Edema Induratum, such as patients with a soft chancre caused by Haemophilus ducrei, or by A colloidal ulcer caused by a lymphogranuloma of a sexually transmitted disease is called a mixed sputum.

(2) Phase II syphilis

For the general stage of syphilis, the period from the disappearance of the hard sputum to the second stage of syphilis, called the second incubation period, the second stage syphilis usually occurs 3-4 weeks after the hard sputum subsides, equivalent to 9-12 after infection. Week, the second phase of syphilis is a syphilis spiral through the lymph nodes into the blood line caused by extensive systemic damage, in addition to causing skin damage, can still invade the internal organs and nervous system.

Secondary syphilis may have flu-like syndrome (headache, low fever, sore limbs) before rash, and these prodromes last for about 3-5 days, and the rash subsides after it leaves.

The skin damage of secondary syphilis can be divided into macules, papules and pustules, the latter being rare.

Spotted rash, also known as rose rash (rose rash), is the most common, accounting for 70%-80% of secondary syphilis. Early-onset rash is similar to typhoid fever. It is light red and varies in size. The diameter is about 0.5-1.0. Cm-sized circular or ellipsoidal erythema, the boundary is clearer, the color fades, each is independent, does not fuse, symmetry occurs, more first in the trunk, gradually extended to the limbs, can be covered in a few days (general neck , the face occurs less), the symptoms are not obvious, so often ignored (not easy to see in the warm environment, it is easy to see at room temperature), in the palm of the hand, can be psoriasis-like scales, base It is fleshy red, the color is not faded, and it is characteristic. After about a few days or 2-3 weeks, the color of the rash changes from reddish to brown, brownish brown, and finally fades. After the infection, the pigmentation remains. Apply anti-syphilis. After drug treatment, it can quickly resolve. Recurrent rash usually occurs 2-4 months after infection, and there are also those who are later than 6 months or 1-2 years. The skin lesions are older than the hair style, such as fingernails or various The size of the coins is small, and they are arranged in a limited manner. The realm is obvious, and they are often found in the limbs. Shoulder blade, and perianal forearm, etc., after a long time of this type, if not treated, can be repeated after the regression of recurrence, it may be through central clearing, edge development, to form a ring (annular roseola).

The syphilis serum reaction was strongly positive in this period, and the PCR detection of Treponema pallidum DNA was positive.

Papular and maculopapular rash are common in clinical practice, accounting for about 40% of secondary syphilis. The time of occurrence is slightly later than that of rash. According to its symptoms and clinical experience, it can be divided into large papules and small papules.

Large papules: about 0.5-1cm in diameter, hemispherical infiltrating papules, smooth surface, dark brown to copper red, long-term rash center absorption, depression or desquamation, occur on both sides of the trunk, abdomen, limbs flexion, scrotum , the size of the labia, anus, groin, etc., may have scaly, called papular scaly syphilis or psoriatic syphilis (Psoriasiform syphilid), with large scaly patches, scales are white or difficult to peel off the skin, There are superficial erosions on the underarms, red halo on the edges, like psoriasis, which occurs in the trunk and limbs.

Small papules, also known as syphilitic moss miliary, are mostly the same size as the hair follicles, and have a cone-like shape. They are solid apex small papules, maroon, cluster or mossy, which occurs later and occur within 1-2 years after infection. Long time, no treatment within 2-3 months does not fade, and some papules arranged in a ring or curved shape, called ring syphilis, occurs in the scrotum and the main parts, can be found in Treponema pallidum, syphilis serum response Positive.

Pustular rash: now rare, can be seen in malnutrition, physical weakness, alcoholism and drug users, large rashes have impetigo-like, deep impetigo-like, crustacean-like, small acne-like and acne-like Form, patients often accompanied by fever, general malaise, etc., skin lesions often have copper red infiltration, according to the history, syphilis and syphilis serum reaction is easy to distinguish with acne vulgaris, impetigo, which has a specific sputum Shell-like skin lesions are easy to identify.

Secondary syphilis mucosal damage can be single, and can be complicated with other syphilis rashes. It is easy to be ignored when it occurs alone. People who smoke, drink alcohol and often take overheated and irritating foods, and those with poor dental hygiene are prone to recurrence or recurrence. Common damage For the leukoplakia (Leukoplasia, Mocus patch), occurs in the oral or genital mucosa, anal mucosa, in the anal mucosa, pain during defecation, and even bleeding, the damage is round or oval, the boundary is clear, the surface is gorgeous, Grayish white or milky white patches slightly above the mucosal surface, surrounded by dark red infiltration, the size of which is like a fingernail or slightly larger, the number varies, can be increased or merged into a flower ring or irregular shape, can also develop into ulcers The base of the ulcer is often black film, which is not easy to be peeled off. The base is not flat after peeling, and it is easy to bleed. There is no self-consciousness. Those who have formed ulcers are painful. There are a lot of syphilis on the surface of the leukoplakia, which is an important source of infection.

Syphilitic hair loss: about 10% of patients with secondary syphilis, which is caused by syphilis infiltration of hair follicles, microvascular obstruction in the hair area, caused by poor blood supply, manifested as syphilitic alopecia areata or diffuse alopecia, the former is about 0.5cm of baldness Hair spots, worm-like, diffuse hair loss, large area, sparse, hair length, common in the ankle, top and occipital, eyebrows, eyelashes, beard and pubic hair also fall off, secondary syphilis alopecia There is a local presence of Treponema pallidum, and the location of Treponema pallidum is basically the same as that of the cell infiltration. Therefore, it is believed that syphilitic alopecia may be related to the invasion site of Treponema pallidum. Treponema pallidum does not invade the dermal papilla and invades the upper part of the hair follicle, so syphilitic alopecia In the case of incomplete alopecia patches, syphilitic alopecia is not permanent alopecia. If treated in time, hair can be regenerated within 6-8 weeks, and it can be regenerated even without treatment.

Symptomatic leukoplakia, more common in women patients, usually occurs 4-5 months or 1 year after infection, occurs on both sides of the neck, can also be found in the chest, back, breast, limbs, armpits, vulva, perianal, etc. The pigment in the affected part is completely lost, and the surrounding pigments are increased. Similar to vitiligo, the size varies, and they can be fused into a large piece. The middle is mesh-like, and the pigmentation in the mesh is often accompanied by syphilitic leucorrhea, which has a long time. Stubborn not easy to disappear, can be 7-8 years, can be extended to the third stage of syphilis, often accompanied by nervous system syphilis or before the occurrence of neurosyphilis, cerebrospinal fluid abnormal changes, syphilis seropositive, according to medical history, other parts of syphilis symptoms , syphilis seropositive, etc., can be identified with vitiligo.

Secondary syphilis can also affect nails, paronychia, nail bed inflammation and other abnormal changes, similar to other non-syphilitic nail disease, there may be dark red infiltration around syphilitic paronychia, bone may also occur in secondary syphilis Inflammation, periostitis, arthritis, iridocyclitis, retinitis, and involving the nervous system, but no clinical symptoms, said phase II no clinical symptoms of neurosyphilis, syphilitic meningitis, cerebrovascular and meningeal vessels Syphilis, headache and corresponding neurological symptoms.

The serum reaction of septic secondary syphilis is mostly strongly positive. The secondary syphilis lesions generally have no symptoms, and occasionally itchy, such as periostitis or osteitis, which is painful at night. Or no pain, can disappear after 1-2 months without treatment, and quickly resolve after anti-mei treatment.

The second-stage syphilis early rash and recurrent rash, the first group of patients with second-stage early rash, characterized by a large number of lesions, small form, most of the symmetry scattered, occurs in the trunk and limbs stretch, subsided After recurrence, the second-stage recurrent syphilis rash is characterized by a small number of lesions, a large shape, and multiple unilateral clusters, often ring-shaped, hemispherical, irregular, etc., occurring in the extremities, such as the head. Face, perianal, vulva, palmar or limb flexion, identification of early rash and recurrent rash have a certain significance for treatment and prognosis, generally early syphilitic rash has a short course, easy to cure, good prognosis, and the recurrence of syphilis Long, efficacy and prognosis are not as good as early syphilis.

(3) Phase III syphilis (late syphilis)

The occurrence time is generally 2 years after the onset of the disease, but it can also be longer for 3-5 years, which occurs between 40-50 years old, mainly due to the lack of anti-syphilis treatment or treatment time, the dosage is not enough, the body Internal and external environmental disorders also have a certain relationship, excessive drinking, swallowing, physical weakness and patients with tuberculosis and other chronic diseases have a poor prognosis.

The characteristics of the third stage syphilis are as follows:

1 The time of occurrence is late (2-15 years after infection), the course of disease is long, if not treated, it can be as long as 10-20-30 years, even for life;

2 complex symptoms, can involve any tissue and organ, including skin, mucous membranes, bones, joints and internal organs, more easily invade the nervous system, easy to be confused with other diseases, difficult to diagnose;

3 In vivo and skin lesions have less syphilis, weaker infective power, but destroy tissue strength, often cause tissue defects, organ damage, can cause disability, and even life-threatening;

4 anti-mei treatment, although effective, but can not repair damaged tissues and organs,

5 syphilis serum reaction is unstable, the negative rate can reach more than 30%, cerebrospinal fluid often changes.

The third-stage syphilis skin and mucous membrane damage accounted for 28.4% of the incidence of advanced benign syphilis, most of which occurred within 3-10 years after infection. Clinically, it can be divided into nodular syphilis, gum swelling, near joint nodules, and skin damage with the following characteristics;

1 small number, isolated or clustered rather than symmetrical, often occurs in vulnerable parts;

2 systemic symptoms are mild, lack of self-consciousness of skin lesions, such as invasion of periosteum and bone, it is painful, at night;

3 There is a tree infiltrating induration, and the ulcer formed after the ulceration still has a hard solid infiltration at the bottom, which is very slow, often for several months or more;

4 ulcers have a specific kidney shape or horseshoe shape;

5 ulcers can be cured at the center, while the edges often continue to expand;

6 damage surface syphilis spirochetes, dark field microscopic examination is difficult to find, but vaccination can be positive;

7 Destruction of tissue strength, healing can form scars.

Nodular syphilis (nodular Syphilid): occurs more than 3-4 years after infection. The damage occurs in the head, shoulders, back and extremities. It is a group of infiltrative knots with a diameter of about 0.3-1.0 cm. Section, copper red, smooth surface or with thin scales, hard, patients have no symptoms, the evolution of nodules may have two endings, one is the nodule flattening absorption, leaving a small shrinkage plaque, long-term retention Dark brown pigmentation, the other end is central necrosis, the formation of small abscess, ulceration after ulceration, the formation of nodular ulcerative syphilis, leaving a shallow scar after the scar, there is pigmentation around the scar, the atrophy is smooth and thin, New damage can occur at the edge, which is characteristic of this disease. New and old rashes come one after another, new ones happen again, and can last for several years.

Gumma is common in the third-stage syphilis, accounting for 61% of the third-stage syphilis. It is an induration under the deep skin. It grows like a pea. It grows like a broad bean or a plum. It is harder or harder. It can be active, the number is indefinite, the starting color is normal skin color, with the nodule increasing, the color gradually turns pale red, dark red or even purple, the nodules are easy to be necrotic, can gradually soften, rupture, out of the gum-like secretions It can form a special circular shape, elliptical shape, horseshoe-shaped ulcer, clear boundary, neat edge like a dike, surrounded by brown red or dark red infiltration, touch hard, often heal at one end, the other end still spread like a snake Symptoms, mild symptoms, such as invasive bone and periosteal pain, especially at night, can appear throughout the body, and more common on the head and calf extension, long course, from months to years or more, After the formation of scars, scars around the pigmentation zone, gums can invade the bones and cartilage, bone damage is more common in long tube osteoarthritis, bone, periostitis can occur, the head often destroys the skull, issued on the palate And the nose can destroy the hard palate and the nasal bones. The nose and the upper sac are connected, and the blood vessels in the vicinity of the large blood vessels can erode large blood vessels, and massive hemorrhage occurs. The gum swelling can be absorbed by the anti-mei treatment without leaving scars, and there is also a shallow infiltrator that does not break and form a clear boundary.

Third-stage syphilis can also have localized or diffuse alopecia, paronychia, and clinical manifestations are the same as secondary syphilis.

Third-stage syphilis can also affect the mucosa, mainly in the mouth, tongue, etc., can occur nodular rash or gum swelling, can be limited to a single gum or diffuse gum infiltration in the tongue, the latter easily develop into a chronic Qualitative glossitis, a sulcus of the sulcus, is a precancerous lesion, should be closely observed, and given a sufficient amount of anti-mei treatment, sometimes the lesion is superficial, the tongue nipple disappears, the red is smooth, the tongue damage is not self-conscious However, eating overheated or acidic foods is painful.

Near joint nodules, near the extension of the large joints such as the hips, elbows, knees and ankles, can appear hard and painless nodules, the surface of the skin without inflammation, normal skin color or darker color, after slow, not broken, nodules Treponema pallidum can be found inside, often combined with other signs of syphilis, syphilis serum test is positive, anti-mei treatment is easy to subside, such nodules are considered to be skin connective tissue, is a special affinity for connective tissue, Treponema pallidum Caused by three-stage syphilis can cause eye damage, such as iridocyclitis, retinitis, keratitis, etc. When cardiovascular is involved, simple aortitis, aortic insufficiency, aortic aneurysm and coronary heart Diseases, etc., can also invade the system of digestion, respiration and urinary, but no specific symptoms, can be combined with the history of the relevant examination, the third stage of syphilis is easy to invade the nervous system, except for clinical changes, cerebrospinal fluid examination has abnormal changes in the asymptomatic nerve In addition to syphilis, meningeal vascular syphilis and brain parenchyma syphilis may occur.

Latent syphilis: latent syphilis refers to patients who have been diagnosed with syphilis. In a certain period of time, no abnormal findings were found on the skin, mucous membranes, and any organ system and cerebrospinal fluid examination. Physical examination, chest X-ray lacks clinical manifestations of syphilis, and cerebrospinal fluid examination is normal. Only syphilis seropositive, or a clear history of syphilis infection, has never had any clinical manifestations, said latent syphilis, the diagnosis of latent syphilis is based on the history of the first stage, secondary syphilis, and syphilis History and the history of infants who have given birth to congenital syphilis, previous syphilis serum test negative results and disease history or exposure history can help determine the duration of latent syphilis, infection time is less than 2 years for early latent syphilis, more than 2 years for The latent latent syphilis, the other is the latent syphilis with unclear disease period. The latent syphilis does not show symptoms because the body's own immunity is strong, or the spirochete is temporarily inhibited due to treatment. During the latent syphilis, the syphilis is still intermittent. In the blood, pregnant women with latent syphilis can infect the fetus in the uterus, and can also be infected with blood by blood donation. .

Pregnancy syphilis: syphilis and pregnancy can affect each other, pregnancy syphilis can pass the placenta to the fetus, due to placental vascular obstruction of pregnancy syphilis, affecting fetal nutrition, prone to miscarriage, premature or stillbirth, although full-term delivery, but about 64.5% The fetus has been infected with syphilis, and congenital syphilis occurs. Among them, 15%-20% are early-onset congenital syphilis. The effect of syphilis on pregnancy is also great. Although women with syphilis can be pregnant, the pregnancy rate is significantly reduced, and the active syphilis is not. The pregnancy rate is 23%~40%, which is 1-5 times higher than normal. Pregnancy syphilis has a great impact on the health of pregnant women. It can cause weight loss, fatigue, nutrient consumption, and decreased resistance to disease. For example, early syphilis affects health. Severe, in addition to the above symptoms, and can occur fever, night sweats, anemia, bones and joints are easily tired, bone decalcification, joint pain, due to vascular infarction in the placenta, prone to early abortion of the placenta and miscarriage, premature birth, Stillbirth.

In addition to the above-mentioned vascular changes, the placenta of syphilis often increases in weight, the mother's face is swollen, and the color is pale. The amount of villus is greatly reduced due to vascular infarction, and the density of interstitial cells is increased. Treponema pallidum can be detected in the placenta.

Pregnancy syphilis must be asked in detail when the patient and his or her spouse have a history of syphilis, whether there is a history of abortion and premature birth, pregnant women with syphilis must undergo syphilis serum test:

1 1 time before and during the first trimester (or late) (not to be done several days before and after childbirth, prone to false positive reactions);

2 If the husband suffers from syphilis and I have no symptoms of syphilis, the serum reaction is negative, but the child born with the symptoms of late syphilis before the age of 10, the mother of the child is treated with latent syphilis;

3 a small number of pregnant women may also have a biological false positive reaction (mostly weak positive), such as pregnant women and their spouses have no history of syphilis and syphilis, no previous suspicious history, two serum tests, one is suspicious, weak at the time of return Positive, should continue to observe, temporarily do not give anti-mei treatment, can be serum reaction once every 2-3 weeks, at the same time as a serum quantitative test, to observe whether the titer rises, I should carry out detailed physical examination, and check during childbirth Whether there is any abnormality in the umbilical cord and placenta, if suspicious, scrape the venous wall of the umbilical cord and the fetal surface of the placenta for dark-field microscopic examination of Treponema pallidum;

4 pregnancy syphilis often complicated by refractory proteinuria, often can disappear after anti-mei treatment;

5 In addition to a comprehensive examination of pregnant women, pregnant syphilis should also be examined in detail.

Pregnant women with syphilis, such as adequate anti-mei treatment in the early pregnancy, the fetus may not be infected, such as in the third trimester of pregnancy, can not prevent fetal infection, mothers with syphilis, follow-up of their newborn baby after delivery At least half a year, pregnant women who use drugs can increase the infection of the fetus.

Fetal syphilis; Treponema pallidum enters the fetus and can cause pathological changes in various organs. The damage is related to the maternal period and the time when the fetus is infected. The main lesions are:

1 skin: the child is smaller than the normal fetus, light weight, less subcutaneous fat, dry skin, dark gray, fragile, easy to peel off to reveal the erosion surface, palmar skin thickening and shiny, often with bullae, if it is stillbirth, then The skin is impregnated and softened, and easily peeled off into a smashed surface. The mucous membrane is prone to ulceration, nasal cavity, oral blockage, and bloody secretions. Most fetuses with such conditions are mostly syphilitic fetuses.

2 Liver: easy to be invaded, increased hardening, weight up to 1/8-1/10 (normally 1/30), appearance is brownish yellow, yellow miliary nodules can be seen on the cut surface, sometimes there are gums Swelling and scarring, microscopic examination showed thickening of the portal vein and hepatic vein wall, thickening of the hepatic duct, narrowing of the lumen, high connective tissue hyperplasia and lymphoid cells around the hepatic lobules, infiltration of plasma cells, and ascites.

3 The lungs can invade one or all of them, showing specific lesions. The lungs are enlarged and solid, showing pale white. The so-called white pneumonia, most of the alveoli have no air, so the lungs can not float in the water, the bronchi and alveolar walls Limited local or diffuse lymphocytes, plasma cells and mononuclear cells infiltrate.

4 spleen, significantly increased weight gain (about 2-3 times more than normal), microscopic infiltration of small blood cells in the blood vessel wall and fibrous changes around the small artery.

5 The kidney is often violated. In addition to small cell infiltration, renal tubular degeneration, hemorrhagic glomerulonephritis and interstitial nephritis may occur.

6 The pancreas enlarges, diffuse fibrosis and cell infiltration under the microscope, and the main mass shrinks afterwards.

7 bone, there is a specific osteochondritis, the long bone between the epiphysis and the backbone is not neat jagged, after the bone and bone can be softly separated to form a false sputum.

Second, congenital syphilis

Congenital syphilis is transmitted to the fetus through the placenta in the fetus by the syphilis pregnant woman. It is also called fetal syphilis. It is usually transmitted through the placenta during the four months of pregnancy. The fetus can die or abort. If the pregnant woman is infected with syphilis for more than five years, the fetus is in the uterus. Internal infection is unlikely, 2 years old is early congenital syphilis, more than 2 years old is late congenital syphilis, characterized by no hard chancre, early lesions are more serious than acquired syphilis, late stage is mild, cardiovascular involvement is less, bones, feeling Tube system such as the eye, nasal involvement is more common.

Early congenital syphilis, shortly after birth, most of the premature infants, malnutrition, low vitality, light weight, thin body, pale skin, face like the elderly, often accompanied by mild fever, rash and acquired syphilis Slightly similar, there are rashes, maculopapular rashes, papules, pustular rashes, etc., and rashes and rashes on the buttocks often merge into dark red infiltrates, and the surface may have debris or slightly moist, often around the mouth. Seborrheic, surrounded by dark red halo, on the anal circumference, vulva and limbs are often wet papules and flat condyloma, pustular rash is more common in palmar, pustules such as pea size, base dark red or copper red infiltration After rupture, there is a smashed surface, wet papules, flat wet sputum and smashed pustules have a large number of syphilis spirochetes. A few patients may also have loose bullae, also known as syphilitic pemphigus, blister There is serous purulent discharge, dark red infiltration on the base, paronychia can occur in nails, nail bed inflammation, and there are lesions of crustacean or deep impetigo, swelling of the lower turbinate, purulent secretions and suede. Can block the nasal cavity and make the patient Suction and sucking difficulties, one characterized by congenital syphilis infants, such as the continued development and can damage the nasal palate, the formation of saddle nose and palate perforation, larynx and vocal cords have been violated, may occur hoarse voice.

May be associated with systemic lymphadenitis, slightly longer children with syphilitic skin lesions and acquired recurrent syphilis, skin lesions are large and numerous, often clustered, flat wet sputum more common, mucosa can also be tired, a small number of sick children can occur gum Swollen, bone damage, bone damage occurs most frequently in early congenital syphilis, syphilitic refers to inflammation caused by diffuse fusiform swelling, involving one or several fingers, sometimes accompanied by ulcers, osteomyelitis common, mostly in long bones, other osteochondral Inflammation, periostitis, pain, limbs can not move, like limb paralysis, it is called syphilitic false sputum.

Visceral damage can be seen in liver splenomegaly, kidney invasion can occur proteinuria, cast, hematuria, edema, etc. In addition, there are still orchitis and epididymitis, often combined with scrotal edema, ocular lesions have syphilitic choroidal inflammation, iris Ciliary body inflammation, retinitis, optic neuritis, etc., the nervous system can also be tired, can occur brain softening, cerebral edema, epileptic seizures, cerebrospinal fluid can appear pathological changes.

Late congenital syphilis usually begins to develop from 5 to 8 years old. It is only after 13-14 years of age that multiple symptoms appear one after another. Late onset symptoms can occur around 20 years old. Late congenital syphilis mainly invades skin, bones, teeth, eyes and Nerve, etc. 1 skin mucosal damage: can cause gum swelling, can cause upper jaw, nasal septum perforation, saddle nose (nose deep collapse, nose hypertrophy like a saddle), saddle nose patients can also see wide distance between the eyes, nostril The saddle nose usually appears at 7-8 years old, and is obvious at 15-16 years old; 2 bone: periostitis, osteitis, bone pain, especially at night, periostitis often involves the lumen, and is often limited to this, can cause bone The front hypertrophy bulge is arched, so it is called Sabre sputum (the middle part of the humerus is thick, protruding forward), the joint water, usually the two knee joint effusion, mild tonic, not painful, characteristic, 1 forehead convex; The semilunar incisors (Ha Qininson Hutchinson teeth) are characterized by the narrow free edge of the two central incisors of the permanent tooth, the half-moon shape defect in the center, the short tooth, the anteroposterior diameter, the dentate blunt, the dentition is not complete, the first molar shape Smaller, the tip of the tooth is concentrated on the occlusal surface The central part, shaped like mulberry, is called mulberry tooth. The above three types of keratitis, syphilitic labyrinthitis and half-moon incisors appear at the same time, called Hao Qinsheng triad, 2 substantial keratitis: 50% of late congenital syphilis This type of lesion can occur. About 95% of the keratitis in the eye is syphilitic. This disease is mostly bilateral, and it can occur on one side first, then on the other side. After a slow period, the course is longer.15

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