Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum that invades multiple systems. Treponema pallidum can affect almost every organ in the body, causing various symptoms and signs, with complex clinical manifestations, and can be transmitted to the fetus through the placenta, causing miscarriage, premature birth, stillbirth and congenital syphilis, which is extremely harmful.
Clinical classification
1. Classification based on different transmission routes
Syphilis is divided into acquired syphilis (acquired syphilis) and congenital syphilis (congenital syphilis).
2. Classification according to the course of acquired syphilis
(1) Early syphilis: refers to a disease course of less than two years, including primary syphilis (chancre), secondary syphilis (systemic rash), and early latent syphilis.
(2) Late syphilis: refers to a disease course of more than two years, including tertiary syphilis and late latent syphilis.
Epidemiology
Infectious
It is contagious, and the “Law on the Prevention and Control of Infectious Diseases” classifies it as a Class B infectious disease, which requires strict management. If it is discovered, it must be reported online within six hours, and if it is in rural areas, it generally does not exceed 12 hours.
Source of infection
The only source of infection of syphilis is syphilis patients. TP is present in the patients’ skin lesions, blood, semen, milk and saliva.
Mode of transmission
About 95% of patients are infected through sexual contact. A pregnant woman with syphilis can pass the pathogen to her child. In most cases, it is difficult for Treponema pallidum to survive outside the human body. Boiling, drying, sunlight, soapy water and ordinary disinfectants can quickly kill it, so it is difficult to be infected through kissing, shaking hands, breastfeeding or contact with clothes and utensils with TP.
1. Transmission through sexual contact
(1) Having unprotected sexual contact with a person with syphilis, such as vaginal, anal or oral sex.
(2) When sharing sex toys with an infected person, small breaks in the skin and mucous membranes are inevitable, which can allow syphilis to invade.
2. Mother-to-child transmission
(1) TP can be transmitted from the pregnant woman to the fetus through the placenta and umbilical vein.
(2) During delivery, newborns may also become infected due to abrasions on the head and shoulders when passing through the birth canal.
(3) Studies have shown that syphilis cannot be transmitted to newborns through breastfeeding, but if the mother has syphilis lesions around her nipples, it is possible to infect the baby.
3. Other communications
(1) Blood from syphilis patients that has been refrigerated for less than 3 days is still infectious, and transfusion of such blood can cause syphilis. This is relatively rare because blood products are currently strictly screened and syphilis has a limited survival time in the outside world.
(2) Some people may be infected by sharing needles for injecting drugs or razors with syphilis patients.
(3) A small number of people have damaged skin and mucous membranes and may be infected if they come into direct contact with objects containing TP.
Incidence
The incidence of syphilis in my country increased from 4.5/100,000 in 2003 to 32.86/100,000 in 2013, with an average annual increase of 13.37%. The incidence of syphilis during pregnancy is 2‰~5‰ in most regions.
Disease trend
In recent years, the incidence of syphilis has shown an upward trend.
Prone population
The sexually active population aged 20 to 39 is a high-risk group and is also the key population for syphilis prevention and control in my country.
High incidence areas
The incidence of syphilis varies greatly in different regions, with the high-incidence areas mainly being the Northwest, Minjiang, Yangtze River Delta, and Pearl River Delta regions.
Causes
Overview
Syphilis is an infectious disease caused by Treponema pallidum (also known as Treponema pallidum). The only source of syphilis is syphilis patients. TP is present in the skin lesions, blood, semen, breast milk and saliva of syphilis patients. Close contact with infected ulcers or skin lesions of syphilis patients may cause infection. This disease is mainly transmitted through sexual contact and mother-to-child transmission.
Basic Cause
1. Acquiring syphilis
After the pallid spirochetes enter the human body through minor injuries of the skin or mucous membranes, they proliferate under the skin and mucous membranes on the one hand, and reach nearby lymph nodes along the lymphatic vessels on the other hand. In the early stage of infection, the human immune system has not yet responded, so the first incubation period occurs; later, primary syphilis occurs due to the local proliferation of spirochetes; due to local immune response, primary syphilis can heal itself. In the early stage of infection, the human body lacks nonspecific immune response, phagocytes cannot fully engulf the spirochetes, and humoral factors such as complement and lysozyme cannot kill them. Therefore, the spirochetes in the lymph nodes enter the blood circulation through the lymphatic vessels, forming spirochetemia, spreading throughout the body, invading various tissues and organs throughout the body, and causing secondary syphilis. The infectious immunity of syphilis is neither sufficient nor reliable, and both cellular immunity and humoral immunity are defective, so syphilis has a progressive course, systemic lesions further develop, and lesions in the skin, mucous membranes, bones and joints, cardiovascular, cerebrospinal cord and internal organs worsen, resulting in tertiary syphilis, which seriously affects the health of patients and shortens their lifespan, and some can lead to death.
2. Congenital syphilis
Placental infection usually occurs after 4 months of pregnancy. Before 4 months of pregnancy, due to the protective effect of Langhans giant cells in the cytotrophoblast of the placenta, spirochetes cannot pass through. At 4 months of pregnancy, Langhans giant cells shrink and even disappear, and Treponema pallidum can pass through the placenta into the fetus. Recent studies have shown that spirochetes can enter the fetus at 7 weeks of pregnancy, but because the fetal immune system is not yet mature, it does not respond to the infection. Treponema pallidum in the mother’s blood passes through the placental barrier directly into the fetal blood circulation and spreads throughout the body, causing fetal syphilis.
Risk factors
The following factors increase your risk of developing syphilis:
1. Having unprotected sex, such as not using a condom.
2. Being sexually active, promiscuous, and having sex with multiple partners.
3. The incidence of male-male homosexuality increases.
4. The sexual partner has syphilis.
5. Patients infected with HIV have an increased risk of developing the disease.
6. Pregnant women with syphilis may transmit Treponema pallidum to the fetus.
symptom
Overview
Syphilis can be divided into primary syphilis, secondary syphilis and tertiary syphilis (late syphilis) according to the course of the disease. The characteristics, degree of damage and infectiousness of each stage are different.
Typical symptoms
1. Primary syphilis
It usually develops about 2 or 3 weeks after infection. Generally, there are no systemic symptoms, mainly chancre and lymphadenopathy.
(1) Chancroid
① Initially, it manifests as small erythema on the external genitalia, mostly on the penis, glans, foreskin and frenulum in men, and mostly on the labia, perineum and uterine opening (cervix) in women. The erythema necroses and forms a painless round or oval ulcer with a diameter of 1 to 2 cm. Because it is painless, it is difficult to detect.
② Chancroid is highly contagious and can last for 3 to 4 weeks or longer if not treated. After it subsides, it will leave dark red scars or discoloration of the skin, but this does not mean that the infection has disappeared.
(2) Swollen lymph nodes
One to two weeks after the onset of chancroid, the lymph nodes in the groin or near the affected area may become noticeably swollen, but there will be no pain.
(3) Disease progression
If primary syphilis is not treated or is not treated thoroughly, the disease can progress to a serious stage.
2. Secondary syphilis
It often occurs 3 to 4 weeks after the chancre subsides (9 to 12 weeks after infection), and sometimes appears at the same time as the chancre. Other symptoms other than skin symptoms may also appear, and you should be alert to the spread of infection to the whole body.
(1) Syphilitic rash
① The characteristic manifestations of secondary syphilis can cover the skin and mucous membranes of the whole body, even the palms and soles of the feet. Syphilitic rash can be manifested as red or reddish-brown papules, maculopapules (redness under the skin around the papules), plaques, etc., similar to common skin diseases, usually not itchy or only slightly itchy. Some skin mucosa may have pustules (bumps on the skin containing pus) and ulcers, which may occur in the mouth, throat or genitals.
② This stage is highly contagious, and the rash usually disappears on its own within 2 to 3 months. Even if the rash heals on its own, it is still contagious.
(2) Symptoms of syphilis spreading throughout the body
Patchy hair loss, muscle aches or joint swelling, fever, sore throat, swollen lymph nodes, decreased vision, blurred vision, etc. In addition, patients may also experience nerve damage, manifested as headaches, vomiting, drowsiness, slow reactions, etc.
(3) Disease progression
If the patient does not receive treatment, the disease may enter a latent stage (hidden stage), during which the patient may not have any clinical symptoms. This latent stage can last for several years. When the patient’s resistance is reduced, symptoms may reappear, which is called recurrent syphilis. In severe cases, the disease may progress to the third stage.
3. Tertiary syphilis
If primary and secondary syphilis are not treated or are not treated adequately, 40% of patients will develop tertiary syphilis after 3-4 years (2 years at the earliest and 20 years at the latest). This stage is less contagious. The main manifestations are permanent skin and mucous membrane damage, and can invade the bones, heart, and nervous system. In severe cases, it is life-threatening.
(1) Skin and mucous membrane damage
① Nodular syphilitic rash: occurs on the head, face, shoulders, and back, and appears as copper-red nodules arranged in clusters.
② Syphiloma: a sign of tertiary syphilis, it is the most destructive type of syphilis damage. The typical damage is a 2-10 cm horseshoe-shaped ulcer with sharp edges and sticky gum-like secretions on the surface. Oral mucosal damage can cause difficulty in pronunciation and swallowing, and eye skin and mucosal damage can cause eye pain, visual impairment, and even blindness.
(2) Skeletal syphilis
Its incidence is second only to skin and mucous membrane damage. Patients may experience bone pain, pathological fractures, bone perforation, joint deformities, etc.
(3) Cardiovascular syphilis
The incidence rate is 10%, and it usually occurs 10 to 20 years after infection. It is divided into five types: syphilitic simple aortitis, syphilitic aortic valve insufficiency, syphilitic coronary artery stenosis or obstruction, syphilitic aortic aneurysm and myocardial gumma.
① Syphilitic simple aortitis: It is difficult to detect in the early stages and may cause discomfort or pain in the middle of the chest, similar to angina pectoris. Some patients may also have intermittent breathing difficulties.
② Syphilitic aortic regurgitation: often complicated by syphilitic aortic aneurysm, doctors can find that the heart is enlarged to the lower left, auscultation has murmurs, and the pulse rises and falls suddenly, like the tide. In severe cases, heart failure may occur, leading to death.
③ Syphilitic coronary artery stenosis or obstruction: manifested by pain in the middle of the chest, similar to angina pectoris, but the attack lasts longer and worsens at night. It is not well responded to nitrites, and in a few cases, death may occur shortly after the onset of symptoms.
④ Syphilitic aortic aneurysm: Some aortic aneurysms have no symptoms and signs when they are not ruptured. When they grow to a certain size, they can compress nearby tissues and organs, such as chest pain, cough, dysphagia, and asthma caused by compression of the pulmonary artery. Hoarseness can occur when the left recurrent laryngeal nerve is compressed. Upper abdominal pain can occur when the spine or other organs are compressed. Compression of the superior vena cava can cause congestion of the head and neck veins and change to bluish purple. In severe cases, the aneurysm can rupture, resulting in compression of the heart and sudden death.
⑤ Myocardial gumma: Very rare, gumma varies in size and is divided into two types: localized and diffuse. The localized type usually has no obvious clinical symptoms and is difficult to diagnose before death. The diffuse type often leads to uncontrollable heart failure and dyspnea.
(4) Neurosyphilis
The incidence rate is 10%, and it usually occurs 3 to 20 years after infection. Common symptoms include headache, mental and behavioral abnormalities, cognitive decline, memory loss, hemiplegia, impaired or lost language comprehension and use, limb coordination disorders that cannot maintain body balance, epilepsy, and uncontrolled urination and defecation. Those with spinal cord involvement may develop tabes dorsalis, which manifests as lightning-like pain in the lower limbs, paresthesia, pain when touched, and difficulty in sensing temperature.
4. Latent syphilis
If a patient has a history of syphilis infection and has not been treated or has been treated inadequately, the patient may experience complete disappearance of symptoms, and a positive result from a syphilis serological test, with normal cerebrospinal fluid examination, indicating latent syphilis. Early latent syphilis refers to infection periods of less than 2 years, and late latent syphilis refers to infection periods of more than 2 years. Latent syphilis may relapse. If latent syphilis is not treated, it may progress to tertiary syphilis.
5. Congenital syphilis
When a mother has syphilis and transmits it to the fetus or newborn during pregnancy or delivery, it is called congenital syphilis. Congenital syphilis increases the risk of neonatal death and complications. Such newborns are often premature, with poor development and nutrition, thinness, loose skin, and look like old people. They cry weakly and hoarsely and are restless. The following damage may also occur:
(1) Skin and mucous membrane damage
It usually appears 3 weeks after birth, but sometimes it appears right after birth. Various types of rashes appear on the palms, soles, and other parts of the body, and cracks often form around the mouth and anus.
(2) Syphilitic rhinitis
It usually occurs within 1 to 2 months after birth. The nasal mucosa ulcers, discharge bloody and viscous secretions, block the nostrils and cause breathing and sucking difficulties. In severe cases, the nasal septum may be perforated, the bridge of the nose may collapse, and a saddle nose may form.
(3) Bone syphilis
The more common ones include osteochondritis, osteomyelitis, periostitis, etc. Children suffer from limb pain and cannot move.
(4) Other damages
Lymph node enlargement, hepatosplenomegaly, anemia, poor growth and development, etc.
complication
1. Mucosal lesions can easily develop into chronic interstitial glossitis, a precancerous lesion that should be strictly observed.
2. Cardiovascular diseases may lead to simple aortitis, aortic valve insufficiency, myocardial infarction, aortic aneurysm or sudden death.
3. Neurosyphilis develops slowly and may cause spinal meningitis, which may compress the spinal cord and cause convulsions and paralysis.
examine
Estimated inspection
Patients who have unsafe sexual contact with patients suspected of syphilis, or who have ulcers, rashes, and other suspected syphilis symptoms in their genital area should seek medical attention promptly. The doctor will first conduct a detailed physical examination of the patient to gain a preliminary understanding of the condition, and then may recommend dark field microscopy, silver staining, nucleic acid amplification test, non-syphilis treponemal serum test, syphilis treponemal serum test, cerebrospinal fluid examination, and X-ray, CT, and MRI examinations, etc., to further understand the syphilis infection and severity in detail, and to help clarify the diagnosis.
Physical examination
Doctors usually conduct a comprehensive examination of patients. Generally, they will first examine the skin and mucous membranes of the vulva, anus, mouth and other parts of the body to see if there are any abnormal manifestations such as rashes, ulcers, white spots, etc., and then examine the lymphatic, bone, eye, cardiovascular, and nervous systems to determine whether there are any tissue or organ lesions, so as to preliminarily judge the development of the patient’s condition.
Laboratory tests
1. Dark field microscopy
This test is mainly used to directly find Treponema pallidum. The doctor will take samples from the patient’s skin and mucosal lesions such as chancres and flat warts, such as skin lesion exudate or lymph node puncture fluid, and observe them under a dark field microscope. Since Treponema pallidum has a special morphology and unique movement mode in the dark field, if active Treponema pallidum can be observed, it can be used as a strong basis for the early diagnosis of syphilis, especially in the chancre stage of primary syphilis. This test has a high diagnostic value. However, its positive rate is affected by many factors such as the sampling site, timing, and the experience of the inspector. Professional and meticulous operation and judgment are required to ensure the accuracy and reliability of the test results, providing key clues for the early diagnosis of syphilis.
2. Silver staining inspection
Based on the silver affinity of Treponema pallidum, silver staining can dye Treponema pallidum brown, which can be clearly seen under an ordinary optical microscope. This inspection method is suitable for situations where the number of Treponema pallidum is relatively small or dark field microscopy is difficult to carry out. Although its specificity is high, its sensitivity is relatively low and false negative results may occur. Therefore, in clinical applications, it is often necessary to combine other inspection methods for comprehensive judgment to make up for its shortcomings, improve the accuracy of syphilis diagnosis, avoid delays in the disease or misdiagnosis due to misleading single inspection results, and buy time and provide protection for the correct treatment of patients.
3. Nucleic acid amplification test
The nucleic acid amplification test diagnoses syphilis by detecting the specific nucleic acid sequence of Treponema pallidum. It has high sensitivity and specificity, and can accurately detect the presence of Treponema pallidum when the number is small. It can be tested on various clinical specimens such as blood, skin lesions, and amniotic fluid. This test can not only be used for the early diagnosis of syphilis, but also for monitoring the treatment effect and diagnosing congenital syphilis. In the diagnosis of congenital syphilis, nucleic acid amplification tests on amniotic fluid or neonatal serum can quickly and accurately determine whether the fetus or newborn is infected with Treponema pallidum, which helps to take appropriate treatment measures in time, reduce the harm of congenital syphilis to the health of newborns, and protect the health of mothers and children. It also provides important technical support for the clinical diagnosis and treatment of syphilis and epidemiological research.
4. Non-treponemal serological test
This test uses cardiolipin, lecithin and cholesterol as antigens to detect anti-cardiolipin antibodies in serum. Commonly used tests include the rapid plasma reagin ring card test (RPR) and the toluidine red unheated serological test (TRUST). This test is relatively simple to operate and can be used for semi-quantitative testing. It is of great significance in the screening of syphilis and the observation of therapeutic effects. If a patient is infected with syphilis, the antibody titer will usually increase as the disease progresses, and will gradually decrease after effective treatment, thus providing an important reference for doctors to judge the changes in the disease and the effect of treatment.
5. Syphilis Treponema Serological Test
This test uses Treponema pallidum antigens to detect specific antibodies in serum, such as Treponema pallidum particle agglutination test (TPPA) and Treponema pallidum enzyme-linked immunosorbent assay (TP-ELISA). It has a high specificity, and once a positive test is detected, syphilis infection can be basically confirmed. However, this specific antibody often exists for life after it is produced in the patient’s body, so this test is mainly used to determine whether the patient is infected with syphilis, and it is difficult to distinguish whether it is a past infection or a current infection. It plays an indispensable and key role in the diagnosis process of syphilis, helping doctors to accurately diagnose the disease and lay the foundation for the subsequent formulation of personalized treatment plans.
6. Cerebrospinal fluid examination
It is mainly applicable to cases where neurosyphilis is suspected, such as when the patient has neurological symptoms such as headache, visual impairment, hearing loss, limb movement disorders, or when the syphilis serological test is positive. The examination includes cell counting and classification, protein quantification, and syphilis serological tests (such as VDRL). The number of white blood cells in normal cerebrospinal fluid generally has a certain range. Patients with neurosyphilis may have an increase in the number of white blood cells, mainly lymphocytes, and the protein content may also be increased. The positive results of syphilis serological tests in cerebrospinal fluid are extremely valuable for the diagnosis of neurosyphilis, and can help doctors determine whether neurosyphilis exists, so as to adjust the treatment strategy in time, prevent further damage to the nervous system, and protect the patient’s nervous system function and overall health.
Imaging tests
If necessary, X-rays, cardiac ultrasound, CT and MRI examinations may be required to check for bone, heart and nervous system lesions.
Pathological examination
The doctor may take tissue from the lesion and send it to the pathology department for examination, which can be used to differentiate it from other similar skin diseases. The basic histopathological changes of syphilis are endovascular inflammation and perivascular inflammation, which are manifested by swelling and hyperplasia of vascular endothelial cells and infiltration of a large number of lymphocytes and plasma cells around the blood vessels; tertiary syphilis is mainly granulomatous lesions with central necrosis and infiltration of a large number of plasma cells and lymphocytes around the periphery, accompanied by infiltration of a large number of epithelial cells and giant cells.
diagnosis
Diagnostic principles
Doctors usually make a clear diagnosis and stage it based on a history of clear or suspected syphilis infection, combined with clinical manifestations and results of physical examinations, laboratory tests, and other tests.
Differential Diagnosis
1. The chancre of primary syphilis should be differentiated from vulvar ulcers of Behcet’s disease, tuberculous ulcers, simple vulvar ulcers and even vulvar cancer. The chancre is single, large, painless and hard like cartilage. Treponema pallidum can be found in the secretions of the lesion. The serum reaction is positive two weeks after the appearance of the chancre, and a biopsy can be taken for pathological examination to confirm the diagnosis.
2. The mucocutaneous rash of secondary syphilis should be differentiated from allergic drug eruptions, psoriasis, and tinea corporis. The former has no history of medication and genital ulcers before the rash appears, which can be differentiated with the help of syphilis serum test.
3. The aorta, heart, and nervous system diseases of tertiary syphilis need to be differentiated from those caused by other diseases. This can be done based on the medical history, the presence or absence of clinical manifestations of primary and secondary syphilis, and syphilis serum tests.
treat
Treatment principles
Syphilis is treated with penicillin, which should be used early, in sufficient amounts, and in a standardized manner. During treatment, doctors may ask patients to undergo blood tests to ensure that antibiotic treatment has had the desired effect. Doctors usually ask patients to inform their sexual partners of their condition, and their sexual partners should be examined and treated at the same time. In addition, doctors may also recommend that patients avoid sexual contact during treatment until blood tests confirm that the patient has been cured.
Drug treatment
1. Penicillins are the first choice for treating syphilis. Commonly used drugs include benzathine penicillin, procaine aqueous penicillin G, and aqueous penicillin G.
2. People who are allergic to penicillin must inform their doctors in advance. Doctors usually choose ceftriaxone sodium as an alternative drug, and sometimes recommend tetracyclines and macrolides, but the efficacy is poorer than penicillin. Pregnant women, children, and people with liver and kidney dysfunction are prohibited from using tetracycline drugs.
3. For those who are resistant to penicillin, if the drug does not work well after taking it, the doctor may recommend corresponding tests to identify better alternative drugs.
4. For different stages of syphilis, doctors will adopt different drug treatment plans based on the patient’s condition, with different drug types, usage, and dosage.
Related drugs
Benzathine penicillin, procaine aqueous penicillin G, aqueous penicillin G, Longdan Xiegan pills, Dabaidu capsules, Bazhen pills
Surgery
No surgical treatment is required.
Traditional Chinese Medicine Treatment
Syphilis is called “Yangmei sore” in traditional Chinese medicine. In clinical practice, Chinese medicine doctors will make a diagnosis and treatment based on clinical manifestations. In the early stage, it is due to excess of evil qi, so it is advisable to clear away heat, detoxify and eliminate evil; in the late stage, it is due to deficiency of righteous qi, so it is advisable to strengthen the righteous qi and eliminate evil.
1. Damp-heat syndrome of liver meridian
(1) Symptoms: Mostly seen in primary syphilis, vulvar scurvy, red and hard, ulcerated and moist, or accompanied by horizontal ulcers; accompanied by irritability, bitter taste in the mouth, yellow urine and hard stools. The tongue is red with a yellow and greasy coating, and the pulse is slippery and rapid.
(2) Treatment method: Clear away heat and dampness, detoxify and expel syphilis.
(3) Prescription: Longdan Xiegan Decoction with modifications. Chinese patent medicines such as Longdan Xiegan Pills can be used.
2. Blood heat and toxic accumulation syndrome
(1) Symptoms: Most common in secondary syphilis. Macules, maculopapular rashes, papules, palmoplantar erythema, flat condyloma, etc. appear all over the body. The macules are red like roses, painless and itchy, or pustules and scales may be seen; accompanied by dry mouth and throat, sores in the mouth and tongue, and constipation. The tongue is red, with a thin yellow or scanty coating, and a smooth or fine pulse.
(2) Treatment method: Cool blood, detoxify, clear heat and resolve stagnation.
(3) Prescriptions: Qingying Decoction combined with Taohong Siwu Decoction with modifications. Chinese patent medicines such as Dabaidu Capsules can be used.
3. Qi and blood deficiency syndrome
(1) Symptoms: Mostly seen in cases with a long course of illness, with ulcers breaking, blisters on the skin, sloughing off of the flesh, and not healing for a long time; accompanied by muscle and bone pain. The tongue is pale with white fur, and the pulse is thin and weak.
(2) Treatment method: Replenish Qi and nourish blood, strengthen the body and consolidate the foundation.
(3) Prescriptions: Shiquan Dabu Pills with modifications. Chinese patent medicines such as Bazhen Pills can be used.
Treatment cycle
The treatment cycle is generally >3 months. The specific course of treatment is affected by factors such as disease stage, symptom severity, treatment plan, treatment timing, age and physical condition, and there are obvious individual differences.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General Prognosis
Syphilis is an infectious disease that cannot heal itself and must be treated reasonably. Antibiotic treatment is effective for all stages of syphilis. Early syphilis can usually be cured, but the damage already caused by late syphilis is difficult to reverse.
Hazards
1. Syphilis is highly contagious and can be transmitted to others. Infected pregnant women can also transmit syphilis to their children.
2. If a pregnant woman has syphilis, the Treponema pallidum may infect the fetus through the placenta. If not treated in time, it will significantly increase the risk of miscarriage, intrauterine fetal death, premature birth, neonatal death and various congenital syphilis complications.
3. Without timely intervention, syphilis can spread to multiple systems and cause serious complications, such as neurosyphilis and cardiac syphilis. Patients may experience vision and motor function impairment in the later stages, which can be fatal in severe cases.
4. Syphilis, as a sexually transmitted disease, can cause great psychological pressure on patients.
Self-healing
Syphilis cannot be cured on its own and must be controlled through antibiotic treatment. Even if some wounds have healed on their own, the pathogens are still latent in the body and are still contagious, or there are intermittent outbreaks.
Curative
Different types of syphilis have different prognoses:
1. Early syphilis, that is, patients diagnosed with primary or secondary syphilis, without other systemic diseases, can be cured if they receive timely and appropriate treatment.
2. Late-stage syphilis has a bleak prognosis and often affects the internal organs, affecting organ function and thus life and even life, and is the main cause of death. Treatment cannot reverse the organic damage that has already occurred.
3. Latent syphilis can last for years or even decades without showing clinical symptoms, but if not diagnosed or treated in time, it may progress to tertiary syphilis at any time in life, causing damage to multiple systems or multiple organ tissues throughout the body, leading to organ dysfunction and even life-threatening.
Cure rate
Due to the lack of large sample data statistics, early syphilis can generally be cured.
Radical
Early syphilis can be cured through scientific and thorough treatment and follow-up examinations, and the patient will be the same as a normal person after recovery. However, the damage caused by late syphilis is difficult to reverse.
Recurrent
1. Although a small number of cases have no clinical symptoms, due to incomplete treatment, Treponema pallidum is still latent in the body and there is a possibility of recurrence.
2. After being cured, some patients may be infected with syphilis again due to lack of scientific protection.
daily
Overview
Syphilis patients should strictly follow the doctor’s instructions to take medicine on a daily basis to avoid worsening of syphilis or incomplete treatment. They should also follow the doctor’s instructions for regular checkups to monitor the treatment effect. They should also do a good job of personal hygiene care and isolation to prevent the spread of the disease.
Psychological care
1. Psychological characteristics
(1) Inferiority and discrimination: After being infected, many syphilis patients are afraid of being found out by their family, being looked down upon by friends and colleagues, and worrying about being scolded and discriminated against. They are under tremendous psychological pressure and are unable to face their illness and refuse professional treatment, which delays treatment, is detrimental to the effectiveness of clinical treatment, and seriously affects their normal life and work.
(2) Fear and terror: Syphilis is highly contagious and can be passed on to the next generation and possibly to people around them. Therefore, syphilis patients are often very worried and fearful after being diagnosed. On the one hand, most syphilis patients have a shallow understanding of syphilis and mistakenly believe that it is a disease that is difficult to control. Therefore, they remain in a state of tension for a long time. On the other hand, syphilis patients worry that their family and friends will stay away from them and that they will be ignored and isolated.
(3) Feelings of loss and doubt: Most patients are young and middle-aged. Syphilis infection has seriously affected their social status, economic income, and normal sexual life. They are often very depressed and negative and do not recognize their own value. When they are depressed, syphilis patients are very anxious and very sensitive to things around them. When they hear people around them whispering, they often think that they are pointing the finger at themselves and are discussing themselves.
(4) Self-guilt and negative mentality: Most syphilis patients are infected due to promiscuity or unclean sexual life, so they have a sense of guilt and a heavy mental burden. Coupled with the social discrimination against syphilis, syphilis patients feel that they deserve it. In addition, due to the prejudice of patients’ relatives, colleagues, and friends against syphilis, they are often very indifferent and alienated from patients, and some even cut off contact with them, making syphilis patients feel abandoned and very lonely and helpless. At the same time, this negative thought accumulates in the heart for a long time, causing patients to feel uneasy, which is not conducive to clinical treatment.
2. Nursing points
(1) Patients and their families should learn about the meaning, progression and transmission of syphilis, view the disease correctly, and enhance patients’ courage and self-confidence in facing the disease.
(2) Family members and nursing staff should listen patiently to the patient’s inner pain, comfort and guide the patient with great enthusiasm, and encourage them to vent their inner emotions through the right channels. For individual patients with extreme behaviors, they need to be treated with tolerance and tolerance, and through active communication and exchanges, they can make the patient realize the mistakes of their negative emotions and behaviors. At the same time, help them to face the current situation positively. Fully respect the patient and keep the patient’s confidentiality.
Postoperative Care
Follow the doctor’s advice to go to the hospital for antibiotic injections. Do not stop taking the medicine midway to avoid affecting the treatment effect and causing incomplete treatment. After injecting the medicine, pay attention to any adverse reactions. If there are any abnormalities, inform the doctor in time and take relevant measures.
Life Management
1. Maintain a regular work and rest schedule, ensure adequate sleep, combine work and rest, and avoid excessive fatigue.
2. Pay attention to self-protection to prevent trauma and bleeding. If bleeding occurs, stop the bleeding in time, and disinfect and isolate yourself to prevent infection.
3. Engage in appropriate physical exercise to strengthen your physical fitness and improve your body’s immunity.
Disease monitoring
1. Symptom monitoring
If a male patient has a new ulcer on the penis, glans, or on one or both sides of the vulva, and it feels hard to the touch and is basically painless when pressed, it may be a manifestation of syphilitic chancre. Be alert to recurrence and seek medical attention immediately to clarify the condition. Patients with a course of more than 1 year, recurrent patients, and patients with abnormal vision or hearing should undergo cerebrospinal fluid examination to determine whether neurosyphilis exists.
2. Monitor the effect of medication
Patients may experience side effects such as fever, headache, joint or muscle pain, nausea, chills, etc. after using penicillin or other antibiotics. In severe cases, they need to seek medical attention in time for appropriate diagnosis and treatment, and adjust the medication plan in time.
Follow-up consultation instructions
After adequate and regular treatment of syphilis, patients should be followed up regularly, including a full physical examination and reexamination of non-treponemal serological tests.
1. Early syphilis
It is recommended to follow up for 2 to 3 years, with a review every 3 months after the first treatment, then every 3 months, and every 6 months after 1 year.
2. Late syphilis
Follow-up is required for 3 years or longer, every 3 months in the first year and every 6 months thereafter.
diet
Diet
Patients with syphilis generally do not need a special diet, but appropriate changes in diet may help control and recover from the disease and avoid worsening symptoms.
Dietary advice
1. The diet should be light and easy to digest.
2. Eat more protein-rich foods, such as lean meat, fish, milk, beans, etc.
3. Eat more fresh vegetables, such as cucumber, loofah, bitter gourd, etc.
4. Eat more fresh fruits, such as bananas, pears, apples, etc.
Dietary taboos
1. Avoid smoking, drinking and coffee.
2. Avoid spicy foods, such as chili peppers, pepper, onions, etc.
3. Try to avoid raw, cold foods, such as cold drinks, ice cream, etc.
prevention
Precautions
Syphilis can be prevented by cutting off the route of transmission.
1. Avoid risky sexual behaviors
(1) Maintain a single, fixed sexual partner and do not have sexual relations with infected people.
(2) Have protected sex and use condoms safely and scientifically.
(3) All suspected patients should undergo preventive screening and syphilis serological tests to facilitate early detection and timely treatment.
2. Prevention of congenital syphilis
Strengthen premarital and prenatal examinations to prevent the occurrence of congenital syphilis. Pregnant women infected with syphilis can transmit syphilis to the fetus in the womb through the placenta, and may also infect the newborn through the birth canal. All pregnant women should undergo syphilis serological screening during the first obstetric examination after pregnancy, and it is best to start the first obstetric examination within 3 months of pregnancy. Pregnant women in areas with high incidence of syphilis or pregnant women at high risk of syphilis need to be screened again in the last 3 months of pregnancy and before delivery.
3. Others
(1) Develop good hygiene habits. Do not bathe in public baths that do not guarantee hygiene, and do not share towels, razors, tableware, etc. with others.
(2) Pay attention to the risk factors of blood-borne diseases, strictly prohibit sharing syringes for injecting drugs, and avoid unhygienic tattoos.
Medical Guide
Outpatient Indications
1. The sexual partner is found to be infected with syphilis or the result of the Treponema pallidum serum test is positive during the physical examination.
2. Suspicious erythema, rashes, ulcers, etc. appear in the reproductive organs and other parts.
3. Other severe, persistent or progressive symptoms and signs occur.
If the above situation occurs, seek medical treatment immediately.
Department
The first department to see is the Department of Venereological Diseases.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. The doctor may examine the external genitalia, skin lesions, etc. Wear easy-to-put-on-and-off clothes to facilitate the examination.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can carry the medicine box.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Have you ever had unclean sex?
4. Does your sexual partner have similar situations?
5. Have you ever had a blood transfusion? Have you ever shared a syringe with others?
6. Have you ever had similar symptoms before?
7. Have you ever been treated before? How was it treated? What was the effect?
8. Are you taking any medication?
Questions Patients Can Ask
1. Is my condition serious? Can it be cured?
2. What disease do I have? How is it transmitted?
3. How should I be treated? Do I need to be hospitalized? How long will it take to recover?
4. Are there any risks with these treatments?
5. If you take medication, what are the usage, dosage, and precautions?
6. What tests do I need to take? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. If I am pregnant, could I infect my baby?
9. Do I need follow-up examinations? How often?