梅 毒Syphilis

Syphilis is a chronic sexually transmitted d

isease caused by the spirochete Treponema pal

lidum.It can effect any organizations and tissu

es. Early syphilis mainly effect skin and muco

us membrane.Late syphilis always effect cardi

ovascular system and nervous system besides s

kin and mucous membrane 。 It can appear div

erse sings and symptoms 。

definition

pathogen ： treponema pallidumThe motility is consisting of three movements by darkfield microscopy:•a projection in the direction of the long axis•a rotation on its long axis

•a bending or twisting from side to side.

etiology

Treponema is not easy to survive in vitro

boil

dry

soapsuds

common antiseptic (bichloride

carbolic acid, alcohol,et)

existing conditions

}Can kill the pathogen

★The primary mode of transmission :sexual contact

★The next most common is transfer across the placent

a

★ Blood transfusion

★Others ： Kissing 、 suckling 、 contacting the blo

od, secretion,dunnage (clothes, towel, razor, table dinn

er service, cigarette holder,et)of the patients

transmission and epidemic

acquired syphilis1 ． early syphilis （ <2years ）： primary syphilis 、secondary syphilis2 ． secondary syphilis （ >2years ） or tertiary syphilis ： tertiary cutaneous syphilis 、 late osseous Syphilis 、cardiovascular syphilis 、 neurosyphilis 、 others3. latent syphilis ： early latent syphilis （ <2years ）late latent syphilis （ >2years ）

course and stage of disease

congenital syphilis 1 ． Early congenital syphilis （ age<2years ）2 ． Late congenital syphilis （ age>2years ）3 ． Congenital latent syphilis

The classic lesion of primary syphilis:the chancre

1 ． Appear about 3weeks （ 10 ～ 75days ） af

ter infection

2 ． Often occur at the external genitalia.

Others: on the mouth, tongue, anus, finger

3 ． a single, painless, borderline clear ， nodus

like a bean ， erosion at the surface ， a little ex

udation, a cartilage-like consistency on palpation.

clinical manifestation

4 ． The regional lymphnodes are enlarged.

5 ． darkfield microscopy ： early chancre,often(+)

late chancre, may (-)

6 ． RPR or VDRL ： eraly(-) , late(+)

7 ． If untreated,the chancre tends to heal

spontaneously in 5~7weeks ， then develop to ea

rly latent syphilis .

the skin manifestations of secondary syphi

lis are syphilids1 ． Appear about 10weeks （ 8 ～ 12weeks ） after inf

ection.

2 ． Presymptom :fever 、 acratia 、 headache 、 arthral

gia

myosalgia 、 anorexia.

3. Eruption :macule 、 papule 、 follicular papule or pust

ule. 、 widespread and dense ， symmetrical ， round or

oval ， red copper .

4 ． Not pain or itch.

5.The general lymphnodes are enlarged. 。6.Mucous membrane lesions are present. condyloma flat c

an appear at anus. darkfield microscopy(+)

7.Periostitis,moth-eaten alopecia, iridocyclitis, retinitis, m

eningitis

8.Blood RPR or VDRL(+) 。9.If untreated, lesions tends to heal spontaneously in seve

ral weeks to 2-3months ， then develop to secondary late

nt syphilis

relapsing secondary syphilid1 ． Appear after early syphilid, in 2 years after

infection

2 ． Eruption is the same as early syphilid ，but less ， only on the face or limbs ， or limit

ed on the palms and soles or mucous membrane ， also symmetrical ， annular or arcuate 。

3.Condyloma flat can appear at anus

4.Skeleton diseases or iridocyclitis or retinitis

5.Blood RPR or VDRL(+) 。6.If untreated , lesions tends to heal

spontaneously in several months ， then devel

op to secondary latent syphilis

Tertiary cutaneous syphilis （ syphiloma ）1 ． 2 years after infection.2 ． Eruption: nodus ， several ， often on the face and limbs ， asymmetrical distribution or clustering ， at the beginning is subcutaneous nodule ，one to several,oftenon the head and leg.develop to syphiloma .3 ． Most nodus is arranged to annuliform 、 polynucleation 、 arc ， hard on palpation, diabrosis or not , regular-borderline if diabrosis.

4.Chronic, heal spontaneously in 1-2 years, leave atrophic scar, hyperpigmentation around the lesion.5.Mucous membrane lesions are present, often on the soft palate, uvula, tongue, nasal septum. the lesions may diabrosis 、 perforate or destroy the tissue.6.Blood RPR or VDRL 70 ％ (+).

tertiary syphilis except cutaneous syphilis

1 ． Late osseous syphilis :arthritis 、 periosti

tis 、 osteitis 、 osteomyelitis 、 syphiloma 。2 ． Cardiovascular syphilis :syphilitic aortiti

s 、 aortic aneurysm 、 aortic insufficiency 、coronary artery stenosis or thrombogenesis ，syphiloma 、 microaneurysm of cerebral or fe

moral arteries

3 ． Neurosyphilis ： tabes dorsalis 、 general

paresis ， meningovascular syphilis 、 syphiliti

c meningitis 、 myelitis and asymptomatic neur

osyphilis.

4 ． others ： ocular syphilis:interstitial keratiti

s 、 iridocyclitis 、 scleritis 、 retinitis 、 opti

c neuritis and syphiloma.also can infect liver,ki

dney, gastrointestinal tract, testis and so on.

early latent syphilis（ include primary ,secondary latent syphilis ）1 ． < 2 years after infection.

2 ． Without clinical symptom or sign.

3 ． Blood RPR or VDRL(+).

4 ． CSF(-) 。

Late latent syphilis（ if has tertiary cutaneous syphilis called tertiary latent syphilis)1 ． > 2 years after infection.2 ． Without clinical symptom ， but has left scar of tertiary syphilis. 3 ． Blood RPR or VDRL(+).4 ． CSF(-) （ if CSF abnormal ， called Asymptomatic neurosyphilis).5 ． Chest fluoroscopy to except syphilitic aortitis.

early congenital syphilis （ age<2years ）1.Parents has a history of STD （ including a history of abortion 、 premature delivery and fetal death ） .2.Parents’ blood RPR or VDRL(+).3.Crimson or red copper coloured invasion plaque 、 papules around it; Often around the mouth and on the buttocks ， bullae or desquamation on the palm and sole; Condyloma flat can appear at anus when 1~2years old; Paronychia 、 onychia and alopecie 。

4 ． Mucous membrane affected ， with rhinitis or lar

yngitis 。5 ． Chondritis and periostitis （ pseudoparalysis ） o

f long bone ， X-ray examination has diagnostic value 。6 ． General lymphadenectasis ， hepatomegalia 。7 ． Malnutrition ， hypodevelopment ， emaciation.

The skin is pinched and drawn,resembling that of an ol

d man or woman.

8 ． Blood RPR or VDRL(+)

late congenital syphilis （ age>2year

s ）1.Parents has a history of STD （ including a hi

story of abortion 、 premature delivery and feta

l death ）2.Parents’ blood RPR or VDRL(+).

3.Reactive lesions ： skin,mucous membrane, s

keleton,internal organs affected ， similar to th

e late lesion of acquired syphilis.

4 ． Malformation ： palate high and narrow ，Hutchinson’s teeth 、 mulberry molars 、saddle nose 、 nerve deafness 、 saber shins 、the unilateral thickening of the inner third of on

e clavicle 、 rhagades of the lips

5 ． Blood RPR or VDRL(+) 。

latent congenital syphilis

（ early or late ） similar to acquired syphilis

laboratory examination

darkfield microscopy

serological test of syphilis

examination of cerebrospinal fluid

serological test of syphilis

•Nontreponemal antigen testUse an antigen comprising lecithin, cholesterol, and purified cardiolipin to detect an antibody against cardiolipin (reagins) .has high diagnostic sensitivity but low diagnostic specificity .As a screening and quantitative test.To observe therapeutic effect 、 relapse and reinfection 。1.Venereal Disease Research Laboratory(VDRL)2.Rapid Plasma Reagin Test (RPR).3.Unheated Serum Reagin Test (USR)

•treponemal antigen test Use the Treponema or components of it as an antigen to detect an antibody against Treponema. High sensitivity and specificity .To confirm the diagnosis.1.Fluorescent Treponemal Antibody Absorption Test(FTA-ABS)2.Treponema Pallidum Hemagglutination Test (TPHA)3.Treponema Pallidum Immobilizing Test (TPI)Most widely used are RPR and TPHA

The reasons for false –positive test results ：Technical false-positive ： sample has bacterial contamination or haematolysisbad quality of reagent mistaken technique

Biologic false-positive ：Infectious diseases :recurrent fever 、 malaria 、 Assam fever 、 tyhpus fever 、 tuberculosis 、 leprosis Collagen diseases :SLE 、 rheumatoid arthritis 、 polyarteritis nodosaHeroin addiction ， some pregnant women and aged people

The reasons for false –negtive test results:

★early syphilis:serum antibody agai

nst cardiolipin has not form

★Late syphilis

★prozone phenomenon

prozone phenomenon patients with very high antibody titers may

have a false negative result when undiluted

serum is tested.The prozone phenomenon w

ill be overcome by diluting the serum.

The diagnosis of syphilis depends o

n clinical findings, examination of le

sion material for treponemes, and/o

r serologic,CSF tests for syphilis.

The diagnose must be cautious.

diagnose and differential diagnosis

therapeutic principle ：early ， sufficient

treatment by rule

find the infective partner and treatment toget

her

sexual intercourse forbidden during treatmen

t

regular follow-up after treatment

prevention

treatment1 ． Early syphilis （ primary 、 secondary 、early latent syphilis ）1) ． procaine penicillin G 0.8mU im qd*10d ，8mU total. 。2) ． Benzathini Benzylpenicilinum 2.4mU im once3) ． penicilin-allergic patients①deoxycycline 100mg ， bid po *14d②tetracycline 500mg ， qid po *14d

③erythrocin 500mg ， qid po *14d

2 ． Relapsing secondary syphilis and late syphilis （ including late latent syphilis ）1) ． procaine penicillin G. 0.8mU im qd*15d ， also can repeat a course of treatment after 2 weeks2) ． Benzathini Benzylpenicilinum2.4mU,im qw*3（ except cardiovascular syphilis ）3) ． penicilin-allergic patients①deoxycycline 100mg bid po *30d②tetracycline 500mg qid po *30d③erythrocin 500mg qid po *30d

3 ． neurosyphilis1) ． aqueous penicillin G 12~24mU ivgtt(2~4mU q4h) *10d 。 benzathine benzylpenicillin G 2.4mU im qw*3 following it2) ． procaine benzylpenicillin G 2.4mU im qd and probenecid 0.5g qid po*10d 。 benzathine benzylpenicillin G 2.4mU im qw*3 following it 3) ． penicilin-allergic patients Tetracycline 500mg qid po×30d To avoid the Jarisch-Herxheimer Reaction by pretreatment with prednisone (5mg qid po*3d) before one day of the injection of penicilin in cardiovascular syphilis and neurosyphilis

4 ． Pregnancy syphilisAt the first 3 months of pregnancy

procaine penicillin G. o.8mU im qd*10dAt the last 3 months of pregnancy

repeat a course of treatmentpenicilin-allergic patients

erythrocin 500mg ， qid po *14dTetracycline forbidden

5 ． Congenital syphilisProcaine penicillinG ， 5oooou/kg/d*10dTotal amount<adult (except late congenital sy

philis) 。 Tetracycline forbidden in the children<8 yea

rs

follow upFollow up 2-3 years after treatmentTesting is repeated every 3 months in the first year,every 6 months laterIncluding clinical examination and blood RPR or VDRL testIf recurrence : including syphilitic lesions and RPR(+) retreatmentcongenital syphilis or other late late syphilis: If Serofast ,does not need retreatment if has treat sufficiently