primary syphilis
Introduction
Introduction to the first phase of syphilis Syphilis is a chronic systemic sexually transmitted disease caused by infection with Treponema pallidum, which is mainly transmitted through sexual intercourse. The disease is extremely complex and can almost invade all organs of the body, causing damage to multiple organs. Such as the first stage syphilis infection ulcer or hard sputum; secondary syphilis skin mucosal damage and lymphadenopathy; third syphilis heart, nerves, stomach, eyes, ear involvement and gum damage, etc., syphilis can also be transmitted through the placenta The next generation, causing congenital syphilis in newborns, is extremely harmful. After syphilis invades the human body, after 2 to 3 weeks of 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 in rabbits proves that the initial histological feature of syphilis is mononuclear cell infiltration. On the sixth day of infection, lymphocytes infiltrate and reach a peak in 13 days. Macrophages appear, and the lymphocytes infiltrated in the lesion are mainly T cells. At this time, Treponema pallidum is found in the epithelial cell space 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. basic knowledge Sickness ratio: 0.001%-0.01% Susceptible people: no special people Mode of transmission: sexual transmission Complications: aortic regurgitation myocardial infarction
Cause
Primary syphilis cause
Sexual contact (30%):
This is the main source of infection for the source of syphilis. Untreated syphilis patients have the strongest contagiousness within 1 year after infection with syphilis. As the disease progresses, the infection becomes smaller and smaller. By 4 years after infection, it is generally not contagious through sexual contact.
Placental infection (10%):
Pregnant women with syphilis can get the fetus through the placenta. It is generally believed that the main cause of syphilis occurs after 4 months of pregnancy. Women who have not been treated for more than 4 years with syphilis, although they have sexual contact, are generally not infected, but can still be transmitted to the fetus during pregnancy. The longer the disease, the less contagious.
Bad health habits (20%):
The cause of syphilis can be transmitted through routes other than sexual contact, such as kissing and breastfeeding; daily necessities such as clothes, towels, razors, tableware, and cigarette holders can also be transmitted by contact with patients with infectious damage.
Blood infection (20%):
Syphilis patients, latent syphilis and hidden syphilis sera are contagious and can infect others through blood transfusions and sharing needles.
Prevention
Primary 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 can not marry without being cured.
Complication
Primary syphilis complications Complications aortic valve insufficiency myocardial infarction
1. Mucosal lesions are easy to develop into chronic interstitial glossitis, which is a kind of precancerous lesion and should be strictly observed.
2. syphilitic cardiovascular disease may occur in 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 spasm.
4. syphilitic osteochondritis: mainly found in the baby half a year after birth, the bacteria often invade the metaphysis of the long bones of the limbs, and form syphilitic granuloma locally, destroying the epiphyseal line, thus preventing bone development.
Symptom
Symptoms of primary syphilis Common symptoms Lymph node enlargement
The incubation period averages 3-4 weeks. The typical damage is that the hard chancre has a red papule or induration at the invasion site of the spirochete. Later, it appears as erosion, forming a shallow ulcer, which is hard, painless, and has a round or elliptical shape. The boundary is clear, the edges are neat, the ridge is bulge, the perimeter is surrounded by dark red infiltration, the characteristic cartilage-like hardness, the base is flat, no pus, the surface is attached with fibrin-like film, it is difficult to remove, such as slightly squeezed, there may be a small amount Serous exudate, containing a large number of Treponema pallidum, is an important source of infection, hard sputum mostly single, there are also 2-3, more than the typical hard chancre.
Female hard squats are more common in the size of the labia, clitoris, urethra, pubic lice, especially in the cervix, easy to miss diagnosis.
Hard squats have the following characteristics:
1 damage is often a single;
2 cartilage hardness;
3 does not hurt;
4 The damaged surface is clean.
A week after the appearance 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 sputum (painless lymphadenitis).
Examine
Primary syphilis examination
1. Dark-field microscopy: At the lesion, use a slide to scrape the tissue exudate or lymph node puncture, see the active Treponema pallidum.
2. Immunofluorescence staining: Green Treponema pallidum was observed under a fluorescence microscope.
3. Biopsy of Treponema pallidum, such as silver staining or fluorescent antibody staining, can be found in Treponema pallidum, dark brown, with a spiral structure, located around the dermal capillaries.
4. The unheated serotonin slide test is also an improvement of the VDRL antigen with similar sensitivity and specificity to VDRL.
Diagnosis
Diagnosis and identification of primary syphilis
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis:
Different from the following diseases:
1 genital herpes: the beginning of the micro-convex erythema, 1, 2 days after the formation of clustered small herpes zoster, self-conscious itching, not hard, can be resolved after 1-2 weeks, but easy to relapse, tissue culture is herpes simplex virus, Tzank Smear test positive, PCR detection of herpes virus DNA was positive.
2 sputum-like pyoderma: the pathogen is Staphylococcus aureus or streptococcus, the lesion morphology is similar to that of hard chancre, but there is no typical cartilage-like hardness, no dark red infiltration around, no history of dirty sex, treponema pallidum negative, nearby lymph nodes It is swollen, but the skin lesions fade as they get better.
3 soft squat: also one of sexually transmitted diseases, sexual contact history, caused by Duyley Haemophilus, short incubation period (3-4 days), acute onset, significant inflammation, pain, soft nature, frequent skin lesions, There is purulent discharge on the surface, and Haemophilus ducrei can be detected. The syphilis serum test is negative.
4 tuberculous ulcers: also more common in the penis, glans, skin lesions are also single-shot isolated in the nature of the shape of the ulcer, the surface often crusted, the symptoms are mild, can detect M. tuberculosis, often accompanied by visceral tuberculosis.
5 Behcet's disease: ulcers can occur in the vulva, women can also be seen in the vagina, cervix, deep ulcers, mild itching, damage to the characteristics of hard chancre, often secondary to oral ulcers, eye damage (iris ciliary Stomatitis, anterior chamber empyema, etc., calf nodular erythema and migratory arthritis, syphilis serum reaction was negative.
6 acute female vaginal ulcer: squat type is similar to hard chancre, but not hard, inflammation is significant, pain, secretion can be found in the crude bacillus.
7 fixed drug eruption: can be found in the inner lobe of the penis foreskin, coronary sulcus, etc., is a bright red erythema, can form shallow erosive, self-conscious itch, no pain, no hard chancre, with medication history, syphilis serum reaction negative.
