Syphilis is caused by Treponema pallidum. After the illness, the course of disease is long, involving genitalia and skin in the early stage and whole body organs in the later stage, with various symptoms and signs. Lesions can involve almost all organs of the whole body. Syphilis can spread among people through sexual behavior, and can be transmitted from mother to fetus, endangering the next generation. Very few patients are infected by kissing, breastfeeding and receiving daily necessities from patients with infectious diseases. Among sexually transmitted diseases, the number of syphilis patients is small, but due to its long course and great harm, it should be paid attention to.
Syphilis is an infectious disease of human beings, and there is no Treponema pallidum in animals, so syphilis patients are the only source of infection. During the transmission of syphilis, about 95% of people are infected through sexual behavior, and a very small number of patients get sick through contact with patients' secretions, or close contact with life, blood transfusion, breastfeeding and other ways. It is generally believed that after 4 months of pregnancy, syphilis can be occasionally infected through contact with the daily necessities used by patients. Kissing, breastfeeding and birth canal can all be infected. In addition, it can also be infected through clothes, towels, razors, tableware, cigarette holders, bedding, sheets, door handles, toilets, medical devices and so on. Early syphilis patients contain a large number of treponema pallidum in the secretion of the focus, so it is the most contagious. Through sexual life, pathogens in these secretions can be directly transmitted to each other. Because the human body has no innate immunity to syphilis, a very small amount of treponema pallidum can cause the other person to get sick. In addition, pregnant women with syphilis can transmit pathogens to the fetus through the placenta, leading to congenital syphilis of the fetus. Congenital syphilis refers to syphilis in children that can be caused by intrauterine infection, and the fetus can be infected after 9 weeks of pregnancy. Syphilis can cause damage to all organs and tissues of children, leading to dysfunction or death. The prevention of congenital syphilis is mainly that mothers can get pregnant after using enough penicillin to cure them.
Generally speaking, syphilis is highly contagious in the first 1 ~ 2 years, and patients with primary and secondary syphilis are highly contagious, and there are a large number of treponema pallidum in their skin and mucosa lesions; Early latent syphilis patients are also contagious. With the extension of the course of disease, the infectivity of syphilis gradually decreases. When the course of disease exceeds 2 years, the infectivity of syphilis will gradually weaken. Even if you have sexual contact with untreated syphilis women with a course of more than 2 years, you will generally not be infected. If the course of disease is more than 8 years, its infectivity is extremely small. The human body has no innate immunity to syphilis. Only when there is treponema pallidum in the body can it be immune to this disease. Once Treponema pallidum disappears from the body after treatment, the immunity will also disappear, and when Treponema pallidum is infected again, syphilis will still occur.
Tre-Tre-Ponema Palidum)1905 was discovered and reported by French scientists Schaudinn and Hoffmanu. Treponema pallidum (pictured) is a small and slender spiral microorganism, with a length of 5-20nm, an average of about 8- 10um, a diameter of less than 0.2nm and 6- 12 spirals. Invisible to the naked eye, in the dark field of optical microscope, people can only see the refraction of Treponema pallidum, and its activity is strong. There are 4-6 flagellate fine fiber bundles at the front end, and the ends are curled. When it is not affected by external factors, the spiral is regular. It is also called Treponema pallidum because it is transparent and difficult to be colored. Treponema pallidum is an anaerobic bacterium, which can survive and reproduce in the body for a long time. As long as the conditions are right, it will propagate in two by transverse fracture. Treponema pallidum has weak resistance to the outside world and is sensitive to chemicals, so it is not easy to survive in vitro. It can be easily killed by boiling, drying, soapy water and general disinfectants (such as mercuric chloride, carbolic acid, lysol, alcohol, potassium permanganate solution of 1: 1000, etc.). ), and can be quickly killed by sunlight and dry environment. Treponema pallidum generally does not survive for more than 1 ~ 2 hours outside the human body. It can survive in anoxic environment for several days, on wet clothes for several hours, and generally in blood bank for 24 hours. Treponema pallidum is not resistant to high temperature. It can die within 2 ~ 3 minutes at 40℃ ~ 60℃ and immediately at 100℃. Treponema pallidum can be eliminated according to its weakness. For example, clothes are exposed to the sun and stored in a dry environment; Boiling utensils or disinfecting with chemicals can kill Treponema pallidum and prevent its spread.
According to the different infection routes of syphilis, it can be divided into acquired syphilis and congenital syphilis. Among them, acquired syphilis can be divided into early syphilis (including primary syphilis and secondary syphilis) and late syphilis (that is, tertiary syphilis) according to different stages of lesion development.
Primary syphilis is characterized by painless chancre of vulva. After sexual intercourse, syphilis enters the body, first proliferates locally, causing inflammatory infiltration, and then enters lymphatic vessels. Within a few hours, it can soak into nearby lymph nodes and enter the blood. After dozens of hours, it can appear in bone marrow, spleen, testis and other places, and soon spread to the whole body. It usually occurs after unclean sexual intercourse 10 ~ 60 days, with an average of 2 1 day. At first, the vulva appeared dark red punctate papules or erythema the size of rice grains, and then it swelled to form induration as big as beans and fingers, and then the surface of the papules eroded, forming superficial ulcers with serous exudation. This kind of ulcer is generally between 1 ~ 2 cm in diameter, single, round or oval, slightly higher than the skin surface, with neat and clear boundaries, protruding edges and hard and solid quality, so it is called hard chancre, also called incipient sore (pictured). The base of the ulcer is clean without pus, with a small amount of serous exudation and little exudate, which contains a lot of Treponema pallidum. Most spirochetes can be seen in the exudate imprint under the dark field microscope. Male chancre is mainly located in the foreskin, coronary sulcus, frenulum and glans penis; Gay men are common in anus, anal canal or rectum. The common parts of chancre in women are labia majora, labia minora, clitoris, vaginal vestibule and cervix. , accounting for more than 95%, sometimes occurs in the anus, lips, breasts and other parts. Initial sore is the earliest skin injury after Treponema pallidum infects human body, and the site where it occurs is the site where Treponema pallidum invades. Atypical chancre can appear after receiving insufficient anti-plum therapy or local medication. The chancre is itchy, painless and tenderness-free, as hard as cartilage, which destroys the surface cleanliness. Without treatment, it can heal itself within 3-8 weeks, leaving no scars or superficial scars, mild atrophic scars or pigmentation. But this does not mean that syphilis has been cured, but is in the incubation period of entering the second stage of syphilis, and will enter the second stage of syphilis after a period of time. If diagnosis and adequate treatment can be made in time during this period, the goal of complete cure will soon be achieved, and the condition is generally good after recovery. At the early stage of chancre, most patients were positive for syphilis, and then the positive rate gradually increased. After 7-8 weeks of chancre, all patients were positive for syphilis.
Often accompanied by painless enlargement of inguinal lymph nodes. A few days after chancre appeared, one inguinal lymph node was swollen, and then the other side was swollen. The characteristics of these lymph nodes are as follows: ① Finger-sized hard objects are scattered and do not merge with each other; ② No pain or tenderness; ③ There is no inflammation such as redness, swelling and heat on the surface skin; ④ No suppuration; ⑤ The puncture fluid contains spirochetes. The surface is often fleshy red. This problem is highly contagious.
Treponema pallidum enters the blood from the lymph nodes near chancre and spreads all over the body. Generally, it will enter secondary syphilis 2-3 months after infection or 6-8 weeks after chancre disappears. At this time, Treponema pallidum has spread to almost all tissues and organs of the whole body through blood circulation, resulting in systemic syphilis rash, which can cause joint damage, eye lesions, central nervous system damage and so on. Secondary syphilis is the most active stage in the course of syphilis, which is highly contagious.
Symptoms of secondary syphilis:
(1) Skin and mucous membrane damage: 80% ~ 95% patients can appear. Headache, fever, sore throat, general malaise, muscle joint pain, anorexia and other systemic symptoms are common before rash. Syphilis rash mostly occurs in the whole body, and it can appear in many parts such as trunk, limbs, face, palm and sole. There are many forms of rash (rose macula, macula, papule, scaly urine papule, rare folliculitis-like or oyster shell-like lesions, etc. ), the symptoms are mild, the whole body is symmetrically distributed, there is no fusion tendency, the boundary is clear, and it is copper red, generally not itchy or occasionally slightly itchy and painless. The serum reaction was strongly positive. In the process of eruption, there will be painless swelling of superficial lymph nodes in the whole body.
The main forms of rash are as follows:
Class rash type: this type is more common. Mainly in the trunk and the proximal inner side of the limbs. Rashes vary in size, mostly erythema with a diameter of 1-4 cm, often oval or round, copper-red, with clear boundaries, which can naturally subside.
Papular type: this type is easy to see. The rash is about the size of rice grains and soybeans to nails, firm, with obvious infiltration, copper red color, clear boundary, and some scales on the surface, similar to psoriasis, and flexion of trunk, limbs, palms and soles is more common.
Abscess type: This type is rare. Most of them occur in patients with weak body, and the whole body symptoms are serious. Rash is similar to acne, acne-like, oyster shell-like, deep pus herpes-like, leaving scars after healing.
Condyloma plana type: The rash around anus and vulva is mostly condyloma plana or wet papule. Condyloma plana belongs to wet papule syphilis rash. It often occurs at the junction of skin and mucous membrane or the parts where skin is easy to rub, such as between labia majora and labia majora, around anus, inside foreskin, inside thigh, armpit and under breast. Wet papules fuse with each other, and the surface is flat, sometimes verrucous or papillary, and the surface is wet and rotten. A large amount of exudate contains treponema pallidum.
Hair loss type: it often occurs around the hair follicle of temporal bone scalp, with "rat bite (insect erosion)" hair loss, accompanied by central decay, which is diffuse and rare.
Syphilitic leukoplakia: the pigment disappears and lasts for several days. Syphilitic leukoplakia is a mucosal lesion in oral cavity, throat and genitals. It looks like thrush caused by oral candida, which is a slightly convex oval lesion. It is covered with a gray-white film, and there is a glow around it. After the white film is removed, the base is red and does not bleed.
Mucosal injury: one is mucosal swelling, the other is linear erosion, and exudate condenses on its surface to form gray mucosal spots. There are also many opportunities for mucosal rashes, called mucosal spots, which are more common in oral and vaginal mucosa and contain a large number of spirochetes.
(2) Bone and joint injuries: Periostitis and arthritis often occur. Because Treponema pallidum invades bones and joints, there is no obvious inflammation. This period is characterized by increased pain at night and at rest, and less pain during the day and during activities. Most of them occur in the long bones of limbs, but also in the attachment points of skeletal muscles, such as olecranon, iliac crest and mastoid process. There was a violent reaction during the initial treatment.
(3) Secondary eye syphilis: it can cause iriditis, iridocyclitis, retinitis, choroiditis, optic neuritis and other eye diseases.
(4) Central nervous system damage: most of them are asymptomatic neurosyphilis. Although there are no symptoms, there are abnormal changes in cerebrospinal fluid, such as increased protein, increased lymphocyte count, positive VDRL test of cerebrospinal fluid and abnormal colloidal gold curve. Very few people have symptoms such as meningitis, cerebral palsy, cerebral vascular syphilis and meningeal vascular syphilis.
The rash of patients with secondary syphilis can subside spontaneously within a few weeks or 2 ~ 3 months even if it is not treated. About14 patients can relapse after symptoms subside due to incomplete treatment, insufficient dosage of therapeutic drugs or decreased immunity, which is secondary recurrent syphilis (pictured), usually occurring within 1 ~ 2 years after infection. There may be skin and mucous membrane, eye, bone and viscera injury recurrence, and the most common is skin and mucous membrane recurrence. The damage is similar to secondary syphilis, but the number of rashes is small and the distribution is limited. Aggregation tendency is more obvious and destructive than secondary syphilis, and it is more common in perianal region, umbilical fossa, armpit, pudendum and palm. Serum recurrence is the most common. Serum recurrence is a precursor to other recurrences. When serum recurs, there are no other symptoms, but when there are other recurrences, serum recurrence usually occurs first.
In short, the main manifestations of secondary syphilis can be summarized into three characteristics: flu-like symptoms, syphilis rash, and generalized lymphadenopathy. Syphilis rash is often ignored by patients because it has no obvious pain. If you see a widely distributed and symmetrical rash in clinic with mild symptoms, you should ask the medical history in detail to avoid missed diagnosis. There are many treponema pallidum on the surface of secondary syphilis rash, so it is also the most contagious.
Tertiary syphilis, also known as late syphilis, is mostly developed from early syphilis without treatment or incomplete treatment. It can occur more than 2 years after infection, usually 3 ~ 4 years after infection. The course of disease is long and can last 10 ~ 30 years. About 1/3 untreated secondary syphilis can develop into advanced active syphilis; Another part of patients have no symptoms of late syphilis, but the syphilis serum reaction continues to be positive, which is late latent syphilis; Some patients can heal themselves.
Lesions can not only damage the skin mucosa and cause diseases such as syphilis nodules, swollen gums and nodules near joints, but also invade the nervous system, cardiovascular system, organs and bones, leading to advanced cardiovascular syphilis, bone syphilis, visceral syphilis, eye syphilis, and nervous system syphilis such as paralytic dementia, meningeal vascular syphilis and spinal tuberculosis. Typical manifestations are nodular rash or swelling of mucous membrane and gingival bone, and a few cases are iridocyclitis, retinitis and keratitis. About 15% patients invade skin, soft tissues and bones, 10%-25% invade cardiovascular system, and 10% invade nervous system, which can cause brain parenchymal virus to show measles dementia. Spinal tuberculosis and optic nerve invasion can cause nerve atrophy. Can lead to disability, and serious diseases can be life-threatening.
The infectivity of advanced syphilis is weakened.
Congenital syphilis (fetal syphilis): Treponema pallidum infects the fetus in the uterus through the serum of the placental mother. Divided into two stages:
1) Early congenital syphilis: less than 2 years old, such as early congenital syphilis and early latent syphilis.
2) Late congenital syphilis: older than 2 years old, such as late congenital syphilis and late latent syphilis.
Main clinical symptoms:
Permanent marks left by early injuries are inactive, but will be submitted.
Second, there are still clinical manifestations caused by active injuries: the common ones are substantive keratitis, nervous deafness, hepatosplenomegaly, gingival swelling and periostitis.
Mainly rely on laboratory diagnosis, syphilis serological test and cerebrospinal fluid examination.
If an untreated syphilis woman has been ill for more than 4 years, although it is no longer transmitted through sexual contact, pregnancy can still be passed on to the fetus. The longer the illness lasts, the less contagious it is. Some scholars believe that if mothers with early syphilis (primary and secondary syphilis) are not treated, half of the babies will have fetal syphilis, and the other half will be stillborn or die shortly after delivery; 20% infants of untreated early latent syphilis mothers were normal or healthy, and 20% died; 40% is fetal syphilis; 70% infants of untreated advanced syphilis mothers can be normal or healthy, 10% are fetal syphilis, and the rest can be stillborn or premature infants. The clinical manifestations of early congenital syphilis often appear in the second to sixth week after delivery, with runny nose, stuffy nose and oral mucosa damage. There are often serious visceral injuries and high mortality. Infants suffering from early congenital syphilis are generally malnourished, with many wrinkles on their skin and, in severe cases, old-fashioned faces. And anemia and hepatosplenomegaly.
Latent syphilis is also called latent syphilis. Although the patient did not receive treatment or the treatment dose was insufficient, the clinical symptoms and signs disappeared, but the syphilis serological reaction was still positive, and the patient had no other diseases that could cause false positive serological reaction, and the cerebrospinal fluid examination was normal.
Early latent syphilis occurred within 2 years after infection, and late latent syphilis occurred more than 2 years. The early latent syphilis is still contagious, and the late latent syphilis disappears, but for pregnant women, the patient's treponema pallidum can still be transmitted to the fetus through the placenta. If left untreated, 30% of latent syphilis patients will develop into advanced syphilis.
[Clinical manifestations and diagnostic points]
1. Primary syphilis (chancre)
1) Have a history of unclean sexual intercourse, whoring, spouse infection or homosexuality.
2) The incubation period is 2-4 weeks.
3) The main manifestation is chancre, which is usually single, painless and non-itchy, with clear boundaries, a diameter of 65,438+0-2 cm, a cartilaginous hardness to the touch, erosion or superficial ulcers on the surface, and a large number of treponema pallidum in the exudate.
4) It often occurs in the external genitalia, such as the male coronary sulcus, glans penis, frenum and foreskin, the female labia majora, labia minora, cervix and other parts, and male homosexuals can occur in the perianal region and rectum, and occasionally in the lips and pharynx.
5) Local lymphadenopathy, unilateral or bilateral.
6) Without treatment for 3-8 weeks, the hard solution can disappear naturally, leaving no trace or only slight atrophic scar.
7) The secretion smear was examined by dark field microscope, and most active spirochetes were found. Syphilis blood sperm test: chancre is negative in the early stage, and most patients are positive after 7-8 weeks.
2. Secondary syphilis
1) usually occurs 8- 10 weeks after the first infection or 6-8 weeks after chancre appears.
2) The main manifestations are skin and mucous membrane damage, such as bone and joint damage such as periostitis and joint pain, eye damage such as iriditis and optic neuritis, and occasionally nerve damage such as meningitis.
3) There are many forms of rash, such as macula, maculopapule, papule, pustular herpes, scaly skin lesions, etc. , is often a generalized symmetric distribution. Brown desquamation maculopapules occurring on palms and soles of feet are characteristic.
4) Mucosal injury can be seen in oral cavity, pharynx, larynx and genital mucosa, which is red, swollen and erosive. Verruca plana can occur around anus and external genitalia, and there are a large number of Treponema pallidum in mucosal lesions.
5) Insect-like alopecia can be seen on the scalp, which is common in the temporal region.
6) Superficial lymphadenopathy of the whole body.
7) The mucous membrane damage and secretion smear of condyloma plana were examined by dark field microscope, and most of the active spirochetes and syphilis serum tests were strongly positive.
Secondary recurrent syphilis: If the secondary syphilis is not treated or treated incompletely, it is called secondary recurrent syphilis when the patient's resistance decreases and the secondary damage subsides and reappears. If you don't treat it, you can repeat it many times. This rash is basically the same as the secondary syphilis rash, but the number is reduced and the distribution is limited.
3. Tertiary syphilis (advanced syphilis)
1) has a history of unclean life or spouse infection, and the history of early syphilis is dispensable.
2) Syphilis of skin and mucous membrane
Nodular syphilis rash: common in forehead, limbs and scapula. Most subcutaneous nodules are cut in a circular arrangement and can naturally fade away, leaving atrophic spots.
Gingival swelling: at first, it is a small subcutaneous induration, which gradually increases and adheres to the skin, forming an infiltrating plaque, and the center decomposes to form an ulcer, which is more common in the head, face and calves. When it invades the mucosa of palate and nasal septum, it can cause perforation of nasal septum and saddle nose.
3) Cardiovascular syphilis: 10-20 years after infection, which can cause syphilitic aortitis, aortic valve insufficiency, aortic aneurysm, etc.
4) Neurosyphilis: It occurs 5- 15 years after infection, which can cause syphilis meningitis, spinal tuberculosis and paralytic dementia, and can also have abnormal changes in cerebrospinal fluid without neurological symptoms.
5) Other organs, such as bones, eyes, breathing, digestion and urinary system, can be invaded.
6) Most syphilis serum tests are positive, and a few can be negative.
Cerebrospinal fluid leukocytosis, abnormal biochemical examination and positive syphilis antibody test.
4. Latent syphilis
There is a history of infection, untreated or inadequate treatment, no clinical symptoms and signs, but syphilis serum is positive, except for other diseases that can cause syphilis serum to be positive, cerebrospinal fluid examination is negative, which can be diagnosed as latent syphilis. Those with a course of less than 2 years are called early latent syphilis, and those with a course of more than 2 years are called late latent syphilis.
5. Early congenital syphilis
1) The biological mother has syphilis.
2) Clinical symptoms usually appear in 3 weeks after birth.
3) Early symptoms are rhinitis and pharyngolaryngitis, which may lead to difficulty in breastfeeding due to nasal congestion.
4) There are various skin manifestations, such as maculopapular scaly skin lesions, blisters and bullous skin lesions, condyloma planum-like skin lesions, squabbles, linear chapped skin lesions around anus, senile dry skin wrinkles, accompanied by alopecia, paronychia and onychomycosis. There are mucosal spots in the mouth.
5) The child is thin, the superficial lymphatic line is swollen, the liver and spleen are also swollen, and there are often osteochondritis and periostitis.
6) Secretions, nasal secretions and umbilical cord blood smears of skin and mucous membrane damage were examined by dark field microscope, and spirochete and syphilis serum tests were positive.
6. Late congenital syphilis
Most of them occur in children and adolescence. Children have syphilis teeth (half-moon incisors), solid keratitis and nervous deafness, which are characteristic. Skin mucosal damage is similar to acquired tertiary syphilis, and active damage such as periostitis and hepatosplenomegaly can also occur.
7. Congenital latent syphilis
Congenital syphilis is untreated and has no clinical symptoms. Those with positive syphilis serum are called congenital latent syphilis.
[Syphilis serum test]
1. non-treponema pallidum antigen serum test: taking cardiolipin as antigen, checking anticardiolipin antibody in serum, that is, reactivity, VDRL test, UST test and RPR test belong to this kind of test. These detection methods are simple and easy to popularize, and are often used for routine clinical detection and large-scale census. In addition, these tests can also be quantitatively determined to observe the curative effect and judge whether there is recurrence or reinfection. However, it should be noted that because the antigen used in the detection is non-specific, it is easy to produce false positive results. Some infectious diseases such as viral hepatitis, measles, upper respiratory tract infection, active pulmonary tuberculosis and autoimmune diseases can produce false positive results, but the serum reaction titer is low and the duration is generally short.
2. Serum test of specific antigen of Treponema pallidum: Anti-Treponema pallidum antibody is determined by living or dead Treponema pallidum or its components, and the tests belonging to this category include fluorescent Treponema pallidum absorption test; Treponema pallidum hemagglutination test: this kind of test has strong specificity and can be used as a confirmation test, but it can not be used to observe the curative effect and judge recurrence and reinfection.
[therapy]
Principle: Once the diagnosis is made, the drug should be used early, sufficiently and regularly, and the patients should be followed up regularly after treatment.
You shouldn't have sex during treatment.
Sexual partners receive treatment at the same time.
The treatment of syphilis should be based on the principle of early treatment and adequate medication. During the treatment, patients should pay attention to rest, strengthen nutrition and avoid sexual life.
Penicillin is the first choice for syphilis.
According to the treatment plan formulated by the Department of Health and Epidemic Prevention of the Ministry of Health, the specific methods are as follows:
1. Early syphilis (primary, secondary and early latent syphilis)
1) cyanotoxin
Procaine penicillin G: 800,000 units, intramuscular injection once a day, for a total of 10- 15 days, with a total amount of 8 million-120,000 units.
Benzathine penicillin G (benzathine benzylpenicillin for injection): 2.4 million units, injected into buttocks in two ways, once a week/kloc-0, 2-3 times * *. Still 2.4 million units, a total of 4.8 million a week.
2) people who are allergic to penicillin
Erythromycin: 500mg/ day, 4 times a day for 30 days.
Doxycycline: 100mg orally, twice a day for 30 days.
2. Late syphilis (including tertiary syphilis, secondary recurrent syphilis and late latent syphilis)
1) penicillin
Procaine penicillin G: 800,000 units, intramuscular injection once a day, total 15 days, total120,000 units. The second course of treatment is 2 weeks apart, with a total of 24 million units. Benzathine penicillin G: 2.4 million units, intramuscular injection 1 time ***3 times a week.
2) people who are allergic to penicillin
Tetracycline: 500mg, taken orally four times a day for 30 days.
Erythromycin: 500 mg orally, 4 times a day for 30 days.
Doxycycline: take 100 mg each time, twice a day for 30 days.
3. See the treatment of advanced syphilis for cardiovascular syphilis. If necessary, the number of courses of treatment can be increased, but benzathine G should not be used.
Some patients may have Chi-Hai reaction during the treatment.
This reaction is caused by the massive death of Treponema pallidum and the release of foreign proteins after the application of penicillin. It usually occurs 3- 12 hours after the first injection of penicillin, showing flu-like symptoms and temporary aggravation of the original syphilis damage. When this happens, you can take aspirin O.6g orally, four times a day, and it usually disappears in 1-2 days. For neurosyphilis and cardiovascular syphilis, oral prednisone 5mg can be taken from the day before injection, 4 times a day for 3 consecutive days, which can play a preventive role.
Syphilis with a course of more than two years (advanced epidermis, skeletal syphilis or latent syphilis with uncertain course) and secondary multiple syphilis:
1. Procaine penicillin sodium: 800,000 units per day, 15 days. The total number is 24 million.
Two, benzathine penicillin sodium (benzathine benzylpenicillin for injection) 2.4 million units once or twice, once a week, * * * three times, a total of 7.2 million units.
3. Erythromycin for people allergic to penicillin: take 0.5g orally each time, 4 times a day, and take it continuously for 30 days as a course of treatment.
cardiovascular syphilis
Procaine penicillin sodium
Usage: 15 800,000 units a day. 120,000 units is a course of treatment. If the virus is serious and necessary, the second course of treatment can be carried out after two sides and three knives, and multiple courses can be given.
Second, erythromycin is allergic to penicillin.
Usage: 0 at a time. 5g orally, 4 times a day, 30 days as a course of treatment.
Neurosyphilis
First, use water penicillin.
Intravenous infusion of 4.8 million units every day, 10 day is a course of treatment, and a course of treatment is repeated on the day of drug withdrawal. The total number is 96 million units.
Second, prubenin penicillin.
Usage: intramuscular injection of 2.4 million tablets every day, and oral administration of probenecid, each time 0. 5g, four times a day, *** 10 day. Then, 2.4 million units were injected intramuscularly with benzathine penicillin sodium every week for 3 weeks. In order to avoid fertility, prednisone 1 can be taken orally 0-3 days before penicillin injection, 30-45mg per day for 3-5 days.
(1) Treatment of early syphilis (including primary syphilis, secondary syphilis and latent syphilis with a course of less than 2 years): Benzathine penicillin G 24,000 units, intramuscular injection on both sides of buttocks, once a week 1 time, for 3 weeks; Or procaine penicillin G, intramuscular injection of 800,000 units per day for 10 ~ 15 days, with a total dose of 8 million ~120,000 units.
Those who are allergic to penicillin can take erythromycin orally 500 mg each time, 4 times a day, for a total of 15 days; Or doxycycline 10 0 mg each time, twice a day, for 15 days.
(2) Treatment of advanced syphilis (including tertiary skin, mucous membrane and skeletal syphilis, late latent syphilis or latent syphilis with uncertain disease stage) and secondary recurrent syphilis: procaine penicillin G was injected into muscles at 800,000 units per day for 20 days; Or benzathine penicillin g240,000 units, intramuscular injection 1 time per week, * * * 3 times in a row.
Syphilis and neurosyphilis in the cardiovascular system in the late stage of syphilis should be treated under the guidance of a doctor.
Fetal syphilis:
(1) Early fetal syphilis; ① intramuscular injection of procaine penicillin G at 50000 u/kg per day 1O days; ② Benzathine penicillin G 50000 U/kg, intramuscular injection 1 time.
(2) Late fetal syphilis: ① Procaine penicillin G was injected intramuscularly at 50000 U/kg daily for 10 days. ② Benzathine penicillin 50000 u/kg, intramuscular injection, 1 time (the dosage of penicillin for older children should not exceed that of adult patients in the same period).
Children with early and late fetal syphilis who are allergic to penicillin can choose erythromycin 7.5 ~ 25 mg/kg orally, four times a day.
Chinese medicine treatment:
1. Damp-heat type of liver meridian: exogenous damp-heat caused by yin and toxin, soaked in liver meridian, injecting yin into viscera, blocking qi-flowing, and damp-heat pathogen congealed, resulting in scabies (hard chancre) and horizontal carbuncle. The main symptoms are swelling or hard rash of external genitalia and anus, swollen and hard inguinal lymph nodes, hypochondriac pain, anorexia, greasy urine, constipation, yellow greasy tongue coating and rapid pulse. Treatment of damp-heat in liver meridian should be clear. The prescription is Longdan Xiegan Decoction: Akebia Akebia, Plantago asiatica, Radix Rehmanniae and Rhizoma Smilacis Glabrae each 65438±05g, Radix Gentianae, Scutellariae Radix, Gardenia, Alismatis Rhizoma and Angelica sinensis each 65438±00g, and Glycyrrhiza uralensis 5g.
2. Qi stagnation and phlegm stagnation type: the drugs of epidemic diseases pour down along the liver meridian, agglutinate in the yin organs, the qi and blood are blocked, and phlegm and blood stasis are mixed. The main symptoms are swollen lymph nodes on one or both sides of the groin, hardness without pain, slight fever without redness, chest tightness, bitter taste, red tongue and rapid pulse. More common in the first stage of syphilis. Treatment should be clearing away heat and toxic materials, resolving phlegm and resolving hard mass. The formula of Huang Xi Pill is: bezoar 0.3g, musk 0. 1 g, frankincense 9g, myrrh 9g, honeysuckle10g, Gleditsia sinensis and pangolin scales10g.
3. Deficiency of positive energy and evil: Yin evil, epidemic toxin accumulation, transverse collapse, long-term loss of qi and blood, and insufficient positive energy to nourish evil. The main symptoms are ulceration of swollen lymph nodes on one or both sides of the groin, prolonged mouth closure, sometimes smelly pus, yellow complexion and Hua Shao, mental fatigue, pale white tongue and weak pulse, which can be seen in the first stage of syphilis lymphadenopathy complicated with infection. The prescription for invigorating qi, nourishing blood, strengthening body resistance and eliminating pathogenic factors is Tori Disinfection Powder: Radix Rehmanniae Preparata, Radix Astragali, Flos Lonicerae and Rhizoma Smilacis Glabrae each 65438±05g, Ginseng Radix, Rhizoma Chuanxiong, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix Angelicae Dahuricae, Atractylodis Rhizoma, Radix Platycodi and Fructus Gleditsiae Abnormalis each 65438±00g, and Glycyrrhrizae Radix 5g.
4. Wind-heat type; The course of the disease is long, the defense system is unstable in the exterior and interior, wind and evil take advantage of it, wind and heat compete, so that heat is trapped inside, and wind and heat are depressed in the skin, resulting in bayberry sores. Seen in secondary syphilis rash. The main symptoms are bright red rash or plaque on chest, waist, abdomen, limbs, face and neck, accompanied by aversion to cold, fever, headache, bitter taste, dry throat, constipation, yellow urine, dry moss and rapid pulse, which should be treated to relieve exterior and interior, clear heat and detoxify. Prescription Fangfeng Tongsheng Powder: Fangfeng, Qi Jing, Herba Ephedrae, Radix et Rhizoma Rhei, Natrii Sulfas, Scutellariae Radix, Fructus Forsythiae, Fructus Gardeniae, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Alba, Atractylodis Macrocephalae and Radix Platycodi each 65438±00g, talc and gypsum each 65438±05g, and Glycyrrhiza uralensis 5g.
5. Damp-heat accumulation type: exogenous damp-heat caused by epidemic diseases. Pathogenic stagnation in the interior, qi stagnation outside, and pathogenic stagnation in the skin, used for bayberry sores. Seen in secondary syphilis rash. The main symptoms are red and white bayberry rash, bayberry pox or bayberry spots on chest, abdomen, waist, limbs, face and neck, abdominal distension, poor appetite, loose stool, thirst, white and greasy fur, and Confucian or slippery pulse. Treatment should clear away heat and toxic materials and promote diuresis. The formula of Rhizoma Smilacis Glabrae mixture: Rhizoma Smilacis Glabrae and Flos Lonicerae each 65438±05g, Radix Clematidis and Cortex Dictamni each 65438±00g, Fructus Xanthii and Radix Glycyrrhizae each 5g.
6. Wind-toxin accumulation type: the epidemic toxin accumulates over time, sinks in the bone marrow, spreads from the inside out, and the wind pathogen is depressed in the skin and becomes toxic everywhere. Seen in tertiary syphilis. The main symptoms are pain in bones and muscles, light day and heavy night, swelling all over, dark red before collapse, yellow water after collapse, thirst and upset, red tongue, yellow fur and rapid pulse, so it is advisable to dispel wind, clear heat and detoxify. The prescription of Soufeng Jiedu Decoction is: Rhizoma Smilacis Glabrae, Coicis Semen, Caulis Akebiae 65438±05g, Flos Lonicerae, Radix Saposhnikoviae, Fructus Chaenomelis, Cortex Dictamni Radicis, Fructus Gleditsiae Abnormalis, Radix Angelicae Sinensis 65438±00g, Radix Ginseng and Radix Glycyrrhizae 5g.