Syphilis is prevalent worldwide. According to WHO estimates, there are approximately 12 million new cases globally each year, mainly concentrated in South Asia, Southeast Asia, and sub-Saharan Africa. It was introduced to Guangdong via India in 1505, and it has been nearly 500 years since then. Before liberation, it was the leading sexually transmitted disease (STD) in China. It was basically eradicated in the early 1960s but re-emerged and spread again in the 1980s. In 1991, there were 1,870 reported cases, 11,336 cases in 1995, and 33,668 cases in 1997. Since 1997, syphilis has accounted for more than 6% of the eight reported STDs, showing a clear increasing trend. Clinically, primary and secondary syphilis are frequently observed, and tertiary syphilis and congenital syphilis have also been discovered. Latent syphilis has been found in voluntary blood donors.
Chapter One: Primary Syphilis
Syphilis spirochetes enter the body through damaged areas, first invading the skin lymphatic spaces. Within hours, they enter nearby lymph nodes and then, after 2-3 days, enter the entire bloodstream. Approximately three weeks after infection, the initial lesion of syphilis appears at the site of invasion, known as a chancre. Common sites include the coronal sulcus, penis, prepuce, labia majora and minora, and healthcare workers' fingers. Initially, it appears as a millet-sized red papule, which swells into a hard lump the size of a fingernail within 1-2 weeks. The surface may ulcerate and become eroded, with exudate. The broken-down tissue and fluid contain large numbers of syphilis spirochetes, making it highly contagious. Chancres are painless and non-itchy, with no tenderness on pressure. The inguinal lymph nodes may swell, but they are not painful or ulcerated. Blood serum tests remain negative in the early stages (about 2-3 weeks after the chancre appears), and only later does the blood test turn positive. The course of primary syphilis lasts about 5-7 weeks. Due to local immune reactions, chancres can heal spontaneously without treatment.
Chapter Two: Secondary Syphilis
(1) Early secondary syphilis rash. After the spontaneous healing of primary syphilis, the body appears to be in a state of calm health, but the syphilis spirochetes continue to multiply. About 2-4 months after infection, the pathogens spread massively through the bloodstream to the entire body, resulting in early secondary syphilis rash. The time between the "cure" of primary syphilis and the onset of secondary symptoms is called latent primary syphilis. There may be prodromal symptoms such as fever, headache, and general malaise 2-3 days before the rash appears. The types of rashes vary greatly, often appearing as pale pink roseola, commonly seen on the front and sides of the trunk and limbs. They initially appear as macules and may develop into papular macules or papules. The damage is generally symmetrical, widespread, dense, and non-fused, characterized by being painless and non-itchy. There are also papular types. After 2-3 months, the early secondary syphilis rash may also heal spontaneously due to increased resistance from the body, but if untreated thoroughly, it often recurs within 1-2 years.
(2) Recurrent secondary syphilis rash. The rash morphology resembles that of early secondary syphilis rash but in fewer numbers and smaller distribution ranges, concentrating on the face and limbs. Additionally, flat condylomas may appear in the anal area and female genitalia. Grayish-white mucosal patches with surrounding congestion may be seen on the oral and genital mucosa. These tissues and lesions contain large numbers of syphilis spirochetes, making them highly contagious.
All types of damage caused by secondary syphilis can heal spontaneously, entering the latent phase of secondary syphilis. However, many live spirochetes remain in the body, ready to cause problems when the opportunity arises. Secondary syphilis is limited to four years; beyond this period, it is referred to as late-stage syphilis.
Chapter Three: Tertiary Syphilis
Tertiary syphilis damage is not limited to the skin and mucous membranes but can invade any internal organ or tissue. Its characteristic feature is gummatous swelling. The skin and mucosal syphilis of tertiary syphilis includes:
(1) Nodular syphilis rash. Clusters of nodules located in the dermis or subcutaneous layer, ranging in size from soybeans to grapes. Initially, they do not adhere to surrounding tissues but gradually become fixed. They are commonly seen on the face and limbs, with an asymmetrical distribution, either uniformly distributed or arranged in rings. The course is slow, and the lesions may completely absorb or ulcerate partially or entirely, being painless and non-itchy. They eventually heal into atrophic scars. They are commonly seen on the upper one-third of the lower legs.
(2) Gumma (gummatous swelling). Initially, it appears as a subcutaneous hard lump that can move, gradually adhering to the skin, breaking down, and forming sharp-edged ulcers resembling chisels, with thick sticky gum-like secretions. They may expand and heal simultaneously. They commonly occur on the scalp, forehead, and lower legs. They can also occur on the palate and nose, often leading to perforation of the hard palate and nasal septum, saddle nose, disfigurement, irregular ulcers on the tongue mucosa, scarring and contraction after inflammation absorption, a hardened tongue, and unclear speech.
Ten to twenty years or even longer after syphilis infection, visceral damage can occur. The main visceral damage involves aortitis, which can lead to aortic aneurysms and aortic insufficiency, presenting peripheral vascular signs such as capillary pulsation, water-hammer pulse (a sign of high pulse pressure), and gun-shot sounds upon femoral artery auscultation. The heart failure experienced by the aforementioned elderly person was due to aortic insufficiency. The main manifestation of neurosyphilis is tabes dorsalis, with common symptoms including leg pain exacerbated by dampness, ranging from mild rheumatic pain to severe cutting pain, sometimes radiating like lightning. Due to the loss of positional sense in the legs, walking feels like stepping on cotton, lifting the legs too high, and stomping excessively, with wide leg separation, indicating ataxia. Patients exhibit unequal pupil sizes, constriction, and irregular edges. Knee and ankle reflexes diminish or disappear, deep sensation and muscle power vanish. Patients find it difficult to stand with their eyes closed, experience multiple areas of lost pain sensation, representing substantial neurological damage.
In summary, syphilis has a long course, complex lesions, and varied presentations after a certain degree of treatment, necessitating careful differential diagnosis. First Disease Recovery Network www.cxtzyz.cn Please retain when reprinting.