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梅 毒 Syphilis

梅 毒 Syphilis. definition.

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梅 毒 Syphilis

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  1. 梅 毒 Syphilis

  2. definition Syphilis is a chronic sexually transmitted disease caused by the spirochete Treponema pallidum.It can effect any organizations and tissues. Early syphilis mainly effect skin and mucous membrane.Late syphilis always effect cardiovascular system and nervous system besides skin and mucous membrane。It can appear diverse sings and symptoms。

  3. etiology • pathogen：treponema pallidum • The 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.

  4. existing conditions Treponema is not easy to survive in vitro boil dry soapsuds common antiseptic (bichloride carbolic acid, alcohol,et) } Can kill the pathogen

  5. transmission and epidemic • The primary mode of transmission :sexual contact • The next most common is transfer across the placenta • Blood transfusion • Others：Kissing 、suckling、contacting the blood,secretion,dunnage (clothes, towel, razor, table dinner service, cigarette holder,et)of the patients

  6. course and stage of disease acquired syphilis 1．early syphilis（<2years）：primary syphilis、 secondary syphilis 2．secondary syphilis（>2years）or tertiary syphilis： tertiary cutaneous syphilis 、late osseous Syphilis 、 cardiovascular syphilis、neurosyphilis、others 3. latent syphilis ：early latent syphilis （<2years） late latent syphilis （>2years）

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

  8. clinical manifestation The classic lesion of primary syphilis:the chancre 1．Appear about 3weeks（10～75days）after 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 exudation, a cartilage-like consistency on palpation.

  9. 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 early latent syphilis .

  10. the skin manifestations of secondary syphilis are syphilids 1． Appear about 10weeks（8～12weeks）after infection. 2．Presymptom :fever、acratia、headache、arthralgia myosalgia、anorexia. 3. Eruption :macule、papule、follicular papule or pustule.、widespread and dense，symmetrical，round or oval，red copper . 4．Not pain or itch.

  11. 5.The general lymphnodes are enlarged.。 6.Mucous membrane lesions are present. condyloma flat can appear at anus. darkfield microscopy(+) 7.Periostitis,moth-eaten alopecia, iridocyclitis, retinitis, meningitis 8.Blood RPR or VDRL(+)。 9.If untreated, lesions tends to heal spontaneously in several weeks to 2-3months，then develop to secondary latent syphilis

  12. relapsing secondary syphilid 1．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 limited on the palms and soles or mucous membrane， also symmetrical，annular or arcuate。

  13. 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 develop to secondary latent syphilis

  14. 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.

  15. 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％(+).

  16. tertiary syphilis except cutaneous syphilis 1．Late osseous syphilis :arthritis、periostitis、osteitis、osteomyelitis、syphiloma。 2．Cardiovascular syphilis :syphilitic aortitis、aortic aneurysm、aortic insufficiency、coronary artery stenosis or thrombogenesis，syphiloma、microaneurysm of cerebral or femoral arteries

  17. 3．Neurosyphilis：tabes dorsalis、general paresis，meningovascular syphilis、syphilitic meningitis、myelitis and asymptomatic neurosyphilis. 4．others：ocular syphilis:interstitial keratitis、iridocyclitis、scleritis、retinitis 、optic neuritis and syphiloma.also can infect liver,kidney, gastrointestinal tract, testis and so on.

  18. 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(-)。

  19. 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.

  20. 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。

  21. 4．Mucous membrane affected，with rhinitis or laryngitis。 5．Chondritis and periostitis（pseudoparalysis）of 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 old man or woman. 8．Blood RPR or VDRL(+)

  22. late 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.Reactive lesions：skin,mucous membrane, skeleton,internal organs affected，similar to the late lesion of acquired syphilis.

  23. 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 one clavicle、rhagades of the lips 5．Blood RPR or VDRL(+)。

  24. latent congenital syphilis （early or late） similar to acquired syphilis

  25. laboratory examination darkfield microscopy serological test of syphilis examination of cerebrospinal fluid

  26. serological test of syphilis • Nontreponemal antigen test • Use 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)

  27. 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

  28. The reasons for false –positive test results： Technical false-positive ： sample has bacterial contamination or haematolysis bad 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 nodosa Heroin addiction ，some pregnant women and aged people

  29. The reasons for false –negtive test results: • early syphilis:serum antibody against cardiolipin has not form • Late syphilis • prozone phenomenon

  30. prozone phenomenon patients with very high antibody titers may have a false negative result when undiluted serum is tested.The prozone phenomenon will be overcome by diluting the serum.

  31. diagnoseand differential diagnosis The diagnosis of syphilis depends on clinical findings, examination of lesion material for treponemes, and/or serologic,CSF tests for syphilis. The diagnose must be cautious.

  32. prevention • therapeutic principle： • early ，sufficient • treatment by rule • find the infective partner and treatment together • sexual intercourseforbidden during treatment • regular follow-up after treatment

  33. treatment 1．Early syphilis （primary 、secondary、early latent syphilis） 1)．procaine penicillin G 0.8mU im qd*10d，8mU total.。 2)．Benzathini Benzylpenicilinum 2.4mU im once 3)．penicilin-allergic patients ①deoxycycline 100mg，bid po *14d ②tetracycline 500mg，qid po *14d ③erythrocin 500mg，qid po *14d

  34. 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 weeks 2)．Benzathini Benzylpenicilinum2.4mU,im qw*3 （ except cardiovascular syphilis ） 3)． penicilin-allergic patients ①deoxycycline 100mg bid po *30d ②tetracycline 500mg qid po *30d ③erythrocin 500mg qid po *30d

  35. 3．neurosyphilis 1)．aqueous penicillin G 12~24mU ivgtt(2~4mU q4h) *10d。benzathine benzylpenicillin G 2.4mU im qw*3 following it 2)．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

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