Syphilis Gonorrhea Nongonococcal Urethritis Condyloma Acuminatum HIV Infection (AIDS)

1. Sexually Transmitted Diseases (STDs)Dr. Yingguo Ding Dept. of Dermatology & VenereologyFirst Affiliated Hospital

2. Syphilis Gonorrhea Nongonococcal Urethritis Condyloma Acuminatum HIV Infection (AIDS) Genital Herpes Lymphogranuloma Venereum (LGV) Chancroid Donovanosis

3. Syphilis • Pathogen: Treponema pallidum - spirochete • Muco-cutaneous symptoms： - ulceration in the genitalia - eruptions on the body - internal organic disease • Chronic, potentially lifelong disease

4. Etiology Treponema pallidum (TP) – delicate spiral spirochete The organism is very fragile- Characteristic movements- in darkfield microscopy

5. darkfield microscopy

6. Transmission • Intimate sexual contact >95%, untreated patient • Transplacental passage -- congenital syphilis later stage of pregnancy (>4 months) • nonsexual contact kiss, suckle, birth canal infection 4. Indirect contact blood transfusions, healthcare work...

7. stages of syphilis • Acquired syphilis • Congenital syphilis • Early syphilis <2 years • Late syphilis >2years • latent syphilis

8. Primary syphilis 1. Early syphilis (< 2 years) 2) Secondary syphilis 3) Early latent syphilis 2. Late syphilis (> 2 years) • Tertiary syphilis • Late latent syphilis Acquired syphilis

9. Congenital syphilis A specific course -- no primary syphilis 1. Early congenital syphilis (< 2 year old) 2. Late congenital syphilis (> 2 year old)

10. Clinical manifestations Acquired syphilis

11. Primary syphilis • Main symptom 1) Chancre - the first cutaneous lesion, from direct inoculation 2) Enlargement of neighboring lymphnodes

12. chancre • ulceration occurs within 2-4 weeks of contact with an infected individual • The classic-appearing ulcer is shallow with sharply defined borders and slightly raised edges -- usually single

13. chancre • Painless • with clean base • cartilage-hard consistency • diameter: several mm-cm • highly infective -- containing numerous TP

14. chancre • Location Genital (>90% ) - Female: vulva, cervix, or perineum. - Male: coronal sulcus, frenum, prepuce Extragenital - Anus, lips, tonsil, female breast…

15. chancre Untreated chancre can heal spontaneously in 3-8 weeks -- the end of primary stage TP continues to multiply in the body

17. 硬下疳

18. Enlargement of regional lymphnode • On one or both sides • Firm,discrete,Painless • 1-2 weeks after the chancre • “bubo indolenta”

19. Diagnosis 1. Sexual contact 2. Clinical feature - Latent period, typical chancre - nontypical syphilitic ulcers 3. Laboratory test - darkfield examination - positive serological test for syphilis(STS)

20. Secondary syphilis • TP spread in the bloodstream and reach their highest numbers • 6 to 8 weeks after the chancre / 3 to 4 weeks after its healing

21. Secondary syphilis • skin manifestations-- Syphilids syphilitic roseola syphilitic alopecia papular syphilide Pustular syphilide condylomata lata Syphilitic leukoderma Papulosquamous eruption (Syphilitic psoriasis) Syphilitic angina--highly infectious mucosal lesion accompanied by tonsillitis in the oral cavity

22. Syphilid Asymptomatic, mostly nondestructive, Symmetrical, generalized (except condyloma lata) -- markedly on the palms and soles Polymorphous lesions highly infective accompanied by slight fever and systemic fatigue, headache, anorexia, nausea… lesion disappear spontaneously after weeks

23. Macular syphilid(Early syphilid) • Symmetric, asymptomatic • Round or oval indistinct macules • light pink, old rose, or reddish brown • 5 to 10 mm in diameter, never confluent

25. Papular syphilid • Usually arise a little later than the macular • Vivid red papules-raw ham or coppery tint • Round, slightly raised, firm papule, 2-5 mm • Surface: smooth, or covered with thick scale • Sites of predilection : face, trunk and flexures of the extremities

27. 二期梅毒 掌跖斑丘疹

30. Papulosquamous eruption (Syphilitic psoriasis

31. condyloma lata • Flat papular lesion, soft, dull pink/gray • with smooth, moist, weeping surface • 0.5 to 3 cm in diameter • genitals, perianal，other moist sites

33. 扁平湿疣组织中可见大量的浆细胞浸润

35. Syphilitic alopecia • involving hair follicles result in patches of hair loss on the scalp (moth-eaten alopecia)

36. Mucous lesions • painless silvery mucous patches - mostly in the mouth / on the genitals

37. Pustular syphilide

38. Recurrent secondary syphilis • Relapse – with no or inadequate treatment • Skin rash - less - larger - deeper red - large rings with characteristically serpiginous margins

40. diagnosis 1. History: sexual contact, chancre 2. Clinical feature - skin rash 3. Laboratory test - darkfield microscopy: skin or mucous membrane lesions, condyloma lata - positive STS

41. Tertiary (late) syphilis Less frequently seen today because of early detection and adequate treatment From inadequate or untreated patients Develop within 3-10 years after infection Destructive lesions, less in number Difficult to detect TP (mostly non-infectious)

42. Tertiary (late) syphilis • damage accumulate in various tissues - skin, bones, eyes, arteries, heart, and nervous tissue…

43. Tertiary (late) syphilis • Clinical features: Nodular syphilid(syphilis nodosa) - at the early stage of tertiary syphilis - some copper-colored nodules - several cm in diameter - usually on the face - heal with scarring in several months.

45. Tertiary (late) syphilis • Clinical features: Gumma - the typical lesion - subcutaneous nodules - soft - ulcers

47. Congenital syphilis • TP passed from mother to child during fetal development - through the placenta • Severe, disabling, life-threatening condition - nearly half of all children infected die shortly before or after birth. • Begins with secondary syphilis

48. Early congenital syphilis(Prior to age 2 years) • clinical features: - low birthweight - preterm delivery - dehydration - premature face - irritability - failure to thrive - anaemia

49. Early congenital syphilis 1. skin and mucous membrane lesions - Within 6 months, mostly within 3 weeks - similar to secondary syphilis - classic mucocutaneous sign: radial scarring around the mouth

50. Early congenital syphilis 2. Syphilitic rhinitis - one of the most characteristic features Snuffle, obstruction and discharge (often bloody) Nasal osteitis - vomer destruction (saddle nose)