What are the physical symptoms of syphilis?

Syphilis is a chronic infectious disease caused by Treponema pallidum, which is mainly transmitted through sexual intercourse. According to the infection route, it can be divided into acquired syphilis and congenital (fetal) syphilis; According to the infection time of 2 years, it can be divided into early syphilis and late syphilis. Syphilis is contagious in the early stage, mainly invading the skin and mucosa. In the late stage, besides skin and mucosa, it is particularly easy to invade the cardiovascular system and central nervous system, and it can also lurk for many years or even be asymptomatic for life.

In recent years, with the increasing incidence of sexually transmitted diseases, the probability of pregnant women infected with syphilis is also increasing, especially for children with congenital syphilis in developing families.

Clinical manifestations of syphilis:

Patients often develop symptoms at 1 ~ 13 weeks after infection, with an average of 3 ~ 4 weeks. After being infected with pathogens, they usually go through the following stages: primary syphilis, secondary syphilis, latent syphilis and tertiary syphilis. Infection can last for many years, occasionally leading to heart damage, brain damage and even death.

(a) acquired syphilis or acquired syphilis (syphilis

Acquisition)

1. Primary syphilis:

(1) chancre: chancre is a small erythema or papule at the beginning, followed by induration and rapid erosion or ulceration. The typical chancre is round or oval, with a diameter of about 1 ~ 2 cm, a clear boundary and a dike-like bulge around it. The base is red, with a small amount of exudate and a large amount of treponema pallidum, which is highly contagious. Men occur in the coronal sulcus, glans penis, foreskin and belt of penis (male homosexuality often occurs in anus, rectum and other places); Women occur in labia majora, labia frenum and cervix. Reproductive organs exist in lips, breasts, tongue, fingers and other parts. The chancre can be cured after about 1 month, leaving a superficial scar. Hard chancre also has the following characteristics: ① the damage is mostly single; ② Chondroid hardness; 3 no pain; (4) The damaged surface is clean.

Heterotypic chancre: ① Multiple chancre; ② Mixed hard chancre (coexisting with soft chancre); ③ erosive chancre; ④ Recurrent chancre, etc.

(2) Nearby lymphadenopathy: 65438+ 0~2 weeks after chancre appeared. Inguinal lymphadenopathy, usually unilateral, is painless, hard and has no inflammation and suppuration on the surface, which is called syphilis. Lymph node puncture fluid contains TP.

(3) Syphilis serum test: chancre began to be positive after 2-3 weeks, and all of them were positive after 7-8 weeks.

(4) Diagnostic basis of primary syphilis: ① A history of unclean sexual intercourse with an incubation period of 3 weeks; ② Typical symptoms, such as simple painless chancre, mostly occur in external genitalia; ③ Laboratory examination: dark field microscope examination, taking down the samples for treponema pallidum: syphilis serum test. Only one of these two tests is positive.

2. Secondary syphilis:

The asymptomatic period from the disappearance of chancre to the appearance of secondary syphilis rash is called the second incubation period. Secondary syphilis usually occurs 7 ~ 10 weeks after infection or 6 ~ 8 weeks after chancre, in a few cases. Secondary skin lesions can overlap chancre. Treponema pallidum spreads to the whole body through blood circulation, mainly showing skin and mucous membrane damage, as well as bone, sensory organs and nerve damage. Highly contagious, there are often precursor symptoms such as low fever, headache, muscle, joint and bone pain before eruption.

(1) Secondary syphilis skin and mucous membrane damage: 80%~95% patients can occur. It can be divided into two types: early-onset syphilis and recurrent syphilis. There are many skin mucosal lesions, which are often compared with non-syphilis skin mucosal diseases and infectious diseases in clinic. Classification includes: ① rash; ② Condyloma plana; ③ baldness; ④ Mucosal injury; ⑤ Others.

1) Rash: There are many kinds of rashes of primary syphilis, from fuzzy macula to pustular herpes, which can be divided into the following types according to their morphology: ① macula: rose rash, annular rash and white macula; ② maculopapular rash; ③ papules; ④ Purulent herpes; ⑤ Purulent herpes; ⑥ Syphilis rash on palms and soles.

The incidence of various rashes is macula and maculopapule, followed by papule, pustular herpes and pustular herpes are the least.

Rash usually has one or more types at the same time, with no symptoms or only slight itching.

(1) Macula: macula

Syphilis) or rosacea (syphilis)

Mseola): it is the earliest rash of secondary syphilis, accounting for about 25% of the rash of secondary syphilis, and it appears about 8~9 weeks after infection. Round or oval rose spot, about 1~2cm in diameter. There is no pain without integration. It often appears in the front of the trunk and the inside of the proximal limb. The rash subsided in about 2~3 weeks, leaving pigmentation or depigmentation. Syphilis rosacea should be differentiated from pityriasis rosea. In addition to rose rash, there are ring rash and white spot rash.

② maculopapular rash: diameter 1cm, purplish red, the distribution is the same as that of rose rash, but it fades slowly.

③ Papule: Papule syphilis (papule)

Syphilis): the most common. It accounts for about 40% of secondary syphilis rash, which usually occurs 12 weeks after infection, but also occurs when the rose rash subsides and even coexists with the rose rash. There are two kinds of papules: big papules and small papules.

Bullous syphilis rash: The diameter is about 0.5- 1cm. It is a hemispherical infiltrating papule with a smooth surface, dark brown to copper red. The center of the rash is absorbed, depressed or desquamated for a long time, and it is prone to occur on both sides of the trunk, abdomen, limbs flexion, scrotum, labia majora, anus and groin. And there may be scales, called papular scaly syphilis rash or psoriatic syphilis rash.

Syphilis rash), the scales are large, the white scales or scab skin are not easy to peel off, the superficial erosion under the scab, and the edge is flushed, showing psoriasis-like. Usually occurs in the trunk, limbs and other parts.

Papular syphilitic eruption: Also known as syphilitic lichen, it is mostly millet-shaped, the same size as hair follicle, conical, with solid pointed papules, reddish brown, clustered or mossy-like. The onset is late and lasts for a long time within 1 ~ 2 years after infection. Without treatment, it will not subside within 2~3 months, and some papules are arranged in a ring or arc, which is called annular syphilis rash.

④ Pustular herpes: This kind of herpes is relatively rare, accounting for about 4% of secondary syphilis. Pustules appear at the top of the papules, containing yellowish pus, which scabs after drying and has small scars after falling off. The patient is malnourished or old and weak.

⑤ pustules

Syphilis): Very rare. Most of this damage is caused by malnutrition, anemia and physical weakness. The forms of pustules are acne-like, acne-like, pustule-like, oyster shell-like and so on.

Patients are often accompanied by fever, general malaise and other clinical manifestations.

⑥ Palmoplantar Syphilis Rash: It is common in clinic and usually coexists with other secondary syphilis rashes. When it occurs alone, it mostly occurs in the late stage of secondary syphilis, which is equivalent to 1 ~ 2 years after infection. It is a kind of hard papule, which occurs in palms and soles of feet. It starts with reddish or light brown, and then turns to yellowish or dirty white. After 3 ~ 5 days, the keratin in the center of the papule falls off, the edge is fixed, and the center is free, forming a squamous annular syphilis rash with red or dark red halo around it. Scattered, symmetrical but not fused, rash can also invade toes. The rash does not exceed the medial malleolus, and the lateral side does not exceed the outer edge of the sole.

2) Lichen planus

This is a special type of papular syphilis rash. There are about 10% patients with secondary syphilis, and there are more female patients than male patients. It often occurs in wrinkled and sweaty parts, such as anus, vulva, armpit, navel, groin, between fingers and toes and nail groove. At first, it was a wet papule with moist surface, which expanded or merged into condyloma plana. Its shape is wide and sessile, with a diameter of 1 ~ 3 cm, flat or lobulated verrucous lesions, dark red infiltration around it, and self-conscious burning and itching. Surface erosion and exudation, containing a large number of spirochetes. In the recurrence of secondary syphilis, condyloma plana is particularly common, with asymmetric damage and invasive changes, which are similar to those of late syphilis, and may be a manifestation of enhanced cellular immunity. Syphilis verruca plana should be differentiated from condyloma acuminatum.

3) Syphilitic alopecia (Syphilitic)

Hair loss): About 10% of secondary syphilis patients occur. Characterized by syphilis alopecia areata or diffuse alopecia. The former is about 0.5cm bald spot, moth-eaten, diffuse alopecia, large area, sparse hair and uneven length. Common in the temporal, parietal and occipital parts, eyebrows, eyelashes, beard and pubic hair will also fall off. But syphilis alopecia is not permanent. If treated in time, hair can regenerate within 6~8 weeks, even without treatment.

4) Mucosal damage: seen in the mouth, tongue, pharynx, larynx or genital mucosa, with surface erosion and a large number of treponema pallidum.

① Erythema erosive Syphilis Rash: At the same time of skin rose rash, there are obvious little finger-sized and well-defined flushing erosive spots on mucosa, sometimes seen in uterus and vagina.

② Mucous spots (mucus

Patch) and breast leukoplakia: At the same time of papular syphilis rash, oral mucosa also appears obvious flushing, invasive hyperplasia, surface turbidity and gray spots.

③ Syphilitic glossitis: It is the tongue manifestation of syphilis rash with smooth and thick mucosa.

④ Syphilitic angina: The pharynx and tonsils are red, swollen, erosive and ulcerated, with hoarse voice, and there are many treponema pallidum in the focus.

5) Others:

① Syphilitic leukoplakia (Syphilitic

Leukderma): rare. Can be divided into primary leukoplakia and secondary leukoplakia. The former is depigmentation caused by Treponema pallidum, which mostly occurs on the side of women's neck, with clear or unclear edges and a round shape, and can also be seen on the back and inner thighs. After treatment, the pigment can be recovered. The latter is the white spot left after the secondary syphilis rash subsided, and this depigmentation can also restore the pigment.

There are a large number of Treponema pallidum on the surface of mucosal leukoplakia, which is highly contagious.

② Syphilitic pigmented rash (syphilitic)

Pigmentation): The irregular gray-black pigmentation spots of soybeans are often distributed on the forehead, mostly secondary pigmentation after the disappearance of rose rash and papular syphilis rash.

③ Syphilis A (Syphilis A)

Disease): It can be divided into onychomycosis and paronychia. Late nail thickening, turbidity, longitudinal groove, fragmentation, deformation, nail loss.

(2) Secondary syphilitic periostitis and arthritis: Periostitis is common in long bones, and arthritis occurs in large joints, which can cause pain aggravation at night.

(3) Systemic lymphadenopathy: the incidence rate is 50%-85%, the lymph nodes are hard and painless, and they do not fester or fester.

(4) Secondary syphilis eye damage: iritis, iridocyclitis, choroiditis, optic retinitis, optic neuritis, keratitis, interstitial keratitis, etc.

(5) Secondary syphilis nerve damage: mainly asymptomatic neurosyphilis, syphilis meningitis, cerebrovascular syphilis, etc.

(6) Secondary recurrent syphilis: the first rash is secondary early syphilis. This rash can subside spontaneously after 2 ~ 3 months, and those who recur within 6 months ~ 2 years are called secondary recurrent syphilis. Most of them are caused by incomplete treatment or low immunity. Serum recurrence is the most common, and skin mucosa, eyes, bones and internal organs can also recur. The second-stage early-onset syphilis rash is generally large in number, with small skin lesions and symmetrical distribution, and is prone to trunk and limbs. The second-stage recurrent syphilis rash is similar to the second-stage early-onset syphilis rash, but the number is small, the rash is large, the shape is strange, and it is often ring-shaped, half-moon-shaped, snake-shaped, and flower-shaped, and its distribution is asymmetric, and it often occurs in the forehead, mouth, neck, vulva and palm.

(7) Diagnostic basis of secondary syphilis: ① History of unclean sexual intercourse and chancre; (2) various rashes, such as rose rash, papule, condyloma plana, palmoplantar syphilis rash, mucosal plaque and moth-eaten alopecia, general malaise and lymphadenopathy; ③ Laboratory examination: specimens of condyloma plana and mucosal spots were taken, and Treponema pallidum was found under dark field microscope, and syphilis serum test was strongly positive.

3. Tertiary syphilis (tertiary

Syphilis) or advanced syphilis.

According to time stages, advanced syphilis occurred 2 years after infection, but mostly occurred 3 ~ 4 years after infection, and cardiovascular and neurosyphilis lasted for a long time. Late syphilis accounts for about 40% of untreated syphilis patients, among which 15% patients are benign syphilis (skin mucosa, bones, etc. ); 10% is cardiovascular syphilis; 10% is neurosyphilis. The reason is that early untreated or incomplete treatment is related to the increase of allergic reaction to residual spirochetes in the body. In skin lesions, Treponema pallidum is extremely difficult to find, but animals can be positive after inoculation, so the infectivity is weak or non-contagious. But it is destructive to body tissues, and if it involves important organ systems, it can lead to disability and death.

(1) Skin and mucous membrane damage: Skin damage is characterized by small quantity, asymmetric distribution and lack or slight symptoms. There are mainly nodular syphilis rash and gingival swelling.

Skin lesions have the following characteristics: ① small number, isolated or clustered rather than symmetrical, often occurring in prone parts; ② Systemic symptoms were mild, and skin lesions lacked conscious symptoms. If the periosteum and bones are invaded, people will feel pain, especially at night. ③ The gum has swelling, infiltration and induration, and there is still hard infiltration at the bottom of the ulcer formed after rupture. Fading slowly, often more than a few months; ④ Ulcer has a specific kidney shape or horseshoe shape; ⑤ The center of ulcer can be cured, and the edge often continues to expand; ⑥ There are few Treponema pallidum on the damaged surface, which is difficult to be detected by dark field microscopy, but the inoculation can be positive; ⑦ The tissue is destructive and can form scars after healing.

The lesions of skin and mucosa are mainly nodular syphilis rash and syphilitic gingival swelling, and joint nodules are rare now.

1) Syphilis nodosa (nodular

Syphilis): The head, shoulders and limbs are easily damaged. It is a group of nodules with a diameter of about 0.3 ~ 1.0 cm. It is copper-red, hard, with infiltration, and nodules can be absorbed, leaving atrophic spots. Nodules can also form ulcers, leaving shallow scars after healing. Skin lesions are often clustered, annular or serpentine, and old and new rashes come one after another, which can last for several years.

2) gumma: It is a typical late syphilis disease, which usually occurs within 3 to 5 years after infection. Gum swelling mainly occurs in skin mucosa (80%), but also in bones and internal organs. At first, it was subcutaneous nodule, dark red, and gradually increased to 3~5cm. The center softens and breaks, one end of the lesion heals, and the other end develops, forming a specific kidney-shaped or horseshoe-shaped ulcer with clear boundaries, sharp and tough edges, and purple-red base, which secretes pus like gum, hence the name gingival swelling. It could also be caused by trauma. Gum swelling in the head and forehead often destroys bones, which will last for months or years, leaving atrophic scars after healing.

3) Mucosal damage of tertiary syphilis: Gum swelling can invade oral and nasal mucosa, causing gum swelling glossitis, perforation of palate and nasal septum and saddle nose.

(2) Tertiary bone syphilis: there are gingival swelling, periostitis, osteomyelitis, osteitis, arthritis, etc.

(3) Eye damage of tertiary syphilis: It is the same as that of secondary syphilis, including iridocyclitis, choroiditis, optic retinitis, optic neuritis, interstitial keratitis, swollen gum, etc.

(4) Cardiovascular syphilis

Syphilis): it usually occurs in lo ~ 30 years after infection. There are Takayasu's arteritis, aortic valve insufficiency, aortic aneurysm, coronary artery stenosis or obstruction, myocardial syphilitic gingival swelling and so on.

(5) neurosyphilis: It usually occurs 3-20 years after infection and can be divided into:

1) Asymptomatic neurosyphilis: No symptoms and signs of nervous system, only VDRL positive in cerebrospinal fluid.

2) Interstitial neurosyphilis: TP invades the cerebral (spinal) membrane and arterioles, causing nervous system dysfunction, also known as cerebral (spinal) membrane vascular neurosyphilis, which can be divided into:

① Acute syphilis meningitis: Symptoms often appear 3 to 7 months after infection or 6 years after infection. About 10% patients have meningitis and secondary syphilis rash at the same time. The main symptoms of meridians are cerebral palsy and increased intracranial pressure.

② Cerebrospinal fluid vascular syphilis: A. Cerebrovascular syphilis: Vascular neurosyphilis can involve the central nervous system, and the common feature is infarction secondary to toxic endocarditis. B. Spinal meningeal angiosyphilis: It is a chronic myelitis, which can directly lead to degeneration of spinal cord parenchyma or thrombosis.

3) Substantive neurosyphilis:

① Spinal tuberculosis: It usually occurs 20 to 30 years (5 to 50 years) after infection. The onset of the disease is hidden, and the affected parts are the posterior column and root of spinal cord, which leads to the gradual loss of peripheral reflex and vibration sensory disturbance and progressive ataxia. Typical triad includes lightning-like pain, sensory disturbance and urinary retention. The most common and earliest triad are abnormal pupil, disappearance of lower limb reflex and Lomborg sign.

Signature. Spinal tuberculosis is often accompanied by optic atrophy.

② Paralytic dementia: onset 3-20 years after infection. It is encephalomyelitis caused by TP directly invading the brain, which causes progressive cortical dysfunction. The biggest harm is the impact on the mind. There are extensive brain parenchymal damage and corresponding memory paralysis, including personality, emotion, reaction, hyperreflexia, eyes (Arroyo pupil, argyle)

Robertson pupil), sensory center (illusion, delusion, hallucination), intelligence (including orientation, counting, judgment, recognition and recent amnesia) and abnormal language ability. Most attacks are insidious. The clinical manifestations are similar to those of any type of mental illness and nervous system diseases. There are four kinds of mental symptoms: megalomania, mania, depression and dementia.

4) Congenital neurosyphilis.

(6) Diagnostic basis of tertiary syphilis: ① History of unclean sexual intercourse and early syphilis; ② Typical symptoms such as nodular syphilis.

1. Hemiplegic gait

It is caused by the damage of one motor neuron. When the affected leg is straight, the ipsilateral arm keeps flexion and adduction (vertebral body type), the affected pelvis is raised and the lower limbs move in circles.

2. Cerebellar ataxia gait: It is caused by cerebellum (occasionally vestibule) damage. When walking, the gait is wide, the gait is unstable, and the body swings from side to side. If one cerebellum is damaged, the body leans to the affected side, and if the vermis are damaged, the gait is backward. Mild patients can only be found by walking test with heel close to toe.

3. Sensory ataxia gait: It is caused by loss of proprioception. Walking gait is quite unstable, but it can be balanced by visual compensation. When walking, the calf is easy to fall or knock. You can't keep your balance in the dark or when the sun is off (see Rhomberg test).

4. Foot drop gait: Due to common peroneal nerve injury (unilateral type) or peripheral neuropathy (bilateral type), the toes are lifted off the ground when walking, and the hips and knees are excessively flexed, forming a cross-threshold gait.

5. Parkinson's gait: due to Parkinson's disease, the upper limbs swing when walking, other random movements are reduced, the posture is unstable, the gait is slowed down, and small steps are dragged. It is difficult to turn around when starting and walking. This gait should be distinguished from the small step gait with bilateral frontal lobe injury, and the arm and trunk of the latter are not affected.

Positive Rhomberg test (difficulty in closing eyes): Stand with your feet together, and then close your eyes to evaluate stability. If the cerebellum or vestibule is damaged, the eyes will be unstable. People who lose proprioception may be slightly unstable when they take small steps when they open their eyes. Fall with eyes closed (Rhomberg test positive), rash, swollen gums, aortic inflammation, arterial valve insufficiency, aortic aneurysm, spinal tuberculosis, paralytic dementia; ③ Laboratory examination: syphilis serum test, non-treponema pallidum antigen syphilis serum test was about 66% positive; The serum test of spirochete antigen was positive. Cerebrospinal fluid examination showed that the number of white blood cells and protein increased, and the laboratory test of VDRL was positive.

4. Latent syphilis

There is a history of syphilis infection, no clinical symptoms or clinical symptoms have disappeared, physical examination and chest X-ray examination lack evidence of syphilis, cerebrospinal fluid examination is normal, and only those who have no syphilis serum reaction are called latent syphilis. The infection time is less than 2 years in early latent syphilis and more than 2 years in late latent syphilis.

(2) Syphilis during pregnancy

Active syphilis or latent syphilis that occurs or is found during pregnancy is called syphilis during pregnancy. Treponema pallidum during pregnancy can enter the fetus through placenta and umbilical vein, causing intrauterine infection. On the other hand, after the placenta is invaded by spirochete, its arterioles become endometritis, and the lumen becomes narrow and infarcted, which leads to placental tissue necrosis and the fetus is not nourished. Can lead to abortion, premature delivery, stillbirth or delivery of congenital syphilis.

(3) congenital syphilis.

It can also be divided into early congenital syphilis, late congenital syphilis and congenital latent syphilis. No chancre is one of the characteristics of congenital syphilis, which is more serious than acquired syphilis, involving bones and sensory organs and affecting the growth and development of infants. Congenital syphilis is also called fetal syphilis. Treponema pallidum is transmitted to the fetus through the placenta in the fourth month of pregnancy. Early congenital syphilis occurs within 2 years old, and late congenital syphilis occurs over 2 years old, showing no chancre. Early pathological changes are more serious than acquired syphilis. In the late stage, it is mild, with less cardiovascular involvement, and bones and sensory systems such as eyes, ears and nose are more common.

1. Early congenital syphilis:

Most of them are premature babies, with malnutrition, light weight, thin body, pale and flabby skin and looking like an old man. Symptoms appear before the age of 2, often accompanied by polymorphic rash, rhinitis, osteochondritis and periostitis, superficial lymphadenopathy, hepatosplenomegaly, which is highly contagious. There are 1 nutritional disorders: developmental malnutrition, loose skin, looks like an old man; ② Skin and mucous membrane damage: similar to adult secondary syphilis rash, with vesicular lesions, verruca plana, radiation chapped angle and perianal scar; ③ Syphilitic rhinitis:

It usually occurs within 1 ~ 2 months after birth. A runny nose, stuffy nose, difficulty breathing, and sucking milk can all damage the nasal bones.

. There may be swelling of turbinate, purulent secretion and skin scabbing. If the nasal cavity is blocked, it will make it difficult for children to breathe and suck milk, which is one of the characteristics of congenital syphilis in infants. ; ④ Bone damage: osteochondritis, periostitis and pain,

Syphilitic finger enteritis causes diffuse spindle swelling, which may involve one or several fingers, sometimes accompanied by ulcers. Osteomyelitis is common, more common in long bones, and there may also be chondritis and periostitis, which are manifested as pain, limb paralysis, limb paralysis and syphilitic pseudoparalysis; ⑤ Lymph nodes, hepatosplenomegaly.

6。 Eye damage: syphilitic choroiditis, iridocyclitis, retinitis, optic neuritis, etc. 7。 Nervous system: encephalomalacia, edema and seizures may occur, and pathological changes may occur in cerebrospinal fluid examination. 8。 Others: it may be accompanied by systemic lymphadenitis, hepatosplenomegaly, nephrotic syndrome and other manifestations.

2. Late congenital syphilis: symptoms appear after 2 years old.

Generally, from the age of 5 to 8 years, various symptoms will appear one after another until the age of13 to14, or as late as the age of 20. Mainly manifested as eye, tooth, bone, nerve, skin and other injuries, non-infectious. ① Skin mucosal damage: Nodular syphilis rash, swollen gums, perforation of palate and nasal septum and saddle nose may appear; ⑦ Skeleton: Sabre tibia (the middle part of tibia is thick and protruding forward), joint hydrops (Clutton joint swelling); ③ Hutchinson's three signs: namely, substantive keratitis; Hutchinson's teeth, that is, the lower edge of the front teeth, are half-moon defects; The Hutchinson's syndrome of nervous deafness is of diagnostic significance.

3. Congenital latent syphilis: asymptomatic after infection, syphilis serum positive.

But the serological test of syphilis was positive. Latent syphilis refers to patients who have been diagnosed with syphilis. In a certain period of time, no abnormalities were found in skin, mucosa, any organ system and cerebrospinal fluid examination, and both auxiliary examination and chest X-ray examination lacked the clinical characteristics of syphilis. Cerebrospinal fluid examination is normal, only syphilis serum is positive, or there is a clear history of syphilis infection, and no clinical manifestations have ever appeared. It is called latent syphilis. It belongs to the category of "Myrica rubra sore" or "mildew sore" in traditional Chinese medicine.