How is syphilis treated?

　　The Ministry of Health of my country issued diagnostic standards and treatment plans for syphilis in November 1991. It is attached here for your reference and implementation.

　　1. Diagnostic criteria for syphilis

　　(1) Diagnostic principles

　　1. Treponema pallidum can invade multiple systems of the human body and appear in various forms with other disease Similar symptoms and signs, therefore the diagnosis must be made carefully based on a comprehensive analysis of the medical history, physical examination and laboratory test results.

　　2. When asking about the medical history, attention should be paid to extramarital sexual behavior (including history of whoring, prostitution or homosexuality), syphilis infection history (including previous treatment history), spouse's infection history, marital status, women's pregnancy and childbirth history, etc. For fetal-transmitted syphilis, one should know the biological mother’s sexually transmitted diseases history.

　　3. Physical examination: A comprehensive physical examination should be carried out, paying attention to the whole body skin , mucous membranes, bones, oral cavity, vulva, anus and superficial lymph node enlargement, etc., if necessary, perform cardiovascular system, nerve System and other system checks, Gynecology Check etc.

　　4. Laboratory examination:

　　(1) Syphilis serology test: Non-treponemal pallidum antigen test, such as VDRL, RPR, USR, etc., is a screening test； Treponema pallidum antigen tests, such as TPHA, FTA-ABS, etc., are confirmatory tests.

　　(2) Dark field examination of Treponema pallidum.

　　(3) Histopathological examination.

　　(4) Cerebrospinal fluid examination.

　　(2) Diagnostic criteria for syphilis in each stage

　　1. Primary syphilis

　　(1) Medical history: There is a history of infection, and the incubation period is generally 2 to 3 weeks.

　　（２）clinical Performance:

　　a. Hard chancre is 1 to 2 cm in diameter, round or oval, slightly higher than the skin surface, with mild surface erosion or shallow ulcer, a little secretion, flesh red or dark red, neither painful nor itchy, and has cartilage-like hardness when palpated. Generally, it can be single or multiple. It is more common in the external genitalia, but can also be found in the anus, cervix, lips, breasts, fingers and other parts.

　　b. The inguinal lymph nodes or the proximal lymph nodes in the affected area may be swollen, often several in number, varying in size, hard, non-adhesive, non-ulcerated, and painless.

　　c. Can subside on its own.

　　(3) Laboratory examination:

　　a. Dark field microscopy: Treponema pallidum can be found in tissue fluid from skin lesions or lymph node puncture fluid.

　　b. Positive serological test for syphilis. If the infection is less than 2 to 3 weeks old, the non-treponemal antigen test may be negative, and a retest after 4 weeks may be positive.

　　Only one of the above two tests must be positive.

　　2. Secondary syphilis

　　(1) Medical history: There is a history of infection, and there may be a history of syphilis within 2 years.

　　(2) Clinical manifestations:

　　a. The rash is multimodal, including macules, papules, scaly rashes, pustules, etc. It is often generalized and symmetrical, and dark erythema and desquamative maculopapular rash are common on the palms and soles. Rashes on the vulva and perianal area are mostly eczema papules and flat condyloma, which are neither painful nor itchy, and may appear moth-eaten on the head. hair loss . In the second stage of recurrent syphilis, the skin lesions are limited and small in number, and annular rashes can still be seen.

　　b. Mucosal plaques may occur in the oral cavity.

　　c. Mild discomfort and superficial lymph node enlargement may occur throughout the body.

　　(3) Laboratory examination:

　　a. Dark field microscopy: Treponema pallidum can be found in the exudate of secondary rashes, especially flat condyloma, eczema papules and mucosal plaques.

　　b. Syphilis serology test is strongly positive.

　　3. Tertiary syphilis (late syphilis)

　　(1) Medical history: There is a history of infection, including primary or secondary syphilis. The disease duration is more than 2 years.

　　(2) Clinical manifestations:

　　Nodular rash and gummy swelling near joint nodules, skin, mucous membranes, bones, etc. Digestive system involvement is more common with hepatic syphilis. The cardiovascular system is most commonly affected by simple aortitis, aortic valve insufficiency, and aortic aneurysm. Nervous system involvement is more common with syphilitic meningitis, tuberculosis and paralytic dementia.

　　(3) Laboratory examination:

　　a. Syphilis serology test: Most non-treponemal antigen tests are positive, but they can also be negative. The treponemal antigen test was positive.

　　b. Histopathological examination.

　　c. Cerebrospinal fluid examination: in neurosyphilis, white blood cells >2/cubic millimeter and protein amount >50 mg/d1, VDRL test is positive

　　4. Latent syphilis (latent syphilis)

　　(1) Have a history of infection, including primary, secondary or tertiary syphilis.

　　(2) The disease period is early latent syphilis within 2 years, and late latent syphilis is more than 2 years old.

　　(3) No clinical symptoms and signs (including skin, mucous membranes, bones, cardiovascular and nervous systems, etc.).

　　(4) Non-treponemal antigen test is positive more than 2 times (biological false positives need to be excluded) or treponemal antigen test is positive. Cerebrospinal fluid examination was negative.

　　5. Prenatal syphilis (congenital syphilis)

　　(1) The biological mother is a syphilis patient.

　　(2) Clinical manifestations a. Early congenital syphilis (within 2 years old): similar to secondary syphilis in adults, but the skin lesions often include erythema, papules, erosions, blisters, bullae, etc. Syphilitic rhinitis and laryngitis, osteochondritis, osteitis and periostitis, lymphadenopathy, hepatosplenomegaly, anemia wait. b. Late congenital syphilis (over 2 years old): It is similar to tertiary syphilis in adults, but is characterized by interstitial keratitis, Herchinson's teeth, and neurological deafness. Gum swelling of the skin and mucous membranes and periostitis may also occur. c. Congenital latent syphilis: In addition to the history of infection, it is the same as acquired latent syphilis.

　　(3) Laboratory examination: a. Treponema pallidum can be found in early skin and mucosal lesions. b. Positive serological test for syphilis.

　　6. Pregnancy syphilis:

　　Active syphilis or latent syphilis occurring or discovered during pregnancy is called gestational syphilis.