Syphilis.ppt
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Transcript Syphilis.ppt
梅 毒
Syphilis
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。
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.
existing conditions
Treponema is not easy to survive in vitro
boil
dry
soapsuds
common antiseptic (bichloride
carbolic acid, alcohol,et)
}
Can kill the
pathogen
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
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)
congenital syphilis
1. Early congenital syphilis (age<2years)
2. Late congenital syphilis (age>2years)
3. Congenital latent syphilis
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.
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 .
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.
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
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。
3.Condyloma flat can appear at anus
4.Skeleton diseases or iridocyclitis or retinitis
5.Blood RPR or VDRL(+)。
6.If
untreated
spontaneously
,
lesions
tends
to
heal
in several months , then
develop to secondary latent syphilis
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.
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%(+).
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
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.
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(-)。
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.
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。
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(+)
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.
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(+)。
latent congenital syphilis
(early or late)
similar to acquired syphilis
laboratory examination
darkfield microscopy
serological test of syphilis
examination of cerebrospinal fluid
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)
•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
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
The reasons for false –negtive test results:
★early syphilis:serum antibody
against cardiolipin has not form
★Late syphilis
★prozone phenomenon
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.
diagnose and 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.
prevention
therapeutic principle:
early ,sufficient
treatment by rule
find the infective partner and treatment
together
sexual intercourse forbidden during treatment
regular follow-up after treatment
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
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
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
4.Pregnancy syphilis
At the first 3 months of pregnancy
procaine penicillin G. o.8mU im qd*10d
At the last 3 months of pregnancy
repeat a course of treatment
penicilin-allergic patients
erythrocin 500mg,qid po *14d
Tetracycline forbidden
5.Congenital syphilis
Procaine penicillinG,5oooou/kg/d*10d
Total amount<adult (except late congenital
syphilis)。
Tetracycline forbidden in the children<8
years
follow up
Follow up 2-3 years after treatment
Testing is repeated every 3 months in the first
year,every 6 months later
Including clinical examination and blood RPR
or VDRL test
If recurrence : including syphilitic lesions and
RPR(+)
retreatment
congenital syphilis or other late late syphilis:
If Serofast ,does not need retreatment if has treat
sufficiently