Syphilis: Symptoms, Diagnosis, Treatment, and Prevention


Syphilis is a chronic, systemic sexually transmitted disease caused by the pale spirochete. Mainly transmitted through the sexual route, can be clinically expressed as syphilis, secondary syphilis, tertiary syphilis, latent syphilis and congenital syphilis.


Syphilis is endemic in the world. According to WHO estimates, there are about 12 million new cases every year in the world, mainly in South Asia, Southeast Asia, and sub-Saharan Africa.

In recent years, syphilis has multiplied in China and has become the most reported sexually transmitted disease. Among reported syphilis, latent syphilis is predominant, first and second syphilis are also common, and the number of reported cases of congenital syphilis is also increasing.

Patients have treponema pallidum in their skin and mucous membranes, and those who do not have the disease may get sick if they have slight skin or mucous membrane damage during sexual contact with patients.

Blood transfusion or route can transmit a tiny number. Acquired syphilis (acquired) Early syphilis patients are the source of infection, more than 95% are transmitted through dangerous or unprotected sexual behavior, and a few are transmitted through the use of kisses, blood transfusions, and contaminated clothing.

Pregnant women suffering from syphilis transmits fetal transmission of syphilis. If one or two pregnant women with early syphilis or early syphilis, the chance of transmission to the fetus is very high.

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1. Source of infection

Syphilis is a disease unique to humans. Patients with dominant and recessive syphilis are the source of infection. The skin lesions and secretions of people infected with syphilis and blood contain Treponema pallidum.

The first two years after infection were the most contagious, and after four years, the sexual transmission of the infection was greatly reduced.

Treponema pallidum can be transmitted to the fetus through the placenta, and the risk of infection of fetuses by early syphilis is high.

2. Transmission route

Sexual contact is the primary route of transmission of syphilis, accounting for more than 95%. The early infectiousness of syphilis infection is the strongest.

With the prolonged period of illness becoming less and less contagious, it is generally believed that the sexual contact of the infection after 4 years of infection is very weak.

Pregnant women with syphilis can be transmitted to the fetus through the placenta, causing fetal intrauterine infection, can lead to miscarriage, premature birth, stillbirth or delivery of syphilis.

It is generally believed that the earlier the period of syphilis in pregnant women, the higher the chance of infection of the fetus. Even pregnant women suffering from asymptomatic recessive syphilis are contagious.

Clinical manifestations

1. Acquired dominant syphilis

(1) Primary syphilis The hallmark clinical feature is hard chancre. The predilection site is the penis, glans, coronary sulcus, foreskin, urethral orifice; labia majora, clitoris, cervix; anus, anal canal, etc. Can also be found in the lips, tongue, breasts, etc. 1The characteristics of hard chancre are 7~60 days after TP infection.

Most patients with hard chancre are solitary, painless and no itching, round or oval, evident boundary ulcers, higher than the surface of the skin, and the sore surface is relatively clean. Subsequent infections have more secretions. There is a cartilage-like hardness.

Duration of 4 to 6 weeks, can be self-healing. Hard chance can coexist with secondary syphilis and must be differentiated from genital ulcer disease such as soft chancre, genital herpes, and fixed drug eruption. 2 Stool lymphadenopathy occurs after hard chancre 1 to 2 weeks, some patients have inguinal or proximal lymph nodes, can be single or multiple, swollen lymph nodes of varying sizes, hard, non-adhesion, no ulceration, Painless.

(2) Secondary syphilis is characterized by secondary syphilis, which has systemic symptoms and usually reoccurs after a period of asymptomatic phase after the hard chancre subsides.

TP spreads with the blood circulation, causing multiple lesions and multiple lesions. Invasion of skin, mucous membranes, bones, internal organs, cardiovascular, nervous system. When syphilis entered the second phase, syphilis serology tests were almost 100% positive.

Systemic symptoms occurred before the rash, fever, headache, bone and joint pain, hepatosplenomegaly, lymphadenopathy. The incidence of males is about 25%; women are about 50%. 3 to 5 days improved.

Syphilis rashes then appeared, and there were repeated features.

1 Syphilis dermatitis occurred in 80% to 95% of patients. It is characterized by a variety of rashes and recurrences, extensive and symmetrical, superficial and itchy, leaving more scars without moving, and expelling plum treatments to subside quickly.

The main rash types are rash-like, papular-like, pustular syphilis and flat warts, palmoplantar syphilis and so on.

2 Recurrent Syphilis After initial syphilis subsides, approximately 20% of patients with secondary syphilis relapse within one year. Cystic papules are the most common.

3 Mucosal damage About 50% of patients with mucosal damage. Occurs in the lips, mouth, tonsils, and throat. It is a mucous plaque or mucositis with exudates or a grayish-white film with reddened mucous membranes.

4 Syphilitic hair loss accounts for about 10% of patients. Mostly sparse, the border is unclear, such as worm-eaten; a few are diffuse.

5 Bone and joint damage Periostitis, osteitis, osteomyelitis, and arthritis. With pain.

6 Phase II Eye Syphilis Syphilitic iritis, iridocyclitis, choroiditis, and retinitis. Often two sides.

7 Secondary neurosyphilis no more apparent symptoms, abnormal cerebrospinal fluid, CRP positive RPR. There may be meningitis or meningeal vascular symptoms.

8 Whole body superficial lymphadenopathy.

(3) Third-stage syphilis Three-stage syphilis occurs in 1/3 of the untreated dominant TP infections. Of these, 15% were benign advanced syphilis, and 15% to 20% were severe late syphilis.

1 Skin and mucous membrane lesions Nodular syphilis occurs in the scalp, shoulder, back, and extensors.

Gum-like swelling usually occurs in the lower legs, deep ulcers form, atrophy-like scars; occurs in the upper forehead, tissue necrosis, perforation; occur in the nose in the case of bone destruction, the formation of saddle nose; tongue were Chiselous ulcers; vaginal damage for the occurrence of ulcers, may form a vaginal bladder leakage or rectal, vaginal leakage.

2 Near joint nodules are subcutaneous fibrous nodules in which syphilitic fibroids grow slowly. Symmetry, size, hardness, inactivity, no ulceration, normal epidermis, no inflammation, no pain, can be eliminated.

3 Cardiovascular syphilis mainly invaded the aortic arch site; aortic insufficiency can occur, causing syphilitic heart disease.

4 The incidence of neurosyphilis is about 10%, which can happen in the early or several years or decades after infection. Asymptomatic, syphilitic meningitis, cerebrovascular syphilis, meningocele, paralytic dementia can also occur.

Meningeal glandular edema is a subcortical lesion involving one cerebral hemisphere, with increased intracranial pressure, headache, and local brain compression. Substantial neurosyphilis is a substantial lesion of the brain or spinal cord.

The former forms paralytic dementia. The latter manifests as degenerative changes of the posterior spinal cord and posterior cord, as well as paresthesias, ataxia and other symptoms, namely spinal cord spasm.

2. Acquired sexual syphilis

After infected with TP, no syphilis was formed, and no symptoms appeared, or symptoms of dominant syphilis subsided after a certain period of activity. Positive serum syphilis test and normal cerebrospinal fluid examination were called latent syphilis. In the first 2 years after infection, it is called early latent syphilis; more than 2 years after infection is called late latent syphilis.

3. Pregnancy syphilis

Pregnancy syphilis is dominant or recessive syphilis occurring during pregnancy. In gestational syphilis, TP can be transmitted to the fetus through the placenta or umbilical vein, resulting in congenital syphilis of the baby born later. In pregnant women, placental tissue necrosis occurs due to arteriitis, resulting in miscarriage, premature birth, and stillbirth. Only a few pregnant women can develop healthy children.

4. Congenital dominant syphilis

(1) Early congenital syphilis Children are thin when they are born; symptoms appear 3 weeks after birth, lymph nodes are swollen, no adhesion, no pain, and stiffness. More syphilitic rhinitis. About 6 weeks after birth, skin lesions appeared.

The lesions were blister-bullous lesions (syphilitic pemphigus) or rashes and papulosquamous lesions. Osteochondritis and periostitis can occur. Liver, splenomegaly. Thrombocytopenia and anemia. Neurosyphilis can occur. No hard squats occur.

(2) Late congenital syphilis occurs after 2 years of age. One is the permanent damage caused by the early lesions of bone, teeth, eyes, nerves, and skin, such as saddle nose, Hao Qinsen teeth, no activity.

The other category is clinical manifestations that are still caused by active impairments such as keratitis, neurological deafness, abnormal neurological events, changes in cerebrospinal fluid, hepatosplenomegaly, nasal or gingival swelling, hydrosalpinges, periostitis, Inflammation and skin and mucous membrane damage.

5. Congenital latent syphilis

Born in syphilis mothers, without treatment, no clinical manifestations, but syphilis seropositive, less than 2 years of age are early congenital latent syphilis, more than 2 years old are advanced congenital latent syphilis.

Diagnosis of Syphilis

Laboratory inspection

(1) Darkfield microscopy check the patient’s suspected skin lesions (such as hard chancre, flat warts, wet papules, etc.), under a dark field microscope examination, see the movement of Treponema pallidum, can be used as the basis for the definite diagnosis of syphilis.

(2) Serological tests for syphilis There are many serological tests for syphilis. The antigens used are non-spinal antigens (cardiolipin antigens) and treponema pallidum-specific antigens. The former has a rapid plasma response card ring test (RPR), toluidine red unheated serology test (TRUST), etc., can be used for quantitative tests to determine the efficacy and determine the extent of disease activity.

The latter has a Treponema pallidum particle agglutination test (TPPA) and Treponema pallidum enzyme-linked immunosorbent assay (TP-ELISA), and has strong specificity and is used for the confirmation of TP infection.

Treponema pallidum IgM antibody detection: After infection with syphilis, IgM antibodies first appeared, and as the disease progressed, IgG antibodies appeared and slowly increased. After sufficient treatment, IgM antibodies disappeared, and IgG antibodies persisted.

The TP-IgM antibody does not pass through the placenta. If the baby is positive for TP-IgM, it means that the baby has been infected. Therefore, the TP-IgM antibody test is of great significance for the diagnosis of transmitted fetal syphilis in infants.

(3) Cerebrospinal fluid examination Patients with neurological symptoms of syphilis, or those who have failed to drive therapy, should be checked for cerebrospinal fluid.

This test helps in the diagnosis, treatment, and prognosis of neurosyphilis. Inspection items should include cell count, total protein determination, RPR, and TPPA testing.

Differential diagnosis

1. A syphilis hard chancre should be identified with soft diarrhea, fixed drug eruption, genital herpes and so on.

2. One-stage syphilis lymphadenopathy should be differentiated from lymphadenopathy caused by chancroid and venereal lymphogranuloma.

3. The rash of secondary syphilis should be identified with pityriasis rosea, erythema multiforme, tinea versicolor, psoriasis, and tinea corporis. Flat warts should be differentiated from genital warts.

complication of Syphilis

1. Syphilis Pregnant women can infect the fetus, causing stillbirth, miscarriage, premature birth, resulting in infants with congenital syphilis, etc., which seriously endanger the health of women and children.

2. Treponema pallidum invades the central nervous system, can cause meningeal vascular disease, spinal cord spasm, paralytic dementia. Invasion of the cardiovascular system can lead to aortitis, aortic insufficiency, and aortic aneurysm. Serious people can die.

3. Treponema pallidum damages the bones, eyes, respiratory tract, digestive tract and other systems, causing the destruction of tissues and organs, loss of function, and severely leading to disability or other adverse consequences.

Treatment of Syphilis

1. The principle of treatment

Emphasis on early diagnosis, early treatment, treatment rules, and adequate dosage. Clinical and laboratory follow-ups were performed regularly after treatment. Sex partners should check with others.

Early treatment of syphilis can be completely cured and eliminate contagiously. Late syphilis treatment can reduce tissue inflammation, but the damaged tissue is difficult to repair.

Penicillin, such as water penicillin, procaine penicillin, benzathine penicillin, etc. as the drug of choice for different stages of syphilis. Tetracycline, erythromycin, etc. may be selected for allergies to penicillin.

2. Early syphilis

(1) Penicillin therapy benzathine penicillin G (long-acting Xilin), intramuscular injection on both sides of the hip, once a week, a total of 2-3 times. Procaine penicillin G, intramuscular injection, continuous 10 to 15 days, a total of 8 million u ~ 12 million u.

(2) Allergic to penicillin tetracycline hydrochloride, oral, and even served for 15 days. Doxycycline, even for 15 days.

3. Late syphilis

(1) Penicillin Benazepenicillin G, once/week, intramuscularly, 3 times in total. Procaine penicillin G, intramuscularly, for 20 consecutive days. The treatment can be repeated once every 2 weeks.

(2) Allergic to penicillin tetracycline hydrochloride, oral, and even served 30 days. Doxycycline, even for 30 days.

4. Neurosyphilis

Should be hospitalized, to avoid the occurrence of Ji Hai’s reaction during treatment, oral prednisone was given 1 day before the injection of penicillin, once daily for 3 days.

(1) Aqueous penicillin G intravenously for 14 consecutive days.

(2) Procaine penicillin G is injected intramuscularly and simultaneously with oral probenecid for 10 to 14 days.

After the above treatment, benzathine penicillin G was administered once a week for intramuscular injection for 3 weeks.

5. Gestational syphilis

Treatment is given according to the syphilis treatment regimen for the corresponding period of illness. Within the first 3 months of pregnancy, one course of treatment is applied and one course of treatment is applied during the last 3 months of pregnancy.

Those who were allergic to penicillin were treated with erythromycin. Even the early stage of syphilis served for 15 days. The second stage of relapse and late syphilis served for 30 days. The baby was given a penicillin supplement.

6. Fetal transmission of syphilis (congenital syphilis)

Congenital syphilis (within 2 years of age) abnormal cerebrospinal fluid: water penicillin G or procaine penicillin G treatment, the specific dose prescribed by the doctor. Normal cerebrospinal fluid: benzathine penicillin G, one injection (with both gluteal muscles).

If a thorough examination of cerebrospinal fluid, abnormal cerebrospinal fluid can be treated.

7. Syphilis treatment for pregnant women

(1) A married woman with a history of syphilis must undergo a comprehensive syphilis test before pregnancy. Women who have had dirty sex or have had syphilis before going into pregnancy are advised to go to regular hospitals for extensive syphilis testing.

For those married women whose syphilis treatment is completed and the symptoms of syphilis are not visible, they must be determined to be syphilis before they can become pregnant.

(2) Pregnancy syphilis examination and treatment: syphilis serology should be performed at the beginning of the third month and the end of pregnancy. If found infected syphilis should regularly be treated to reduce the chance of fetal syphilis.

9. Diet considerations

After suffering from syphilis diet, like other infectious diseases, you must eat fresh vegetables and fruits rich in vitamins, eat less greasy foods, eat spicy foods, quit smoking, and drink more alcohol, which is beneficial to the body’s toxins exclude.


After the treatment of syphilis, how to judge whether it is cured or not, is usually decided by the syphilis serology test. The RPR (rapid plasma renin ring card test) and TPPA (trehalose granules agglutination test) are commonly used in major hospitals at present. ).

RPR is a non-specific syphilis serology test and is often used to determine efficacy. TPPA detects serum-specific Treponema pallidum antibodies with high sensitivity and specificity.

Once the test is positive, it will remain favorable for life, regardless of whether the disease is treated or whether the disease is active.

The titer change is not related to the activity of syphilis, so it cannot be used as an indicator to evaluate the efficacy or determine recurrence and reinfection. It can only be used as syphilis. Confirmation test.

For those diagnosed with syphilis, it is best to do RPR quantitative tests before treatment. When the titer changes in two quantitative analyses differ by more than 2 dilutions, the titer decrease can be determined.

After undergoing formal treatment, syphilis patients are required to review RPR once every three months, review RPR semiannually after half a year, follow-up for 2 to 3 years, and compare the current and previous RPR titer changes.

After 3 to 6 months of treatment, the titer decreased by more than 4 times, indicating that the treatment was effective. The titer can drop steadily or even become negative.

If the results of three or four consecutive tests are negative, it can be considered that the patient’s syphilis has been clinically cured.

After syphilis treatment, the serum response of syphilis patients generally has three possible changes:

1. The serum turns negative.

2. Serum titer reduction does not change or serum resistance.

3. After becoming negative, it becomes positive again, or it rises during the continuous decline, indicating recurrence or reinfection.

Each phase of syphilis is treated with different drugs, and the rate of negative conversion of serum response may be different. The first and second stage of syphilis were treated with any anti-Mei drugs. The rate of negative conversion of serum was high, usually ranging from 70% to 95% within 1 to 2 years.

When the first phase of syphilis is treated with plum resistance for 12 months, after 24 months of secondary syphilis, the serum reaction remains positive, which is clinically called serum resistance or serum fixation.


First of all, health education and publicity should be strengthened to avoid unsafe sex. The following preventive measures and precautions should be taken.

1. Follow the patient’s sexual partners, find all sexual contacts of the patient, conduct preventive examinations, follow up observations and perform necessary treatments, and prohibit sexual behavior before curing.

2. Suspicious patients should be tested for prevention, do syphilis serum test so that early detection of patients and timely treatment.

3. For pregnant women suffering from syphilis, effective treatment should be given in time to prevent the infection of syphilis to the fetus. Unmarried syphilis, it is best to cure and then get married.

4. If you need to donate blood, go to a regular blood collection site and do a thorough blood test before the blood donation to prevent infection.

If a blood transfusion is required, blood transfusion units are expected to show proof of examination of the transfused blood to prevent unnecessary trouble.

5. Syphilis patients should pay attention to work and rest, perform necessary functional exercises, and maintain an excellent attitude to facilitate recovery.

 6. Syphilis patients should prohibit sexual activity before they are cured and must use condoms if they do.

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