Article 153: Self-examination methods for secondary syphilis, diagnosis of syphilis, and Western medical treatment.

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Treatment and recuperation of common diseases

How to self-test for secondary syphilis

Patients with primary syphilis chancres can recover spontaneously within 3-4 weeks without treatment. The period from the disappearance of the chancre to the appearance of secondary syphilis rashes is called the second incubation period. During this period, Treponema pallidum enters the bloodstream from the local lesion and spreads to all parts of the body.

Secondary syphilis lesions mainly occur on the skin and mucous membranes, and may also be accompanied by skin appendage damage (such as hair loss). Before the appearance of skin and mucous membrane lesions, prodromal symptoms of varying severity often appear, such as fever, headache, bone pain, neuralgia, and loss of appetite. After the rash appears, the above prodromal symptoms gradually disappear.

Secondary syphilis presents with a wide variety of skin lesions, generally classified into three types: macules, papules, and pustules, with pustules being less common. Although these skin lesions are complex, they typically share common characteristics: the skin initially appears pale red, gradually turning dark red or bronze; they are painless and non-itchy; the rashes vary in size, are numerous, symmetrically distributed, and isolated; they most commonly occur on the chest, abdomen, sides of the trunk, and back, but rarely on the face. Syphilitic pustules can develop in debilitated or malnourished patients, often accompanied by high fever and systemic symptoms.

In addition, there are some special types of skin lesions, such as condyloma latum, psoriatic syphilis, and annular papular syphilis. These typical and special types of local surfaces should be differentiated from similar skin lesions.

Secondary syphilis manifests on the mucous membranes as leukoplakia, diffuse erythematous syphilitic rash, syphilitic glossitis, and tonsillitis. Because the mucous membranes are thinner than the skin, the lesions easily infiltrate the surrounding tissues, spreading diffusely and readily forming ulcers.

Secondary syphilis is highly contagious. If it is not treated properly or at all, it often progresses to visceral, neurological, bone, and joint syphilis. However, if treated promptly and appropriately, it can be completely cured.

How to diagnose syphilis

1. Medical history: Attention should be paid to whether there is a history of extramarital sexual activity and abnormal sexual behavior, including the time and frequency of promiscuity and whether the contacts have sexually transmitted diseases; whether the patient has had painless and non-itchy skin or mucous membrane rashes or ulcers on the genitals or other parts of the body in the past; whether there is a history of sexually transmitted diseases in family members, and the health status of the spouse and children, etc.

2. Physical examination: The focus should be on examining the skin and mucous membranes of the whole body, especially the genitals, for rashes and ulcers; attention should also be paid to whether the lymph nodes are swollen and painful, and whether there are any lesions in the bones and joints; for patients with a long course of disease, the cardiovascular and nervous systems should also be examined for any abnormalities.

3. Laboratory tests: In the early stages, specimens can be taken from skin rashes and ulcers for smear preparation and examined using a dark-field microscope or special staining to look for Treponema pallidum. Additionally, blood should be drawn for serological testing to check for non-specific or specific Treponema pallidum antibodies. In late-stage patients, cerebrospinal fluid examination may be necessary. Some skin and mucous membrane samples should be biopsied for pathological examination.

Only through detailed medical history taking, thorough physical examination, and necessary laboratory test results can a more reliable and accurate diagnosis and timely treatment of syphilis at each stage be made.

How does Western medicine treat this?

The principles of syphilis treatment are accurate diagnosis, timely treatment, adequate dosage, and a standardized course of treatment. Regular follow-up observation is necessary after treatment, and the patient's spouse and sexual partners should also be examined and treated simultaneously. Currently, penicillin is the first-line drug for treating syphilis, with advantages including high efficacy, short treatment course, low toxicity, and no cases of drug resistance have been reported to date. The treatment regimen for syphilis is as follows:

1. Early syphilis (including primary, secondary, and latent syphilis with a course of illness within 2 years):

Procaine penicillin G, 800,000 units daily, intramuscular injection, for 10 consecutive days, totaling 8 million units.

Benzathine penicillin G (long-acting penicillin), 2.4 million units each time, administered intramuscularly to both arms, once a week for a total of 2 times.

For those allergic to penicillin, the following alternative medications can be used:

Tetracycline 500 mg, orally, 4 times a day, for 15 days, total dose 30 g (contraindicated in patients with hepatic or renal insufficiency).

Erythromycin 500 mg, orally, 4 times daily, for 15 consecutive days.

2. Syphilis with a duration of more than 2 years (tertiary cutaneous, mucosal, and skeletal syphilis, latent syphilis with a duration of more than 2 years, and secondary recurrent syphilis):

Procaine penicillin G, 800,000 units daily, intramuscular injection, for 15 consecutive days as one course of treatment. A second course of treatment may also be considered. Discontinue medication for 2 weeks between courses of treatment.

Benzathine penicillin G, 2.4 million units each time, once a week, intramuscular injection, for a total of 3 times.

For those allergic to penicillin, alternative medications should be selected:

Tetracycline 500 mg, orally, 4 times a day, for 30 days as one course of treatment.

Erythromycin 500 mg, usage and dosage are the same as tetracycline.

3. Cardiovascular syphilis:

Only procaine penicillin G should be used, 800,000 units daily, intramuscularly, for 15 consecutive days as one course of treatment, for a total of 2 courses (or more), with a 2-week break between courses. Benzathine penicillin is not permitted.

For those allergic to penicillin, using alternative medications often results in very poor efficacy.

Tetracycline 500 mg, orally, 4 times a day, for 30 days as one course of treatment.

Erythromycin 500 mg, usage and dosage are the same as tetracycline.

4. Neurosyphilis:

Aqueous penicillin G, 4.8 million units daily, intravenous drip, 10 days as one course of treatment, with a 2-week interval, repeating one course of treatment.

Procaine penicillin G, 2.4 million units daily, intramuscular injection, and probenecid 0.5 g orally four times daily for 10 days; followed by benzathine penicillin G, 2.4 million units intramuscular injection once a week for 3 weeks.

5. Syphilis during pregnancy:

Procaine penicillin G, 800,000 units daily, intramuscular injection, for 10 consecutive days. One course of treatment is given during the first three months of pregnancy, and another course is given during the last three months of pregnancy.

For patients allergic to penicillin, only erythromycin is used, with the same administration and dosage as for non-pregnant patients, but their infants are treated with penicillin.

6. Congenital syphilis:

Procaine penicillin G, 50,000 units/kg daily, intramuscular injection, for 10 consecutive days as one course of treatment; a second course of treatment may be considered for late-stage congenital syphilis.

Benzathine penicillin G, 50,000 units/kg, once intramuscularly. Not used in patients with neurosyphilis lesions (poor efficacy).

The dosage of penicillin for older children should not exceed the same treatment dose for adults. For those allergic to penicillin, erythromycin should be used instead. Tetracycline is contraindicated in children under 8 years of age.