What Is a Syphilis Rash?

Syphilis is a chronic classic sexually transmitted disease caused by Treponema pallidum. It can invade various organs of the body and produce a variety of clinical symptoms and signs. The disease can also be incubated for many years without symptoms. Syphilis is mainly transmitted through sexual contact and can also be transmitted to the next generation through the placenta. A few are infected through direct or indirect contact with pollutants or stab wounds of contaminated sharps by medical staff.

Basic Information

Visiting department

Dermatology, Sexually Transmitted Diseases

Common causes

Treponema pallidum

Contagious

Have

way for spreading

Sexual contact, placenta, direct contact, indirect contact with pollutants

Causes of skin syphilis

The pathogen is Treponema pallidum, which is a small and slender spiral-shaped microorganism. Treponema pallidum is not easy to survive in vitro. It is easy to kill by boiling, drying, soapy water, and general disinfectants such as mercury, carbolic acid, and alcohol. Death at 41 to 42 ° C for 1 to 2 hours. Can survive for several years at low temperatures, maintaining its morphology, vitality and toxicity. Treponema pallidum reproduces by transecting.

Clinical manifestations of skin syphilis

Stages of syphilis: Syphilis is divided into congenital syphilis (fetal syphilis) and acquired syphilis according to the different ways of transmission. It can also be divided into early syphilis and late syphilis according to the development of the disease. Sometimes the illness may be absent or overlapping.

Acquired syphilis is divided into: early syphilis, with a course of 2 years, divided into primary, secondary, and latent syphilis; late syphilis, with a course of more than 2 years, is divided into benign syphilis (invasion of skin, mucous membranes, bones, eyes, etc.), visceral syphilis, Neurosyphilis and advanced syphilis.

Congenital syphilis is divided into early (2 years old) and includes gum swell, neurosyphilis, cardiovascular syphilis, and late latent syphilis.

Early syphilis is contagious, and late syphilis is not.

1. a period of syphilis

The main symptom is hard chancre, which occurs 2 to 4 weeks after unclean sexual intercourse. The skin lesions first appear at the site of Treponema pallidum invasion. The most common are genital areas, but also in the lips, pharynx, and cervix. The hard chancre begins as a macula, then becomes pimples, and soon the center ulcerates. The typical skin lesion is round, 1 ~ 2cm in diameter, with clear boundaries, the sore surface is slightly higher than the skin surface, it is flesh-red erosion, there is a small amount of exudate, and the surface has a large amount of syphilis. Typical hard chancre is seen in 60% of patients. The initial syphilis serum test for hard chancre was negative, and all became positive after 6 to 8 weeks.

2.Second stage syphilis

Second-stage syphilis rash is a systemic manifestation of Treponema pallidum that enters the blood from local lymph nodes and spreads widely in the human body. It usually appears 7 to 10 weeks after infection or 6 to 8 weeks after hard chancre. The secondary syphilis rash disappeared after 4 to 12 weeks.

Early flu-like symptoms can occur, including fever, general malaise, headache, loss of appetite, muscle pain, runny nose, and tears.

The mucosal manifestations of second-stage syphilis are extensive, symmetrical in the early stage, polymorphic in the future, and limited by the rash. The symptoms are mild, destructive, and highly contagious. Common secondary syphilis include spotted rash, maculopapular rash, pimples, pimples scaly syphilis, hair follicle rash, yarrow-like rash, pustular herpes, rash-like rash, and ulcer. The initial damage was spot rash, which occurred 5 to 8 weeks after the hard chancre, distributed on the trunk, limb flexion, round or oval, rose-colored, 0.5 to 1 cm in diameter, and subsided after a few days. The most common rash is maculopapular rash, which occurs 2 to 4 months after infection and is distributed throughout the body, including the face, trunk, limb flexion, copper-red, and rashes characteristic of the palmar plantar area. Pimples are also the most common and characteristic rash of secondary syphilis. The number is less than macular rash, copper-red, flat or pointed, and the surface is smooth. It is distributed on the palms, trunks, upper and lower limbs, and face. Some rashes spread. Or widespread, some rashes isolated, spread the rash to form a ring or bow.

Condyloma acuminata: Occurs in areas where the skin of the vulva, perianum, and between the toes rubs against wet areas. The surface is formed by the fusion of wet papules, slightly higher than the skin, the surface is wet and eroded, the boundaries are clear, there is a gray-white film, and a large amount of syphilis , Very contagious.

Mucosal damage: About one-third of patients with secondary syphilis will have mucosal damage. The most typical skin lesions are mucosal plaques, which occur concurrently with pimples, and are located on the inner sides of the lips and cheeks, tongue, tonsils, and perineum. They show red and swollen mucosa, shallow erosion, round, flat, or slightly raised, and gray-white discharge on the surface. No pain. Mucosal plaques can also occur in the external genitals and anus.

3.Phase III syphilis

40% of untreated syphilis patients develop active advanced syphilis, and 15% have benign advanced syphilis. Skin lesions invade non-lethal tissues and organs, such as skin, mucous membranes, muscles, bones, and testes.

Most of the tertiary skin mucosal syphilis occurs 3 to 7 years after infection, and gum edema occurs later, basically decades later. The later the time, the less skin lesions and the greater the damage. The third-stage rash has the following characteristics: scleroderma caused by syphilitic granulomatosis; the number of skin lesions is small, confined to one place, and the distribution is asymmetric; inflammation and subjective symptoms are slight; ulcers can be formed, there is central healing, and all around Tendency to spread outwards; great destructiveness, superficial scars formed after healing, pigmentation on the edges; anti-syphilis treatment heals faster. Skin lesions are mainly nodular syphilis rash, gum edema, and near joint nodules.

Nodular syphilis is mainly a small subcutaneous nodule, about 0.5 cm in diameter, bronze-colored, with limited layout and asymmetrical distribution on the forehead, hips, shoulders, between shoulders, and extremities. The clusters can fuse into plaques, arranged in a ring, serpentine, and kidney shape, leaving atrophic scars to heal. Gum swelling begins as a small subcutaneous nodule, which gradually increases and connects with the skin to form an invasive plaque with a diameter of 4 to 5 cm. The center gradually softens, ulcers occur, purulent secretions are eliminated, and it expands deeper, often healing on one side. On the one hand, it expands to form a kidney-shaped, horseshoe-shaped puncture ulcer. More common in the extremities of the extremities, forehead, head, hips, under the sternum and lower limbs. The number is small, and it can heal without scars for half a year or more without any treatment. Proximal joint nodules occur near the knee, hip, elbow, and sacroiliac joints. They are symmetrical, hard, and there is no inflammatory reaction on the skin surface. There is a slight pain during compression, which develops slowly, 1 to 2 cm in diameter, does not rupture, and gradually fades after treatment. .

4. Early fetal syphilis

Most syphilis children are normal at birth except they are thin and have low birth weight. Two thirds of the children had clinical manifestations after 3 to 8 weeks, and almost all of them had clinical manifestations within 3 months. 20% of children have enlarged lymph nodes on the tackle, which is diagnostic.

Syphilitic rhinitis is the most common manifestation of mucous membranes, with watery secretions that gradually become thick, purulent, and bloody, block the nose, and make breastfeeding difficult. Skin damage occurs in 33% to 58% of children and occurs 6 weeks after birth. The rash is symmetrical and multi-modal. Skin lesions occur on the face, diaper area, and palmar area. A common type of rash is blister-bulous skin lesions (syphilitic pemphigus), which is characteristic and is a severe manifestation of the disease, which occurs in the palms and palms. The second type of rash is maculopapular and papular scaly lesions, which are common in palmar plantar, external genitalia, buttocks and lower face. It is copper-colored with or without scales. Erosion can occur in wet areas. Skin lesions around the mouth, nose, and anus can form radioactive scars, which are characteristic.

5. Late fetal syphilis

It occurs after the age of 2 years, with scars caused by early fetal syphilis and developmental abnormalities due to early infection. It most often occurs between the ages of 7 and 15 and also occurs after the age of 30. The performance is divided into two groups. One is a permanent marker, which is left over from early lesions. It is inactive and has characteristics, including forehead convexity, sabre tibia, Hao Qinsheng teeth, mulberry teeth, saddle nose, radial palate around the orifice, chest Clavicular joint bone hypertrophy, etc. The other group is the clinical manifestations caused by still active damage, including nasal and frontal gum edema, abnormalities of the cerebrospinal fluid, hepatomegaly, joint effusion, synovitis, finger inflammation, and damage to the skin and mucous membranes.

Skin syphilis diagnosis

Syphilis has a long course and complex symptoms, which can resemble the manifestations of many other diseases. A comprehensive analysis is required to combine the results of medical history, physical examination, and laboratory tests to obtain a diagnosis. The medical history includes a history of infection, whether non-marital sex and extramarital sex; history of sexually transmitted diseases, history of hard chancre and second and third stage syphilis; history of marriage; history of delivery and treatment. Carry out a comprehensive and detailed physical examination, including the palmar plantar area, external genitalia, oral cavity and other parts. Patients with a long course of disease mainly check the nervous system, bones, and heart.

Laboratory tests for syphilis are very important and have important value for the diagnosis of the disease, including the examination of Treponema pallidum, syphilis serum tests, etc., including non-borrelia antigen tests (USR, VDRL, RPR, TRUST) and Treponema antigen serum tests (TPPA, FTA-ABS, EIA, etc.).

Skin syphilis treatment

Syphilis treatment principles include clear diagnosis, timely and early treatment, standardized and sufficient treatment, and follow-up.

Penicillin is the drug of choice for the treatment of syphilis at various stages, including benzathine penicillin and procaine penicillin. Treatment failure is very rare. Other drugs include tetracycline, doxycycline, erythromycin, and third-generation cephalosporin antibiotics, which have been proven to have a strong syphilis killing effect in laboratory and clinical trials, but the clinical effect is not as good as penicillin. Many cases of treatment failure. Doxycycline is more effective than tetracycline, and tetracycline is more effective than erythromycin.