What Is Tertiary Syphilis?

Syphilis is a chronic systemic sexually transmitted disease caused by Treponema pallidum infection, mainly through sexual transmission. The manifestations of this disease are extremely complex and can invade almost all organs of the human body, causing damage to multiple organs. Such as ulcers or hard chancrees in the first-stage syphilis infection site; second-stage syphilis can cause skin and mucosal damage and lymphadenopathy; third-stage syphilis usually occurs 2 years after the onset of the disease, but there are also longer 3 to 5 years. Heart, nerve, stomach, eye, ear and other damage. Syphilis can also be transmitted to the next generation through the placenta, causing congenital syphilis in the newborn.

Basic Information

English name: tertiary syphilis
Visiting department: Department of Infectious Diseases
Common locations: Heart, nerves, stomach, eyes, ears, etc.
Common causes: Treponema pallidum

Common symptoms: Symptoms are complex and can involve any tissues, including skin, mucous membranes, bones, joints, and various internal organs, and are more likely to invade the nervous system
Contagious: weak
way for spreading: Sexual transmission

Causes of Stage III Syphilis

Mainly due to lack of anti-syphilis treatment or insufficient treatment time, insufficient medication. There is also a certain relationship between internal and external environmental disorders. Excessive drinking, pharyngeal suction, physical weakness, and chronic diseases such as tuberculosis have a poor prognosis.

Clinical manifestations of tertiary syphilis

Occurrence time is generally 2 years after the onset, but there are also people who last longer for 3 to 5 years, and are more likely to occur between the ages of 40 and 50. This is mainly due to the lack of anti-syphilis treatment or insufficient treatment time and insufficient medication. The characteristics of the third stage syphilis are as follows:

1. Late onset (2 to 15 years after infection), long course of disease, if not treated, it can be as long as 10 to 20 to 30 years, or even lifetime.

2. Symptoms are complicated and can involve any tissues and organs, including skin, mucous membranes, bones, joints, and various internal organs. They are more likely to invade the nervous system, easily confused with other diseases, and difficult to diagnose.

3. Treponema pallidum in the body and skin lesions are few and the infection is weak, but the tissue destruction is strong, often causing tissue defects, organ damage, can cause disability, and even endanger life.

4. Although anti-mei treatment is effective, it cannot repair damaged tissues and organs.

5. The serum response of syphilis is unstable, the negative rate can reach more than 30%, and the cerebrospinal fluid often changes.

Tertiary syphilis skin and mucosal damage accounted for 28.4% of the incidence of advanced benign syphilis, most of which occurred within 3 to 10 years after infection. Clinically, it can be divided into nodular syphilis rash, gum swell, and near joint nodules. Skin damage has the following characteristics: The number is small, isolated or clustered but not symmetrical, and often occurs in vulnerable areas. The systemic symptoms are mild, and the lack of consciousness of skin lesions is painful, such as invasion of periosteum and bone, especially at night. There is gum infiltration and induration, and the ulcers formed after ulceration still have a hard and solid infiltration at the base, which subsides slowly, often for more than several months. The ulcer has a specific kidney or horseshoe shape. The center of the ulcer can be cured, while the edge often continues to spread. There is less treponema pallidum on the damaged surface, and it is difficult to detect by dark field microscopy, but the vaccination can be positive. strong tissue destruction, healing can form scars.

Phase III syphilis test

Dark field microscopy

At the skin lesion, use a glass slide to scrape out tissue exudate or lymph node puncture fluid. See Treponema pallidum active.

2. Immunofluorescence staining

Green Treponema pallidum was visible under a fluorescence microscope.

3. Syphilis serum test

Depending on the antigen used, the syphilis serum test is divided into the following two categories:

(1) Serum test for non- Treponema pallidum antigen. Cardiolipin is used as the antigen, and the anticardiolipin antibody in the serum is measured, which is also called reactin. The rapid plasma reagin test is an improved test for venereal disease research laboratory experiment (VDRL) antigen. The sensitivity and specificity are similar to VDRL. The advantage is that the results can be read with the naked eye. The unheated serum reagin slide test is also an improvement of VDRL antigen, with similar sensitivity and specificity to VDRL.

(2) Treponema pallidum antigen serum test Fluorescent syphilis antibody absorption test: This method is a more sensitive and specific Borrelia test. Treponema pallidum hemagglutination test: The sensitivity and specificity are high, and the operation is simple, but it is not as sensitive to the first phase syphilis as the fluorescent Treponema pallidum antibody adsorption test (FTA-ABS) test.

Stage III syphilis diagnosis

1. Have unclean sex, early history of syphilis.

2. Typical symptoms such as nodular syphilis rash, gum swelling, aortic inflammation, aortic valve insufficiency, aortic aneurysm, spinal ridge, and paralytic dementia.

3. Laboratory tests have a syphilis serum test, about 66% of the non-spiral antigen serum test is positive; the spirochial antigen serum test is positive. Cerebrospinal fluid examination showed an increase in white blood cells and protein, and a positive STD research laboratory test (VDRL).

Stage III syphilis differential diagnosis

1. Diseases distinguished from advanced skin syphilis

(1) Diseases distinguished from nodular syphilis Lupus vulgaris is small, often sunk in the skin, brownish red, lightly infiltrated, soft in nature, and often fuses to form larger ulcers after ulceration, which is prone to occur It may damage the tissue near the face, nose and nose, causing disfigurement. Rheumatic nodules should be distinguished from near joint nodules. The joint nodules are small, with signs of inflammation such as redness, swelling, short duration, and other symptoms of acute RF. Others include tumor type leprosy.

(2) Diseases distinguished from skin gum edema. Skin tuberculosis occurs in subcutaneous tissues and is apt to invade lymph nodes. It is common in cervical lymph nodes and can also be seen in the limbs. It is difficult to heal after passing slowly. The edge of the ulcer formed after ulceration is thin and irregular, such as rat bite puncture, often forming sinus, thin secretions, mixed with particles, and form a strip-like scar after healing, anti-TB treatment is effective. Sporotrichosis is arranged along the path of lymphatics. The initial onset can be painless, hard, and movable nodules. Later, it softens and ulcerates to form an ulcer. However, there is no infiltration of syphilis around the ulcer and secretions can be found in mycelia . Chronic calf ulcers are often accompanied by varicose veins in the calf. Nodules are first onset, and there is pus on the surface of the ulcer, which does not damage bone. Others include necrotic skin tumors.

2. Diseases distinguished from advanced mucosal syphilis

There are neoplastic leprosy, systemic lupus erythematosus (SLE), Behcet syndrome (Behcet syndrome), and nasopharyngeal carcinoma.

3. Diseases identified from advanced genital syphilis

Sexually transmitted lymphogranuloma (LGV), groin granuloma, prostate cancer, uterine fibroids, and ovarian cysts.

4. Diseases distinguished from advanced bone and joint syphilis

There are purulent periostitis, osteomyelitis, osteitis, various bone tumors, rheumatoid arthritis, bone and joint tuberculosis, senile arthritis and subcutaneous fibroma.

5. Diseases distinguished from advanced eye syphilis

There are tuberculosis or leprosy interstitial keratitis, brain tumors and other combined eye diseases.

6. Diseases distinguished from cardiovascular syphilis

There are hypertension, aortic sclerosis, coronary heart disease, rheumatic aortic valve insufficiency, and mediastinal tumors.

7. Distinguish from advanced neurosyphilis

There are tuberculous meningitis, meningiomas, cerebral thrombosis, cerebral hemorrhage, cerebral embolism, neurasthenia, schizophrenia and brain tumors.

Tertiary syphilis complications

It is more destructive to tissues, which can be life-threatening when severe, and can invade the central nervous system, cardiovascular system, and skeletal system, causing tissue and organ damage, loss of function, and disability or death.

Tertiary syphilis treatment

1. Three-stage syphilis western medicine treatment method

Syphilis penicillin treatment plan: Late syphilis includes patients with stage III skin, mucosal, and bone damage, and latent syphilis with a disease duration of more than two years, as well as cardiovascular syphilis and neurosyphilis. For the treatment of benign advanced syphilis (vascular, mucosal, bone, etc.), procaine penicillin G can be injected intramuscularly, or benzathine penicillin can be injected intramuscularly. For cardiovascular and central nervous system syphilis, benzathine penicillin is not used and procaine penicillin is injected intramuscularly. The treatment method for congenital syphilis over two years old can be carried out according to the corresponding disease period of the adult, and the dosage should not exceed the adult's dosage.

2.Traditional Chinese Medicine Treatment Method of Three Stage Syphilis

The treatment is mainly based on exorcising evil spirits, taking into account righting, so that the evil poison is gone, vitality is filled, and it works. The treatment of this disease should be mainly antibiotics, supplemented by traditional Chinese medicine. Among antibiotics, penicillin is the main. It should be administered in a sufficient amount and continuously. It must be thorough. In addition to traditional adjuvant therapy, traditional Chinese medicine can also improve the body's immunity and achieve therapeutic effects.

Tertiary syphilis prevention

First of all, health education and education should be strengthened to combat inappropriate sexual behavior. Second, the following precautionary measures should be taken:

Preventive inspection

Suspect patients should undergo preventive examinations and syphilis serum tests to detect new patients early and treat them promptly.

2. Isolation treatment

Patients found to have syphilis must be forced to undergo isolation and treatment. The patient's clothing and supplies, such as towels, clothes, razors, tableware, bedding, etc., must be strictly disinfected under the guidance of medical staff to prevent the source of infection.

3. Patient tracking

Tracing patients' sexual partners, including self-reported by patients and medical staff's visits, finding all sexual contacts of patients, conducting preventive inspections, follow-up observations and performing necessary treatments, the spouse is absolutely forbidden to have sex before being cured.

4. Pregnant woman treatment

For pregnant women suspected of having syphilis, preventive treatment should be given in time to prevent the infection of syphilis to the fetus; unmarried men and women cannot marry without cure.