Clinical symptoms of syphilis. Acquired syphilis can be divided into early syphilis and late syphilis. The disease period of early syphilis is within two years after infection, including primary syphilis and secondary syphilis, and the disease period of late syphilis is more than two years after infection, that is, tertiary syphilis. Primary syphilis: onset 3 weeks after infection (10-30 days). A hard and painless round nodule appeared at the infected site. It began to flush and wet, and gradually burst, and the first-stage syphilis rotted, forming an ulcer, which is the hard chancre of the first-stage syphilis. Its main damage is chancre, which is caused by the initial invasion and reproduction of Treponema pallidum. The typical chancre is a painless red induration, as hard as cartilage, with clean basal part, a little exudate or thin scab on the surface and neat edges. The number of damages is mostly single or multiple. It occurs in the external genitalia. Men mostly occur in the foreskin, coronary sulcus, glans penis or penile frenulum. Gay men often occur in the anus and rectum. Women usually occur in the inner side of labia majora and labia minora, but also in the cervix and other places. At the same time, bilateral inguinal lymph nodes are swollen, but it is not painful. By kissing an infected person, chancre can occur on the lips, mandible and tongue, eyelids, fingers and breasts, and sometimes it can be accompanied by other sexually transmitted diseases, such as gonococcal dermatitis, and then it can be cured. There are many spirochetes in chancre of primary syphilis, often accompanied by local lymphadenopathy. Very infectious. After 2-6 weeks, chancre will disappear, leaving no scars. However, because the female chancre is hidden and asymptomatic, it is often ignored, which increases the chance of transmission. If primary syphilis is not treated or treated improperly, spirochete spreads to the whole body through blood circulation and lymph nodes, and develops into secondary syphilis after a few weeks. Secondary syphilis: untreated patients can develop secondary syphilis from 6 weeks to 6 months after infection. It is because the treponema pallidum in the primary syphilis chancre reaches lymph nodes through lymphatic vessels and spreads to the whole body through blood circulation. In the early stage, fever, fatigue, headache, sore throat, muscle pain, joint pain, anorexia and other systemic symptoms may occur. More than half of the patients have systemic lymphadenopathy and occasionally hepatosplenomegaly. Hemogram may include leukocytosis, anemia and elevated erythrocyte sedimentation rate. About 70% patients have a rash called syphilis rash. Syphilis rash can have many different manifestations, generally symmetrical and widely distributed, without itching. (1) Macular syphilis (rose rash). This is the first syphilis rash, a red, brown or pigmented rose rash, which usually occurs first on the trunk. Later, secondary syphilis developed to limbs, palms and soles. Erythema is round and basically symmetrically distributed in the palm and sole. This is also the reason why syphilis is commonly known as "Myrica rubra big sore". (2) papular syphilis. This is due to the development of the course of the disease, and some macules can thicken and evolve into papules. It is common in trunk, buttocks, calves, palms, soles of feet and face. It can be manifested as maculopapules, papules, scaly papules, rings and psoriasis-like lesions. (3) Flat wart. This is a papule that occurs around skin folds and moist parts such as external genitalia and anus. The damage is smooth, thick, flat and flat, with a layer of gray film on the surface and a large number of treponema pallidum. Condyloma plana is more contagious than other secondary syphilis. (4) About 30% patients have oral mucosal lesions, which are called mucosal spots. The damaged surface is covered with a gray film, which contains a large number of treponema pallidum. Flake or diffuse alopecia can occur in the process of secondary syphilis. Generally, hair loss can heal itself. Secondary syphilis can sometimes endanger the nervous system, bones or eyes. The symptoms and signs of secondary syphilis are: usually lasting for several weeks, it will subside on its own, and if it is not treated, it will often recur within L-2 years. Secondary syphilis is characterized by a systemic rash. It is characterized by obvious objective findings, and may have low fever, headache, sore throat, joint pain and other similar cold symptoms. At this time, it is highly contagious and can be naturally improved into latent syphilis. Tertiary syphilis: more than two years after infection. There are mainly the following types: (1) advanced benign syphilis. Its basic damage is gingival swelling, which may be caused by inflammatory reaction to Treponema pallidum antigen, and its pathogenesis is still unclear. Under the microscope, active diseases become granulomas, and old diseases become extensive fibrosis. Treponema pallidum is generally not found in swollen gums. This kind of inflammation can invade any organ, but the most common ones are skin and bones. Skin lesions include dermal or subcutaneous nodules, ulcerative nodules and swollen gums. Nodules often occur in the face, trunk and limbs of tertiary syphilis, showing asymmetric cluster distribution, painless, slow progress and gradual ulcer. Ulcers generally heal slowly from the center, leaving scars. The swelling of the skin and gums is a single induration, which gradually increases into an infiltration block and forms an ulcer after collapse. In the course of the disease, some areas will heal themselves and leave scars. For example, when oral mucosa and nasal mucosa are involved, it can lead to perforation of nasal septum and soft and hard palate, and bone damage mainly includes periostitis and gingival swelling. (2) Cardiovascular syphilis. There may be aortitis, aortic valve insufficiency, aortic aneurysm, etc. (3) neurosyphilis. There may be spinal tuberculosis, paralytic dementia, optic atrophy and so on. Second, congenital syphilis congenital syphilis is passed from mother to fetus through placenta, which often causes premature delivery and stillbirth. 1. Early congenital syphilis. Symptoms appear in people under two years old. The main manifestations are rhinitis, besides pharyngitis, emaciation, insomnia, lymphadenopathy, hepatosplenomegaly, osteochondritis, pseudoparalysis and so on. Mucosal lesions of the skin include papules, scales or large scar rashes, flat warts, mucosal spots and so on. 2. Late congenital syphilis. Symptoms appear in people over two years old. The manifestations are substantive keratitis, saddle nose, hilt, Hutchinson's teeth, nervous deafness and so on. Others are generally similar to tertiary acquired syphilis. 3. Latent syphilis (recessive syphilis). The symptoms and signs of untreated secondary syphilis often fade naturally and enter an asymptomatic period, which is called incubation period. If left untreated, patients usually relapse within two years. Patients within two years are called early latent syphilis. Patients with more than two years are called late latent syphilis. Latent syphilis rarely recurs, but pregnant women can still transmit it to their babies. Latent syphilis has no other symptoms except positive serum reaction. Although latent syphilis is asymptomatic, treponema ostreatus continues to lurk in important organs in the body, such as tertiary syphilis, such as eye and nose damage, cardiovascular syphilis, neurosyphilis and mental disorders. , will appear in a few years or even decades, or even die out. After a female syphilis patient is pregnant, Treponema pallidum can reach the placenta through maternal blood, destroy the placenta and then pass it on to the fetus. The fetus is infected at 6-7 weeks of pregnancy, leading to miscarriage, stillbirth and premature delivery. Children with fetal syphilis may have syphilis damage to skin, bones, teeth, liver and spleen, which will appear one after another after they are 2 years old. In severe cases, they may have blindness and brain damage. Syphilis serum test is the main method to diagnose syphilis. When the primary syphilis is hard and hard, the serum test can be negative. At this time, the exudate of hard chancre or abdominal groove lymph puncture fluid can be placed on the glass to observe the movement state of spirochete and make diagnosis. By the second half of chancre, the positive rate of serum test is very high.