Stage 1 syphilis
The incubation period of an average of 3-4 weeks, the typical damage for the hard chancre (Hard Chancre, Ulcus Durum) began in the spirochete invasion site appeared in a small red papule or a hard nodule, and later manifested as vesiculation, the formation of a shallow in the ulcers, the nature of the hard, painless, garden-shaped or oval-shaped, the border is clear, the edges are neat, around the dark red infiltration, there is a characteristic cartilage-like hardness, the base is a little bit hard. The ulcer is hard, painless, garden-shaped or ellipsoidal, with clear boundaries, neat margins, a dike-like elevation, surrounded by a dark red infiltrate with characteristic cartilaginous hardness, a flat base, no pus, and a fibrous protein-like film attached to the surface, which is not easy to remove, and, if pinched a little, a small amount of plasma exudate may be present, containing a large number of syphilis spirochetes, which is an important source of infection. The chancre is mostly single, but there may be two or three. The above is a typical chancre. However, if the chancre occurs in a pre-existing vesicle, laceration or eroded herpes or glans, the chancre takes on the same shape as the pre-existing lesion and should be tested for syphilis spirochetes. As the chancre is contracted through sexual intercourse, the damage is most often found on the vulva and at the site of sexual contact, in men near the glans, the coronal groove and the ligament, the inner lobe of the prepuce or the penis, the root of the penis, the urethral opening or the urethra, the latter of which is easily misdiagnosed. The hard chancre is often combined with edema of the foreskin. In some patients, lymphangitis may be present on the dorsum of the penis in the form of a harder, linear lesion. In women, noma is most common in the labia majora and minora, the clitoris, the urethra, the mons veneris, and especially in the cervix, where it can be easily missed. Extra-vaginal noma is most common on the lips, tongue, tonsils, fingers (health-care workers can also be infected with finger noma), breasts, eyelids and outer ears. In recent years, chancre of the anus and rectum has also become common. It is often accompanied by severe pain, difficulty in defecation and easy bleeding. When it occurs in the rectum, it is easily misdiagnosed as rectal cancer. Chancre on the vulva is often atypical and should be tested for syphilis spirochetes and genetic diagnostic tests. The following characteristics of the noma are present: (1) the injury is often single; (2) it is cartilaginous and hard; (3) it is painless; and (4) the surface of the injury is clean.
One week after the appearance of the hard chancre, the nearby lymph nodes become enlarged, which is characterized by painlessness, no redness or swelling of the skin surface, no adhesion to the surrounding tissue, and no ulceration, and is known as painless transverse chancre (painless lymphadenitis). The hard chancre can heal on its own after 3-4 weeks if left untreated. It can heal rapidly with effective treatment, leaving a superficial atrophic scar. Two to three weeks after the onset of the chancre, syphilis seropositivity begins. In addition to the chancre, a small number of patients with stage I syphilis may also have a hard, tough edema on the labia majora, prepuce or scrotum. This is called edema induratum. If the patient is also infected with a soft chancre caused by Haemophilus ducreyi or a disintegrating ulcer caused by lymphogranuloma venereum, it is called a mixed chancre.
The diagnosis of syphilis is based on: ① a history of unclean sexual intercourse with an incubation period of 3 weeks; ② typical symptoms, such as a single painless chancre, which occurs mostly in the external genitalia; ③ laboratory tests: PCR test for positive syphilis spirochete genes, or dark-field microscopy, the spirochete is found in the chancre sampled; syphilis serology test is positive. One of these three tests is positive.
Differential diagnosis: and the first stage of syphilis need to differentiate between the diseases
①genital herpes: the beginning of the micro-convex erythema, 1, 2 days after the formation of clusters of small herpes, self-awareness of itching and pain, not hard, 1-2 weeks after the subsidence, but prone to recurrence. Tissue culture was positive for herpes simplex virus and Tzank smear. PCR was positive for herpes virus DNA.
②Noma-like pyoderma: the pathogen is Staphylococcus aureus or Streptococcus. The morphology of the lesions is similar to that of the chancre, but without the typical cartilage-like hardness, without dark red infiltration around them, without a history of unclean sexual intercourse, and with a negative syphilis spirochete test. Nearby lymph nodes may be enlarged, but the lesions subside after healing.
3) Noma: It is also one of the sexually transmitted diseases (STDs), with a history of sexual contact, and is caused by the bacterium Haemophilus ducreyi (Duery). The incubation period is short (3-4 days), the onset is acute, inflammation is remarkable, pain, soft nature, lesions are often multiple, the surface has purulent secretion, Duery's haemophilus can be detected, and the syphilis serologic test is negative.
④Tuberculous ulcers: also seen in the penis, glans. The lesions are also single isolated shallow garden-shaped ulcers, the surface is often crusted, self-conscious symptoms are mild, can detect tuberculosis bacilli. Often accompanied by visceral tuberculosis.