Post-Treatment Reactions to Syphilis: What to Expect - Internal Medicine

Dr. Liao Zhongxin reply Internal Medicine

---

Transmission Methods:
1.
Close contact during sexual intercourse and other sexual activities is the primary route of transmission.
Direct contact of wounds with secretions, bodily fluids, and other excretions (such as semen, blood, and vaginal secretions) from skin or mucosal lesions is highly infectious.
2.
Bloodborne transmission: This can occur through blood transfusions, sharing needles, and other sharp instruments.
3.
Vertical transmission from mother to child: If appropriate treatment is not received during early pregnancy, the infection can be transmitted to the fetus through the placenta, leading to congenital syphilis in newborns, which can result in stillbirth or death.
Susceptibility and Resistance:
1.
Every individual is susceptible to Treponema pallidum, the bacterium that causes syphilis, with approximately a 30% chance of transmission upon contact with an infected person.
2.
After infection, immunity to Treponema pallidum gradually develops; however, this immunity does not confer protection against other spirochetes.
Early syphilis, if treated appropriately, does not lead to the development of this immunity.
3.
Co-infection with HIV can reduce the normal resistance to Treponema pallidum.
4.
Although syphilis can be treated, there is no lifelong immunity, and reinfection can still occur.
Clinical Symptoms:
Syphilis is a systemic chronic infectious disease with complex and highly variable symptoms.
It typically manifests at sites of skin or mucosal lesions and can rapidly spread throughout the body, affecting various organs and tissues.
However, some patients may remain completely asymptomatic.
Based on the duration of infection and presence of infectiousness, syphilis is classified into early and late stages.
Early Syphilis: This refers to the period within two years post-infection, characterized by higher infectiousness.
Painless ulcers and hard chancres appear at the site of contact, with extremely high infectivity, commonly occurring on any part of the male penis or in the female vagina.
If early syphilis is left untreated, hard chancres may spontaneously heal within weeks, but the disease will progress.
Systemic symptoms may emerge, including headaches, fatigue, nausea, fever, weight loss, and muscle and joint pain.
Subsequently, a rash may develop, often presenting as raised red spots the size of beans on the skin, with generalized lymphadenopathy being a common symptom.
Enlarged lymph nodes feel firm like rubber and are painless, typically found in the groin, neck, occipital, axillary, and supraclavicular regions.
Following this, syphilis can enter a stage with no clinical symptoms, lasting from several months to even 20 years.
During this asymptomatic period, Treponema pallidum remains present in the body, continuing to cause damage to bodily tissues and organs.
This often affects the nervous system, with mild and subtle symptoms such as headaches, vomiting, and papilledema.
Recurrent rashes and mucosal lesions may appear, leading to recurrent syphilis.
Distinguishing between syphilis rash and drug allergies can sometimes be challenging, and treatment approaches differ.
If a drug allergy is suspected, it can be severe, and immediate evaluation and treatment at a nearby medical facility are advised.

---

Reply Date: 2022/08/19