Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and management of syphilisGB 159741995
This standard is specially formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and the Measures for the Implementation of the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases. 1 Subject matter and scope of application
This standard specifies the diagnosis and management of syphilis. This standard applies to the diagnosis, reporting and management of syphilis by health and epidemic prevention and medical care institutions at all levels. 2 Terminology
Infection history: The person has had extramarital (premarital) sexual contact, marriage, prostitution or homosexual sexual contact, and blood transfusion and other routes of infection. 3 Diagnostic principles
The diagnosis of syphilis must be based on a comprehensive analysis of medical history, clinical symptoms, physical examination and laboratory tests, and a careful diagnosis must be made. 3.1 Medical history: Attention should be paid to infection history, marital history, pregnancy history, childbearing history, etc. For congenital syphilis, the mother's syphilis history should be understood. 3.2 Physical examination: A comprehensive physical examination should be conducted, paying attention to the skin, mucous membranes, bones, oral cavity, vulva, anus and superficial lymph nodes of the whole body. If necessary, cardiovascular system, nervous system and other system examinations and gynecological examinations should be conducted. 3.3 Laboratory examinations:
3.3.1 Dark field microscope examination of Treponema pallidum. 3.3.2 Syphilis serological tests: Non-treponemal antigen tests, such as VDRL, RPR, USR tests, etc., are screening tests. Treponema pallidum antigen tests, such as TPHA, FTA-ABS tests, etc., are confirmatory tests. 3.3.3 Histopathological examination.
4 Diagnostic criteria for syphilis staging
4.1 Primary syphilis
4.1.1 Medical history: There is a history of infection, and the incubation period is generally 2 to 3 weeks. 4.1.2 Clinical manifestations:
a. Typical hard lower mass: generally single, 1-2 cm in size, round or oval, slightly higher than the skin surface, with flesh-red erosion or shallow ulcer. The sore surface is clean, with little secretion, and the periphery and base are obviously infiltrated with cartilage-like hardness, painless. It often occurs in the external genitalia, and can also be seen in the anus, cervix, lips, breasts and other parts. b. The groin or the affected part of the proximal lymph nodes may be enlarged, often several, of varying sizes, hard, non-adhesive, non-ulcerated, and painless. 4.1.3 Laboratory examination:
a. Dark field microscopy examination: Treponema pallidum can be found in skin and mucosal lesions or lymph node puncture fluid. b. Syphilis serological test: Syphilis serological test is positive. If the infection is less than 2-3 weeks, the non-syphilis treponema antigen test may be negative. It should be re-examined 4 weeks after infection.
Suspected case; suspected cases are those with 4.1.1 and 4.1.2. Approved by the State Administration of Technical Supervision on December 15, 1995, 218
Implementation from July to January, 1996
GB 15974--1995
Confirmed cases: Suspected cases plus any one of the items in 4.1.3 are confirmed cases. 4.2 Secondary syphilis
4.2.1 History of infection, may have a history of primary syphilis, the disease period is less than 2 years. 4.2.2 Clinical manifestations:
a. The rash is polymorphic, including macules, maculopapular rashes, papular rashes, scaly rashes and pustular rashes, etc., often diffuse and symmetrical; dark red spots and desquamative maculopapular rashes are easily seen on the palms and soles: the rashes on the vulva and perianal areas are mostly moist papules and flat condylomata, etc., painless but itchy. Insect-like alopecia may occur on the head. Secondary recurrent syphilis, the skin lesions are limited, the number is small, and annular rashes can still be seen. b. Mucosal spots may occur in the oral cavity, and eye damage, bone damage, visceral and nervous system damage may also occur. c.bzxz.net
Mild discomfort and superficial lymphadenopathy may occur throughout the body. 4.2.3 Laboratory examination:
Dark field microscopy: Secondary rashes, especially flat condyloma acuminatum, moist papules and mucosal spots, are easy to detect Treponema pallidum. a.
b. Syphilis serological tests (non-treponemal antigen test and treponemal antigen test) are strongly positive. Suspected cases: Suspected cases are those with 4.2.1 and 4.2.2. Confirmed cases: Suspected cases plus any one of 4.2.3 are confirmed cases. 4.3 Tertiary syphilis (late syphilis)
4.3.1 Medical history: There is a history of infection, and there may be a history of primary or secondary syphilis. The disease lasts for more than 2 years. 4.3.2 Clinical manifestations: Common nodular rashes, near-articular nodules, and gumma of the skin, mucous membranes, and bones. Cardiovascular system involvement is often seen in simple aortitis, aortic valve insufficiency and aortic aneurysm. Nervous system involvement is often seen in syphilitic meningitis, tabes dorsalis and paralytic dementia.
4.3.3 Laboratory examination:
Syphilis serological test: Non-syphilis Treponema antigen test is mostly positive, but can also be negative, while syphilis Treponema antigen test is positive. a.
Histopathological examination: There are histopathological changes of tertiary syphilis (see Appendix C). Cerebrospinal fluid examination: Neurosyphilis: Lymphocytes ≥10×10°/1., protein level>50mg/dL, VDRL test positive c.
Suspected case: Suspected case is a case with 4.3.1 and 4.3.2. Confirmed case: Suspected case plus any one of 4.3.3 is a confirmed case. 4.4 Latent syphilis (recessive syphilis)
4.4.1 History of infection, may be primary, secondary, or tertiary syphilis. 4.4.2 No clinical symptoms and signs of syphilis. 4.4.3 Non-treponemal antigen test is positive for more than 2 times or Treponema pallidum antigen test is positive (biological false positives must be excluded). Cerebrospinal fluid examination is negative.
4.4.4 Early latent syphilis is within 2 years of illness, and late latent syphilis is more than 2 years. 4.5 Congenital syphilis (congenital syphilis)
4.5.1 The biological mother is a syphilis patient.
4.5.2 Clinical manifestations:
a. Early congenital syphilis (less than 2 years old): similar to acquired secondary syphilis, but the skin lesions often include erythema, papules, erosions, blisters, bullae, fissures, osteochondritis, osteitis and periostitis, etc., and may have syphilitic rhinitis and laryngitis, lymphadenopathy, hepatosplenomegaly, anemia, etc. Late congenital syphilis (over 2 years old): similar to acquired tertiary syphilis, but with interstitial keratitis, chondroitin, saddle nose, neurological deafness, etc. as more common features, and may also appear skin, mucosal gumma and periostitis, etc. c. Congenital latent syphilis: except that the infection originates from the mother, the rest is the same as acquired latent syphilis. 4.5.3 Laboratory examination:
a. Treponema pallidum can be found in the skin and mucosal lesions of early congenital syphilis. b. Syphilis serological test is positive.
4.6 Pregnancy syphilis
GB15974-1995
Active syphilis or latent syphilis that occurs or is discovered during pregnancy is called pregnancy syphilis. 5 Treatment principles
The diagnosis of syphilis must be clear, the earlier the treatment, the better the effect, the dosage must be sufficient, the course of treatment must be regular, follow-up observation must be carried out after treatment, and the source of infection and sexual contacts should be examined and treated at the same time. The main treatment drug is cyanol, and its usage and dosage are shown in Appendix D (Syphilis Treatment Plan). 5 Post-treatment observation
Syphilis patients should also be observed regularly after adequate and regular treatment, including full body examination and non-syphilis treponema antigen serological tests (VDRL, RPR or USR tests, etc.) to understand whether they are cured or relapsed. 6.1 Early syphilis should be reexamined every 3 months in the first year after treatment, and then every 6 months for 2 to 3 consecutive years. If the serum reaction changes from negative to positive or the titer increases four times (such as from 1:2 to 1:8), it is considered a serum relapse, or if there is a symptomatic relapse, double the dose should be used for retreatment. If the serum does not turn negative for more than 2 years, it is considered a serum fixation. If there is no clinical symptom relapse, whether to retreat depends on the specific condition; regardless of retreatment or not, a neurological examination and cerebrospinal fluid examination should be performed to detect asymptomatic neurosyphilis early. 6.2 The follow-up examination after treatment of late syphilis is the same as that of early syphilis, but it should be observed for 3 consecutive years. For those with a fixed serum reaction, a neurological examination and cerebrospinal fluid examination should be performed.
6.3 After treatment of syphilis during pregnancy, the syphilis serum reaction should be reviewed monthly before delivery. After delivery, the observation is the same as other syphilis, but the baby should be observed until the serum is negative. If the titer is found to be elevated or symptoms occur, treatment should be carried out immediately. 7 Syphilis Cure Standards
There are two standards for judging whether syphilis is cured: clinical cure and serum cure. 7.1 Clinical cure: Lesions of primary syphilis (hard ulcer), secondary syphilis and tertiary syphilis (including skin, mucous membranes, bones, eyes, nose, etc.) heal or disappear, and symptoms disappear.
The following situations do not affect the judgment of clinical cure: 7.1.1 Secondary or residual functional impairment (visual impairment, etc.). 7.1.2 Residual scars or tissue defects (saddle nose, dental dysplasia, etc.). 7.1.3 Syphilis lesions heal or disappear, and syphilis serological reaction is still positive. 7.2 Serological cure: Within 2 years after anti-syphilis treatment, the serological reaction of syphilis (non-syphilis treponema antigen test, such as VDRL, RPR, USR test) changes from positive to negative, and the cerebrospinal fluid examination is negative. In primary syphilis (early stage of hard subacute syphilis), when the serum reaction is negative, sufficient anti-syphilis treatment has been received, and a positive reaction may not occur. In this case, there is no problem of serum cure
A1 Principle
GB15974—1995
Appendix A
Dark field microscopy
(Supplement)
Dark field microscopy is the only rapid and direct method for diagnosing syphilis treponema infection, and is necessary for diagnosing early syphilis. During the examination, light enters the objective lens from an oblique angle and shines on the microorganisms or particles, making them appear as a luminous image on a dark background. A2
2 Specimen collection and preparation
For primary and secondary syphilis skin or mucosal lesions, first clean the lesions with saline cotton balls, gently wipe with dry cotton balls, and squeeze to produce serum exudate. Contact the exudate with a glass slide, add a drop of saline on the specimen, cover with a cover glass, and immediately examine under a microscope, or aspirate lymph node fluid for microscopic examination.
Examination of specimens
Drop immersion oil on the condenser of a dark field microscope, raise the condenser until the immersion oil and the bottom of the glass slide are in good contact, first examine with a low-power microscope (10×10) and a high-power microscope (10×40), and then examine with an oil immersion microscope if necessary. The syphilis spirochete glows white on a dark background, and its spiral is neat and has a regular movement pattern: it can rotate around the long axis, stretch forward like a spring, or bend all over like a snake. It is identified based on its typical morphology, size, and movement pattern. Failure to detect spirochetes does not rule out the diagnosis of syphilis. Negative results may indicate: A3.1 Insufficient number of spirochetes (single dark field microscopy positive rate is less than 50%); A3.2 The patient has received antibiotics or drugs that kill Treponema pallidum; A3.3 The lesions are close to spontaneous regression;
A3.4 The lesions are not syphilis.
Appendix B
Syphilis serological examination
(Supplement)
B1 Non-treponemal antigen test
Currently, the Venereal Disease Research Laboratory Test (VDRL) and Rapid Plasma Reagin Circle Card Test (RPR) are commonly used. Principle: The antigen used is an ethanol solution of cardiolipin, lecithin and cholesterol. When Treponema pallidum destroys human tissues, an antigenic cardiolipin is released in the body, which can stimulate the body to produce reagin, which can react with cardiolipin extracted from bovine heart in vitro. The role of lecithin is to strengthen the antigenicity of cardiolipin, and cholesterol can enhance the sensitivity of antigens. Cardiolipin and lecithin form colloidal solutions when they meet water, and cholesterol precipitates crystals when it meets water. During the reaction, the crystals become carriers (cores). Around the carriers or cores, a layer of cardiolipin and lecithin is wrapped to form a kind of colloidal particles. When these particles encounter syphilis serum antibodies (IgG, IgM), they adhere to the colloidal particles and form a hydrophobic film. Due to shaking and collision, the particles adhere to each other to form visible particle agglutination and precipitation, which is a positive reaction. If non-syphilis serum is encountered, because there is more albumin than globulin in the body fluid, and albumin has a protective effect on the colloidal particles, forming a hydrophilic film, even if it is shaken and collided in the same way, because there is no adhesion of immunoglobulin around the antigen particles, it cannot form larger particles, and there is no visible agglutination and precipitation, so it is a negative reaction. 221
B1.1VDRL slide test
B1.1.1VDRL slide qualitative test
GB15974--1995
B1.1.1.1 Inactivate the serum to be tested in a 56℃ water bath for 0.5h, draw 50μL serum and add it to the circle on the slide. B1.1.1.2 Use a 1mL syringe with a needle to draw 1 drop of antigen suspension. B1.1.1.3 Shake the slide by hand or with a mechanical rotator (180 times per minute) for 4min. B1.1.1.4 Immediately judge the result according to the following standards: (2+-3+) Large or medium-sized agglutination can be observed with the naked eye, which is positive, (1+) Small lumps can be observed with the naked eye, the liquid is turbid, and it needs to be observed with a 100x microscope, which is weakly positive. (i) Only tiny antigen particles can be seen under the microscope, and there are no agglutinations, which is negative. B1.1.2VDRL slide quantitative test
To observe the efficacy, a quantitative test should be performed: to exclude the "prozone phenomenon", a slide quantitative test should also be used. The serum to be tested is diluted in a test tube with isotonic saline to 6 dilutions: original serum, 1:2, 1:4, 18, 1;16, 1:32, and then the results are determined and judged according to the qualitative test method.
B1.2RPR test
Advantages: Activated carbon particles are added to the RPR antigen, and the test is carried out on a special white paper card. The appearance of black agglutinated particles or flakes on the white bottom plate is a positive reaction. The test results are easy to judge and can be observed with the naked eye. The serum does not need to be inactivated and can also be tested with plasma. B1.2.1RPR qualitative test
B1.2.1.1 Add 50μL of serum to be tested in the circle of the card and expand it to the entire circle. B1.2.1.2 Use a dropper and a special needle to add 1 drop of RPR antigen invitation liquid. B1.2.1.3 Rotate the card by hand or with a mechanical rotator (100 times per minute) for 8 minutes. B1.2.1.4 Immediately judge the results according to the following standards: Positive reaction: Irregular black agglutination blocks can be seen in the circle. Negative reaction: No black agglutination blocks can be seen in the circle, only uniform non-agglutination phenomenon (bright gray) can be seen. This test only reports "positive" or "negative", and any degree of positive reaction requires quantitative testing. B1.2.2 RPR quantitative test
B1.2.2.1 The serum to be tested is diluted on the card with isotonic saline at 5 dilutions: original serum, 1:2, 1:4, 1:8, 1:16. B1.2.2.2 Follow the qualitative test steps and report the results at the highest dilution that produces a positive reaction. Non-syphilis Treponema antigen test, due to its high sensitivity, can still produce false positive reactions in certain infectious diseases and collagen diseases, so positive reactions must be identified in combination with clinical conditions. This test is suitable for the diagnosis of primary syphilis (positive rate 75% to 85%) and secondary syphilis (positive rate 100%). It is also suitable for observation of efficacy, determination of recurrence and monitoring of reinfection. Due to its simple operation and quick results, it is also suitable for census, marriage examination, prenatal examination and other health examinations. B2 Treponema pallidum antigen test
Because the antigen is Treponema pallidum, the detection of anti-Treponema pallidum antibodies in serum has high sensitivity and specificity. Fluorescent Treponema Antibody-Absorption Test (FTA-ABS) and Treponema Pallidum Hemagglutination Assay (TPHA) are commonly used. B2.1 FTA-ABS test
B2.1.1 Test steps
B2.1.1.7 Apply Nichol strain Treponema pallidum on a slide and fix with acetone. B2.1.1.2 Drop the serum to be tested treated with absorbent, incubate at room temperature for 30 minutes to allow antigen-antibody reaction with Treponema pallidum, and rinse with PBS (the absorbent is made of non-pathogenic Reiter strain spirochete culture fluid, which can remove non-specific antibodies in the serum to be tested). B2.1.1.3 Add fluorescein-labeled rabbit (or sheep) anti-human IgG to the antigen-antibody complex on the slide, incubate at room temperature for another 30 minutes, rinse with PBS, and seal with glycerol.
GB 15974—1995
B2.1.1.4 Observe under a fluorescence microscope. If Treponema pallidum on the film is bright green, it indicates a positive reaction. No bright green fluorescence staining indicates a negative reaction.
B2.2TPHA test
TPHA kit contains:
Rehydration solution (distilled water);
Absorption diluent;
Sensitized blood cells (lyophilized);
Non-sensitized blood cells (lyophilized);
Positive control serum (lyophilized);
Each dropper is calibrated to 25μL
Other materials: U-shaped microhemagglutination reaction plate (96 wells). B2.2.1TPHA qualitative test steps
B2.2.1.1 Dilute the serum to be tested with absorption diluent to 1:20, 2 wells, and incubate at room temperature for 30 minutes. B2.2.1.2 Add 75μL of non-sensitized blood cells and sensitized blood cells to these two wells respectively. B2.2.1.3 Shake, incubate at room temperature for 2 hours, and observe the results with the naked eye. Positive reaction: Red blood cells smoothly cover the entire bottom of the well or form a ring around it, which is a blood coagulation phenomenon. a.
Negative reaction: Red blood cells sink tightly to the center of the bottom of the well or form a button shape without holes, indicating that there is no blood coagulation phenomenon. Suspicious reaction: A small round hole is formed in the center of the bottom of the well. This experiment should have three groups: positive control, negative control, and reagent control. B2.2.2TPHA quantitative test steps
B2.2.2.1 All positive sera should be subjected to quantitative tests to determine their endpoint titers. B2.2.2.2 According to the qualitative test steps, the positive serum is diluted in multiples, with titers ranging from 1:80 to 1:5120. B2.2.2.3 Results: The highest dilution that produces a strong positive or weak positive reaction is reported. The Treponema pallidum antigen test, due to its high specificity and sensitivity, is suitable for secondary syphilis (positive rate 100%), tertiary and late latent syphilis (positive rate 95% to 98%), and as a confirmation test. Appendix C
Histopathology of Syphilis
(Supplement)
Basic pathological changes of syphilis: a. Swelling and proliferation of endothelial cells in blood vessels, especially arterioles. b. Infiltration of a large number of lymphocytes and plasma cells around blood vessels. Granulomatous infiltration composed of epithelioid cells and multinucleated giant cells is common in late secondary syphilis and tertiary syphilis. C1 Primary syphilis
Typical hard subcutaneous wart: The epidermal acanthosis at the edge of the lesion is thickened, the epidermis gradually becomes thinner near the center, and edema and inflammatory cell infiltration occur. Epidermal defects may appear in the center of the lesion. The endothelial cells of the dermal blood vessels, especially arterioles, swell and proliferate, forming occlusive endarteritis, surrounded by a large number of plasma cells and lymphocyte infiltration. Silver staining can see Treponema pallidum around the dermal blood vessels and in the epidermis. C2 Secondary syphilis
Dermal blood vessels dilate, the walls thicken, endothelial cells swell, and inflammatory cells infiltrate around the blood vessels, mainly plasma cells. The longer the course of the disease, the more plasma cells there are. Due to the significant swelling of endothelial cells, they form a cuff-like shape in combination with the surrounding inflammatory cell infiltration. Silver staining can reveal syphilis spirochetes in about one-third of cases.
C3 Tertiary syphilis
GB 15974—1995
Granulomatous infiltration of the dermis composed of epithelial cells, lymphocytes, and plasma cells, which contains many blood vessels and often multinucleated giant cells
Nodular type: Infiltration is limited to the dermis, the granuloma is small, and caseous necrosis is not extensive or even absent. Gummatous type: Infiltration invades the dermis and subcutaneous tissue, with a large number of plasma cells, lymphocytes, epithelial cells, and multinucleated giant cells, and there is a large block of coagulative necrosis in the center of the lesion. Elastic fibers are destroyed at the lesion site, and the more severe the inflammation, the more severe the destruction. C4 Visceral syphilis
Pathological changes are gumma and diffuse interstitial inflammation. C5
Congenital syphilis
There are no local lesions of primary syphilis hard ulcer, and the other skin lesions are the same as those of acquired syphilis at each stage. The difference is that early congenital syphilis may have vesicles and bullous lesions.
C5.1 The top of the herpes is 1 to 2 layers of loose immature epidermal cells. C5.2 The blister fluid contains varying amounts of mononuclear and polymorphonuclear leukocytes and desquamated epidermal cells. C5.3 The dermis is diffusely infiltrated with acute inflammation, and the infiltrating cells are polymorphonuclear leukocytes and lymphocytes, without plasma cells. C5.4 Silver staining shows that a large number of Treponema pallidum can be found in the loose tissue spaces and blister fluid. Appendix D
Syphilis treatment plan
(reference)
D1 Early syphilis (including primary, secondary syphilis and early latent syphilis)DI.1 Penicillin therapy
8. Benzathine penicillin G (long-acting penicillin) 2.4 million u, divided into two sides of the buttocks intramuscular injection, once a week, a total of 2 to 3 times. b. Procaine penicillin G 800,000 u/day, intramuscular injection, for 10 to 15 consecutive days, a total of 8 million u to 12 million u. D1.2 For those who are allergic to penicillin
a, tetracycline hydrochloride 500 mg, 4 times/day, for 15 to 30 consecutive days. b. Strong penicillin 100 mg, 2 times/day, for 15 consecutive days. D2 Late syphilis (including tertiary skin, mucosal, bone syphilis, late latent syphilis) and secondary recurrent syphilis D2.1 Penicillin therapy
a. Aromatic penicillin G 2.4 million u, once a week, intramuscular injection, 3 times in total. b. Procaine penicillin G 800,000 u/day, intramuscular injection, 20 consecutive days. D2.2 Those allergic to penicillin
a. Tetracycline hydrochloride, 500 mg, 4 times/day, for 30 consecutive days. b. Doxycycline 100 mg, 2 times/day, for 30 consecutive days D3 Cardiovascular syphilis
Should be hospitalized for treatment. If there is heart failure, treatment should be started after the heart function is compensated. To avoid the Jarish-Herxheimer reaction, start with a small dose of penicillin injection, such as aqueous penicillin G, 100,000 u on the first day, once a day, 100,000 u on the second day, twice a day, and 200,000 u on the third day, twice a day, intramuscular injection. From the fourth day on, treat according to the following plan. And take oral prednisone 10 mg each time, twice a day, for 3 consecutive days the day before the penicillin injection.
D3.1 Procaine penicillin G 800,000 u/day, intramuscular injection, 15 consecutive days as a course of treatment, a total of two courses of treatment, and take a 2-week break between courses. D3.2 For those who are allergic to penicillin
tetracycline 500 mg, 4 times/day, for 30 consecutive days. D4 Neurosyphilis
Should be hospitalized. To avoid the occurrence of the J-H reaction during treatment, oral prednisone should be taken one day before the injection of penicillin, 10 mg each time, twice a day, for 3 consecutive days.
D4.1 Aqueous penicillin G, 12 million u per day, intravenous drip (2 million u every 4 hours), for 14 consecutive days. D4.2 Procaine penicillin G, 1.2 million u per day, intramuscular injection; at the same time, take 0.5 g of rapenecid orally each time, 4 times a day, for a total of 10 to 14 days. If necessary, use penicillin G, 2.4 million u, once a week, intramuscular injection, for a total of 3 times. D5 Syphilis during pregnancy
D5.1 Procaine penicillin G, 800,000 u/day, intramuscular injection, for a course of 10 consecutive days. Inject one course of treatment within the first 3 months of pregnancy, and inject one course of treatment in the last 3 months of pregnancy.
D5.2 For those who are allergic to penicillin, use erythromycin, 500 mg each time, 4 times/day, for 15 consecutive days for early syphilis, and for 30 consecutive days for secondary relapse and late syphilis. One course of treatment is carried out in the first 3 months of pregnancy and the last 3 months of pregnancy (tetracycline and doxycycline are prohibited), but the infants born should be treated with penicillin.
D6 Congenital syphilis (fetal syphilis)
D6.1 Early congenital syphilis (under 2 years old)
For those with abnormal cerebrospinal fluid:
a. Aqueous penicillin G, 50,000 u/kg body weight per day, divided into 2 intramuscular injections or intravenous drips, for a total of 10 days. b. Procaine penicillin G, 50,000 u/kg body weight per day, intramuscular injection, for a total of 10 days. For those with normal cerebrospinal fluid: 50,000 u/kg body weight of tarostar penicillin, injected once. For those whose cerebrospinal fluid is not checked, they can be treated as those with abnormal cerebrospinal fluid. D6.2 Late congenital syphilis (over 2 years old)
Procaine penicillin G, 50,000 u/kg body weight per day, intramuscular injection, 10 consecutive days as a course of treatment, the total amount shall not exceed the adult dose. For those who are allergic to penicillin, erythromycin can be used, 7.5 to 12.5mg/kg body weight, divided into 4 doses, for 30 consecutive days. Tetracycline is contraindicated for children under 8 years old.
Appendix E
Syphilis treatment reactions
(reference)
In anti-syphilis treatment, the most common reactions are mainly Jarish-Herxheimer reaction and penicillin allergy reaction. Jarish-Herxheimer reaction E1
Within 4 hours after the first injection of penicillin or other highly effective anti-syphilis drugs, some syphilis patients experience varying degrees of fever, chills, headache, fatigue, and aggravation of syphilis symptoms and signs. This phenomenon is called Jarish-Herxheimer reaction. It reaches a peak in about 8 hours, and symptoms such as fever can disappear without treatment within 24 hours, and aggravated rashes can also improve. When this anti-syphilis drug is injected again, the symptoms will not reappear. This reaction can occur in 50% of primary syphilis, 75% of secondary syphilis, and early congenital syphilis. The JH reaction in late syphilis is rare, but once it occurs, it can cause serious secondary reactions, such as coronary artery obstruction in cardiac syphilis, epileptic seizures and pseudomeningitis in nervous system syphilis, and sharp visual impairment in optic neuritis.
GB 15974—1995
There is no exact explanation for the mechanism of the JH reaction. Since the clinical manifestations of this reaction are similar to those of endotoxemia, some people believe that after the injection of highly effective antisyphilis drugs, a large number of syphilis spirochetes die and release a large amount of endotoxin. However, the severity of the JH reaction is not significantly related to the number of spirochetes in the body, which does not support this view. In order to prevent the occurrence of the JH reaction, bismuth was often used for preparatory treatment in the past, which is especially important for patients with cardiovascular syphilis. At present, the use of penicillin and prednisone can reduce the severity of the JH reaction. Antihistamines are ineffective against the JH reaction. E2 Penicillin allergic reaction
Penicillin is almost non-toxic. The side effects of penicillin in the treatment of syphilis are mainly allergic reactions to penicillin. It is estimated that for every 10 injections of penicillin, 10 to 40 cases of anaphylactic shock occur, and for every 60,000 injections, one death may occur due to penicillin anaphylactic shock. The manifestations of penicillin allergic reactions are diverse, the most important of which are anaphylactic body rashes, laryngeal edema, bronchial edema, serum sickness syndrome, various types of drug eruptions (including urticaria, angioedema, erythema multiforme, etc.) and drug fever. E3 Prevention of penicillin allergic reactions
E3.1 Before injecting penicillin, a skin test should be strictly performed (preferably with saline as a control). If the skin test is positive, penicillin should be prohibited and other drugs should be selected.
E3.2 Confirmation and denial of penicillin allergy is very important in the treatment of syphilis. If it is easily confirmed, the quality of anti-syphilis treatment will be affected, and if it is easily denied, it may lead to serious reactions. In case of suspected penicillin allergy, the previous allergy history should be strictly reviewed and the skin test should be performed carefully.
E3.3 For those with a history of penicillin allergy or evidence of allergy, do not use the small-volume incremental injection method for penicillin injections or desensitization treatment to prevent danger. For those who are allergic and cannot tolerate other antibiotics, it is best to consult with relevant experts. E3.4 During penicillin treatment, attention should be paid to the early manifestations of allergic reactions such as anaphylactic shock so that timely detection and timely treatment can be carried out.
E3.5 There must be sufficient and convenient rescue equipment and drugs in the injection room. E3.6 Various penicillins have a common β-lactam structure and cannot be used as substitutes when allergic to penicillin. Various cephalosporins are also prone to cross-allergy with penicillin and cannot be used as substitutes. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and was jointly drafted by Jishuitan Hospital Affiliated to Capital Medical College, the Third Affiliated Hospital of Beijing Medical University, Xinjiang Institute of Endemic Diseases, and Xinjiang Autonomous Region Hospital. The main drafters of this standard are Li Shitai, Long Zhenhua, Li Shiyin, Zhang Kun and Shi Deren. The Ministry of Health has entrusted the Office of Communicable Disease Supervision and Management to interpret this standard.
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