Article 151: Characteristics of the Chancre in Primary Syphilis and Symptoms of Secondary Syphilis

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Treatment and recuperation of common diseases

The characteristics of chancre are:

(1) Palpation reveals cartilaginous hardness.

(2) No pain or tenderness (when there is no secondary infection).

(3) The number of damages is usually only 1.

(4) Damage to surface cleaning.

(5) Without treatment, it disappears naturally in 3-4 weeks, leaving no trace or only a slight atrophic scar. Insufficient anti-syphilis treatment or topical medication may result in atypical chancres.

Several days after the appearance of the chancre, swelling of the inguinal lymph nodes on one side occurred, followed by swelling on the other side. These lymph nodes are characterized by:

(1) About the size of a fingertip, relatively hard, scattered and not fused together.

(2) No pain or tenderness.

(3) There are no signs of inflammation such as redness, swelling, or heat on the surface of the skin.

(4) No suppuration.

(5) The puncture fluid contains spirochetes.

In the early stages of chancre, most patients have a positive syphilis serological reaction. The positive rate gradually increases thereafter. Seven to eight weeks after the appearance of chancre, all patients have a positive serological reaction.

If left untreated, a chancre will disappear naturally within 3-4 weeks. However, the lesion is not yet cured and is in the incubation period of secondary syphilis. If it is diagnosed and treated promptly during this period, a complete cure can be achieved quickly, and the prognosis is generally good.

2. Secondary Syphilis: After the appearance of a chancre in primary syphilis, Treponema pallidum enters the bloodstream from the lymph nodes near the chancre and spreads throughout the body, affecting almost all tissues and organs. After an incubation period of 6-8 weeks, symptoms may appear including low-grade fever, headache, general malaise, muscle and joint pain, loss of appetite, swollen superficial lymph nodes, skin and mucous membrane rashes, periostitis, iridocyclitis, and meningitis. This stage is clinically called secondary syphilis. Secondary syphilis rashes have a large number of Treponema pallidum on their surface, making them the most infectious.

The main manifestations of secondary syphilis are as follows:

(1) Early secondary syphilitic rash: Characterized by complex symptoms, diverse rash types, widespread, dense, and symmetrical lesions with no tendency to merge, clear borders, copper-red color, and no pain or itching; strong positive serological reaction; and complete eradication without treatment. Although the rash has many forms, the main types are as follows:

Maculopapular type: This type is common. It is mainly distributed on the trunk and the inner proximal parts of the limbs. The rash varies in size, mostly consisting of erythematous patches 1-4 cm in diameter, often oval or round, copper-red in color, with clear borders, and can resolve spontaneously.

Papular type: This type is more common. The rashes are about the size of a grain of rice, a soybean to a fingernail, firm, obviously infiltrated, copper red in color, with clear borders, and some have scales on the surface, similar to psoriasis. They are most commonly seen on the trunk, flexor surfaces of the limbs, and palms and soles.

Pustular type: This type is rare. It often occurs in patients with weakened constitutions and more severe systemic symptoms. The rash resembles acne, pustules, oyster shells, and deep pustules, leaving scars after healing.

Condyloma latum type: This belongs to the wet papular type of syphilis. It commonly occurs at the junction of skin and mucous membranes or in areas of skin prone to friction, such as between the labia majora and minora, anus, inside the foreskin, inner thighs, armpits, and under the breasts. The wet papules merge together, become raised, and have a flat surface. Sometimes they appear wart-like or papillary, with a moist and eroded surface, and a large amount of exudate containing Treponema pallidum.

Alopecia type: often occurs in the temporal region, presenting as worm-eaten appearance, diffuse type is rare.

Syphilitic leukoplakia: loss of pigmentation, which can last for several days.

Mucosal damage: One type is redness and swelling of the mucosa, and the other type is erosion of the mucosa with exudate that coagulates on the surface to form grayish-white mucosal patches.

(2) Secondary skeletal damage: This is caused by Treponema pallidum invading the bones and joints, without obvious inflammation. The characteristic of this stage is that the pain worsens at night and during rest, while it is milder during the day and during activity. It mostly occurs in the long bones of the limbs, and can also occur at the attachment points of skeletal muscles, such as the olecranon of the ulna, the iliac crest, and the mastoid process. There is often an exacerbation reaction upon initial treatment.

(3) Secondary neurosyphilis: mostly asymptomatic neurosyphilis. Although there are no symptoms, there are abnormal changes in the cerebrospinal fluid, such as increased protein and increased lymphocyte count. Meningitis, cerebrovascular syphilis and meningovascular syphilis may also occur.

(4) Secondary ocular syphilis: It can cause iritis, iridocyclitis, choroiditis, optic neuritis and retinitis.

(5) Secondary recurrent syphilis: Due to incomplete treatment or decreased immunity, secondary lesions may reappear after they have subsided. This usually occurs within one to two years after infection. Recurrence can occur in the skin, mucous membranes, eyes, bones, and internal organs. The most common recurrence is in the skin and mucous membranes. The lesions are generally similar to those in secondary syphilis, but the number of rashes is less, the distribution is more localized, and the tendency to cluster is more pronounced than in the secondary stage. The lesions are more destructive and commonly occur in the perianal area, navel, armpits, genitals, and palms.

Serum relapse is the most common. Serum relapse is a precursor to other relapses. There may be no other symptoms during serum relapse, but serum relapse usually precedes other relapses.