Talent was needed in the division 3 months, provided the patient of 3 syphilis positive, the play that be the same as the door says: Are you to there is the constitution that attracts syphilitic?
As a surgical doctor, can change medicine for the patient everyday, when should facing syphilis positive patient, my adviser made a very good model for us: Never dodge because of what patient syphilis positive behaves not as good as, know the patient affected syphilis helicoid, maintain common heart, notice and be on guard oneself infection risk can, patient of straight even contact also is some.
The great a long time of own begin is awaited, without what different, but, , the ointment of the besmear outside lying between the patient of a piece of bed to do not have with him, think with syphilis electropositive patient borrows ointment, I checked directly. Think inside the heart, even if take no account of across to affect, ointment touchs those who cross blood, had been you used also affected how to do?
Later, I think over: I think be opposite after all incorrect, venereal and general travel through sexual behavior, blood, likely also and perpendicular transmission, can syphilis helicoid travel through blood? In the meantime, mechanism of what kind of infection be after all? Can be you cured?
1 epidemiology
According to the newest estimation of World Health Organization, the whole world had 17.7 million 15~49 about 2012 year old the person contracts syphilis, estimation has 5.6 million every year to send case newly. Distributinging crowd is as follows:
2 clinical expression reach infectivity
Patient of the former syphilis that send a gender is in 3 weeks after infection inside, main show is in genital or other involve a gender to contact the body place with standoff ministry ill lymph node to appear individual ulcer or much point pathological change; These are painless normally and solve initiatively, less important expression, include to have a fever, have a headache and flank, shoulder, arm, the spot papula of bosom or back, include the palm and sole normally. As body ask forring and semiotic subsidise, the patient is entered preclinical, can last several years.
As a result of 25 ％ 2 period syphilis has recrudescent risk, before 1~2 year preclinical patient still is thought to have infectivity. Historical literature makes clear, the without cure individual meeting development of 15~40 ％ is 3 class syphilis, expression is ruinous heart or neurological disease, severe skin or splanchnic pathological changes (gum) or bone sex be put into trouble.
Those who need an attention is, nerve syphilis normally by described as terminal expression, but actually it also can happen in inchoate syphilis.
Those who suffer infection is individual abide by normally in ≥ 10 years during cent is primary, intermediate, conceal and the disease course of 3 class. Normally, "Inchoate syphilis " it is to point to the infection that can transmit through the gender (include to send a gender formerly, afterwards hair sex and inchoate conceal sex appeal are caught) , and with mobile sex (infectivity) syphilis is synonymous. World Health Organization will " inchoate syphilis " the definition is: <2 year the infection of duration, and the guideline that comes from the United States and Europe is its definition infection <1 year duration.
Different guidelines is inchoate defer definition the 1~2 after exposing year begin.
Syphilis transmission way basically is sexual transmission and mother baby transmission, the 1~2 before luetic sex transmits those who happen after the contact year (what affect namely is primary, intermediate and inchoate preclinical) . Mu Ying travels (MTCT) the risk is in primary with intermediate level highest, it is inchoate conceal syphilis next.
Individual viewpoint: More or less does the amount that catchs body by existence decide the possibility size of venereal transmission, it is OK to catch body the blood that consist in accepts infection put oneself in another's position and humoral in, so, resemble conditional pathogenic bacteria same, when you are frail, you are met go to the bad, same, should infect body to achieve a certain quantity of when, you also can have infection risk, if want not to have infection risk, must remember protecting oneself, for instance, wear cap guaze mask, the glove must be worn when changing medicine, notice other perhaps place has small cut to wait a moment on him hand certainly, put an end to infection body to invade our body.
Configuration of 3 syphilis helicoid
Why to define for helicoid? Main because of syphilis every extremely dynamical flagellum, get together in peptide twine all round the cylinder of candy coping, inter cell is in jackknife, bring to bear on to get together in stretch peptide by rigid filament the force on candy makes cylinder is out of shape the smooth wave form that produced helicoid thereby.
Below electric lens:
4 diagnose
Luetic diagnoses the serological reaction that can affect through measuring a patient to be opposite to undertake.
What appear above all is the IgM antibody that is aimed at syphilis helicoid albumen, antibody of a few Zhou Houyou IgG appear.
IgM and IgG antibody can use close helicoid test, if be measured,hematic cell agglutinate analyses cadaverous close helicoid (TPHA) , syphilis helicoid particle determines (TPPA) , antibody of fluorescent syphilis helicoid is absorbed determine (FTA-ABS) , enzymatic immunity determines (EIA) determine with chemical glow immunity (CIA) .
The IgM that is aimed at the protein with syphilis not distinctive helicoid and IgG antibody (antibody of blame close helicoid) can use protein of fast and serous reaction (RPR) , venereal research lab (VDRL) or toluene amine is red did not add hot-blooded Qing Dynasty (TRUST) the test will detect, and after close helicoid antibody normally 2~3 week appears. Albumen of fast and serous reaction is commonly usedly in the hospital at present.
Result of albumen of fast and serous reaction
Normally, through effective treatment (here shows arbitrarily when 6 months) , be not level of close helicoid antibody to drop, and close helicoid antibody still can maintain Gao Shuiping old.
6 months after the patient of about 20 ％ is being treated are put in blame particularity antibody continuously; These people are to have serum state by mark. After be being treated repeatedly, the patient that has 11 ％ about still is behaved for serum condition.
5 cure
Growing effect penicillin preparation to be like G of benzyl star penicillin is the first selection therapeutics of most syphilis patient.
Guan Limei's poisonous main factor is inchoate discovery, use effective antibiotic to treat plan seasonable cure and patient of syphilis of remedial infection sex (former hair sex, afterwards sends a gender or inchoate conceal is affected) sexual spouse.
The guide that about growing up inchoate syphilis runs mixes World Health Organization European guideline is identical. CDC (Chinese disease precaution controls a center) the guideline does not offer procaine penicillin to serve as cure, but in other side identical. Terminal syphilis patient has infectivity no longer. Accordingly, remedial purpose is the complication that precaution does not have semiotic patient (namely, have terminal conceal syphilis) or if the patient has the show of 3 class disease,prevent its to develop. The period of treatment of the cure that fight bacterium with terminal luetic longer than inchoate disease need cure (still have a curability) .
The mental health of 6 syphilis patient
The patient of syphilis positive can bring about serious social disgrace to feel, intense awkwardness, and to retaliation, domestic force or the fear that lose a relationship.
Communal and wholesome expert thinks, syphilis is to compare other sex to transmit infection to diagnose more discreditable germ, although this is very difficult affirmatory, because consider to plan apt to will track working key to be put on syphilis, because the gender transmits the serious consequence that infection causes, is not. But in the research that measures the ashamed level related to skin disease of a few kinds of discreditable sexes in, the patient is ashamed to luetic move is the biggest, exceed AIDS, transmit infection or condition of skin of a few kinds of damage with etc sex.
7 look into
World Health Organization offers the following challenge and desire detailed account to syphilis management:
Epilogue
As treat operation patient, contagion series checks the basic safeguard that is safety of medical personnel oneself, if be syphilis positive patient, should look up albumen of fast and serous reaction first, with diagnose, judge its infectivity size.
If be contagious syphilis patient really, so, as the medical worker, we want to accomplish, not be to dodge absolutely not as good as, maintain common heart however, at the same time cut of scrupulous processing patient, bring a solace for the patient: Although be in abyss personally, also somebody accompanies my person of the same trade.
