妊娠合并梅毒

　　　梅毒是由梅毒螺旋体引起的慢性全身性传播疾病。梅毒患者的皮肤、黏膜中含梅毒螺旋体，未患病者在与梅毒患者的性接触中，皮肤或黏膜若有细微破损则可得病。极少数可通过输血或其他途径传染。患梅毒孕妇能通过胎盘将螺旋体传给胎儿，引起晚期流产、早产、死产或分娩先天梅毒儿。

　　20. Syphilis during pregnancy can cause intrauterine infection through the placenta, leading to miscarriage, preterm birth, stillbirth, neonatal death, or the birth of congenital syphilis children. This disease has a great harm to perinatal infants and is one of the key monitoring objects for high-risk pregnancy.

　　This disease has different characteristics in different stages, as follows:

　　First, latent syphilis

　　Pregnant women have been diagnosed as syphilis patients, but at a certain period of time, there were no abnormalities found in the examination of skin, mucosa, and any organ system and cerebrospinal fluid, except for the positive syphilis serum reaction.

　　Second, the first stage of syphilis

　　The typical lesion is the chancre. Female chancres are more common on the labia majora and minora, clitoris, urethral opening, pubic area, especially on the cervix, and are prone to be misdiagnosed. One week after the chancre appears, the nearby lymph nodes become swollen. In addition to the chancre, a small number of patients may also have hard, edematous swellings on the labia minora.

　　Third, the second stage of syphilis

　　The rash of the second stage of syphilis usually occurs 3-4 weeks after the chancre subsides, which is equivalent to 9-12 weeks after infection. Papules and macules account for about 40% of the second stage of syphilis. Before the rash appears, there may be influenza-like symptoms, such as headache, low fever, and malaise in the limbs, lasting for 3-5 days, and the rash subsides immediately. About 10% of patients with the second stage of syphilis may experience hair loss. Syphilitic leukoplakia is more common in female patients. Generally occurring 4-5 months or 1 year after infection, it is more common on both sides of the neck, and can also be seen on the chest, back, breasts, limbs, axilla, vulva, perianal area, etc.

　　Fourth, the third stage of syphilis

　　9. The onset time is late (2-15 years after infection), with a long course of disease. Without treatment, it can last for 10-30 years, even lifelong.

　　8. The symptoms are complex, involving any tissue and organ, including skin, mucosa, bone, joints, and various internal organs. It is more likely to invade the nervous system, easily confused with other diseases, and difficult to diagnose.

　　7. The infectivity of Treponema pallidum in the body and skin lesions is weak, but its ability to destroy tissues is strong, often causing tissue defects, organ damage, and can lead to disability, even threatening life.

　　6. Although antisyphilis treatment has an efficacy, it cannot repair the organs and tissues that have been destroyed.

　　5. The syphilis serum reaction is unstable, and the negative rate can reach more than 30%, and there are often changes in cerebrospinal fluid.

　　Syphilis can be transmitted from the mother to the fetus. Early symptoms in children include large blisters, rashes, rhinitis or nasal congestion, liver adenopathy, lymphadenopathy, etc.; late symptoms include wedge-shaped teeth, saddle nose, interstitial keratitis, periostitis, neurosensory hearing loss, etc.

　　In terms of prevention, it is necessary to strengthen health education and propaganda, and oppose illegal sexual behavior. All suspected patients should undergo preventive examination, including syphilis serum tests, to enable early detection of new patients and timely treatment. Isolation and treatment must be carried out for syphilis patients. The clothing and articles of the patients, such as towels, clothes, razors, tableware, bedding, etc., should be strictly disinfected under the guidance of medical personnel to eliminate the source of infection. Syphilis patients should be prohibited from sexual activity before complete recovery, and if it occurs, a condom must be used. Pregnant women suspected of having syphilis should be given preventive treatment in a timely manner to prevent the infection of syphilis to the fetus. Unmarried male and female patients cannot marry until cured.

　　The main examination methods for this disease are as follows.

　　1、Pathogen examination：Take a small amount of serum exudate from the hard chancre of the first stage of syphilis, place it on a glass slide, and observe it under a dark field microscope. The diagnosis can be confirmed based on the strong refractive index and movement of the spirochete.

　　2、Syphilis serological examination：Non-syphilis treponemal antigen serological test is a routine screening method for syphilis. Common methods include Fluorescent Treponemal Antigen Absorption Test (FTA-ABS) and Treponema pallidum Hemagglutination Test (TPHA).

　　After suffering from syphilis, dietary adjustments should be the same as other infectious diseases, including eating fresh vegetables and fruits rich in vitamins, eating less greasy foods, avoiding spicy and刺激性 foods, quitting smoking and alcohol. Drinking enough water is beneficial for the elimination of toxins in the body. In addition, patients with secondary syphilis should eat less animal fat and sweets.

　　Traditional Chinese medicine divides the treatment of this disease into the following types of syndromes.

　　1、Liver meridian damp-heat syndrome

　　Main Symptoms：Liver meridian damp-heat syndrome is common in the first stage of syphilis, with patients presenting with hard, smooth ulcers on the external genitalia, syphilis sores mostly on the lower limbs, abdomen, and perineum, accompanied by bitter and dry mouth, jaundice, constipation, red tongue with yellow greasy fur, and wiry slippery pulse.

　　Therapeutic Principle：Mainly focuses on clearing heat and dampness, detoxifying and expelling syphilis.

　　Prescription：Modified Dragon Bone Decoction for Liver and Gallbladder.

　　2、Blood heat and toxin syndrome

　　Main Symptoms：Blood heat and toxin syndrome is common in the second stage of syphilis, with patients presenting with widespread syphilis sores, pink in color, painless and itchy, or with papules, pustules, and scales. In addition, there may be symptoms such as dry mouth and throat, mouth ulcers, constipation, red and dark tongue fur, thin yellow fur or little fur, and fine and slippery or rapid pulse.

　　Therapeutic Principle：Cool blood and detoxify, expel heat and dissipate blood stasis.

　　Prescription：Clearing Nutrient Decoction combined with Modified Four Herbs Decoction for Peach and Red Flower.

　　3、Liver and kidney deficiency syndrome

　　Main Symptoms：Liver and kidney deficiency syndrome is common in the third stage of syphilis and spinal tuberculosis, with a duration of illness that can last for decades. Gradually, both feet may become paralyzed or weak, with numbness or pruritus like insects,窜痛 of the tendons and bones, weakness of the waist and knees, difficulty in urination, pale tongue with thin white fur, and deep, thin, weak pulse.

　　Therapeutic Principle：Tonify the Liver and Kidneys, fill the marrow and calm the wind.

　　Prescription：Decoction of Rehmannia for Enriching the Kidneys and Liver.