1. DAI cuong

benh giang mai la 1 benh lay qua duong tinh duc hay gap, gay boi xoan khuan Treponema pallidum. Benh lay lan qua nhung con duong tinh duc, duong mau va me sang con. Tren thuc te, benh giang mai van la mot van de suc khoe nang, dac biet la o mot so nuoc co thu nhap thap, nhat la o nhom dong tinh canh may rau. Dac diem lam sang dien hinh cua benh giang mai gom co sang benh giang mai, dao ban, san, gom giang mai¿ Mat khac, thuong ton duong mieng cung co kha nang thay trong benh giang mai, nhung ma khong hay gap cung nhu kho khan chan doan neu nhu don doc. Biet danh ma mot so bac si lam sang dat cho giang mai la ¿Ga bat chuoc khong lo¿ (¿the great imitator¿) do thuong ton giang mai vo cung da kieu cung voi co rat nhieu diem tuong dong voi cac benh khong giong.

2. LAM SANG

giang mai 2 la ket trai cua van de lan truyen cua vi rut vao trong mau, co kha nang dau hieu nhan biet tai bat ki bo phan nao, hay bat gap la da, khop, than kinh cung voi mat. Thuong ton mieng cua benh giang mai hau het thay trong thoi ky nay (khong moi quan he den thoi quen quan he tinh duc voi duong mieng), hiem khi co tai thoi ky tien phat, co the sinh ton don doc, gay nen van de tri hoan chan doan.¿...........................................

nhung khu vuc hay gap: niem mac moi, ria luoi, khau cai cung, khau cai xiu, than luoi, luoi ga, amidan.

thuong ton co ban rat da kieu, gom co:

thuong ton trot, loet: don doc hoac nhieu ton thuong, cap hoac man, dau hoac khong cam giac dau, don doc hoac cong voi nhung ton thuong phia ngoai mieng. Co the tuong tu thuong ton loet ap doi voi bo mau trang, it gia mac.

San, dam niem mac, nodule: co kha nang co gia mac, trot loet, kieu bach san, dang lichen phang.

mot tim hieu cua A.Lampros thuc hien tren 206 benh nhan giang mai 2 tai Phap, trong do co 38 nguoi benh (chiem 18%) co ton thuong niem mac khoang mieng. Trong so do co 14 nguoi benh chi co thuong ton mieng don doc (chiem 37%). Nhung dang ton thuong khoang mieng thuong gap la trot ban cap/ton thuong loet (55%), san mang niem mac tai luoi (53%), nodule (10%), thuong ton day sung mau trang ¿ leukokeratosis (5%). Thoi diem trung binh de ket luan benh giang mai trong nghien cuu nay la 4.5 thang, nhom benh nhan chi co ton thuong duong mieng don doc mat khong it khoang thoi gian de ket luan hon nhom con lai (8.8 thang so doi voi mot.8 thang, p = 0.02).

3. CAN LAM SANG

cac tham kham ket luan giang mai: test som, RPR, TPHA¿

Sinh thiet: khong quan trong trong ket luan. Mot thong ke tren 15 nguoi benh thay rang, nhung dac thu tren mo benh hoc chinh la thuong bi day khong deu, tham nhap tuong bao tai vung noi, quanh mach va than kinh, tang trieu chung ICAM-1 va VEGF tren nhuom hoa mo mien dich.

4. Phong doan phan loai

Lichen phang niem mac khoang mieng

Pemphigus thong thuong

Loet boi vi chan thuong

Loet ap

Bach san khoang mieng

Ung thu bieu mo te bao vay nen

5. Dieu tri

Nhu quy trinh tri giang mai. Ton thuong mieng trong benh giang mai 2 thuong cai thien trong 1-2 tuan sau mui penicillin thu 2.

6. Phong doan

tinh chat lam sang cua giang mai rat da dang, dan toi van de kho chan doan va tri hoan chan doan. Thuong ton duong mieng trong giang mai, dac biet la cac tinh huong don doc, coi la mot thach thuc cho nhung chuyen gia lam sang. Cac loai thuong ton thuong bat gap la trot, loet, dam trang, dam niem mac. Chan doan tim Tuy thuoc vao xet nghiem huyet thanh va dieu tri bang khang sinh doi voi su gia tang nhanh chong.