How does syphilis manifest itself in women. Syphilis: signs, manifestations of all stages, diagnosis, how to treat Malignant syphilis

Syphilis is caused by a bacterium called Treponema pallidum.

Infection most often occurs through sexual contact, somewhat less often through blood transfusion or during gestation, when the bacterium falls from mother to child. Bacteria can enter the body through small cuts or abrasions on the skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes during its early latency period.

Syphilis is not spread by using the same toilet, bath, clothing or utensils, through doorknobs and pools.

How is syphilis transmitted?

The main mode of transmission of syphilis is sexual. The disease is transmitted through unprotected sexual contact with a carrier of treponema.

The cause of infection can be not only vaginal, but also anal and oral-vaginal contacts. The second way of transmission of syphilis - household in the modern world has become less common.

In theory, you can get infected by using the same personal hygiene items, bedding, outerwear with a sick person. However, such cases of infection are extremely rare, since the main causative agent of the disease is extremely unstable to environmental conditions.

signs

1. In the place where the microorganism has invaded the human body, primary syphiloma appears - the so-called hard chancre. It looks like a small (up to a centimeter in diameter) painless erosion of an oval or round shape with slightly raised edges.
   It can be found in men on the foreskin or in the region of the glans penis, in women on the labia majora and labia minora, in the cervix, as well as near the anus and on the rectal mucosa, less often on the abdomen, pubis and thighs. There are also extra-sexual localizations - on the fingers (more often in gynecologists, laboratory assistants), as well as on the lips, tongue, tonsils (a special form is chancre-amygdalite).
2. A week after syphiloid, the next symptom of the disease appears - regional lymphadenitis. With the localization of the chancre in the genital area under the unchanged skin in the inguinal region, painless mobile formations appear, resembling beans or hazelnuts in size and shape and consistency. These are enlarged lymph nodes. If the primary syphiloma is located on the fingers, lymphadenitis will appear in the area of ​​​​the elbow bend, with damage to the mucous membranes of the oral cavity - submandibular and chin, less often - cervical and occipital. But if the chancre is located in the rectum or on the cervix, then lymphadenitis goes unnoticed - the lymph nodes located in the pelvic cavity increase.
3. The third symptom, typical of primary syphilis, is found more often in men: a painless cord appears on the back and at the root of the penis, sometimes with slight thickenings, painless to the touch. This is what syphilitic lymphadenitis looks like.

Sometimes the appearance of unusual erosion causes anxiety in the patient, he consults a doctor and receives appropriate treatment. Sometimes the primary element goes unnoticed (for example, when localized in the cervical region).

But it is not so rare that a painless sore of a small size does not become a reason for contacting doctors. They ignore it, and sometimes they smear it with brilliant green or potassium permanganate, and after a month they sigh with relief - the ulcer disappears.

This means that the stage of primary syphilis has passed, and it is being replaced by secondary syphilis.

If left untreated, tertiary syphilis develops in 30% of people with secondary syphilis. One fourth of those infected die from tertiary syphilis. It is extremely important to recognize the signs of syphilis in women and men at least at this stage.

Signs of tertiary syphilis:

• In men, tertiary syphilis is diagnosed through the appearance of tubercles and gums. The tubercles are quite small in size and quite a lot of them form on the body. Gummas are single, rather large and deep in the tissues. These formations do not contain such a large number of treponemas, so the risk of infecting another person is much lower than with secondary syphilis.
• In the tertiary form, the first signs of syphilis in women are bumps and gums like in men. Both tubercles and gummas eventually turn into ulcers, from which scars will remain after healing. These scars adversely affect the state of organs and tissues, severely deforming them. Gradually, the functions of organs are violated, which can eventually lead to death. If infection with syphilis occurred from a sexual partner, then the rash will primarily be in the genital area (on the vagina, etc.).
• In children, tertiary syphilis affects the skin, internal organs and nervous system with special tubercles - syphilides. Syphilides are formed due to the development of hypersensitivity of the child's body to treponemas, which are found in excess in the child's body.

Tertiary syphilis can last for decades. The patient may suffer from the development of mental insanity, deafness, loss of vision, paralysis of various internal organs. One of the most important signs of tertiary syphilis is a significant change in the patient's psyche.

Women who have had syphilis are interested in the question of whether a healthy pregnancy is possible after this disease. However, doctors cannot give a definite answer, since everything will depend on the stage and timeliness of the treatment of syphilis. Early detection of syphilis and rapid therapy ensure that there are no complications in the future. A gynecologist will help determine the safe time for conception.

When syphilis is determined at the stage of tertiary development (the beginning of damage to internal organs), the doctor will insist on terminating the pregnancy in order to avoid serious consequences for the child. In this case, a favorable outcome is excluded.

After infection with syphilis, some time must pass before the first signs of the disease appear. As a rule, the incubation period lasts from 2 to 6 weeks, depending on the location of the entrance gate of the infection, how many pathogens have entered the body, the state of the immune system, concomitant diseases and a host of other factors.

On average, the first signs of syphilis can be noticed after 3-4 weeks, but sometimes this period can stretch up to 6 months.
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In the vast majority of cases, the onset of the disease is indicated by the appearance of primary syphilis - a hard chancre. It is a small, painless ulcer, round or oval in shape, with a hard base.

It may be reddish or the color of raw meat, with a smooth bottom and slightly raised edges. The size varies from a few millimeters to 2-3 centimeters.

Most often, its diameter is about a millimeter.
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Syphilis is a sexually transmitted disease that occurs in a similar way in both sexes. The only difference is that primary syphilis is more often diagnosed in men, while the secondary and latent form is more common in women.

In men

Before starting treatment for syphilis, it is worth knowing how syphilis manifests itself. So the most important symptom of syphilis in a patient manifests itself in the form of a hard, dense chancre and a significant increase in the size of the lymph nodes.

In men, syphilis most often affects the penis and scrotum - it is on the external genitalia that the disease manifests itself, first of all, in the form of negative symptoms. In women, the disease most often affects the labia minora, vagina and mucous membranes.

If sexual partners practice oral or anal sex, respectively, there is an infection and subsequent damage to the circumference of the anus, the oral cavity, the mucous throat and the skin in the chest and neck.

The course of the disease is long, if it is not treated in a timely manner, it differs in its wave-like manifestation of negative symptoms, a change in both the active form of the pathology and the latent course.

Primary syphilis begins from the moment when primary syphiloma appears at the site of the introduction of pale spirochetes - a hard chancre. A hard chancre is a solitary, rounded erosion or ulcer that has clear, even edges and a shiny bluish-red bottom, painless and non-inflamed. The chancre does not increase in size, has scanty serous contents or is covered with a film, a crust, at the base of which there is a dense, painless infiltrate. Hard chancre does not respond to local antiseptic therapy.

The formation of a painless hard chancre on the labia in women or the head of the penis in men is the first sign of syphilis. It has a dense base, smooth edges and a brown-red bottom.

In the incubation period, there are no clinical signs of the disease, the primary signs of syphilis are characterized by a hard chancre, the secondary ones (lasting 3-5 years) - spots on the skin. The tertiary active stage of the disease is the most severe, with untimely treatment leads to death. The patient's bone tissue is destroyed, the nose "falls in", the limbs are deformed.

Primary signs

Almost all changes occurring in the body at the primary and secondary stages are reversible, even if they concern the internal organs. But if the treatment is delayed, the disease can go into a late stage, at which all its manifestations become a serious problem and can lead to the death of the patient.

Reversible manifestations

These include the symptoms of primary syphilis - a hard chancre, as well as part of the secondary - spotty and nodular rashes, baldness, a necklace of Venus. All these manifestations - regardless of their location - normally disappear after treatment and most often do not leave marks. Even meningitis of early neurosyphilis can be cured.

Irreversible manifestations

These include purulent manifestations of secondary syphilis, as well as all the symptoms of tertiary. Purulent lesions vary in size and depth - from small pustules to large ulcers.

When the ulcers pass, they leave scars of the same size. Tubercles and gummas are more dangerous formations. When destroyed, they damage the surrounding tissue, disfigure the patient and can even make him disabled.

What else can or cannot do syphilis in the body of the victim? Let's try to "filter" the myths from the real facts.

Does syphilis affect hair?

Yes, it does, but not always. Hair suffers, as a rule, in the second year of the disease, when repeated rashes develop.

Hair damage is manifested by several types of baldness. The most characteristic is "small-focal" alopecia - in the form of small areas (foci) of a round or irregular shape on the occipital or parietal-temporal region.

At the same time, the hair in these areas does not fall out completely, and the overall picture resembles "fur eaten by moths."
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The second type of baldness with syphilis is "diffuse" baldness, that is, a uniform lesion of the entire scalp. This sign is found not only in syphilis, but also in many other diseases (pyoderma of the scalp, systemic lupus erythematosus, seborrhea, and others).

Also, there are combined variants of alopecia, including diffuse and small focal types at the same time.

In addition, rashes on the scalp are often covered with a greasy crust and look very similar to seborrhea.

All hair changes caused by the manifestation of syphilis are temporary and quickly disappear after treatment.

Can eyebrows or eyelashes be affected by syphilis?

Yes they can. The eyebrows and eyelashes, as well as the hair on the head, may fall out during the secondary period. Their growth is gradually recovering, but it occurs unevenly. As a result, different lengths of hairs form a stepped line. This phenomenon in medicine is called the "Pincus symptom".

Are teeth affected by syphilis?

- The defeat of the teeth for syphilis is not typical, but it can occur if a person is sick with it from birth. The abnormal condition of the teeth in congenital syphilis is manifested by the deformation of the anterior incisors: the chewing edges become thinner and form a semilunar notch. Such teeth are called Hutchinson's, and are combined, as a rule, with congenital blindness and deafness.

Can acne be a symptom of syphilis?

They can. One of the forms of rashes of the secondary period is manifested in the form of pustules, which are very reminiscent of ordinary youthful acne. They are called acne-like pustular syphilides. Such "pimples" are located, as a rule, on the forehead, neck, back and shoulders.

They are quite difficult to distinguish from ordinary acne.

You should suspect syphilis if:

• rashes do not correspond to the age of the owner - i.e. these are not youthful rashes;
• they periodically appear and disappear (relapses of secondary syphilis);
• the patient often manifests other infectious diseases - pustular syphilides appear, as a rule, in persons with weakened immunity.

Are there discharges from the genital tract with syphilis?

The classic first manifestations of the disease are the appearance of a hard chancre (primary syphiloma) and an increase in lymph nodes.

A hard chancre is an ulcer or a focus of erosion of a round or oval shape with clear edges. It is usually red in color (the color of raw meat) and secretes serous fluid, which gives it a "lacquered appearance".

Allocations of hard chancre with syphilis contain many causative agents of syphilis, they can be found there even at a time when a blood test does not show the presence of a pathogen in the body. The base of the primary syphiloma is solid, the edges are slightly raised (“saucer-shaped”).

A hard chancre usually does not cause pain or any other disturbing symptoms.

Incubation period

Before choosing the right treatment for syphilis, you should know at what stage the disease develops. The disease itself has 4 stages of the course - we will consider them in more detail. Treatment of the disease is quite possible at each of its stages, with the exception of the last, when all organs and systems are affected and cannot be restored - the only difference is the duration and intensity of the course.

The symptoms of syphilis during its incubation, latent period, do not manifest themselves as such - in this case, the disease is diagnosed not by its external manifestations, but based on the results of analyzes carried out using the PCR technique. The duration of the incubation period is 2-4 weeks, after which the disease passes to the stage of primary syphilis.

The primary stage of syphilis and its symptoms

Each person should know how the disease manifests itself - the sooner it is diagnosed, the sooner treatment of syphilis is started, the better the chances for a successful recovery.

How does syphilis manifest itself in men? Before describing the signs of the disease, it is worth talking about the incubation period. It lasts about three weeks. But there are also cases when this period increases from about a couple of months to three. It may also appear after eight days, without showing any special symptoms indicating the severity of the disease.

How long does it take for syphilis to show up in men? Considering the issue, it should be noted that when during the incubation period a person used antibiotics of any kind, the manifestation of symptoms may be delayed for a longer period. This also happens when a man has a venereal ulcer.

The incubation period is no less dangerous for others and sexual partners than a pronounced disease.

The course of syphilis is long undulating, with alternating periods of active and latent manifestations of the disease. In the development of syphilis, periods are distinguished that differ in the set of syphilides - various forms of skin rashes and erosions that appear in response to the introduction of pale spirochetes into the body.

It starts from the moment of infection, lasts an average of 3-4 weeks. Pale spirochetes spread through the lymphatic and circulatory pathways throughout the body, multiply, but clinical symptoms do not appear.

A patient with syphilis is unaware of his illness, although he is already contagious. The incubation period can be shortened (up to several days) and lengthened (up to several months).

Lengthening occurs when taking medications that somewhat inactivate the causative agents of syphilis.

On average, it is 4-5 weeks, in some cases the incubation period of syphilis is shorter, sometimes longer (up to 3-4 months). It is usually asymptomatic.

The incubation period may increase if the patient has taken some antibiotics due to other infectious diseases. During the incubation period, the test results will show a negative result.

The time between infection and the appearance of the first signs of syphilis depends on the person's immunity and on the way in which the bacteria were transmitted. As a rule, this happens after a month, but the manifestations may be indicated earlier or later, or absent altogether.

The very first visible symptom of syphilis is an ulcer, which appears in the place where the syphilitic bacteria have invaded. In parallel, the lymph node located nearby becomes inflamed, followed by the lymphatic vessel. In physicians, this stage stands out in the primary period.

After 6-7 weeks, the ulcer disappears, but the inflammation spreads to all the lymph nodes, and a rash appears. Thus begins the second period. It lasts from 2 to 4 years.

Hard chancre on the genitals

During this time, periods with active manifestations of syphilis alternate with a latent course without symptoms. Rashes of various types and forms appear and disappear several times on the face and body of the patient, all the lymph nodes become inflamed, and some internal organs are affected. If these manifestations are still ignored, and the person does not receive treatment, then syphilis flows into the final stage - the tertiary.

Syphilis can be described as a systemic disease that affects the entire body. Its external manifestations are often similar to those of other diseases, therefore, for an accurate diagnosis, in addition to studying the clinical picture, it is imperative to do laboratory skin tests to identify the presence of the causative agent of syphilis and take blood for the Wasserman reaction.

What kind of signs of syphilis will appear in a particular patient depends on many factors. The state of the immune system, age, lifestyle and other individual characteristics matter.

Syphilis occurs in three clinical periods:

• primary period,
• secondary
• and tertiary, which are preceded by an almost asymptomatic period of about 3 weeks.

Third stage

In our time, every person infected with pale treponema can quickly and efficiently receive adequate and effective treatment. Only a few pass through all stages of syphilis. Without treatment, a person lives in terrible agony for 10 or even 20 years, after which he dies. Below is a brief description of the stages of syphilis. Stage of the incubation period

Stage of primary syphilis

congenital syphilis

If infection occurs during fetal development from an infected mother, then they speak of congenital syphilis. This is one of the most dangerous and severe forms, because most cases end in the death of the child before birth or immediately after it. But in some cases, he survives and is born already infected with syphilis.

Symptoms may appear immediately after birth or during infancy (early syphilis) or years later, at the age of 10-15 years. But most often children are born already with signs of infection. Which systems will suffer, it is difficult to predict in advance.

Characteristic features are low birth weight, sunken nose bridge, large head, flabby and pale skin, thin limbs, dystrophy, pathologies of the vascular system, as well as a number of characteristic changes in the liver, kidneys, lungs and endocrine glands.

The symptoms of this disease are extremely diverse and can affect almost all organ systems.

Neonatal syphilis in pregnancy results in fetal death in 40% of infected pregnant women (stillbirth or death shortly after birth), so all pregnant women should be screened for syphilis at their first prenatal visit.

Diagnosis is usually repeated in the third trimester of pregnancy. If infected children are born and survive, they are at risk of serious problems, including developmental delays.

Fortunately, syphilis during pregnancy is treatable.

Syphilis can be transmitted during pregnancy, from an infected mother to her baby at 10-16 weeks. Frequent complications are spontaneous abortions and fetal death before delivery. Congenital syphilis according to time criteria and symptoms is divided into early and late.

early congenital syphilis

Children with a clear lack of weight, with wrinkled and flabby skin, resemble little old people. Deformation of the skull and its facial part ("Olympic forehead") is often combined with dropsy of the brain, meningitis.

There is keratitis - inflammation of the cornea of ​​​​the eyes, loss of eyelashes and eyebrows is visible. In children aged 1-2 years, a syphilitic rash develops, localized around the genitals, anus, on the face and mucous membranes of the throat, mouth, nose.

The healing rash forms scars: scars that look like white rays around the mouth are a sign of congenital lues.

Syphilitic pemphigus - a rash of vesicles, observed in a newborn a few hours or days after birth. It is localized on the palms, the skin of the feet, on the folds of the forearms - from the hands to the elbows, on the trunk.

Secondary syphilis

This stage develops after 2.5-3 months from the moment of infection and lasts from two to four years. It is characterized by undulating rashes that disappear on their own in a month or two, leaving no marks on the skin. The patient is not bothered by itching or fever. Most often, a rash occurs

• roseolous - in the form of rounded pink spots;
• papular - pink, and then bluish-red nodules, resembling lentils or peas in shape and size;
• pustular - pustules located on a dense base, which can ulcerate and become covered with a dense crust, and when healed, often leaves a scar.
  Different elements of the rash may appear at the same time, such as papules and pustules, but any type of rash contains a large number of spirochetes and is very contagious. The first wave of rashes (secondary fresh syphilis) is usually the brightest, plentiful, accompanied by generalized lymphadenitis. Later rashes (secondary recurrent syphilis) are paler, often asymmetrical, located in the form of arcs, garlands in places subject to irritation (inguinal folds, mucous membranes of the mouth and genital organs).

In addition, with secondary syphilis, there may be:

• Hair loss (alopecia). It can be focal - when bald patches the size of a penny appear in the temples and the back of the head, eyelashes and eyebrows, a beard are less often affected, and it can be diffuse, when hair loss occurs evenly throughout the head.
• Syphilitic leukoderma. Whitish spots up to a centimeter in size, better visible in side lighting, appear most often in the neck, less often on the back, lower back, abdomen and limbs.

Unlike rashes, these manifestations of secondary syphilis do not spontaneously disappear.

Alas, if the vivid manifestations of secondary fresh syphilis did not force the patient to seek help (and our people are often ready to treat such an “allergy” on their own), then less pronounced relapses go unnoticed all the more. And then, after 3-5 years from the moment of infection, the tertiary period of syphilis sets in - but this is a topic for another article.

Thus, the pale spirochete does not cause its owner any special troubles in the form of pain, itching or intoxication, and rashes, all the more prone to pass on their own, unfortunately, not everyone becomes a reason to seek medical help.

Meanwhile, such patients are contagious, and the infection can be transmitted not through sexual contact. Common utensils, bed linen, towels - and now the primary element is looking at the new infected with bewilderment.

Syphilis today is an extremely important problem for medicine, since this disease has its impact on the social sphere, can lead to the inability to have children, disability, mental disorders and death of patients.

Some time after scarring of the primary chancre, there are no clinical manifestations. After 2-3 months, secondary syphilides appear, this time all over the body. They are quite abundant, varied in shape and can be located on any part of the body, including the palms and feet.

What kind of rashes will appear, it is difficult to say. It can be just reddish or pink spots (roseola), papules (nodules) or pustules (vesicles with liquid), pustules.

Rare, but characteristic symptoms of secondary syphilis are the necklace and diadem of Venus - a chain of syphilis on the neck or along the scalp.

Sometimes there are foci of alopecia - hair loss. Most often, the scalp suffers, less often - eyelashes, eyebrows, axillary and inguinal region.

Clinical manifestations of secondary syphilis are not constant. A few weeks after the appearance, it turns pale until it disappears completely. Often this is perceived as the disappearance of the disease, but this is only a temporary relief. How long it will last depends on many factors.

Syphilis typically has a relapsing course. Asymptomatic periods are replaced by obvious manifestations of the disease. The rash appears and then disappears. Relapses are characterized by more faded rashes located in places that are subjected to mechanical irritation.

Other clinical signs may also appear - headaches, weakness, slight fever, joint and muscle pain.

It is difficult to say how long the secondary stage of the disease will last. Without treatment, it can last from 2-3 to tens of years.

At this stage, the patient is most contagious. The separable rash, especially weeping, contains a large number of pathogens. It is in this case that there is a possibility of domestic infection of people living in the same house.

A photo of such manifestations of the disease will not cause positive emotions in anyone. The secondary stage occurs approximately at the eighth week after the first chancre appeared and disappeared. If nothing is done now, then the secondary period can last about five years.

- elevated temperature;

- headache;

- decreased appetite;

- dizziness;

- increased fatigue and malaise;

- the presence of a runny nose and cough, which is similar to a cold;

Secondary syphilis begins 2 to 4 months after infection and can last 2 to 5 years. Characterized by generalization of infection.

At this stage, all systems and organs of the patient are affected: joints, bones, nervous system, organs of hematopoiesis, digestion, vision, hearing. The clinical symptom of secondary syphilis is rashes on the skin and mucous membranes, which are ubiquitous (secondary syphilides).

The rash may be accompanied by body aches, headache, fever, and resemble a cold.

Rashes appear paroxysmal: lasting 1.5 - 2 months, they disappear without treatment (secondary latent syphilis), then reappear. The first rash is characterized by profusion and brightness of color (secondary fresh syphilis), subsequent repeated rashes are paler colored, less abundant, but larger in size and tend to merge (secondary recurrent syphilis).

The frequency of relapses and the duration of latent periods of secondary syphilis are different and depend on the immunological reactions of the body in response to the reproduction of pale spirochetes.

Syphilis of the secondary period disappear without scarring and have a variety of forms - roseola, papules, pustules.

Syphilitic roseolas are small rounded spots of pink (pale pink) color that do not rise above the surface of the skin and epithelium of the mucous membranes, which do not flake off and do not cause itching, when pressed on them turn pale and disappear for a short time. Roseolous rash with secondary syphilis is observed in 75-80% of patients. The formation of roseola is caused by disorders in the blood vessels, they are located throughout the body, mainly on the trunk and limbs, in the face area - most often on the forehead.

The secondary period begins about 5-9 weeks after the formation of a hard chancre, and lasts 3-5 years. The main symptoms of syphilis at this stage are skin manifestations (rash), which appears with syphilitic bacteremia; wide warts, leukoderma and alopecia, nail damage, syphilitic tonsillitis.

There is generalized lymphadenitis: the nodes are dense, painless, the skin over them is of normal temperature (“cold” syphilitic lymphadenitis). Most patients do not notice any special deviations in well-being, but the temperature may rise to 37-37.50, runny nose and sore throat.

Because of these manifestations, the onset of secondary syphilis can be confused with a common cold, but at this time, lues affects all body systems.

The main signs of a rash (secondary fresh syphilis):

• The formations are dense, the edges are clear;
• The shape is correct, rounded;
• Not prone to merging;
• Do not peel off in the center;
• Located on visible mucous membranes and over the entire surface of the body, even on the palms and feet;
• No itching and soreness;
• Disappear without treatment, do not leave scars on the skin or mucous membranes.

In dermatology, special names have been adopted for the morphological elements of the rash, which can remain unchanged or transform in a certain order. The first on the list is a spot (macula), which can go into the stage of a tubercle (papula), a vesicle (vesicula), which opens with the formation of erosion or turns into an abscess (pustula), and when the process spreads deep into an ulcer.

All of the listed elements disappear without a trace, unlike erosions (after healing, a stain first forms) and ulcers (the outcome is scarring). Thus, it is possible to find out from trace marks on the skin what the primary morphological element was, or to predict the development and outcome of already existing skin manifestations.

For secondary fresh syphilis, the first signs are numerous pinpoint hemorrhages in the skin and mucous membranes; profuse rashes in the form of rounded pink spots (roseolae), symmetrical and bright, randomly located - roseolous rash. After 8-10 weeks, the spots turn pale and disappear without treatment, and fresh syphilis turns into secondary latent syphilis, which occurs with exacerbations and remissions.

The exacerbation stage (recurrent syphilis) is characterized by the preferential localization of the elements of the rash on the skin of the extensor surfaces of the arms and legs, in the folds (groin, under the mammary glands, between the buttocks) and on the mucous membranes.

The spots are much smaller, their color is more faded. The spots are combined with a papular and pustular rash, which is more often observed in debilitated patients.

At the time of remission, all skin manifestations disappear. In the recurrent period, patients are especially contagious, even through household contacts.

The rash in secondary acute syphilis is polymorphic: it consists simultaneously of spots, papules and pustules. Elements group and merge, form rings, garlands and semi-arcs, which are called lenticular syphilides.

After their disappearance, pigmentation remains. At this stage, the diagnosis of syphilis by external symptoms is difficult for a non-professional, since secondary recurrent syphilis can be similar to almost any skin disease.

Lenticular rash in secondary recurrent syphilis

Pustular (pustular) rash with secondary syphilis

You can find out what syphilis looks like only after the end of the incubation period. In total, the disease has four stages, each of which is characterized by its own symptoms.

The long incubation period lasts 2-6 weeks, but sometimes the disease may not develop for years, especially if the patient has taken antibiotics, was treated for infectious colds. At this time, laboratory tests will not give a reliable result.

There are not so many features that depend on the gender of a person. Sex differences may be related to:

• with the time of detection;
• with the risk of infection;
• features of the disease itself;
• with complications;
• as well as with different social significance of the disease in each sex.

After what time syphilis will appear, it does not depend on gender, but on the characteristics of the body of a particular person. But the disease in women is often diagnosed later - already in the secondary period, approximately 3 months or more after infection. This is because the appearance of a hard chancre in the vagina or on the cervix usually goes unnoticed.

It is also believed that women are at higher risk of infection. If there are microdamages on the skin and mucous membranes, then the probability of transmitting the disease increases several times. The most traumatic of all types of sexual contact is anal. Women in anal intercourse often act in a passive role. But it should be noted that homosexual men are also at risk. Read more about the routes of transmission and the risks of infection in a special material.

We will consider the features of the course, complications and social significance for each sex separately.

How is syphilis diagnosed?

In the process of diagnosing such a serious disease, you should not diagnose yourself even if its characteristic symptoms and signs are clearly expressed. The thing is that a rash, thickening and enlargement of the lymph nodes can also manifest itself in other diseases as a characteristic symptom.

It is for this reason that the disease itself is diagnosed by doctors using a visual examination of the patient, identifying characteristic symptoms on the body, and by conducting laboratory tests.

In the process of a comprehensive diagnosis of the disease, the patient undergoes:

1. Examination by a dermatologist and venereologist. It is these specialists who examine the patient, his genitals and lymph nodes, skin, take an anamnesis and refer him to laboratory tests.
2. Identification of treponema in the internal contents, gum fluid and chancre by using PCR, direct reaction to immunofluorescence and through dark-field microscopy.

In addition, doctors conduct various tests:

• non-treponemal - in this case, in the composition of the blood in the laboratory, the presence of antibodies against the virus, as well as tissue phospholipids that are destroyed by it, is detected. it Wassermann reaction, VDRL and others.

• treponemal, when the presence or absence of antibodies to such a pathogen as pale treponema is diagnosed in the blood. These are RIF, RPHA, ELISA, a study on the level of immunoblotting.

In addition, doctors also prescribe instrumental examination methods to search for gums - this is a study using ultrasound, MRI, CT and x-rays.

Possible consequences

Pathology in both sexes and all ages is associated with serious consequences:

• failure or deformation of internal organs;
• internal hemorrhages;
• irreversible changes in appearance;
• fatal outcome.

In some cases, syphilis may also appear after treatment: with re-infection or unscrupulous therapy.

Most often, the following consequences of a neglected form of syphilis are observed:

1. The brain is affected, and this contributes to the progression of paralysis of both the upper and lower extremities. Mental disorders can also be observed. Sometimes dementia progresses and cannot be treated.
2. When the spinal cord is damaged, walking is disturbed, orientation in space is lost. The most severe case is when the patient cannot move at all.
3. The circulatory system is affected, primarily large vessels.

The consequences of treated syphilis usually include a decrease in immunity, problems with the endocrine system, and chromosomal damage of varying severity. In addition, after the treatment of pale treponema, a trace reaction remains in the blood, which may not disappear until the end of life.

If syphilis is not detected and treated, it can progress to the tertiary (late) stage, which is the most destructive.

Late stage complications include:

1. Gummas, large ulcers inside the body or on the skin. Some of these gums “dissolve” without leaving any traces; syphilis ulcers form in place of the rest, leading to softening and destruction of tissues, including the bones of the skull. It turns out that a person simply rots alive.
2. Damage to the nervous system (hidden, acute generalized, subacute (basal) meningitis, syphilitic hydrocephalus, early meningovascular syphilis, meningomyelitis, neuritis, spinal cord, paralysis, etc.);
3. Neurosyphilis, which affects the brain or the membrane that covers the brain.

If the infection with treponema occurred during pregnancy, then the consequences of the infection may occur in a child who receives pale treponema through the mother's placenta.

Syphilis occurs under the guise of many other diseases - and this is another danger of this infection. At every stage - even late - the insidious venereal disease can pretend to be something else.

Here is a list of the diseases most similar to syphilis. But note that it is by no means complete. Differential diagnosis of syphilis (i.e. ways to distinguish it from other diseases) is a difficult task. For this patient, they are interviewed in detail, a thorough examination is carried out, and most importantly, laboratory tests are prescribed.

It is impossible to make a diagnosis on your own from a photo or description of manifestations. In case of any suspicion, it is necessary to contact a venereologist - in our time this can be done anonymously.

Treatment of syphilis

Due to the defeat of the immune system, the disease can damage the health of a woman. Therefore, diagnosis and treatment should be immediate. Depending on the stage of the disease, the treatment regimen is determined.

Attention! It is strictly forbidden to self-medicate if syphilis is suspected. Taking self-prescribed antibiotics will only muffle the symptoms, but will not have a detrimental effect on the pathogen.

Video - Consequences, complications and prevention of syphilis

Modern treatment with effective drugs allows us to talk about the timely cure of the patient, but only if the disease has not passed into the last stage of its course, when many organs, bones and joints are destroyed and affected, which cannot be restored.

The treatment of pathology should be carried out exclusively by a qualified venereologist in a medical hospital, based on the results of the examination, patient interviews and the results of laboratory and instrumental studies.

So the treatment of syphilis at home, with our own and folk methods and recipes is unacceptable. It is worth remembering that this disease is not just SARS, which can be cured with hot tea with raspberries - this is a very serious infectious period that destroys the body from the inside.

At the first suspicions, symptoms of the disease - immediately consult a doctor, undergo an examination and the prescribed course of treatment.

Treatment of syphilis begins after a reliable diagnosis is made, which is confirmed by laboratory tests. Treatment of syphilis is selected individually, carried out in a complex manner, recovery should be determined by laboratory.

Modern methods of treating syphilis, which venereology owns today, allow us to talk about a favorable prognosis for treatment, provided that the therapy is correct and timely, which corresponds to the stage and clinical manifestations of the disease.

But only a venereologist can choose a rational and sufficient therapy in terms of volume and time. Self-medication of syphilis is unacceptable.

Untreated syphilis turns into a latent, chronic form, and the patient remains epidemiologically dangerous.

The basis of the treatment of syphilis is the use of antibiotics of the penicillin series, to which the pale spirochete is highly sensitive. In case of allergic reactions of the patient to penicillin derivatives, erythromycin, tetracyclines, cephalosporins are recommended as an alternative.

In cases of late syphilis, in addition, iodine, bismuth, immunotherapy, biogenic stimulants, and physiotherapy are prescribed.

It is important to establish sexual contact with a patient with syphilis, it is imperative to carry out preventive treatment of possibly infected sexual partners. At the end of treatment, all previously syphilis patients remain under dispensary observation by a doctor until a complete negative result of a complex of serological reactions.

The main treatment for syphilis is antibiotic therapy. At the moment, as before, antibiotics of the penicillin series are used (short and prolonged penicillins or durant penicillin drugs).

In the event that this type of treatment is ineffective, or the patient has an individual intolerance to this group of drugs, he is prescribed drugs of the reserve group (macrolides, fluoroquinolones, azithromycins, tetracyclines, streptomycins, etc.).

) It should be noted that at an early stage of syphilis, antibacterial treatment is the most effective and leads to a complete cure.
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The attending physician in the course of treatment can adjust its scheme, and, if necessary, prescribe a second course of antibiotic therapy.

An important criterion for the patient's cure is the conduct of control serological reactions.

In parallel with the antibacterial, the patient is prescribed immunostimulating therapy. Non-specific treatment is also mandatory (vitamin therapy, injections of biogenic stimulants, pyrotherapy and ultraviolet irradiation).

During treatment, any sexual contact is prohibited, as this can lead to infection of the sexual partner or to re-infection of the patient.

Note: if unplanned sexual intercourse has occurred without the use of personal protective equipment (or with a violation of the integrity of the condom during intercourse), experts recommend making a prophylactic injection that almost 100% prevents the development of syphilis.

Antibiotics are the mainstay of treatment for syphilis. Pale treponema is extremely sensitive to penicillin.

One therapeutic course (2-2.5 months) at the initial stage of the development of the disease is quite enough to completely get rid of the infection. In case of intolerance to penicillin, erythromycin, tetracycline, etc. are prescribed. As an additional therapy for syphilis, the intake of vitamins and immunomodulatory drugs is indicated.

With an advanced form of the disease, the treatment period can stretch for a year or more. After the expected recovery, the patient must undergo a second examination of the body and pass some tests to judge the success of the therapy.

It should be recalled that the human body is not able to develop immunity to syphilis, as, say, to chicken pox, therefore, even after a complete cure, re-infection with this infection is possible.

Treatment of syphilis is carried out taking into account the clinical stages of the disease and the susceptibility of patients to drugs. Seronegative early syphilis is easier to treat, with late variants of the disease, even the most modern therapy is not able to eliminate the consequences of syphilis - scars, organ dysfunction, bone deformities and disorders of the nervous system.

Two main methods of treatment of syphilis are used: continuous (permanent) and intermittent (course). In the process, control tests of urine and blood are required, the well-being of patients and the work of organ systems are monitored. Preference is given to complex therapy, which includes:

• Antibiotics (specific treatment for syphilis);
• General strengthening (immunomodulators, proteolytic enzymes, vitamin and mineral complexes);
• Symptomatic drugs (painkillers, anti-inflammatory, hepatoprotectors).

Assign nutrition with an increase in the proportion of complete proteins and a limited amount of fat, reduce physical activity. Prohibit sex, smoking and alcohol.

Psychotrauma, stress and insomnia adversely affect the treatment of syphilis.

In women and men, the treatment of syphilis should be comprehensive and individual. This is one of the most formidable sexually transmitted diseases, leading to serious consequences if not properly treated, so under no circumstances should you self-medicate at home.

The basis of the treatment of syphilis is antibiotics, thanks to them, the effectiveness of treatment has approached 100%. The patient can be treated on an outpatient basis, under the supervision of a doctor who prescribes a comprehensive and individual treatment.

Today, penicillin derivatives in sufficient doses (benzylpenicillin) are used for antisyphilitic therapy. Premature termination of treatment is unacceptable, it is necessary to complete the full course of treatment.

At the discretion of the attending physician, additional treatment with antibiotics may be prescribed - immunomodulators, probiotics, vitamins, physiotherapy, etc. During treatment, a man or woman is strictly contraindicated in any sexual intercourse and alcohol.

After the end of treatment, it is necessary to pass control tests. These may be quantitative non-treponemal blood tests (for example, RW with cardiolipin antigen).

Follow-up

After you have been treated for syphilis, your doctor will ask you to:

• periodically take blood tests to make sure that the body responds positively to the usual dosage of penicillin;
• avoid sexual contact until treatment is completed and blood tests show that the infection has been completely cured;
• inform your partners about the disease so that they also undergo diagnostics and, if necessary, treatment;
• get tested for HIV infection.

Diagnostics

When infected with syphilis, the causes always fade into the background. The main thing in such a situation is to correctly diagnose the stage, type and form of the disease.

For the most accurate diagnosis of syphilis, as a rule, an infected person is offered to undergo a series of treponemal or serological tests, on the basis of which the doctor receives a complete picture of the disease and develops an optimal treatment regimen.

How to get tested for syphilis? When a patient presents with a suspected infection, the doctor will follow a specific course of action. Initially, the doctor will perform a visual examination of the patient in order to analyze the external clinical manifestations of syphilis in the body.

To do this, the lymph nodes are probed, the oral cavity, the mucous membranes of the genital organs, the hairline and the nasopharynx are examined. If no symptoms, such as syphilis on the skin and mucous membranes, are found, the examination is completed, and the patient is sent to the laboratory for testing.

Analyzes are of treponemal and non-treponemal types, depending on the stage of the disease and on how long syphilis appears after infection. Treponemal tests are less effective in the secondary and tertiary stages of the disease, since they are based mainly on the detection of spirochete bacteria in the blood.

Non-treponemal tests can detect the presence in the body of an infected person of antibodies that react to the spreader of the infection, the spirochete, and are released in a pathologically large amount.

Treponema pallidum bacteria can also be identified and detected by microbiological analysis based on a chancre swab from an infected person. As a rule, ulcerative lesions on the skin contain a large number of harmful microorganisms, which are easy to see with a certain method of staining and examination on a tinted glass.

Note that the analyzes of the primary manifestations of syphilis are carried out on the basis of smears taken directly from the surface of the ulcers. It is in the ulcers that a large number of dangerous bacteria are contained, which are then easily identified under a microscope.

Diagnostic measures for syphilis include a thorough examination of the patient, taking an anamnesis and conducting clinical studies:

1. Detection and identification of the causative agent of syphilis by microscopy of serous discharge of skin rashes. But in the absence of signs on the skin and mucous membranes and in the presence of a "dry" rash, the use of this method is impossible.
2. Serological reactions (non-specific, specific) are performed with serum, blood plasma and cerebrospinal fluid - the most reliable method for diagnosing syphilis.

Diagnosis of syphilis will directly depend on the stage at which it is located. It will be based on the symptoms of the patient and the tests received.

In the case of the primary stage, hard chancres and lymph nodes are subject to examination. At the next stage, the affected areas of the skin, papules of the mucous membranes are examined.

In general, bacteriological, immunological, serological and other research methods are used to diagnose infection. It should be borne in mind that at certain stages of the disease, the results of tests for syphilis can be negative in the presence of the disease, which makes it difficult to diagnose the infection.

To confirm the diagnosis, a specific Wasserman reaction is performed, but it often gives false results of the analysis. Therefore, for the diagnosis of syphilis, it is necessary to simultaneously use several types of tests - RIF, ELISA, RIBT, RPGA, microscopy, PCR analysis.

How to recognize syphilis at different active and chronic stages, the doctor knows. If you suspect a disease, you should contact a dermatovenereologist.

At the first examination, a hard chancre, lymph nodes are examined, at a secondary examination - the affected areas of the skin, papules of the mucous membranes. For the diagnosis of syphilis, bacteriological, immunological, positive serological and other tests are used.

For confirmation, a specific Wassermann reaction is carried out, which reveals a 100% result of infection. False-positive reactions to syphilides are not excluded.

Possible Complications

The course of syphilis is characterized by a destructive nature, since it affects many internal organs and systems. In addition, in the absence of timely treatment, syphilis can lead to the most dangerous complications - death. If a woman became infected with pale treponema, but refused treatment, or the incubation period was prolonged for one reason or another, then the following complications are highly likely:

• the development of neurosyphilis (brain damage) leads to destruction of the nervous system and complete (sometimes partial) loss of vision;
• the advanced stage of the disease leads to damage to the joints and bones;
• with neurosyphilis, the development of meningitis;
• paralysis;
• infection of the fetus during pregnancy.

Carefully! If pale treponema is not blocked in a timely manner, then tertiary syphilis can lead to irreversible processes (ulcerative formations on internal organs) and, as a result, death.

Pregnant mothers and newborns

Mothers infected with syphilis are at risk of miscarriages and premature births. There is also a risk that a mother with syphilis will pass the disease to her fetus. This type of disease is known as congenital syphilis (as discussed above).

If a child has congenital syphilis and is not detected, the child may develop advanced syphilis. This can lead to problems with:

• skeleton;
• teeth;
• eyes;
• ears;
• brain.

neurological problems

Syphilis can cause a number of problems with your nervous system, including:

• stroke ;
• meningitis;
• hearing loss;
• loss of pain and temperature sensations;
• sexual dysfunction in men (impotence);
• urinary incontinence in women and in men;
• sudden, lightning pains.

Cardiovascular problems

These can include aneurysms and inflammation of the aorta - your body's main artery - and other blood vessels. Syphilis can also damage the heart valves.

HIV infection

Prevention of syphilis

To date, doctors and scientists have not yet invented special vaccines that are effective in preventing syphilis. If the patient had previously had this sexually transmitted infection, he can become infected and get it again. As a result, only preventive measures will help to avoid infection and thereby prevent damage to the internal organs and body systems.

First of all, it is necessary to exclude promiscuity with an unverified partner, especially without a condom. If there was such sex, immediately treat the genitals with an antiseptic and visit a doctor for a preventive examination and examination.

Having syphilis once does not mean that a person is protected from it. After it heals, you can change it again.

It is enough to understand that not every person knows that he is currently a carrier of the infection, and if the patient has a regular sexual life, doctors recommend regularly undergoing examinations by highly specialized doctors, being tested for STDs, thereby detecting the disease in its early stages. currents.

After undergoing treatment, patients are required to be under dispensary observation (for each form of syphilis there is an appropriate period determined by the instructions). Such methods provide a clear control over the successful conduct of antisyphilitic therapy.

Without fail, all sexual and household contacts of the patient must be identified, examined and sanitized in order to prevent the possibility of the spread of infection among the population.
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During the entire period of dispensary observation, patients who have had syphilis are required to refrain from sexual intercourse, and they are also forbidden to be blood donors.

Public preventive measures are considered to be:

• Annual medical examination of the population (over 14 years old) providing for blood donation for RMP.
• Regular screening for syphilis of persons at risk (drug addicts, homosexuals and prostitutes).
• Examination of pregnant women in order to prevent congenital syphilis.

Pregnant women who have previously had syphilis and have already been deregistered are prescribed additional preventive treatment.

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Syphilis (syphilis) refers to infectious diseases, transmitted in most cases sexually. The causative agent of syphilis is a spiral-shaped microorganism Treponema pallidum(pale treponema), is very vulnerable in the external environment, multiplies rapidly in the human body. Incubation period, that is time from infection to first symptoms, approximately 4-6 weeks. It can be shortened to 8 days or lengthened to 180 with concomitant sexually transmitted diseases (,), if the patient is weakened by an immunodeficiency state () or took antibiotics. In the latter case, the primary manifestations of syphilis may be absent altogether.

Regardless of the length of the incubation period, the patient at this time is already infected with syphilis and is dangerous to others as a source of infection.

How can you get syphilis?

Syphilis is transmitted mainly through sexual contact - up to 98% of all cases of infection. The pathogen enters the body through defects in the skin or mucous membranes of the genitals, anorectal loci, mouth. However, approximately 20% of sexual partners who have been in contact with patients with syphilis remain in good health. Risk of infection significantly reduced if there are no conditions necessary for the penetration of infection - microtrauma and a sufficient amount of infectious material; if sexual intercourse with a patient with syphilis was single; if syphilides (morphological manifestations of the disease) have a small contagiousness(the ability to infect). Some people are genetically immune to syphilis because their body produces specific protein substances that can immobilize pale treponema and dissolve their protective membranes.

It is possible to infect the fetus in utero or in childbirth: then congenital syphilis is diagnosed.

The everyday way - through any objects contaminated with infectious material, handshakes or formal kisses - is realized very rarely. The reason is the sensitivity of treponemas: as they dry, the level of their contagiousness drops sharply. Get syphilis through a kiss it is quite possible if one person has syphilitic elements on the lips, oral mucosa or throat, tongue containing a sufficient amount of virulent (that is, live and active) pathogens, and another person has scratches on the skin, for example, after shaving.

The causative agent of syphilis is Treponema pallidum from the Spirochete family.

Very rare routes of transmission of infectious material through medical instruments. Treponemas are unstable even under normal conditions, and when sterilized or treated with conventional disinfectant solutions, they die almost instantly. So all the stories about syphilis infection in gynecological and dental offices most likely belong to the category of oral folk art.

Transmission of syphilis with blood transfusions(blood transfusions) almost never occurs. The fact is that all donors must be tested for syphilis, and those who have not passed the test simply will not be able to donate blood. Even if we assume that there was an incident and there are treponemas in the donor blood, they will die during the preservation of the material in a couple of days. The very presence of a pathogen in the blood is also rare, because Treponema pallidum appears in the bloodstream only during treponemal sepsis» with secondary fresh syphilis. Infection is possible if enough virulent pathogen is transmitted with direct blood transfusion from an infected donor, literally from vein to vein. Given that the indications for the procedure are extremely narrowed, the risk of contracting syphilis through the blood is unlikely.

What increases the risk of contracting syphilis?

• Liquid secretions. Since treponemas prefer a humid environment, mother's milk, weeping syphilitic erosions and ulcers, sperm discharged from the vagina contain a huge number of pathogens and are therefore the most infectious. Transmission of infection through saliva is possible if there is syphilides(rash, chancre).
• Elements of dry rash(spots, papules) are less contagious, in abscesses ( pustules) treponema can be found only along the edges of the formations, and in pus they are not at all.
• Disease period. With active syphilis, nonspecific erosions on the cervix and head of the penis, herpetic rash vesicles and any inflammatory manifestations leading to defects in the skin or mucous membranes are contagious. In the period of tertiary syphilis, the possibility of infection through sexual contact is minimal, and papules and gummas specific for this stage are actually not contagious.

With regard to the spread of infection, latent syphilis is the most dangerous: people are unaware of their illness and do not take any measures to protect their partners.

• Accompanying illnesses. Patients with gonorrhea and other STDs are more easily infected with syphilis, since the mucous membranes of the genitals are already damaged by previous inflammations. Treponemas multiply rapidly, but the primary lues is "masked" by the symptoms of other venereal diseases, and the patient becomes epidemically dangerous.
• The state of the immune system. People who are debilitated by chronic diseases are more likely to contract syphilis; AIDS patients; in alcoholics and drug addicts.

Classification

Syphilis can affect any organs and systems, but the manifestations of syphilis depend on the clinical period, symptoms, duration of illness, age of the patient, and other variables. Therefore, the classification seems a little confusing, but in reality it is built very logically.

1. depending from time span, which has passed since the moment of infection, early syphilis is distinguished - up to 5 years, more than 5 years - late syphilis.
2. By typical symptoms syphilis is divided into primary(hard chancre, scleradenitis and lymphadenitis), secondary(papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis) and tertiary(gummas, damage to internal organs, bone and joint systems, late neurosyphilis).

chancre - an ulcer that develops at the site of introduction of the causative agent of syphilis

1. primary syphilis, according to blood test results, may be seronegative and seropositive. Secondary according to the main symptoms are divided into stages of syphilis - fresh and latent (recurrent), tertiary are differentiated as active and latent syphilis, when treponemas are in the form of cysts.
2. By preference damage to systems and organs: neurosyphilis and visceral (organ) syphilis.
3. Separately - fetal syphilis and congenital late syphilis.

Primary syphilis

After the end of the incubation period, the characteristic first signs appear. At the site of penetration of treponema, a specific rounded erosion or ulcer is formed, with a hard, smooth bottom, “tucked” edges. The sizes of formations can vary from a couple of mm to several centimeters. Hard chancres can disappear without treatment. Erosions heal without a trace, ulcers leave flat scars.

Disappeared chancres do not mean the end of the disease: primary syphilis only passes into a latent form, during which the patient is still contagious to sexual partners.

in the figure: chancres of genital localization in men and women

After the formation of a hard chancre, after 1-2 weeks begins local enlargement of lymph nodes. When palpated, they are dense, painless, mobile; one is always larger than the others. After another 2 weeks it becomes positive serum (serological) reaction to syphilis, from this point on, primary syphilis passes from the seronegative stage to the seropositive stage. The end of the primary period: the body temperature may rise to 37.8 - 380, there are sleep disturbances, muscle and headaches, aching joints. Available dense swelling of the labia (in women), head of the penis and scrotum in men.

Secondary syphilis

The secondary period begins about 5-9 weeks after the formation of a hard chancre, and lasts 3-5 years. Main symptoms syphilis at this stage - skin manifestations (rash), which appears with syphilitic bacteremia; wide warts, leukoderma and alopecia, nail damage, syphilitic tonsillitis. Present generalized lymphadenitis: the nodes are dense, painless, the skin above them is of normal temperature ("cold" syphilitic lymphadenitis). Most patients do not notice any special deviations in well-being, but the temperature may rise to 37-37.50, runny nose and sore throat. Because of these manifestations, the onset of secondary syphilis can be confused with a common cold, but at this time, lues affects all body systems.

syphilitic rash

The main signs of a rash (secondary fresh syphilis):

• The formations are dense, the edges are clear;
• The shape is correct, rounded;
• Not prone to merging;
• Do not peel off in the center;
• Located on visible mucous membranes and over the entire surface of the body, even on the palms and feet;
• No itching and soreness;
• Disappear without treatment, do not leave scars on the skin or mucous membranes.

accepted in dermatology special names for morphological elements of the rash that can remain unchanged or transform in a certain order. First on the list - spot(macula), may progress to stage tubercle(papula) bubble(vesicula), which opens with the formation erosion or turns into abscess(pustula), and when the process spreads deep into ulcer. All of the listed elements disappear without a trace, unlike erosions (after healing, a stain first forms) and ulcers (the outcome is scarring). Thus, it is possible to find out from trace marks on the skin what the primary morphological element was, or to predict the development and outcome of already existing skin manifestations.

For secondary fresh syphilis, the first signs are numerous pinpoint hemorrhages in the skin and mucous membranes; profuse rashes in the form of rounded pink spots(roseolaе), symmetrical and bright, randomly located - roseolous rash. After 8-10 weeks, the spots turn pale and disappear without treatment, and fresh syphilis becomes secondary. hidden syphilis flowing with exacerbations and remissions.

For the acute stage ( recurrent syphilis) is characterized by a preferential localization of the elements of the rash on the skin of the extensor surfaces of the arms and legs, in the folds (groin, under the mammary glands, between the buttocks) and on the mucous membranes. The spots are much smaller, their color is more faded. The spots are combined with a papular and pustular rash, which is more often observed in debilitated patients. At the time of remission, all skin manifestations disappear. In the recurrent period, patients are especially contagious, even through household contacts.

Rash with secondary acute syphilis polymorphic: consists simultaneously of spots, papules and pustules. Elements group and merge, forming rings, garlands and semi-arcs, which are called lenticular syphilides. After their disappearance, pigmentation remains. At this stage, the diagnosis of syphilis by external symptoms is difficult for a non-professional, since secondary recurrent syphilis can be similar to almost any skin disease.

Lenticular rash in secondary recurrent syphilis

Pustular (pustular) rash with secondary syphilis

Pustular syphilis is a sign of a malignant ongoing disease. More often observed during the period of secondary fresh syphilis, but one of the varieties - ecthymatous- characteristic of secondary exacerbated syphilis. Ecthymes appear in debilitated patients approximately 5-6 months from the time of infection. They are located asymmetrically, usually on the shins in front, less often on the skin of the trunk and face. Syphilides number 5 - 10, rounded, about 3 cm in diameter, with a deep abscess in the center. A gray-black crust forms above the pustule, below it there is an ulcer with necrotic masses and dense, steep edges: the shape of the ecthyma resembles funnels. After that, deep dark scars remain, which eventually lose their pigmentation and become white with a pearly tint.

Necrotic ulcers from pustular syphilides, secondary-tertiary stages of syphilis

Ecthymes can go into rupioid syphilides, with the spread of ulceration and disintegration of tissues outward and deep. Centered rupees multilayer "oyster" crusts are formed, surrounded by an annular ulcer; outside - a dense roller of a reddish-violet color. Ecthymas and rupees are not contagious, during this period all serological tests for syphilis are negative.

Acne syphilides - abscesses 1-2 mm in size, localized in the hair follicles or inside the sebaceous glands. Rashes are localized on the back, chest, limbs; heal with the formation of small pigmented scars. Smallpox syphilides are not associated with hair follicles, they are lentil-shaped. Dense at the base, copper-red color. syphilis similar to impetigo- purulent inflammation of the skin. It occurs on the face and scalp, pustules are 5-7 mm in size.

Other manifestations of secondary syphilis

Syphilitic warts similar to warts with a wide base, often formed in the fold between the buttocks and in the anus, under the armpits and between the toes, near the navel. In women - under the breast, in men - near the root of the penis and on the scrotum.

Pigmentary syphilide(spotted leukoderma literally translated from Latin - "white skin"). White spots up to 1 cm in size appear on the pigmented surface, which are located on the neck, for which they received the romantic name "Venus' necklace". Leukoderma is determined after 5-6 months. after infection with syphilis. Possible localization on the back and lower back, abdomen, arms, on the front edge of the armpits. The spots are not painful, do not peel off and do not become inflamed; remain unchanged for a long time, even after specific treatment for syphilis.

Syphilitic alopecia(alopecia). Hair loss can be localized or cover large areas of the scalp and body. Small foci of incomplete alopecia are often observed on the head, with rounded irregular outlines, mainly located on the back of the head and temples. On the face, first of all, attention is paid to the eyebrows: with syphilis, the hairs first fall out from their inner part, located closer to the nose. These signs marked the beginning of visual diagnostics and became known as " omnibus syndrome". In the later stages of syphilis, a person loses absolutely all hair, even vellus.

Syphilitic angina- the result of damage to the mucous membrane of the throat. Small (0.5 cm) spotty syphilides appear on the tonsils and soft palate, they are visible as bluish-red foci of sharp outlines; grow up to 2 cm, merge and form plaques. The color in the center quickly changes, acquiring a grayish-white opal shade; the edges become scalloped, but retain the density and original color. Syphilides can cause pain during swallowing, a feeling of dryness and constant tickling in the throat. Occur along with a papular rash during the period of fresh secondary syphilis, or as an independent sign of secondary exacerbated syphilis.

manifestations of syphilis on the lips (chancre) and tongue

Syphilides on the tongue, in the corners of the mouth due to constant irritation, they grow and rise above the mucous membranes and healthy skin, dense, the surface is grayish in color. May become covered with erosions or ulcerate, causing pain. papular syphilis on the vocal cords initially manifested by hoarseness of voice, later a complete loss of voice is possible - aphonia.

syphilitic nail damage(onychia and paronychia): papules are localized under the bed and at the base of the nail, visible as reddish-brown spots. Then the nail plate above them becomes whitish and brittle, begins to crumble. With purulent syphilis, severe pain is felt, the nail moves away from the bed. Subsequently, depressions in the form of craters form at the base, the nail thickens three or four times compared to the norm.

Tertiary period of syphilis

Tertiary syphilis is manifested by focal destruction of the mucous membranes and skin, any parenchymal or hollow organs, large joints, and the nervous system. Main features - papular rashes and gummas degrading with rough scarring. Tertiary syphilis is rarely defined, develops within 5-15 years if no treatment has been carried out. Asymptomatic period ( latent syphilis) can last for more than two decades, is only diagnosed by serological tests between secondary and tertiary syphilis.

what can affect advanced syphilis

Papular elements dense and rounded, up to 1 cm in size. They are located in the depths of the skin, which becomes bluish-red above the papules. Papules appear at different times, grouped into arcs, rings, elongated garlands. Typical for tertiary syphilis focus rashes: each element is determined separately and in its stage of development. The disintegration of papular syphilomas begins from the center of the tubercle: rounded ulcers appear, the edges are sheer, there is necrosis at the bottom, and a dense roller along the periphery. After healing, small dense scars with a pigmented border remain.

Serpinginous syphilides are grouped papules that are in different stages of development and spread to large areas of the skin. New formations appear along the periphery, merge with the old ones, which at this time already ulcerate and scar. The sickle-shaped process seems to crawl to healthy areas of the skin, leaving a trail of mosaic scars and pigmentation foci. Numerous tubercular seals create a colorful picture true polymorphic rash, which is visible in the late periods of syphilis: different sizes, different morphological stages of the same elements - papules.

syphilitic gumma on the face

syphilitic gumma. At first it is a dense knot, which is located in the depth of the skin or under it, mobile, up to 1.5 cm in size, painless. After 2-4 weeks, the gumma is fixed relative to the skin and rises above it as a rounded dark red tumor. A softening appears in the center, then a hole forms and a sticky mass comes out. In place of the gumma, a deep ulcer is formed, which can grow along the periphery and spread along the arc ( serping gummy syphilis), and in the "old" areas there is healing with the appearance of retracted scars, and in the new ones - ulceration.

More often syphilitic gummas are located alone and are localized on the face, near the joints, on the legs in front. Closely located syphilides can merge to form gum pad and turn into impressive ulcers with compacted, uneven edges. In debilitated patients, with a combination of syphilis with HIV, gonorrhea, viral hepatitis, gum may grow in depth - mutilating or irradiating gumma. They disfigure the appearance, can even lead to the loss of an eye, testicle, perforation and death of the nose.

gummas in the mouth and inside the nose disintegrate with destruction of the palate, tongue and nasal septum. Defects appear: fistulas between the cavities of the nose and mouth (nasal voice, food can get into the nose), narrowing of the orifice(difficulty swallowing), cosmetic problems - failed saddle nose. Language first increases and becomes bumpy, after scarring it wrinkles, it becomes difficult for the patient to talk.

Visceral and neurosyphilis

At visceral tertiary syphilis, organ damage is observed, with the development neurosyphilis- symptoms from the central nervous system (CNS). During the secondary period, early syphilis of the central nervous system appears; it affects the brain, its vessels and membranes ( meningitis and meningoencephalitis). In the tertiary period, manifestations of late neurosyphilis are observed, these include atrophy of the optic nerve, dorsal tabes and progressive paralysis.

Dorsal tabes– Manifestation of syphilis of the spinal cord: the patient literally does not feel the ground under his feet and cannot walk with his eyes closed.

progressive paralysis It manifests itself as much as one and a half to two decades after the onset of the disease. The main symptoms are mental disorders, from irritability and memory impairment to delusional states and dementia.

optic nerve atrophy: with syphilis, one side is first affected, a little later vision deteriorates in the other eye.

Gummas affecting the head brain are rarely observed. According to clinical signs, they are similar to tumors and are expressed by symptoms of brain compression - increased intracranial pressure, rare pulse, nausea and vomiting, prolonged headaches.

bone destruction in syphilis

Among the visceral forms predominates syphilis of the heart and blood vessels(up to 94% of cases). Syphilitic mesaortitis- inflammation of the muscular wall of the ascending and thoracic aorta. It often occurs in men, accompanied by an expansion of the artery and phenomena of cerebral ischemia (dizziness and fainting after exercise).

Syphilis liver(6%) leads to the development of hepatitis and liver failure. The total proportion of syphilis of the stomach and intestines, kidneys, endocrine glands and lungs does not exceed 2%. Bones and joints: arthritis, osteomyelitis and osteoporosis, the consequences of syphilis - irreversible deformities and blockade of joint mobility.

congenital syphilis

Syphilis can be transmitted during pregnancy, from an infected mother to her baby at 10-16 weeks. Frequent complications are spontaneous abortions and fetal death before delivery. Congenital syphilis according to time criteria and symptoms is divided into early and late.

early congenital syphilis

Children with a clear lack of weight, with wrinkled and flabby skin, resemble little old people. Deformation skull and its facial part ("Olympic forehead") is often combined with dropsy of the brain, meningitis. Present keratitis- inflammation of the cornea of ​​​​the eyes, loss of eyelashes and eyebrows is visible. Children aged 1-2 years develop syphilitic rash, localized around the genitals, anus, on the face and mucous membranes of the throat, mouth, nose. A healing rash forms scarring: scars that look like white rays around the mouth are a sign of congenital lues.

syphilitic pemphigus- a rash of vesicles, observed in a newborn a few hours or days after birth. It is localized on the palms, the skin of the feet, on the folds of the forearms - from the hands to the elbows, on the trunk.

Rhinitis, the causes of its occurrence are syphilides of the nasal mucosa. Small purulent discharge appears, forming crusts around the nostrils. Breathing through the nose becomes problematic, the child is forced to breathe only through the mouth.

Osteochondritis, periostitis- inflammation and destruction of bones, periosteum, cartilage. It is most often found on the legs and arms. There is local swelling, pain and muscle tension; then paralysis develops. During early congenital syphilis, destruction of the skeletal system is diagnosed in 80% of cases.

late congenital syphilis

late form manifests itself in the age period of 10-16 years. The main symptoms are visual impairment with the possible development of complete blindness, inflammation of the inner ear (labyrinthitis), followed by deafness. Skin and visceral gummas are complicated by functional disorders of organs and scars that disfigure the appearance. Deformation of teeth, bones: the edges of the upper incisors have semilunar notches, the legs are bent, due to the destruction of the septum, the nose is deformed (saddle-shaped). Frequent problems with the endocrine system. The main manifestations of neurosyphilis are tabes dorsalis, epilepsy, speech disorders, progressive paralysis.

Congenital syphilis is characterized by a triad of signs Getchinson:

• teeth with an arched edge;
• cloudy cornea and photophobia;
• labyrinthitis - tinnitus, loss of orientation in space, hearing loss.

How is syphilis diagnosed?

Diagnosis of syphilis is based on clinical manifestations characteristic of different forms and stages of the disease, and laboratory tests. Blood take to conduct a serological (serum) test for syphilis. To neutralize teponems in the human body, specific proteins are produced - which are determined in the blood serum of an infected or sick person with syphilis.

RW analysis blood test (Wassermann reaction) is considered obsolete. It can often be false positive in tuberculosis, tumors, malaria, systemic diseases and viral infections. Among women- after childbirth, during pregnancy, menstruation. The use of alcohol, fatty foods, and certain drugs before donating blood for RW can also be the cause of an unreliable interpretation of the analysis for syphilis.

It is based on the ability of antibodies (immunoglobulins IgM and IgG) present in the blood of those infected with syphilis to interact with antigen proteins. If the reaction has passed - analysis positive, that is, the causative agents of syphilis are found in the body of this person. Negative ELISA - no antibodies to treponema, no disease or infection.

The method is highly sensitive, applicable for the diagnosis of latent - hidden forms - syphilis and checking people who have been in contact with the patient. positive even before the first signs of syphilis appear (according to IgM - from the end of the incubation period), and can be determined after the complete disappearance of treponema from the body (according to IgG). ELISA for the VRDL antigen, which appears during alteration (“damage”) of cells due to syphilis, is used to monitor the effectiveness of treatment regimens.

RPHA (passive hemagglutination reaction)- bonding of erythrocytes that have antigens on their surface Treponema pallidum with specific antibody proteins. RPHA is positive in case of illness or infection with syphilis. Remains positive throughout the patient's life even after complete recovery. To exclude a false positive response, RPHA is supplemented with ELISA and PCR tests.

Direct Methods laboratory tests help to identify the causative microorganism, and not antibodies to it. With the help, you can determine the DNA of treponema in the biomaterial. Microscopy a smear from a serous discharge of a syphilitic rash - a technique for visual detection of treponema.

Treatment and prevention

Treatment of syphilis is carried out taking into account the clinical stages of the disease and the susceptibility of patients to drugs. Seronegative early syphilis is treated more easily, with late variants of the disease, even the most modern therapy is not able to eliminate consequences of syphilis- scars, organ dysfunction, bone deformities and disorders of the nervous system.

There are two main methods of treatment for syphilis: continuous(permanent) and intermittent(course). In the process, control tests of urine and blood are required, the well-being of patients and the work of organ systems are monitored. Preference is given to complex therapy, which includes:

• Antibiotics(specific treatment of syphilis);
• Restorative(immunomodulators, proteolytic enzymes, vitamin-mineral complexes);
• Symptomatic drugs (painkillers, anti-inflammatory, hepatoprotectors).

Assign nutrition with an increase in the proportion of complete proteins and a limited amount of fat, reduce physical activity. Prohibit sex, smoking and alcohol.

Psychotrauma, stress and insomnia adversely affect the treatment of syphilis.

Patients with early latent and contagious syphilis undergo the first course of 14-25 days in the clinic, then they are treated on an outpatient basis. Treat syphilis with penicillin antibiotics- intramuscularly injected sodium or potassium salt of benzylpenicillin, bicillins 1-5, phenoxymethylpenicillin. A single dose is calculated according to the weight of the patient; if there are inflammatory signs in the cerebrospinal fluid (spinal fluid), then the dosage is increased by 20%. The duration of the entire course is determined according to the stage and severity of the disease.

permanent method: the starting course for seronegative primary syphilis will take 40-68 days; seropositive 76-125; secondary fresh syphilis 100-157.

course treatment: tetracyclines are added to penicillins ( doxycycline) or macrolides ( azithromycin), preparations based on bismuth - bismovrol, biyoquinol, and iodine - potassium or sodium iodide, calcium iodine. Cyanocobalamin (vit. B-12) and solution coamide enhance the action of penicillin, increase the concentration of the antibiotic in the blood. Injections of pyrogenal or prodigiosan, autohemotherapy, aloe are used as means of non-specific therapy for syphilis, which increase resistance to infection.

During pregnancy, syphilis is treated only with penicillin antibiotics, without drugs with bismuth salts.

Proactive(preventive) treatment: carried out as in the case of seronegative primary syphilis, if sexual contact with the infected was 2-16 weeks ago. One course of penicillin is used for medical prophylaxis of syphilis if the contact was no more than 2 weeks ago.

Prevention of syphilis- Identification of the infected and the range of their sexual partners, preventive treatment and personal hygiene after sexual intercourse. Surveys for syphilis of people belonging to risk groups - physicians, teachers, staff of kindergartens and catering establishments.

Video: syphilis in the program “Live healthy!”

Video: syphilis in the encyclopedia of STDs

Syphilis malignant, galloping, oligosymptomatic
and asymptomatic

In its course, a syphilitic infection causes a number of diverse manifestations from the body affected by it. In most patients, the manifestations have a certain chronological sequence, which generally fits into those schemes of syphilis that have been described. In the schematic course of syphilis, there are often such factors that undoubtedly indicate individual characteristics in the reaction of one or another organism to the syphilitic virus.

We have already mentioned that in a number of cases a woman who has never had any symptoms of syphilis gives birth to a child with certain manifestations of congenital syphilis. When examining such a mother, she usually has positive serological tests.
In some patients, the symptoms of syphilis are extremely insignificant from the very beginning, and in the future, even without sufficient anti-syphilitic treatment, the disease passes into a long latent state. An insignificant number of syphilides, a small number of relapses, and sometimes their absence make it possible to speak of "low-symptomatic" syphilis. Such cases are not uncommon. Sometimes patients seek help in the secondary fresh period of syphilis with an extremely negligible amount of syphilides. In such patients, it is difficult to find a few single syphilitic spots or papules somewhere on the skin of the trunk. Often one has to meet people who have had a syphilitic infection, who had manifestations of the primary or secondary period of the disease several decades ago. These patients in the distant years took one or two anti-syphilitic courses that were inadequate, from the modern point of view, and since then they have never had any clinical manifestations of syphilis. This form of syphilis is also referred to as low-symptomatic syphilis. Such a low-symptom manifestation of syphilis in no way guarantees the patient from the possible onset of severe forms of syphilis, beyond any expectation, which can cause destruction in the patient's vital organs and threaten him with serious complications, and sometimes even end in the death of the patient. Thus, "low-symptomatic" syphilis cannot be identified with "benign" syphilis, since it can subsequently cause extremely severe lesions.

The term "malignant syphilis" is often found in the literature. Syphilidologists interpret it differently. In the pre-Salvar era, malignant forms of syphilis usually included those forms that were resistant to ongoing mercury and iodine therapy. Now such forms of syphilis in the vast majority respond well to the influence of salvarsan, bismuth and penicillin treatment and, on the basis of resistance to antisyphilitic therapy, cannot be classified as malignant syphilis.

Hence, it seems to us that, in order to determine the malignancy of a syphilitic infection, it is more correct to proceed not only from the resistance of its manifestations to all modern antisyphilitic drugs, which is extremely rare, but also to take into account the presence of early rashes of numerous syphilides in the patient, leading to the destruction of the affected tissues and severe disorders of the general the patient's condition.
The malignancy of the course of syphilis can manifest itself already in the first period of infection, when primary syphiloma will be accompanied by gangrenous decay of the ulcer itself or phagedenization phenomena. Timely initiated antisyphilitic treatment usually quickly stops the process of tissue breakdown. However, there is no certainty that in the future syphilis in this patient will proceed benignly, and not malignantly.

In the malignant course of syphilis, there is a stronger reaction from the lymph nodes and more pronounced prodromal phenomena at the end of the second incubation period. Prodromal phenomena in such cases tend to drag on for the period of secondary rashes following them. However, it is well known that in patients with severe cachexia, in whom syphilis is usually severe, there may be no reaction from the lymph nodes and even no regional bubo. Often in the prodromal period and during the period of rashes of syphilidol, the patient has a rather significant increase in temperature, which lasts for a long time even when syphilides have already appeared.

Often such patients complain of severe headaches, pain in the joints; the joints may swell at the same time, and an effusion is found in them; there are also painful swelling of the periosteum.
Rashes of the secondary period show in such cases a tendency to decay; either ecthymas or rupees are formed. Formed ulcers tend to increase in size, along their periphery a purple-colored border clearly protrudes, on which pustules in turn form. It is generally accepted that the appearance of pustular syphilis portends a malignant course of syphilis. Pustular syphilides can be detected at the first rash as manifestations of fresh secondary syphilis, but can also occur with recurrent rashes. After pustular eruptions in the fresh secondary period of syphilis, recurrent eruptions may be in the nature of only spotted or papular rashes. Most often, a patient has polymorphic rashes, when, along with pustular elements, there are both spotty and papular rashes.
Manifestations of malignant syphilis can be localized not only on the skin, but also on the mucous membranes; both internal organs and the nervous system are affected.
We have already emphasized the appearance of severe headaches, which indicate participation in the process of the central nervous system, resp. meninges.

From the group of malignant syphilis, galloping syphilis is distinguished, characterized by the early onset of tertiary manifestations of syphilis with a short secondary period or even its absence. At the same time, syphilis, which usually occurs in the form of a chronic infection, takes on the character of an acute course, syphilis that have barely appeared are already prone to decay. In addition, galloping syphilis is characterized by a heap of relapses following one after another.
The term "crippling syphilis" is also used, indicating the significant disfiguring destruction that is caused by a syphilitic infection. This is usually noted with lesions of syphilis of the tertiary period in those patients who have been left without treatment for a long time with a weakened resistance of the body.

In addition, there is the term "syphilis gravis", when syphilides affect the vital organs of the patient and thereby create a threat to the very existence of the latter.
Neither crippling syphilis nor syphilis gravis are in any way connected with the concept of malignant syphilis and have nothing to do with it.
Serological reactions in malignant syphilis may be negative. In the process of crotivosyphilitic treatment, with an improvement in the general condition of the body, seroreactions from negative can turn into positive ones.
It should be mentioned that in the manifestations of malignant syphilis it is difficult to detect a pale spirochete.

We will dwell on the causes that cause the appearance of malignant syphilis in a patient in more detail in the chapter in which we will analyze the course and prognosis of syphilis. Timely initiated antisyphilitic treatment has an extremely favorable effect on the disappearance of syphilides of malignant syphilis; in such patients, who are under observation for a long time, as a rule, no particularly severe deviations in the course of syphilis are found.

Kartamyshev A.I. Skin and venereal diseases

What is syphilis? Chronic infectious pathology that develops when pale treponema enters the body. The disease progresses rapidly, affects all systems and organs, is accompanied by various complications.

Syphilis is transmitted by entry into the body of pale treponema

Classification of syphilis

Syphilis (Lues) is a sexually transmitted disease, the symptoms of which appear intermittently, which often makes diagnosis difficult. To classify the disease, various criteria are used - the duration of infection, the degree of damage to internal organs.

How is syphilis classified?

1. According to the period of infection- incubation, primary, secondary, tertiary.
2. According to the duration of the course of the disease. Early latent syphilis - infection occurred less than 2 years ago, the nervous system was not affected. Late latent syphilis - more than 2 years have passed since the infection, pathogenic bacteria are present in the cerebrospinal fluid. Unspecified - the time of infection could not be determined.
3. On the way to infection- an early and late form of a congenital disease, sexual, domestic, transfusion, headless acquired syphilis.
4. Neurosyphilis- pale treponema affects the vessels and membranes of the brain, then the tissues of the organ.
5. Visceral syphilis- divide the disease depending on which organs are destroyed.

The main feature of syphilis is an undulating course. In the active form, the clinical picture is pronounced. The latent form of the disease is the remission phase, there are no signs of infection, the pathogen can only be detected using laboratory tests.

Incubatory syphilis

The incubation period lasts an average of 3-4 weeks, with strong immunity it can be extended up to 3 months, in people with a weakened body it is reduced to 9-11 days.

After infection, there are no clinical manifestations, after the end of the initial period, characteristic ulcers and erosion appear at the site of penetration of pathogenic bacteria - a hard chancre, most often in the genital area, as it looks, can be seen in the photo.

The appearance of hard chancres on the skin is the first sign of syphilis in the incubation period

Primary Period

Duration - 6-7 weeks. The first signs - a red spot appears, which gradually thickens. A distinctive feature is that the rashes have the correct shape in the form of a circle or oval, they resemble raw meat in color, the surface is polished, since little serous fluid is released.

Hard chancres can occur anywhere, but most often they are found on the genitals, in the mouth, mammary glands, and in the rectal area. The amount of erosion can reach the size of a ten-kopeck coin, usually there are no more than 5 of them. After 4-8 weeks, they disappear on their own, even without drug therapy, a slight scar may remain - this does not mean that the disease has passed into a latent form, while the bacteria continue to actively multiply.

Types of hard chancre:

1. Chancre panaritium- is formed on the phalanx of the finger, accompanied by swelling, redness, the ulcer has an uneven edge, a dirty-gray plaque accumulates in it, with a neglected form, the nail is rejected.
2. Chancre-amygdalite- is formed on one of the tonsils, the affected tonsil swells, turns red, thickens, pain occurs when swallowing, a headache in the back of the head.
3. Mixed chancre- the result of simultaneous infection with syphilis and chancre, the disease can develop within 3-4 months.

In the secondary stage of the disease, pink syphilitic papules appear on the palms.

Six months later, the signs of the disease, spotted syphilides disappear. In this form, the disease can persist until the end of life in 50–70% of patients, in other people it passes into tertiary syphilis. Secondary syphilis is fresh and recurrent.

Tertiary syphilis

A slowly progressive inflammatory process that occurs after 5–10 years of illness. Pathology affects almost all internal organs, which causes death.

Signs:

• severe cardiovascular disease, stroke, complete or partial paralysis;
• large single nodes (gummas) gradually turn into long-term non-healing ulcers, after which specific scars remain in the form of asterisks;
• small group rashes on the lower leg, shoulder blades, shoulders.

Specific scars that remain in place of large single nodes

In tertiary syphilis, ulcers are deep, often destroy bone tissue, form an opening between the nasal and oral cavity, which manifests itself in the form of a nasal voice.

Visceral syphilis

Syphilitic visceropathy- damage to the internal organs of pale treponema, develops with a secondary and tertiary form of syphilis, is diagnosed in every 5 patients.

A separate form of the disease is malignant syphilis, the disease develops quickly, is difficult, it is diagnosed in people with weakened immunity, HIV-infected people, diabetics, in the presence of autoimmune pathologies.

Causes of the disease

The causative agent of syphilis is treponema pallidum, mobile spiral bacterium, anaerobe, no nucleus, DNA without chromosomes. The pathogenic microorganism stains poorly under the influence of dyes, which are used in the diagnosis of sexually transmitted diseases.

Ways of infection:

1. Sexual- the main route of infection, the cause of the disease is sexual intercourse with the carrier of the infection, you can also get infected through a kiss, if there are wounds in the mouth, bacteria can also be present in saliva.
2. intrauterine- Congenital syphilis is considered the most dangerous form of the disease, causing the formation of various pathologies. An early type of the disease is diagnosed in a child under 2 years old, a late one - in children over 3 years old.
3. Vertical- transmitted through milk to the child during lactation.
4. Household way- upon contact with a person on whose body there are open syphilitic rashes.
5. Transfusion- Infection occurred through an accidental transfusion of infected blood.
6. Headless- bacteria enter the bloodstream through cuts, syringe needles.

Syphilis can be contracted through a transfusion of infected blood.

With transfusion and decapitated syphilis, pathogenic microorganisms penetrate directly into the blood, so a hard chancre does not occur, signs of a secondary form of the disease immediately appear.

Which doctor should I contact?

When signs of syphilis appear, a venereologist is necessary. After examination and identification of specific symptoms, it may be required,. Some clinics have a syphilidologist - a specialist in syphilis.

It is possible to completely get rid of syphilis only in the early stages of the development of the disease, when the pathological processes in the internal organs are still reversible, at the last stage the disease cannot be treated, ends in death.

Diagnostics

Syphilis has a number of characteristic features that allow you to make a preliminary diagnosis after the initial examination, the main criteria are the nature and location of the rashes.

Types of skin manifestations and rash with syphilis:

• roseolous syphilides- rounded pink spots appear on the legs, arms, in the area of ​​\u200b\u200bthe ribs, on the mucous membranes, noticeably turn pale when pressed;
• papular syphilides- small nodules, dense, with a clear border;
• pigmented syphilis- appears six months after infection, a rash of dark color;
• acne syphilides- conical small pustules, covered with crusts, do not disappear for a long time;
• impetiginous syphilis- dry out quickly
• smallpox syphilis- spherical small dense rashes;
• syphilitic ecthyma- a sign of late syphilis, a deep and large pustule, covered with a thick crust, after which purple-blue ulcers, a scar remain on the skin;
• syphilitic rupee- solitary rashes, prone to scarring;
• pustular syphilides- acne-like syphilitic rash with purulent contents;
• syphilitic alopecia- the appearance of small bald spots on the head;
• syphilitic leukoderma- white spots, located on the neck, chest, lower back.

Other external manifestations are an increase in lymph nodes, an increase in temperature, a decrease in pressure, muscle pain, headache, and heart rhythm disturbance.

Laboratory tests

After the examination, the doctor gives directions for tests that can confirm the diagnosis, show the degree of the disease, the presence of damage to internal organs. For laboratory studies, samples are taken from rashes on the skin and mucous membranes of the genital organs, in the anus, in the mouth, puncture of the lymph nodes, cerebrospinal fluid.

Diagnostics:

• clinical analysis of urine and blood;
• dark field microscopy- use a special microscope, against a dark background, you can clearly see the treponema;
• direct fluorescence reaction- after processing the biomaterial with a special serum, pathogenic bacteria begin to glow;
• PCR- allows you to detect the presence of treponema DNA in the blood, cerebrospinal fluid;
• VDRL- shows the presence of antibodies, is highly reliable, only this reaction becomes negative after a complete cure, unlike other serological methods of research;
• Wassermann reaction- it can be positive, negative, doubtful, weakly positive, sharply positive;
• REEF- detects the presence of antibodies that the immune system produces after infection;
• RPGA- when plasma and specially prepared red blood cells are mixed, the blood becomes granular, even after a complete cure, the reaction remains positive for life.

Almost all methods for diagnosing syphilis are based on blood tests in various specific ways.

ELISA is one of the main methods for detecting various infectious pathologies, it allows you to determine the number of bacteria, to indicate the statute of limitations of infection. 14 days after infection, IgA antibodies are present in the blood, after 4 weeks the body produces immunoglobulins such as IgA, IgM. If IgG joins the two previous groups of antibodies, the disease is at its peak of exacerbation.

Why do false positive test results happen?

In the diagnosis of syphilis, several types of tests are always used, since false positive results often occur.

Main reasons:

• exacerbation of chronic infectious diseases;
• serious injury;
• heart attack;
• any vaccination a few days before testing;
• intoxication against the background of food poisoning;
• pathological processes in connective tissues;
• tuberculosis, HIV, hepatitis B, C;
• kidney disease;
• autoimmune diseases.

Often false-positive reactions to syphilis occur in pregnant women - this is due to the restructuring of the body at the hormonal and immune levels.

Is there a cure for syphilis?

Syphilis can only be treated with antibacterial drugs, all other means and methods are useless. In therapy, drugs are used mainly in the form of injections, the dosage and duration of the course depends on the severity of the disease.

How to treat:

• Bicillin-1 - injections are done every 24 hours;
• Bicillin-3 - administered intramuscularly in the morning and evening;
• Bicillin-5 - injections are shown 2-3 times a week;
• Tetracycline - twice a day;
• Ceftriaxone - once a day;
• Doxycycline - morning and evening;
• drugs in tablets - Rovamycin, Sumamed, Cefotaxime, Amoxicillin, you need to drink them every 8 hours.

In the treatment of syphilis, ceftriaxone injections are given daily.

If a woman has a history of even completely cured syphilis, she is advised to undergo prophylactic treatment during pregnancy in order to avoid infecting the child.

Consequences and complications of syphilis

In both sexes, the disease proceeds and is treated in the same way, but complications are sometimes different. Men sometimes develop phimosis, which develops against the background of the formation of a hard chancre in the foreskin. In women, a hard chancre can be in the vagina, cervix.

What is the danger of the disease - the consequences of the disease, depending on the stage of the syphilitic process:

1. Primary syphilis- an atypical hard chancre, located in a hard-to-reach, unusual place in the mouth, on the tonsils. Hard chancre can cause the development of balanitis, balanoposthitis, ulcerative necrotic processes.
2. Secondary syphilis- initial damage to the nervous system and internal organs, various types of rash.
3. Tertiary syphilis. With an advanced form of the disease, a lot of gum is formed on the outside and on the internal organs - bumps that can destroy bone and muscle tissue.

Pale treponemas are able to bypass the human immune system, when the body begins to fight pathogens on its own, the bacteria go into an armored form, which can last for several months.

Prevention

To avoid contracting syphilis, it is necessary to use condoms when engaging in any kind of sex, people who have an active sex life, often change partners, should be tested for STIs every six months.

The constant presence of an infected person nearby increases the risk of household transmission of the disease, in order to prevent this, it is necessary to exclude any bodily contact, provide the sick person with individual dishes, bedding, a bath and a toilet must be regularly treated with antiseptics and disinfectants.

After unprotected intercourse with a possible carrier of the infection, it is necessary to visit a venereologist within 48 hours, the doctor will select antibiotics for preventive treatment.

A condom reduces the likelihood of contracting syphilis, but infection cannot be completely ruled out - if there are erosions and ulcers on the body, they contain a lot of treponema.

Syphilis is a dangerous disease from which you can die, mainly sexually transmitted. Treatment is effective only in the early stages of the development of the disease, then irreversible processes begin to occur in tissues and internal organs.

Despite successful laboratory experiments on infecting animals, under natural conditions, animals are not susceptible to syphilis. Transmission of infection in a natural way is possible only from person to person. As a source of infection, patients pose the greatest danger in the first 2 years of the disease. After 2 years of infection, the contagiousness of patients decreases, infection of contact persons occurs less frequently. A necessary condition for infection is the presence of an entrance gate - damage (microtrauma) of the stratum corneum of the epidermis or the epithelium of the mucous membrane.

There are three ways of infection transmission: contact, transfusion and transplacental. The most common infection with syphilis occurs by contact.

contact way

Infection can occur through direct (direct) contact with a sick person: sexual and non-sexual (domestic).

The most common infection occurs through direct sexual contact. The direct non-sexual route of infection is rarely realized in practice (as a result of a kiss, a bite). In domestic conditions, young children are at particular risk of infection if their parents have active forms of syphilis. Be sure to carry out preventive treatment of children who were in close contact with patients with syphilis. Cases of direct professional infection of medical workers (dentists, surgeons, obstetrician-gynecologists, pathologists) when examining patients with syphilis, performing medical procedures, contact with internal organs during operations, autopsies are rare.

Infection can occur through indirect (mediated) contact - through any objects contaminated with biological material containing pathogenic treponema. Most often, infection occurs through objects that come into contact with the oral mucosa - glasses, spoons, toothbrushes.

The risk of household infection with syphilis is real for people who are in close household contact with the patient: family members, members of closed groups. Indirect infection in medical institutions through reusable medical instruments is excluded if it is properly processed.

A patient with syphilis is contagious during all periods of the disease, starting with incubation. The greatest danger is posed by patients with primary and especially secondary syphilis, who have weeping rashes on the skin and mucous membranes - erosive or ulcerative primary syphilomas, macerated, erosive, vegetative papules, especially when located on the oral mucosa, genitals, and also in skin folds.

Dry syphilides are less contagious. Treponema is not found in the content of papulo-pustular elements. The manifestations of tertiary syphilis are practically not contagious, since they contain only single treponemas located deep in the infiltrate.

The saliva of patients with syphilis is contagious in the presence of rashes on the oral mucosa. Breast milk, semen and vaginal secretions are contagious even in the absence of rashes in the mammary glands and genitals. The secret of the sweat glands, lacrimal fluid and urine of patients do not contain treponema.

In patients with early forms of syphilis, any non-specific lesions are contagious, leading to a violation of the integrity of the skin and mucous membranes: herpetic eruptions, erosion of the cervix.

Transfusion route

Transfusion syphilis develops during the transfusion of blood taken from a donor with syphilis, and in practice it is realized extremely rarely - only in the case of direct transfusion. Drug users are at real risk of infection by sharing intravenous syringes and needles. With the transfusion route of transmission, the pathogen immediately enters the bloodstream and internal organs, so syphilis manifests on average 2.5 months after infection with immediately generalized rashes on the skin and mucous membranes. At the same time, there are no clinical manifestations of the primary period of syphilis.

Transplacental route

In a pregnant woman with syphilis, intrauterine infection of the fetus can occur with the development of congenital syphilis. In this case, treponemas penetrate the placenta immediately into the bloodstream and internal organs of the fetus. With congenital infection, the formation of a chancre and other manifestations of the primary period are not observed. Transplacental infection usually occurs no earlier than the 16th week of pregnancy, after the completion of the formation of the placenta.

The following variants of the course of syphilitic infection have been established: classical (staged) and asymptomatic.

Syphilis is characterized by a staged, undulating course with alternating periods of manifestation and a latent state. Another feature of the course of syphilis is progression, i.e., a gradual change in the clinical and pathomorphological picture in the direction of increasingly unfavorable manifestations.

Periods

During syphilis, four periods are distinguished - incubation, primary, secondary and tertiary.

incubation period. This period begins from the moment of infection and continues until the appearance of primary syphiloma - an average of 30 - 32 days. It is possible to shorten and lengthen the incubation period compared to the indicated average duration. The shortening of incubation up to 9 days and its lengthening up to 6 months are described.

When entering the body, cells of the monocyte-macrophage system are already encountered in the area of ​​​​the entrance gate of treponema, however, the processes of recognition of a foreign agent by tissue macrophages, as well as the transmission of information by T-lymphocytes in syphilis, are impaired for several reasons: glycopeptides of the treponema cell wall are similar in structure and composition to glycopeptides human lymphocytes; treponemas secrete substances that slow down the recognition process; after introduction into the body, treponema quickly penetrate into the lymphatic capillaries, vessels and nodes, thereby avoiding the macrophage reaction; even being phagocytosed, treponema in most cases does not die, but becomes inaccessible to the body's defenses.

The early stages of syphilis are characterized by partial inhibition of cellular immunity, which contributes to the reproduction and spread of pathogens throughout the body.

Already 2-4 hours after infection, the pathogen begins to move along the lymphatic tract, invading the lymph nodes. From the moment of infection, treponema begins to spread by hematogenous and neurogenic routes, and on the first day the infection becomes generalized. Bacteria from this time are found in the blood, internal organs and the nervous system, but in the tissues of the diseased during this period there is still no morphological response to the introduction of pathogens.

The humoral link of immunity is not able to ensure the complete destruction and elimination of pale treponema. During the entire incubation period, pathogens actively multiply in the area of ​​the entrance gate, the lymphatic system and internal organs. At the end of incubation, the number of treponema in the body increases significantly, so patients during this period are contagious.

primary period. It begins with the onset of the primary affect and ends with the appearance of generalized rashes on the skin and mucous membranes. The average duration of primary syphilis is 6 to 8 weeks, but it can be reduced to 4 to 5 weeks and increased to 9 to 12 weeks.

A few days after the onset of the primary affect, an increase and thickening of the lymph nodes closest to it is observed. Regional lymphadenitis is an almost constant symptom of primary syphilis. At the end of the primary period, about 7-10 days before its end, there is an increase and thickening of the groups of lymph nodes, remote from the area of ​​the entrance gate of infection.

During the primary period of syphilis, there is an intense production of antitreponemal antibodies. First of all, their number in the bloodstream increases. Circulating antibodies immobilize treponemas, form membrane-attacking immune complexes, which leads to the destruction of pathogens and the release of lipopolysaccharide and protein products into the blood. Therefore, at the end of the primary - the beginning of the secondary period, some patients have a prodromal period: a complex of symptoms caused by intoxication of the body with substances released as a result of mass death of treponema in the bloodstream.

The level of antibodies in tissues gradually increases. When the amount of antibodies becomes sufficient to ensure the death of tissue treponemas, a local inflammatory reaction occurs, which is clinically manifested by widespread rashes on the skin and mucous membranes. Since that time, syphilis passes into the second stage.

Secondary period. This period begins from the moment the first generalized rash appears (on average, 2.5 months after infection) and lasts in most cases for 2 to 4 years.

The duration of the secondary period is individual and is determined by the characteristics of the patient's immune system. Relapses of secondary rashes can be observed 10-15 years or more after infection, while in debilitated patients the secondary period may be shortened.

In the secondary period, the wave-like course of syphilis is most pronounced, i.e., the alternation of manifest and latent periods of the disease. During the first wave of secondary rashes, the number of treponemas in the body is the largest - they multiplied in large numbers during the incubation and primary periods of the disease.

The intensity of humoral immunity at this time is also maximum, which leads to the formation of immune complexes, the development of inflammation and mass death of tissue treponemas. The death of some pathogens under the influence of antibodies is accompanied by a gradual cure of secondary syphilides within 1.5 - 2 months. The disease passes into a latent stage, the duration of which may be different, but on average it is 2.5 - 3 months.

The first relapse occurs approximately 6 months after infection. The immune system again responds to the next reproduction of pathogens by increasing the synthesis of antibodies, which leads to the cure of syphilides and the transition of the disease to a latent stage. The wavelike course of syphilis is due to the peculiarities of the relationship between pale treponema and the patient's immune system.

The further course of a syphilitic infection is characterized by a continuing increase in sensitization to treponema with a steady decrease in the number of pathogens in the body.

After an average of 2-4 years from the moment of infection, the tissue response to the pathogen begins to proceed according to the Arthus phenomenon, followed by the formation of a typical infectious granuloma - an infiltrate of lymphocytes, plasma, epithelioid and giant cells with necrosis in the center.

Tertiary period. This period develops in patients who received no treatment at all or were treated insufficiently, usually 2 to 4 years after infection.

The balance that exists between the pathogen and the controlling immune system during the latent course of syphilis can be disturbed under the influence of adverse factors - injuries (bruises, fractures), weakening the body of the disease, intoxication. These factors contribute to the activation (reversion) of spirochetes in any part of a particular organ.

In the later stages of syphilis, the reactions of cellular immunity begin to play a leading role in the pathogenesis of the disease. These processes proceed without a sufficiently pronounced humoral background, since the intensity of the humoral response decreases as the number of treponemas in the body decreases.

Malignant course of syphilis

Severe comorbidities (such as tuberculosis, HIV infection), chronic intoxication (alcoholism, drug addiction), malnutrition, heavy physical labor and other causes that weaken the patient's body affect the severity of syphilis, contributing to its malignant course. Malignant syphilis in each period has its own characteristics.

In the primary period, ulcerative chancres are observed, prone to necrosis (gangrenization) and peripheral growth (phagedenism), there is no reaction of the lymphatic system, the entire period can be shortened to 3-4 weeks.

In the secondary period, the rash is prone to ulceration, papulo-pustular syphilides are observed. The general condition of patients is disturbed, fever, symptoms of intoxication are expressed. Often there are manifest lesions of the nervous system and internal organs. Sometimes there is a continuous recurrence, without latent periods. Treponemas in the discharge of rashes are found with difficulty.

Tertiary syphilides in malignant syphilis may appear early: one year after infection (galloping course of the disease). Serological reactions in patients with malignant syphilis are often negative, but may become positive after the start of treatment.

Re-infection with syphilis

True, or sterile, immunity does not develop with syphilis. This means that a person who has been ill can become infected again, just like a person who has never had this disease before. Re-infection with syphilis of a person who had previously been ill and completely cured is called reinfection. The latter is regarded as convincing proof of the complete curability of syphilis.

With syphilis, the so-called non-sterile, or infectious, immunity develops in the patient's body. Its essence is that a new infection is impossible while pale treponemas remain in the body.

Primary Period

The following complex of clinical symptoms is characteristic of the primary period of syphilis: primary syphiloma, regional lymphadenitis, specific lymphadenitis, specific polyadenitis, prodromal phenomena.

Primary syphiloma is the first clinical manifestation of the disease that occurs at the site of the introduction of pale treponema through the skin and mucous membranes (in the area of ​​​​the entrance gate).

The appearance of an erosive or ulcerative defect is preceded by the appearance of a small hyperemic inflammatory spot, which turns into a papule after 2 to 3 days. These changes are asymptomatic and are not noticed by either the patient or the doctor. Soon after the appearance of the papule, the epidermis (epithelium) covering it undergoes decay, and erosion or an ulcer is formed - the actual primary syphiloma. The depth of the defect in this case depends on the severity and nature of the tissue reaction to the introduction of the pathogen.

Clinical features of a typical primary syphiloma.

1. Primary syphiloma is an erosion or superficial ulcer.

2. Primary syphilomas are single or single (2 - 3 elements).

3. Primary syphiloma has round or oval outlines.

4. Primary syphiloma usually has a size of 5 - 15 mm. There are also dwarf primary affects with a diameter of 1 - 3 mm. Giant chancres up to 4–5 cm in diameter or more are ulcerative, covered with serous-hemorrhagic or purulent-hemorrhagic crusts and have extragenital or perigenital localization.

5. Having reached a certain size, primary syphiloma does not tend to grow peripherally.

6. The boundaries of primary syphiloma are even, clear.

7. The surface of the primary syphiloma has a bright red color (the color of fresh meat), sometimes covered with a dense coating of grayish-yellow color (the color of spoiled fat).

8. The edges and bottom of erosive syphiloma lie on the same level. The edges and bottom of the ulcerative chancre are separated from each other by the depth of the defect.

9. The bottom of the primary syphiloma is smooth, covered with scanty transparent or opalescent discharge, giving it a kind of mirror or lacquer sheen.

10. At the base of the primary syphiloma, there is a dense elastic infiltrate, clearly delimited from the surrounding tissues and extending 2–3 mm beyond the syphiloma.

11. Primary syphiloma is not accompanied by subjective sensations. Soreness in the area of ​​primary affect appears when a secondary infection is attached.

12. There are no acute inflammatory skin changes around the primary syphiloma.

Localization of primary syphilomas: primary syphilomas can be located on any part of the skin and mucous membranes where the conditions for the introduction of treponemas have developed, i.e., in the area of ​​​​the entrance gate of infection. By localization, primary syphilomas are divided into genital, perigenital, extragenital and bipolar.

Atypical primary syphilomas. In addition to primary affects with a typical clinical picture and its many varieties, atypical chancres can be observed that do not have the characteristic signs inherent in typical syphilomas. These include indurative edema, chancre-felon, chancre-amygdalite. Atypical forms of syphilomas are rare, have a long course and often cause diagnostic errors.

Indurative edema is a persistent specific lymphangitis of small lymphatic vessels of the skin, accompanied by symptoms of lymphostasis.

It occurs in the genital area with a richly developed lymphatic network: in men, the foreskin and scrotum are affected, in women - large labia and very rarely - small lips, clitoris, lips of the cervical os.

Chancre panaritium is localized on the distal phalanx of the finger and has a great resemblance to the banal panaritium. It is characterized by the formation of an ulcer on the dorsum of the terminal phalanx of the finger. Deep - down to the bone - an ulcer with uneven, tortuous and undermined edges, lunate or horseshoe-shaped. The bottom of the ulcer is pitted, covered with purulent-necrotic masses, crusts, there is abundant purulent or purulent-hemorrhagic discharge with an unpleasant odor.

Chancre-amygdalitis is a specific unilateral increase and significant compaction of the tonsil without a defect on its surface. The tonsil has a stagnant red color, but is not accompanied by diffuse hyperemia.

There are the following complications of primary syphiloma:

1) impetiginization. A hyperemic corolla appears along the periphery of the syphiloma, the tissues acquire pronounced puffiness, the brightness of the element increases, the discharge becomes abundant, serous-purulent or purulent, there is a burning sensation, soreness in the area of ​​syphiloma and regional lymph nodes;

2) balanitis and balanoposthitis - in men, vulvitis and vulvovaginitis - in women. High humidity, constant temperature, the presence of a nutrient medium in the form of smegma in the preputial sac contribute to the reproduction of microorganisms and the development of clinical manifestations of balanitis - inflammation of the skin of the glans penis. In women, secondary infection contributes to vulvovaginitis;

3) phimosis. In men who have not undergone circumcision, the inflammatory process of the skin of the preputial sac due to the developed lymphatic network often leads to phimosis - narrowing of the foreskin ring. Inflammatory phimosis is characterized by a bright diffuse hyperemia, mild swelling and an increase in the volume of the foreskin, as a result of which the penis acquires a cone-shaped shape, becomes painful;

4) paraphimosis, which is an infringement of the glans penis by a narrowed ring of the foreskin, drawn to the coronal sulcus. Occurs as a result of forced exposure of the head during phimosis. This leads to a violation of the blood and lymph flow, aggravation of the edema of the preputial ring and severe pain in the penis;

5) gangrenization. Syphiloma undergoes necrotic decay, which is clinically expressed by the formation of a scab of a dirty gray, brown or black color, tightly soldered to the underlying tissues and painless;

6) phagedenism, which begins with the appearance of a larger or smaller area of ​​necrosis against the background of an ulcer. But the necrotic process is not limited to the chancre and extends not only in depth, but also beyond the syphiloma.

Regional lymphadenitis. It is an enlargement of the lymph nodes that drain the site of primary syphiloma. This is the second clinical manifestation of primary syphilis.

specific lymphangitis. It is an inflammation of the lymphatic vessel from a hard chancre to regional lymph nodes. This is the third component of the clinical picture of primary syphilis.

Specific polyadenitis. At the end of the primary period of syphilis, patients develop a specific polyadenitis - an increase in several groups of subcutaneous lymph nodes, remote from the area of ​​​​the entrance gate of infection.

prodromal syndrome. Approximately 7-10 days before the end of the primary period and during the first 5-7 days of the secondary period, general symptoms are noted, due to intoxication as a result of the massive presence of treponema in the bloodstream. It includes fatigue, weakness, insomnia, decreased appetite and performance, headache, dizziness, abnormal fever, myalgia, leukocytosis, and anemia.

Secondary period

The secondary period of syphilis is characterized by a complex of such clinical manifestations as spotted syphilis (syphilitic roseola), papular syphilis, papulo-pustular syphilis, syphilitic alopecia (baldness), syphilitic leucoderma (pigmented syphilis).

Spotted syphilide, or syphilitic roseola. This is the most frequent and earliest manifestation of the secondary period of the disease. Roseolous rash appears gradually, jerkily, 10-12 elements per day. The rash reaches full development in 8-10 days, exists on average for 3-4 weeks without treatment, sometimes less or more (up to 1.5-2 months). Roseolous rash resolves without a trace.

Syphilitic roseola is a hyperemic inflammatory spot. The color of roseola varies from pale pink to deep pink, sometimes with a bluish tint. Most often it has a pale pink, faded color. Long-standing roseola acquires a yellowish-brown hue. The size of the spots ranges from 2 to 25 mm, with an average of 5 to 10 mm. The outlines of roseola are rounded or oval, the borders are indistinct. The spots do not have peripheral growth, do not merge, are not accompanied by subjective sensations. Peeling is absent.

Roseolous rash is localized mainly on the lateral surfaces of the trunk, chest, in the upper abdomen. Rashes can also be observed on the skin of the upper thighs and flexor surface of the forearms, rarely on the face.

In addition to the typical roseolous syphilis, its atypical varieties are distinguished: elevating, confluent, follicular and scaly roseola.

Elevating (towering) roseola, urticarial roseola, exudative roseola. In this form, the spots appear to rise slightly above the level of the skin and become similar to an urticarial rash with urticaria.

Drain roseola. It occurs with a very abundant rash of spots, which, due to the abundance, merge with each other and form continuous erythematous areas.

Follicular roseola. This variety is a transitional element between roseola and papule. Against the background of a pink spot, there are small follicular nodules in the form of dotted granularity of copper-red color.

Flaky roseola. This atypical variety is characterized by the appearance of lamellar scales on the surface of the spotty elements, resembling crumpled tissue paper. The center of the element appears somewhat sunken.

Papular syphilis. Occurs in patients with secondary recurrent syphilis. Papular syphilis also occurs in secondary fresh syphilis, in which case papules usually appear 1 to 2 weeks after the onset of a roseolous rash and are combined with it (maculopapular syphilis). Papular syphilides appear on the skin jerky, reaching full development in 10-14 days, after which they exist for 4-8 weeks.

The primary morphological element of papular syphilis is a dermal papule, sharply delimited from the surrounding skin, regularly rounded or oval in shape. In shape, it can be hemispherical with a truncated top or pointed. The color of the element is initially pink-red, later becoming yellowish-red or bluish-red. The consistency of the papules is densely elastic. Elements are located in isolation, only when localized in folds and irritation, there is a tendency for their peripheral growth and merging.

There are no subjective sensations, but when pressing on the center of a newly appeared papule with a blunt probe, pain is noted.

Depending on the size of the papules, four types of papular syphilis are distinguished.

Lenticular papular syphilis. This is the most common variety, which is characterized by a rash of papules with a diameter of 3–5 mm, observed both in secondary fresh and in recurrent syphilis.

Miliary papular syphilis. This variety is extremely rare, its appearance is considered evidence of a severe course of the disease.

The morphological element is a cone-shaped papule of a dense consistency with a diameter of 1–2 mm, located around the mouth of the hair follicle. The color of the elements is pale pink, as a result of which they hardly stand out against the surrounding background.

Nummular papular syphilis. This manifestation of the disease occurs mainly in patients with secondary recurrent syphilis. Rashes appear in small numbers, usually grouped. The morphological element is a hemispherical papule with a flattened apex, 2–2.5 cm in diameter. The color of the elements is brownish or bluish-red, the outlines are rounded. With the resorption of nummular papules, pronounced skin pigmentation persists for a long time.

Plaque papular syphilis. It occurs very rarely in patients with secondary recurrent syphilis. It is formed as a result of peripheral growth and fusion of nummular and lenticular papules that are exposed to external irritation. Most often, plaque-like syphilis is formed in the area of ​​​​large folds - on the genitals, around the anus, in the inguinal-femoral fold, under the mammary glands, in the armpits.

Papulo-pustular syphilis. It is observed in debilitated patients suffering from alcoholism, drug addiction, severe concomitant diseases, and indicates a severe, malignant course of syphilis.

The following clinical varieties of papulopustular syphilis are distinguished: acneiform (or acneiform), smallpox (or varioliform), impetigo-like, syphilitic ecthyma, syphilitic rupee. Superficial forms of papulo-pustular syphilis - acne-like, pock-like and impetigo-like - are most often observed in patients with secondary fresh syphilis, and deep forms - syphilitic ecthyma and rupee - are observed mainly in secondary recurrent syphilis and serve as a sign of a malignant course of the disease. All varieties of pustular syphilides have an important feature: they have a specific infiltrate at their base. Pustular syphilides arise as a result of the collapse of papular infiltrates, so it is more correct to call them papulo-pustular.

Syphilitic alopecia. There are three clinical varieties of alopecia: diffuse, small-focal and mixed, which is a combination of small-focal and diffuse varieties of alopecia.

Diffuse syphilitic alopecia is characterized by an acute general thinning of the hair in the absence of any skin changes. Hair loss usually starts at the temples and spreads to the entire scalp. In some cases, other areas of the hairline are also subject to baldness - the areas of the beard and mustache, eyebrows, eyelashes. The hair itself also changes: it becomes thin, dry, dull. The severity of diffuse alopecia varies from barely noticeable hair loss, slightly exceeding the size of the physiological change, to complete loss of all hair, including vellus.

Small-focal syphilitic alopecia is characterized by a sudden, rapidly progressive appearance on the scalp, especially in the temples and occiput, of many randomly scattered small foci of hair thinning with a diameter of 0.5 - 1 cm. Hair in the lesions does not fall out completely, only a sharp thinning occurs.

Syphilitic leukoderma, or pigmented syphilide. This is a kind of skin dyschromia of unknown origin, which occurs in patients with secondary, mostly recurrent, syphilis. A typical localization of leukoderma is the skin of the back and sides of the neck, less often the anterior wall of the armpits, the area of ​​the shoulder joints, the upper chest, and the back. On the affected areas, diffuse yellowish-brown hyperpigmentation of the skin first appears. After 2 - 3 weeks, whitish hypopigmented spots with a diameter of 0.5 to 2 cm, rounded or oval outlines appear on a hyperpigmented background. All spots are approximately the same size, located in isolation, not prone to peripheral growth and merging.

There are three clinical varieties of pigmented syphilis: spotted, mesh (lace) and marbled. In spotted leukoderma, the hypopigmented spots are separated from each other by wide layers of hyperpigmented skin, and there is a pronounced difference in color between hyper- and hypopigmented areas. With a mesh form, hypopigmented spots are in close contact with each other, but do not merge, remaining separated by thin layers of hyperpigmented skin. At the same time, narrow areas of hyperpigmentation form a grid.

In leukoderma marble, the contrast between hyper- and hypopigmented areas is negligible, the boundaries between the white patches are indistinct, and the overall impression is of dirty skin.

Damage to the nervous system. Neurosyphilis is usually divided into early and late forms, depending on the nature of the pathomorphological changes observed in the nervous tissue. Early neurosyphilis is a predominantly mesenchymal process affecting the meninges and vessels of the brain and spinal cord.

It usually develops in the first 5 years after infection. Early neurosyphilis is characterized by the predominance of exudative-inflammatory and proliferative processes.

Damage to internal organs. Syphilitic lesions of internal organs in early syphilis are inflammatory in nature and are similar in morphological pattern to changes occurring in the skin.

Damage to the musculoskeletal system. Lesions of the skeletal system, mainly in the form of ossalgia, less often - periostitis and osteoperiostitis, are localized mainly in the long tubular bones of the lower extremities, less often - in the bones of the skull and chest.

Tertiary period

Damage to the skin and mucous membranes in tertiary active syphilis is manifested by tuberculous and gummy rashes.

Tubercular syphilide. It can be located on any part of the skin and mucous membranes, but the typical places of its localization are the extensor surface of the upper limbs, torso, face. The lesion occupies a small area of ​​the skin, is located asymmetrically.

The main morphological element of the tubercular syphilis is the tubercle (dense, hemispherical, cavityless formation of a rounded shape, densely elastic consistency). The tubercle is formed in the thickness of the dermis, sharply demarcated from apparently healthy skin, has a size of 1 mm to 1.5 cm. The color of the tubercles is first dark red or yellowish-red, then becomes bluish-red or brownish. The surface of the elements is at first smooth, shiny, later fine-lamellar peeling appears on it, and in case of ulceration - crusts. There are no subjective sensations. Fresh elements appear along the periphery of the focus.

The following clinical varieties of tubercular syphilis are distinguished: grouped, serping (creeping), tubercular syphilis with a platform, dwarf.

The grouped tubercular syphilide is the most common variety. The number of tubercles usually does not exceed 30 - 40. The tubercles are at different stages of evolution, some of them have just appeared, others have ulcerated and crusted, others have already healed, leaving scars or cicatricial atrophy.

Due to the unequal growth of the tubercles and the different depths of their occurrence in the dermis, individual small scars differ in color and relief.

Serping tubercular syphilis. The lesion spreads over the surface of the skin either eccentrically or in one direction, when fresh bumps appear at one pole of the lesion.

In this case, the individual elements merge with each other into a dark red horseshoe-shaped roller raised above the level of the surrounding skin with a width of 2 mm to 1 cm, along the edge of which fresh tubercles appear.

Tubercular syphilis platform. Separate tubercles are not visible, they merge into plaques 5–10 cm in size, of bizarre outlines, sharply demarcated from unaffected skin and towering above it.

The plaque has a dense texture, brownish or dark purple color. The regression of the tubercular syphilis with a platform occurs either dry, with the subsequent formation of cicatricial atrophy, or through ulceration with the formation of characteristic scars.

Dwarf tubercular syphilide. Rarely observed. It has a small size of 1 - 2 mm. The tubercles are located on the skin in separate groups and resemble lenticular papules.

Gummous syphilide, or subcutaneous gumma. This is a node that develops in the hypodermis. The characteristic places of localization of gums are the shins, head, forearms, sternum. There are the following clinical varieties of gummy syphilis: isolated gums, diffuse gummous infiltrations, fibrous gums.

Isolated gumma. Appears as a painless node 5-10 mm in size, spherical in shape, densely elastic consistency, not soldered to the skin. Gradually increasing, the subcutaneous gumma is soldered to the surrounding tissue and skin and protrudes above it in the form of a hemisphere.

The skin above the gumma becomes first pale pink, then brownish-red, crimson. Then a fluctuation appears in the center of the gumma, and the gumma opens up. At autopsy, 1-2 drops of a sticky, yellow liquid with crumbly inclusions are released from the gummy node.

Hummous infiltrations. They arise independently or as a result of the merger of several gums. The gummous infiltrate disintegrates, the ulcerations merge, forming an extensive ulcerative surface with irregular large-scalloped outlines, healing with a scar.

Fibrous gums, or periarticular nodules, are formed as a result of fibrous degeneration of syphilitic gums. Fibrous gummas are localized mainly in the area of ​​the extensor surface of large joints in the form of formations of a spherical shape, very dense consistency, ranging in size from 1 to 8 cm. They are painless, mobile, the skin above them is not changed or slightly pinkish.

Late neurosyphilis. It is a predominantly ectodermal process affecting the nervous parenchyma of the brain and spinal cord. It usually develops after 5 years or more from the moment of infection. In late forms of neurosyphilis, degenerative-dystrophic processes predominate. The actual late forms of neurosyphilis include: dorsal tabes - the process of destruction of the nervous tissue and its replacement with connective tissue, localized in the posterior roots, posterior columns and membranes of the spinal cord; progressive paralysis - degenerative-dystrophic changes in the cerebral cortex in the frontal lobes; taboparalysis - a combination of symptoms of dorsal tabes and progressive paralysis. In the tertiary period, lesions of the meninges and blood vessels can still be observed.

Late visceral syphilis. In the tertiary period of syphilis, limited gummas or diffuse gummous infiltrations can occur in any internal organ, and various dystrophic processes can also be observed. The morphological basis of lesions in late visceral syphilis is an infectious granuloma.

Damage to the musculoskeletal system. In the tertiary period, the musculoskeletal system may be involved in the process.

The main forms of bone damage in syphilis.

1. Hummous osteoperiostitis (lesion of spongy bone):

1) limited;

2) diffuse.

2. Hummous osteomyelitis (damage to spongy bone and bone marrow):

1) limited;

2) diffuse.

3. Non-gummous osteoperiostitis.

Most often, the tibia is affected, less often the bones of the forearm, collarbone, sternum, skull bones, and vertebrae. Damage to muscles in the form of gummous myositis and joints in the form of acute or chronic synovitis or osteoarthritis in the tertiary period are rare.

Latent syphilis is diagnosed on the basis of positive results of serological reactions in the absence of active manifestations of the disease on the skin and mucous membranes, signs of a specific lesion of the nervous system, internal organs, and the musculoskeletal system.

Latent syphilis is divided into early (with a disease duration of up to 1 year), late (more than 1 year) and unspecified, or unknown (it is not possible to determine the timing of infection). This time division is due to the degree of epidemiological danger of patients.

Congenital syphilis occurs as a result of infection of the fetus during pregnancy by the transplacental route from a mother with syphilis. A pregnant woman with syphilis can pass pale treponema through the placenta, starting from the 10th week of pregnancy, but usually intrauterine infection of the fetus occurs at the 4th to 5th month of pregnancy.

Congenital syphilis is most often observed in children born to sick women who have not been treated or received inadequate treatment. The likelihood of congenital syphilis depends on the duration of the infection in a pregnant woman: the fresher and more active the syphilis in the mother, the more likely the unfavorable ending of pregnancy for the unborn child. The fate of a fetus infected with syphilis may be different. Pregnancy may end in stillbirth or live birth with disease manifestations occurring immediately after delivery or somewhat later. It is possible to give birth to children without clinical symptoms, but with positive serological reactions, who subsequently develop late manifestations of congenital syphilis. Mothers who have had syphilis for more than 2 years can give birth to a healthy baby.

Syphilis of the placenta

With syphilis, the placenta is hypertrophied, the ratio of its mass to the mass of the fetus is 1: 4 - 1: 3 (normally 1: 6 - 1: 5), the consistency is dense, the surface is bumpy, the tissue is fragile, flabby, easily torn, the color is variegated. It is difficult to find treponemas in the tissue of the placenta, therefore, to detect the pathogen, material is taken from the umbilical cord, where treponemas are always found and in large numbers.

Fetal syphilis

The changes that have occurred in the placenta make it functionally defective, unable to provide normal growth, nutrition and metabolism of the fetus, resulting in its intrauterine death at the 6-7th month of pregnancy. The dead fetus is pushed out on the 3rd - 4th day, usually in a macerated state. A macerated fruit, compared to a normally developing fetus of the same age, has a significantly smaller size and weight. The skin of stillborns is bright red, folded, the epidermis is loosened and easily slides off in extensive layers.

Due to the massive penetration of pale treponema, all internal organs and the skeletal system of the fetus are affected. A huge number of treponema found in the liver, spleen, pancreas, adrenal glands.

Early congenital syphilis

If a fetus affected by a syphilitic infection does not die in utero, then the newborn may develop the next stage of congenital syphilis - early congenital syphilis. Its manifestations are found either immediately after birth, or during the first 3-4 months of life. In most cases, newborns with severe manifestations of early congenital syphilis are not viable and die in the first hours or days after birth due to functional inferiority of internal organs and general exhaustion.

Clinical signs of early congenital syphilis are detected on the part of the skin, mucous membranes, internal organs, musculoskeletal system, nervous system, and generally correspond to the period of acquired syphilis.

The appearance of a newborn with early congenital syphilis is almost pathognomonic. The child is poorly developed, has a small body weight, the skin due to the lack of subcutaneous tissue is flabby, folded. The face of the infant is wrinkled (senile), the skin is pale earthy or yellowish, especially on the cheeks. Due to hydrocephalus and due to premature ossification of the bones of the skull, the size of the head is sharply increased, the fontanel is tense, and the skin veins of the head are dilated. The child's behavior is restless, he often screams, develops poorly.

Lesions of the skin and mucous membranes can be represented by all varieties of secondary syphilides and special symptoms characteristic only of early congenital syphilis: syphilitic pemphigoid, diffuse skin infiltrations, syphilitic rhinitis.

Massive bone stratification on the anterior surface of the tibia as a result of repeatedly recurring osteoperiostitis ending in ossification leads to the formation of a falciform protrusion and the formation of false saber tibiae. Periostitis and osteoperiostitis of the skull bones can lead to various changes in its shape. The most typical are the buttock-shaped skull and the Olympian forehead.

In patients with early congenital syphilis, various forms of damage to the nervous system can be observed: hydrocephalus, specific meningitis, specific meningoencephalitis, cerebral meningovascular syphilis.

The most typical form of damage to the organ of vision is damage to the retina and choroid - specific chorioretinitis. With ophthalmoscopy, mainly along the periphery of the fundus, small light or yellowish spots are found, alternating with dotted pigment inclusions. The visual acuity of the child does not suffer.

Late congenital syphilis

This form occurs in patients who previously had signs of early congenital syphilis, or in children with a long asymptomatic course of congenital syphilis. Late congenital syphilis refers to symptoms that appear 2 years or more after birth. Most often they develop between 7 and 14 years, after 30 years they rarely occur.

The clinical picture of active late congenital syphilis is generally similar to acquired tertiary syphilis: tuberculous and gummous syphilides, lesions of the nervous system, internal organs, and the musculoskeletal system, as in tertiary syphilis, can be observed. But along with this, with late congenital syphilis, there are special clinical signs that are divided into reliable, probable and dystrophies.

Reliable signs of late congenital syphilis, resulting from the direct impact of treponema on the child's organs and tissues, include parenchymal keratitis, specific labyrinthitis, and Hutchinson's teeth.

Probable signs of late congenital syphilis include Robinson-Fournier radial paraoral striae, true saber tibiae, saddle nose, buttock-shaped skull, syphilitic gonitis. Probable signs are taken into account in combination with reliable or in combination with data from a serological examination, anamnesis.

Dystrophies (stigmas) arise as a result of the indirect effect of the infection on the organs and tissues of the child and are manifested by their abnormal development. They acquire diagnostic value only when the patient simultaneously reveals reliable signs of late congenital syphilis, positive serological reactions. The most characteristic dystrophies are the following: a sign of Avsitidia - a thickening of the thoracic end of the clavicle, more often the right one; axiphoidia (Keira's symptom) - the absence of the xiphoid process of the sternum; Olympic forehead with very convex frontal tubercles; high (Gothic) hard palate; symptom of Dubois - Gissar, or infantile little finger, - shortening and curvature of the little finger inward due to hypoplasia of the fifth metacarpal bone; hypertrichosis of the forehead and temples.

The main diagnostic criteria:

1) clinical examination of the patient;

2) detection of pale treponema in the serous discharge of weeping syphilides of the skin and mucous membranes by examining the native drug crushed drop by dark-field microscopy;

3) results of serological reactions;

4) confrontation data (survey of sexual partners);

5) results of trial treatment. This diagnostic method is rarely used, only in late forms of syphilis, when other methods of confirming the diagnosis are not possible. With early forms of syphilis, trial treatment is unacceptable.

Early forms of syphilis are completely curable if the patient is given therapy that is adequate to the stage and clinical form of the disease. In the treatment of late forms of the disease, in most cases, clinical recovery or stabilization of the process is observed.

A specific treatment can only be given to a patient if the diagnosis of syphilis is clinically justified and confirmed in accordance with the criteria listed above. There are the following exceptions to this general rule:

1) preventive treatment, which is carried out in order to prevent the development of the disease to persons who have had sexual or close household contact with patients with early forms of syphilis, if no more than 2 months have passed since the contact;

2) prophylactic treatment prescribed for pregnant women who are ill or have had syphilis, but not taken off the register, in order to prevent congenital syphilis in a child, as well as children born to mothers who did not receive prophylactic treatment during pregnancy;

3) trial treatment. It can be prescribed for the purpose of additional diagnostics in case of suspected late specific damage to the internal organs, nervous system, sensory organs, musculoskeletal system in cases where it is not possible to confirm the diagnosis with laboratory tests, and the clinical picture does not allow to exclude the possibility of a syphilitic infection.

The drugs of choice for the treatment of syphilis are currently antibiotics of the penicillin group:

1) Durant (prolonged) preparations of penicillin - the group name of benzathine benzylpenicillin (retarpen, extencillin, bicillin-1), ensuring the stay of the antibiotic in the body up to 18 - 23 days;

2) drugs of medium duration (procaine-benzylpenicillin, novocaine salt of benzylpenicillin), which ensure the stay of the antibiotic in the body for up to 2 days;

3) preparations of water-soluble penicillin (benzylpenicillin sodium salt), ensuring the stay of the antibiotic in the body for 3-6 hours;

4) combined preparations of penicillin (bicillin-3, bicillin-5), which ensure the stay of the antibiotic in the body for 3-6 days.

The most effective preparations are water-soluble penicillin, the treatment of which is carried out in a hospital in the form of round-the-clock intramuscular injections or intravenous drip. The volume and duration of therapy depend on the duration of the syphilitic infection. Therapeutic concentration of penicillin in the blood is 0.03 IU / ml and above.

In case of intolerance to drugs of the penicillin group, treatment of patients with syphilis is carried out with reserve antibiotics that have a wide spectrum of action - semi-synthetic penicillins (ampicillin, oxacillin), doxycycline, tetracycline, ceftriaxone (rocefin), erythromycin.

Specific treatment for syphilis should be complete and vigorous. Medicines should be prescribed in strict accordance with the approved instructions for the treatment and prevention of syphilis - in sufficient single and course doses, observing the frequency of administration and the duration of the course.

At the end of treatment, all patients are subject to clinical and serological control. During follow-up, patients are subjected to a thorough clinical examination and serological examination every 3 to 6 months.