Atypical forms of syphilitic roseola. Secondary syphilis - symptoms and features of the course. Symptoms of syphilitic roseola

Syphilis is an infectious disease caused by the microorganism Treponema pallidum, or pale treponema. The pathogen enters the human body through damaged skin or mucous membranes. Transmission of the microorganism through the placenta and through blood transfusion is possible.

Skin manifestations of syphilis

Skin manifestations can be a sign of primary syphilis, when the microbe multiplies directly at the site of penetration. This forms a hard chancre.

When treponema spreads through the bloodstream, the body begins to fight the infection and produces antibodies. During the interaction of the microbe and the immune system, biologically active substances are released, leading to the development of manifestations of secondary syphilis. One of these signs is a syphilitic rash.

Tertiary, or late syphilis, occurs long after infection. It is accompanied by damage to the bones, nervous system and other organs. A rash with syphilis in the late period is one of the frequent manifestations of the disease.

Skin manifestations accompany the congenital form of the disease.

In each phase of the disease, rashes with syphilis have their own characteristics.

Primary syphilis

The first symptoms of a syphilitic rash appear at the end of the incubation period, which on average lasts from 2 weeks to 2 months. A defect with a diameter of 2 mm to 2 cm or more appears on the skin or mucous membrane. The primary lesion is called a "hard chancre" and looks like a rounded ulcer with even edges and a smooth bottom, often saucer-shaped.

The ulcer is painless, the discharge from it is insignificant. It is located on a compacted area - an infiltrate. It is very dense and resembles thick cardboard, cartilage, rubber to the touch.

Erosion is similar to an ulcer, but does not have well-defined edges. This is a superficial defect that can go unnoticed. A hard chancre or erosion is most often single, but several foci may form.

Small ulcers are more common in women and are located on mucous membranes. Giant chancres up to 5 cm in diameter are localized on the skin of the abdomen, inner thighs, perineum, chin, upper limbs (hands and forearms) and are recorded mainly in men.

A hard chancre can be located on the lips or on the tongue. In the latter case, a slit-like or stellate form of the defect occurs.

In the focus of damage, treponema intensively multiply, so the primary chancre can serve as a source of infection for other people. The ulcer persists for about 7 weeks, after which it heals with a scar.

congenital syphilis

With early congenital syphilis, which manifests itself soon after birth, typical secondary syphilides are often observed. However, this form of the disease is characterized by special skin manifestations.

Papular syphilide may be represented by skin infiltration. The skin thickens, reddens, swells, then peeling begins. This sign appears on the palms, soles, buttocks, as well as around the mouth and on the chin. The affected skin is damaged with the formation of diverging cracks. After their healing, scars remain for life. The nasal cavity and vocal cords are affected.

Syphilitic pemphigus is another typical manifestation of congenital syphilis. Bubbles with transparent contents, up to 2 cm in size, surrounded by a red rim, form on the skin. They usually appear on the palms and soles. Bubbles do not increase and do not merge. At the same time, the internal organs suffer, the general condition of the child worsens significantly.

syphilitic pemphigus

In the late period of the congenital form of the disease, gummous and tubercular formations (syphilides) typical of the Tertiary period are found.

Diagnosis and treatment

How to determine what caused skin changes? When rashes of unknown origin appear, you should consult a dermatologist. In many cases, the diagnosis becomes clear on examination.

To confirm the syphilitic cause of the disease, additional studies are carried out:

• detection of treponema in discharge from hard chancre or erosions;
• non-treponemal tests (microprecipitation reaction or rapid reaction with plasma);
• treponemal tests (immunofluorescence reaction, treponema immobilization reaction);
• enzyme immunoassay (passive hemagglutination reaction).

Laboratory diagnosis of syphilis is quite difficult. It is difficult to interpret the results on your own, so you need to consult a doctor.

Syphilitic roseola, like other skin rashes that appear with syphilis, is evidence that the disease has passed into the secondary stage. If we talk about specific terms, then such a rash appears a few weeks later (from 5 to 8) after the onset of symptoms of the primary form of the disease - hard chancre. If you are interested in what roseola syphilitic looks like, the photo will help you figure it out as accurately as possible, since there are a lot of diseases with similar symptoms.

Syphilitic roseola: symptoms

There are certain diseases, and syphilis of the secondary period is also among them, which are difficult to diagnose due to the fact that manifestations can be characteristic of not one, but several diseases at once. It is enough to study the photos of rashes in patients with such a diagnosis available on the Internet and compare them in the photo, for example, with allergy symptoms, as it becomes clear why many people are in no hurry to seek medical help: they are simply sure that there is nothing dangerous for them roseola does not carry health, and therefore it is not necessary to take measures at all. It is important to remember that roseola with syphilis is already a signal that time has been lost: if at the first stage the disease is completely cured without leaving consequences, then the second can turn into irreversible disorders, and at the third stage only stabilization of the condition is possible, but not cure.

If you carefully read the photo, but are still not sure that your rashes are associated with sexually transmitted diseases, pay attention to the following symptoms that accompany the rash:

• The outlines of the spots are unclear, the size is up to 1 cm;
• The surface of the rashes is smooth, but they themselves do not merge with each other;
• The lesions do not protrude above the level of the skin and do not increase in size (however, they do not decrease either);
• With mechanical pressure, the spots of the rash brighten, but very quickly restore their previous color;
• The rash is not accompanied by pain or itching;
• The most frequent localization, which can be traced by studying the photo, is the limbs, but it rarely appears on the face or hands.

In addition to the most common - typical syphilitic roseola, a scaly or elevating form of the disease can also be observed. The rashes themselves are not dangerous, but require urgent medical attention.

Secondary syphilis develops 6-7 weeks after the first symptoms of syphilis; if it has not been carried out, it lasts 2-4 years, it proceeds in waves: active manifestations are replaced by hidden ones, in connection with which they distinguish - secondary fresh syphilis, secondary recurrent and latent, latent.

In secondary syphilis, a generalization of a syphilitic infection occurs; at the same time, the blood and especially the rashes contain a large number of spirochetes, so the manifestations are very contagious (the contagiousness of erosive elements is especially high).

Secondary syphilis symptoms:

Clinically characterized by a predominant lesion of the skin and mucous membranes; to a lesser extent - changes in internal organs and the nervous system (sometimes at the subclinical level). Rashes of the secondary period are polymorphic in nature: spotted (spotted, roseolous syphilides), papular (papular syphilides); vesicles, pustules (pustular syphilides) are much less common.

There are no acute inflammatory changes in the rash area (the rash does not have a bright color; its color or shade is compared with copper, ham). Rashes have rounded outlines, do not merge; there is no trend towards peripheral growth. Elements can occur on any part of the skin and have a dense infiltrate at the base (with the exception of roseola).

Erosed papule

Characteristic is the absence of subjective sensations (soreness, itching, burning) in the area of ​​secondary syphilides. Changes in the secondary period are characterized by relative goodness - the rashes disappear even without treatment, leaving no trace (scars remain only after deep pustular syphilides), are not accompanied by an increase in body temperature and a significant violation of the general condition. The rash quickly regresses under the influence of antisyphilitic treatment.

Rashes of the secondary period are accompanied by positive CSR (R. Wasserman and sedimentary - in 98-100%).

Syphilitic roseola.

Syphilitic roseola (spotted syphilide) is one of the frequent manifestations of the secondary period. This is a soft, rounded spot of a pinkish-bluish color with fuzzy borders, without peeling. The spots do not merge, without a tendency to peripheral growth, there are no signs of acute inflammation, subjective sensations.

Roseola is localized more often on the lateral surfaces of the body; spontaneously disappear after a few days (less often - 2-3 weeks), without peeling, leaving no trace. In atypical cases, roseola is observed: with peeling, confluent, edematous (or urticarial), granular (follicular; sometimes visually and palpation is determined in the form of perifollicular seals - in debilitated persons with tuberculosis).

Syphilitic roseola may resemble the manifestations of toxicoderma, rashes with acute infections, insect bite spots, and "marble" skin. After the first injections of antibiotics (penicillin series), roseola becomes brighter - "ignites", can transform into atypical (as a manifestation of the Herxheimer-Lukashevich reaction; "endotoxic shock" - due to the release of endotoxins during the massive decay of spirochetes).

Papular syphilis.

Another characteristic manifestation of secondary syphilis are papular rashes. Traditionally, varieties of papular syphilides are described that differ in size (miliary, lenticular, nummular, wide condylomas), peeling features (seborrheic, psoriasiform), localization (palmo-plantar), type of grouping of elements (corimbiform), relief (frambesiform), etc.

With all the variety of descriptions, attention should be paid to the inherent ones: papules of regular shape, with a dense infiltrate, no tendency to peripheral growth, ham shade. Peeling along the periphery of the papules ("Biett's collar"), the absence of subjective sensations is characteristic. Papules can erode, turning into weeping syphilis (especially characteristic of wide condylomas - in folds); bright red papules without epithelium are often observed in the oral cavity. It should be noted that when syphilis is combined with some kind of dermatosis, a kind of “layering” of clinical symptoms is possible.

For example, we observed manifestations of secondary syphilis in a patient who suffered from psoriasis for a long time; his syphilides were psoriasiform, but with a bluish tinge; many papules had a mixed type of peeling - with silvery-white scales and the type of "Biett's collar"; against the background of specific treatment, there was a rapid regression of "psoriatic" elements. Sometimes isolated syphilitic papules appear on the soles, resembling manifestations of mycosis, resembling corns (we observed single papules in the interdigital folds of the feet).

Pustular syphilis.

Pustular syphilides are distinguished by a special “diagnostic insidiousness”, resembling manifestations of banal pyoderma and other infections (hence the names - impetiginous, acne), but having a bluish tint, high density (there may be a copper-red roller on the periphery, often - "Biett's collar") .

Syphilitic leukoderma.

Syphilitic leukoderma (“necklace of Venus”) - occurs more often 4-6 months after infection (refer to manifestations of secondary recurrent syphilis). It is localized more often on the back and side of the neck (however, it can also capture larger areas of the skin - the upper back, the area of ​​the shoulder joints). Depigmented spots appear on the affected areas, surrounded by a zone of hyperpigmentation. The spots have a rounded shape and in different patients - different sizes and quantities. Pigmented syphilis can last for a long time (many months); its manifestations are referred to as trophic disorders (a kind of neurodystrophic process).

In the study of cerebrospinal fluid in patients with leukoderma, changes were detected (pathology of neurocytes, etc.). It is believed that disorders of the autonomic and central nervous system play an important role in the development of leukoderma, and therefore, in the presence of the "necklace of Venus", attention should be paid to the neurological status; according to indications, involve a neuropathologist - with the appointment of neurotropic therapy and drugs that improve the penetration of antisyphilitic drugs into the cerebrospinal fluid (ethamide, prodigiosan, systemic polyenzymes, cavinton, sermion, cinnarizine, piracetam, etc.). In differential diagnosis, one should keep in mind secondary leukodermas (occur after regression of some skin rashes, for example, with multi-colored lichen).

Syphilitic alopecia.

Syphilitic alopecia - also appears more often in patients with secondary recurrent syphilis; manifests itself in forms: small-focal, diffuse and mixed. At the same time, bald spots appear (“moth-eaten fur”) or a general thinning of hair is observed; the skin is not changed. It is believed that hair falls out due to vasculitis, the formation of specific perivascular and perifollicular infiltrates, which leads to trophic disorders; at the same time, according to their severity, one can partially judge the degree of vascular discorrelations. Although this process is benign (hair grows back), rheologically active and trophic-improving drugs (nicotinic acid, complamin, etc.), vitamins C, rp.B, P, A, E should be additionally prescribed. Patients with syphilitic alopecia should refrain from walking in cold weather without a headdress, because this exacerbates trophic disorders and hair loss. The syphilitic nature of alopecia is established on the basis of other manifestations of syphilis, as well as positive serological reactions.

Of great practical importance are the distinctive signs of secondary fresh and recurrent periods of syphilis. With secondary fresh syphilis, residual manifestations of primary syphilis may be observed (ulcerative hard chancre, regional scleradenitis, polyadenitis); while there is no leukoderma and alopecia. In secondary recurrent syphilis, there are no manifestations of primary lues, the appearance of leukoderma and alopecia are characteristic of this period.

With secondary fresh syphilis, the rashes are abundant, widespread, scattered, small in size and brighter in color. In secondary recurrent syphilis, a small amount of rash is more often observed, a tendency to group it; while the elements are larger, their color is faded. However, the difficulty of differentiating fresh and recurrent syphilis is currently noted; at the same time, their clinical differences are “erased” - so the symptoms characteristic of recurrent syphilis can occur with fresh syphilis and vice versa (for example, a bright, profuse, medium-sized rash - with recurrent syphilis). Rashes with itching, burning, with monopalmar (or plantar) syphilis are more often recorded (in the absence of a rash in other places); sometimes papules have a "wafer" symptom similar to that of parapsoriasis. Among the "updated", "modern" features of secondary syphilis include an increase in the number of patients with lesions of the mucous membranes (erythematous-papular rashes, manifestations such as tonsillitis, etc.). With the difficulty of distinguishing between fresh and recurrent syphilis, the designation sometimes arises: “secondary fresh-recurrent syphilis” (treatment is prescribed in the “interests of the patient” - according to the schemes of the recurrent period).

Palmar syphilides
plantar syphilis

As noted, after rashes of secondary fresh syphilis, a latent period begins; after some time (varies in different patients) is replaced by new active manifestations, i.e. with the development of secondary recurrent syphilis. In this case, relapses of the secondary period can be for 2-4 years (alternate with latent manifestations). Secondary latent syphilis is characterized by the absence of clinical symptoms that would make it possible to suspect the presence of syphilis in a patient. However, blood tests show positive CSR.

We can once again note the social significance of secondary syphilis - in view of the long course of this period and the high contagiousness. In this regard, data for the diagnosis of secondary syphilis are of great practical importance:

1. Clinical manifestations: the appearance of rashes on the skin and mucous membranes (usually roseola, papules), without a bright inflammatory color and subjective sensations. The peculiarity of the morphology and location of the rash reflects the stage of the disease - multiple, bright, small rashes in combination with the remains of ulcerative chancre and polyadenitis indicate secondary fresh syphilis; with recurrent - a rash - a few, less bright, but larger, with a tendency to group; additional signs of recurrent lues are neurotrophic disorders (leukoderma, alopecia).
2. Visualization of a pale spirochete in the discharge of erosive syphilides (especially wide condylomas, elements in the oral cavity).
3. An important diagnostic criterion is the results of immunological tests (CSR, RIBT, RIFT). With secondary fresh syphilis, the CSR is positive in 100%, with secondary recurrent - 98%.
4. "Veneremic alertness" is necessary - even when examining patients who, it would seem, "cannot have syphilis", including those suffering from dermatoses; it is possible to avoid mistakes if the rule is followed - all patients with spotted, papular (“parapsoriasis”), pustular rashes (abundant or localized, especially of unclear origin) should definitely undergo a serological study, because if overlooked, the secondary period may go to.

Humanity learned about such a terrible and very dangerous disease as syphilis, which is caused by pale treponema, back in 1530. But even four centuries later, at the end of the 20th century, there was no disease in the world that would frighten with its consequences and external manifestations, more than syphilis. This disease belongs to the classic sexually transmitted diseases, although infection transmitted from mother to child or in the process of blood transfusion is not ruled out. True, household infection with this disease is extremely rare. This disease is characterized by a long, slowly progressive course, leading in the later stages to serious damage to the internal organs, as well as the nervous system.

Syphilis has three stages. At the first stage, at the site of penetration of the pathogen, on the mucous membrane of the mouth, in the rectum or on the genitals, ulcers appear with a dense solid base (chancre), which disappear on their own after 3-6 weeks. The second period begins about two months after the onset of the disease and is characterized by the appearance of a symmetrical pale rash all over the body, including the palms and soles of the feet. Syphilitic roseola, or spotted syphilis, is precisely the name of the form of skin lesions in secondary fresh syphilis. Tertiary syphilis, if left untreated, may appear several years after infection. In this case, the nervous system, spinal cord and brain, bones and internal organs, including the liver and heart, are affected. If the infection occurred during pregnancy, the child often has congenital syphilis.

Speaking of syphilitic roseola, it should be noted that these generalized rashes appear 2 months or 5-8 weeks after the onset of hard chancre. Roseola, in this case, is initially pink, and then somewhat pale with indistinct outlines of spots, 1 cm in diameter with a smooth surface, not merging with each other. These spots are not characterized by elevation above the skin and do not have peripheral growth. Roseola appears gradually, 10-15 spots daily, and reaches its full development on the 8-10th day. When pressed on it, roseola temporarily disappears or turns pale, and then appears again. Long-standing roseola becomes yellowish-brown.

This lesion of the skin is located randomly, asymmetrically, mainly on the limbs and torso, practically not appearing on the face, hands and feet. Syphilitic roseola is not accompanied by pain.

It should be noted that with secondary fresh syphilis, this manifestation on the skin occurs in a much smaller amount, usually localized in separate areas of the skin. Spots in this case are often grouped into rings, arcs and semi-arcs. The size of recurrent roseola is usually much larger than fresh roseola, and their color becomes cyanotic. In the treatment of secondary syphilis, after the first injections of penicillin, an exacerbation occurs, expressed in an increase in body temperature. Roseola in this regard is clearly manifested, becoming richly pink. In addition, it also appears in those places where it did not affect the skin before the start of treatment.

In addition to the typical roseola, there are also its varieties, such as scaly roseola, which is a lamellar scales, outwardly similar to crumpled papyrus paper, somewhat sunken in the very center, as well as an elevation or rising roseola, which rises above the skin level, resembling blisters and is not accompanied by this itch.

By itself, syphilitic roseola is not dangerous, but is a symptom of a terrible disease that cannot be ignored. Already at the first appearance of ulcers on the body, you should immediately consult a doctor who will diagnose and take measures to treat this disease, preventing damage to the bone and muscle system, damage to blood vessels, the spinal cord, and also the brain. It is important to immediately respond to the primary symptoms of the disease also because only primary syphilis can be completely cured. Secondary and tertiary syphilis is only healed. Take care of yourself, and do not neglect contraceptives that will help you avoid this serious illness!

About such a terrible and very terrible disease as syphilis, which is caused by pale treponema, humanity identified back in 1530. But besides, four centuries later, at the end of the last century, there was no disease in the world that would frighten with its consequences and external manifestations, more than syphilis. This disease belongs to the classic sexually transmitted diseases, despite the fact that infection transmitted from mother to child or during blood transfusion cannot be ruled out. Indeed, household infection with this disease is seen very rarely. This disease is characterized by a long, slowly progressive course, leading in the later stages to important lesions of the internal organs and the nervous system.

Syphilis has three stages. At the first stage, at the site of penetration of the pathogen, on the mucous membrane of the mouth, in the rectum or on the genitals, ulcers appear with a dense hard base (chancre), which disappear on their own after 3-6 weeks. The second period begins approximately two months after the end of the onset of the disease and is characterized by the appearance of a symmetrical pale rash all over the body, except for the palms and soles of the feet. Syphilitic roseola, or spotted syphilis, is precisely what they call the form of skin lesions in secondary fresh syphilis. Tertiary syphilis, if left untreated, may appear a couple of years after the end of the infection. Along with this, the nervous system, spinal cord and brain, bones and internal organs, including the liver and heart, are affected. If the infection occurred during pregnancy, the child usually has congenital syphilis.

Speaking of syphilitic roseola, it must be emphasized that these generalized rashes appear after 2 months or 5-8 weeks after the end of the origin of the hard chancre. Roseola, in this case, is initially pink, and after that a pair of spots that have turned pale with indistinct outlines, 1 cm in diameter with a smooth surface, do not merge with each other. These spots are not characterized by elevation above the skin and do not have peripheral growth. Roseola appears slowly, 10-15 spots every day, and reaches its full development on 8-10 days. When pressed on it, roseola temporarily disappears or turns pale, and then appears again. Long-standing roseola becomes yellowish-brown.

This lesion of the skin is located inconsistently, not symmetrically, mainly on the limbs and trunk, actually not appearing on the face, hands and feet. Syphilitic roseola is not accompanied by pain.

It should be noted that with secondary fresh syphilis, this manifestation on the skin appears in a much smaller amount, in most cases localized in separate areas of the skin. Spots in this case are quite often grouped into rings, arcs and semi-arcs. The size of recurrent roseola, in most cases, is much larger than fresh roseola, and their color becomes cyanotic. In the treatment of secondary syphilis, already at the end of the first injections of penicillin, an exacerbation appears, expressed in an increase in body temperature. Roseola, as a result, clearly manifests itself, becoming richly pink. In addition, it also appears in those places where it did not affect the skin before the start of treatment.

In addition to the usual roseola, one can also see its varieties, such as flaky roseola, which is a lamellar scale, looks like crumpled papyrus paper on the outside, a couple sunken in the very center, and an eluting or rising roseola, which rises above the level of the skin, resembling tumors and not accompanied by along with that itch.

By itself, syphilitic roseola does not represent danger, but is a symptom of a terrible disease that cannot be ignored. Already at the first appearance of ulcers on the body, it is urgent to go to a doctor who will diagnose and take measures to treat this disease, preventing damage to the bone and muscle system, damage to blood vessels, spinal cord, and the brain. It is fundamentally important to instantly respond to the primary symptoms of the disease, also due to the fact that only primary syphilis can be completely cured. Secondary and tertiary syphilis is only healed. Take care of yourself, and do not neglect contraceptives, which will help you avoid this serious disease!