Chancre. What does a syphilitic (hard) chancre look like?

Hard chancre is a symptom of primary syphilis. It is also called primary syphiloma or erosion. Hard chancre appears in men and women about three weeks after the introduction of the causative agent of the disease, treponema pallidum, into the body. Its symptoms are an erosive or ulcerative formation on the skin or mucous membranes.

Hard chancre has the following features:

• characterized by limited localization;
• does not affect the internal organs and systems of the body;
• responds well to treatment.

The hard chancre got its name from the type of base of the formed ulcer or erosion. The duration of the existence of primary syphiloma is from six to eight weeks.

Localization

Localization of primary syphiloma can be absolutely any. A hard chancre in a person appears directly at the site of introduction of pale treponema into the human body after a certain time after infection. Its most common localization is the external genitalia - in women the labia, clitoris, in men the head, base and trunk of the penis, the outer or inner leaves of the foreskin. In some cases, a hard chancre is formed on the internal mucous membranes: in the urethra in men, on the walls of the vagina or cervix in women.

In ten percent of all cases, an extragenital location of the chancre is observed. Hard chancre in women and men can be localized:

• in the oral cavity;
• in the language;
• on the border of the lips;
• on the tonsils in the throat;
• on the mammary glands of women.

Symptoms

Outwardly, a hard chancre looks like a reddish spot with clearly defined, even edges, up to 1.5 centimeters in size. It has the shape of a geometrically correct circle or oval. Sheer or undermined edges indicate a bacterial complication.

Symptoms of hard chancre are only external. It does not disturb the patient in any way, does not cause any pain. Complications develop only if a bacterial infection has joined the lesion.

After a few days, the redness turns into a flat papule, and after a while - into erosion or an ulcer with a compacted base. Hard chancre has a bottom, which is located on the same level with the skin or slightly raised above.

In almost 90% of cases in women and men, a hard chancre looks like erosion. An ulcer forms:

• when the body is weakened as a result of concomitant chronic diseases;
• as a result of intoxication;
• when self-medicating with local irritants;
• in case of non-observance of elementary rules of personal hygiene;
• in young or elderly patients.

When formed in men on the penis, a hard chancre is covered on top with a transparent, dense detachable film. It is in it that pale treponemas are located, which are then used to determine syphilis. If a hard chancre is located on an open area of ​​the body, then on top it is covered with a dense brownish film.

Hard chancre in size is:

• from 1 to 3 mm - dwarf, it is considered the most dangerous from an epidemiological point of view;
• from 1 to 2 cm - medium;
• up to 4-5 cm - gigantic, localized on the skin of the thighs, pubis, forearms or face.

Hard chancre in humans can vary in the number of morphological units, that is, it can be single and multiple. If multiple chancres are present, then they can appear all at once at the same time or sequentially, one after another, after some time. If there are multiple lesions on the skin, then a hard chancre occurs in several places at once, that is, where pale treponema enters the body. Multiple chancres most often occur during repeated sexual intercourse with a partner with syphilis.

Atypical hard chancre

Rarely, men and women infected with syphilis have a hard chancre in an atypical form. These include:

• amygdalitis;
• indurative edema;
• chancre-panacir.

Chancre-amygdalite is very different from the usual hard chancre on the tonsils. He has other outward symptoms. In most cases, amygdalitis looks like a unilateral enlargement of the tonsil, which occurs very abruptly. It becomes dense to the touch and hyperemic. This symptom is sometimes confused with manifestations of angina.

Indurative edema occurs in the area of ​​the labia in women or the foreskin in men. The affected area, unlike a typical hard chancre, after a while increases in size by two to three times, becomes dense to the touch and acquires a bluish tint. Edema is non-painful, it is not accompanied by acute inflammatory symptoms.

Chancre panaritium is the most atypical manifestation, its danger lies in the fact that the symptoms completely coincide with the usual panaritium, and it looks exactly the same. This can lead to misdiagnosis. The chancre panaritium is characterized by localization on the distal phalanx of the thumb or index finger. A bluish-red swelling appears on the affected area, which turns into an ulcer with a purulent coating on the bottom and uneven deep edges. For chancre-panaritium, symptoms such as throbbing or shooting pains are characteristic. Most often, it occurs in gynecologists and operating surgeons who are in direct contact with the body of a person infected with syphilis, thus, chancre panaritium in most cases is the result of occupational infection.

Syphilis in the form of chancre-panaritium is very rarely detected on time, and therefore the diagnosis becomes known already in the second stage of the disease. Timely detection of atypical chancre is very important, since the primary stage of syphilis is treated most effectively.

Treatment

A hard chancre in a person infected with syphilis is treated in an inpatient or outpatient setting. Throughout the course of therapy, a cessation of any sexual contact is required. It is necessary to treat all sexual partners of a person with syphilis, no matter how many there were. The fact is that the probability of their infection with pale treponema is extremely high.

Treatment of hard chancre is carried out with antibacterial drugs of the penicillin group, since the causative agent of syphilis has not lost sensitivity to them. Most often, these are injectable forms of ampicillin and benzylpenicillin.

You need to know that a hard chancre in itself is not dangerous. It allows you to identify syphilis at its earliest stage. Therefore, timely treatment makes it possible to prevent the further development of the disease and the occurrence of complications. If you find a formation on the skin that resembles the description of a hard chancre, you should immediately consult a doctor for examination.

After suspicious unprotected sexual intercourse, prophylactic treatment may be prescribed, which will prevent the penetration of the causative agent of syphilis into the body. To do this, without delay, contact a dermatovenereologist.

And what syphilis looks like in women can be seen in the photo.

Most often, infection occurs sexually, when a mobile spiral microorganism or pale treponema contributes to development if it penetrates through cracks in the skin, starting to show a reaction against a background of reduced immunity and remaining in cells for a long time with a latent course of the disease.

Pale treponema or spirochete, when penetrating into damaged areas of the integument of the skin or mucous membrane, proceeds in 3 stages, quickly begins to divide and multiply.

• Stage 1 - incubation period with a duration of 3-4 weeks;
• stage 2 - after 7 weeks, when septicemia begins to develop if bacteria enter the subclavian vein with the appearance of secondary syphilomas;
• Stage 3 - the development of secondary syphilis with the spread of pale treponema with blood flow throughout the body.

Syphilis manifests itself in different ways and you can see a photo in women: in the form of herpes, a single ulcer or chancre on the body. However, only diagnostics, a complete examination of the microbiological level in the body, can determine with accuracy the type of infection and the causative agent of the disease.

A serology test for primary syphiloma may show a negative result. The reaction will become positive at the secondary stage of the disease, although the incubation period can be quite long, up to 1-2 years.

What does it look like?

Syphilis is a hard chancre in women or an erosive formation with a smooth bottom and clear borders of a bright red color at the base with a dense infiltrate. This is a deep defect with the appearance on the skin or mucous membrane of the labia, cervix, tongue, lips, palate on the inside of the cheeks or near the anus in women.

Usually these are single ulcerative formations on the skin, but rapidly growing in the absence of timely therapeutic effects.

If small ulcers reach a size of no more than 3 mm in diameter, then the largest red infiltrate (6-7 cm) heals longer, leads to a pronounced seal at the base and subsequent scarring in places of localization with abundant fatty tissue: on the abdomen, pubis. In women with syphilis, papules are usually localized in intimate places: near the anus or external genitalia.

The main sign of the development of syphilis is the appearance of a small pustular rash. Eruptions on the body can be erratic. First - red, then - gradually fading in the form of papules, lentils or medium-sized coins with a dense structure and clear shapes. Primary symptoms of syphilis:

• Enlarged lymph nodes;
• Temperature up to 38gr;
• Fever;
• Bouts of vomiting;
• Sleep disturbance;
• Headache;
• swelling of the genitals;
• General malaise;
• The appearance of irritability;
• Lack of appetite.

If the disease is not treated, then in 180-270 days a syphilitic rash will spread throughout the body, which will lead to damage to bone tissue, internal organs, the endocrine system, and the central nervous system.

With the transition to the secondary stage, the papules begin to take the form of nodules, with the discharge of blood particles and pus upon opening. The stage often proceeds secretly and can last from 2 years to 5 years. Symptoms can appear from time to time, having a relapsing course.

Dense formations either flare up on the body again, then gradually turn into dried crusts, fall off and become almost invisible.

At the third or terminal stage of the disease, syphiloma begins to spread to all internal organs, when tuberculous nodular formations take on a bluish-copper-red hue with asymmetric clear boundaries and reach the size of a cherry stone, and as it progresses, with a large walnut.

At the terminal stage, a viscous liquid oozes from the papules upon opening, leaving behind an asterisk-like trail. Ulcers are difficult to heal. Deformation and disintegration of the tissue is observed in the places of localization of the chancre. The vital activity of bacteria in the nose and palate leads to the destruction of bones, to disruption of the functioning of the whole organism as a whole, up to death.

Any suspicion of the appearance of a hard chancre in one place or another, knowing what syphilis may look like in women, should be the reason for diagnosis and appropriate treatment. Syphilis can lead to irreversible consequences, severe deformation of organs and tissues.

Other signs

It has been proven that the infection is transmitted not only through sexual contact, but also through kissing and oral sex. A chancre with a hard bottom can be localized on the lips or in the mouth - palate, tonsils. With syphilis for:

• The labia and organs usually manifest as a rash with the shape of an inflamed crescent or even circle, the area begins to fester or bleed;
• Buttocks rash resembles an allergy or single manifestations;
• The mucous membrane of the vagina outside the labia looks like a solid nodule from 3 mm to 2 cm in diameter with an increase in lymph nodes around the circumference and discharge of serous fluid at autopsy.

In the photo you can see how syphilis visually looks in women when the chancre is located in that other place.

Additionally, there are symptoms such as itching, burning, discharge of a thick flocculent mass at the opening of papules. Already in the secondary period, the bacteria progress, spreading in the form of a rash throughout the body: on the palms, soles of the feet, scalp, when women experience:

• Loss of eyelashes, eyebrows, hair;
• Malaise, temperature up to 38 degrees;
• Aches in the bones;
• Syphilitic hoarseness in the tongue, tonsils, ligaments in the mouth.

If untreated, secondary syphilis will begin to develop, when relapses are inevitable. With syphilis in the third stage, signs such as: nasal retraction, cartilage deformation, overgrowth of the chancre tumor-like body will appear. As a result, the entire body may become covered with tubercles.

The peculiarity of the appearance of a female chancre, unlike men, is the location and, as a rule, in the form of a solitary neoplasm with a seal at the base on the labia, near the urethra.

Often there is a location on the cervix, as a rounded erosive spot of red color with a flat bottom and clear boundaries. When localized on the labia and in the clitoris, it resembles a single erosion, a seal at the base with a possible violation of blood flow and lymph damage, when the tubercle acquires a bluish tint, but is painful to the touch. Soon, the seal may crust or begin to crack.

An erosive ulcer or indurated edema on the genitals are the primary signs of syphilis in women.

Infection with syphilis is dangerous for pregnant women when there is a threat of miscarriage of a baby, birth dead or with defects incompatible with life. Only timely detection and treatment will avoid unpredictable consequences.

In case of suspicion, it is advised not to postpone the trip to the gynecologist, to take a smear or sample (washouts) from the affected area for infection with a venereal infection or the causative agent - pale treponema. The disease is treated with antibiotics and antiseptics for external use in order to quickly suppress the development of infection, intoxication effects on the body, and prevent the transition to a recurrent form.

Self-medication is excluded. Only a doctor should prescribe treatment, since treponema does not show sensitivity to a number of antibiotics and the use of correct, narrowly targeted drugs is required to completely suppress the bacterial flora and prevent relapses in the future.

The primary manifestation of syphilis is the chancre (syphiloma). With its timely detection and the beginning of therapeutic therapy, the chances of recovery increase significantly. That is why it is so important to know what a chancre looks like with syphilis, and what processes in the body are indicated by its appearance.

The formation of chancre most often occurs 3 to 5 weeks after infection with syphilis. The beginning of this process indicates the transition of the disease from the incubation to the primary stage. Syphiloma is the place where the causative agent of the disease, Treponema pallidum, entered the body of an infected person. Here she begins to actively multiply, because for this she needs an ambient temperature of 37 degrees.

If retaliatory measures are not taken, the disease will progress, there will be much more treponema. The secondary and tertiary periods are syphilis without chancre. However, other characteristic external symptoms appear, and the carrier of the disease becomes dangerous to others.

For the formation of a chancre, it is necessary that the causative agent of syphilis penetrate into the tissues of a healthy person. This is possible under the following circumstances:

• unprotected sexual contact;
• use of non-sterile medical and cosmetic instruments;
• the presence of damage to the skin and mucous membranes upon contact with the patient;
• kiss;
• use of other people's things;
• blood transfusion and surgery.

Unsafe sex remains the main route of transmission. Also at risk are representatives of the medical profession and drug addicts.

Localization and characteristic features

The mode of transmission of the disease affects where the syphilis chancre appears. Most often it is found on the genitals, as well as in the mouth. When infected through a wound on the skin, syphiloma can form anywhere, depending on the location of the damage.

Chancre can appear in the following areas:

• head and body of the penis, foreskin;
• labia;
• perianal area;
• Cervix;
• clitoris;
• pubis;
• lips;
• cheeks from the oral cavity;
• gums;
• throat;
• language;
• sky;
• fingers;
• breast;
• stomach;
• rarely - on the eyelids and conjunctiva of the eyes.

Syphiloma is quite easy to distinguish from other types of formations. It is characterized by such signs:

• an area of ​​redness initially appears without any discomfort in this area;
• then there is a nodular neoplasm with a bluish tint on the surface of the skin or mucous membranes at the site of redness;
• an ulcer opens in the center of the nodule, while there are no pain sensations, if we are talking about a typical form of syphiloma;
• the edges of the chancre are dense and even, the bottom resembles cartilage in structure;
• the shape of the formation is predominantly round or oval;
• the color of the ulcer is dark red or brown;
• there are secretions in a small amount, resembling pus, and it is in these secretions that treponemas are contained;
• there is an increase in nearby lymph nodes, low-grade fever.

Types of formations and their features

A typical hard chancre makes it quite easy to diagnose the disease.

In this case, syphilomas can be classified according to a number of criteria:

Atypical forms

It is much more difficult to diagnose syphilis if the chancre appears in an atypical form. That is why the final diagnosis can only be established by a qualified doctor.

The most common types of atypical syphilomas are:

Such chancres not only complicate the diagnostic process, but are also accompanied by various complications. In addition, they are characterized by the presence of pain, although with syphilis this symptom is extremely rare.

Chancroid

A special form of skin formations is chancroid - soft chancre. It appears under the influence of streptobacillus, it does not contain the causative agent of syphilis, pale treponema.

The characteristic features of such a neoplasm are:

• soft edges of the ulcer, lack of a solid base;
• the presence of a pain symptom;
• erosion color - bright red;
• copious purulent discharge is present;
• peeling of the skin;
• the appearance of small ulcers, independent of chancroid, which can merge with it into a single focus of inflammation.

Due to the active reproduction of streptobacilli and their spread through the bloodstream, the patient has signs of general intoxication of the body: nausea, headaches and dizziness, and malaise. The inflammatory process raises the body temperature.

Unlike hard chancre, soft chancre is transmitted exclusively through sexual contact. In addition, after healing, it leaves noticeable scars, which is associated with severe inflammation of the superficial lymph nodes and the formation of bubonic ulcers, as well as their opening. Syphiloma disappears almost without a trace.

Effects

The presence of a chancre clearly indicates the presence of the causative agent of syphilis in the body. This disease in itself is very dangerous, as it can affect the internal organs, provoking their failure.

Also, the consequences of infection are destructive processes in bone tissues, which deprives a person of the ability to lead a normal life and provokes physical deformities. If left untreated, the risk of developing neurosyphilis increases. In the future, as the disease progresses, a fatal outcome occurs - this is the price of ignoring the problem.

If we consider directly the consequences associated with the formation of a chancre, it is worth highlighting the following:

• damage to deep layers of tissues;
• suppuration and tissue necrosis;
• self-amputation of damaged areas, in particular, external genital organs;
• bleeding;
• the formation of rough scars;
• perforation of the urethra;
• accession of infections;
• endocervitis of the cervix;
• balanoposthitis;
• syphilitic gangrene;
• bartholinitis.

Similar complications occur mainly in atypical syphilomas. Common chancre often goes unnoticed and passes without a trace as the disease passes into the secondary phase.

Diagnostics

For successful treatment, it is important to detect syphilis chancre in time and start treating the disease. Before prescribing drug therapy, it is necessary to verify the correctness of the diagnosis, since the possibility of false suspicions is not excluded.

The following types of studies can be used for diagnosis:

• Wasserman reaction;
• microprecipitation reaction;
• RIBT;
• passive hemagglutination reaction;
• serological tests.

Syphilis is confirmed by the presence of treponema pallidum in tissue scrapings, as well as antibodies to it in blood samples. Based on the results of the tests and the physical examination, one can judge the degree of prescription of infection.

It is also necessary to conduct a differential diagnosis of such diseases (depending on the location of the chancre and the presence of concomitant symptoms):

• angina;
• herpes;
• candidiasis;
• tuberculosis;
• traumatic erosion.

Treatment Methods

The sooner treatment is started, the better for the patient. Instructions for taking medications are drawn up on an individual basis, depending on the nature of the course of the disease and the characteristics of the patient's body.

As the main therapeutic drugs are used:

• penicillin antibiotics;
• fluoroquinolones;
• tetracyclines;
• macroliths;
• immunostimulants;
• probiotics;
• vitamin complexes;
• antimycotics;
• bismuth preparations;
• iodine preparations.

When syphiloma is found in the mouth, rinsing with solutions of boric acid, furacilin, gramidicin is prescribed. It is imperative to observe hygiene standards to prevent the addition of secondary infections.

The passage of preventive treatment and constant monitoring is required by the sexual partners of an infected person with whom he had a relationship in the last few months. Before the onset of a stable remission, you should not stop taking medications without obvious reasons, as well as engage in intimate relationships. We also recommend watching the video in this article to learn more about syphilitic chancre.

A hard chancre may indicate the development of a sexually transmitted infection. Although this phenomenon occurs in various pathologies, it is customary to identify it with the onset of syphilis, since it is the syphilitic chancre that is most common. At the same time, when such a formation appears, additional studies are required to differentiate syphilis from other pathologies. An accurate diagnosis allows you to start timely adequate treatment, and at the stage of chancre formation it still allows you to ensure complete recovery.

The essence of education

A hard chancre is a morphological formation on the skin or mucous membrane, which is not an independent disease, but is considered the primary sign of a sexually transmitted disease, most often syphilis. It is an erosion or ulcer of a rounded configuration of dark red color with characteristic elevated borders and a dense base of cartilaginous tissue. Syphilitic hard chancre has another name - primary syphiloma.

The formations in question appear 20–28 days after the penetration of the infection - pale treponema or spirochete. Hard chancre is deservedly recognized as a marker of pathology, since it is formed at the site of the initial introduction of the pathogen into the human body and is the main (and sometimes the only) manifestation of the initial stage of the disease.

Chancre exists for a short time, developing from an initial red spot to a well-defined ulceration. With the transition of the pathology to the next stage, the primary syphiloma spontaneously disappears, giving way to secondary syphilides, which manifest themselves in the form of a skin rash.

Primary education has specific features:

• well-defined localization of the lesion;
• non-spread of the lesion beyond the skin, i.e., no effect on internal organs;
• high chances of a complete cure of the disease.

At the initial stage, the infection does not penetrate deep into the body, which makes it possible to use standard treatment regimens. However, if you miss a favorable moment in therapy, then spirachets begin active reproduction, and the pathology becomes systemic.

A syphilitic ulcer is formed in the following order:

1. Initially, a red spot appears on the skin or mucous membrane at the site of treponema introduction, indicating the onset of an inflammatory reaction.
2. Gradually, the destructive effect of the pathogen leads to the formation of erosion of the epithelium.
3. After that, the treponema continues to deepen into the skin tissues.
4. The appearance of a hard chancre indicates that it has reached the subcutaneous tissue, and sometimes the muscle layer, having passed the submucosal layer.

External manifestations

About what a hard chancre looks like, those who are directly confronted with its appearance and development know. Having gone from a small spot to an ulcer with syphilis, the chancre acquires a specific appearance, which the photo illustrates. It, as a rule, has a correct, clear geometry and fairly even borders. The base of the ulcer is dense with a transparent, shiny film, in which a large amount of infection is concentrated. If the lesion is located on an open area of ​​\u200b\u200bthe body, then the coating gradually becomes brown. To the touch, the structure of the base of the chancre resembles cartilage.

The size of a syphilitic ulcer can range from 1.5 to 55 mm, and most often they are 12–14 mm. At the bottom of such a “crater”, a purulent, yellowish coating on a brown-red background can be found, but the inflammation does not spread to the surrounding tissues, and the shape remains unchanged. After the chancre heals and disappears, a pigmented spot remains in its place for some time. The duration of the existence of an ulcer ranges from 25–28 days to 3–3.5 months.

It is necessary to note the specific signs of syphilitic chancre. It does not hurt or itch, i.e. pain and itching are completely absent. You can also detect the syndrome of "weeping chancre". When you press the formation along the edges, a transparent liquid substance (sometimes with a yellowish tinge) is released on the surface of its base.

The primary syphilitic symptom is usually classified according to its magnitude:

1. A pygmy or miniature chancre has a diameter in the range of 1.5–4.5 mm. It stands out for its increased infective ability.
2. Medium chancre. The size ranges from 5–20 mm.
3. Giant education. Such a chancre is formed on the hips, pubis, scrotum, abdomen, in the shoulder region and can reach a size of 40–56 mm.

According to the depth of the lesion, hard chancres are divided into erosive (superficial defect) and ulcerative (deep penetration into the skin layers) type.

In addition, they can be single and multiple.

Ulcer localization

The classification of signs is also carried out according to their localization on the human body:

Varieties of formations

All the specific properties considered refer to typical hard chancres, which are most often found in the initial stage of syphilis. However, in addition to this form, there are other types of pathology:

Possible consequences

As noted, hard chancre is the initial stage of sexually transmitted diseases, most often syphilis. How long such a symptom lasts, so much time does the surface (local) distribution of the infection within the skin cover take. Then it penetrates deep into the body, causing a systemic lesion, and the disease passes to the next stage. The main complications of chancre are associated with the progression of the disease, and this is a direct path to infertility and impotence.

Already at the stage of chancre formation, the disease can be accompanied by serious complications. If left untreated, men develop pathologies such as balanitis and balanoposthitis, paraphimosis, phagedenic ulcer, inflammatory phimosis. The defeat of the genital organs of the inflammatory type is also noted in women.

Proper diagnosis is of great importance in organizing the treatment of the disease. Unfortunately, a blood test only detects treponema 5 to 7 weeks after infection, when the pathogen reaches the blood vessels. At the initial stage, the basis of differentiated diagnosis is laboratory research using a dark-field microscope.

Principles of treatment

Properly organized treatment of the disease in the first stage gives a good chance to completely get rid of the pathology. Such clinical manifestations as hard chancre signal the onset of the disease and the need for effective measures. Treatment at this stage solves the following tasks - the destruction of the infection, the cessation of the spread of pathology, the elimination of the risk of complications and exacerbations, the regeneration of the affected skin layers, and the increase in immune security.

It should be noted once again that hard chancre is not an independent disease, and therefore it is not necessary to treat it, but the main cause - primary syphilis. You can not self-medicate and even more so squeeze out a defect. Such techniques can only lead to exacerbations and serious consequences. Pathology treatment is provided by complex therapeutic methods using systemic and local (external) drugs.

To eliminate pale treponema, antibiotics of the penicillin series are prescribed. Extencillin, administered by two intramuscular injections, is recognized as a modern basic remedy. Additionally, Bicillin injections and Erythromycin, as well as Doxycycline in tablet form are provided. Other penicillins are sometimes used, such as the parenteral versions of Ampicillin and Benzylpenicillin.

The external therapeutic effect ensures the restoration of damaged tissues, excludes the addition of another infection, and solves symptomatic problems. Tissue regeneration in the area of ​​ulcerative lesions is accelerated when using solutions of Benzylpenicillin and Dimexide.

In addition, positive results are achieved when treating the lesion with mercury, heparin, erythromycin, synthomycin or levorin ointment. Lesions in the oral cavity are eliminated by using solutions for rinsing based on Furacillin, boric acid and Gramicidin.

The treatment regimen for the disease at the stage of hard chancre is developed by the doctor, taking into account the individual characteristics of the organism, the type of lesion, the clinical picture and the severity of the course of the pathology. Particular attention is paid to the individual tolerance of prescribed drugs. The antibiotics used can cause allergic reactions, and therefore they are often taken simultaneously with antihistamines such as Tavegil or Suprastin. Taking probiotics is helpful to rule out disturbances in the intestinal microflora.

A hard chancre is a sign of the initial stage of a sexually transmitted disease. Such a clinical manifestation of the disease gives a chance for timely initiation of treatment. At this stage of its development, modern medications create the possibility of a complete recovery, and such a chance should not be missed.

Today, syphilis is an extremely common disease that is sexually transmitted, you must be extremely careful about choosing a partner and contraceptives, because your health depends on it. Well, if this disease took you by surprise, there is nowhere to go - you will have to study all the information that will help you cope with the disease one way or another. The first and most important thing to do if you find symptoms of the disease is to consult a doctor, self-medication is extremely dangerous and can lead to death.

Attention! Do not self-medicate, with such a disease it can be life threatening.

The main symptoms of the manifestation of the disease are chancre, the so-called ulcer, which appears on the body, most often on the mucous membranes of the genital organs or in the mouth, but it happens throughout the body. The word Chancre itself has French roots and denotes an ulcer on the body, which at first is a blister, which bursts, turns into a final chancre.

Some of the photos presented on this page are not desirable for children and suspicious people, so a big request - if you are under 18, you should not look at shocking photos.

Symptoms and signs

First, redness appears, then a papule forms at the site of redness, and after the papule ruptures, a chancre forms in its place. An ulcer (chancre), usually round or oval (oblong) in shape, with clear boundaries protruding 1-2 mm above the skin surface. Around the sores, the skin has a healthy pink color. When pressed, a secret flows out of the wound, which is a distributor of bacteria. The base of the ulcer has a hard, cartilaginous structure to the touch.

Most often, the genitals become the places of localization, because. the infection is transmitted sexually.

The initial stage is usually painless, because. ulcers form on the skin, do not have severe inflammation and local pain.

Localization of ulcers

The syphilitic chancre in men and women is localized on the skin of the genital organs, namely:

• Along the coronal sulcus;
• In the area of ​​the scrotum and testicles;
• On the head of the penis;
• On the skin of the foreskin;
• Lobke;
• On the surface of the labia.

Develops scleradenitis and lymphadenitis (inflammation of the lymph node). Lymph nodes close to the localization zone increase in size. In the future, the disease affects all the lymph nodes. By the end of the first stage, syphilitic polyadenitis (inflammation of several groups of lymph nodes) develops, which is the first and main symptom of the second stage.
There are also atypical chancres, with symptoms uncharacteristic of syphilis.
At the first stage, they appear in the form of edema noticeable in the photo in men. It can also appear:

• On the scrotum;
• On the head of the penis;
• In the area of ​​the foreskin;
• On the surface of the cervix;
• On the surface of the clitoris.

With swelling, the skin becomes reddish-bluish in color. But unlike ordinary edema, there is no dent when pressing on the edematous surface.
A favorite place for the appearance of syphilis is the oral cavity. The first symptoms are usually visible within a month after infection. The infection can be brought into the oral cavity during a banal visit to the dentist, or other operations inside the oral cavity.
What can provoke the appearance of symptoms of syphilis in the oral cavity?

• Non-sterile instruments;
• Microcracks and wounds on the oral mucosa;
• The entry of bacteria into the blood during an injection;

Most often, chancres are located on the extreme edge of the lips, on the surface of the palatine tonsils, or on the mucous surface of the middle part of the tongue.

Here the disease is localized in the form of such manifestations as a chancre on the lip, a chancre on the tongue and a chancre of the amygdalitis.

Types of chancre

Distinguish erosive, ulcerative and angina-like chancre (chancre amygdalite).
First, the tonsil turns red, erosion appears, then an ulcer forms, and then an increase in lymph nodes occurs. Chancre has a round or oval (oblong) shape. Smooth edges protruding above the surface of the tonsils, as well as a dense bottom (base).

For erosive and ulcerative types of chancre, the unilateral nature of the lesions is characteristic. Scleradenitis of the submandibular lymph nodes of a specific etiology develops, as well as scleradenitis of the anterior and posterior cervical lymph nodes.

Syphilis can develop inside the mouth and affect one of the tonsils.

Such a lesion is called the chancre amygdalite, and is an atypical manifestation of a hard chancre for syphilis. At the same time, on the side where the bacterium settled, there is an increase in the lymph nodes of the submandibular and cervical regions (posterior and anterior). The tonsil, from the side of penetration of the bacteria, increases. It acquires a reddish-crimson color and becomes dense to the touch.
Blocking the lumen of the throat, an enlarged amygdala provokes a change in voice. In this case, the following symptoms may be observed:

• Discomfort when swallowing food;
• General malaise;
• Increased body temperature.

However, these symptoms should not be confused with a sore throat, because. inflammation is unilateral. In this case, the similarity of symptoms with angina complicates the diagnosis of syphilis. Despite this, starting from the 4th week, bacteria actively multiply and the disease can be diagnosed. To do this, you need to pass tests and conduct a diagnosis. Serologic reactions by this time may show a positive reaction, signaling that treatment can begin.

Serological reactions

• Sometimes a chancre can visually look like a crack on the upper or lower lip.
• Statistics show that the favorite place of bacteria is just the lower lip.
• Chancre can also be observed in the corners of the mouth, or in small labial folds.
• Although the external manifestation is similar to a strip, when the fold (crack) opens, where a hard chancre has formed, a typical oval shape is observed.
• Ulcers located in the corners of the mouth are more reminiscent of seizures, which dulls the vigilance of the owner.

As a rule, the chancre on the tongue is single. It is located on the middle third of the tongue, as well as on the back. Basically, there are two forms of chancre, erosive and ulcerative. However, ulcers that look like cracks are also observed. Inside such a crack is the same ulcer, which has a typical oval shape, with a hard bottom. The inflammation is painless, around the chancre the skin is of a healthy color.

Less commonly, syphilitic chancre appears on the hard and soft palate, as well as on the cheeks and gums.

Chancre of the gums is quite difficult to diagnose. As a rule, the ulcer has the shape of a crescent and is located at the neck of the tooth, and more often two teeth. Given the external similarity of the chancre with a common ulcer, it can be difficult to distinguish them. the only difference is the absence of painful manifestations in a syphilitic ulcer.

Chancres are the primary and very important signs of the disease. Their size, as a rule, varies from 5 to 10 mm, in some cases it can reach 20 mm. If treatment is not started in time, chancre in men can go into a more latent phase and continue its destructive effect inside the body, leading to severe and irreversible consequences.
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Peculiarities

What does a syphilitic chancre look like? Chancres are the primary signs of syphilis infection. They occur on the skin, and are a small purulent formation with smooth edges, compacted at the bottom and covered with a crust on top.

• It is in this protective crust that the largest number of spirochetes is contained.
• Due to this, syphilis infection can be determined by taking a smear from the chancre of the infected area.
• Chancres differ from other similar skin lesions in that they cause little or no pain, itching, or burning.
• The skin around the chancre may become slightly inflamed.

In advanced cases, chancres can cause severe inflammation of the tissues and lymph nodes. However, with timely access to the doctor and proper treatment, ulcerative formations disappear within two weeks after the start of therapy.

It is worth remembering that with an irresponsible attitude towards infection, chancres can also disappear from the skin on their own. However, this should not be taken as a sign of recovery. The disappearance of the meringue chancre is a sign of the transformation of syphilis into a new stage, which is characterized by damage to internal organs and massive skin rashes.

Dimensions of hard chancre photo

The size of the hard chancre varies over a very wide range. Its surface can be covered with a thin, moist luster, as if eroded epithelium, which is especially characteristic. When palpated, a cartilaginous density infiltrate is felt. With a more pronounced erosion surface, the skin appears dark red, as if granular. With ulcerated syphilis an ulcer is always smaller than a hard roller, and has a dense base. With ulceration, it may be the case, depending on the method of formation:

1. With ulcerated sclerosis.
2. With sclerosed ulceration.

In the latter case, the situation may be different. First, a very small nodule formed at the site of infection can turn into a vesicle and an ulcer before the actual syphilitic infiltrate is detected.

On the other hand, the existing bubble, especially the bubble herpes, can serve as a site for the penetration of spirochetes, which happens relatively often. In this case, an ulcer quickly forms.

How it starts, photo

The most important role in the origin of infiltrating, sclerosing ulcers is played by chancroid. It may have existed prior to the infection with syphilis or was acquired at the same time as it. With this simultaneous infection: a soft and hard chancre, which is not uncommon, a soft chancre develops first. It has a much shorter incubation period of only a few days. Hardening, as a result of simultaneous infection with syphilis, is detected after 2-3 weeks. The base and circumference of the soft ulcer are compacted: a "mixed chancre" (chancre mixte) is obtained.

• Not only that, a chancre ulcer may heal before a lump develops.
• "Mixed chancre" deserves special attention.
• Namely, it must be remembered that with the presence of a soft chancre ulcer, the possibility of simultaneous infection with syphilis cannot be ruled out before the expiration of several weeks. syp-foto.ru

Syphilitic chancre - the primary symptom of the disease

Syphilis is an extremely dangerous chronic venereal disease that can have remissions and, upon transition to the tertiary stage, causes massive destruction of the epithelium and death. Since infection with spirochete bacteria occurs through direct sexual contact, syphilitic chancres most often occur on the genitals and oral mucosa.

• However, in medical practice, there are cases of syphilis infection through household contact through dishes or bathroom accessories.
• In this case, chancres can be localized on the hands or neck of the infected.
• It should be remembered that spirochetes die when exposed to high temperatures, ultraviolet rays and bactericidal agents.
• It is important to constantly monitor the hygiene of personal belongings and regularly diagnose the body in order to prevent the occurrence of syphilis and chancre as its direct signs.

The reason that so far it has not been possible to invent a preventive vaccine against syphilis is that spirochete bacteria are extremely sensitive to the external conditions of their life and do not survive in an artificial environment. Spirochete reproduction requires a moist environment and the absence of light and oxygen. Microscopic analysis, for which a swab is taken from the chancre of an infected person, is carried out by staining the spirochete bacteria with a contrast dye and further drying the biological material. By nature, a colorless bacterium acquires a shade, and with a multiple increase it manifests itself in a peculiar structure that is different from other bacteria.

Beginning of the incubation period

Timely detection of syphilis in the body is complicated by the fact that spirochete bacteria, moving through the body of the carrier in search of a place for reproduction, do not manifest themselves as pathogenic signs and are not detected in blood tests. The incubation period during which bacteria spread throughout the body and begin to attach to soft tissues can last from a week to a month.

• Once attached, the spirochete begins to divide and distribute toxins in the person's blood.
• At the site to which the bacterium has attached, a small chancre begins to appear, which, in the absence of therapy, can increase in size several times.
• In medicine, there are cases when chancres could not be removed by medication and had to be removed surgically.

When does the incubation period end?

The appearance of a syphilitic chancre in the mouth or in another area with a mucous coating indicates the end of the incubation period and the onset of the primary stage of syphilis. If you do not act on the body with antibiotics in time and do not kill the bacteria, then soon a hard syphilitic chancre causes inflammation of the lymph nodes and swelling of the skin around the affected areas.

Thanks to the study of the structure and characteristics of syphilitic chancre, modern microbiology is able to accurately determine not only the source of infection with the spirochete bacterium, but also the time when it entered the body. This helps to identify people who may be infected but are unaware of it.

How is it developing?

Primarily, the chancre appears on the skin of an infected person in the form of a small red spot, which at a rapid pace gradually turns into an erosive destruction of the skin. A typical syphilitic chancre is a sign of the penetration of the treponema bacteria into the subcutaneous tissue or into the interstitial spaces, where it begins its reproduction. In a more serious form, syphilitic chancre can droop into muscle tissue and leave deep scars behind.

External signs

The size of the syphilitic chancre can vary depending on the stage of development of the infection and range from 1 mm to 5 cm in diameter. Most often, chancre no larger than 2 centimeters in size are found on the body of infected people.

• The shape of the syphilitic chancre is a regular geometric circle, with smooth edges and a dense base, similar to a small nodule or cartilaginous formation. Depending on the location of the chancre, they can be blood red or purple. On open areas of the skin, the chancre is most often brown or brown.
• In rare cases, purulent discharge may appear on the surface of the chancre crust, however, the syphilitic type of chancre is not characterized by profuse discharge of pus and does not cause much discomfort to the carrier of the virus.
• Due to the fact that the syphilitic chancre usually does not hurt or itch, it is often preferred not to notice it. If you press on the edges of the chancre, a yellowish liquid may ooze out of it, which is a concentration of spirochetes and is called "weeping chancre" in medicine.

What are the atypical forms

The primary form of syphilis can often be combined with other sexually transmitted infections in the body. Because of this, chancres acquire atypical forms and may have the characteristics of several types of ulcerative formations at the same time. The only common phenomenon that unites all chancres of the syphilitic type is the presence in them of a large number of treponema pallidum bacteria. In order to correctly diagnose and understand the cause of infection, it is important to know the differences between atypical forms of chancres and their main types:

• Syphiloma is an atypical form of chancre, which is characterized by uneven, as if “spilled” on the skin edges and inflammatory processes in adjacent areas of the skin. It can be distinguished from other types of syphilitic inflammation by pressing on the skin at the site of infection with a finger. After pressing on the surface of the swollen skin, there should be no indentations from the fingers.
• Amygdalitis. It develops mainly in the larynx and oral cavity of an infected person. It is characterized by inflammation of one tonsil and can be detected by a simple examination of the patient's throat. In order not to confuse amygdalitis with tonsillitis, you should pay attention to the asymmetric location of the inflammation. Infection with a spirochete is indicated by the defeat of only one of the tonsils.
• Felon. A form of chancre that affects the upper limbs, especially the fingers and hands. An atypical manifestation of this type of chancre is extremely acute pain, which can be compared with pain from cuts or punctures. Inflammation occurs in a particularly acute form, can cause feverish attacks, inflammation of the lymph nodes, and vomiting.
• Herpes on the head of the penis. Develop on the head and foreskin of the penis. They cause acute inflammatory processes, due to which the head may be deformed or swelling of the penis may occur.

Ignorance of the differences between atypical forms of chancre and incorrect diagnosis can lead to a deterioration in the patient's condition and the rapid development of infection in the body. You should not engage in self-diagnosis by scanning the Internet with queries like “how to treat syphilitic chancre”, “syphilitic chancre on the lip”, “hard chancre forum”, “hard chancre color”, “hard chancre flakes off”. Contact us. We will help you find the best clinic for a complete diagnosis and effective treatment of syphilis at any stage!
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For primary syphilis

With primary syphilis, which is combined with other infections (gonorrhea, chlamydia, genital herpes), there are atypical forms of hard chancres. Perhaps the appearance of multiple syphilomas, mixed erosive-ulcerative, with a weak compaction of the bottom and even resembling scratches and micro-erosion in herpes. However, in all types of chancre it is found Treponema pallidum. Knowledge of the main features of atypical hard chancres is important for differentiating the signs of syphilis from the symptoms of other diseases.

1. Syphiloma with a spilled seal, not limited by its edges ( indurated edema). It differs from ordinary edema in that after pressing with a finger on an atypical chancre, there are no pits left.
2. Amygdalitis- a painful chancre without erosion or ulcer, located on the pharyngeal tonsil, can be confused with a sore throat. However, with angina, both tonsils become inflamed and enlarged, become loose, the temperature rises and the lymph nodes are painful. With primary syphilis, there is no pain and temperature, only one of the tonsils is enlarged, the tissue is compacted, the lymph nodes are painless.
3. Chancre- felon, purulent process on the fingertip of the brush. Symptoms are not typical for syphilis. Chancre causes severe pain, signs of septic inflammation are pronounced (edema, suppuration, fever). The profession of the patient will help to suspect syphiloma - it is more common among physicians, the infection is transmitted through instrumentation.
4. Syphiloma-herpes giving, inflammation of the skin of the glans penis and the inner leaf of the foreskin. Difference: with syphiloma, the foreskin, moved away from the head of the penis, is not always possible to return back and the head may be pinched by a skin ring.

Atypical types of chancre create problems with the diagnosis of syphilis and give severe complications associated with impaired blood circulation and tissue trophism. With gangrene, the surface of the chancre is covered with a black scab; is also developing phagedenism- necrosis of tissues in depth and beyond the syphiloma. Destructive changes can result in self-amputation of the external genital organs, bleeding, perforation of the urethra, and the formation of disfiguring scars.

Hard chancre of genital localization

Primary chancre about in 90% are formed on the genitals or near them(abdomen, thighs, pubis), since most cases of syphilis infection occur during sex. In men, the prevailing location of syphilomas is the head and body of the penis, in women - the posterior commissure of the labia majora and the cervix. more often Features of chancres in men and women associated with the localization of the process were revealed.

• Hard chancre in men, located on penis in the frenulum, may be in the form of a strongly elongated oval and bleed during erection.
• Chancre the mouth of the urethra also bleeds easily, in the urethra - dense and painful on palpation. Extensive ulcers are known mainly from colorful and frightening photos of chancre, of which there are many on the Internet.
• In fact, primary syphilitic manifestations look harmless enough or go unnoticed in almost half of the cases.
• For example, a hard chancre on the head of the penis looks like micro-erosion and may not be palpable, and instead of the characteristic red bottom, a dense grayish-yellow coating is visible.

In women, the chancres in the region of the posterior commissure are rather soft, near the opening of the urethra they are dense, and on the labia they may have uneven edges. Chancres in the vagina are very rare. The cervix and cervical canal are more often affected, syphiloma can be mistaken for ordinary erosion. In this case, scleradenitis, characteristic of syphilis, affects not the external (inguinal), but the internal lymph nodes of the small pelvis.

It is impossible to feel them, but they are visible during a tomography or MRI.

Treatment of syphiloma

The main tasks are to cure the infection, avoid complications and block the spread of syphilis.

Treponema sensitive to antibiotics penicillins, tetracyclines (doxycycline) and macrolides (azithromycin), cephalosporins (ceftriaxone). Against the background of antibiotic therapy, control tests are done to obtain confirmation of the effectiveness of the drugs. Both partners are always treated, sexual intercourse is prohibited until complete recovery. When localizing syphilomas in the mouth and on the fingers, it is important to separate items for individual use - dishes, bed linen, towels, toothbrushes, etc. Treatment of chancres begins with antibiotics, and local remedies are also used.

• Extencillin- the basic drug for the treatment of syphilis. Enter intramuscularly (in / m), twice. A dose of 2.4 million units is diluted in 0.5% novocaine at the rate of 100,000 units per 1 ml. In primary seronegative syphilis, a single injection is sufficient. Injections are preferably done in the buttocks.
• Bicillin-5, intramuscularly, 3 million units once every 5 days, twice.
• Tablets: erythromycin 0.5 x 4 per day, before meals for 30 minutes or after, after an hour and a half. Doxycycline 0.5 x 4 per day, during or immediately after a meal.
• In local treatment, the main thing is the hygiene of the chancre area. They also use baths or lotions with benzylpenicillin and dimexide, which help drugs penetrate deep into. Applications with mercury and heparin ointments are shown. Accelerate the healing of weeping erosions and ulcers erythromycin (1-3%), 10% mercury and mercury-bismuth, synthomycin (5-10%) and levorin (5%) ointments.
• Chancres in the oral cavity: rinsing with solutions of furacillin at a dilution of 1:10,000, boric acid (2%) or gramicidin (2%).

The duration of treatment and dosage is prescribed by the doctor. Antibiotics are selected individually, taking into account the combined infection and drug tolerance. Patients prone to allergies are additionally prescribed suprastin or tavegil.
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Syphilis

Syphilis(Lues) - an infectious disease that has a long, undulating course. Syphilis is classified as a systemic disease in terms of the amount of damage to the body, and as a venereal disease in terms of the main route of transmission. Syphilis affects the entire body: skin and mucous membranes, cardiovascular, central nervous, digestive, musculoskeletal systems. Untreated or poorly treated syphilis can last for years, alternating periods of exacerbations and latent (latent) course. During the active period, syphilis manifests itself on the skin, mucous membranes and internal organs, in the latent period it practically does not manifest itself.

Syphilis ranks first among all infectious diseases (including STIs), in terms of incidence, contagiousness, degree of harm to health, and certain difficulties in diagnosis and treatment.

Features of the causative agent of syphilis

The causative agent of syphilis is the microorganism pallidum spirochete (treponema - Treponema pallidum). Pale spirochete has the appearance of a curved spiral, is able to move in different ways (translationally, rotationally, flexion and wave-like), reproduces by transverse division, stains with aniline dyes in a pale pink color.

• Pale spirochete (treponema) finds optimal conditions in the human body in the lymphatic tracts and lymph nodes, where it actively multiplies, in the blood in high concentration appears in the stage of secondary syphilis.
• The microbe persists for a long time in a warm and humid environment (optimum t = 37°C, in wet linen up to several days), and is resistant to low temperatures (in the tissues of corpses it is viable for 1-2 days).
• Pale spirochete dies when dried, heated (55 ° C - after 15 minutes, 100 ° C - instantly), when treated with disinfectants, solutions of acids, alkalis.

A patient with syphilis is contagious during any period of illness, especially during periods of primary and secondary syphilis, accompanied by manifestations on the skin and mucous membranes. Syphilis is transmitted when a healthy person comes into contact with a sick person through secrets (sperm during intercourse, milk - in lactating women, saliva when kissing) and blood (during direct blood transfusion, during operations - with medical staff, using a common straight razor, a common syringe - in drug addicts). The main route of transmission of syphilis is sexual (95-98% of cases). An indirect household route of infection is less commonly observed - through wet household items and personal items (for example, from sick parents to children). There are cases of intrauterine transmission of syphilis to a child from a sick mother. A necessary condition for infection is the presence in the patient's secrets of a sufficient number of pathogenic forms of pale spirochetes and a violation of the integrity of the epithelium of the mucous membranes and skin of his partner (microtraumas: wounds, scratches, abrasions).

Periods of syphilis

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 a set of syphilides - various forms of skin rashes and erosions that appear in response to the introduction of pale spirochetes into the body.

• Incubation period

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.

• Primary syphilis

Lasts 6-8 weeks, characterized by the appearance at the site of penetration of pale spirochetes of primary syphiloma or hard chancre and subsequent enlargement of nearby lymph nodes.

• Secondary syphilis

It can last from 2 to 5 years. There is a defeat of the internal organs, tissues and systems of the body, the appearance of generalized rashes on the mucous membranes and skin, baldness. This stage of syphilis proceeds in waves, periods of active manifestations are replaced by periods of no symptoms. There are secondary fresh, secondary recurrent and latent syphilis.

Latent (latent) syphilis does not have skin manifestations of the disease, signs of a specific lesion of internal organs and the nervous system, it is determined only by laboratory tests (positive serological reactions).

• Tertiary syphilis

It is now rare, occurs in the absence of treatment years after the lesion. It is characterized by irreversible disorders of internal organs and systems, especially the central nervous system. It is the most severe period of syphilis, leading to disability and death. It is detected by the appearance of tubercles and nodes (gum) on the skin and mucous membranes, which, disintegrating, disfigure the patient. They are divided into syphilis of the nervous system - neurosyphilis and visceral syphilis, in which internal organs (the brain and spinal cord, heart, lungs, stomach, liver, kidneys) are damaged.

Symptoms of primary syphilis

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.

• Chancre can be located on any part of the skin and mucous membranes (anal region, oral cavity - lips, corners of the mouth, tonsils; mammary gland, lower abdomen, fingers), but most often located on the genitals. Usually in men - on the head, foreskin and shaft of the penis, inside the urethra; in women - on the labia, perineum, vagina, cervix.
• The size of the chancre is about 1 cm, but it can be dwarfed - with poppy seeds and giant (d = 4-5 cm). Chancres can be multiple, in case of numerous small lesions of the skin and mucous membranes at the time of infection, sometimes bipolar (on the penis and lips).
• When a chancre appears on the tonsils, a condition occurs that resembles a sore throat, in which the temperature does not rise, and the throat almost does not hurt. The painlessness of the chancre allows patients not to notice it, and not attach any importance.
• Soreness is distinguished by a slit-like chancre in the fold of the anus, and a chancre - panaritium on the nail phalanx of the fingers.
• During the period of primary syphilis, complications (balanitis, gangrenization, phimosis) may occur as a result of the addition of a secondary infection. Uncomplicated chancre, depending on the size, heals in 1.5 - 2 months, sometimes before the appearance of signs of secondary syphilis.

5-7 days after the appearance of a hard chancre, an uneven increase and compaction of the lymph nodes closest to it (usually inguinal) develops. It can be unilateral or bilateral, but the nodes are not inflamed, painless, have an ovoid shape and can reach the size of a chicken egg. Toward the end of the period of primary syphilis, specific polyadenitis develops - an increase in the majority of subcutaneous lymph nodes. Patients may experience malaise, headache, insomnia, fever, arthralgia, muscle pain, neurotic and depressive disorders.

This is associated with syphilitic septicemia - the spread of the causative agent of syphilis through the circulatory and lymphatic systems from the lesion throughout the body. In some cases, this process proceeds without fever and malaise, and the transition from the primary stage of syphilis to the secondary patient does not notice.

Symptoms of secondary syphilis

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, which do not rise above the surface of the skin and mucous epithelium, 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.

• A papular rash is a rounded nodular formation protruding above the surface of the skin, bright pink in color with a bluish tint.
• Papules are located on the trunk, do not cause any subjective sensations.
• However, when pressing on them with a bellied probe, there is a sharp pain.
• With syphilis, a rash of papules with greasy scales along the edge of the forehead forms the so-called "crown of Venus".

Syphilitic papules

Syphilitic papules can grow, merge with each other and form plaques, get wet. Weeping erosive papules are especially contagious, and syphilis at this stage can easily be transmitted not only through sexual contact, but also through handshakes, kisses, and the use of common household items. Pustular (pustular) rashes with syphilis are similar to acne or chicken rash, covered with a crust or scales. Usually occurs in immunosuppressed patients.

The malignant course of syphilis can develop in debilitated patients, as well as in drug addicts, alcoholics, and HIV-infected people. Malignant syphilis is characterized by ulceration of papulo-pustular syphilides, continuous relapses, a violation of the general condition, fever, intoxication, and weight loss.

In patients with secondary syphilis, syphilitic (erythematous) tonsillitis (sharply pronounced reddening of the tonsils, with whitish spots, not accompanied by malaise and fever), syphilitic seizures in the corners of the lips, syphilis of the oral cavity may occur. There is a general mild malaise, which may resemble the symptoms of a common cold. Characteristic of secondary syphilis is generalized lymphadenitis without signs of inflammation and pain.

During the period of secondary syphilis

During the period of secondary syphilis, skin pigmentation disorders (leukoderma) and hair loss (alopecia) occur. Syphilitic leukoderma is manifested in the loss of pigmentation of various skin areas on the neck, chest, abdomen, back, lower back, and armpits. On the neck, more often in women, a "necklace of Venus" may appear, consisting of small (3-10 mm) discolored spots surrounded by darker areas of the skin. It can exist without change for a long time (several months or even years), despite ongoing antisyphilitic treatment. The development of leukoderma is associated with a syphilitic lesion of the nervous system; during examination, pathological changes in the cerebrospinal fluid are observed.

Hair loss is not accompanied by itching, peeling, by its nature it happens:

• diffuse - hair loss is typical for normal baldness, occurs on the scalp, in the temporal and parietal region;
• small-focal - a vivid symptom of syphilis, hair loss or thinning in small foci located randomly on the head, eyelashes, eyebrows, mustache and beard;
• mixed - both diffuse and small focal are found.

With timely treatment of syphilis, the hairline is completely restored.

Skin manifestations of secondary syphilis accompany lesions of the central nervous system, bones and joints, and internal organs.

Symptoms of tertiary syphilis

If a patient with syphilis was not treated or the treatment was inadequate, then a few years after infection, he develops symptoms of tertiary syphilis. Serious violations of organs and systems occur, the patient's appearance is disfigured, he becomes disabled, in severe cases, death is likely. Recently, the incidence of tertiary syphilis has decreased due to its treatment with penicillin, and severe forms of disability have become rare.

Allocate tertiary active (in the presence of manifestations) and tertiary latent syphilis.

The manifestations of tertiary syphilis are a few infiltrates (tubercles and gums), prone to decay, and destructive changes in organs and tissues. Infiltrates on the skin and mucous membranes develop without changing the general condition of patients, they contain very few pale spirochetes and are practically not contagious.

Tubercles and gummas on the mucous membranes of the soft and hard palate, larynx, nose, ulcerating, lead to a disorder of swallowing, speech, breathing (perforation of the hard palate, "failure" of the nose). Gummy syphilides, spreading to bones and joints, blood vessels, internal organs cause bleeding, perforation, cicatricial deformities, disrupt their functions, which can lead to death.

All stages of syphilis cause numerous progressive lesions of internal organs and the nervous system, their most severe form develops with tertiary (late) syphilis:

• neurosyphilis (meningitis, meningovasculitis, syphilitic neuritis, neuralgia, paresis, epileptic seizures, dorsal tabes and progressive paralysis);
• syphilitic osteoperiostitis, osteoarthritis, synovitis;
• syphilitic myocarditis, aortitis;
• syphilitic hepatitis;
• syphilitic gastritis;
• syphilitic nephritis, nephronecrosis;
• syphilitic eye disease, blindness, etc.

Complications of syphilis

Syphilis is formidable in its complications. In the stage of tertiary syphilis, the disease is difficult to treat, and the defeat of all body systems leads a person to disability and even death. Intrauterine infection of a child with syphilis from a sick mother leads to the occurrence of a severe condition - congenital syphilis, which is manifested by a triad of symptoms: congenital deafness, parenchymal keratitis, Hutchinson's teeth.

Diagnosis of syphilis

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 made with serum, blood plasma and cerebrospinal fluid - the most reliable method for diagnosing syphilis.

Nonspecific serological reactions are: RPR - rapid plasma reagin reaction and RW - Wasserman reaction (compliment binding reaction). Allow to determine antibodies to pale spirochete - reagins. Used for mass examinations (in clinics, hospitals). Sometimes they give a false positive result (positive in the absence of syphilis), so this result is confirmed by carrying out specific reactions.

• Specific serological reactions include: RIF - immunofluorescence reaction, RPHA - passive hemagglutination reaction, RIBT - pale treponema immobilization reaction, RW with treponemal antigen.
• Used to determine species-specific antibodies. RIF and RPGA are highly sensitive tests, they become positive already at the end of the incubation period.
• They are used in the diagnosis of latent syphilis and for the recognition of false positive reactions.
• Positive indicators of serological reactions become only at the end of the second week of the primary period, so the primary period of syphilis is divided into two stages: seronegative and seropositive.

Nonspecific serological reactions are used to evaluate the effectiveness of the treatment. Specific serological reactions in a patient who has had syphilis remain positive for life; they are not used to test the effectiveness of treatment.

Treatment of syphilis

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-treatment 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 the complete negative result of the complex of serological reactions.

In order to prevent syphilis, examinations of donors, pregnant women, employees of children's, food and medical institutions, patients in hospitals are carried out; representatives of risk groups (drug addicts, prostitutes, homeless people). The blood donated by donors is necessarily examined for syphilis and canned.

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