Specific treatment methods for the prevention of syphilis. Does a condom protect against syphilis: how to properly use barrier contraceptives to protect against infection. Prevention of household transmission of syphilis

Prevention is measures aimed at preventing the disease, including preventive treatment.

Timely access to a doctor for examination and treatment.

If any symptoms appear and you suspect a certain infection, do not start any treatment in advance. Seek medical attention immediately and get tested. Visit a doctor - dermatovenereologist, gynecologist or urologist.

Be sure to consult your doctor regularly. Subsequently, do this regularly - 2 times a year for a preventive examination.

The danger of self-medication

You should not self-medicate - this can lead to a delay in the incubation period of syphilis, to false test results and more serious consequences. Self-medication can lead to chronic infection and the development of severe complications. For example, it is not uncommon for neurosyphilis to be diagnosed in patients with neurological problems that were previously treated on their own.

Emergency prevention of syphilis. Use of methods of emergency prevention and contraception.

Emergency prevention of syphilis is a series of measures taken in the event of unprotected sexual intercourse or if a condom breaks during any sexual intercourse. Breaking a condom during intercourse or unprotected intercourse poses a high risk of contracting syphilis.

Emergency prevention of syphilis is possible if carried out correctly. Without a visit to the doctor, the effectiveness of prevention methods available at home is low. For a variety of reasons, these methods do not guarantee protection against syphilis. After their use, the occurrence and development of this STD is quite possible. Washing the genitals, urinating, or douching after sex does not protect against syphilis.

Medical prevention of syphilis

Today, there is such a measure as drug prevention of sexually transmitted diseases. This procedure protects against the disease after unprotected sexual contact with a patient with syphilis and prevents the disease from developing at the initial stage (during the incubation period). Drug prevention of unprotected intercourse is possible within a few days after intercourse.

Drug prophylaxis is, in fact, a preventive treatment that prevents the development of many classic and new sexually transmitted diseases. Therefore, the prevention of casual relationships is consistent with the treatment regimen for acute infection without complications. Drug prophylaxis is a preventive treatment prescribed by a dermatovenereologist and in his presence.

If you still had unprotected sexual intercourse with a casual partner (even if the condom “just” broke), it is better not to take risks and take medical prophylaxis after a casual relationship. Medical prophylaxis is also carried out in our department.

Be sure to consult with a venereologist whether prevention is indicated for you. Drug prophylaxis after casual sex is an extreme (reserve) method for the prevention of sexually transmitted diseases. For many reasons, it cannot be carried out often (especially regularly). Its frequent use can lead to various complications.

Laboratory diagnostics and tests for syphilis

3-4 weeks after contact, it is imperative to undergo a diagnosis for sexual infections - pass a control analysis with full preparation. Immediately after sexual intercourse, it does not make sense to be examined for syphilis. The result of laboratory tests will still not be reliable and informative, because. most laboratory diagnostic methods do not detect syphilis at the stage of the incubation period.

The incubation period for syphilis is on average ... days. To determine syphilis, when a hard chancre appears, a smear is taken from it for microscopic examination. In his absence, a blood test is taken. It is done no earlier than 6 weeks after sexual contact.

Table of the effectiveness of methods for labdiagnosis of syphilis from ... a week.

Lack of immunity after suffering syphilis.

The fact that you have already had syphilis will not protect you from reinfection. Even after you have been successfully treated, you can still be re-infected.

Measures to prevent syphilis are varied. However, the key ones will be various tips and recommendations, that is, non-drug methods that can protect a person from a serious illness called syphilis.

If there is an infected person in the environment of a person, he can be advised:

Use separate dishes and cutlery;
Refrain from sexual intercourse with an infected person. Kissing is also not recommended, since transmission of the pathogen can also occur through saliva.

Subject to the above recommendations, the risk of contracting syphilis in everyday life is practically reduced to zero. There is a great danger of contracting an infection through sexual contact with an unfamiliar person without using a condom (). Of course, in some cases, a condom may break or a healthy person may be raped by an infected person. The tactics of action in such cases will be completely different.

Emergency prevention of syphilis: injections and more

If, however, unwanted sexual intercourse has occurred, immediately after it, you can take some preventive measures:

Within two hours after sexual intercourse, preventive therapy is required. To do this, you can contact any medical institution or anti-venereal point of care. It will be possible to put an injection. But most often the genital organs are treated with special antibacterial solutions. Such solutions are capable of destroying the pathogen. A week later, you will need to pass an analysis that will confirm the presence or absence of infection. Only after following all these recommendations will it be possible to have sex again, but preferably with a trusted partner;
It is desirable to hand over the analysis also in two weeks. The indicated time is the incubation period of syphilis, and that is why in a couple of weeks it can be detected with the help of an examination;
Do not use self-treatment measures. This may exacerbate the situation.

Such preventive treatment is usually carried out with antibiotics from the penicillin () group. However, treatment can be started only after examination and consultation with a venereologist, and also only if the disease is still at the stage of incubation. If such treatment is started, for example, at the first stage of the course of syphilis, this can lead to a prolonged course of the disease due to an insufficient dose of antibiotic.

Ceftriaxone for the prevention of syphilis is also effective.

Syphilis: preventive measures of a preventive nature

Using a condom for all types of sexual intercourse, whether it be vaginal, oral or anal sex;
Drug prevention of syphilis includes the use of contraceptives during sex, such as vaginal tablets and capsules, creams and gels. Their action is to protect against unwanted pregnancy and germs. The most popular are Benateks, Kontrateks, Farmateks.

Prevention after syphilis should again consist in competent sexual behavior and conscious sexual intercourse. It is necessary to begin to live sexually only when the patient knows that he has completely recovered from such a complex and serious disease.

Now we will tell you how doctors prevent an epidemic by solving the issue globally.

Syphilis is a contagious disease with very serious damage to human health. Such diseases are socially significant. This means that the causative agent of the disease is under special control, and the utmost attention is paid to each identified case. The organization of public prevention of such infections is the responsibility of the state. Everyone is tested for treponema indiscriminately before any medical intervention, and periodically everyone whose work is associated with increased social responsibility (for example, teachers, doctors, cooks), or who are in a group with an increased risk of infection.

Public prevention of syphilis

Who is at risk for syphilis?

Basically, these are people who have frequent and promiscuous sexual intercourse, as well as people who do not take care of themselves and their hygiene. In addition, all workers exposed to occupational infection are at risk for syphilis. We single out the main groups in descending order of the risk of infection:

Health care workers (especially obstetrician-gynecologists, surgeons, dentists, laboratory assistants and pathologists).
Employees of hairdressing and beauty salons (beauticians, manicurists, hairdressers, tattooists).
People who neglect the basic rules of hygiene (homeless people, alcoholics, drug addicts).

Who should be screened for syphilis?

Upon admission to study or work associated with increased risk or social responsibility, they are required to pass a medical examination. And this examination always includes tests for syphilis, as well as a number of other diseases. This study is carried out not because you are suspected of something, but because it is a screening, i.e. obligatory for all, regardless of external manifestations. Such a strict approach to control the safety of the population is due to the fact that syphilis has latent forms and is highly contagious.

Mandatory screening is subject to:
Workers of various professions (both when entering a job and during it), students of schools and universities. Most often - 4 times a year - employees who have close contact with young children are examined for syphilis: kindergarten teachers, nurseries, doctors and honey. staff in maternity hospitals and pediatric hospitals. The rest of the employees undergo a medical examination 1 or 2 times a year. These include:

all medical workers,
employees of schools and educational institutions,
food business workers
transport workers,
employees of hotels, hostels and hostels,
employees of hairdressing salons, beauty parlors, baths, saunas and other enterprises providing sanitary and hygienic services,
trade workers.

Pregnant. All pregnant women are examined three times: at the first visit to the antenatal clinic, at 28-30 weeks of pregnancy and two to three weeks before delivery. When syphilis is detected, special treatment is carried out. Infection with syphilis during pregnancy or during the last two years before it is extremely dangerous for the child to develop congenital syphilis.

Patients on inpatient treatment, as well as donors of blood, sperm and other biological fluids and substrates. Any admission to the hospital is accompanied by a study for syphilis and a number of other diseases (including HIV-infection).

How is a screening test for syphilis done?

During the examination, a blood test is performed for the Wasserman reaction, which is indicated as. In fact, only the name has traditionally remained from the classical Wassermann reaction, discovered at the beginning of the 20th century. The modern screening method is the microprecipitation reaction, which can be referred to as RMP , MP , PRP or VDRL. The syphilis test does not have an “expiration date”, it is valid until the next casual unprotected intercourse.

The screening test for syphilis is not a primary test and may give false positive results. If the results are positive, an additional study is carried out by another method.

Much less often, this analysis gives false negative results. As a rule, this occurs during the incubation or tertiary period of the disease.

Syphilis vaccination - reality or fiction?

There is no vaccine for syphilis. This is due to the fact that after the illness, the body does not develop stable specific immunity and a new infection is possible. Therefore, vaccination, i.e. artificial infection with weakened bacteria is pointless.

Individual prevention:

But all public preventive measures still do not guarantee absolute protection against meeting with a carrier of syphilis. Therefore, we summarize and recall what can be done for personal prevention of the disease.

Safety

Everything is standard here: avoiding casual sex and using a condom during sexual intercourse. It must be remembered that a condom must be used for any form of sexual intercourse (oral, anal). In addition to the condom, there are additional means of protection: vaginal suppositories, vaginal capsules and tablets, creams and gels that have contraceptive and antimicrobial effects. These include: Benzalkonium chloride (Benatex, Gynecotex, Kontratex, Pharmatex), Nonoxynol (Sterilin, Patentex Oval N) and others. These products reduce the likelihood of infection, but protect against it completely, so they cannot be a good substitute for a condom.

Emergency prevention

It is carried out no later than 2 hours after accidental unprotected contact. It can be carried out at home or in round-the-clock prevention centers with KVD.

It is carried out with the help of special means (chlorhexidine bigluconate, miramistin, potassium permanganate, silver nitrate, etc.) in accordance with the basic rules for the prevention of sexual infections. Emergency prophylaxis is a last resort and is carried out only with accidental unprotected contact. It cannot replace a condom, as it does not completely protect against infection, but only reduces its likelihood. In addition, frequent vaginal douching can lead to the development of bacterial vaginosis or thrush.

Drug (drug) prevention

If there was sexual or close household contact with a patient with a primary or secondary form of syphilis, then during the first two months (or until the first signs of syphilis appear), preventive (preventive) treatment of syphilis is indicated.

Specific - drug - prevention of syphilis can only be prescribed by a doctor, since self-treatment is dangerous for the development of complications.

Penicillin preparations are prescribed in a short course:

Benzathine benylpenicillin at a dose of 2.400.000 ED intramuscularly once, or
Bicillin 3 at a dose of 1.800.000 ED
Bicillin 5 at a dose of 1.500.000 ED intramuscularly 2 injections per week for a total of 4 injections, or
Benzylpenicillin novocaine salt at a dose of 600.000 ED intramuscularly, 1 time per day, for 7 days.

Preventive treatment is carried out only(!) during the incubation period and only(!) after examination by a venereologist. If preventive treatment is started after the onset of the disease (and it is not always noticeable), then the dose of antibiotics may not be enough to completely cure syphilis, and this will lead to the formation of a long-term and difficult to treat form of the disease.

Confirmed syphilis in the family

Separately, it is worth mentioning the measures for the prevention of syphilis in the family. If one of the family members, husband or wife, is sick with syphilis, it is important to protect children and other family members from this disease. It is necessary for the duration of treatment to allocate individual dishes, towels, personal hygiene products to a person with syphilis. It is important for children to forbid playing and sleeping on the parent's bed, taking other people's toothbrushes, towels, and washcloths. Since syphilis can be transmitted through saliva, it is necessary to exclude kisses and any other touch of the mucous membrane with the body or things (nipples, spoons, toys) of children.

For spouses, it is important to exclude sexual contact and even kissing during treatment, including if both are infected.

Usually, for every case of syphilis, doctors isolate the infected person, and all family members and close contacts are prescribed a careful examination and, if signs of the disease are not detected, preventive treatment before the test results are available. There is no need to be afraid and hide. Any inconvenience associated with these measures is mere trifles compared to the lives broken by syphilis.

Occupational syphilis

Occupational syphilis affects medical workers, hairdressers, beauty salons and beauty parlors. For personal prevention, as well as to prevent infection of customers, all employees must wear disposable gloves and use only sterile instruments. Everyone must have a medical book, and the enterprise must have a valid license.

Syphilis is a socially significant disease. Treponema Pallidum (the causative agent of pathology) is under state control and special attention is given to each detected case. To avoid infection and prevent the development of syphilis, public and individual preventive measures have been developed, which we will discuss in the article.

Syphilis is a dangerous disease that is easier to prevent than to treat. Compliance with public and individual preventive measures will avoid infection and development of syphilis.

Public prevention of syphilis

Public preventive measures include a set of procedures and examinations that are carried out by health workers:

Regular examinations of the population for the purpose of early diagnosis of the disease;
Registration and regular examination of pregnant women (at least 3 times during the gestation period);
Sanitary and educational activities among adolescents;
Treatment, clinical examination of infected patients, explanatory work.

As part of public prophylaxis, all patients, without exception, are checked for treponema before any medical manipulations. Periodic examination for infection are people of social professions (teachers, cooks, doctors) and patients with an increased likelihood of contracting treponema.

The risk group includes people who lead a promiscuous sex life, do not observe personal and intimate hygiene, as well as workers who are prone to occupational infection: medical staff (surgeons, obstetrician-gynecologists, pathologists, laboratory assistants, dentists), employees of beauty salons and hairdressers.

Individual prevention of syphilis

Compliance with public preventive measures cannot provide absolute protection against infection with pale treponema. Following individual preventive measures will also help to avoid infection and the development of the disease.

Protective prophylaxis

As part of preventive measures, men and women should avoid casual intimate relationships. It is important to use barrier contraceptives (condoms) every time you have sex. In this case, the condom should be used not only for vaginal, but also for anal intimate relationships.

There are also other additional methods of protection: vaginal tablets and capsules, gels, creams that have an antimicrobial and contraceptive effect. They reduce the risk of infection, but do not guarantee one hundred percent results.

Emergency prevention of syphilis

Emergency prophylaxis consists in douching the vagina with the help of special solutions. It is important to douche no later than two hours after unprotected intimacy. It can be carried out at home or in preventive round-the-clock centers. Emergency prophylaxis is performed in extreme cases, only with accidental unprotected sexual contact. It does not replace the condom, because it does not completely protect against infection, but only reduces its risk. Moreover, frequent douching can disturb the vaginal microflora, provoking the development of bacterial vaginosis or thrush.

Medical prevention of syphilis

If a person has been in contact with a patient with primary or secondary syphilis, had unprotected sexual intercourse, preventive (prophylactic) therapy for syphilis is carried out for 2 months or until the first manifestations of the disease appear. At the same time, the use of antibacterial drugs of the penicillin group is indicated (if they are intolerant or ineffective, other drugs are prescribed). Antibiotics for the prevention of syphilis are used in a short course in the form of intramuscular injections.

Preventive treatment is prescribed only during the incubation period. Carrying out preventive therapy after the manifestation of the disease can lead to an incomplete cure of the pathology, as well as the formation of a severely treatable and long-term form of the disease.

Tablets and other drugs for the prevention of syphilis are selected and prescribed only by a doctor after a preliminary consultation and examination. Attempts to self-treat can provoke the development of serious consequences.

Syphilis: preventive measures in the family

Special attention should be paid to the prevention of syphilis in the family. When one of the family members (wife, husband) is sick with syphilis, it is necessary to protect children and other family members from this disease. For the period of treatment, the sick person needs to allocate separate dishes, personal hygiene products, and a towel. Children are not recommended to sleep and play in the bed of their parents, use other people's washcloths, brushes, cups and other household items. Since spirochete pallidum can be transmitted through saliva, it is important to exclude kissing and any contact of the mucous membrane with things (toys, spoons, pacifiers) and the child's body. Spouses at the time of treatment should refrain from sexual intercourse and kissing.

As a rule, in each case of detection of syphilis, the infected patient is isolated, and a comprehensive examination is prescribed for family members. In the absence of signs of pathology, preventive treatment is carried out.

Prevention of congenital syphilis

In a child, congenital syphilis develops if the mother becomes pregnant against the background of the disease or becomes infected with the infection during gestation. Infection of the fetus occurs through the placenta at 4-5 months of gestation. Before the deadline, the baby does not show signs of syphilis.

During pregnancy, each woman undergoes a serological examination for the presence of treponema three times: at the first visit to the doctor, at registration and at 24-30 weeks of gestation. If an infection is detected, appropriate treatment is prescribed to help prevent infection of the fetus. For pregnant women, special treatment regimens have been developed. The choice of the most optimal tactics of therapeutic action is carried out by the attending physician, taking into account the form and stage of the disease, the duration of pregnancy and the patient's condition.

Preventive treatment of syphilis is prescribed to every pregnant woman who, before the moment of conception, suffered the disease and is not deregistered. If the main therapy was carried out in the early stages of gestation, then preventive treatment is prescribed at 6-7 months. If the main course was carried out at a later date, preventive therapy is prescribed after 2 weeks.

It also screens, treats and prevents syphilis in newborns whose mothers were undertreated during pregnancy or before conception. Children are prescribed penicillin antibiotics. The dose of the drug is selected taking into account the age and weight of the child.

Treponema pallidum infection can lead to damage to the cardiovascular, central nervous, digestive, respiratory, musculoskeletal systems, organs of hearing, vision, and other disorders. Despite the effectiveness of the developed treatment regimens, the first signs of syphilis may go unnoticed and treatment will begin late. To prevent infection with the virus and avoid the development of serious complications will allow the observance of individual and public prevention measures.

Specific treatment is prescribed to a patient with syphilis after the diagnosis is established. The diagnosis is established on the basis of the clinical picture, the detection of the causative agent of the disease (with appropriate clinical manifestations) and the results of a serological study (CSR, RIF and, in most cases, RIT). Such specific tests for confirming the diagnosis as ELISA, passive hemagglutination reaction - RPHA can also be used.

Preventive treatment carried out in order to prevent syphilis to persons who have had sexual or close household contact with patients with infectious forms of syphilis. Preventive treatment is not prescribed to persons who have had sexual or close household contact with patients with tertiary, late latent, syphilis of the internal organs, nervous system. Also, preventive treatment is not carried out for persons who have had sexual contact with patients who are prescribed preventive treatment (ie, with contacts of a second contact). If patients with syphilis are identified in the children's team, preventive treatment is prescribed to children in cases where close household contact with employees who had manifestations of primary or secondary syphilis on the oral mucosa cannot be ruled out.

Preventive treatment carried out by pregnant, sick or ill with syphilis, and children born to such mothers.

trial treatment can be prescribed for suspected specific damage to the internal organs, nervous system, sensory organs, musculoskeletal system, when it is not possible to confirm the diagnosis with convincing laboratory data, and the clinical picture does not allow us to exclude the possibility of a syphilitic infection.

Patients with gonorrhea with unidentified sources of infection are subject to preventive antisyphilitic treatment if it is impossible to establish dispensary observation for them (homeless people, vagrants, etc.). If such a patient has a permanent place of residence and work, then preventive treatment against syphilis is not carried out for him, but after treatment of gonorrhea, he must be under clinical and serological observation for 3 months.

Each patient with syphilis undergoes a thorough clinical and laboratory examination in the hospital. The study of cerebrospinal fluid for diagnostic purposes is carried out in patients with clinical symptoms of damage to the nervous system, as well as in latent and late forms of syphilis.

Prior to the start of treatment, it is necessary to find out the question of the tolerability of penicillin preparations (or other antibiotics) in the past and record this in the medical records. In addition, 30 minutes before the first injection of penicillin, as well as before each injection of penicillin durant preparations, 2 tablets of one of the antihistamines should be prescribed.

Schemes for the treatment of patients with syphilis

Preventive treatment. Preventive treatment is carried out for persons who have sexual or close household contact with patients with early stages of syphilis, if no more than 2 months have passed since the moment of contact.

Treatment is carried out on an outpatient basis with bicillins 1, 3, 5, in single doses, respectively, 1,200,000 IU, 1,800,000 IU and 1,500,000 IU, 2 times a week, for a course of 4 injections. Benzathinepenicillin (retarpen, extencillin) is administered once at 2,400,000 IU intramuscularly in a two-stage manner. Retarpen is dissolved in 5 ml of a 0.25% solution of novocaine, water for injection, physiological saline. Extencillin is dissolved in 8 ml of a solvent and injected into each buttock, 1,200,000 IU.

Preventive treatment of recipients who received the blood of patients with syphilis is carried out within a period of not more than 2 months after transfusion with a double administration of drugs of 2,400,000 IU with an interval of 1 week.

In the hospital, they are treated with sodium or potassium salt of penicillin - 400,000 IU per injection 8 times a day (every 3 hours) for 14 days; for a course of 44,800,000 units. Perhaps the use of novocaine salt of penicillin 600,000 IU 2 times a day for 14 days; per course - 16 800 000 units.

Persons who have passed from 2 to 4 months from the moment of contact with patients with syphlis are subjected to a double clinical and serological examination (with a study of DAC, RIT, RIF) with an interval of 2 months. If more than 4 months have passed since the contact, a single clinical and serological examination is performed.

Treatment of patients with primary and secondary fresh syphilis carried out according to one of the following methods: bicillin-1, 3, 5. Single dose - 1,200,000 IU, 1,800,000 IU, 1,500,000 IU, respectively; the number of injections - 7 (for primary seronegative syphilis), 8 (for primary seropositive), 10 (for secondary fresh syphilis). The first injection is carried out in an incomplete dose of 300,000 IU; the second - in a full single dose, is carried out in a day; subsequent injections are carried out 2 times a week.

The novocaine salt of benzylpenicillin is used at 600,000 IU 2 times a day for 16 days; the course dose is 19,200,000 IU.

Treatment is carried out with water-soluble penicillin, which is administered intramuscularly at 400,000 IU every 3 hours for 14 days; course dose - 44,800,000 IU (for the primary seronegative period of syphilis). With primary seropositive and secondary fresh syphilis, treatment lasts 16 days, on the 16th day, 3 hours after the end of penicillin therapy, bicillin-3 is administered once at a dose of 4,800,000 units (2,400,000 units intramuscularly in each buttock) or bicillin-5 in dose of 3,000,000 IU.

In primary seronegative syphilis, benzathinepenicillin preparations are administered once intramuscularly at a dose of 2,400,000 units. In primary seropositive and secondary fresh syphilis, retarpen or extencillin is administered at a dose of 2,400,000 IU twice with an interval of 1 week.

Treatment of patients with secondary recurrent and latent early syphilisbicillin-1, 3, 5. For the first injection, a dose of 300,000 IU is used, for subsequent injections, a single dose of 1,200,000 IU, 1,800,000 IU, 1,500,000 IU, respectively. Injections are carried out 2 times a week, the number of injections is 14, regardless of which of the bicillins is used.

Novocaine salt of penicillin is used at 600,000 IU 2 times a day for 28 days.

Treatment is carried out with water-soluble penicillin 400,000 IU 8 times a day for 28 days.

Patients with secondary recurrent and early latent syphilis are given 3 injections of extencillin, 2,400,000 units each, with an interval of 1 week.

In the treatment of patients with secondary recurrent and latent early syphilis with retarpen, the first injection is carried out at a dose of 4,800,000 IU (2,400,000 IU in each buttock), the second and third injections - 2,400,000 IU with an interval of 1 week.

Treatment is carried out with water-soluble penicillin (sodium salt) intramuscularly in single doses of 1,000,000 IU (penicillin is diluted in 2 ml of saline or distilled water) 6 times a day for 28 days; course dose - 168,000,000 units).

In the malignant course of syphilis, transfusion syphilis and early neurosyphilis, the latter technique is preferable in combination with non-specific and symptomatic therapy.

In those cases when in patients with latent early syphlis, by confrontation, study of anamnesis and according to laboratory tests, the duration of the disease is reliably established, corresponding to primary seropositive or secondary fresh syphilis, the treatment of these patients can be carried out according to the methods recommended for the treatment of these stages of syphilis.

Specific treatment of patients with secondary recurrent and early latent syphilis should be combined with non-specific therapy.

Principles of treatment of patients with syphilis with concomitant infections of the genitourinary tract. Patients with syphilis should be tested for HIV and other sexually transmitted infections.

If a patient with syphilis has gonorrhea, treatment is carried out with antibiotics that are active against both gonococcus and treponema pallidum (penicillin preparations, doxycycline, sumamed).

With a combination of early forms of syphilis and chlamydial infection, or syphilis, gonorrhea and chlamydial infection, treatment with sumamed (azithromycin) is recommended. The treatment is carried out for 14 days, the drug is applied 0.5 g 1 time per day (or 0.25 g 2 times a day) 2 hours after meals or 1 hour before meals. On the first day of treatment, the dose of sumamed is 1.0 g, taken in one or two piems (morning and evening).

If trichomoniasis is detected in a patient, its treatment is carried out simultaneously with antisyphilitic therapy.

If HIV antibodies are detected in a patient, he is sent for further treatment and constant monitoring to the regional AIDS treatment center with appropriate recommendations regarding the treatment of syphilis.

If possible, patients with syphilis should be screened for other sexually transmitted infections of the urogenital tract, followed by treatment according to the diagnosis at the end of syphilis therapy. It is also possible to simultaneously treat concomitant infections with drugs that are highly effective against pale treponema.

Treatment of patients with late late syphilis. Treatment begins with the preparation of biyoquinol 2 ml every other day until 12-14 ml of the drug is obtained, after which penicillin therapy is added at 400,000 IU after 3 hours for 28 days. The total dose of biyoquinol is adjusted to 40-50 ml. In this technique, biyoquinol can be replaced by bismoverol, which is used 1 ml every other day or 1.5 ml 2 times a week; for a course of 18-20 ml.

During penicillin therapy, it is advisable to use chymotrypsin 5 mg intramuscularly 2 times a day. Chymotrypsin promotes better penetration of the antibiotic into organs and tissues.

If there are contraindications to the appointment of bismuth drugs, then the treatment is carried out with two courses of penicillin 400,000 IU every 3 hours for 28 days. Before the start of the first course, erythromycin, tetracycline or oletethrin 0.5 g four times a day are prepared for 10 days. In the second course, bicillins may be used instead of soluble penicillin. Bicillin-1 is administered in a single dose of 1,200,000 IU, bicillin-3 - at a dose of 1,800,000 IU, bicillin-5 - at a dose of 1,500,000 IU; injections 2 times a week; for a course of 7 injections.

Specific treatment of patients with late latent syphilis should be combined with the appointment of non-specific agents. Treatment of patients with latent unspecified syphilis is recommended to be carried out individually (similar to late or early latent syphilis).

Treatment of patients with visceral and tertiary syphilis. Treatment of patients with visceral syphilis should include, in addition to specific, also non-specific and symptomatic drugs and be carried out under the supervision of a therapist.

Specific treatment of patients with visceral and tertiary syphilis is carried out according to the scheme of late latent syphilis with a longer preparation with biyoquinol (up to a dose of 20 ml). In the treatment of late syphilitic hepatitis, as well as specific lesions of the kidneys and urinary tract, bismuth preparations are not prescribed. In other cases, the question of the use of bismuth is decided individually.

In syphilitic aortitis complicated by aortic aneurysm or aortic valvular insufficiency, the preparation of biyoquinol should begin with a single dose of 1 ml (3 injections), followed by an increase to 1.5 ml (3 injections) and then to 2 ml. After receiving 25-30 ml of the drug, penicillin therapy is added. The latter is started with a single dose of 50,000 IU after 3 hours. An increase in a single dose is carried out every other day according to the following scheme: 50,000 - 100,000 - 200,000 - 400,000 IU. The duration of penicillin therapy is 28 days. With contraindications to the use of bismuth, preparation is carried out with erythromycin or oletethrin 0.5 g 4 times a day for 2 weeks. If there are contraindications to the appointment of bismuth drugs, treatment is carried out with two courses of penicillin, 400,000 IU every 3 hours for 28 days (in the second course, from the very beginning, a single dose of penicillin is 400,000 IU).

If clinical symptoms of the disease remain after the penicillin-bismuth course, it is advisable to prescribe an additional 2 courses of bismuth therapy, one of which is carried out with biyoquinol (40-50 ml per course), the other with bismoverol (16-20 ml per course).

Specific treatment of visceral syphilis is carried out under the control of the functional state of the affected organ (blood tests, urine tests, biochemical tests, blood coagulation parameters, ECG, etc.).

The choice of treatment for gummous lesions depends on the location of the gum and the general condition of the patient. With tertiary syphilis with the localization of gumma on the skin, treatment is carried out similarly to late latent syphilis.

Treatment of patients with neurosyphilis. In early forms of neurosyphilis, treatment is carried out according to the following method: water-soluble penicillin (sodium salt) intramuscularly in single doses of 1,000,000 IU 6 times a day for 28 days.

To increase the concentration of penicillin in the cerebrospinal fluid, it is advisable to use drugs that delay the excretion of antibiotics from the body, in particular, probenecid 0.5 g 4 times a day, or etamide 1.05 g (3 tablets) 4 times a day for 10 days.

Patients with late neurosyphilis, with the exception of patients with atrophy of the optic nerves, are subject to treatment according to the schemes of late latent syphilis.

Each course of specific therapy must be supplemented with vitamins, general strengthening and stimulating agents. Treatment should be carried out under the supervision of a neuropathologist and an ophthalmologist: the first two courses in the hospital (and in case of atrophy of the optic nerves - all 3 courses in the hospital).

With primary atrophy of the optic nerves, the first course of treatment begins with vitamin saturation:

taking vitamin A 33,000 IU 2 times a day in any of the following forms: dragees or retinol acetate tablets; oil solution of retinol acetate in capsules; tablets or oil solution of retinol palmitate;

taking a complex of vitamins in the form of a mixture in powder: ascorbic acid 0.15 g, nicotinic acid 0.05 g, glutamic acid 0.5 g, riboflavin (vitamin B 2) 0.025 g;

intramuscular injections of vitamins B 1 (thiamine chloride 5% - 2 ml daily No. 30), B 6 (pyridoxine 5% - 1 ml every other day No. 15) and B 12, 200 mcg daily No. 30;

taking calcium preparations (preferably calcium glycerophosphate) 0.1 g 3 times a day.

In parallel, penicillin therapy begins with low doses (50,000 IU), with a further increase by 50,000 IU every other day (50,000 - 100,000 - 150,000 - 200,000 IU). Penicillin in a single dose of 200,000 units is used for a week, after which the single dose is increased to 400,000 units. The duration of penicillin therapy is 28 days.

In the future, 2 more courses of penicillin therapy are carried out in a single dose after 3 hours for 28 days. The interval between courses is 1 month.

In parallel with specific therapy in each course, non-specific, stimulating and vitamin therapy should be carried out, systematic observation of an oculist is necessary.

Reserve methods of treatment of patients with syphilis. In case of intolerance to penicillin preparations, broad-spectrum antibiotics are used: erythromycin, tetracycline, oletethrin, doxycycline, sumamed.

For preventive treatment, erythromycin, tetracycline and oletethrin are used 0.5 g 4 times a day; doxycycline capsules 0.1 g 3 times a day for 14 days.

With fresh forms of syphilis, these antibiotics in the same doses are used for 20 days in the primary period of syphilis, 25 days in the secondary fresh. In secondary recurrent and early latent syphilis, 2 courses of 30 days of the above antibiotics in the indicated doses are recommended, the interval between courses is 2 weeks.

With simultaneous intolerance to penicillin, erythromycin and tetracyclines, treatment can be carried out with cefazolin (cefamisin). The drug is used intramuscularly at 1.0 g six times a day for 14 days with primary seronegative, 16 days with primary seropositive and secondary fresh syphilis, 28 days with secondary recurrent and latent early syphilis.

In the treatment of fresh forms of syphilis, sumamed (azithromycin) can be used orally at 0.25 g twice a day or 0.5 g once a day for 14 days.

With late latent syphilis, reserve antibiotics are used in the amount of 2-3 courses. The duration of antibiotic therapy is 28 days, the interval between courses is 2 weeks.

Nonspecific therapy of patients with syphilis. Non-specific therapy is indicated for latent, late forms of the disease, syphilis of the nervous system and internal organs, congenital syphilis, with comorbidities, including alcoholism, with signs of a malignant course of the disease, with a slowdown in negative serological reactions, serorelapses and seroresistance. It is advisable to prescribe nonspecific therapy for secondary recurrent and early latent syphilis, and with indications and with its fresh forms.

The methods of non-specific therapy include: pyrotherapy, vitamin therapy, biogenic stimulants and agents that affect tissue metabolism (aloe extracts, placenta, vitreous body, splenin, asparkam, etc.), immunomodulators (decaris, methyluracil, sodium nucleinate, pyrroxane), UV reinfusion - irradiated autoblood. Nonspecific therapy should be prescribed after a thorough examination of the patient, taking into account the indications and contraindications for a particular drug.

Pyrotherapy leads to increased heat production processes, improved blood and lymph circulation in the affected organs and tissues, activation of the histiocytic-reticular system, increased phagocytosis, enzymatic and secretory activity of the stomach and salivary glands. Among the pyrogenic drugs, pyrogenal and prodigiosan are the most tested and recommended.

Pyrogenal - a complex polysaccharide complex - is prescribed as intramuscular injections into the upper outer quadrant of the buttock, at an initial dose of 5-10 mcg, with a gradual increase by 10-30 mcg per injection, increasing to 120-150 mcg, depending on the reaction of the body. The drug is administered 1 time in 2-3 days, for a total of 10-15 injections per course of treatment.

Prodigiosan - lipopolysaccharide, similar in effect to pyrogenal on the body, is administered intramuscularly 2 times a week in doses from 25 to 100 mcg; only 4-6 injections per course.

Biogenic stimulants (FiBS for injection, suspension and extract of the placenta for injection, splenin, plasmol, vitreous body, polybiolin) are prescribed as subcutaneous injections of 1 ml daily for 10-20 days. Splenin is administered intramuscularly daily at 2 ml for 10 days, polybiolin is administered intramuscularly daily at 5 ml of solution (the contents of the vial - 0.5 g - are dissolved in 5 ml of 0.25-0.5% novocaine solution) for 10 days.

vitamins FROM , groups AT , aevit used simultaneously with specific treatment throughout the course of treatment of patients with syphilis. Ascorbic acid is used 0.2 g 3 times a day, aevit in capsules 1 capsule 3 times a day. Vitamins B 1 , B 6 , B 12 in the form of ampoule solutions are administered intramuscularly every other day, for a course of 10-15 injections. Individual patients with syphilis should include adaptogenic drugs in complex therapy - pantocrine, eleutherococcus extract, Rhodiola rosea, ginseng tincture, lemongrass tincture.

Immunocorrective therapy is usually prescribed in cases where there are signs of a malignant course of the disease, in the presence of concomitant diseases developing against the background of immunosuppression (mucocutaneous candidiasis, chronic pyoderma, etc.), also in patients suffering from chronic alcoholism at the same time. Immunocorrective therapy is recommended to be carried out under the control of immunograms.

Levamisole (decaris) increases the functional activity of phagocytes and T-lymphocytes. The drug is prescribed at 150 mg daily for 3 days, followed by a break for 4 or 7 days, in total 2-4 such cycles (under the control of the number of blood cells). Adverse reactions are possible in the form of urticaria, nausea, vomiting, toxic effects on erythrocytes and leukocytes.

Methyluracil accelerates the processes of cellular regeneration, stimulates cellular and humoral resistance factors. It is prescribed in cycles of 0.5 g 4 times a day for 10-14 days with 5-7 day breaks, in total 2-3 cycles.

Nucleinate sodium increases the functional activity of immunocompetent cells, stimulates factors of nonspecific resistance of the organism. The drug is prescribed in two-week cycles of 0.1 g 3 times a day with a week break.

Pyrroxan in the complex therapy of syphilis, it is used mainly in people suffering from chronic alcoholism. It has a detoxifying effect, stops the effects of alcohol withdrawal, improves the absorption of oxygen by tissues. It is used orally in tablets of 0.015 g 3 times a day, 2 cycles of 10 days, with a break of 7-10 days.

Taktivin and thymalin - preparations of a polypeptide nature, isolated from the thymus of cattle. In immunodeficiency states, these drugs normalize the quantitative and functional parameters of the T-system of immunity, the functional activity of hematopoietic stem cells, enhance phagocytosis, and normalize other indicators of cellular immunity. It is advisable to start the introduction of immunomodulators from the 10-12-14th day of antibiotic therapy.

Taktivin is injected subcutaneously in 1 ml of a 0.01% solution once a day for 3 days in a row, then 2 times a week; for a course of 6-8 injections.

Timalin is administered intramuscularly at 10 mg (dilute in 1-2 ml of isotonic sodium chloride solution until a uniform suspension is obtained) every other day; for a course of 6-8 injections.

Thymogen - synthetic peptide - glutamyltryptophan. It normalizes the number of T-helpers, restores the ratio of immunoregulatory subpopulations of T-lymphocytes. Thymogen is administered intramuscularly at 100 mcg (dissolved in 1 ml of isotonic sodium chloride solution) 2 times a week; for a course of 5-8 injections.

Specific, prophylactic and preventive treatment of pregnant women

If early stages of syphilis are detected in pregnant women, treatment is carried out according to one of the methods described in the relevant sections of these recommendations.

If primary or secondary fresh syphilis is detected in pregnant women, specific treatment is carried out with penicillin at 400,000 units every 3 hours for 14-16 days, if secondary recurrent or early latent syphilis is detected, in those single or daily doses for 28 days. When latent late syphilis is established, treatment is carried out with three courses of penicillin, 67,200,000 IU per course, in single doses of 400,000 IU every 3 hours, with an interval between courses of 7-10 days.

Treatment pregnant women, retarpen or extencillin is made in accordance with the diagnosis in the above doses, but at least two injections are made. Preventive treatment of pregnant women is carried out with 2-3 antibiotic injections of 2,400,000 IU with an interval of 1 week.

For the prevention of congenital syphilis, a double serological examination of pregnant women is recommended: in the first half of pregnancy (when attending an obstetrician-gynecologist for pregnancy registration) and in its second half (at the 6-7th month, but no later than maternity leave). In an unfavorable epidemiological situation, by decision of the health authorities, a three-time serological examination of pregnant women for syphilis may be introduced. The third examination is carried out immediately before childbirth. With positive results of CSR, a differential diagnosis is made using RIT, RIF and other specific serological reactions. In case of negative results of these tests, the pregnant woman should be under clinical and serological control with a monthly study of CSR, RIT, RIF before delivery and within 3 months after them.

In exceptional cases, in the absence of the possibility of studying RIT and RIF or other specific seroreactions, in pregnant women with a sharply positive CSR, the study of CSR is repeated, and with a sharply positive result, a diagnosis of latent syphilis is made. With repeated weakly positive results of CSR, a pregnant woman is subject to careful clinical and serological monitoring in dynamics in order to differentiate biologically false positive results of CSR due to pregnancy.

Women who, after full-fledged treatment, have persistent CSR negativity (negative results for at least a year before pregnancy), are not subject to prophylactic treatment during pregnancy. An exception may be women with a persistent sharp positivity of RIT and / or RIF without a tendency to decrease.

For women who have fluctuated in TFR positivity (from negative to positive) during the year before pregnancy, or who have maintained TFR positivity, prophylactic treatment during pregnancy is recommended.

Women who have received preventive antisyphilitic treatment are not subject to prophylactic treatment during pregnancy.

Preventive treatment pregnant women carried out using one of the following methods:

method No. 1. Water-soluble penicillin is administered at 400,000 IU 8 times a day for 14 days;

method No. 2. Novocaine salt of benzylpenicillin is administered at 600,000 IU 2 times a day for 14 days;

method No. 3. Bicillins-1, 3, 5 are administered at a dose of 1,200,000 IU, 1,800,000 IU, 1,500,000 IU, respectively, 2 times a week; for a course of 7 injections.

If specific treatment is carried out in the first months of pregnancy, then preventive treatment should be started no later than 6-7 months. If specific treatment is carried out in late pregnancy, then prophylactic treatment follows it without interruption.

Preventive treatment of pregnant women is carried out in accordance with these recommendations (see section “Preventive Treatment”).

In the treatment of pregnant women with intolerance to penicillin drugs, it is not advisable to use erythromycin, since, having a good clinical effect in the mother, it does not sufficiently penetrate the placenta and does not prevent the occurrence of congenital syphilis in the child. Tetracycline drugs prevent congenital syphilis, but are deposited in the bone tissue and teeth of the fetus.

Given this, it is advisable to use oxacillin in pregnant women, which is administered intramuscularly at 1,000,000 IU at intervals of 6 hours, 4 times a day, for 14 or 28 days, depending on the stage of the disease.

Treatment and prevention of syphilis in children. Preventive, prophylactic and specific treatment of children is carried out with penicillin preparations. For children under the age of 2 years, sodium and novocaine salts of penicillin are used, over 2 years - also bicillins. The daily dose of penicillin (sodium and novocaine salts) is calculated at the rate of 100,000 U / kg for children under the age of 6 months, 75,000 U / kg from 6 months to 1 year, 50,000 U / kg - over 1 year. The daily dose is divided into 6 equal single doses for water-soluble penicillin and 2 doses for its novocaine salt.

Bicillins 1, 3 or 5 are administered 300,000 IU 1 time per day. With good tolerance after several injections, you can switch to the introduction of 600,000 IU once every 2 days (300,000 IU in each buttock).

The duration of preventive treatment is 2 weeks; prophylactic - from 2 to 4 weeks; specific, with early congenital syphilis - 4 weeks; with late congenital - 4 weeks of antibiotic therapy in combination with bismuth drugs. The duration of treatment of acquired syphilis in children with fresh forms of the disease is 2 weeks, with secondary recurrent and latent early - 4 weeks.

With intolerance to penicillin, oxacillin and ampicillin can be used.

Oxacillin administered intramuscularly in the following daily doses: newborns - 20-40 mg / kg of body weight, children under the age of 3 months - 200 mg / kg, from 3 months to 2 years - 1.0 g per day, from 2 years and older - 2.0 g per day.

It is possible to use oxacillin orally, 1 hour before meals or 2-3 hours after it in the following daily doses: newborns - 90-150 mg / kg of body weight, under the age of 3 months - 200 mg / kg, from 3 months to 2 years - 1.0 g per day, from 2 years and older - 2.0 g per day.

Ampicillin sodium salt used intramuscularly in the following doses: newborns - 100 mg / kg, other children - 50 mg / kg, maximum - 2.0 g per day. The daily dose is divided into 4-6 injections.

Ampicillin in tablets, it is used orally in the same doses, regardless of the meal. The daily dose is divided into 4-6 doses.

In case of intolerance to semi-synthetic penicillins, it is possible to use erythromycin for children aged 1 to 3 years - at a dose of 0.4 g per day, 3-6 years old - 0.5-0.7 g, 6-8 years old - 0.75 g, 8-12 years - up to 1.0 g per day. The drug is given in equal doses 4-6 times a day.

To prevent allergic reactions before and during treatment, antihistamines and calcium preparations should be prescribed. On the 2-3rd day of treatment and at the end of the course, blood should be examined for CSR.

preventive treatment children . The issue of preventive treatment is raised in cases where the possibility of infection of children through close household or sexual contact with patients with infectious forms of syphilis and early latent syphilis has been established.

Given the peculiarities of caring for children and their communication with each other, under the age of 3 years, treatment is usually indicated. For older children, the issue of treatment is decided individually, taking into account the form of syphilis, the localization of the rash and the degree of contact with the child.

Preventive treatment is carried out if no more than 2 months have passed since the last contact with the patient. For a longer period, the child needs to undergo a complete clinical and serological (CSR, RIT, RIF) examination.

In the absence of data for syphilis, treatment is not prescribed, and after 4 months a re-examination is carried out, after which the observation is stopped.

In cases of blood transfusion to children from donors with syphilis, preventive treatment is prescribed up to 3 months after the transfusion.

Preventive treatment children . Children born to mothers with syphilis are not subject to clinical and serological examination and observation in a dermatovenerologic dispensary in cases where the mother, after a full-fledged specific treatment, had a persistent negative CSR before pregnancy (negative results of CSR during the year).

The rest of the children born to mothers who had syphilis or who were in close contact with patients with infectious forms of syphilis during pregnancy should undergo a clinical and serological examination in the first months of life (preferably at the age of 2.5-3 months). The mandatory components of the examination are: consultation of a pediatrician, dermatovenereologist, neuropathologist, otolaryngologist, ophthalmologist, blood tests (CSR, RIF, RIT), radiography of the bones of the extremities. In the presence of clinical neurological changes, spinal puncture is indicated.

Children whose mothers were subject to prophylactic treatment during pregnancy and received it (including mothers with seroresistant), in the absence of clinical, serological and radiological signs of the disease in children, are not subject to prophylactic treatment, but remain under the supervision of a dermatovenerological dispensary for 1 year old.

Children whose mothers were subject to prophylactic treatment, but did not receive it, as well as children whose mothers received inadequate syphilitic treatment, are subject to prophylactic treatment lasting 2 weeks.

Children born to untreated mothers with syphilis are subject to preventive treatment according to the scheme of early congenital syphilis lasting 4 weeks, even in the absence of clinical, serological and radiological signs of the disease in children.

In case of doubtful results of the examination of a child born to a mother with syphilis, the issue of treatment is decided individually, taking into account the history, the age of the child and the amount of treatment received by the mother.

If a child is examined for the first time at the age of over 1 year, then if the results of the examination are negative, treatment is not carried out. In doubtful cases, penicillin therapy is recommended for a duration of 2 weeks.

specific treatment children , sick congenital syphilis . Treatment of children with early congenital syphilis is carried out with sodium or novocaine salt of benzylpenicillin in a hospital (single and daily doses are indicated above). The duration of treatment is 28 days.

Treatment of children with late congenital syphilis is carried out with penicillin preparations in combination with bismuth, similar to late latent syphilis in adults. Treatment begins with biyoquinol, administered intramuscularly 2 times a week, at the age dosage. In the presence of contraindications, biyoquinol can be replaced by bismoverol.

Upon reaching 1/4 of the course dose of biyoquinol, its administration is interrupted and switched to injections of soluble penicillin or its novocaine salt. The daily dose is calculated according to the body weight of the child. The duration of penicillin therapy is 28 days. At the end of the antibiotic administration, treatment with bismuth preparations is continued until the course dose is reached.

In case of intolerance to penicillin preparations, oxacillin, ampicillin or erythromycin are prescribed. Simultaneously with antibiotic therapy, it is recommended to take nystatin and antihistamines.

Single and course doses of bismuth preparations in the treatment of children with congenital syphilis.

Age up to 3 years - biyoquinol (ml) - a single dose of 0.5 - 1.0, a course dose of 12.0-15.0; bismoverol (ml) - a single dose of 0.2-0.4, a course dose of 4.0-4.8.

Age from 3 to 5 years - biyoquinol (ml) - single dose 1.0-1.5, course 15.5-20.0; bismoverol - 0.4-0.6 and 6.0-8.0, respectively.

Age from 6 to 10 years - biyoquinol (ml) - 1.0-2.0 and 20.0-25.0; bismoverol - 0.4-0.8 and 8.0-10.0.

Age from 11 to 15 years - biyoquinol (ml) - 1.0-2.0 and 25.0-30.0; bismoverol - 0.6-0.8 and 10.0-12.0.

Treatment acquired syphilis at children . Treatment is carried out with penicillin preparations according to the principle of treating syphilis in adults. The calculation of the daily dose of the antibiotic is carried out as indicated. Duration of therapy for primary and secondary fresh syphilis - 14 days, secondary recurrent and latent early - 28 days. With late latent acquired syphilis, treatment is carried out in the same way as with late congenital.