Malignant syphilis. General course and periodization of syphilis. Types of skin manifestations and rashes with syphilis

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

Syphilis is transmitted by entry into the body of pale treponema

Classification of syphilis

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

How is syphilis classified?

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

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

Incubatory syphilis

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

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

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

Primary Period

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

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

Types of hard chancre:

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

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

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

Tertiary syphilis

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

Signs:

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

Specific scars that remain in place of large single nodes

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

Visceral syphilis

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

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

Causes of the disease

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

Ways of infection:

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

Syphilis can be contracted through a transfusion of infected blood.

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

Which doctor should I contact?

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

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

Diagnostics

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

Types of skin manifestations and rash with syphilis:

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

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

Laboratory tests

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

Diagnostics:

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

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

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

Why do false positive test results happen?

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

Main reasons:

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

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

Is there a cure for syphilis?

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

How to treat:

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

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

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

Consequences and complications of syphilis

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

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

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

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

Prevention

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

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

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

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

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

Latent syphilis. It is characterized by the fact that the presence of a syphilitic infection is proved only by positive serological reactions, while clinical signs of the disease, neither specific lesions of the skin and mucous membranes, nor pathological changes in the nervous system, internal organs, bones and joints can be detected. In such cases, when the patient does not know anything about the time of his infection with syphilis, and the doctor cannot establish the period and timing of the disease, it is customary to diagnose "latent syphilis, unspecified."

In addition, the group of latent syphilis includes patients with a temporarily or long-term asymptomatic course of the disease. Such patients already had active manifestations of a syphilitic infection, but they disappeared spontaneously or after the use of antibiotics in doses insufficient to cure syphilis. If less than two years have passed since the moment of infection, then, despite the latent course of the disease, patients with such early latent syphilis are very dangerous in epidemiological terms, since they can expect another relapse of the secondary period with the appearance of infectious lesions on the skin and mucous membranes. Late latent syphilis, when more than two years have passed since the onset of the disease, is epidemiologically less dangerous, since the activation of the infection will, as a rule, be expressed either in damage to the internal organs and nervous system, or in low-contagious tertiary syphilides of the skin and mucous membranes.

Syphilis without chancre ("headless syphilis"). When infected with syphilis through the skin or mucous membranes at the site of the introduction of pale treponema, primary syphiloma is formed - a hard chancre. If pale treponema enters the body, bypassing the skin and mucous barrier, then it is possible to develop a generalized infection without previous primary syphiloma. This is observed if infection occurs, for example, from deep cuts, injections or during surgical operations, which is extremely rare in practice, as well as during blood transfusion from a donor with syphilis ( transfusion syphilis). In such cases, syphilis is detected immediately in the form of generalized rashes characteristic of the secondary period. Rashes usually occur 2.5 months after infection and are often preceded by prodromal phenomena in the form of headache, pain in the bones and joints, and fever. The further course of "headless syphilis" does not differ from the course of classical syphilis.

Malignant syphilis. This term is understood as a rare form of the course of a syphilitic infection in the secondary period. It is characterized by pronounced violations of the general condition and destructive rashes on the skin and mucous membranes that occur continuously for many months without hidden periods.

Primary syphiloma in malignant syphilis, as a rule, does not differ from that in the usual course of the disease. In some patients, it has a tendency to proliferation and deep decay. After the primary period, sometimes shortened to 2-3 weeks, in patients, in addition to the usual rashes for the secondary period (roseola, papule), special forms of pustular elements appear, followed by skin ulceration. This form of syphilis is accompanied by more or less severe general symptoms and high fever.

Along with skin lesions in malignant syphilis, deep ulcerations of the mucous membranes, lesions of the bones, periosteum, and kidneys can be observed. Damage to internal organs and the nervous system is rare, but severe.

In untreated patients, the process does not tend to go into a latent state, it can proceed in separate outbreaks, following one after another, for many months. Prolonged fever, pronounced intoxication, soreness of destructive rashes - all this exhausts patients, causes weight loss. Only then the disease begins to gradually subside and goes into a latent state. The relapses that occur then are, as a rule, of a normal nature.

61) Latent form of syphilis.
Latent syphilis from the moment of infection takes a latent course, is asymptomatic, but blood tests for syphilis are positive.
In venereological practice, it is customary to distinguish between early and late latent syphilis: if a patient has contracted syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.
If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent, unspecified syphilis, and the diagnosis can be clarified during the examination and treatment.

The reaction of the patient's body to the introduction of pale treponema is complex, diverse and insufficiently studied. Infection occurs as a result of the penetration of pale treponema through the skin or mucous membrane, the integrity of which is usually broken.

Many authors cite statistical data, according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis in 90% of patients is detected during preventive examinations, in antenatal clinics and somatic hospitals. This is explained both by a more thorough examination of the population (i.e., improved diagnosis) and a true increase in the number of patients (including due to the widespread use of antibiotics by the population for intercurrent diseases and the manifestation of syphilis, which are interpreted by the patient himself not as symptoms of a sexually transmitted disease, but as, for example, the manifestation of allergies, colds, etc.).
Latent syphilis is divided into early, late and unspecified.
Hidden late syphilis in epidemiological terms, it is less dangerous than early forms, since when the process is activated, it manifests itself either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of slightly infectious tertiary syphilides (tubercles and gums).
Early latent syphilis in time corresponds to the period from primary seropositive syphilis to secondary recurrent syphilis, inclusive, only without active clinical manifestations of the latter (on average, up to 2 years from the moment of infection). However, these patients may develop active, contagious manifestations of early syphilis at any time. This makes it necessary to classify patients with early latent syphilis as an epidemiologically dangerous group and to carry out vigorous anti-epidemic measures (isolation of patients, a thorough examination of not only sexual, but also household contacts, if necessary, compulsory treatment, etc.). Like the treatment of patients with other early forms of syphilis, the treatment of patients with early latent syphilis is aimed at the rapid sanitation of the body from syphilitic infection.

62. The course of syphilis in the tertiary period . This period develops in patients who received no treatment at all or were treated insufficiently, usually 2–4 years after infection.

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

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

The plaque has a dense texture, brownish or dark purple color.

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

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

Isolated gumma. Appears as a painless node 5-10 mm in size, spherical in shape, densely elastic consistency, not soldered to the skin.

Hummous infiltrations. The gummous infiltrate disintegrates, the ulcerations merge, forming an extensive ulcerative surface with irregular large-scalloped outlines, healing with a scar.

Fibrous gums, or periarticular nodules, are formed as a result of fibrous degeneration of syphilitic gums.

Late neurosyphilis. It is a predominantly ectodermal process affecting the nervous parenchyma of the brain and spinal cord. It usually develops after 5 years or more from the moment of infection. In late forms of neurosyphilis, degenerative-dystrophic processes predominate.

Late visceral syphilis. In the tertiary period of syphilis, limited gummas or diffuse gummous infiltrations may occur in any internal organ.

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

The main forms of bone damage in syphilis.

1. Gummous osteoperiostitis:

2. Hummous osteomyelitis:

3. Non-gummous osteoperiostitis.

63. Tubercular syphilis of the skin. Tubercular syphilide. Typical places of its localization are the extensor surface of the upper limbs, torso, face. The lesion occupies a small area of ​​the skin, is located asymmetrically.

The main morphological element of the tubercular syphilis is the tubercle (dense, hemispherical, cavityless formation of a rounded shape, dense elastic consistency).

The grouped tubercular syphilide is the most common variety. The number of tubercles usually does not exceed 30–40. The tubercles are at different stages of evolution.

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

Name:

Pale treponema(Treponema pallidium) belongs to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically, pale treponema (pallid spirochete) differs from saprophytic spirochetes.

The most common route of infection with syphilis is sexual, with various forms of sexual contact.

Syphilis infection occurs through small genital or extragenital lesions of the skin, or through the epithelium of the mucous membrane upon contact with hard chancre, erosive papules on the skin and mucous membranes of the genital organs, oral cavity, wide condylomas containing a significant number of pale treponemas.

In saliva, pale treponemas can only be found when there are rashes on the oral mucosa.

Syphilis can be contracted through the semen of a sick person in the absence of visible changes on the genitals.

Rarely, infection with syphilis can occur through close household contact, in exceptional cases through household items. Possible infection with syphilis through the milk of a nursing woman with syphilis. There were no cases of syphilis infection through urine and sweat. Syphilis (falsely use the word "syphilis") from the moment of infection is a common infectious disease that lasts for many years in untreated patients and is characterized by an undulating course with alternating periods of exacerbation.

During an exacerbation of the disease, active manifestations of syphilis are observed on the mucous membranes, skin, and internal organs.

One of the main reasons for changes in the clinic, the duration of the incubation period, the latent course of syphilis, is the frequent use of antibiotics, changes in the body's immune status and other factors. The classical course of syphilis is characterized by the alternation of active manifestations of the disease with a latent period. The classification of the course of syphilis is divided into the incubation period, primary, secondary and tertiary periods.

Primary syphilis(syphilis I primaria) - the stage of syphilis with the appearance of a hard chancre and enlargement of the lymph nodes.

• seronegative primary syphilis(syphilis I seronegativa) - syphilis with negative serological reactions during the course of therapy.
• Primary seropositive(syphilis I seropositiva) - syphilis with positive serological reactions.
• Primary latent syphilis(syphilis I latens) - syphilis with no clinical manifestations in patients who started treatment in the primary period of the disease and did not complete it.

Secondary syphilis(syphilis II secundaria) - the stage of syphilis, caused by the hematogenous spread of pathogens (treponema) from the primary focus, manifested by polymorphic rashes (roseola, papules, pustules) on the skin and mucous membranes.

• Fresh secondary syphilis(syphilis II recens) - a period of syphilis with multiple polymorphic rashes on the skin and mucous membranes; not infrequently there are residual signs of hard chancre.
• Secondary recurrent syphilis(syphilis II recidiva) - a period of secondary syphilis, which is manifested by a few polymorphic grouped rashes and, sometimes, damage to the nervous system.
• Secondary latent syphilis(syphilis II latens) - the secondary period of syphilis, which proceeds latently.

Tertiary syphilis(syphilis III tertiaria) - the stage following secondary syphilis with destructive lesions of internal organs and the nervous system with the appearance of syphilitic gums in them.

• Active tertiary syphilis manifested by the active process of the formation of tubercles, resolved with the formation of ulcers, scars, the appearance of pigmentation.
• Latent tertiary syphilis- syphilis in persons who have had active manifestations of tertiary syphilis.

Latent syphilis(syphilis latens) - syphilis, in which serological reactions are positive, but there are no signs of damage to the skin, mucous membranes and internal organs.

• Early latent syphilis(syphilis latens praecox) - latent syphilis, less than 2 years have passed since the infection.
• late latent syphilis(syphilis latens tarda) - latent syphilis, more than 2 years have passed since the infection.
• Unspecified latent syphilis(syphilis ignorata) is a disease of unknown duration.

Household syphilis- syphilis, infection of which occurs in the household way.

congenital syphilis- syphilis, in which infection occurred from a sick mother during fetal development.

Transfusion syphilis- when transfusing donor blood of a patient with syphilis, the recipient develops transfusion syphilis. Infection of medical personnel is possible when examining patients with syphilis, during surgery, performing medical procedures, during autopsy (especially newborns with early congenital syphilis).

Syphilis headless- infection occurs when treponema enters directly into the blood (through a wound, in a blood test). The absence of a hard chancre is characteristic.

Syphilis of the nervous system- neurosyphilis (neurosyphilis): early (neurosyphilis praecox) - disease duration up to 5 years, late (neurosyphilis tarda) - more than 5 years.

There are the following forms of early neurosyphilis:

• hidden latent syphilitic meningitis;
• acute generalized syphilitic meningitis;
• syphilitic hydrocephalus;
• early meningovascular syphilis;
• syphilitic meningomyelitis.

Forms of late neurosyphilis:

• late latent syphilitic meningitis;
• late diffuse meningovascular syphilis;
• syphilis of cerebral vessels (vascular syphilis);
• brain gumma;
• progressive paralysis.

Syphilis visceral(syphilis visceralis) - syphilis, in which the internal organs (heart, brain, spinal cord, lungs, liver, stomach, kidneys) are affected.

Syphilis malignant- severely flowing syphilis with a massive lesion of internal organs and the nervous system, characteristic of tertiary syphilis.

In the primary period, the first clinical sign of syphilis appears - chancre(in the place where pale treponema entered the body). A hard chancre is a red spot that turns into a papule, then into an erosion or ulcer that occurs at the site of penetration of pale treponema into the body. Hard chancre is more often localized on the genitals (in women often on the cervix), which indicates sexual infection; much less common are extra-sexual chancres, which can be located on any part of the skin or mucous membranes: lips, tonsils, on the skin of the pubis, thighs, scrotum, abdomen. After 1-2 weeks, after the appearance of a hard chancre, the lymph nodes closest to it begin to increase.

The disappearance of a hard chancre indicates that syphilis has passed into a latent stage, during which pale treponemas are rapidly multiplying in the body. The secondary period of syphilis traditionally begins 5–9 weeks after the appearance of a hard chancre (primary syphiloma) and continues without treatment for 3–5 years.

The course of secondary syphilis is undulating: the period of active manifestations is replaced by a latent form of syphilis.

The latent period is characterized by the absence of clinical signs of syphilis and only positive serological blood tests indicate the course of the infectious process.

Clinical signs of tertiary syphilis may appear many years later after a long asymptomatic course of the disease from the moment of infection with syphilis. The main reason influencing the formation of tertiary syphilis is the absence or inadequate treatment of patients with earlier forms of syphilis.

Tests for syphilis consist of clinical and laboratory data:

• research on pale treponema;
• blood test for RV (Wasserman reaction);
• RIF (immune fluorescence reaction);
• RIBT (treponema pallidum immobilization reaction).

Diagnosis of syphilis the primary period is carried out by examining the detachable hard chancre, punctate of regional lymph nodes.

In the diagnosis of syphilis of the secondary period, the material of papular, pustular elements, erosive and hypertrophic papules of the skin and mucous membranes is used.

Analyzes for syphilis by the bacterioscopic method (microscopic) are carried out by detecting pale treponema in a dark-field microscope.

Treponemal methods for diagnosing syphilis include:

• Wasserman reaction (RW);
• immunofluorescence reaction (RIF).
• RW (Wasserman reaction) is of great importance for confirming the diagnosis of syphilis in the presence of active manifestations of the disease, detecting latent (latent) syphilis, and the effectiveness of the treatment of syphilis. RW is also important for the prevention of congenital syphilis.

The Wasserman reaction is positive in 100% of patients with syphilis of the secondary period, with early congenital syphilis, in 70–80% of patients with tertiary syphilis.

Treponemal test method for syphilis is also an immunofluorescence test (RIF). RIF is the most highly sensitive method for diagnosing syphilis and becomes positive even with primary seronegative syphilis.

RIF is positive in secondary syphilis, congenital syphilis in 100%, in tertiary syphilis - in 95-100%, in late forms of syphilis (internal organs, syphilis of the nervous system) - in 97-100%.

Treatment of syphilis is built according to the relevant standards established in the world and is carried out only after the diagnosis has been established and confirmed by laboratory research methods.

The treatment of syphilis requires the venereologist to take into account various factors, various indicators, complicating moments. This, in many respects, determines the subsequent choice of the method of treatment of syphilis.

In the treatment of syphilis, specific antibacterial products of several groups and generations are used and they are the basis of therapy. In the treatment of syphilis, the patient must also strictly observe the recommended regimen (sufficient sleep, rational nutrition, vitamins, prohibition of alcohol), the duration of the intervals between courses of treatment, which significantly increases the effectiveness of the treatment of syphilis. Essential for the successful treatment of syphilis is, in addition to ongoing therapy, the condition of the patient's body, its reactivity, therefore, in the course of treatment, it will be necessary to increase resistance to infection. For this, products are prescribed that stimulate the protective reactions of the body.

The venereologist determines in each case, depending on the stage of syphilis, complications, concomitant diseases from other organs and systems, allergic background, body weight, the percentage of absorption and bioavailability of the drug, the necessary doses of medications, the additional use of immunomodulators, enzymes, vitamin products, physiotherapy.

After the end of the treatment of syphilis, repeated clinical and serological blood control is required for several months or years (depending on the stage of syphilis).

If, after the treatment of syphilis for a year, the blood does not become negative, a state of seroresistance is ascertained and additional treatment for syphilis is prescribed.

Syphilis is a classic sexually transmitted disease. Syphilis in men, women and children at different stages is characterized by such signs as damage to the skin, mucous membranes, internal organs (cardiovascular system, stomach, liver), osteoarticular and nervous systems.

Symptoms of the disease, among other manifestations, can serve as:

• fever (temperature);

The causative agent - pale treponema, or pale spirochete - was discovered in 1905. "Pale" - because it almost does not stain with the usual aniline dyes adopted for this purpose in microbiology. Pale treponema has a spiral shape, resembling a long thin corkscrew.

Stages of syphilis

Syphilis is a very long disease. A rash on the skin and mucous membranes is replaced by periods when there are no external signs and the diagnosis can be made only after a blood test for specific serological reactions. Such latent periods can drag on for a long time, especially in the later stages, when in the process of long-term coexistence, the human body and pale treponema adapt to each other, reaching a certain "balance". Symptoms of the disease do not appear immediately, but after 3-5 weeks. The time preceding them is called incubation: bacteria spread with the flow of lymph and blood throughout the body and multiply rapidly. When there are enough of them, and the first signs of the disease appear, the stage of primary syphilis begins. Its external symptoms are erosion or a sore (hard chancre) at the site of penetration of the infection into the body and an increase in nearby lymph nodes, which disappear without treatment after a few weeks. After 6-7 weeks, a rash occurs that spreads throughout the body. This means that the disease has passed into the secondary stage. During it, rashes of a different nature appear and, having existed for some time, disappear. The tertiary period of syphilis occurs after 5-10 years: nodes and tubercles appear on the skin.

Symptoms of primary syphilis

Hard chancres (sores), one or more, are most often located on the genitals, in places where microtrauma usually occurs during sexual intercourse. In men, this is the head, foreskin, less often - the trunk of the penis; sometimes the rash may be inside the urethra. In homosexuals, they are found in the circumference of the anus, in the depths of the skin folds that form it, or on the mucous membrane of the rectum. In women, they usually appear on the small and large labia, at the entrance to the vagina, on the perineum, less often on the cervix. In the latter case, the sore can only be seen during a gynecological examination on a chair using mirrors. In practice, chancres can occur anywhere: on the lips, in the corner of the mouth, on the chest, in the lower abdomen, on the pubis, in the groin, on the tonsils, in the latter case, resembling a sore throat, in which the throat almost does not hurt and the temperature does not rise. In some patients, thickening and swelling appear with severe redness, even blue skin, in women - in the region of the labia majora, in men - in the foreskin. With the addition of a "secondary", i.e. additional infection, complications develop. In men, this is most often inflammation and swelling of the foreskin (phimosis), where pus usually accumulates and you can sometimes feel the seal at the site of the existing chancre. If, during the period of increasing swelling of the foreskin, it is pushed back and the head of the penis is opened, then the reverse movement is not always possible and the head is restrained by a sealed ring. It swells and if it is not released, it can become dead. Occasionally, such necrosis (gangrene) is complicated by ulcers of the foreskin or located on the glans penis. About a week after the appearance of a hard chancre, nearby lymph nodes (most often in the groin) painlessly increase, reaching the size of a pea, plum, or even a chicken egg. At the end of the primary period, other groups of lymph nodes also increase.

Symptoms of secondary syphilis

Secondary syphilis begins with the appearance of a profuse rash all over the body, which is often preceded by a deterioration in well-being, the temperature may rise slightly. The chancre or its remnants, as well as the enlargement of the lymph nodes, are still preserved by this time. The rash usually consists of small, evenly covering the skin, pink spots that do not rise above the surface of the skin, do not itch or flake. This kind of spotty rash is called syphilitic roseola. Since they do not itch, people who are inattentive to themselves can easily overlook it. Even doctors can make a mistake if they have no reason to suspect syphilis in a patient, and diagnose measles, rubella, scarlet fever, which are now often found in adults. In addition to roseolous, there is a papular rash, consisting of nodules ranging in size from a match head to a pea, bright pink, with a bluish, brownish tinge. Much less common are pustular, or pustular, similar to common acne, or a rash with chicken pox. Like other syphilitic eruptions, pustules do not hurt. The same patient may have spots, nodules, and pustules. The rashes last from several days to several weeks, and then disappear without treatment, so that after a more or less long time they are replaced by new ones, opening a period of secondary recurrent syphilis. New rashes, as a rule, do not cover the entire skin, but are located in separate areas; they are larger, paler (sometimes barely visible), and tend to cluster into rings, arcs, and other shapes. The rash may still be patchy, nodular, or pustular, but with each new appearance, the number of rashes decreases, and the size of each of them becomes larger. For the secondary recurrent period, nodules are typical on the vulva, in the perineum, near the anus, under the armpits. They increase, their surface becomes wet, forming abrasions, weeping growths merge with each other, resembling cauliflower in appearance. Such growths, accompanied by a fetid odor, are not painful, but can interfere with walking. In patients with secondary syphilis, there is a so-called "syphilitic angina", which differs from the usual one in that when the tonsils are reddened or whitish spots appear on them, the throat does not hurt and the body temperature does not rise. On the mucous membrane of the neck and lips, whitish flat formations of oval or bizarre outlines appear. On the tongue, bright red areas of oval or scalloped outlines are distinguished, on which there are no papillae of the tongue. There may be cracks in the corners of the mouth - the so-called syphilitic seizures. Brownish-red nodules encircling it sometimes appear on the forehead - the "crown of Venus". In the circumference of the mouth, purulent crusts may appear that mimic ordinary pyoderma. A very characteristic rash on the palms and soles. If any rashes appear in these areas, you must definitely check with a venereologist, although skin changes here may be of a different origin (for example, fungal). Sometimes on the back and sides of the neck small (the size of a little finger nail) rounded light spots are formed, surrounded by darker areas of the skin. "Necklace of Venus" does not peel off and does not hurt. There is syphilitic alopecia (alopecia) in the form of either uniform hair thinning (up to pronounced), or small numerous foci. It resembles fur beaten by moths. Eyebrows and eyelashes often fall out as well. All these unpleasant phenomena occur 6 or more months after infection. For an experienced venereologist, a cursory glance at the patient is enough to diagnose him with syphilis on these grounds. Treatment quickly enough leads to the restoration of hair growth. In weakened, as well as in patients who abuse alcohol, multiple ulcers scattered all over the skin, covered with layered crusts (the so-called "malignant" syphilis) are not uncommon. If the patient has not been treated, then a few years after infection, he may have a tertiary period.

Symptoms of tertiary syphilis

Single large nodes appear on the skin up to the size of a walnut or even a chicken egg (gum) and smaller ones (tubercles), usually arranged in groups. The gumma gradually grows, the skin becomes bluish-red, then a viscous liquid begins to stand out from its center and a long-term non-healing ulcer with a characteristic yellowish bottom of a "greasy" appearance is formed. Gummy ulcers are characterized by a long existence, dragging on for many months and even years. Scars after their healing remain for life, and by their typical star-shaped appearance, it can be understood after a long time that this person had syphilis. Tubercles and gummas are most often located on the skin of the anterior surface of the legs, in the area of ​​​​the shoulder blades, forearms, etc. One of the frequent places of tertiary lesions is the mucous membrane of the soft and hard palate. Ulcerations here can reach the bone and destroy the bone tissue, the soft palate, wrinkle with scars, or form openings leading from the oral cavity to the nasal cavity, which makes the voice acquire a typical nasality. If the gummas are located on the face, then they can destroy the bones of the nose, and it "falls through." At all stages of syphilis, internal organs and the nervous system can be affected. In the first years of the disease, syphilitic hepatitis (liver damage) and manifestations of "hidden" meningitis are found in some patients. With treatment, they pass quickly. Much less often, after 5 years or more, seals or gums are sometimes formed in these organs, similar to those that occur on the skin. The aorta and heart are most commonly affected. A syphilitic aortic aneurysm forms; on some part of this most important vessel for life, its diameter expands sharply, a sac with strongly thinned walls (aneurysm) is formed. A ruptured aneurysm leads to instant death. The pathological process can also "slide" from the aorta to the mouths of the coronary vessels that feed the heart muscle, and then angina attacks occur, which are not relieved by the means commonly used for this. In some cases, syphilis causes a myocardial infarction. Already in the early stages of the disease, syphilitic meningitis, meningoencephalitis, a sharp increase in intracranial pressure, strokes with complete or partial paralysis, etc. can develop. These severe events are very rare and, fortunately, respond well to treatment. Late lesions (tasco dorsalis, progressive paralysis). Occur if a person has not been treated or treated poorly. With dorsal tabes, pale treponema affects the spinal cord. Patients suffer from bouts of acute excruciating pain. Their skin loses sensitivity so much that they may not feel the burn and pay attention only to damage to the skin. The gait changes, it becomes "duck", first there is difficulty urinating, and later urinary and fecal incontinence. Damage to the optic nerves is especially severe, leading to blindness in a short time. Gross deformities of large joints, especially the knees, may develop. Changes in the size and shape of the pupils and their reaction to light are detected, as well as a decrease or complete disappearance of tendon reflexes, which are caused by a hammer strike on the tendon below the knee (patella reflex) and above the heel (Achilles reflex). Progressive paralysis usually develops after 15-20 years. This is irreversible brain damage. Human behavior changes dramatically: working capacity decreases, mood fluctuates, the ability to self-criticism decreases, either irritability, explosiveness appear, or, conversely, unreasonable gaiety, carelessness. The patient does not sleep well, his head often hurts, his hands tremble, his facial muscles twitch. After a while, it becomes tactless, rude, lustful, reveals a tendency to cynical abuse, gluttony. His mental abilities fade, he loses his memory, especially for recent events, the ability to correctly count with simple arithmetic operations "in the mind", when writing, he skips or repeats letters, syllables, handwriting becomes uneven, sloppy, speech is slow, monotonous, as if " stumbling." If treatment is not carried out, then he completely loses interest in the world around him, soon refuses to leave the bed, and with the phenomena of general paralysis, death occurs. Sometimes with progressive paralysis, megalomania occurs, sudden bouts of excitement, aggression, dangerous to others.

Diagnosis of syphilis

Diagnosis of syphilis is based on evaluation of blood tests for syphilis.
There are many types of blood tests for syphilis. They are divided into two groups:
non-treponemal (RPR, RW with cardiolipin antigen);
treponemal (RIF, RIBT, RW with treponemal antigen).
For mass examinations (in hospitals, clinics), non-treponemal blood tests are used. In some cases, they can be false positive, that is, be positive in the absence of syphilis. Therefore, a positive result of non-treponemal blood tests is necessarily confirmed by treponemal blood tests.
To evaluate the effectiveness of treatment, quantitative non-treponemal blood tests (for example, RW with cardiolipin antigen) are used.
Treponemal blood tests remain positive after suffering syphilis for life. Therefore, treponemal blood tests (such as RIF, RIBT, RPHA) are NOT used to evaluate the effectiveness of treatment.

Treatment of syphilis

Treatment of syphilis is carried out only after the diagnosis is established and confirmed by laboratory research methods. Treatment of syphilis should be comprehensive and individual. Antibiotics are the mainstay of treatment for syphilis. In some cases, treatment is prescribed that supplements antibiotics (immunotherapy, restorative drugs, physiotherapy, etc.).

Remember! It is dangerous to self-medicate syphilis. Recovery is determined only by laboratory methods.

Complications of syphilis

An insane amount of problems arise in a person who has lived to see tertiary syphilis, which is already difficult to treat and can lead to death. A sick pregnant woman will pass the infection to her baby in utero. Congenital syphilis is a serious condition.

The malignant form of syphilis develops during a syphilitic infection, characterized by the severity and severity of the clinical manifestations of the disease, especially from the skin and mucous membranes. The malignant form of syphilis is currently almost never found in the Russian Federation.

Primary syphiloma in cases of malignant syphilis in most cases does not differ from that in the usual course of syphilis. Only in some patients does it have a tendency to peripheral growth and deeper decay.. After the primary period, often shortened to 3-4 weeks, in patients accompanied by severe general phenomena and high fever, skin lesions appear in the form of pustular syphilides. Much less often, a malignant form of syphilis occurs as a relapse at 5-6 months from the onset of the disease. There is damage to the mucous membranes, in the form of deep ulcerations, as well as damage to the bones, periosteum and testicles. Damage to the internal organs and nervous system are relatively rare, but they are extremely severe. A peculiar feature of malignant syphilis is the slight severity, and often the complete absence of changes in the lymph nodes, as well as often a negative result of serological reactions..

Not having a tendency to stop and go into a latent state, the process can drag on in separate outbreaks, following one after another, for many months. Only then the disease begins to gradually subside and goes into a latent state. Subsequent recurrences are common.

Pathologically, malignant syphilis is characterized by phenomena of exudative-purulent inflammation, with massive leukocyte infiltration of tissues and their subsequent purulent fusion. There is neutrophilia in the blood.

The pathogenesis of malignant syphilis has not yet been fully established. The peculiar course of syphilis is due in most cases to the weakening and exhaustion of the body under the influence of severe general diseases, intoxication, starvation, difficult living conditions and, in connection with this, a decrease in its reactivity.

see syphilis

Saenko I. A.

Sources:

1. Kozorez E. S. Skin and venereal diseases: textbook. allowance for students of higher education. honey. textbook establishments. M.: Publishing house VLADOS-PRESS, 2005.
2. Pavlov S. T. Textbook of skin and venereal diseases for students of the Military Medical Order of Lenin Academy. S. M. Kirov. Edition of the Military Medical Order of Lenin Academy. S. M. Kirov. Leningrad, 1960.
3. Skripkin Yu. N., Sharapova G. Ya., Selissky G. D. Sexually transmitted diseases - L .: Medicine, 1985.