Tertiary syphilis: symptoms, treatment, causes. Tertiary syphilis and its manifestations in men and women Causes and development of the disease

The venereal disease syphilis is characterized by three stages of the course, and the last (tertiary) is the most severe in terms of clinical manifestations and symptoms.

In each patient, the manifestations of a syphilitic infection are very diverse; at different years of life, various manifestations of infection appear. However, the last period of the disease is characterized by a state of pronounced disturbances in the functioning of all internal organs and systems of the body.

The last tertiary stage of the disease occurs when the duration of infection is from five to eight years.

Currently, tertiary syphilis occurs in 60% of patients who have not received specific treatment before, and in 15% of patients who do not comply with the entire treatment regimen during treatment.

It is also worth noting that the most common tertiary period of syphilitic infection occurs in patients who have not previously observed the regularity of medical examinations. Advanced cases of the disease occur in patients who have not previously been observed by doctors and have not passed appropriate screening tests over the past 5-10 years.

Nowadays, venereologists are extremely attentive to the examination of patients with a pronounced clinical picture of syphilis. This is explained by the fact that at a later stage, therapy is lengthy and expensive.

Every year, venereologists discover new methods that are effective even at later stages. In this article, we will answer all the most frequently asked questions to doctors about whether it is possible to completely cure tertiary syphilis with late detection, how much it costs to treat this form of infection in modern clinics, and how exactly to treat tertiary syphilis is recommended by experienced venereologists.

Symptoms of tertiary syphilis are severe skin symptoms, severe complications from the internal organs, and neurological pathologies. With a long course and inaction on the part of the patient, treponemal infection ends in death.

A typical sign of the last stage of the disease are tertiary syphilides - seals and granulomas in any tissues and organs. These formations are noticeable only in the form of areas of seals under the skin, which to the touch resemble tubercles or nodes, completely painless when touched or pressed.

Tuberculous syphilides on the skin appear as elevations up to a centimeter in size and are also distinguished by their color - a slight red or burgundy tint.

Such nodular granulomas can gradually appear under the skin one after another. However, they do not merge into a common conglomerate.

As compaction occurs, tissue necrosis in the center and the transition to an ulcer. After healing of such ulcers, scar marks often remain on the body of patients, with or without a rim of pigmentation. With extensive areas of syphilides, patches of mosaic scars form on the skin, which are clearly visible when examined by a doctor.

Also, against the background of prolonged multiplication of treponemal infection in the tissues of internal organs, bone or connective tissue structures, such as tertiary gummy formations appear. Such gummas initially resemble a seal in the form of a knot under the skin or in the area of ​​large or small joints. Most often, these formations are single, less often multiple, can be localized both in the region of the upper or lower extremities, and on the face.

When feeling syphilitic gums, patients do not experience pain or discomfort, for the first weeks such nodular formations are mobile under the skin, but as they increase in size, the gums fuse tightly with surrounding tissues. Over time, the gummous areas become softer in the center, a hole appears through which the contents, similar to a jelly-like jelly, are separated. After all the contents are released, the ulcer gradually heals, and a scar in the form of a scar remains on the skin.

Complications of tertiary syphilis

Against the background of rapidly progressing lesions of all internal organs and tissues in the tertiary period, syphilitic gummy appear not only on the skin, but also under the skin in the fiber, cartilage, bones, blood vessels, muscles.

Against the background of damage to the mucous tissues, a long-term complicated course of inflammatory diseases of the nasal cavity and mouth, larynx and pharynx is observed. Symptoms resemble a runny nose and sore throat, while the gradual destruction of the cartilage of the nasal cavity and acute inflammation of the tonsils and pharynx begin. With damage to the bone and cartilage structures of the nasal cavity due to syphilitic infection, patients experience subsidence and deformities of the nose, constant bleeding and suppuration.

Today's cases of tertiary syphilis are observed after infection for more than ten years.

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Such patients are most often admitted to intensive care units of hospitals with severe pathology of the heart and blood vessels, heart attacks and inflammation of the aorta and heart muscle, with impaired cerebral blood flow, ischemia and stroke attacks, or with severe neurological symptoms.

When the digestive organs are affected, severe cases of gastritis with ruptured ulcers in the stomach are observed. If the bones and cartilage of the lower and upper extremities are affected, patients are admitted with osteomyelitis or osteoporosis, inflammation in the bones or fractures due to excessive fragility.

It is not surprising that due to the extensive symptoms in a disease such as tertiary syphilis, the diagnosis consists in a complete, comprehensive examination of the patient.

How is tertiary syphilis diagnosed?

Treatment of tertiary syphilis is developed only after a thorough examination. First of all, laboratory tests are carried out to detect treponemal infection and a patient is interviewed to determine the duration of infection.

Blood is used for research and at least three tests are carried out. The Wasserman screening reaction under certain conditions can be negative, but the RIF and RIBT tests for late-stage syphilis are positive in 94% of cases. Additionally, studies of cardiac function and the state of blood vessels, liver and stomach are carried out.

With symptoms of damage to the nervous structures, a study of the cerebrospinal fluid and an encephalogram is performed. In case of damage to the cartilaginous elements of the nose, the nasal cavities, nasal septum, pharynx, and larynx are examined with special tools.

Fundamentals of treatment

Quite often, patients can hear questions about how a venereologist treats tertiary syphilis and whether the disease is treated with a course duration of ten years or more.

It should be noted that at present, all patients with confirmed treponemal infection are shown serious treatment, while in the case of a long course of the disease, therapy is longer. . According to the results of sensitivity tests, at least 2 drugs are used to choose from.

Most often, erythromycin or tetracycline, and derivatives, are used for treatment, which are then replaced with large doses of penicillins.

As therapy is carried out, mandatory monitoring of liver and kidney function indicators, monitoring of heart function and the general condition of the patient. Also, to strengthen the properties of the immune system, preparations of plant complexes, vitamin compositions and minerals are shown.

With complications from the work of internal organs, impaired digestion and intestinal motility, inflammatory processes in the respiratory organs, memory impairment and manifestations of brain damage, symptomatic therapy is indicated under the control of tests.

Relatives and friends of patients often ask if tertiary syphilis can be treated at the stage of severe clinical manifestations of the disease. We will answer that in our time, venereologists have the opportunity to provide treatment even at the stage of tertiary manifestations of the disease, however, therapy in this case is indicated for a long time, strictly within the walls of a medical institution and under the supervision of experienced specialists.

You should not take risks and engage in home treatment, because the risk of death with tertiary syphilis is extremely high. Currently, you can get guarantees of effective treatment and qualified medical care only when you contact real professionals.

If you don't know who to contact, the Guide to Venereology is ready to help you.

Our specialists help each patient with the choice of a modern clinic and an experienced venereologist for quality treatment and follow-up.

Contact the "Guide to Venereology", and you are guaranteed to appreciate the European level of medical services.

Syphilis is an infectious sexually transmitted disease that manifests itself with a variety of clinical symptoms depending on the duration of the course. Tertiary syphilis occurs within 5-10 years from the moment of infection in the case when no treatment was prescribed during the primary and secondary stages of the disease or it was performed poorly. The appearance of syphilis is closely related to childhood and old age, concomitant chronic diseases, injuries, and alcoholism. According to the statistics of sexually transmitted diseases, it becomes clear that the tertiary form of syphilis develops in a third of those infected, of which about a quarter of cases are fatal.

In most cases, the causative agent of syphilis enters the body during sexual contact. The most dangerous patients with primary syphilis. Also, the infection is transmitted from a sick mother to a fetus in the womb. Possible infection during the blood transfusion procedure.

Complications: what is the danger of tertiary syphilis

In the course of the disease, vital organs are affected, which can lead to the death of the patient, disability, and defects in appearance.

Complications that are fraught with death:

• syphilitic aortic aneurysm;
• syphilitic aortitis;
• syphilitic bronchiectasis and pneumosclerosis.

Complications that can lead to disability:

• gummous osteomyelitis, osteitis, periostitis: cause restriction of movement, coordination;
• saddle nose: makes breathing difficult;
• perforation of the hard palate: deprives the patient of the possibility of independent food intake;
• dementia.

Complications causing persistent psychoneurological disorders:

• late meningovascular syphilis, causing damage to the auditory and optic nerve;
• progressive paralysis;
• tabes.

Cosmetic defects:

• saddle nose;
• the formation of disfiguring scars in place of gummy and tubercular syphilides.

Complications during pregnancy:

• miscarriage and premature birth;
• fetal death;
• early congenital syphilis, leading to the death of the newborn;
• late congenital syphilis threatens with disability and early death of the child.

Symptoms of tertiary syphilis

With tertiary syphilis, almost all systems of internal organs are affected: the cardiovascular system, nervous system, back and brain, liver, kidneys, stomach, testicles, bone tissue. Syphilis can last for decades, causing mental insanity, blindness and deafness in the patient. Patients are characterized by bouts of rage, depression, paranoia. The tertiary period is characterized by the appearance of infectious granulomas - a kind of accumulation of cells that form large nodes. Lesions of the mucous membranes and skin at this stage are called tertiary syphilides. They occur in small quantities and are manifested by tubercles or gums. These manifestations are not contagious, since treponemas die during the decay of the infiltrate. However, granulomas and gummas compress and destroy the organs in which they are located, endangering the life of the patient. Specialists distinguish between active tertiary syphilis and latent.

To understand that the disease has passed into the final third period, specific signs and the most characteristic symptoms allow:

• gummous syphilides;
• hump syphilides;
• negative serological reaction in a patient with clear signs of syphilis;
• damage to the nervous system;
• damage to internal organs.

In children, late congenital syphilis appears between the ages of 5 and 15 years. Characteristic signs of the disease:

• clouding of the cornea of ​​​​the eyes;
• deafness;
• damage to internal organs;
• damage to the central nervous system.

Diagnosis and definition of tertiary syphilis

Patients with signs of tertiary syphilis are examined serologically. With a positive reaction, an analysis of cerebrospinal fluid, an x-ray of the brain and an examination of the aorta are prescribed. In most patients, the serological test shows a negative result, therefore, great importance is attached to blood tests using RIBT and RIF.

To determine the degree of damage to organs and the somatic system, an ECG and ultrasound of the heart, liver, kidneys, aortography, gastroscopy, liver tests, bone radiography, and lung radiography are performed. Also, patients are referred for additional consultations of a neurologist, cardiologist, gastroenterologist, otolaryngologist, ophthalmologist.

Treatment of tertiary syphilis

Treatment of the disease at this stage is carried out exclusively in the hospital. In no case should you self-medicate. Given the symptoms in the tertiary period of syphilis, therapy is not aimed at completely eliminating the disease and its symptoms, but at stopping the progression of the infection and improving the quality of life of the patient. For treatment, antibiotic and antibacterial drugs of several groups and the latest generations, medicines containing bismuth, medicines for syphilis, including iodine, are used. The preparatory phase consists of a two-week course of tetracycline and erythromycin. Then proceed to penicillin therapy. Duration, number of courses and dosages correspond to the selected drugs. Changing medications and interruptions in treatment are strictly controlled by the doctor. In the treatment of the tertiary form, the time between therapies is one and a half months. It is allowed to extend the breaks only between the last courses. In total, up to 8 courses of treatment are recommended. The sixth and seventh include osarsol in combination with bismuth and mercury preparations. With damage to the liver and kidneys, bismuth is contraindicated for the patient. It is replaced by penicillin. The eighth is carried out only with bioquinol. Of great importance is the condition of the patient's body, so resistance to infections should be increased. To do this, the doctor, based on data on the stage of syphilis, complications from other organs, the presence of allergies, age and body weight, calculates the doses of medications, immunomodulators, vitamins and minerals, enzymes. It is important to observe the regime of work, rest and nutrition, refuse to drink alcohol, adhere to the prescribed interval between courses of treatment. Additionally, physiotherapy procedures can be performed to eliminate skin lesions. The formation of gum does not cause severe pain, however, if timely treatment is not started, this process can lead to a prolapse of the septum between the mouth and nose. For the prevention and treatment of eye lesions and neurosyphilis, an aqueous solution of penicillin is also used. Patients with a severe allergy to penicillin are given ceftriaxone. Treatment of asymptomatic neurosyphilis is also necessary to avoid new neurological lesions. Patients with affected articular cartilage, pain syndromes with spinal dryness take analgesics and carbamazepine.

During the treatment period, the condition of the affected organs is monitored: blood and urine tests, ECG, ultrasound, biochemical tests. If necessary, symptomatic treatment is carried out.

It is worth touching on the negative trends that are often observed in state skin and venereal dispensaries. Doctors with a budget salary and working in overcrowded departments do not have the opportunity to attend to every patient. Often, patients are not prescribed immunostimulation. This is fraught with the appearance in the patient's body of bacteria that are not sensitive to antibiotics.

For the treatment of children, the same drugs are used as for adults: injections of mercury preparations and salvarsan. Babies are well tolerated by the one-stage method of treatment: injections of miarsenol or an infusion of novarsenol, and after half an hour bioquinol or mercury in one and a half dosage. Such therapy should be carried out once a week. Children need to carry out from 6 to 8 courses of treatment. If the Wasserman reaction is still positive, an additional course of treatment is prescribed.

At the end of the last therapy, patients are observed in the dispensary for another five years. If the treatment is effective, then during this time the patient does not have symptoms, he is considered cured completely. However, tertiary syphilis is the stage of neglect of the disease, at which it is possible to temporarily stop the destruction of the body and extend the life cycle of the patient. A complete cure is not possible at this stage. Every day for an infected person is considered a small victory over a deadly disease.

Lack of treatment in the tertiary stage of syphilis reduces the life of the patient by almost half, turns a person into a creature covered with ulcerative scabs, deprived of the opportunity to see the world around him, hear its sounds and leads to a painful death. The Internet is full of creepy photos of patients with tertiary syphilis, showing the importance of timely diagnosis and treatment.

Tertiary syphilis develops in those patients who did not complete the course of medication or took inappropriate drugs. This stage of the development of the infection is dangerous for the health and life of the patient, since treponema affects the internal organs and systems of the body.

The concept of tertiary syphilis

Symptoms and consequences of syphilis depend on its stage of development. An infectious disease goes through 3 stages:

1. primary syphilis. It lasts no more than 3 months. This disorder is characterized by the appearance of a hard chancre in the place where the infection has penetrated.
2. Secondary syphilis. This period lasts up to 4 years. The disease is quite easy to detect, since characteristic rashes appear on the patient's body.
3. Tertiary syphilis. Treponema actively multiply in the body, affecting the vital organs. Cartilage, bones and the brain are affected by them. Tertiary syphilis appears 7-10 years after infection.

The duration of each stage depends on the state of the immune system and whether the patient is taking any medications. For example, there are cases when a person is treated with antibiotics for another disorder. They are not able to eliminate the activity of treponemas, but they inhibit their reproduction. Therefore, the patient does not notice the manifestations of an infectious disease, and each stage continues for a long period of time.

Patients with the tertiary form of syphilis should immediately seek help from a specialist, since in 60% of cases the disease ends in death.

Signs and symptoms

For a long time, tertiary syphilis proceeds without any symptoms of the disorder. The patient does not experience discomfort, therefore he leads a normal life and does not stop sexual activity. This leads to infection of other people and aggravation of the condition of the carrier.

As treponema multiplies in the body, the following symptoms will become noticeable:

• there is a violation of the nervous system, kidneys, intestines and lungs, this leads to the development of neurosyphilis;
• tubercular syphilide is formed on the skin;
• bone tissue is destroyed, as a result, osteomyelitis or osteoporosis is diagnosed;
• syphilitic gummas appear;
• chronic hepatitis develops due to liver problems;
• found problems in the cardiovascular system.

In the photo in our article, you can see what skin lesions look like with syphilis. Usually, patients seek medical help because of the presence of skin rashes, so we want to talk about them in more detail.

Tubercular syphilis has a smooth surface and a blue tint. The tubercles do not merge with each other and after 2 weeks are transformed into purulent ulcers. This type of rash is formed on any part of the body and head, after healing, a scar remains in their place.

Syphilitic gumma is a nodule, it is formed on the muscles, bone tissue or fatty tissue. Seal does not exceed 2 cm in size. At the site of the lesion, the skin becomes purple, with pressure, pain and discomfort are felt. Over time, the gumma increases as pus accumulates there. The lesion affects the nerve endings, so periodically there are severe pains in the muscles or bones.

In the presence of concomitant diseases, the patient has late roseola. They grow up to 8 cm in diameter and have a rich pink color. During tertiary syphilis, lesions of the mucous membranes occur. They are diagnosed in the mouth, nose and near the genitals.

Can tertiary syphilis be cured?

Treatment of tertiary syphilis is performed in a hospital setting. It is possible to recover from an infectious disease, but this will require several courses of antibiotics. Doctors will be able to eliminate treponema in the body, but the consequences of their activities become irreversible.

Penicillin drugs inhibit the activity of microbes, but do not contribute to the restoration of structures and internal organs that have suffered from this. Several doctors are involved to help the patient at once. Therapy is selected by a dermatovenereologist, therapist and neurologist if necessary.

Simultaneously with taking basic medicines, the patient is prescribed procedures or medications that help reduce the negative effects of syphilis. In addition to conservative treatment, patients with the tertiary form also need surgery to restore bone or cartilage tissue.

In dermatovenereology, the treatment of tertiary syphilis takes from several months to 2-3 years. The duration of therapy depends on the presence of complications and how effective the drugs will be in relation to treponema.

Factors affecting the development of tertiary syphilis

People who seek medical help do not encounter the tertiary form of syphilis, since medications can stop the disease in a timely manner and eliminate microorganisms.

One of the provoking factors of the tertiary stage of infection is age. Adolescents face a violation when they begin to have sex. Against the background of hormonal changes, treponema progresses faster. The elderly are also at risk.

The development of tertiary syphilis is facilitated by:

If the patient did not find clinical manifestations of secondary syphilis in himself and did not seek help from a doctor, then this factor will become the main reason for the development of the third stage of syphilis. Some patients during the treatment of the infection are recognized as non-contagious, but the ban on sexual activity remains, since sex will aggravate the patient's condition.

Diagnostics

The doctor determines the diagnostic method depending on the patient's condition and the presence of concomitant diseases.

The primary diagnosis is made during the examination, then laboratory tests are carried out that confirm the doctor's assumption.

There are several options for diagnostic procedures:

• RIF, allows you to detect treponema in the body;
• serological method, determines the presence of immunoglobulins, which are produced when an infection occurs in the body;
• PRC, with its help, doctors find the DNA of bacteria;
• bacterioscopic examination, necessary to detect treponema in fluids;
• analysis of cerebrospinal fluid, with its help determine the content of lymphocytes, monocytes and protein.

In case of serious lesions of internal organs and systems, the patient needs a complete diagnostic examination. It allows you to characterize the patient's condition and select effective medicines. Obligatory consultation of an otolaryngologist, neurologist, ophthalmologist, cardiologist and gastroenterologist. Extensive damage to internal organs is accompanied by ultrasound and ECG.

How and how to treat tertiary syphilis

You should not refuse hospitalization in the treatment of tertiary syphilis, since at any time serious complications may arise that require immediate medical attention.

The patient is prescribed antibiotics of various groups and drugs with a high content of iodine. Therapy begins with a two-week course of tetracycline and erythromycin, possibly the appointment of bicillin. Doctors then prescribe penicillin drugs. The tertiary form of syphilis involves the passage of at least 8 courses. In the final stages, doctors include mercury and bismuth preparations. Bioquinol completes therapy.

Along with taking antibiotics, drugs are used that can increase the body's resistance to treponema. Specialists select immunostimulating drugs, vitamin complexes and enzymes. These drugs are also needed in order to minimize the negative effect of antibiotics on internal organs.

A set of measures is also carried out for the speedy healing of the skin and mucous membranes. If the eyes are affected, a solution of penicillin is used. To relieve pain and normalize the condition of the joints, analgesics and fenlepsin are prescribed. Throughout the treatment, doctors monitor the patient's condition. A person will have to go through all the laboratory tests several times so that the specialist can verify the effectiveness of the therapy.

After the end of drug therapy, doctors monitor the patient's condition for another 5 years. During this period, complications or signs that syphilis may not be completely cured may appear. Therefore, do not neglect visiting a doctor.

If within 5 years the patient does not show the characteristic symptoms of syphilis, then he is considered healthy.

Complications of the late form of the disease

During tertiary syphilis, internal organs and systems are destroyed. The presence of complications depends on when exactly the patient sought help from a doctor and how much the disease had progressed.

We list the most common types of complications encountered in patients:

1. Deformation of the skin. Syphilides and gummas trigger necrotic processes, after which the skin practically does not recover.
2. Mucosal damage. Neoplasms appear in the mouth, nose and genitals. It is dangerous when seals appear on the tongue, as they leave behind a large scar that makes speech and chewing difficult.
3. Musculoskeletal disorders. There is destruction of bones and bone marrow, which makes the patient disabled.
4. Damage to internal organs. Serious changes in the body lead to inflammation of the aorta, impaired bile outflow, myocarditis, pathological changes in the lungs, kidneys and intestines.
5. Changes in the nervous system. With such violations, the patient becomes disabled, because they cannot be reversed. Miningitis, dropsy, neurosyphilis develops, or damage to the cranial nerves is observed.

Treatment of tertiary syphilis allows you to improve the functioning of internal systems and stop the progression of bacteria. But to achieve the result, it is necessary to consult a doctor in a timely manner and follow all his instructions.

Syphilis is an infectious disease that affects the mucous membranes, skin, as well as the bone, cardiovascular and nervous systems of the body. The disease is usually divided into three stages, the latest of which is tertiary syphilis. It develops at the 7th year of infection in the absence of proper treatment of the disease in the early stages or too late diagnosis.

Peculiarities

The tertiary stage of syphilis develops due to insufficiency or lack of treatment of the initial stages of the disease. It is accompanied by the formation of infiltrates or granulomas in the mucous membranes, skin and internal organs of a person. The resulting granulomas provoke tissue destruction. If you do not start therapy in time, there is a high probability of severe complications, including death.

Today, this type of syphilis is extremely rare. Most cases of the disease are detected in the early stages. Tertiary syphilis can develop as a result of improper use of drugs prescribed by a doctor or insufficient dosage.

Syphilis develops as a result of the vital activity of pale treponema. These microorganisms settle in intercellular spaces, vessels or nerve fibers. Most often, the disease affects people suffering from alcoholism or chronic diseases. The risk group also includes young children and the elderly.

There are several factors that contribute to the development of the disease:

• Unfavorable living conditions.
• The presence of injuries or chronic diseases.
• Reduced immunity due to prolonged illness.
• Constant mental and physical overload.
• Incorrect or insufficient nutrition.

The disease develops quite quickly. Therefore, it is important to take appropriate action as soon as possible.

Note! According to statistics, the disease most often affects people aged 20 to 30 years. The number of men and women is approximately equal.

Skin syphilis and its symptoms

The most common form of the disease is cutaneous syphilis. It is characterized by the formation of syphilides, which lie under the skin. There are the following types of such formations:

• Tubercular.
• Gummous.
• Erythema.

Each of these formations has its own characteristics and is localized in different parts of the body. Depending on this, the symptoms of tertiary syphilis will also be determined.

Tubercular syphilides

They are small nodules that are located under the skin. Their diameter does not exceed 7 mm. The greatest number of such formations is observed in the limbs, lower back, face, head or back. Such syphilides have a red-brown hue. After the healing of some syphilides, new ones may form in their place.

At the very beginning of the disease, tiny nodules appear, the diameter of which does not exceed 3 mm. Gradually, they begin to increase in size. Over time, ulcers will appear in their place. After treatment, scars remain.

Specialists distinguish several varieties of tubercular syphilides:

• Grouped. The formations are tightly adjacent to each other, but at the same time they do not merge into a single whole. One group includes no more than 40 nodules. Often such groups form long chains, which can be closed in a circle. Such syphilides are found in the region of the face, back and lower extremities.
• Serping. Nodules appear sequentially. Those that existed before are scarred. Such formations occupy an impressive area of ​​\u200b\u200bthe skin. A mosaic scar is formed in the center of the focus. Small scars gradually form around it.
• Dwarf. Their formation is observed 15 years after the onset of the disease, when the late tertiary period of syphilis begins. On the surface of the skin, small rounded formations of a red tint are formed. They are grouped into figures resembling papules of secondary syphilis. In place of syphilides, ulcers do not form. After treatment, scars may form, which smooth out over time.
• Diffuse. This is the rarest form of cutaneous syphilis. The resulting syphilides can be localized in any part of the body, but most often on the hands and soles. Several nodules gradually merge into one infiltrative area, which has a reddish tint and an oval shape. The diameter of such a site does not exceed 10 cm. They are never divided into separate tubercles. Deep cracks can form on the surface of such an area, which cause pain.

Note! In some cases, tertiary syphilis can affect the human psyche. Often, the patient experiences bouts of rage, depression, and even paranoia. At such a moment, it is important not to leave the victim alone.

Gummous syphilides

Gumous formations are larger in size. They are painted dark red. Tightly adhere to the subcutaneous tissue. Such syphilides bring severe pain. Gummous syphilides often appear singly.

Syphilides are most often localized in the sternum, thighs, upper limbs, genitals. The newly appeared formations are similar in size to a pine nut. They can be easily moved under the skin. The epithelium over the tubercle acquires a dark red hue. In the center, a lilac speck is noticeable. Later, an ulcer appears in its place. At its bottom there is a necrotic rod, the discharge of which leads to the appearance of a scar.

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In some cases, gummas can pass without the formation of ulcers. In such a situation, after the node is reduced, it is completely replaced by a dense tissue.

Erythema

Erythema or tertiary roseola is considered the rarest manifestation of tertiary syphilis. It is a light pink spot. Such spots can be grouped. They are folded into various geometric shapes with an area of ​​​​5 to 15 cm.

Most often, erythema can be observed on the buttocks, lower back, abdomen or back. As a rule, they always appear in the same place. Such areas can peel off over time.

Neurosyphilis

If the focus of infection is in the tissues of the brain, then the entire nervous system is affected. With this form of tertiary syphilis, the symptoms will depend on the form of the disease:

• Meningitis. This form develops five years after infection. Gumous formations begin to form around the vessels of the brain. The disease is accompanied by a significant increase in body temperature, severe headaches, dizziness, bouts of vomiting and nausea, a person painfully reacts to bright light. If the auditory nerve is involved in the process, then a significant hearing loss occurs.
• Meningoencephalitic. This form of the disease can develop even 30 years after infection. Most often it is observed in the representatives of the stronger sex. In this case, the same symptoms appear, one hundred and with the meningitis form of the disease. In addition to them, mental disorders appear. A person can be tormented by hallucinations, unmotivated attacks of aggression.
• Dorsal dryness. With this type of disease, the horns of the spinal cord are affected. In this case, the limbs may lose sensitivity, muscle atrophy occurs, vision decreases, and the process of urination and defecation is disturbed. Often accompanied by vascular lesions. There are three stages of this form of the disease:
  • Neuralgic. It is characterized by shooting pains in the lower extremities, which are paroxysmal in nature. Pain can be felt in the stomach and intestines.
  • Ataxic. It manifests itself in an unsteady shaky gait. The condition is aggravated if a person walks with his eyes closed.
  • Paralytic. Tendon reflexes disappear, muscle tone decreases, pupils stop responding to light.
• Paralysis. At the same time, all the signs of dementia appear, a person can lose the simplest everyday skills. Often this form of syphilis is combined with dorsal tabes.
• Vascular. In the shell of small arteries, an inflammatory process is born. It leads to the formation of blood clots. As a result, the lumen of the vessels narrows to critical values, certain parts of the brain begin to soften. This form of the disease is often found in young men. The main signs of such a lesion are headaches, dizziness, seizures that resemble epileptic seizures. If the treatment of tertiary syphilis of this form is started in a timely manner, then the prognosis is favorable.

Note! In some cases, neurosyphilis can occur in a latent form. Signs of the disease are detected only during a medical examination.

Damage to the osteoarticular apparatus

The manifestation of tertiary syphilis in the form of damage to the joints and bones is rare. Gummas appear in flat bones or diaphyses of large tubular bones. Formations are often found in the bones of the skull, humerus and ulna, tibia. Gummas can be concentrated in the periosteum, spongy or cortical substance. There are several types of the disease:

• Periostitis. It is characterized by pain in the bones, which worsen at night. Palpation reveals swelling. If proper treatment is not carried out, then tubercles or thickenings are formed at the site of the swelling, which are visible on x-rays.
• Osteoperiostitis. The inflammatory process originates in the periosteum. Later, it passes to the entire bone tissue. At the same time, a person is tormented by severe bouts of boring pain, which become especially unbearable at night. On palpation in the area of ​​the periosteum, swelling is felt, which subsequently develops into coarse growths with cater-shaped depressions. There is a high risk of ulcer formation.
• Osteomyelitis. This form of tertiary syphilis occurs due to the fact that gummas are concentrated in the bone substance. Inflammation soon spreads to the bone marrow. The process can also occur in reverse order. The main symptoms are fever and pain.

Tertiary syphilis can also affect the joints. At the same time, hydrarthrosis, osteoarthritis, and arthralgia develop. There are severe pains that are not associated with movement.

Note! Joint symptoms may persist even after appropriate treatment. Relief comes from taking medications containing potassium iodide.

Visceral syphilis

This type of tertiary syphilis can have the most serious consequences. The appearance of gummy formations can be observed in any internal organs. In this case, severe disruptions occur in the metabolism. Most often, the disease affects the cardiovascular system or the liver.

One of the manifestations of this form of syphilis is aortitis. In this case, foci of infection appear in the aortic membrane. Later they are replaced by connective tissue. The problem may be accompanied by significant vasoconstriction of the heart, aneurysm, or aortic valvular insufficiency.

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In the early stages, the disease may be asymptomatic. Later, symptoms similar to those of coronary heart disease appear. There are painful sensations in the chest, murmurs in the heart.

Syphilis can also affect the liver. This form of the disease often manifests itself between the ages of 35 and 50 years. There are four forms of such a problem:

• Focal gummous hepatitis. First of all, the peripheral parts of the liver are affected. Gummas are localized under the capsule of the liver, which leads to a change in the size of the organ.
• interstitial hepatitis. Pathological processes originate around the lobes of the liver.
• miliary hepatitis.
• Chronic epithelial hepatitis.

Hepatitis with syphilis has similar symptoms. There are painful sensations in the hypochondrium, a person is tormented by bouts of nausea, the sclera turns yellow, and the normal functioning of the intestine is disturbed. Diagnosis is hampered by the fact that symptoms appear simultaneously from several organs.

Diagnostic methods

It is possible to determine the tertiary stage of syphilis after a thorough examination and questioning of the patient, as well as carrying out appropriate diagnostic measures. During the interview of a person, a specialist should find out the symptoms of the problem and the measures that were taken earlier. During the examination, the doctor determines the presence of manifestations of the disease. At this point, it is important to correctly distinguish them from tuberculosis, mycosis and other diseases.

Among the main diagnostic methods used are the following:

• Laboratory studies of blood samples. First, a non-treponemal analysis is performed. After that, a treponemal study is also carried out for control. This is the only way to make an accurate diagnosis.
• bacterioscopic examination. For the presence of traces of treponema, samples taken from the lymph nodes or from the bottom of the ulcers are checked.
• Study of the cerebrospinal fluid. Such an examination is carried out if neurosyphilis is suspected. An increased content of protein, monocytes and lymphocytes in the sample is detected.

Only after a full diagnosis, a specialist will be able to make a reliable diagnosis. Based on this, a competent treatment program will be developed in the future.

Therapy of the disease

It is necessary to start treatment as early as possible. Only in this case, a successful cure is possible. The main therapeutic method is the use of drugs containing benzalpenicillin. Thanks to this, the work of internal organs and systems is adjusted. If a patient has an allergic reaction to penicillin antibiotics, they are replaced with Doxycycline, Ceftriaxone or Amoxicillin. In rare cases, there is an allergy to all antibiotics. In such a situation, medications from the macrolide group are used for treatment. A good result is the use of Summamed, Josamycin, Clarithromycin.

If tertiary syphilis is not accompanied by damage to internal organs, then the following methods of using penicillin antibiotics can be used:

• Novocaine salt of penicillin is used. It is administered in equal doses 4 times a day for 28 days. After the first two weeks, a break is made for 14 days. After that, the drug is resumed.
• The specialist prescribes a water-soluble penicillin. It is also injected into the patient's blood 4 times a day for 28 days. If necessary, the course of treatment is repeated, but procaine-penicillin is already used. It is administered for 10 days.
• Procaine penicillin. The course of treatment with this drug is 20 days. After this, a ten-day break is made, after which the use of the medication is resumed for another 10 days.

If the disease is accompanied by damage to internal organs, then complex treatment of tertiary syphilis is carried out. The following techniques may be applied:

• The first two weeks, a preparatory stage is carried out, in which the patient is prescribed Tetracycline or Erythromycin. After that, penicillin is administered to the patient for 28 days.
• After the preparatory stage with the use of Tetracycline or Erythromycin, treatment is carried out with the use of novocaine salt of penicillin.
• At the end of the preparatory stage, treatment is carried out using procaine-penicillin.

Treatment of neurosyphilis is also carried out with the use of antibacterial drugs of the penicillin series. Six months after the end of the main course of treatment, repeated laboratory tests are carried out. This is the only way to check the success of therapy.

Specific drugs and their dosage is determined by a specialist based on the form and severity of the disease. Sometimes you have to apply several courses of therapy to achieve a result.

Note! If gummous nodes are found in the brain or spinal cord, then Prednisolone is prescribed simultaneously with antibiotic therapy. This enhances the effectiveness of antibiotics and reduces the likelihood of regression of symptoms.

On average, therapy for tertiary syphilis takes from two months to several years. Everything will depend on the complications that have appeared and how sensitive the patient is to the drugs used. During treatment, the patient is advised to refrain from sexual intercourse without the use of a condom. It is necessary to periodically undergo an examination for preventive purposes.

Syphilis, even in the last phase, can be cured. The sooner treatment is started, the greater the chance of a successful cure. Always be attentive to your health and consult a doctor at the first unpleasant symptoms.

Tertiary syphilis is one of the forms of an infectious disease dangerous to human life and health, provoked by the penetration of pale treponema into the body. The pathological presence of the named bacterium in the body manifests itself in the form of damage to certain areas of the skin, mucous membrane, internal organs and the nervous system.

The considered tertiary stage of the disease is the most dangerous for the body, which is associated with the absence of pronounced signs of the disease. In some cases, patients are unaware of its onset for a decade, while being chronic carriers of the bacterium.

With the use of modern methods of treatment, the tertiary stage of syphilis develops extremely rarely. The factors provoking primary syphilis most often become elderly or infancy (secondary and tertiary are the most dangerous).

Lack of treatment, or incorrectly calculated doses of drugs, if secondary syphilis was nevertheless treated:

• Lack of personal hygiene, living in unacceptable social and living conditions;
• Injuries, chronic diseases;
• Violation of the immune system, accompanied by immunodeficiency;
• Physical, mental and mental stress accompanying secondary syphilis;
• Improper nutrition, lack of the required amount of proteins, vitamins and trace elements in food.

If secondary syphilis was not detected and treated in a timely manner, then it is he who becomes the most common cause of the transition of the disease to the tertiary stage, the symptoms of which are described below. Predisposing factors for this are also alcohol dependence, smoking and promiscuity. At the same time, patients in whom syphilis has reached the tertiary stage of development may not be contagious. Pale treponemas are located inside the granuloma and die when they decay.

Signs and types

The disease is characterized by long periods of latency. Tertiary syphilides (gums, tubercles, roseola) develop over many years. The patient does not experience discomfort. Clinical signs are as follows:

• Rashes appear on the skin - a specific type of tubercle (tubercular syphilis);
• A gummous ulcer develops (gummy syphilide);
• The cardiovascular system is affected (myocardial infarction, aortitis);
• Changes in the structure of bone tissue (osteoporosis, osteomyelitis);
• There are problems with the liver (chronic hepatitis);
• Gastritis and stomach ulcers are formed;
• There are difficulties in the work of the kidneys, intestines, lungs, nervous system (neurosyphilis).

Ulcers (gummas) and tubercles disfigure the appearance of the patient. Such manifestations of tertiary syphilis are most unpleasant for women.

Most often they occur on the face, hands, in the armpits. If the disease is not treated, it becomes irreversible and leads to the death of the patient. Both secondary and tertiary syphilis are successfully treated, the clinic of the disease is difficult, but modern drugs cope well with the disease at any stage.

Tertiary roseola

A rare variety of tertiary syphilis, a photo of which is posted below. It is a pale pink spot, with a diameter of 15 centimeters or more. Groups of spots are localized in the area of ​​the arms, legs and sacrum. Their appearance is associated with vascular disorders. The spots may coalesce, with various patterns forming on the skin.

Subjective sensations about the appearance of spots in patients are absent (nothing bothers). Roseolas remain viable for 1 year, after which they disappear or recur. A soft scar forms in their place.

gummas

Gumma: A deep, nodular syphilis that occurs in about half of people with tertiary syphilis. Gumma is formed under the skin in the fiber and the deep layer of the dermis. The gumma nodule is formed in the subcutaneous adipose tissue, it is mobile, changes in size and merges with the skin. In turn, the skin at the confluence becomes thinner and stretched, acquiring a red-violet hue. The diameter of the gumma often reaches 10 centimeters.

Having reached the maximum volume, the nodule begins to disintegrate, which is accompanied by the opening of the granuloma and the formation of an oozing ulcer in its place. The liquid released from the wound stretches, does not have a specific color, and smells unpleasant. The depth of the ulcer reaches 1 centimeter, it has the shape of a circle with clear boundaries and steep edges. The bottom of the ulcer is dense, there are gray granulations.

The healing of the gummy nodule is slow, sometimes it takes several months. After the process is completed, an ugly pink star-shaped scar remains on the skin. Over time, the scar acquires a normal shade, but does not completely disappear.

In some cases, the opening of the gum does not occur, while the atrophic type of scar is still formed. Gummas can be fibrously reborn, or petrified. Several gummas can merge and form a gummous infiltration that spreads to healthy areas of the skin and destroys tissues and bones.

Tubercular syphilide

Tubercular primary syphilis is a dense tubercle (rash) of a spherical shape, which is formed on the skin and mucous membrane simultaneously with the gums. Tubercular syphilides are located asymmetrically, differ in copper-red color with an admixture of cyanosis. The size of the tubercle does not exceed 1 cm in diameter, its consistency is dense, the boundaries are clear.

At least 10 such tubercles are formed on the human body. From the moment of their development and before healing, it can take several months. The process of formation and healing is uneven, the presence of tubercles on the skin, which are at different stages of development, is a standard phenomenon. Separate hillocks are located in groups, but in most cases there is no merging between them.

Healing of the tubercles occurs according to the type of dry necrosis, or with the formation of ulcers. The result of the decay of syphilis is the formation of atrophic scars. The following varieties of tubercular syphilis are distinguished:

• Grouped tuberculous primary syphilis. The resulting tubercles are homogeneous, never merge, painless, characterized by polymorphism, have a smooth, shiny surface and a red-brown hue. During healing, an atrophic scar is formed, or an ulcer, which results in the appearance of an unpleasant type of scar with a pigment spot around it. The shape of the scars is round;
• Creeping primary syphilis. A characteristic feature of this form of the disease is the fusion of tubercles, with their subsequent spread to healthy areas of the skin. At the same time, the nature of the rash at the edges may differ from the quality of the tubercles in the center. It is often possible to identify clear zones of growth, decay and scarring. Healed tissue has a bluish-red tint. Refusal to treat the disease leads to an increase in the area of ​​the lesion;
• Dwarf primary syphilide. A rare variety of tuberculous syphilis, mainly manifests itself 10 years after infection. The rash is small, does not exceed 2-3 millimeters in diameter. The color of pimples depends on the degree of damage, there is a rash of light yellow and dark red, almost brown. Pimples do not open, heal dry, followed by the formation of atrophic scars;
• Syphilis playground. This type of syphilis is characterized by the fusion of tubercles and the formation of a plaque-like infiltrate as a result of this, with a diameter of up to 20 centimeters. The color of the rash is brown-red. After the decay is completed, unpleasant scars form on the skin.
• Vegetative syphilis. A group of tubercles is formed on the skin, as a result of the opening of which ulcers appear with lush granulations at the bottom.

Regardless of the variety of tubercular syphilis, its localization area remains constant. Most often, the rash appears on the skin of the face, back, elbows and knees. In this case, the patient does not experience any discomfort.

Visceral syphilis

The most severe form of the disease (late tertiary syphilis), accompanied by significant complications. Pathological gummas and tubercular syphilides affect internal organs, primarily the liver, heart, blood vessels, intestines, stomach and lungs.

A consequence of the development of the visceral form of syphilis is the formation of syphilitic aortitis or myocarditis, which leads to deformation of the inner lining of the aorta, the development of aneurysms, the formation of blood clots, and damage to the heart muscle. When the liver is damaged, syphilitic hepatitis is formed.

Due to the numerous lesions of internal organs, the diagnosis of the disease is difficult, as evidenced by the presented presentation.

Neurosyphilis

Neurosyphilis is diagnosed when the nervous system is affected, manifests itself in the form of:

• Chronic meningitis;
• Meningomyelitis;
• Hummous lesions of the brain and spinal cord;
• vascular lesions;
• Dorsal tabes;
• progressive paralysis.

Neurosyphilis develops gradually, its obvious signs may appear after 10 or even 40 years.

Diagnosis and treatment

Diagnosis of tertiary syphilis is based on clinical and laboratory findings. To identify the stage of the disease, a RIF (immunofluorescent reaction) and a RIBT blood test are performed. In order to identify the degree of damage to individual internal organs, patients are sent for ultrasound of the heart, ECG study, aortography, X-ray of the bones.

Treatment of tertiary syphilis begins with erythromycin or tetracycline. Upon completion of a two-week course of antibiotics, the patient is prescribed penicillin therapy, combined with intravenous administration of Bismuth.

If there are contraindications to this drug, an additional intake of penicillin-containing drugs is prescribed. The duration and treatment regimen depend on the form and degree of neglect of the disease. Simultaneously with treatment, blood counts are regularly measured, ECG and ultrasound data are studied,

The tertiary period of syphilis is extremely dangerous, characterized by multiple complications, but fortunately, it is rare, modern diagnostic tools make it possible to identify the first signs of the disease at an early stage.