How long does it take for chancre to appear? Chancre: a manifestation of primary syphilis. How and how long does it take for syphilis to appear: all stages During what period does chancre appear
![How long does it take for chancre to appear? Chancre: a manifestation of primary syphilis. How and how long does it take for syphilis to appear: all stages During what period does chancre appear](https://i1.wp.com/vekzhivu.com/sites/default/files/imagecache/resizeimgpost-500-500/u93/2015/12/cherez-kakoe-vremja-projavljaetsja-sifilis-2.jpg)
Syphilis is an ancient disease known back to the times of Ancient Greece. Many treatises and scientific works have been written about the disease. People have suffered from it at all times, regardless of class and status. Scientists are still looking for methods for quick and painless treatment, early diagnosis and possible elimination of consequences.
The causative agent of syphilis is Treponema pallidum from the family Spirochaetaceae, genus Treponema, previously nicknamed spirochete. This microorganism, similar to a corkscrew, is literally screwed into the victim's body.
Currently, practical medicine knows the following ways of contracting syphilis:
- Sexually. The most common method, registered in 95% of cases of detected infections, with women most often affected;
- By everyday means. Most often through personal belongings used by different people, as well as through cutlery and dishes;
- In utero from mother to fetus through the placenta or during passage through the birth canal. Sometimes a second generation infection occurs - from a healthy woman, infected at birth, who has undergone treatment, a mutated gene is passed on to her child;
- By the transfusion method, that is, when transfusing infected donor blood in violation of the rules of transfusion. An extremely rare accident, usually occurring due to negligence during direct transfusion;
- Medically, during medical examinations or procedures due to contact with instruments or equipment with untreated antiseptic. This path was often observed until disposable devices, especially syringes and droppers, came into use.
In the last two cases, there is no barrier preventing the penetration of Treponema pallidum into the human body. But these cases are extremely rare. In the first cases of direct contact with a patient, whether through household or sexual contact, infection depends on many reasons, because every fifth person remains absolutely healthy after possible routes of infection.
This is explained by the fact that there is individual immunity to syphilis, a high level of immunity, and the absence of microcracks.
There is a professional route of infection when medical staff are accidentally infected. This happens among dentists, gynecologists, surgeons, pathologists, and salon cosmetologists who neglect protective methods.
Learn more about the disease syphilis from this video from the Live Healthy program.
The disease has several stages of development. Based on the time of infection, the stage of syphilis is determined. Between each stage there is a latent period when there are no characteristic symptoms of the disease.
Doctors classify the disease into three stages:
- Primary or early;
- Secondary;
- Tertiary.
With early syphilis, a sick person develops a chancre at the site where Treponema pallidum was introduced - an ulcer without much pain, similar to a mosquito bite or wart. After a month and a half, the ulcer goes away without any scars.
The primary period lasts from 10 to 100 days after infection. The chancre, when pressed, releases a large number of microorganisms that are dangerous to others. Often, at an early stage of the disease, the lymph nodes in the neck and groin areas become enlarged. Localization of chancre: genitals, lips, anus, rectum, perineum, oral cavity.
The secondary stage of the disease is characterized by the complete spread of infection throughout the body. The lymph nodes throughout the patient's body become enlarged.
The main symptoms of secondary syphilis are:
- Decreased appetite;
- Pain in bones, joints and muscles;
- Impaired visual acuity;
- Headache;
- Hearing loss;
- General weakness;
- A sore throat;
- Increased body temperature;
- Nausea;
- Small pink rash.
These symptoms can manifest themselves in combination or individually. 1% of those infected have all symptoms at the same time.
There are fresh, recurrent and latent periods of secondary disease. Years later, in the absence of the necessary treatment, tertiary syphilis manifests itself. This happens to those people who are negligent about their health and do not visit medical institutions for prevention.
Tertiary syphilis has 3 forms of development:
Mild syphilis at a late stage of development manifests itself many years after infection. The patient is tormented by severe drilling pain in the bones, gummas appear - soft scars.
Tertiary syphilis of the cardiovascular form occurs more than 10 years after infection.
The characteristic symptoms are:
- Rough cough;
- Chest pain;
- Paralysis of complete or partial vocal cords;
- Frequent respiratory tract infections.
Neurosyphilis is the most terrible form of the disease.
At the same time, it manifests itself in the form:
- Meningitis vascular neurosyphilis;
- Asymptomatic veiled neurosyphilis;
- Tabes dorsalis;
- Parenchymatosis.
There are even less common forms of tertiary syphilis. The disease is cyclical, periods of exacerbation are replaced by false remission.
Tertiary syphilis behaves less actively; the immune system suppresses Treponema pallidum, which prevents it from reproducing outside its carrier. However, the immune system weakens over time, and the person again becomes a source of infection, gradually dying. Between periods, as already written, there is a latent period when there are no symptoms of the disease.
Sometimes the disease goes unnoticed by the infected person, since nowadays almost all diseases are treated with various antibiotics, which, acting on Treponema pallidum, suppress and kill it.
The question often arises about how long it takes for syphilis to appear. It is known that the contagiousness of the disease depends on the period of its development. Infection occurs asymptomatically when neither partner is aware of the disease.
The incubation period can last a week or 3 months. On average, after 3 weeks the disease manifests itself slowly, but with increasing effect. The manifestation of infection depends on a person’s immunity and gender, age and the presence of other diseases.
Low reactivity is associated with other diseases and the use of medications that blur the clinical picture of syphilis.
The main and sure sign of the disease can be perceived as enlarged lymph nodes in the groins and neck after unprotected sex with an untested partner or after a direct blood transfusion.
The second obvious sign will be the appearance of weeping ulcers or erosive abrasions in intimate places or the oral cavity.
If casual sexual contact occurs and there is a suspicion of infection, you should definitely undergo a test to detect syphilis. This will help identify it at an early stage, prevent infection of loved ones, and help quickly get rid of the disease.
In modern conditions, the disease is no longer so terrible and is easily treated. Early treatment will prevent complications and destruction of the body.
Based on materials from vekzhivu.com
When diagnosing syphilis in a victim, experts mean a chronic venereal disease that affects the skin and mucous membranes of the body, internal organs, bone tissue, and the central nervous system. The formation of the disease is provoked by a pale spirochete, which, being outside the human body, is characterized by weak resistance to alcohol, soapy water, and high temperatures. At the same time, syphilis is a very dangerous condition, since the causative agent of the disease is able to penetrate the human body through damage even invisible to the eye.
Let's look at syphilis and its spread. It is not for nothing that the disease is called a venereal disease, since the disease is transmitted from the carrier to the victim, with the exception of only 5% of cases through sexual contact. In this case, infection occurs not only during vaginal contact, but also during anal and oral intercourse. Syphilis can also be:
- Household - this form is extremely rare, since even if treponema gets on personal hygiene items, it quickly dies.
- Congenital (observed in infants) - infection occurs either during gestation or during labor. The lactation period is also quite dangerous if the mother is sick with syphilis.
- Another rare method is blood transfusion. Modern medicine carefully examines donors; moreover, when the substance is preserved, the pathogen dies within five days. Only direct transfusion from a carrier poses an increased danger, which occurs infrequently.
But even if contact with a carrier has taken place, manifestations of syphilis may be absent in 20% of cases - infection does not occur because the necessary conditions for this do not exist. In particular, the amount of viral agents in an infected biomaterial can be very small; the absence of microtrauma or individual immunity plays a role. The risk of infection increases when the patient has primary or secondary syphilis, accompanied by erosive and weeping elements of pathological rashes. If we are talking about late pathology - latent or tertiary - infection occurs very rarely during contact with a carrier.
Since a syphilitic rash can form in any area of the skin or mucous membrane, condoms cannot be considered reliable protection; they only reduce the risk of infection, also protecting against urogenital infections that usually accompany the underlying disease.
As for how long it takes for syphilis to manifest itself, it is important to have an idea of the incubation period. On average, its duration is from three to four weeks, but the interval can decrease to two weeks or increase to six months if the victim takes antimicrobial drugs for any reason. It should be understood that even in the case of active development of pathology, symptoms may be absent at first. Laboratory tests can determine the presence of the disease only two to four weeks after its primary period begins. Accordingly, all partners of the carrier who had sexual contact with him during this period are at risk of infection, hence the need to test for syphilis.
The standard primary signs of pathology are the formation of hard chancre along with an increase in the size of the lymph nodes. A chancre is an ulcer or erosive lesion of a round shape, distinguished by clear boundaries. Usually it has a red tint, secretes a serous substance, thus acquiring a “varnished” appearance. The discharge contains an increased amount of pathogens; when examining the fluid, they can be detected even in cases where nothing suspicious is found in the blood during laboratory tests. The base of the chancre is hard, its edges are slightly raised, forming a shape similar to a shallow saucer. Syphiloma is usually not accompanied by pain or other uncomfortable symptoms.
There are many places for the formation of syphiloma - it can be the genitals, mouth or anus, it all depends on the type of sexual contact. The formation of primary symptoms occurs in stages:
- From the moment the pathogen enters the body until the symptom is formed, it usually takes from two to six weeks.
- Enlargement of the lymph nodes that are located closest to syphiloma usually begins after seven days.
- After another three to six weeks, the ulcers have healed so that there are no visible symptoms.
There are a number of additional signs that accompany the formation of chancre, in this case the first manifestations include:
- problems with sleep, development of insomnia;
- fever (increased body temperature);
- headache and joint pain, bone discomfort;
- general malaise;
- swelling of the genitals.
Atypical symptoms of the pathology include the appearance of amygdalitis chancres in areas of the tonsils, the formation of chancre felons on the fingers, indurative swelling in the labia area, regional lymphadenitis and lymphangitis.
When characterizing syphilis, we can classify it as a systemic pathology that can affect the entire body. External clinical manifestations are often similar to symptoms characteristic of other diseases; therefore, accurate diagnosis includes laboratory tests of the skin and blood sampling for the Wassermann reaction. What specific symptoms of the pathology will appear in the victim largely depend on a number of factors, including his age category, lifestyle, immune system, and other individual characteristics.
The development of syphilis occurs in three periods - primary, secondary, tertiary. They are preceded by a three-week asymptomatic incubation period. Let's consider how syphilis manifests itself in different periods of formation.
We discussed the incubation and primary periods above. It should perhaps be added that during the incubation period the carrier is not infectious, so the Wasserman reaction will show a negative result. As for primary syphilis, at this stage of the development of the disease the patient becomes infectious. Now about chancre - its disappearance occurs without any treatment, and a scar is formed at the site of syphiloma. At this stage, increased attention is required - even in the case when the chancre completely disappears, it is impossible to talk about healing, since the development of the disease continues.
After the treponemes enter the lymph nodes, they are carried throughout the body along with the bloodstream. The presence of a primary period of pathology can be indicated by either unilateral or bilateral enlargement of the lymph nodes, usually observed in the groin area. They are distinguished by their dense elastic consistency, mobility and painlessness. In the first half of this period, the Wasserman reaction, along with other blood tests, continued to remain negative. However, in the second half of the period - usually the sixth or seventh week from the onset of infection - blood tests show a positive result, revealing the presence of syphilis in the body. The above weakness, fever and pain occur at the end of the primary stage of syphilis - these signs can be considered harbingers of the formation of a generalized rash, which marks the beginning of the secondary stage of the pathology.
About ten weeks after infection of the body - which implies the typical development of pathology with syphilis - signs appear on the skin indicating a fresh secondary stage of the disease. We are talking about a syphilitic rash, including pustules and spots, nodules. None of the listed elements causes discomfort. The rash disappears after a few weeks, without requiring the use of any medications. After it passes, we can talk about the onset of secondary latent syphilis. It is characterized by certain manifestations, including:
- syphilitic rash;
- hair loss;
- discolored spots on the skin of the neck;
- positive Wasserman reaction along with other tests performed for syphilis.
Any of the elements of the rash at this stage are highly contagious, but completely painless.
A feature of the secondary period of syphilis is an increased risk relative to the possibility of domestic infection. The duration of this stage is usually from two to four years.
Let's see how tertiary syphilis manifests itself. Typically, this stage occurs five or more years after infection. The main features characterizing the tertiary stage include:
- The formation of gummas - foci - in bone tissue, skin, liver and brain, lungs and heart muscle and even eyes. Gummas are subject to decay, resulting in the destruction of the area in which they were formed.
- The appearance of ulcers on the mucous layers of the palate and back of the pharynx and nasal cavity.
- Possible damage to the nasal septum and its gradual destruction.
- The symptoms of this stage are closely related to the destruction of nerve cells in both the spinal cord and the brain; they manifest themselves in dementia and the appearance of progressive paralysis.
At this time, visible lesions practically do not include the pallidum spirochete, and accordingly they are rarely infectious. When carrying out the Wasserman reaction and other laboratory tests, a weakly positive or negative reaction is noted. Regardless of the syphilitic symptoms, each stage of the pathology is curable. However, at the third stage, the disease not only affects, but can also destroy many human organs, making cell restoration impossible. Quite often in such a case, the victim becomes disabled for the rest of his life.
The main symptom of syphilis is a rash, the appearance of which is not accompanied by unpleasant sensations. At the initial stage of the pathology, it is a hard chancre; at the secondary stage, syphilis can manifest itself with a variety of elements, from pink spots to papules and pustules. Spots of a centimeter in diameter in gray, blue or red shades may appear on the skin. In this case, all types of rash can form simultaneously, most often localized on the hands or sole of the foot. Usually there is no pain or itching at all. An unpleasant sensation occurs in very rare cases when palpating papules.
Given the almost complete absence of discomfort, victims often ignore the rash. In addition, it goes away on its own, and therefore therapeutic measures are used with considerable delay. Nevertheless, syphilitic rashes have a number of characteristic signs:
- The rash is copper colored.
- The lesion that accompanies the rash is peeling or the formation of dirty brown, gray scabs.
- The rash can both disappear and reappear - here the ratio of treponema pallidum and antibodies contained in the blood plays an important role.
- If a relapse occurs, the rash can change. It becomes larger, ovals or circles form on the skin and mucous membranes. This development can be observed over a period of four or five years - all the time that secondary syphilis continues.
- In the presence of tertiary syphilis, subcutaneous compactions occur. Their diameter can reach 1.5 cm. Such compactions transform into ulcers over time. Lumps may form on the skin, forming circles, in the center of which ulcerative lesions appear and necrosis forms.
Considering all the dangers of the disease, if suspicious symptoms appear, it is necessary to immediately contact a venereologist to make an accurate diagnosis and develop a therapeutic regimen.
When comparing the signs of pathology developing in representatives of different sexes, it can be noted that the main differences lie in the localization of foci of syphilis. In men, lesions are concentrated on the scrotum or penis, in women - on the labia minora and vaginal mucosa. If anal and oral sex takes place in love affairs, negative phenomena are concentrated on the sphincter, mucous membrane of the mouth, throat, lips and tongue. The skin of the neck or chest may be affected.
In the fairer sex, the formation of hard chancre most often occurs on the vaginal walls or on the uterine cervix, in the area of the labia. A problem with identifying the disease in the initial stages of development is possible when syphiloma forms on the uterine cervix. Much less often, chancre forms on the chest or in the mouth, on the thighs or in the perineal area. Most often, one chancre is formed, but the formation of two, and sometimes more, syphilomas at once is not an exception.
If you do not pay attention to the symptoms indicating the formation of a problem, syphilis can remain in the body for not just years - decades! At the same time, its course is undulating, and the lesions become dangerous and severe over time. Is it possible to identify signs of syphilis on your own? Undoubtedly, if you follow a number of existing recommendations:
- If there has been a suspicious contact, the entire body should be thoroughly examined two or three weeks after the contact. During this period, the main attention should be paid to the possibility of forming a painless chancre.
- If a chancre or similar formation is detected, you will need to mentally analyze your condition. In this case, we are talking about primary syphilis, so attention should be paid to fever and rising temperature, headaches, insomnia and muscle pain.
- The next step is palpation of the lymph nodes, first of all the most characteristic ones. Their increase, especially if there is a formation resembling a chancre nearby, is a possible sign of syphilis. When palpated, the lymph nodes should be mobile and elastic, fairly dense, but painless.
To confirm the presence of syphilis, it is necessary to contact a venereologist at the same time when chancre was first discovered - only timely treatment prevents complications of the pathology.
During the process of bearing a child, a woman infected with syphilis can infect the fetus from the tenth week of pregnancy through the placenta. If secondary syphilis occurs, the child is 100% infected; in the presence of late forms of pathology, infection does not occur so often. Infection of the fetus occurs most rarely in the case of primary syphilis in the mother. If the fetus is infected with syphilis, the consequences can be catastrophic - the death of the embryo with spontaneous abortion is possible. The possibility of a stillborn child cannot be ruled out. In the case when the baby is nevertheless born, symptoms of congenital pathology are detected in his childhood, depending on when exactly the mother was infected. Congenital pathology can be early or late. The first includes infections of the fetus, infants and young children:
- Fetal syphilis leads to its death in the sixth or seventh month; death occurs due to exposure to toxins of the pathogen.
- When a child is under one year of age, if signs of pathology are visible, we can talk about the baby’s non-viability. Immediately after its birth, a skin lesion occurs - syphilitic pemphigus. Syphilitic runny nose is observed, and damage to bone tissue, spleen or liver is often diagnosed. If the brain is affected, meningoencephalitis is formed.
- With congenital syphilis in children from one to five years of age, the signs resemble secondary syphilis; symptoms include a syphilitic rash on the mucous and skin layers.
With late congenital syphilis, which manifests itself from 5 to 15 years, eye damage is observed, deafness develops, problems appear in the internal organs, and the central nervous system is affected.
Preventive measures for congenital syphilis include mandatory tests for the presence of pathology, which are carried out three times during pregnancy. If the result is positive, a visit to a venereologist is necessary - the specialist will decide on the continuation of pregnancy and treatment of the pathology. If there is an increased risk of congenital syphilis, pregnancy can be terminated in accordance with medical indications. Women who have had syphilis should plan to conceive no earlier than five years after final healing.
Based on materials from venerbol.ru
Syphilis can occur in a latent form for a long time. In order to prevent transmission of the disease, it is worth knowing how syphilis manifests itself, the characteristics of its course, symptoms and treatment rules. Sexually transmitted diseases are dangerous pathologies that can lead to serious health complications. The fact is that many of them are not accompanied by symptoms at the initial stage, for this reason the disease can simply not be noticed, and at this time it gradually affects the internal organs. One of these diseases is syphilis. It can occur in women and men.
- Causes
- Symptoms
- Syphilis rash
- Forms
- Primary
- Secondary
- Tertiary
- Diagnostics
- Types of tests for diagnosing syphilis
- Features of treatment
- Prevention
- Emergency prevention of syphilis
- Prevention of syphilis in pregnant women
Photograph of the stages of disease development
The development of syphilis can occur for various reasons, but the most important is considered to be sexual contact. Infection often occurs during sex with an infected sexual partner. The causative agent of the disease, Treponema pallidum, penetrates the mucous membrane and damaged skin.
Subsequently, the bacteria quickly enter the structure of the lymph nodes, where they instantly multiply and, together with the blood flow, spread throughout the body. As a result, they settle in internal organs, bones, joints and the central nervous system.
The manifestation of syphilis can also be provoked by other reasons:
- It can appear in women and men after using contaminated personal hygiene items - shower and bath products, towels, linen, brushes, washcloths, dishes with residual saliva particles;
- the risk of infection is increased during professional contacts. This disease can be caught while working in a laboratory or in hospitals. Infection occurs especially often through careless handling of medical instruments, cutting and piercing objects, which can damage the skin of the hands, fingers and come into contact with dangerous microflora of the virus.
The disease is especially dangerous during pregnancy and for women who are planning childbirth. The fact is that an infection in the body (treponema pallidum) can develop for a long time without signs, during which time it can have a negative impact on the development of the unborn child.
The main danger of syphilis is that at the initial stage this disease does not manifest itself in any way and is not accompanied by symptoms. For this reason, many simply do not notice the presence of a pathological process, and meanwhile the infection spreads to internal organs, systems, and bone tissue.
The incubation period of the disease takes on average from 2 to 6 weeks. However, sometimes it may not develop for years; this can happen when taking antibiotic drugs, during the treatment of infectious colds. During this period, laboratory tests will not be able to give reliable results.
Syphilis manifests itself by internal and superficial lesions. Common symptoms include the following:
- chancre and enlarged lymph nodes - these are the most important symptoms. They are the ones who 100% confirm that a pathogen has entered the body. A chancre is a smooth, painless ulcer with a dense infiltrate. The formation has rounded, slightly raised edges with a diameter of about 1 centimeter. Accompanied by a bluish-red color and may be painful. Within a week after the onset of chancre, an increase in lymph nodes is observed;
- headaches and symptoms of general malaise are observed;
- pain in the muscles and joints;
- temperature increase;
- decreased hemoglobin level;
- increase in leukocytes in the blood;
- indurative edema may form;
- felon. Accompanied by an inflammatory process of the nail bed. The condition may last for several weeks;
- amygdalitis may occur. During it, swelling of the reddened tonsils and difficulty swallowing are observed.
It is important not to forget that syphilis infection can occur through any form of sexual intercourse. Therefore, oral sex is especially dangerous when infected, during which condoms are rarely used.
Thus, primary syphiloma is formed at the site of the introduction of pallidum treponema; with oral infection, the chancre will be located in the mouth or throat. Moreover, if your partner has a chancre in the mouth, you can become infected without sex, just through a kiss.
If the infection occurs during anal sexual intercourse, the chancre is localized in the anal area. At the same time, it often looks atypical and, in shape, is not round, but slit-like.
For infection to penetrate, contact of the pathogen with the mucous membranes is not always necessary. The skin can also become an entry point for infection, especially if it is damaged. Chancroid in such situations is often localized on the skin of the thighs, face or abdomen.
Approximately 3-4 weeks after the incubation period, skin rashes may be observed. They are not accompanied by itching or pain. Skin manifestations of syphilis are dark red in color, have a dense consistency, and straight edges without peeling.
The rash can be of different types:
- Rosaceae. During a rash of this type, small oval or round spots (about one and a half cm) form. They are located over the entire surface of the body, arms, legs. Their boundaries are not clearly defined, do not blur and do not rise above the skin;
- Papular. Round formations with a pale pink color. The size of the rash is 1 centimeter. The surface is smooth, there are slight peelings. The main locations are the area of the soles of the feet, on the palms, on the surface of the mucous membranes of the genitals. Sometimes a pale rash appears all over the body;
- Condylomas. These are connected papules that have ulcers;
- Leucoderma. This condition is characterized by the appearance of white spots against the background of darkening of the skin. Over time, they acquire a brownish-yellow color. The rashes are localized on the neck, armpits, chest, arms;
- Arthematous sore throat. Rashes appear on the oral mucosa, near the pharynx, and on the surface of the hard palate. The Treponema pallidum bacteria themselves are located inside the cavity of the papules;
- Alopecia. A large number of rashes with a diameter of 1-2 mm are formed on the surface of the scalp. Over time, hair loss occurs in these areas.
In order to understand how the types of rash can manifest themselves and what they look like, it is worth looking at the photo.
Syphilis can occur in several forms, and each of them can have distinctive features. For this reason, it is worth taking a closer look at the manifestations of each.
The primary form is early latent syphilis. It is usually observed several weeks after the moment of infection.
Patients with primary syphilis do not immediately notice its manifestations. For this reason, the disease can spread to internal organs, tissues, systems and cause serious health complications.
During the initial form of syphilis, symptoms appear:
- the appearance of specific ulcers with rounded shapes, which are also called chancre;
- After about 2 weeks, the chancre completely disappears. This means that pathogenic bacteria have entered the body;
- damage to the lymph nodes appears, and their enlargement is also observed;
- the primary form affects internal organs and systems.
At the 11th week of infection, symptoms of secondary syphilis appear. This form is accompanied by the appearance of syphilitic infectious lesions in the form of spots, rashes, ulcers, and nodules on the skin.
The formations have no pain or discomfort. If treatment is not carried out in a timely manner, they will disappear completely over time. This means that the disease goes into a latent form. Over time, secondary syphilis may reappear, during which all the characteristic symptoms may reappear.
The secondary stage can last for 4 years. However, it is accompanied by serious health complications.
Approximately 5 years after the secondary stage, the disease becomes tertiary. It is considered the most severe, during which the following complications may occur:
- severe damage to internal organs;
- the appearance of lesions (threshing floors) on the skin;
- lesions can be observed on the mucous membranes and internal organs - on the heart, liver, lungs, brain. They also attack bones and eyes;
- Often the disease affects the nasal mucosa. Lesions lead to complete destruction of the nasal septum;
- At this stage, dementia and progressive paralysis appear.
Diagnosis should be carried out as soon as the first symptoms of syphilis appear. Of course, this disease can occur in a latent form for a long time, but still, if you start treating it at the initial stage, you can quickly eliminate all its unpleasant manifestations.
It is also worth starting the examination if you have recently had sexual contact with a carrier of the disease. In these cases, infection is most likely to be confirmed. And in order to get the most accurate results, laboratories conduct blood tests, which are taken from a vein.
Modern serological and immunological blood tests make it possible to identify the disease with maximum accuracy within a few weeks of infection. The test allows you to detect the disease with an accuracy of 99.8-100%.
There are many types of tests that can detect the presence of a pathogen in the body. However, the diagnostic criterion for syphilis is usually serological tests.
The principle of serological reactions is to detect antibodies to Treponema pallidum in the blood. Moreover, if little time has passed since the moment of infection, the body may not yet have time to produce antibodies. This type of syphilis is called primary seronegative and is difficult to diagnose. In this case, in the presence of hard chancre, a preliminary diagnosis is made based on the clinical picture and survey data. In the future, the patient needs to be tested again to confirm the infection.
At the stage of tertiary syphilis, the body's immune response may be low. However, standard research methods do not detect the presence of antibodies in the blood. This happens in about a third of cases of tertiary syphilis. To establish an accurate and definitive diagnosis in this situation, additional tests are required.
Diagnosis may require the following blood tests:
- RPR and MP;
- Linked immunosorbent assay;
- Immunofluorescence reaction;
- Treponema pallidum immobilization reaction;
- Passive hemagglutination reaction.
The previously popular classical Wasserman reaction is not used today due to its low efficiency in comparison with RPR. In the old fashioned way, this test can continue to be called RV.
Tests are divided into non-treponemal (RPR and microprecipitation reaction) and treponemal (RIF, RIBT, RPGA, ELISA).
Non-treponemal ones, that is, those that do not determine the presence of the pathogen itself, are cheaper than treponemal ones. However, such tests are less effective and require additional checks if the reactions are positive. Let us consider the principles of each of the analyzes and the degree of their effectiveness for diagnosis.
RPR– screening research method. It is used to diagnose early asymptomatic forms of the disease. It is this study that is used in preventive tests.
RPR is not accurate enough for a definitive diagnosis.
A positive RPR is not a diagnostic criterion and requires additional testing. In some cases, such an analysis can give false positive results:
- Diabetes;
- Tuberculosis;
- Malignant neoplasms;
- Alcohol and drug abuse;
- Viral hepatitis;
- Acute inflammatory diseases;
- Recent vaccination;
- Pregnancy.
Eating fatty foods and alcohol before the test can also cause a false positive result.
ELISA– the most accurate analysis for seropositive forms of syphilis. It detects the presence of antibodies, which is a clear criterion for diagnosis.
REEF, or the immunofluorescence reaction detects the presence of pale treponema themselves in the blood. This is a complex and expensive test, so it is used only when there is a clear indication. For example, with severe symptoms and negative RPR and ELISA.
RIBT- another complex study that most accurately determines the presence of infection. During this procedure, the blood is examined under a microscope for the presence of pathogens, which are previously immobilized with special antibodies.
RIBT is highly effective against syphilis. It is used even if other tests did not give a positive result.
RPGA- an accurate treponemal test, quite often used to diagnose the disease. When it is carried out, sheep red blood cells, processed in a special way, are introduced into the serum. Red blood cells stick together and settle to the bottom if the result is positive.
Syphilis that appears on the skin is usually treated with penicillin-based drugs. Treponema pallidum, unlike other bacteria, has not lost its sensitivity to this substance; for this reason, penicillin and its derivatives are prescribed to treat this disease.
- if there are ulcers with a hard frame on the skin, then penicillin preparations are prescribed. Injections are given daily;
- Injections are given in two buttocks at once. First, injections of Penicillin are given, and then Bicillin-3;
- the use of antihistamines is additionally prescribed;
- in the primary form, injections are given within 16 days;
- during the secondary form, injections of water-soluble Penicillin or Doxycycline are prescribed, and it is also recommended to use Ceftriaxone;
- in the secondary form, injections are given for 32 days, while antibiotics are taken.
- the tertiary form is treated with injections of Penicillin with Bioquinol. The course is long, it is determined by the doctor.
Syphilis therapy requires monitoring.
The effectiveness of antibiotics is checked using ELISA - the criterion is a decrease in antibody titers to Treponema pallidum.
If the titer does not decrease, this means that the antibiotic is ineffective against this strain of pathogen. In this case, the attending physician changes the drug and treatment regimen.
After completing the course of therapy, the patient takes tests again to confirm the absence of infection. Sometimes there are cases of so-called sero-resistant syphilis. This is a form of the disease in which, despite complete recovery, serological tests remain positive. Such cases require special attention to the level of titers: if they are reduced by less than four times, additional treatment is required.
If, after six months of therapy, tests show an infection, but the reagin titer is reduced by four times or more, they speak of a slowdown in seroreactions. Observation of such patients continues for another six months.
Restorative treatment may be recommended at the discretion of the physician. In general, additional therapy for true or relative seroresistance can last from six months to one and a half years. Additionally, such patients undergo consultations with an immunologist - seroresistant syphilis can be a consequence of pathologies of the immune system.
It is imperative to follow preventive measures that will help protect against this dangerous disease. This also applies to women who are planning to have children; a successful pregnancy and childbirth depends on this. Otherwise, in the future we can expect congenital syphilis in children, which can cause serious harm to a fragile child’s body.
The following preventive measures must be observed:
- maintaining personal hygiene;
- protected sexual intercourse, use of barrier contraception (condoms);
- you should not lead a promiscuous sex life;
- use of personal hygiene items;
- regular visits to the doctor.
People who are sexually active are recommended to take an RPR screening test for syphilis at least once every six months. Since there is a great risk of infection through unprotected oral sex, it is important to remember the need for barrier contraception during any sexual contact.
If the giving partner is a man, regular condoms are used.
When it comes to a woman, you can use the so-called “female condoms”. They are a thin latex napkin that is used to cover the female genitals during oral sex.
In addition to early prevention, there is also emergency prevention. It is aimed at preventing the development of the disease after dangerous contact has occurred.
The primary stage of such prevention consists of thoroughly washing and douching the mucous membranes. For douching, antiseptic solutions are used, for example, Chlorhexidine and Miramistin.
The next stage requires antibiotic therapy and is carried out strictly as prescribed by a venereologist. In this situation, a specialist prescribes a loading dose of antibacterial drugs, which are taken once. Treatment can be done with tablets or injections.
Remember! You should not take antibiotics on your own or without advice.
A person without medical education does not know the exact and correct dosages of drugs. Not all antibiotics are effective against Treponema pallidum. In addition, uncontrolled use of antibiotics is associated with the risk of developing allergic reactions and complications from their use.
If a woman is at risk of contracting syphilis during pregnancy, prevention is necessary. In this case, the possible negative impact of antibiotics on the fetus is lower than the potential harm of syphilis for the unborn child.
In this case, antibiotics are taken strictly under the supervision of doctors. To prevent syphilis in pregnant women, drugs with the least toxic effect on the fetus are used.
It is imperative to remember that syphilis is a dangerous disease that causes serious health problems. This disease can be cured at almost any stage, but the sooner the better. Moreover, in the early stages, the disease is eliminated with maximum accuracy without health problems.
- Gardnerellosis
- Condylomatosis
- Thrush
- Syphilis
- Trichomoniasis
- Balanoposthitis
- Herpes
- Gonorrhea
- Mycoplasmosis
- Ureaplasmosis
- Urethritis
- Chlamydia
Based on materials from onvenerolog.ru
How quickly chancre appears. The primary period of syphilis. Primary syphiloma.
Chancre is the primary stage of syphilis. Syphilis belongs to a number of infectious diseases and has 3 stages. Its causative agent is Treponema pallidum. Chancroid is also known as primary syphiloma, and it occurs at the site through which the pathogen entered the body.
- What does chancre look like?
- Atypical form of the disease
- Basic aspects of therapy
Hard chancre, or primary syphilis, forms 3-4 weeks after penetration of Treponema pallidum. The causes of infection are usually the same - sexual contact with an infected person, use of common hygiene products. Chancroid is the most benign form of syphilitic infection because:
- its localization is limited (most often found on the penis or in the oral cavity);
- the active form is characterized by sparseness and monomorphism;
- the formation does not affect internal organs;
- effective and relatively easy to treat.
Most often, signs of chancroid appear in the genital area. However, in 10% of cases, hard chancre can appear on the mucous membrane of the mouth, on the tongue, on the lip, on the chest in women, on the tonsils.
Hard chancre begins with a red spot with smooth edges (what primary syphilis looks like can be seen in photos 1, 2). The spot diameter is no more than 15 mm. The spot has a regular round or oval shape. It does not cause any discomfort to the patient, does not itch or burn. However, if a bacterial infection occurs, complications may occur. The latter is evidenced by uneven edges of the formation and pain when touched.
Photo 1 and photo 2. Localization of chancre in the genital area.
After a few days, the spot becomes a flat papule, and a little later it turns into a state of erosion or ulcer (less often) with a compacted base. The bottom of the ulcer is level with the skin around it or rises slightly above it.
In the vast majority of cases, chancre takes the form of erosion. Ulcer formation occurs due to:
- the patient has other chronic infections;
- intoxication of the body;
- therapy using topical irritants;
- neglect of personal hygiene measures;
- teenage or elderly patient.
There are 3 types of chancre depending on the size of the formation:
- Dwarf - 1-3 mm.
- Average - 10-20 mm.
- Giant - 40-50 mm. Typically appears on the thighs, pubic area, face and forearms.
In addition, chancre is classified according to the number of formations on the patient’s body:
- Single type.
- Multiple type. In this case, chancre is formed simultaneously or sequentially in several locations through which treponema pallidum entered the body.
In addition to the hard form of chancre, soft chancre is also isolated. It differs somewhat in morphology from solid. Hard and soft chancroid are symptoms of a syphilitic infection.
In rare cases, people who contract syphilis from a sick person may develop atypical chancroid. These include:
- indurative edema;
- amygdalitis;
- chancre-pansirium.
Indurative edema is localized in the area of the foreskin (in men) or the labia (in women). Over time, the affected area increases in size by 2-3 times, becomes dense and cyanotic. In this case, the swelling does not cause pain.
As mentioned above, sometimes symptoms of the disease can appear on the tonsils. However, amygdalitis is different from the usual form of chancroid. There is a sharp increase in size of the tonsil, and on one side. The body of the tonsil becomes dense and inflamed. This phenomenon can be mistakenly taken for one of the symptoms of a sore throat.
The symptoms of chancre-felon are almost identical to those of ordinary felon. This complicates the diagnosis of chancre. Chancre felon appears on the phalanges of the fingers. The lesion is characterized by bluish-red swelling with further formation of an ulcer with the formation of pus. With this type of primary syphilis, the infected person feels throbbing or shooting pain in the affected area.
If a person is diagnosed with chancroid, he is prescribed treatment in a hospital or on an outpatient basis. Since the main and most common method of transmission of infection is sexual, any sexual contact with the patient should be stopped during treatment. In addition, all previous and current sexual partners of the patient should undergo examination and, if necessary, therapy, even if they do not have any symptoms.
Primary syphilis is treated with antibiotics of the penicillin group, since Treponema pallidum is sensitive to them. Often injections of benzylpenicillin and ampicillin are performed.
Chancroid is an early stage of syphilitic infection.
By starting treatment at this stage, the infected person will recover easily and quickly, preventing the infection from progressing and eliminating the possibility of complications.
As soon as formations similar in morphology to chancre are found on the body in characteristic locations, a person should immediately seek advice from a dermatovenerologist.
If a person has had sexual intercourse with a suspected carrier of the causative agent of syphilis, he should also contact a specialist to take preventive measures to avoid infection.
Chancre is a symptom of primary syphilis. It is also called primary syphiloma or erosion. Hard chancre appears in men and women approximately three weeks after the introduction of the causative agent of the disease, Treponema pallidum, into the body. Its symptoms are erosive or ulcerative formations on the skin or mucous membranes.
Chancre has the following features:
- characterized by limited localization;
- does not affect the internal organs and systems of the body;
- responds well to treatment.
Hard chancre gets its name from the type of base of the ulcer or erosion formed. The duration of primary syphiloma is six to eight weeks.
The localization of primary syphiloma can be absolutely any. Hard chancre in humans appears directly at the site of introduction of Treponema pallidum into the human body a certain time after infection. Its most common location is the external genitalia - in women the labia, clitoris, in men the head, base and shaft of the penis, the outer or inner layers of the foreskin. In some cases, chancre forms on the internal mucous membranes: in the urethra in men, on the walls of the vagina or cervix in women.
In ten percent of all cases, an extragenital location of the chancre is observed. Chancre in women and men can be localized:
- in the oral cavity;
- on the tongue;
- on the edge of the lips;
- on the tonsils in the throat;
- on the mammary glands of women.
Externally, chancre looks like a reddish spot with clearly defined, smooth edges, up to 1.5 centimeters in size. It has the shape of a geometrically regular circle or oval. Sheer or undermined edges indicate a bacterial complication.
Symptoms of chancroid are only external. It does not bother the patient in any way and does not cause any painful sensations. Complications develop only if a bacterial infection is added to the lesion.
After a few days, the redness turns into a flat papule, and after some time into an erosion or ulcer with a compacted base. A hard chancre has a bottom that is located at the same level with the skin or slightly raised above.
In almost 90% of cases in women and men, chancre looks like erosion. An ulcer is formed:
- when the body is weakened as a result of concomitant chronic diseases;
- as a result of intoxication;
- when self-medicating with local irritants;
- failure to comply with basic personal hygiene rules;
- in young or elderly patients.
When formed on the penis in men, the hard chancre is covered on top with a transparent, dense detachable film. It is in it that pale treponema is found, which is then used to determine syphilis. If a chancre is located on an open area of the body, then on top it is covered with a dense brownish film.
The size of chancre can be:
- from 1 to 3 mm – dwarf, it is considered the most dangerous from an epidemiological point of view;
- from 1 to 2 cm – average;
- up to 4–5 cm – gigantic, localized on the skin of the thighs, pubis, forearms or face.
Hard chancre in humans can vary in the number of morphological units, that is, it can be single or multiple. If multiple chancres are present, they can appear all at once or sequentially, one after another, after some time. If there are multiple lesions on the skin, then chancre appears in several places at once, that is, where Treponema pallidum penetrates the body. Multiple chancre most often occurs during repeated sexual intercourse with a partner with syphilis.
Rarely, men and women infected with syphilis have chancroid in an atypical form. These include:
- amygdalitis;
- indurative edema;
- chancre-pansirium.
Amygdalitis chancre is very different from the usual hard chancre on the tonsils. It has other external symptoms. In most cases, amygdalitis looks like a unilateral enlargement of the tonsil, which occurs very suddenly. It becomes dense to the touch and hyperemic. This symptom is sometimes confused with manifestations of tonsillitis.
Indurative edema occurs in the labia in women or the foreskin in men. The affected area, unlike a typical chancre, after some time increases in size two to three times, becomes dense to the touch and acquires a bluish tint. The swelling is not painful and is not accompanied by acute inflammatory symptoms.
Chancroid felon is the most atypical manifestation; its danger lies in the fact that the symptoms completely coincide with ordinary felon, and it looks exactly the same. This may lead to an incorrect diagnosis. Chancre-felon is characterized by localization on the distal phalanx of the thumb or index finger. A bluish-red swelling appears on the affected area, which turns into an ulcer with a purulent coating at the bottom and uneven deep edges. Chancre-felon is characterized by symptoms such as throbbing or shooting pains. Most often, it occurs in gynecologists and operating surgeons who are in direct contact with the body of a person infected with syphilis, thus chancre-felon in most cases is the result of occupational infection.
Syphilis in the form of chancre-felon is very rarely detected on time, and therefore the diagnosis becomes known already in the second stage of the disease. Timely detection of atypical chancre is very important, since the primary stage of syphilis is treated most effectively.
Chancroid in a person infected with syphilis is treated in an inpatient or outpatient setting. Throughout the course of therapy, cessation of any sexual contact is required. It is necessary to treat all sexual partners of a person with syphilis, regardless of how many there were. The fact is that the probability of their infection with Treponema pallidum is extremely high.
Treatment of chancre is carried out with antibacterial drugs of the penicillin group, since the causative agent of syphilis has not lost sensitivity to them. Most often these are injectable forms of ampicillin and benzylpenicillin.
You need to know that chancre in itself is not dangerous. It allows you to detect syphilis at its earliest stage. Therefore, timely treatment makes it possible to prevent further development of the disease and the occurrence of complications. If you find a formation on the skin that resembles the description of a chancre, you should immediately consult a doctor for examination.
After suspicious unprotected sexual intercourse, prophylactic treatment may be prescribed to prevent the syphilis pathogen from entering the body. To do this, you should immediately contact a dermatovenerologist.
Primary syphilis manifests itself in enlarged lymph nodes and chancre. What is chancre? These are symptoms of syphilis, which are round sores with a diameter of about one centimeter on the patient’s body.
They are red and blue in color, sometimes they are painful, but generally the patient does not perceive pain at the site of erosion. The first signs of syphilis in men: the formation of a chancre on the head of the penis, and in women, symptoms of syphilis appear on the walls of the uterus and on the external genital organs. These sores also occur on the pubis, near the anus, on the tongue and lips.
Syphilis develops quickly, and the lymph nodes become inflamed and enlarged first, and then the formation of hard chancre.
It may resolve on its own, even without drug treatment, after one to two months. It goes away almost without a trace, although if the ulcers are large, dark spots may remain.
Chancre in syphilis is a focus of syphiloma, which forms at the site of treponema in the body.
Chancre gets its name from the French word, which means ulcer or erosion. In some infectious diseases there is chancre, but in the case of syphilis, this erosion is the first sign of syphilis in the first stage. Formation of hard chancre on the body a little more than 4 weeks after infection with this disease. During this period, the spirochete infection manages to get into many organs and lymph, and begins to multiply, which causes an inflammatory process and a fever may appear.
They are classified according to the type, size, number of ulcers on the body, and their location.
- erosive - this is erosion that affects the layers of the mucous system;
- Ulcerative chancre is an ulcer that penetrates into the deep layers of tissue.
According to the quantitative classification, chancre is divided into:
- single is a chancre, which consists of one ulcer;
- multiple is an erosion that consists of many ulcers and creates a single wound.
Syphilomas of chancre are classified according to size:
- small (dwarf) - diameter less than 10 mm;
- medium - diameter from 20 mm;
- large (giant) - diameter 50 mm and above.
Place of appearance of hard chancre on the body:
- extragenital - the tongue, anus, chest, throat, legs, gums are affected by ulcers;
- genital - these are erosions that appear on the genitals of a sick person;
- bipolar are chancres that simultaneously appear on the genitals and other parts of the body.
By the end of the primary period of syphilis, chancre becomes a form of the disease that:
- has localization in specific places, in the oral cavity and on the genitals;
- does not have a numerous form;
- does not affect internal organs;
- It is quite easy to treat and leaves no consequences.
In people who have contracted syphilis infections and at the same time have reduced immunity, ulcerative lesions necessarily appear. Also, the formation of ulcers on the body occurs due to chronic infections, toxicity of the body and for age-related reasons. As a result of self-medication of syphilis, purulent erosions are formed, which, after attenuation, leave pigment spots and scars.
It begins to develop with redness, which does not cause itching or pain. After 48 to 72 hours, this redness begins to form a bump and form a papule. At this point, the epithelium from the chancre may peel off, and the infected person begins to feel pain for the first time.
In the following hours and days, the syphiloma becomes larger, spreading around the circumference. A hard crust begins to form on the papule, under which an ulcer forms. Over time, the crust is rejected and a sign of syphilis appears - chancre.
The shape of the chancre is slightly raised, with clear round edges. Sometimes these edges are oval in shape. The surface of the chancre is smooth, sometimes has a grayish coating, but the main color of the chancre is red.
The shape of chancre varies:
- nodule shape - this ulcer has clear boundaries. This ulcer grows into the deep layers of tissue and retains its clear boundaries. This chancre is localized on the foreskin of the penis;
- the shape of a plate or coin - the chancre is localized on the upper layers of tissue and is located on the labia, shaft of the penis, and on the scrotum;
- leaf-shaped - erosion has clear boundary lines and is located mainly on the head of the phallus.
In addition to chancre, there is also atypical chancre and many of its types:
- indurative edema is a large lump that forms on the foreskin of the penis, genitals in women and in the lip area on a person’s face;
- Panaritium is a chancre that develops on the nails and does not heal for several months. There may even be nail rejection;
- lymph nodes - increase in this period. Depending on which part of the body the chancre formed, the lymph nodes closest to the chancre become inflamed;
- a bubo is a lymph node that has a mobile shape and has no painful signs and is located closest to the chancre: on the patient’s neck, if the chancre is in the tonsils, and in the groin part of the body, if the chancre is on the penis, in the genital area;
- polyadenitis is inflammation and hardening of all lymph nodes, from this moment we can assume that symptoms of secondary syphilis began to appear.
Complications of syphilis in the first period are very serious both for women and also have serious consequences for the male part of the population.
- on the labia majora and minora;
- on the clitoris;
- on the walls of the cervix;
- in the area between the anus and vagina.
On the walls of the vagina, chancroid with syphilis occurs very rarely, since the acidity of the vagina has a detrimental effect on treponema.
Very often, syphilis chancre forms on the cervix. This chancre is invisible and is diagnosed mainly at the second stage of the disease.
Over 10 percent of women with syphilis in the first stage have a hard chancre on the walls of the cervix. Syphilis chancre is detected only when the uterus is examined using medical equipment. This examination is carried out by a gynecologist or venereologist.
In the oral cavity, chancre forms on the tongue, lips, soft palate and tonsils. There are frequent cases of ulcers on the gums, cheeks, fingers and chest.
Diagnosis of syphilis consists of several types of examinations and tests:
- serological diagnosis is the detection of Treponema bacteria from scraping of chancre. Based on the results of this examination, the doctor makes a diagnosis;
- Treponema immobilization reaction;
- immunofluorescence reaction;
- Wasserman reaction;
- microreaction on glass;
- linked immunosorbent assay;
- microprecipitation reaction;
- passive hemagglutination reaction.
Syphilis is a sexually transmitted disease that occurs in a classic form. Syphilis chancre is the main symptom of this disease. Chancroid is a symptom of primary syphilis only.
Syphilis in the first stage of its development manifests itself in enlarged lymph nodes and chancre. Towards the end of this period the following symptoms appear:
- state of general malaise;
- constant headache;
- elevated temperature;
- pain in muscle tissue;
- aches and pain in the bones;
- decreased hemoglobin;
- significant increase in leukocytes.
Syphilic chancre has the ability to go away on its own and leave no traces, so people who self-medicate can assume that syphilis has been cured.
This is a misconception, because the disappearance of chancre is preceded by secondary syphilis, which is much more dangerous than syphilis in the first stage of development and treatment of this type is much more complex and lengthy.
As complications of syphilitic chancre, other infections can penetrate the chancre, which leads to painful symptoms and the accumulation of pus in this place.
There are several reasons for infection:
- chancre injury;
- lack of hygiene;
- diabetes mellitus;
- HIV infection;
- development of tuberculosis bacillus in the body.
The female body develops:
- syphilitic gangrene;
- infectious vaginitis;
- inflammatory bartholinitis;
- endocervicitis of the cervix.
Complications in the male body lead to:
- balanitis;
- balanoposthitis of the head of the penis;
- phimosis of the foreskin;
- paraphimosis of the foreskin;
- gangrenization of the head of the penis;
- phagedenism of the penis.
At the primary stage, the task is to cure the infection and prevent syphilis from moving into the second stage. Chancre, treatment must be carried out as early as possible.
The main drugs used in treatment are antibiotics of different groups and directions:
- penicillins;
- macrolites;
- tetracyclines;
- fluoroquinolones.
Together with antibiotics, the following are involved in the treatment process:
- antifungal drugs;
- immunomodulators;
- multivitamins;
- probiotics.
The treatment regimen for syphiloma is prescribed by the attending physician, based on the diagnosis and test results.
During the course of treatment, tetracyclines and drugs based on bismuth and iodine are added to penicillins. This complex of drugs can increase the effect of the antibiotic in the body.
If syphilis is diagnosed, both sexual partners are treated.
At the time of therapy, the patient is prescribed a diet in which protein foods predominate and the consumption of fats and carbohydrates is limited.
During this period, smoking and drinking alcohol are contraindicated, and it is also necessary to reduce physical stress on the body.
The main condition for quality treatment is to observe the rules of personal hygiene and not to have sex during the treatment period.
It is necessary to treat chancroid with antibiotics:
- Extensillin - intramuscular injections, it is enough to carry out the procedure twice;
- Bicillin - injections, twice, every 5 calendar days;
- Erythromycin - 0.5 mg taken 4 times a day;
- Doxycycline - 0.5 mg taken 4 times a day.
For local treatment of chancre, lotions on the chancre with benzylpenicillin and dimexide are needed.
It is necessary to lubricate the syphilitic chancre with heparin ointment, erythromycin ointment, ointment based on mercury and bismuth. Synthomycin ointment and levorin ointment help remove pus from the ulcer.
Chancres that are in the mouth must be rinsed with solutions:
Hard chancre is a very important sign in recognizing syphilis in the body. The earlier an infection is detected in the body, the sooner treatment of the disease will begin, and the duration of the course of drug treatment may be minimal. In this case, treatment with folk remedies and self-medication are contraindicated.
Only a competent doctor can make a diagnosis and prescribe the necessary treatment. Compliance with all doctor’s instructions, a healthy lifestyle, and hygiene will give a positive result in curing syphilis at the first stage of the disease.
Clinical picture. Primary syphilis is characterized by the development at the site of penetration of pale treponema chancre (ulcus durum, primary syphiloma) and regional lymphangitis and lymphadenitis. Sometimes, between the chancre and enlarged regional lymph nodes, a strand of regional lymphangitis can be seen and palpated.
Thus, the clinical manifestations of the primary period of syphilis are represented by three elements: hard chancre, regional lymphadenitis and regional lymphangitis.
At the end of the primary period, general flu-like disorders are sometimes observed: headache, osteoarticular and muscle pain, general weakness, insomnia, increased body temperature.
Hard chancre most often persists until the onset of the secondary period and heals soon; it rarely exists for up to several weeks and after the appearance of a generalized rash, and even less often it heals before the onset of secondary manifestations. This depends mainly on its size. Concomitant regional lymphadenitis usually occurs 7–10 days after the appearance of chancre. A chancre is a very characteristic erosion or ulcer, but it does not immediately take on these features. After the incubation period, a red spot first appears at the site of treponeme penetration, which then turns into a dense nodule with sharply defined boundaries. Within 7–10 days, the nodule increases significantly in size, and the infiltration of its base takes on the character of a specific compaction. Due to malnutrition of the epidermis caused by vascular damage characteristic of syphilis, necrotization occurs in the center of the infiltrate and erosion or ulceration forms.
The main clinical signs of a typical chancre are: erosion (ulcer) with the absence of acute inflammatory phenomena; loneliness or singularity; regular (round or oval) outlines; clear boundaries; size - about a small coin; elevation of the element above the surrounding healthy skin (mucosa); smooth, shiny (“varnished”) bottom; flat (saucer-shaped) edges; bluish-red color of the bottom; scanty serous discharge; dense elastic (“cartilaginous”) infiltrate at the base (nodular, lamellar, leaf-shaped); painlessness; resistance to local disinfectant and anti-inflammatory therapy.
Along with the described classic form of chancroid, there are various deviations in one or more of its listed characteristics, which creates quite numerous varieties of primary syphiloma. Multiple chancre is rare (in about 1/5 of patients). Their number rarely exceeds 10. The multiplicity of chancre is explained by the presence in the patient at the time of infection of numerous minor violations of the integrity of the skin or mucous membrane. Concomitant skin diseases, such as eczema or scabies, can play a decisive role, especially when localized on the genitals. It is characteristic that no matter how numerous the hard chancre may be, they are all at the same stage of development if they are the result of the simultaneous penetration of infection through several entrance gates. These are the so-called twin chancres. If the infection occurred at different times (for example, as a result of repeated sexual intercourse with an interval of several days), then the chancre will appear at different times and differ from each other in the degree of maturity. These are the so-called sequential chancre. Giant hard chancres are usually located in places with abundant subcutaneous fatty tissue: in the pubic area, abdomen. Their size can reach a child's palm. Dwarf chancre is extremely small in size - down to the size of a poppy seed, but under a magnifying glass all the characteristic signs of primary syphiloma are revealed. Diphtheritic hard chancres, covered with a grayish necrotic film, are very common. Cortical chancre is observed in places where the discharge easily dries out: on the face (nose, chin), on the skin of the lips, sometimes on the stomach, the shaft of the penis. It may be very similar to pyodermic elements: impetigo, ecthyma. Slit-like chancres, shaped like a crack or the pages of a book, are usually localized in small folds of the skin: in the corners of the mouth, in the interdigital folds, in the anus. Folman's erosive chancre does not have a clear compaction at the base and is usually localized on the head of the penis. Hard chancre located at the external opening of the urethra, in the folds of the anus and on the tonsils can be accompanied by significant pain. The localization of chancre depends on the route of infection of a given patient with syphilis. In case of sexual infection, chancre usually appears on the genitals or adjacent areas (pubis, abdomen, inner thighs, perineum, anus). Chancres on the cervix occur in 12% of sick women. In this regard, examining women with suspected syphilis using a vaginal speculum is of great importance. In some cases, during sexual infection, chancre is located extragenitally (for example, on the lips, tongue, mammary glands, fingers). Extragenital chancre can be located on any part of the skin and mucous membranes. The second place after the genital organs in terms of the frequency of localization of primary syphiloma is occupied by the oral mucosa (lips, gums, tongue, soft palate, tonsils). Other localizations of chancroid are rare.
Atypical hard chancres include indurative edema, chancre-amygdalitis and chancre-felon .
Indurative edema usually occurs on the labia or foreskin. The affected area enlarges 2–4 times, becomes dense, the skin acquires a stagnant bluish color or retains its normal color. The lesion is characterized by painlessness and the absence of acute inflammatory phenomena, which distinguishes indurative edema from processes such as bartholinitis or inflammatory phimosis (such diagnoses are most often given to patients).
Chancroid-amygdalitis should be distinguished from erosive (ulcerative) chancre on the tonsils. Chancre-amygdalitis is characterized only by a sharp, usually unilateral enlargement of the tonsils. The tonsil is dense, there are no acute inflammatory phenomena. Chancroid-amygdalitis is very similar to indurative edema. This atypical chancre is often mistaken for a common sore throat. L1ankr-felon is the most atypical of all chancre. It is indeed very similar to a banal panaritium: on the distal phalanx, usually the index or thumb, against the background of bluish-red swollen skin there is a deep ulcer with uneven, overhanging, as if gnawed edges and a purulent-necrotic coating. Chancroid felon is accompanied by sharp, “shooting” pains. Most often it occurs in surgeons, gynecologists, pathologists and is the result of occupational infection; it is rarely diagnosed in a timely manner. Typically, the diagnosis of syphilis is made after the appearance of secondary period rashes.
Chancre felon should not be confused with typical chancre on the finger. Histologically, a typical chancre is an infiltrative-erosive or infiltrative-ulcerative formation with characteristic changes in the vessels of the dermis. It has a number of pathohistological signs: the absence of the epidermis (and part of the dermis) in the central zone of the preparation due to the formation of foci and zones of necrosis; in the dermis there is a dense infiltrate of lymphocytes and plasma cells, along the periphery the infiltrate has a perivascular location; changes in the blood and lymphatic vessels of the dermis in the form of proliferation and infiltration of all membranes (panvasculitis) with obliteration and thrombosis of some vessels; many pale treponema in all areas (especially in the walls of blood vessels and in their circumference).
When spirochetes have penetrated, for which an insignificant, completely imperceptible violation of the integrity of the skin is enough. After the first incubation period, most often at the end of the second week, a small nodule appears. It very often, but not always, ulcerates. Gradually it turns into an extremely dense, cartilaginous hard infiltrate, forming the base and edge of the developing ulcer. This phenomenon is called chancroid in men and women. We will look at the photo and the initial stage as primary signs in the article.
Specific signs of chancre with syphilis are the following changes in the skin. The rash, also known as infiltration, is mostly flat and sharply demarcated. It feels as if there is a hard plaque in the skin. But depending on where it is located, the nature of the rash can be very different.
There is usually only one primary rash. But it is relatively common to encounter several hard chancre. Moreover, they are all at the same stage of development, since they all appear simultaneously depending on the same infection. Further transfers in the same patient from one chancre are not observed, since after infection, immunity to a new infection soon occurs. Moving to another place of the skin, as opposed to chancroid, is not observed with this primary sign of syphilis.
The size of chancre varies within very wide limits. Its surface can be covered with a thin, moist sheen, as if eroded epithelium, which is especially characteristic. When palpated, a cartilaginous infiltrate is felt. With a more pronounced erosion surface, the skin appears dark red, as if granular. When ulcerated, the ulcer is always smaller than a hard cushion and has a dense base. When ulceration occurs, depending on the method of formation:
- With ulcerated sclerosis.
- With sclerotic ulceration.
In the latter case, the situation may be different. Firstly, a very small nodule formed at the site of infection can turn into a vesicle and an ulcer before the actual syphilitic infiltrate is detected.
On the other hand, an existing vesicle, especially a vesicle, can serve as a site of entry for spirochetes, which is relatively common. In this case, an ulcer quickly forms.
Plays the most important role in the origin of infiltrating, sclerosing ulcers. It may have existed before syphilis infection or was acquired at the same time as it. With such simultaneous infection: soft and hard chancroid, which is not uncommon, soft chancroid develops first. It has a much shorter incubation period of only a few days. Hardening, as a result of simultaneous infection with syphilis, is detected after 2-3 weeks. The base and circumference of the soft ulcer become denser: a “mixed chancre” (chancre mixte) is obtained.
Not only that, but a chancre ulcer may heal before a lump develops. “Mixed chancre” deserves special attention. Namely, we must remember that if a chancre ulcer is present, the possibility of simultaneous infection with syphilis cannot be excluded before the expiration of several weeks.
Ulcerating sclerosis, i.e., a sequentially decaying syphilitic infiltrate, can lead to the formation of:
- then flat
- either deep or crater-shaped,
- either smooth or having a pitted bottom,
- then a gangrenous or serpiginous ulcer.
It is only important to remember that an ulcer of chancre is never so sharply demarcated and such a regular round shape as an ulcer of soft chancre. And that it always has a hard bottom and a hard cushion. It is also characteristic that on the edge surrounding the ulcer a very narrow strip always appears red, eroded, and devoid of epithelium.
Depending on the location, chancre may present some differences. Thus, when localized in the coronary sulcus, sclerosis often appears in the form of a dense ridge, sometimes running parallel to the entire length of the sulcus. Often this results in phimosis or paraphimosis. Sclerosis, hidden by phimosis, is felt when palpated, mostly in the form of limited hardening.
Of the mucous membranes, the sites of sclerosis are mainly:
All sclerosis of the mucous membranes soon disintegrates into deep, crater-shaped ulcers with a dense bottom and ridge. Every place on the skin and visible mucous membranes can be a site of primary sclerosis.
If sclerosis sits on the edge of the foreskin, then perpendicular to the opening of the preputial sac an ulceration forms in the form of a crack in a dense ring.
A particularly peculiar picture is obtained when a significant, diffuse inflammatory swelling appears on the genital organ, as a sequential condition.
Then the penis takes on a completely shapeless appearance and appears doughy and swollen to the touch (indurative edema).
A similar condition occurs on the vulva.
If sclerosis is on the finger, then the primary lesion often looks like paronychia or panaritium; recognition can be extremely difficult.
Often primary sclerosis occurs on the lip and on the breast nipple, where it forms a dense, limited, eroded and ulcerated tumor.
The most important feature of every syphilitic primary manifestation is, without a doubt, the presence of spirochetes.
Based on materials from zdos.ru
Chancre is the first manifestation of the introduction of Treponema pallidum into the skin.
The asymptomatic period of syphilis upon infection usually lasts 3-4 weeks.
In the place where the treponema has penetrated the skin or mucous membranes, a small nodule appears, shaped like a circle or oval, colored reddish, initially vaguely demarcated from healthy skin. Soon the nodule gradually changes its consistency; it becomes dense and sharply demarcated from the surrounding parts. Then, upon palpation, a sharply demarcated hardening is felt, in typically pronounced cases of cartilaginous, densely elastic consistency.
Signs of chancroid
That's what it is syphilitic sclerosis – .
Subsequently, sclerosis, having existed for several days, becomes covered with whitish scales, which, peeling off, disappear. Gradually, sclerosis resolves, initially leaving a pigment spot, which then disappears. In other cases, sclerosis erodes, forming an erosive chancre. Sometimes sclerosis, gradually developing, begins to disintegrate from the surface, followed by the formation of ulcerative chancre. Thus, the primary syphilitic lesion can be in the form of a single round or oval surface erosion, non-painful, with sharply defined, smooth edges, or in the form of an ulcer, and the bottom of the ulcer is saucer-shaped, even, smooth, shiny, the color of living meat. It is located at the level or slightly higher than the surrounding parts, due to the deposition of a specific infiltrate in the bottom and edges. The discharge from the ulcer is mostly not purulent, but serous-sucrose, not profuse.
When you squeeze the bottom of the ulcer between your thumb and index finger, you get a feeling of density and hardening. Where did the name of this lesion come from - chancroid or primary sclerosis.
Typically, erosions or ulcers of primary syphilis are single. However, in cases where the infection occurs simultaneously through several lesions, multiple erosions or ulcers are formed. They are at approximately the same stage of development, which is very typical for such lesions.
The size of erosions or ulcers of chancre varies. On average, it ranges from a few millimeters in diameter (dwarf chancre) to a centimeter in diameter or more (giant chancre).
Most often, their size reaches an average of ½ cm - 1 cm. If erosions or ulcers are located in skin folds, they lose their characteristic round or oval shape and become oblong, in the form of cracks.
The average duration of existence of hard chancre is from 3 to 6 weeks. Then it begins to heal, leaving temporary pigmentation after erosion or a permanent mark in the form of a scar after an ulcer. This is, in general terms, the usual course of chancre.
In typical cases, the appearance and development of hard chancre occurs without noticeable inflammatory phenomena along the periphery. However, sometimes it can be complicated by acute inflammatory phenomena, gangrene, phagedenism and associated chancroid.
Acute inflammatory phenomena can complicate the course of chancroid. Both due to contamination by pyogenic microbes, and from the introduction of chancroid sticks.
Uncleanliness and inappropriate treatment in the form of excessive cauterization with irritating substances, for example, lapis, copper sulfate, etc. also often contribute to the appearance of acute inflammatory phenomena.
The picture of chancre in these cases will differ from the usual one: redness appears around the chancre, the sharpness of the boundaries is lost, and the nature of the erosion may change - it becomes painful and separates a lot of pus. In appearance, it becomes similar to a chancroid ulcer. The healing of such an ulcer is delayed.
And only after the source of inflammation has been eliminated, it again takes on the typical picture of chancre. As a result of sometimes developing inflammatory phenomena, men may develop phimosis and paraphimosis. And women have sharp, dense swelling of the lips major and minor. In some cases, with hard chancre, regardless of its size, a special peculiar swelling develops around the chancre, which does not have the character of acute inflammatory edema. This is the so-called indurative edema - oedema indurativum, which is extremely characteristic of the primary period of syphilis. With this swelling from pressure, there is no pitting and there is no redness (the color is dark red, with a bluish tint).
The swelling exhibits a special dense elastic consistency. Most often, indurative edema develops in men on the foreskin and scrotum, in women - on the labia majora and minora. When complicated by gangrene, a small area of superficial necrosis forms in the center of the chancre, in the form of a dense grayish-black mass.
If the course is favorable, after a few days the area of necrosis is cleared, the ulceration granulates, scars and heals. In other cases, necrosis quickly spreads, the ulcer is covered with a solid black scab, tightly fused to it. Then the scab becomes mobile, falls off and the ulcer heals with the formation of an irregular, ugly scar. The course of such chancre is long and painful for the patient. When the causes that caused gangrene are eliminated, healing, although it will be slow, does not cause major tissue destruction and ugly scars.
Phagedenism (necrotization) It also begins with gangrenization of the surface of the ulcer, and the ulcer can heal on one edge and spread further on the other.
Once the gangrenous scab falls off, the process does not stop. Gangrenous outbreaks are repeated and, as a result, deep tissue destruction occurs. So, for example, the entire labia majora, the entire foreskin, etc. may be destroyed.
Phagedenism develops mainly in severely malnourished people, alcoholics, the elderly, and tuberculosis patients. When simultaneous infection with chancroid and syphilitic infection occurs, the so-called mixed chancroid – ulcus mixtum – develops. In this case, on the second or third day, one or more typical deep ulcers of the chancre are formed.
With undermined soft edges, a greasy bottom, with copious purulent discharge, with noticeable inflammation along the periphery, very painful.
After two to three weeks, when the first incubation period expires, phenomena characteristic of syphilis appear, and the edges and bottom of the ulcers acquire a specific cartilaginous density. After the ulcer heals, it leaves scars that are located on the seal. The latter disappears after some time.
In some of these cases, the disease is accompanied by the formation of an inflammatory bubo, characteristic of chancre. But subsequently the glands acquire changes typical of syphilis.
Atypical chancroid
Hard chancre can be localized on any part of the human body, depending on where the infection penetrates. Most often, the primary syphilitic lesion is localized on the genital parts, resulting from infection during sexual intercourse.
Atypical chancre(extragenital sclerosis) can be localized on the lips, mouth, pharynx, and tongue.
On the cheeks, on the gums, on the wings of the nose, on the eyelids, on the breast nipples, on the arms, on the legs and other places.
Histologically, with the primary syphilitic phenomenon - chancre, the most significant changes occur in the vessels - lymphatic, arterial and venous.
The spirochete penetrates through damaged skin or mucous membrane, first into the intercellular spaces and then into the lymphatic crevices and capillaries of the skin itself. It causes inflammatory phenomena of varying degrees, with the release of lymphocytes from the vessels, changes in the walls of blood vessels and the formation of a special cellular infiltrate around them.
The latter consists of lymphocytes, plasma cells, proliferating connective tissue cells, as well as a few epithelioid and giant cells.
The vascular endothelium multiplies, desquamates, blood clots appear, blockage of the lumens of blood vessels, and tissue breakdown.
The density of chancre depends on the sharply developed limited cellular infiltration of blood vessels, and also, apparently, on their hyaline degeneration. Some also associate this density with the development of a finely looped network of lattice fibers in the infiltrate.
The pale spirochete is found between epithelial cells. And also in the lumen of blood vessels, especially lymphatic ones, in their walls and along the periphery.
The rapid spread of the spirochete depends on its early penetration into the lumens of blood vessels and intercellular spaces, on its rapid entry into the lymphatic system, glands and epidermis, from where it can also serve as an easy source of infection.
The presence of the spirochete causes significant changes in the skin itself, as well as in the epidermis. Where vacuolar degeneration develops, the death of a number of layers, rejection of the horny, granular, spiny, erosive chancre occurs. If there are changes in the blood vessels, endo-meso-peri-vasculitis leads to blockage of blood vessels, causing disorders in tissue nutrition and tissue breakdown, destruction of the skin itself, and ulcerative chancroid occurs.
With erosive chancre, the death of the skin itself and underlying tissues does not occur. Therefore, the process ends without a lasting trace; the epidermis from the periphery of the erosion, growing, compensates for the former defect.
With ulcerative chancre, not only the papillary layer is destroyed. But often also the deeper parts of the skin and subcutaneous fat. Therefore, after an ulcerative chancre there is always a permanent mark, a scar.
A constant companion of chancroid is the so-called primary lymphadenitis. It develops 1-2 weeks after the appearance of chancre.
Depending on the location of the chancre, the corresponding lymph glands thicken and swell. So, for example, when sclerosis is localized on the genitals, the inguinal glands are affected earlier than other glands.
When sclerosis is localized on the chest or arm, the axillary or ulnar glands are affected.
If sclerosis is located on the tonsil, then the submandibular or anterior ear gland is affected.
If on the lips, then the submandibular glands, etc., swell; with syphilitic primary adenitis, one gland swells. Later, other glands of this group enlarge.
The glands gradually acquire a special density, different sizes, and are not fused to each other, neither to the skin, nor to the underlying tissues. The glands are painful, round or oval in shape, often arranged in a row in a distinct manner.
Swelling of the lymph glands in syphilis is not limited to the location of the primary sclerosis. 3-4 weeks after the appearance of the latter or 7-8 weeks after infection, all other lymph glands swell and enlarge. General polyadenitis develops. This is a progressive enlargement of the lymph glands. It, like a number of other characteristic painful symptoms, precedes the appearance of secondary syphilis - general polyadenitis develops at the end of the primary period.
Diagnosis of chancre
Hard chancroid is diagnosed based on the clinical manifestations described above and the presence of a pale spirochete in the discharge of erosions or ulcers. Some blood reactions are not important in the diagnosis of primary sclerosis, because they become positive only 4-6 weeks after infection.
When making a differential diagnosis, one should first of all keep in mind chancroid.
The clinical picture of a typical hard chancre differs sharply from that of a soft chancre.
A developed soft chancre is an ulcer; a hard chancre can be in the form of erosion, disappearing without a lasting trace. If you are dealing with ulcerative chancroid, it usually does not have inflammatory phenomena along the periphery, but soft chancroid does.
The edges of an ulcer of a soft chancre are undermined, while with a hard chancre they are dense, not undermined, and go directly into the bottom, which is usually smooth, shiny, and the discharge of the ulcer is scanty. In addition, with a soft one, the bottom of the ulcer is uneven, has separate depressions, and abundant purulent discharge.
An ulcer of a soft chancre is painful, a hard one is usually painless.
The number of ulcers with syphilis is always less.
Soft chancre is usually multiple - new ulcers gradually form, since their secretion is easily released. With syphilis, new ulcers do not appear - their secretion does not appear in the patient, or more precisely, it appears only during the first 10-12 days of the existence of the primary phenomenon.
Objective data are supplemented with chancroid by the presence of characteristic painless primary lymphadenitis or polyadenitis.
In mild cases, the glands are painful, welded together, with subcutaneous tissue, skin, and have a tendency to produce buboes.
When examining discharge from ulcers or punctate lymph glands in syphilis, a pale spirochete is detected, and in chancre, streptobacilli.
The anamnesis complements the clinic - with chancre the incubation period is short - 2-3 days, with syphilis - 2-3 weeks.
Primary lymphadenitis is always observed with hard chancre; with soft chancre, adenitis may be absent. Lymphangitis does not always occur with syphilis, for example, along the back of the penis.
If it is present, unlike soft-chancroid lymphangitis, there is no inflammatory swelling of the skin - it is not fused either to the skin or to the underlying parts.
With chancre, there are usually severe inflammatory phenomena. And sometimes the transition of lymphangitis to suppuration, then the so-called bubonulus is formed - a small bubo. In many cases, it is practically important to promptly distinguish erosive chancroid from erosions of herpes, which often recurs on the genitals. However, a careful examination usually reveals that erosion after herpes resulted from the merger of a group of erosions after former blisters. Since about the periphery there are scalloped outlines of the lesion and the inflamed background on which they arose. When palpating the erosion of herpes, they do not detect compactions or infiltrates, which are so characteristic of chancroid.
Concomitant lymphadenitis, if it occurs with herpes, is usually of an acute inflammatory nature. Bacterioscopic examination facilitates diagnosis.
If you suspect syphilis, contact the author of this article, a venereologist in Moscow with 15 years of experience.
The primary manifestation of syphilis is chancre (syphiloma). With its timely detection and initiation of therapeutic therapy, the chances of recovery increase significantly. That is why it is so important to know what chancre looks like with syphilis, and what processes in the body its appearance indicates.
The formation of chancre most often occurs 3 to 5 weeks after infection with syphilis. The beginning of this process indicates the transition of the disease from the incubation to the primary stage. Syphiloma is where the causative agent of the disease, Treponema pallidum, entered the body of an infected person. Here it begins to actively reproduce, because for this it requires an ambient temperature of 37 degrees.
If you do not take countermeasures, the disease will progress, and there will be much more treponemes. The secondary and tertiary periods are syphilis without chancre. However, other characteristic external symptoms appear, and the carrier of the disease becomes dangerous to others.
For the formation of a chancre, it is necessary that the causative agent of syphilis penetrate into the tissues of a healthy person. This is possible under the following circumstances:
- unprotected sexual contact;
- use of non-sterile medical and cosmetic instruments;
- the presence of damage to the skin and mucous membranes upon contact with the patient;
- kiss;
- using other people's things;
- blood transfusion and surgical procedures.
Unsafe sex remains the main route of transmission. Also at risk are representatives of medical professions and drug addicts.
Localization and characteristic signs
The mode of transmission of the disease affects where the chancre appears in syphilis. It is most often found on the genitals and also in the mouth. When infected through a wound on the skin, syphiloma can form anywhere, depending on the location of the damage.
Chancre may appear in the following areas:
- head and body of the penis, foreskin;
- labia;
- perianal region;
- Cervix;
- clitoris;
- pubis;
- lips;
- cheeks from the oral cavity;
- gums;
- throat;
- language;
- sky;
- fingers;
- breast;
- stomach;
- rarely - on the eyelids and conjunctiva of the eyes.
Syphiloma is quite easy to distinguish from other types of formations. It is characterized by the following symptoms:
- an area of redness initially appears without any discomfort in this area;
- then a nodular neoplasm appears with a bluish tint on the surface of the skin or mucous membranes at the site of redness;
- an ulcer opens in the center of the nodule, with no pain if we are talking about a typical form of syphiloma;
- the edges of the chancre are dense and smooth, the bottom resembles cartilage in structure;
- the shape of the formation is predominantly round or oval;
- the color of the ulcer is dark red or brown;
- there is a small amount of discharge that resembles pus, and it is these discharges that contain treponema;
- There is an increase in nearby lymph nodes and a low-grade fever.
Types of formations and their features
A typical chancre makes it quite easy to diagnose the disease.
In this case, syphilomas can be classified according to a number of criteria:
Classification category and photo | Main types |
By quantity |
|
According to the degree of penetration into the tissue structure |
|
To size |
|
By shape |
|
By nature of location |
|
Atypical forms
It is much more difficult to diagnose syphilis if the chancre manifests itself in an atypical form. That is why the final diagnosis can only be made by a qualified doctor.
The most common variants of atypical syphilomas are:
Title and photo | Short description |
chancre-herpes | The manifestations are similar to balanoposthitis; the foreskin and head of the penis are affected, as well as sometimes the lips (can also be observed in the oral cavity). |
Syphiloma felon | It is located on the fingers, closer to the nail plate, which can provoke its rejection. There is a pronounced inflammatory process. |
Amygdalite | One of the pharyngeal tonsils is affected, there are no erosive changes in the mucous membrane, no pain. All this allows us to differentiate the problem from a sore throat. |
Indurative syphiloma | Tissue swelling occurs, affecting areas near the chancre. When pressing on the neoplasm, no visible marks remain. |
Such chancrees not only complicate the diagnostic process, but are also accompanied by various complications. In addition, they are characterized by the presence of pain, although with syphilis this symptom is extremely rare.
Chancroid
A special form of skin formation is chancroid - soft chancre. It appears under the influence of streptobacilli, it does not contain the causative agent of syphilis, Treponema pallidum.
Characteristic signs of such a neoplasm are:
- soft edges of the ulcer, lack of a hard base;
- the presence of a pain symptom;
- erosion color – bright red;
- there is copious purulent discharge;
- peeling of the skin;
- the appearance of small ulcers independent of the chancroid, which can merge with it into a single focus of inflammation.
Due to the active reproduction of streptobacilli and their spread through the bloodstream, the patient exhibits signs of general intoxication of the body: nausea, headaches and dizziness, malaise. The inflammatory process increases body temperature.
Unlike hard chancre, soft chancre is transmitted exclusively through sexual contact. In addition, after healing it leaves noticeable scars, which is associated with severe inflammation of the superficial lymph nodes and the formation of bubonic ulcers, as well as their opening. Syphiloma disappears almost without a trace.
Consequences
The presence of chancre clearly indicates the presence of the causative agent of syphilis in the body. This disease in itself is very dangerous, as it can affect internal organs, causing their failure.
Also, the consequences of infection are destructive processes in bone tissue, which deprives a person of the ability to lead normal life activities and provokes physical deformities. Without treatment, the risk of developing neurosyphilis increases. Later, as the disease progresses, death occurs - this is the price of ignoring the problem.
If we consider directly the consequences associated with the formation of chancre, it is worth highlighting the following:
- damage to deep tissue layers;
- suppuration and tissue necrosis;
- self-amputation of damaged areas, in particular the external genitalia;
- bleeding;
- formation of rough scars;
- urethral perforation;
- accession of infections;
- endocervitis of the cervix;
- balanoposthitis;
- syphilitic gangrene;
- bartholinitis.
Such complications occur mainly with atypical syphilomas. Common chancre often goes unnoticed and disappears without a trace as the disease moves into the secondary phase.
Diagnostics
To carry out successful treatment, it is important to detect syphilis chancre in time and begin treatment of the disease. Before prescribing drug therapy, it is necessary to verify the correctness of the diagnosis, since the possibility of false suspicions cannot be excluded.
The following types of studies can be used for diagnosis:
- Wasserman reaction;
- microprecipitation reaction;
- RIBT;
- passive hemagglutination reaction;
- serological tests.
Syphilis is confirmed by the presence of treponema pallidum in tissue scrapings, as well as antibodies to it in blood samples. Based on the results of tests and physical examination, one can judge the extent of the infection.
It is also necessary to carry out a differential diagnosis of the following diseases (depending on the location of the chancre and the presence of accompanying symptoms):
- angina;
- herpes;
- candidiasis;
- tuberculosis;
- traumatic erosions.
Treatment methods
The sooner treatment is started, the better for the patient. Instructions for taking medications are drawn up on an individual basis, depending on the nature of the disease and the characteristics of the patient’s body.
The main therapeutic drugs used are:
- penicillin antibiotics;
- fluoroquinolones;
- tetracyclines;
- macrolites;
- immunostimulants;
- probiotics;
- vitamin complexes;
- antimycotics;
- bismuth preparations;
- iodine preparations.
If syphiloma is detected in the mouth, rinsing with solutions of boric acid, furatsilin, gramidicin is prescribed. It is imperative to observe hygiene standards to prevent secondary infections.
Sexual partners of an infected person with whom he has had contact in the last few months require preventive treatment and constant monitoring. Until stable remission occurs, you should not stop taking medications without obvious reasons, or enter into intimate relationships. We also recommend watching the video in this article to learn more about syphilitic chancre.
Chancre is a serious, chronic infectious disease caused by the bacterium Treponema pallidum (treponema pallidum). The disease is transmitted sexually. If left untreated, the infection is long-lasting, with exacerbations followed by periods of remission. In men and women, specific local inflammations appear in all organs.
The incubation period lasts from the moment of infection until the appearance of skin lesions. The duration of this period is about 3-4 weeks (can vary from 10 to 80 days). The latent period is lengthened by taking antibiotics.
In primary syphilis, primary syphiloma forms at the site of entry of Treponema pallidum. The secondary stage begins 9-10 weeks after infection and lasts from 3 to 5 years. It is characterized by changes in the skin, mucous membranes, internal organs and central nervous system.
Half of patients develop tertiary syphilis many years after contact with the pathogen. Irreversible damage affects bones, joints, skin and mucous membranes.
The development of syphilis occurs in four stages:
- Primary.
- Secondary.
- Latent.
- Late (tertiary).
At the beginning of the disease, skin lesions appear. It is a painless ulcer with hard borders. Chancre occurs at the site of infection in the body. There are no signs of inflammation around it. The central part of the wound is covered with a thick gray-yellow coating. Its diameter ranges from 10 to 20 mm.
Typically, chancre is located on the external genitalia of both men and women. It affects the glans penis, foreskin, and less commonly the skin of the scrotum and pubis, labia majora and labia minora. In medical practice, cases of syphiloma occurring in the anal canal, oral cavity, tongue, lips, nipples or throat are described. Thus, this hard ulcer can appear on any part of the body.
Occurring approximately 21 days after exposure, chancroid usually heals within 6 weeks even without the use of medication. Enlargement of the lymph nodes located in the groin, under the arms and on the neck occurs within a week after the formation of syphiloma.
How long does it take for symptoms of secondary syphilis to appear?
Signs of the secondary stage of the disease are observed within 6 weeks - 6 months after contact. During this period, the skin of men and women is covered with a rash in which active forms of bacteria are present. Skin rashes are pustules and blisters on mucous membranes and other parts of the body. Often. For example, the palms, soles of the feet, face and scalp are affected.
Ulcers on the mucous membranes and in the folds of the skin merge into one large wound, which over time becomes covered with a gray-pink coating. Spotted syphilis on the mucous membrane is a typical diagnostic sign (appears on the lips, inside the nasal cavity, vulva and vagina).
At this stage, other systemic symptoms of the disease are also characteristic:
- headache;
- fever;
- fatigue;
- weight loss;
- a sore throat;
- alopecia areata;
- swollen lymph nodes;
- loss of appetite.
The person's immune system can fight off these symptoms without treatment, but they may reappear after 1-2 years. The body of men and women is not able to completely cope with the infection, but it can eliminate the symptoms for a while.
Late stages of Treponema pallidum infection
Without treatment, syphilis can go into the latent (hidden) stage. In this case, tests for Treponema pallidum are positive, but there are no external signs of the disease. This stage is quite lengthy and takes several years.
Some people never have any symptoms again, but in 30-50% of untreated patients the disease progresses to tertiary (late) syphilis.
At this stage, slow destruction of the nervous and circulatory systems occurs. Bacterial toxins stimulate severe damage to the heart and aorta, brain and eyes, bones and joints. Irreversible destruction of organs and systems ends in the death of the patient.
In the late period of syphilis, bacterial cell clusters (infectious granulomas) develop in various tissues of the body. Cutaneous granulomas are called gummas. Such syphilitic chronic infiltrates in the form of a node disintegrate, causing irreversible damage. For example, disintegration of granulomas in the soft or hard parts of the palate causes tissue perforation.
Diagnosis of chancre
Laboratory diagnosis of infectious material is carried out using a dark-field microscope. Blood tests for syphilis are now increasingly used, but the disease can only be detected in the blood 4-6 weeks after the appearance of chancre.
In a sick mother who neglects treatment, in 80-85% of cases the fetus in the uterus becomes infected, as the treponema passes through the placental barrier. Thus, the child is born with symptoms of congenital syphilis.
During the primary stage of syphilis in men, the following complications are possible:
- balanitis;
- balanoposthitis;
- inflammatory phimosis;
- paraphimosis;
- phagedenic ulcer.
At the 3-5th month of the disease, hair begins to fall out intensively (syphilitic alopecia). The resulting foci of inflammation, osteomyelitis, osteoarthritis and other destructive processes are a direct consequence of the influence of tertiary syphilis on the body.
Treatment of the disease
The gold standard of treatment is daily intramuscular injections of procaine penicillin. The dosage and duration of therapy largely depends on the clinical picture: the size and location of chancre, secondary mucous manifestations, neurosyphilis. If there are no pronounced symptoms, then the dosage is determined in accordance with the serological test results.
An alternative treatment option is a single injection of benzathine penicillin, which can treat primary and secondary syphilis. This injection is also recommended for partners with whom the patient has had unprotected sexual contact in order to prevent the disease in them.
Syphilis is a chronic venereal disease transmitted mainly through sexual contact. The skin, mucous membranes, and internal organs may be affected.
Etiology
The causative agent of syphilis is represented by Treponema pallidum - Treponemapallidum, which belongs to the gram-negative spirochetes. This spiral-shaped bacterium has 8-14 whorls, allowing it to move.
She makes characteristic movements - around her axis. Treponemas can form L-forms, which increases their level of adaptability to the action of unfavorable factors.
In this way, their ability to change their virulent and antigenic properties is expressed, which complicates the treatment of syphilis.
Transmission routes
- sexual (with unprotected sexual intercourse);
- contact-household (in contact with the patient’s clothing, personal hygiene items, things of common use, during kissing, breastfeeding, injection manipulations, in tattoo parlors), transplacental, blood transfusion (during blood transfusion)
Risk factors
- Promiscuous sexual intercourse;
- Unprotected sex;
- Multiple sexual partners;
- Failure to comply with personal hygiene rules if you are in contact with a person sick with syphilis;
- Presence of other sexually transmitted diseases;
- Immunodeficiency conditions;
- Taking narcotic substances;
- Asocial way of life.
How to identify syphilis
At different stages of the disease, people with syphilis may experience different symptoms, as they are expressed by different signs.
Primary syphilis
Many people are interested in the question of how long it takes for syphilis to appear. The primary form visually begins to appear at the end of the incubation period, that is, one to two months from the moment of infection.
At the site of invasion of the pale spirochete (on the genitals, near the rectum, on the mucous membrane of the mouth), a hard chancre is formed - a syphilitic ulcer, which at first does not cause any discomfort or pain.
After some time, an inflammatory process appears and the chancre becomes red or blue in color.
If there is a manifestation of syphilis in the oral cavity, it may resemble a relapse of chronic tonsillitis or lacunar tonsillitis. A chancre near the anus has many similarities with a fissure of the anal fold.
After the first week, the patient begins to be bothered by inflammation of the lymph nodes and vessels that are located next to the primary focus of the skin lesion - scleradenitis.
With the development of the inflammatory process in the oral cavity, the submandibular lymph nodes enlarge, which leads to swelling of the throat, difficulty swallowing and breathing.
If the chancre is localized in the genital area, symptoms of scleradenitis appear in the groin area, which makes walking and defecation difficult.
Secondary syphilis
This stage of the disease is characterized by certain skin manifestations of syphilis. The secondary form manifests itself 2-4 months after the pathogen enters the body, and is characterized by the development of syphilitic elements of a rash on the legs, arms, torso, head, and nails.
At first, syphilis on the skin may manifest itself by covering the area around the chancre with spots and ulcers, which merge with each other and form extensive lesions.
Syphilitic changes will manifest themselves as so-called syphilides; they are inherent in the secondary stage.
They come in several types:
- Roseola rash is pink, cavity-free spots that do not protrude above the skin and have clear or blurred boundaries.
- Papular rash - small cone-shaped growths of pink color that tend to peel
- Pustular rash - growths with a cavity filled with purulent exudate.
- Pigmented leucoderma - white spots that appear on the neck in the form of a “Venus necklace”
- Seborrheic rash - formations covered with scales or crusts in areas of the sebaceous glands with increased secretion production (forehead, nasolabial folds)
Syphilis of the nails, damage to the nail plate is characterized by its thickening, gray-dirty coloring, the appearance of pathological notches and grooves, and ingrown nails.
In parallel with dermatovenerological symptoms, signs of damage to the nervous system appear: decreased cognitive functions (memory, thinking), vision, impaired coordinated movements.
The patient may also be bothered by partial or complete hair loss on the head.
Tertiary syphilis
This stage of the disease can manifest itself a long time after the first external symptoms of primary and/or secondary syphilis are detected.
Syphilides, characteristic of this period, can occur on the skin and mucous membranes. The first group includes tubercular and gummous syphilis.
Tuberculate may appear as burgundy dense tubercles that do not cause pain. Gummous is represented by nodules the size of a nut, which lie in the deep layers of the skin.
Syphilides of the mucous membranes are:
- Gumma of the nose with subsequent deformation of the nose
- Gumma of the hard palate, as a result of which food is thrown from the oral cavity into the nasal cavity.
- Gumma of the soft palate, causing it to become immobilized and red with a dark tint. Later, the gumma breaks through and ulcers form in this area
- Gumma of the tongue, causing the tongue to atrophy, leading to speech defects, problems with chewing and swallowing bolus food.
- Gumma of the pharynx makes swallowing difficult.
The most severe manifestations of tertiary syphilis are the formation of gummas in the internal organs with organ failure, which can be fatal, and the development of neurosyphilis. This disease is characterized by various symptoms, depending on the location of the nervous system damage.
These may be: meningeal signs (dizziness, nausea, severe headache, tinnitus, muscle rigidity, positive meningeal symptoms), circulatory disorders in the form of ischemic or hemorrhagic stroke, paresis, sensory innervation disorders, loss of deep reflexes, paralysis, cranial damage -brain nerves with corresponding symptoms, cognitive disorders, dementia.
How does syphilis manifest in girls and men?
There are no significant gender differences in the course of the disease. The only distinguishing feature is the place of formation of chancre.
For a woman, the characteristic location of the primary lesion is the cervix, external labia; in men, hard chancre can be found on the penis, at its base, on the head, on the scrotum, in the urethra.
Congenital syphilis
If a pregnant woman becomes infected with syphilis, this has a very negative effect on the development of the fetus, which in the future increases the risk of disability or even death.
There are four forms of congenital syphilis:
Fetal syphilis
It is discovered during intrauterine gestation, after the fifth month of pregnancy. There is compaction and change in the size of internal organs as a result of inflammatory reactions.
Using X-ray examination methods, signs of syphilitic osteochondrosis can be detected. Fetal syphilis is one of the reasons for the birth of premature babies and late miscarriage.
Early congenital syphilis
It is diagnosed in children from birth to two years of age. In children in the first months of life, syphilis can occur in the form of specific pemphigus. Syphilitic runny nose at this time is characterized by swelling of the mucous membrane and extremely difficult nasal breathing.
As a result, a saddle nose may develop. In infants, the larynx is affected by syphilitic ulcers, which leads to hoarseness.
Boys are often diagnosed with orchitis and hydrocele. Multiple deformations of bone structures also occur, which are still only in the formation stage.
Late congenital syphilis
In children older than two years, the disease is called late congenital; adolescents are more often affected.
Clinical manifestations of syphilis at this age have in common with the signs of the tertiary stage of the disease, because gummous or tuberculate syphilides are formed. Saber-shaped shins and dystrophies may form.
Hutchinson's triad, which includes dental anomalies, diffuse keratitis and syphilitic labyrinthitis, is a specific diagnostic triad of symptoms characteristic of syphilis
Latent congenital syphilis
It can occur in children of any age. It is characterized by blurred clinical symptoms and is diagnosed using positive serological research methods.
Complications
Syphilis is dangerous due to its complications if not treated in a timely or incorrect manner.
They are divided into early ones, which occur with primary and secondary syphilis, late ones, which appear during the tertiary stage of the disease, and complications during pregnancy.
The first group includes:
- gangrenous changes in the penis with the possibility of further self-amputation;
- blindness and deafness due to the development of syphilitic meningoneuritis with dysfunction of the 1st and 2nd pairs of cranial nerves;
- syphilitic orchiepididymitis (inflammation of the testicle and its epididymis);
- pathological changes in the liver and kidneys;
- scarring at the site of chancre.
The second group of complications includes:
- damage to the heart and blood vessels with the development of syphilitic aortitis, aortic aneurysm, leading to death;
- pathology of the respiratory system: syphilitic pneumosclerosis and bronchiectasis;
- pathological changes in the hard palate, as a result of which food intake is impossible;
- saddle nose with difficulty inhaling and exhaling;
- gummous osteitis, osteomyelitis with limitation of movements;
- late meningovascular syphilis with dysfunction of the optic and auditory nerves;
- late neurosyphilis;
- paralysis;
Infection with syphilis during pregnancy is a risk factor for the development of premature termination of pregnancy, fetal death, early and late congenital syphilis with disability and possible death.
Diagnostics
To determine syphilis, different research methods are used, which show true results at different stages of the disease. How long does it take for syphilis to appear?
The first signs of the disease develop after the incubation period ends.
By this time, the patient’s body begins to produce specific antibodies to spirochete pallidum antigens, which simplifies laboratory diagnosis.
- Bacterioscopic method - to carry it out, material is taken from the skin surface of the genitals, from suspicious erosions or ulcerative defects, from the surface of chancre. The material undergoes special preparation and is examined under a dark field microscope. To confirm syphilis, you need to detect at least a couple of living pale spirochetes in the field of view, distinguished by certain movements. You can find out the results of a bacterioscopic examination within half an hour.
- Nonspecific (non-treponemal) serodiagnosis: RMP analysis, Wasserman reaction with cardiolipin antigen and RPR (Rapid Plasma Reagin Test). They are used when conducting preventive examinations for syphilis among the population. When diagnosing bladder cancer, blood is taken from the patient's finger, in which the presence of antibodies to the cardiolipin-lecithin-cholesterol antigen, which is part of the bacterial membranes, is determined, because it has many similarities with the antigens of the pale spirochete and the body reacts to it as an antigen of the causative agent of the disease. After how many days can the test be effective? Antibodies that can be detected in the blood during syphilis begin to be produced on the 7th day after the end of the incubation period (1-3 months). This test is not the main diagnostic test to confirm the diagnosis of syphilis. An analysis for bladder cancer can be false positive, that is, antibodies in the human body are produced as a result of the development of another disease - AIDS, hepatitis, gout, tumor processes, rheumatoid arthritis, systemic lupus erythematosus, diabetes mellitus, myocarditis.
- Specific (treponemal) serodiagnosis is represented by the following research methods:
- ELISA is a highly sensitive method for diagnosing the disease, during which it is possible to determine the presence of the causative agent of syphilis at the end of the incubation period. There are two ways to conduct research: direct and indirect. When choosing the direct method, the first step is to react the antigen with an antibody labeled with an enzyme. After the formation of the “AG-AT” complex, the substrate is added. If the antigen matches the antibody, a chemical reaction occurs and the solution changes color. At the first stage of the indirect method, an “AG-AT” complex is formed, to which antibodies labeled with an enzyme are added that bind to the complex. After this, the substrate is added and the solution changes color.
- RPGA is based on the phenomenon of agglutination. If a person is infected with syphilis, his immune cells produce specific antibodies. Sheep red blood cells, sensitized with the Treponemapallidum antigen, and the patient's blood plasma are injected into the wells. If the antigen and antibody match, a characteristic pattern forms in the wells. If the result is positive, it represents an area limited by a ring. The quantitative RPGA method is also used, in which the antibody titer is calculated. A positive test is confirmed when the titer is more than 1:80.
- RIF is a highly informative method for diagnosing syphilis; it allows you to detect immunofluorescein antibodies, the presence of which confirms the diagnosis, a week after infection. To conduct the study, the resulting “AG-AT” complex is used, which is treated with fluorescent-labeled antiglobulin antibodies. As a result of a positive test, a green glow can be observed under the influence of UV rays. This is determined using a fluorescence microscope.
- RIBT is the most specific reaction to syphilis. At the initial stages of the disease it is not informative, but in case of tertiary syphilis it produces results with high reliability. This research method is also used for false positive findings to confirm or refute them. Immobilisin antibodies, which are localized in the serum of patients with syphilis, have the ability to immobilize pale spirochetes. Instead of an antigen, a mixture of syphilis pathogens from tissues of syphilitic orchitis of a rabbit is used. When the patient's blood is added to this suspension, the spirochetes stop moving. The reaction is considered positive if 51 to 100% of Treponemapallidum amenable to immobilization.
- Immunoblotting consists of detecting antibodies of the IgG and IgM classes in human serum, which are produced in response to pallidum spirochete antigens, separated by electrophoresis and transferred to a nitrocellulose membrane.
- Molecular genetic research methods - PCR.
- Histological examination of syphilides - various elements of skin rash due to syphilis. This method is most informative during the development of tertiary syphilis, when tubercular syphilides are formed. In this case, a syphilitic granuloma is detected, which lies in the reticular layer of the dermis and affects the blood vessels. Collagen vessels atrophy and undergo destruction with the formation of cheesy necrosis.
- Cerebrospinal fluid examination is most often performed when there is suspicion of damage to the nervous system due to syphilis.
Prevention
Prevention of syphilis includes the following measures:
- Build sexual relationships with one trusted partner;
- Use condoms to protect against STDs;
- In case of unprotected sexual intercourse with a casual partner, carry out preventive treatment within two hours, and after a few weeks get tested for syphilis, for example, bladder cancer;
- Compliance with personal hygiene rules;
- Be regularly examined for sexually transmitted infections, especially for people who are at risk - prostitutes, homosexuals, swingers, drug addicts;
- Do not develop chronic diseases that can lead to decreased immunity;
- Serological testing of pregnant women for the purpose of preventing congenital syphilis in the unborn baby;
- Checking blood and its components for syphilis before blood transfusion;
- Dissemination of information about the dangers of syphilis and preventive methods of protection against infection among the population;
- Conducting events on the topic of sex education, safe sex, STDs with schoolchildren, students, young people;
- Submission of control laboratory tests by patients who have undergone treatment for syphilis;
- Examination of individuals surrounded by people with syphilis.