Places of manifestation of syphilis. Syphilis - general information. How is syphilis transmitted?
Syphilis is one of the few sexually transmitted diseases that can lead to criminal liability if others and a sexual partner are infected. In most cases, signs of the disease in women and men do not appear immediately, but some time after the direct fact of infection. This feature makes syphilis even more dangerous.
Syphilis also stands out from other socially significant diseases (which can harm not only health, but also lead to death) in that today in Russia the syphilis epidemic is acquiring a progressive trend. The disease's growth rate has increased fivefold over the past decade. If left untreated, this pathology can lead to male or female infertility, and during the pregnancy of an infected woman, infection of the fetus is observed in 70% of cases. After infection, the fetus either dies or is born with congenital syphilis.
Syphilis is distinguished:
according to the timing of occurrence - late and early;
according to the stage of the disease - tertiary, secondary, primary;
by origin - acquired and congenital.
Diagnosis of the disease
Under no circumstances can such a serious disease as syphilis be diagnosed “on the Internet,” simply by reading about the symptoms and treatment of the disease. You need to know that rashes and other visual changes can be copied from completely different diseases to such an extent that sometimes even doctors can make mistakes. That is why the diagnosis of the disease must take place according to all the norms of the clinic, starting with an examination by a doctor for characteristic signs and ending with laboratory tests:
examination by a dermatovenerologist. The doctor examines the lymph nodes, genitals, skin in detail and conducts a survey regarding the course of the disease;
detection of treponema itself or its DNA in the composition of syphilides, chancre, gum by PCR, direct immunofluorescence reaction, dark-field microscopy;
carrying out serological tests: treponemal - search for Treponema pallidum antibodies (RIBT, immunoblotting, ELISA, RPGA, RIF); non-treponemal - search for antibodies against tissue phospholipids, treponema membrane lipids that are destroyed by the pathogen (fast plasma reagin test, VDRL, Wasserman reaction). It is worth noting that the result may be false positive, that is, show the presence of syphilis when it is actually absent;
instrumental studies: search for gummas using x-rays, CT, MRI, ultrasound.
Properties of the pathogen
The causative agent of syphilis is the spirochete Treponema pallidum. In the human body, treponema is capable of multiplying very quickly, which causes damage to internal organs. Among other things, there are a lot of these microorganisms on the mucous membranes. It is this property that causes a high risk of transmission through sexual or household contact, for example, through personal hygiene items, shared utensils and other items that are in common use. Treponema pallidum is not an infection for which the body gains lasting immunity, so if a sexual partner has had syphilis, he or she runs the risk of contracting it again through unprotected sexual intercourse with a sick partner.
Treponema is unstable to the external environment and dies almost instantly when boiled. When exposed to a temperature of 55 degrees, it destroys treponema within 15 minutes. Also, the microorganism does not tolerate drying out, but in a humid environment and low temperatures the spirochete exhibits significant “survivability”:
viability remains throughout the year, subject to freezing to -78 degrees;
survives on dishes in residual moisture for several hours;
Even if a syphilitic patient dies, his corpse is capable of infecting others for another 4 days.
Methods of transmission of syphilis
Syphilis is transmitted through:
through saliva - this route of transmission is quite rare, mainly among dentists who work without protective gloves;
through household objects, provided that the patient has open ulcers or decaying gums;
intrauterine transmission (congenital syphilis in a child);
through mother's milk (acquired syphilis in a child);
through blood (sharing shaving utensils, toothbrushes, shared syringes among drug addicts, during blood transfusions);
sexual contact (anal, oral, vaginal).
In case of unprotected, casual sexual contact of any kind, for emergency prevention of the disease, it is necessary to carry out the following procedure (it is advisable to perform no later than 2 hours after sexual intercourse): first, you must thoroughly wash the inner thighs and external genitals with soap and water with the antiseptic solution “Miramistina” or "Chlorhexidine". In this case, women should syringe the vagina with this solution, and men should inject an antiseptic into the urethra.
But it is worth noting that this method is an exclusively emergency measure, which does not provide a 100% guarantee (only 70%) and cannot be used constantly. A condom is by far the best means of protection against STIs, but even when using a condom with an unreliable sexual partner, emergency preventive measures should be taken. Also, after casual sexual contact, you should be examined by a venereologist for the presence of other infections, but it is worth remembering that in order to establish a diagnosis of syphilis, it is worth examining a few weeks later, since, as mentioned above, the incubation period of the disease takes just that long.
External ulcers, erosions, papules are very contagious. If a healthy person has microtraumas of the mucous membrane, then if he comes into contact with a sick person, he runs the risk of becoming infected. The blood of a person with syphilis is contagious from the first to the last day of the disease, so transmission of the infection can occur not only through transfusion, but also when the mucous membranes and skin are injured by manicure and pedicure instruments in beauty or medical salons that contain the blood of a sick person.
Incubation period of the disease
After entering the human body, Treponema pallidum is sent to the lymphatic and circulatory systems, through which it quickly spreads throughout the body. However, a person who has just become infected continues to feel well and does not observe any manifestations of the disease. From the moment of infection to the appearance of the first symptoms of syphilis, it may take from 8 to 107 days, but on average the incubation period takes 20-40 days.
Thus, for 3 weeks to 1.5 months after direct infection, syphilis may not manifest itself in any way, and not only are there no external signs and symptoms, but even a blood test does not detect the disease.
The incubation period can be extended by:
taking medications: corticosteroids, antibiotics and others;
a condition of the body that is accompanied by high body temperature for a long time;
old age.
A reduction in the incubation period occurs in the presence of massive infection, when a large number of treponemas penetrate the body at one time.
It is worth remembering that a person is contagious even at the stage of the incubation period, but at this time infection of another person can only occur through blood.
Syphilis statistics
Syphilis in the early stages is perfectly treatable, however, even despite this fact, the disease confidently ranks 3rd among STDs, second only to trichomoniasis and chlamydia.
According to international official statistics, about 12 million new patients are registered on the planet every year, but it is worth considering that the numbers do not reflect the full scale of the disease, since a large number of people self-medicate.
Most often, people between the ages of 15 and 40 become infected with syphilis, with the peak incidence occurring between 20 and 30 years of age. Women are more susceptible to infection (due to the appearance of microcracks in the vagina during sexual intercourse) than men, but recently it has been men who have taken first place in the number of infected people. This trend is explained by the increase in the number of homosexuals in the EU countries and the USA.
The Ministry of Health of the Russian Federation does not have a unified record of patients with syphilis in the country. In 2008, there were 60 cases of the disease per 100,000 people. At the same time, the bulk of the infected are people without permanent residence, service sector workers, representatives of small businesses, people who have low-paid jobs or do not have a regular income.
Most cases of syphilis are recorded in the Volga, Far Eastern and Siberian districts. Recently, in some regions there has been an increase in the number of cases of neurosyphilis, which is not treatable. The number of registrations of such cases increased accordingly from 0.12% to 1.1%.
The first signs of the disease are the stage of primary syphilis
If syphilis proceeds according to the classic scenario, then the main symptoms are enlarged lymph nodes and chancroid. At the end of the primary period, patients are concerned about the following symptoms:
increase in the number of leukocytes in the blood;
decreased hemoglobin levels;
high body temperature;
arthralgia, pain in bones, muscles;
general malaise;
headache.
A chancre, or typical chancre, is a smooth erosion or ulcer that has rounded, slightly raised edges and reaches a diameter of 1 cm. The ulcer may be painful or not painful at all, and it has a bluish-red color. At the moment of palpation of the chancre, a hard infiltrate is felt at its base, which gave rise to the name of this type of chancre. In men, hard chancre is found in the foreskin or glans, and in women, mainly on the labia or cervix. Also, chancre may be present on the mucous membrane of the rectum or on the skin near the anus; in some cases, erosions are located on the thighs, abdomen, and pubis. For medical workers, chancre may be located on the fingers, lips, or tongue.
Erosion on the mucous membrane or skin can be either single or multiple, and most often manifests itself at the site of infection. In most cases, a week after the chancre appears, the lymph nodes begin to enlarge, but sometimes patients notice an enlargement of the lymph nodes before the chancre itself appears. After oral sex, enlarged lymph nodes and chancre may resemble symptoms of lacunar tonsillitis or an exacerbation of chronic tonsillitis. This feature may cause inadequate treatment of the disease. Also, anal chancre can lead “the wrong way,” since its symptoms resemble a fissure of the anal fold without infiltration and with elongated outlines.
Even in the absence of therapy, chancre disappears on its own after 4-6 weeks, and the dense infiltrate gradually resolves. Most often, after the chancre disappears, no traces remain on the skin, however, with gigantic erosion, pigment spots of black or dark brown color may remain. Ulcerative chancre leaves behind rounded scars that are surrounded by a pigment ring.
Usually, when such an ulcer appears, a patient with syphilis experiences a feeling of anxiety and concern about his health, so the disease is diagnosed in a timely manner and treatment is carried out in a timely manner. But in cases where the chancre remains invisible (for example, on the cervix), when the ulcer is deliberately ignored or through self-medication (treatment with brilliant green or potassium permanganate), it disappears after a month. The person calms down and forgets about the problem, but the danger from the disease remains, and it passes into the secondary stage.
Atypical chancre. In addition to classic chancre, there are other varieties, so recognizing syphilis is a difficult task:
indurative edema. A large, bluish-red or pale pink lump on the labia majora, foreskin, or lower lip that extends beyond the ulcer or erosion. Without adequate therapy, such a chancre can persist for several months;
felon. Chancre, which manifests itself in the form of ordinary inflammation of the nail bed, which is accompanied by almost identical symptoms of panaritium, namely: the finger is swollen, painful, purplish-red. Nail rejection occurs quite often. The only difference is that such a chancre does not heal for several weeks;
amygdalitis. This is not just a hard ulceration on the tonsil, but a hard, red, swollen tonsil that makes swallowing difficult and painful. Usually, by analogy with ordinary sore throat, amygdalitis causes increased body temperature, malaise, and general weakness. In addition, headaches may appear, mainly in the occipital region. A sign of syphilis may be unilateral damage to the tonsil and low effectiveness of treatment;
mixed chancre. A mixture of soft and hard chancre, which appears during parallel infection with these pathogens. In this case, an ulcer of soft chancroid initially appears, since its incubation period is much shorter, after which thickening and symptoms characteristic of hard chancroid appear. Mixed chancroid is characterized by a delay in laboratory tests by 3-4 weeks and, accordingly, the appearance of signs of secondary syphilis.
Lymph nodes. Primary syphilis is accompanied by enlarged lymph nodes, mainly in the groin area. If the chancre is localized in the rectum or on the cervix, the enlargement of the lymph nodes may go unnoticed, since they are located in the pelvis, but if syphiloma appears in the mouth, then the enlargement of the submandibular and mental lymph nodes is difficult to miss. If chancre appears on the skin of the fingers, then the ulnar lymph nodes become enlarged. One of the main signs of male syphilis is a painless cord with periodic thickenings that forms at the root of the penis. This condition is called syphilitic lymphadenitis.
Regional lymphadenitis (bubo). This is a mobile, painless, dense lymph node, which is close to the chancroid:
chancre on the nipple - lymph node under the arm;
chancre on the tonsils - on the neck;
chancre on the genitals - in the groin.
Regional lymphangitis. This is a mobile, painless, dense cord that is located under the skin between the enlarged lymph node and the chancre. On average, the thickness of such a formation is 1-5mm.
Polyadenitis. Appears at the end of the primary period of syphilis. This is compaction and enlargement of all lymph nodes. In general, from this moment the disease passes into the secondary stage.
Complications of primary syphilis
In most cases, complication of the disease in the primary period occurs due to a decrease in the body's defenses or when a secondary infection attaches to the area of chancre. This may lead to:
phagedenization (a type of gangrene that penetrates wide and deep into the chancre. Such gangrene can cause rejection of part or even the entire organ);
gangrene;
paraphimosis;
narrowing of the foreskin;
inflammation of the vulva and vagina;
balanoposthitis.
Symptoms of secondary syphilis
Secondary syphilis appears 3 months after infection and on average the duration of this period of the disease ranges from 2 to 5 years. It is characterized by the presence of wave-like rashes that go away on their own after 1-2 months, leaving no marks on the skin. In addition, the patient is not bothered by either an increase in body temperature or itchy skin. Initially, the symptoms of secondary syphilis are:
Cutaneous syphilides. Secondary syphilides are different types of skin rashes, but they are all similar:
the rash does not hurt or itch;
different elements appear at different times;
the rash does not lead to fever and lasts several weeks;
With appropriate treatment, syphilis is characterized by a benign course and rapid disappearance.
Syphilide options:
pigmented (Venus necklace) – leucoderma (white spots) on the neck;
pustular - multiple ulcers, which subsequently ulcerate and scar;
seborrheic - formations covered with greasy crusts or scales that form in areas with increased activity of the sebaceous glands (nasolabial folds, forehead skin); if such papules appear along the edge of hair growth, they are usually called the “crown of Venus”;
miliary – cone-shaped, dense, pale pink. It disappears later than other elements of the rash, leaving behind characteristic spotty pigmentation;
papular - multiple dry and wet papules, quite often combined with syphilitic roseola;
syphilitic roseola is an irregular or round-shaped spot of pale pink color, which is most often present on the sides of the body.
Syphilides of the mucous membranes. First of all, these are pharyngitis and tonsillitis. Syphilides can spread to the oral mucosa, tongue, tonsils, pharynx, vocal cords. Most often found:
pharyngitis. If syphilide develops in the area of the vocal cords, hoarseness may appear until the voice completely disappears;
pustular tonsillitis. It manifests itself as pustular lesions of the mucous membrane in the pharynx area;
papular tonsillitis. A large number of papules appear in the pharynx area, which begin to merge, and then ulcerate and become covered with erosions;
erythematous sore throat. Syphilides are present on the tonsils and soft palate in the form of bluish-red erythema.
Baldness. There may be two types. Focal - represents small rounded areas without hair on the eyebrows, mustache, beard, head. Diffuse alopecia is excessive hair loss on the scalp. Hair grows back 2-3 months after the start of treatment for the disease.
Complications of secondary syphilis. The most severe complication of the secondary period of syphilis is the transition of the disease to the tertiary period, in which neurosyphilis and its attendant complications develop.
Tertiary syphilis
Over the years or decades, after the end of the secondary period of syphilis, treponemes begin to transform into L-forms and cysts, gradually beginning to destroy internal systems and organs.
Skin syphilides of the tertiary period
Gummous is a sedentary nodule that is the size of a pigeon egg or a walnut and is located deep under the skin. As the gumma grows, it begins to ulcerate, and after it heals completely, a scar appears on the skin. In the absence of adequate treatment, such gumma may be present for several years.
Tubercle is a dense, painless, burgundy-colored bump that lies in the skin. In some cases, such tubercles can be grouped, forming garlands that resemble scattered shot. After the disappearance of syphilides, scars remain.
Syphilides of the mucous membranes of the tertiary period
First of all, they are represented by a variety of gums, which ulcerate and destroy soft tissues, cartilage and bones, leading to permanent body deformities (deformities).
Gumma of the pharynx - accompanied by disorders and painful sensations that make swallowing difficult.
Gumma of the tongue - there are 2 main forms of tongue pathologies in tertiary syphilis: sclerosing glossitis - the tongue loses its mobility, becomes dense, then wrinkles and completely atrophies (the ability to swallow and chew food is impaired, speech suffers); gummous glossitis - small ulcerations on the mucous membrane of the tongue.
Gumma of the soft palate. Gumma appears in the thickness of the palate, which is why it becomes motionless, dense and has a dark red color. Subsequently, a breakthrough of the gum occurs in several places simultaneously, and long-term non-healing ulcers appear.
Gumma of the nose. Destruction of the bridge of the nose or hard palate, causing deformation of the nose (sagging), leading to food entering the nasal cavity.
Complications of the tertiary period of syphilis:
The formation of gummas on internal organs (stomach, aorta, liver), which, when developed, cause severe failure or sudden death.
Neurosyphilis - accompanied by paresis, dementia, paralysis.
Features of syphilis symptoms in men and women
The secondary and tertiary periods have almost the same symptoms. Differences in symptoms for men and women are present only in the primary period, when chancre appears on the genitals:
chancre on the cervix. Signs of syphilis, when hard chancre is located on the uterus in women, are practically absent and can only be detected during a gynecological examination;
gangrenous chancre on the penis - there is a possibility of self-amputation of the distal part of the penis;
chancre in the urethra is the first sign of syphilis in males, which is manifested by discharge from the urethra, a dense penis and an inguinal bubo.
Atypical syphilis
This is latent syphilis. This form of the disease is characterized by an invisible course for the patient and can only be diagnosed through tests, while the carrier can infect others.
Today in the world, venereologists are increasingly faced with cases of latent syphilis, which is due to the widespread use of antibiotics in cases where the first signs of syphilis were not diagnosable and the patient began to independently treat the disease. In most cases, antibiotics are used to treat stomatitis, ARVI, and sore throat. Also, during diagnosis, secondary infections (chlamydia, gonorrhea, trichomoniasis) may be detected; in such cases, the doctor prescribes antibiotics to treat these STDs. As a result, syphilis is not treated and becomes latent.
Transfusion. It is distinguished by the absence of a primary period and chancre and begins with secondary syphilis, from the moment of transfusion of infected blood (2-2.5 months).
Erased. There are no symptoms of the secondary period of syphilis, or they are present, but almost invisible. After this, the disease turns into asymptomatic meningitis and neurosyphilis.
Malignant. The rapid course of the disease, which is accompanied by severe exhaustion, decreased hemoglobin and gangrene of chancre.
Congenital syphilis
A woman who is infected with syphilis can pass it on hereditarily, right down to her grandchildren and great-grandchildren.
Early syphilis – sallow skin color, severe exhaustion, continuous crying, deformation of the baby’s skull.
Late syphilis is manifested by the so-called Hutchinson triad: keratitis, labyrinthine symptoms (dizziness, deafness), semilunar edges of the teeth.
Treatment of syphilis
Which doctor should I contact for treatment of syphilis?
People with syphilis are treated by a dermatovenerologist, and they need to go to a dermatovenereal dispensary.
How long does it take to treat syphilis?
Syphilis requires long-term treatment. If the disease was detected at the primary stage, then treatment will take about 2-3 months, and it should be noted that treatment should be continuous. If syphilis was diagnosed at the secondary stage, then its treatment may take over 2 years. During the treatment period, active sexual activity is prohibited, and the entire family and close circle of the patient must undergo preventive treatment.
What folk remedies exist for treating syphilis?
If you have syphilis, it is strictly contraindicated to self-medicate or use folk remedies. Such “treatment” is not only dangerous and ineffective, but also complicates the diagnosis of the disease, blurring the clinical picture of the pathology. In addition, the effectiveness of therapy and cure of the disease is determined not by the absence of symptoms, but by laboratory data. Also, in many cases, hospital treatment is required rather than home treatment.
What drugs are used to treat syphilis?
The most effective treatment method is the introduction of water-soluble penicillins into the body. This therapy is carried out in a hospital setting for 24 days with injections every 3 hours. The causative agent of syphilis is quite sensitive to penicillin antibiotics, but there is a possibility of an allergic reaction to these drugs or the ineffectiveness of such therapy. In this case, penicillin is replaced with drugs of the tetracycline, macrolide, and fluoroquinolone groups. In addition to antibiotics, natural immune stimulants, vitamins, and immunostimulants are also indicated for syphilis.
How is preventive treatment carried out for the family of a patient with syphilis?
Syphilis is a highly contagious infection that has a high probability of sexual transmission, however, in the presence of skin manifestations of syphilis, the risk of infection increases significantly. Therefore, if there is a person with syphilis in the house, it is necessary to minimize the risk of transmission of the disease through household means. To do this, the patient must have individual dishes, linen and toiletries. It is also necessary to exclude physical contact of the patient with family members if the patient is at the infectious stage.
How to plan a pregnancy if a woman has had syphilis?
To avoid congenital syphilis in a child, a pregnant woman should be examined by a doctor several times. If a woman planning a pregnancy has been successfully treated and has had syphilis and is no longer registered with a dermatovenerological clinic, she still needs to consult a doctor and undergo preventive therapy.
Sexual path - The vast majority of cases of syphilis are caused by sexual transmission. Moreover, infection can occur through any type of sexual contact (oral, anal, etc.). In this type of infection, the key point is that Treponema pallidum gets on the mucous membrane or in the area of the skin defect. The highest concentration of pale treponema is observed in the discharge from a syphilitic ulcer, in semen or vaginal secretions.Household way – in some cases, damage to the oral mucosa by Treponema pallidum is observed. In this regard, the saliva of such a patient may contain a large number of treponemes. Therefore, infection through kissing, sharing utensils, and cigarettes is possible. It is also impossible to exclude the transmission of infection through a shared towel, underwear, etc.
Transfusion or transplantation(during transfusion of blood components or organ transplantation).
As we have already said above, treponema is able to penetrate the blood and spread through the bloodstream to all tissues and organs. Therefore, during blood transfusion of such patients or organ transplantation, infection with syphilis is possible. This route is unlikely, since all biological fluids intended for transfusion and donor organs are thoroughly tested, including for the presence of syphilis.
Professional – This refers to the increased risk of infection among medical workers, employees of dental offices, cosmetologists and tattoo parlor workers. All manipulations that lead to damage to the skin and contact with blood are potentially dangerous in relation to infection with Treponema pallidum.
Vertical – Syphilis can be transmitted from mother to fetus both during the period of intrauterine development of the child and during childbirth. That’s why all pregnant women undergo screening for sexually transmitted infections. If a syphilis infection is detected, a course of treatment is prescribed and the question of the method of delivery is decided individually.
Types of syphilis - symptoms
Considering the fact that syphilis is This is a disease that has a wide variety of symptoms; there is a need to consider them separately and relate them to the clinical stages of the infectious process. So, syphilis develops in stages - each stage indicates the evolution of the disease and the spread of infection.
Primary syphilis
It appears 10-90 days after the initial infection. The main symptom at this stage is the formation of a syphilitic ulcer (syphilitic granuloma). These ulcers are formed at the site of penetration of Treponema pallidum through the outer integument. In this focus all the processes described above occur:- Penetration of treponemas into the deep layers of mucous membranes,
- Reproduction in a limited area of pale treponema
- Toxic damage by bacteria to blood vessels in this area,
- Formation of blood clots in affected areas of blood vessels
- Death of skin or mucous membranes in which there is no blood circulation
- Formation of a hard, compacted crust over the ulcer.
It is worth noting that in the area of chancre there is a very high concentration of pale treponema - therefore during this period the patient is most dangerous to others.
In the event that adequate treatment is not undertaken during this period, treponema pallidum spreads with the lymph flow to nearby organs - lymph nodes. In response to the penetration of bacteria into the lymph nodes, the latter become inflamed, thicken, increase in size, and become painful.
Secondary syphilis
The formation of symptoms of secondary syphilis is associated with the spread of Treponema pallidum through the bloodstream throughout the body. The most specific symptoms of this stage of syphilis are the appearance of a skin rash or subcutaneous lumps.
Skin rash (maculate or nodular rash)- characterized by local compactions rising above the general level, with redness and pinpoint subcutaneous hemorrhages. These nodules contain a lot of pale treponema, therefore, if they are damaged, there is a high risk of infecting surrounding people through household means.
Subcutaneous nodules (tubercles)– are also a cluster of pale treponema. They are characterized by a palpable lump under the skin that is painless and raised above the skin level.
Alopecia areata- observed only among 10-15% of those infected with syphilis. Multifocal baldness with clear boundaries is characteristic.
Tertiary syphilis
As the infectious process progresses, the treponemes that have spread throughout the body multiply intensively, releasing many toxins into the external environment and damaging the connective tissue of all tissues and organs. Particularly severely affected at this stage are organs such as the brain, heart, and kidneys.If the brain is damaged, signs of meningitis, paralysis, paresis, and deafness may occur. Psycho-emotional disorders are also common – frequent changes of depression and nervous agitation (emotional lability).
Diagnosis of syphilis
The diagnosis of syphilis is based on several basic elements: examination of the patient and collection of the necessary information, a blood test to detect treponema or to identify antibodies to it.Examination of the patient
This type of examination can provide very important information:- Detection of syphilitic ulcers (ulcerated granulomas) on the genitals, perineum or mouth
- Skin manifestations of secondary syphilis (rashes, bumps)
- Patchy baldness on the scalp
Laboratory tests for syphilis
- Detecting Treponema pallidum itself
Direct fluorescence reaction– during this study, biomaterial taken from a syphilitic ulcer is painted with a special fluorescent paint (luminous).
PCR (polymerase chain reaction)– this method is carried out using special equipment. Thanks to specially created conditions, multiple copies of the genetic material of the treponema occur, if any is present in the material under study.
- Detecting antibodies to Treponema pallidum
Wasserman reaction– through this examination, the binding activity of chains of protein molecules involved in the immune response (complement) is assessed. The result is assessed in positive terms and can be either positive or negative. A positive result can be of 3 degrees: one pole (+) - when the result is doubtful, two pluses (++) - when the result is weakly positive, 3 pluses (+++) - when the result is positive, 4 pluses (++++) – when the result is sharply positive. In the first 2 cases (1 and 2 pluses), it is difficult to interpret the result - additional research is necessary; if there are 3 and 4 pluses, the result can be interpreted as confirming the presence of syphilis.
Immunofluorescence reaction (RIF) – The blood serum being tested is mixed with a reagent containing antibodies labeled with a fluorescent substance. Anti-treponema antibodies from serum specifically interact with labeled reagent antibodies. After binding, the biomaterial is examined.
Enzyme-linked immunosorbent assay (ELISA)– using this analysis, you can detect different classes of IgG, IgM antibodies. Another important advantage of the study is the ability to identify the amount of antibodies of different classes. These properties of the study make it possible to identify the disease itself, its activity, the effectiveness of the treatment, and determine the likelihood of a patient’s cure.
The method is based on the specific interaction of antibody and antigen in the material under study (human blood).
Treatment of syphilis
Nowadays, syphilis can be cured at any stage. However, it is easier to treat at the initial stage, when the infection is localized and there is no spread of infection throughout the body.Therefore, responsibility, competence of the doctor and diligence of the patient are the main factors in the successful treatment of syphilis.
Rules for the treatment of syphilis:
- Antibacterial drugs of various groups are the main ones in the treatment of syphilis: Tetracycline, Macrolides (erythromycin, medicamycin), Fluoroquinolones (ciprofloxacin), Azitnomycin.
- The course of treatment is prescribed individually by a venereologist; the duration of medication use, as well as the daily dosage, can only be adequately determined by the attending physician.
- If the patient seeks medical help at an early stage of syphilis, then treatment with antibiotics for 2-3 months leads to a complete cure.
- If treatment is sought later - at a more advanced stage - then long-term use of antibacterial drugs will be required - about a year.
- Before starting treatment, laboratory blood tests are required to determine the types of antibodies and their quantity. These indicators will change during the treatment process, therefore they will be indicators of the effectiveness of the treatment and cure.
- Immunomodulatory drugs are used to stimulate the immune system. The fact is that antibiotics are only an auxiliary weapon against Treponema pallidum, while the main job of destroying Treponema is performed by the immune system. Therefore, drugs from the group of immunostimulants are often necessary. Unfortunately, drugs in this group have a number of side effects, so they can only be prescribed by the attending physician.
Diagnosis of cure for syphilis
Based on the disappearance of symptoms of syphilis (syphilitic ulcers, skin rashes).The results of laboratory studies that monitor the dynamics of antibody concentrations in the blood, the presence or absence of IgM, and precipitation microreaction data.
Prevention of syphilis
Natural rules for preventing infection with any sexually transmitted disease are also acceptable for syphilis.
- Maintaining marital fidelity or observing the principles of monogamy in relation to a partner.
- Using a condom during casual sex.
- If you suspect that you are infected with syphilis, you should conduct laboratory tests immediately.
Syphilis in children and pregnant women
Syphilis (outdated name - lues) is a systemic disease with a chronic course, related to sexually transmitted infections. It is accompanied by damage to the integumentary tissues and mucous membranes, nervous and musculoskeletal systems, as well as most internal organs. Depending on the characteristics of the course of syphilis and the stage of pathology, the clinical manifestations of the infection can be very diverse.
According to the generally accepted (in the scientific world it is also called traditional) classification of syphilis, all its types can be divided into: primary, secondary (early and late), tertiary.
A special place is occupied by congenital syphilis, characterized by severe combined damage to the nervous, cardiovascular, respiratory and musculoskeletal systems.
The symptoms of syphilis at the initial stage are associated only with dermatovenerological syndromes (and often go unnoticed by patients). The third stage of syphilis has much more dangerous and unpleasant health consequences. About the features of the syphilitic process at all stages of the development of the disease - in our review.
Causes and stages of the disease
The specific causative agent of syphilis is Treponema palidum (treponema pallidum), a type of gram-negative spirochete with an elongated shape and several curls.
The infection is mainly transmitted sexually through unprotected sex. However, blood and a number of other biological fluids are contagious, so cases of infection are not uncommon when:
- transfusion of drugs made from donor blood (plasma, red blood cells);
- sharing syringes and other medical instruments that come into contact with blood;
- using a shared razor, toothbrush and other “bloody” household appliances;
- feeding the baby with breast milk.
The household route of spread of infection is possible only with prolonged contact with a patient with syphilis of the last (3) stage. At this stage, the pathogen is actively released from syphilitic gums and can enter damaged mucous membranes of a healthy person through kissing, sharing utensils and household items. Infection of medical personnel most often occurs during work with biological material, as well as autopsies of patient corpses (especially children with congenital forms of syphilis).
Note! According to the latest data, the incidence of this sexually transmitted infection in Russia remains quite high - 52.6 people per 100 thousand population. There is a significant (almost 7 times) increase in the number of infected people compared to statistical data obtained from the USSR.
With the standard development of the pathological process, the following periods of syphilis are distinguished:
- incubation;
- primary;
- secondary;
- tertiary.
All these types of syphilis are characterized by different development mechanisms and characteristic features of the course.
Incubation period
On average, 20 days pass from the first entry of the pathogen into the body until clinical signs of syphilis appear. However, in medicine there have been cases of shortening the incubation period to several days and lengthening it to 5-6 weeks. The first is typical for infection from several sources simultaneously or with the development of a mixed infection (the combined action of several pathogens). A long course often develops while taking broad-spectrum antibiotics for the treatment of another disease.
At this stage of syphilis, Treponema palidum enters the body and reproduces through division (every 28-32 hours the number of microbial bodies increases exponentially). There are no clinical, morphological and serological manifestations of the disease yet: the analysis of the incubation period and the possible route of entry of the infection into the body is carried out after the appearance of its first signs.
This stage of the disease ends with the appearance of primary damage (affect) - chancre, which indicates the development of the clinic of primary syphilis.
Primary syphilis
The primary period of syphilis lasts about 6-7 weeks. For a long time it was divided into two subtypes - seronegative, lasting up to three to four weeks, and characterized by a negative result of classical serological tests (Wasserman, Sachs-Vitebsky, Kahn, Kolmar reactions). If a positive result appeared from at least one of the tests, the disease became seropositive. However, thanks to the development of modern highly specific and highly accurate diagnostic methods (PCR, RIF, RIBT), this classification has lost its relevance. Today, specific avid antibodies to pathogen antigens are detected no later than during the diagnosis of other infections.
Chancre is an important diagnostic sign
The main clinical manifestation of syphilis at an early stage is the appearance of chancre (primary syphiloma). This formation is a dense, painless ulceration at the site of Treponema palidum invasion. The inflammatory infiltrate, the integrity of the skin or mucous membrane on the surface of which is damaged, has a round shape. Erosion with clear, smooth edges and a scarlet shiny surface can be covered with scanty transparent discharge and does not bleed. The size of standard primary syphiloma is 10-20 mm, but small (2-5 mm) and giant (30-40 mm) chancres are also found.
Read also on the topic
The first symptoms of syphilis, how to recognize the disease?
Among the typical localizations of formation:
- head of the genital organ, pubic skin, scrotum;
- mucous membrane of the urethra and external opening of the urethra;
- vulva and vestibule of the genital organ;
- anorectal region;
- belly and thighs;
- hands and forearms;
- mammary gland;
- chin, oral mucosa.
Based on appearance and other features, primary syphiloma can easily be confused with chancroid. Among the common features of these pathological formations, identical mechanisms of development of affect are identified - the introduction of the pathogen through the skin or mucous membranes, the formation of a pustule and its transformation into an ulcer.
Typical differences are shown in the table below.
Sign | Chancre | Chancroid |
---|---|---|
Disease and pathogen | Develops in syphilis caused by Treponema palidum | Develops in chancroid caused by Haemophilus ducreyi |
The edges | Solid | Soft |
Exudation | No or light serous discharge | Gray or yellowish purulent discharge |
Pain | Painless | Painful |
Liquidation | Disappears on its own after 3-6 weeks (even without taking antibiotics) | Do not go away without specific treatment |
Localization | Genital organs and extragenital localization | Mainly genitals |
In addition, syphilitic chancre does not contain dense adhesions with surrounding tissues and does not have a tendency to grow and form additional ulcers. Its formation reflects the body’s immune (protective) response to the introduction of a bacterial agent into the patient’s body.
According to research by dermatovenerologists, atypical forms of the location of primary affect have become widespread. Among them:
- multiple chancre;
- chancre on the skin of the fingers;
- indurative (dense) edema;
- chancre-amygdalitis.
Multiple chancre is characterized by the formation of several dense infiltrates with ulceration close to each other. Its formation is associated with the introduction of a large number of pathogens into the body and an active immune response.
Chancroid felon often develops in medical workers. In terms of its clinical course, it is practically no different from non-syphilitic purulent inflammation of the fingers; it usually affects the phalanges of 1-3 fingers of the right hand. Unlike the classic primary affect, it may be accompanied by pain. Sometimes combined with syphiloma located on the skin of the genitals.
Indurative edema develops if the initial introduction of the pathogen occurs in the genital area. The scrotum in men or the labia area in women increases in size, acquires a stagnant blue-violet color, intense in the center and less pronounced at the periphery of the lesion. When palpating the skin, there is no pit or other signs of “classic” edema. As a rule, patients do not complain of pain, but swelling and induration may cause them mild discomfort associated with wearing underwear and clothing. This variant of the primary stage of syphilis lasts 1-4 weeks.
Amygdalitis develops in cases where the site of infection is the oropharynx. Such a primary affect is accompanied by a unilateral increase in lymphoid tissue (tonsils), which acquires a denser consistency, protrudes significantly into the pharynx, and is accompanied by pain and a feeling of discomfort when swallowing. The disease is differentiated from tonsillitis, which, as a rule, is characterized by bilateral enlargement of the palatine tonsils.
Note! It is necessary to distinguish chancre-amygdalitis from classic primary syphiloma located on the tonsil. Unlike it, it does not have an ulcerative defect and causes a uniform increase in volume of the palatine tonsil.
In addition to primary syphiloma, both in the classical and atypical variants of the course, regional lymphadenitis attracts attention. In this case, the lymph nodes closest to the ulcer formation:
- increased in size;
- have a denser consistency;
- do not adhere to surrounding tissues;
- “cold” (no local increase in temperature).
In addition, some patients complain of weakness, fatigue, and a feeling of weakness - common signs of intoxication.
By the end of the initial period of pathology, all clinical manifestations, including primary syphiloma, disappear (even in the absence of antibacterial treatment). The second, bacteremic period of the disease begins.
Secondary syphilis
The second stage of syphilis manifests itself with the generalization of the infectious process and the penetration of treponema into the systemic (general) bloodstream. It is characterized by pathological changes not only at the site of Treponema palidum introduction, but throughout the entire body.
Symptoms of syphilis in the second stage are varied. Meet:
- Dermatological lesions. Most often, a pale spotty rash develops on the skin of the neck (“Venus necklace”), chest, and abdomen. Many small subcutaneous hemorrhages may appear.
- Dryness, fragility and hair loss (even baldness).
- Lymphadenitis. At stage 2, not only regional, but also main lymph nodes throughout the body are inflamed.
- Intoxication symptoms include low-grade fever (often the temperature does not rise above 37-37.2 °C), weakness, a flu-like condition, accompanied by catarrh of the nasopharyngeal mucosa (runny nose, sore throat, cough), symptoms of conjunctivitis.
27.06.2017
Syphilis is a sexually transmitted infectious disease caused by a microorganism Treponema pallidum.
Treponema pallidum infection negatively affects human organs, skin and mucous membranes of the body, as well as the nervous and vascular system. The pale spirochete or treponema has the ability to multiply by fission and penetrate into the lymph nodes and blood. With the help of the blood system, it quickly spreads throughout the body, affecting organs and systems. This disease is one of those diseases that are mainly sexually transmitted.
The first signs of syphilis do not appear immediately, but after some time, which makes this disease dangerous.
The first symptoms of syphilis are very diverse and appear depending on the period of the disease.
The origin of the disease is acquired or congenital.
The stage of syphilis is the first (primary) stage, the second stage, and the third stage of the disease.
The timing of the onset of the disease is early and late.
Syphilis - methods of infection with Treponema pallidum
Disease syphilis and pathogenThe pale spirochete is transmitted from a sick person to a healthy person in several ways:
- sexual contact not protected by a condom;
- oral and anal sex;
- through blood from a sick person to a healthy person;
- in utero from a sick mother to a newborn child;
- through mother's milk when feeding a baby;
- through general hygiene items;
- It is quite rare that the disease is transmitted through saliva.
The most common causes of syphilis are unprotected sex and sharing a syringe among drug addicts.
The best way to protect yourself from infection is to use a condom. Even if you used a condom during sexual intercourse with a casual partner, it is necessary to treat the genitals with antiseptics. Testing for syphilis takes place almost a month after exposure. Treponema pallidum begins to appear in the body 21 calendar days and up to 30 calendar days after infection occurs. Previously, the disease does not manifest itself in any way, and test results may be negative.
All ulcers and erosions on the body of a person suffering from syphilis are very dangerous, because the separated fragments of these wounds are contagious and can infect a healthy person through contact if he has abrasions and microtraumas on the skin. From the very first day until the final period of recovery, the patient’s blood has an infectious form and there are possible options for transmitting syphilis through common objects.
Incubation period for syphilis disease
As soon as the treponema bacterium is in the body, it passes into the blood supply system, and passes into the lymph, and with the help of these systems it is carried to the organs. At first, a person feels absolutely healthy and strong. Syphilis disease first symptoms appear on average from 21 calendar days to 50 days after the spirochete bacterium enters the human body.
Within a period of up to 20 days from the moment of infection, even tests show a negative result for spirochete pallidum infection.
The incubation period for syphilis infection is lengthened by:
- a condition of the body that is accompanied by elevated temperature;
- treatment of viruses in the body and inflammatory processes with a complex of antibiotics;
- age, the older the person, the longer the incubation period.
If a lot of treponemas enter the human body, then the incubation period is significantly reduced and signs of syphilis disease begin faster.
Signs of syphilis in the first stage
Syphilis in the first stage of the disease - signs manifest themselves in enlarged lymph nodes and chancre. The first signs of syphilis in men: the formation of a chancre on the head of the penis, and in the female body, 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.
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.
Chancroid is a round ulcer with a diameter of about one centimeter on the patient’s body. They are red and blue in color, sometimes they are painful, but mostly not.
The chancre 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.
Over a period of 21 - 30 days, the pale spirochete infection manages to get into many organs and lymph, and begins to multiply, which causes an inflammatory process and a fever may appear. In addition to hard chancre, primary syphilis produces an atypical chancre with many of its types:
- indurative edema;
- felon;
- bubo;
- polyadenitis.
Lymph nodes become very enlarged during this period. Depending on what part of the body the chancre has formed, the lymph nodes closest to the chancre become inflamed.
Complications of syphilis in the first period of development of the disease can be very serious for both sexes. Failure to begin treatment for spirochete pallidum in the primary period threatens the development of the disease in the more complex secondary syphilitic period.
Symptoms of syphilis in the second period of disease development
Syphilis and its symptoms at the secondary stage begin no earlier than 90 days after infection and last up to 5 years. During this period of development of the disease, periodicity appears, and after 30-60 days it passes without leaving traces, and so on throughout the entire period.
Signs of syphilis in the second period of development include skin syphilides - a rash that does not itch and lasts for several weeks.
There are different types of syphilides:
- roseola syphilitica;
- papular syphilide;
- miliary syphilide;
- seborrhea;
- pustular syphilide;
- pigmented type of syphilide.
Syphilides, which form on the mucous membranes and manifest themselves in the form of several types of sore throat and pharyngitis:
- erythematous sore throat;
- tonsillitis papular;
- pharyngitis.
In the second stage of the disease, hair loss may occur and hair begins to grow back after two or three months.
The main complication of syphilis in the second period of development of the disease is that it can develop into a state of neurosyphilis.
The third stage of development of syphilis
Tertiary syphilis can begin a period of destruction of the body many years or even decades after the secondary period.
Syphilides on the skin of the tertiary period form tubercular and gummous syphilide.
Nasal gummas are gummas that destroy the bridge of the nose and deform the nose or hard palate.
Linguistic gumma deforms the tongue, which atrophies over time and cannot properly perform its function.
Syphilis symptoms and treatment during this period are the most difficult of all stages of the disease.
Complications are gummas that form on the internal organs of the human body and can lead to the destruction of this organism and death.
And also the transition of syphilis to the state of neurosyphilis, followed by dementia, paralysis and death.
Hidden form of syphilis
Latent syphilis is a disease that is caused by infection with Treponema pallidum and occurs without obvious signs and symptoms of syphilis. Discovercausative agent of syphilisis possible only with the help of laboratory tests. Just like regular syphilis, latent syphilis goes through several stages of disease development. When spirochete microorganisms enter the body, they can remain in the lymph nodes for a long time without revealing any signs. If the body is weakened and the immune system cannot cope with its defense, then the spirochete is activated and begins to destroy the body.
The latent form of syphilis has no visually visible symptoms and signs. This makes latent syphilis dangerous for sexual partners, for the immediate environment (the likelihood of infection through household means), for the unborn child (if syphilis is in a pregnant woman).
Symptoms of latent syphilis can occur in a person according to the signs of some other diseases:
- body temperature rises to 38 degrees, for no apparent reason and regularly, as in inflammatory processes or viral diseases;
- causeless and sudden weight loss - as with oncology;
- psychological disorders depression, apathy as in the development of schizophrenia and dementia;
- a state of weakness throughout the body, as in diseases associated with diseases of the internal organs;
- enlargement and hardening of lymph nodes.
Diagnosis of pale spirochete (treponema)
In order to establish a diagnosis of syphilis, it is necessary to conduct an examination of the body for the presence of treponema in the body. It is necessary, first of all, to visit the office of a venereologist, who will examine the patient and refer him for tests. Only after an examination of a person’s skin, his genitals and lymph nodes has been carried out, as well as the results of research microbiology, You can make a correct diagnosis and prescribe treatment.
For laboratory confirmation of treponema in the body, you need to submit for analysis a scraping from a chancre ulcer or a smear of syphilitic discharge from the genitals.
20-21 days after the pale spirochete enters the body, the seropositive stage of the disease begins, and tests show a positive result for the presence of syphilis.
Differential diagnostic testing of syphilis at the first stage is carried out:
- with traumatic erosion of the genital organs;
- with balanoposthitis, which passes into the stage of gangrene, which can develop either independently or be a complication of diseases of the genital area;
- with chancre, genital lichen, staphylococcal infection, streptococcal infection or fungal diseases;
- with ulcers and erosions caused by gonococcal infection and Trichomonas;
- with ulcers on the labia of female adolescents.
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.
Based on a diagnostic examination and laboratory results, a venereologist draws up a treatment regimen for syphilis in the primary stage.
Treatment of disease caused by spirochete pallidum
To fight with the causative agent of syphilis— microorganism pale spirochete, necessary at the first stage of disease development. At the primary stage, the task is to cure the infection and prevent syphilis from moving into the second stage. Syphilis is a disease that takes a long time to treat. If syphilis was diagnosed at the first stage, in this case treatment can take up to 90 calendar days. If the diagnosis showed syphilis at the second or later stage, then drug treatment can last for up to 2 years. All family members should undergo examination and undergo a complex of treatment for prevention.
The main drugs used in the treatment of treponema pallidum are antibiotics of different groups and directions:
- penicillins;
- macrolites;
- tetracyclines;
- fluoroquinolones.
Together with antibiotics, the following are involved in the treatment of syphilis:
- antifungal drugs;
- immunomodulators;
- multivitamins;
- probiotics.
Treatment of syphilis at the first stage is the following method: administration of penicillins every 3 hours for 24 days in a hospital setting. Patients with early hidden appearance are treated in the clinic for at least 3 weeks. After this, you can continue treatment on an outpatient basis. The duration of treatment depends on the stage of the disease and its severity. In case of an allergy to penicillin, the patient is administered macrolides, fluoroquinolones and tetracyclines and drugs based on bismuth and iodine. This complex of drugs can increase the effect of the antibiotic in the body. Also, when treating a disease, in addition to antibiotics, vitamins and immunostimulants are prescribed to the patient.
If syphilis is diagnosed, both sexual partners must be 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.
At this stage, 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 refrain from sexual contact during the treatment period, even if they are protected by a condom.
Primary syphilis treatment must begin with antibiotics:
- Josamycin 750 mg 3 times a day;
- Erythromycin - 0.5 mg taken 4 times a day;
- Doxycycline - 0.5 mg 4 times a day;
- Extensillin - intramuscular injections, two injections are enough;
- Bicillin - injections, two injections, every 5 days.
For local treatment of chancre with primary syphilis, lotions on chancre using benzylpenicillin and dimexide are necessary.
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:
- furatsilina;
- boric acid;
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, self-medication is unsafe for the body. Only a competent doctor can establish 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.
Consequences of advanced syphilis
All stages of the course of the disease syphilis cause disorders of the body systems and organ pathologies, but the most severe damage to the body occurs in the third (advanced) stage of the disease. Complications of tertiary syphilis can be life-threatening:
- neurosyphilis;
- syphilitic meningitis and meningovasculitis;
- syphilitic neuritis and neuralgia caused by spirochetes;
- syphilitic osteoperiostitis and treponema-induced osteoarthritis;
- myocarditis and aortitis caused by spirochetes;
- hepatitis, consequences of interruption of treponema in the body;
- gastritis provoked by a spirochete;
- syphilitic nephritis;
- blindness as a consequence of neurosyphilis.
Syphilis is one of the common diseases that is sexually transmitted. The causative agent of syphilis is the microbe spirochete pallidum (another name is treponema pallidum).
Main characteristics of syphilis: damage to the mucous membrane, skin, nervous and osteoarticular systems, as well as internal organs (liver, stomach, cardiovascular system). The microbe that causes syphilis cannot remain outside the human body for more than a few minutes.
It can be transmitted from one person to another only through close contact. The main route of transmission of the pallidum spirochete is sexual contact with a patient suffering from syphilis. In rare cases, syphilis can be transmitted through the use of non-sterile medical instruments. A child can become infected with syphilis by being raped by an adult patient. There is also a possibility of infection of the fetus in the womb (this type of disease is called congenital syphilis).
The microbe that causes syphilis enters the human body through the skin and mucous membranes. Often, the causative agent of this disease penetrates into the body through the skin and mucous membranes of the genital organs, pharynx, and oral mucosa. From the mucous membranes and skin, the pale spirochete enters the regional lymph nodes and within a few hours rapidly spreads throughout the human body.
Stages of development of syphilis
Exists primary, secondary and tertiary syphilis. This classification is based on data on the time elapsed since infection and the stage of the disease. Each stage of development of syphilis is separated from the other by a latent period that lasts quite a long time, characterized by practically complete absence of symptoms of the disease. Carriers of the first and second stages of syphilis are contagious to others.As mentioned above, syphilis is transmitted sexually (including through oral, vaginal and anal sex), but there is also a possibility of non-sexual transmission of syphilis - from an infected mother to the fetus (transplacentally) and through the skin. With a single contact with a patient, the risk of transmission of infection is at the first stage of the disease 30 %, when transmitted from a sick mother to the fetus - up to 80 %. Immunity does not develop after an illness, so there is a possibility of re-infection (so-called reinfection).
Symptoms and signs of syphilis
Syphilis can occur at any stage of development and can harm one or more internal organs, often manifesting itself as other diseases. The development of syphilis is accelerated and aggravated by HIV infection. With this scenario, meningitis, eye damage and other neurological complications cannot be ruled out.Primary syphilis. After the incubation period (usually it lasts 3-4 weeks, but in general can last up to 13 weeks) at the site of introduction of the pathogenic microbe, a primary lesion appears - chancre. In the first stages, it is just a small red spot, which soon turns into an ulcer (chancroid). Chancroid is usually called a painless ulcer, dense at the edges and hard at the base. If you rub the chancre, a clear liquid containing a large number of spirochetes will appear.
The most contagious are patients with chancre located on the genitals. The lymph node closest to the chancre, located both in the neck and in the groin area, may be enlarged, painless and dense (lymphadenopathy).
During syphilis, chancre can appear on any part of the body, but the most common location is:
among men: anus, penis, rectum;
among women: cervix, vulva, perineum, rectum;
oral cavity, lips - in representatives of both sexes.
After a few weeks, the chancre closes, but this does not indicate recovery. The causative agents of syphilis, treponema, remain in the body and continue the reproduction process.
Secondary syphilis. At this stage, spirochetes from the lymph nodes and chancre spread through the blood throughout the body. As soon as they enter the skin again, it is damaged again. In addition, secondary syphilis is characterized by enlargement of lymph nodes throughout the body and, in a smaller percentage of cases, damage to other organs. Symptoms of secondary syphilis are usually detected through 6-12 weeks after chancre formation, while in 25 % patients at this time chancre remains.
Symptoms of secondary syphilis are: increased body temperature, nausea, decreased appetite, general weakness. In some cases, headaches, dizziness, decreased hearing, bone pain, and blurred vision are observed.
More than 80 % Patients with syphilis experience lesions of the skin or mucous membranes, all kinds of small pink rashes (syphilitic dermatitis), which can affect any area on the body. Even if untreated, skin lesions disappear within a few days or weeks, but they can remain on the skin and mucous membranes for several months or return after disappearing. As a result, the rash disappears even in the absence of treatment and itching.
Syphilitic dermatitis, usually found on the feet and palms. Some round-shaped elements, often flaky, can connect and form large-area lesions, but they are painless and do not itch. After the rash disappears, a light or dark spot may form in its place. If the rash was on the scalp, patches of baldness may appear.
Another sign of syphilis is wide condylomas. Condylomas are flat, wide skin growths of pink or gray color that are located in the folds of the skin and in its moist areas (under the breasts, in the perianal area). Syphilitic condylomas are extremely contagious. Condylomas of the larynx, oral cavity, vulva, rectum or penis are raised and, as a rule, have a round shape and a gray-white hue with a red border.
Secondary syphilis can affect any organ. U 50 % patients experience enlargement of the lymph nodes - lymphadenopathy (most often widespread, with isolated dense lymph nodes) and enlargement of the liver and spleen - hepatosplenomegaly.
In one case in ten, patients suffer from uveitis (eye damage), periostitis (bone damage), glomerulonephritis (kidney damage), hepatitis (kidney damage), damage to the meninges, spleen and joints.
IN 10-30 % cases of syphilis inflammation of the meninges develops (so-called erased meningitis), but only 1 % Patients present with severe symptoms of this disease, including neck muscle tension, headache, visual and hearing impairment.
Latent period of syphilis. This stage of development of syphilis is characterized by the absence of symptoms of the disease, however, signs of infection are found in the patient’s blood (antibodies against treponemes). Since primary and secondary syphilis, as a rule, do not have pronounced symptoms and often go unnoticed, syphilis is diagnosed at its latent stage, when a blood test for syphilis is performed (Wassermann reaction, microaglutination reaction).
Syphilis can go undetected for a long time, so patients receiving antibiotics for other illnesses can be cured of syphilis without even knowing they were infected.
Tertiary or late syphilis. More than a third of patients who did not receive treatment develop tertiary syphilis several years (or even decades) after the first infection. It can exist in the following forms: mild tertiary syphilis, cardiovascular syphilis, and neurosyphilis.
Mild late gummous syphilis usually develops after 3-10 years from the time of infection and can affect bones, skin and internal organs. Gummas formed during syphilis are soft formations consisting of dead tissue, located in the thickness of the walls of organs and skin. Gummas grow gradually, heal over a fairly long period of time, leaving behind scars.
The result mild tertiary syphilis bone pain is inflammation and destruction of bone tissue, which leads to boring pain, which usually intensifies at night.
Manifestation cardiovascular syphilis usually occurs by 10-25 years after the first infection. Basically, cardiac syphilis has the following manifestations: aortic valve insufficiency, aneurysm of the ascending aorta, narrowing of the coronary arteries. The dilated aorta, pulsating, leads to symptoms of compression or damage to adjacent structures of the chest. Symptoms include: respiratory tract infections due to pressure on the trachea, rough cough, painful erosions of the sternum and ribs or spine, hoarseness due to paralysis of the vocal cords.
Forms neurosyphilis may be as follows:
meningovascular neurosyphilis,
asymptomatic neurosyphilis,
tabes dorsalis,
parenchymal neurosyphilis.
Syphilis during pregnancy
Infection with syphilis can cause significant complications during pregnancy and cause all sorts of fetal defects or even lead to its death. For this reason, all pregnant women are regularly screened for syphilis. Syphilis is treated in pregnant women according to the same rules as in other patients.Diagnosis of syphilis
A blood test for syphilis helps diagnose syphilis. There are several types of tests for syphilis, in general they are divided into two groups:non-treponemal (RW with cardiolipin antigen, RPR);
treponemal (RIBT, RW with treponemal antigen, RIF).
Non-treponemal blood tests are used to conduct mass examinations in clinics and hospitals. In some cases they may give a positive result in the absence of syphilis, that is, be false positive. To avoid errors in diagnosis, non-treponemal tests must be confirmed with treponemal blood tests.
To assess the effect of the treatment, quantitative non-treponemal blood tests are used (for example, RW with cardiolipin antigen).
Treponemal blood tests show a positive result after syphilis throughout life. Thus, to assess the effect of the prescribed treatment, treponemal tests are not used!
Treatment of syphilis
Only after the diagnosis of syphilis has been made and confirmed by laboratory tests can treatment of syphilis begin. Treatment of syphilis should be carried out individually and comprehensively. Treatment is based on antibiotics. In certain cases, treatment is prescribed that complements the use of antibiotics (physio- and immunotherapy, restorative drugs, etc.).All sexual partners of the patient should be treated for syphilis. If a patient is diagnosed with primary syphilis, then examination and, if necessary, treatment is carried out on all partners who have had sexual contact with him during the previous three months. If a patient has secondary syphilis, then all his sexual partners are examined and treated within a year.
Important to remember: Trying to cure syphilis on your own is dangerous! Only laboratory methods can guarantee recovery.