The first signs of syphilis: manifestations, diagnosis, treatment. Syphilis: symptoms, treatment, photos, how is it transmitted? Lewis disease
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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 chancre. 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 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.
Syphilis is an infectious disease that is classified as venereal. The main signs of this disease are damage and changes in the skin, mucous membranes, internal organs, as well as bone and muscle tissue, the nerve system and strict division into developmental stages.
Etiology
Treponema pallidum, or pale treponema- this is the main and only pathogen that provokes the occurrence and development of syphilis.
It is a rather long, thin, Gr- (non-Gram-staining) spirochete with 8 to 14 whorls. Its length ranges from 8 to 20 microns, diameter - 0.20-0.40 microns. Anatomically, it consists of an axillary body and flagella. This treponema is capable of independent movement by contracting its own body.
This treponema is detected only using the Romanovsky-Giemsa staining method, when it acquires a light pink color (hence its name - pale treponema). In addition, microscopic diagnostic methods such as dark-field microscopy, fluorescence, and phase-contrast microscopy can be used.
Since treponema pallidum is, in fact, the only possible pathogen, treatment of syphilis is aimed specifically at its eradication (destruction).
Transmission routes
The mechanisms of transmission of syphilis are entirely determined by the biological characteristics of Treponema pallidum, namely the necessary temperature conditions, certain humidity and anaerobicity. Because of this, she cannot remain in the external environment on her own for a long time.
The most favorable route of infection for treponema is sexual contact. When transmitted sexually, syphilis primarily affects the vagina, rectum and mouth.
Much less frequently, syphilis is transmitted during blood transfusions (blood transfusions) and transplacentally (from mother to child in the womb). The household route of infection is quite rare, since it requires immediate direct contact with a patient who develops tertiary syphilis.
The incubation period lasts from 4-6 days to 4-6 weeks and averages 25 days. After this, as a rule, signs of syphilis become obvious, clinical symptoms of syphilis appear and patients seek treatment.
More about the disease
Symptoms of syphilis of various forms
Treponema pallidum begins the process of active reproduction immediately after it enters the human body, also releasing endotoxins. This period is called the incubation period, and its duration depends on the body’s defenses, the number of treponemas that have penetrated, or the use of antibacterial agents in the treatment of other diseases (for example, tonsillitis).
After the time required for the incubation period, the first clinical symptom of the disease can already be detected at the site of primary syphilis infection.
In the further classical development of this pathology, 3 forms (they are also stages of development) of syphilis can be distinguished:
- Primary.
- Secondary.
- Tertiary.
The first manifestation of syphilis, as a rule, is chancre. Further, after 4-8 days, other early signs of syphilis appear: regional lymphadenopathy (enlargement of local lymph nodes) and lymphangitis (inflammation of the lymphatic vessels), and scleradenitis (bubo) gradually forms.
The main symptom of primary syphilis, chancre, is an ulcer of dense consistency, not fused with the surrounding tissues, which does not show a tendency to grow. As a rule, it occurs at the site of primary infection.
In addition to classic chancre, the following may be observed:
- Multiple chancre. The emergence of two or more formations.
- Chancre amygdalitis. It develops in the oral cavity and is accompanied by an enlargement of one of the palatine tonsils. At the same time, it bulges into the pharynx, disrupting swallowing and causing pain. Reminds me of a sore throat clinic.
- Chancre felon. Uniform typical for doctors. Occurs on the 1st-3rd fingers of the right hand. In most cases, the symptoms resemble typical panaritium.
- Indurative edema. It is characterized by a massive enlargement of the scrotum and labia, as well as a change in the color of the local horse integument - cyanosis occurs.
The primary form of syphilis is divided into two periods that are important for diagnosis:
- Seronegative. Lasts the first 3-4 weeks. During this period, standard diagnostic methods (RW - Wasserman reaction and ELISA - enzyme-linked immunosorbent assay) are negative.
- Seropositive. The transition to this stage occurs after the occurrence of primary syphiloma. In it, all diagnostic methods become positive and indicate the presence of the disease.
The total duration of the primary form of syphilis is from 6 to 8 weeks.
Occurs 2.5-3.5 months after the initial infection. In the secondary stage, hematogenous (through the bloodstream) spread of treponemes throughout the body occurs. In this case, new signs of syphilis arise - skin rash, rashes on the mucous membranes, symptoms of central nervous system damage (early neurosyphilis).
This form also has several periods:
- Early or fresh.
- Recurrent or recurrent.
- Hidden.
The first signs of the transition of syphilis to the secondary form are specific skin rashes, which can be roseolous, papular or pustular. This manifestation occurs as a result of the abundant release of angioparalytic endotoxins from Treponema pallidum, which are destroyed under the influence of the immune system. After 1-2 weeks, the body adapts to such conditions, and the rash disappears, and the disease becomes latent.
The presence of rashes is usually accompanied by low-grade fever (37.0-37.5°C) and general malaise. Additionally, nonspecific symptoms of syphilis may occur: conjunctivitis, cough, runny nose.
Over time, when a person's immunity weakens, a relapse occurs - the skin rash appears again. Such manifestations of syphilis can be repeated, then they speak of recurrent syphilis.
With relapses, the symptoms of syphilis appear more and more intense each time: the number of elements of the rash increases, and there is a tendency for them to unite into foci.
The second stage lasts on average2-5 daysin some cases - up to 2 weeks.
The tertiary form occurs in case of inadequate treatment or its complete absence. At the same time, syphilis, due to a strong decrease in the body’s resistance, gradually affects all organs and systems, after which severe deformations and changes in the function of the affected tissues occur. A characteristic feature of the tertiary form is syphilitic gumma.
Syphilitic gumma or deep syphilide is a node that forms in the tissues of the affected organ and causes irreversible changes in the structure of the tissues, followed by the formation of scars. Clinically, it represents a small round or oval tumor, 3-4 centimeters in diameter, which has a dense and elastic consistency and is not fused to the surrounding tissues. Gradually it enlarges, loses its mobility, and the skin above it becomes pink. As the gumma develops, painful ulcers appear on its surface, and then scars.
The most common gummas:
- Gumma of the nose. Causes total destruction of the nasal septum and deformation of the nasal concha. It can disrupt the integrity of the palate and cause food to enter the nasal cavity.
- Gumma of the soft part of the palate. With its gradual development, the sky gradually loses its mobility, becomes denser and changes its pink color to a dark red color. With further progression, it simultaneously “breaks through” in 2-3 places, forming ulcers.
- Gumma of the tongue. There are two options for tongue damage due to syphilis:
- Gummy glossitis. Formation of a large number of small ulcers on the upper surface of the tongue.
- Sclerosing glossitis. In this case, the tongue becomes denser, loses its normal mobility, after which it shrinks and becomes exhausted (atrophies). As a result of such pathological changes, a person gradually loses the ability to speak, chew and swallow.
- Gumma throats. It is characterized by difficulty swallowing, voice disturbances and a feeling of “heaviness” in the throat.
In the tertiary stage, syphilis occurs with a certain cyclicity. Exacerbations that occur are usually associated with the influence of factors of decreased immunity: infectious diseases, stress, injuries, poor nutrition, etc.
In the absence of appropriate treatment for syphilis, disorders of almost all organs and systems develop over the course of 5-20 years.
Syphilis most often affects:
- CNS - brain and spinal cord.
- Main vessels, incl. aorta.
- Tissues of the skeletal and muscular systems.
- Skin and mucous membranes.
In addition to the main forms of classical syphilis, another type of syphilis that occurs in children is possible - congenital syphilis.
Congenital syphilis can manifest itself in two forms:
- Early. In this case, symptoms of syphilis occur immediately after childbirth. They include: deformation of the skull bones, constant crying of the child, exhaustion, brownish color of the skin.
- Late. It is characterized by Hutchinson's triad: crescent deformation of teeth, signs of labyrinthitis (deafness, dizziness), keratitis.
Types of syphilis
Signs of syphilis in men and women, diagnosis of the disease
Signs of syphilis of the secondary and tertiary stages in male and female representatives are absolutely the same. Certain sex differences in the symptoms of syphilis arise when the primary form is diagnosed. They are mainly due to anatomical differences between male and female genital organs.
For men:
- Chancre in the lumen of the urethra (urethra). It manifests itself as bloody discharge, significant thickening of a limited area of the penis and an inguinal bubo.
- Gangrenous chancre on the skin of the penis. In the absence of appropriate treatment for syphilis, the risk of arbitrary self-amputation of part of the penis increases.
Among women:
- Chancre on the mucous membrane of the cervix. There are practically no symptoms of syphilis. In the vast majority of cases, the diagnosis of Syphilis is made during a routine examination by a gynecologist.
- Greater tendency to inducing swelling of the genital organs.
The main diagnosis, both in men and women, is based not only on the clinical signs of syphilis, but also on laboratory diagnostic methods. The most used among them are: RW (Wassermann reaction) and ELISA (enzyme-linked immunosorbent assay).
R.W. It is a specific complement fixation reaction. It uses lipoid antigen and reagin from the patient's blood serum. The resulting AG-AT complex is detected using a hemolytic system, which consists of: sheep erythrocytes and hemolytic serum. The RW result is assessed in “pluses”: negative - “-”, weakly positive - “+” or “++„, positive - “+++” and strongly positive - “++++”.
ELISA. The essence of the method is to bind the antigen (antigen) of syphilis to the antigen of the patient’s blood serum. The syphilis antigen itself is sorbed (absorbed) on a solid-phase carrier. The purpose of the reaction is to identify a specific AG-AT (antigen-antibody) complex using immune serum labeled with the necessary enzyme. The reaction results are evaluated similarly to RW.
As alternative or additional studies to confirm the primary diagnosis of Syphilis, the following can be used:
- RIBT.
- RPGA.
Diagnostics
Treatment of syphilis, possible consequences and prevention
Treatment of syphilis is carried out only in the hospital of a specialized dermatovenerological dispensary. The course of therapy for the primary form lasts from 2 to 4 months of continuous treatment, for the secondary form - up to 2.5 years.
Drug therapy primarily consists of antibacterial agents. Despite many years of use of penicillin antibiotics, Treponema pallidum still remains sensitive to them. The drug of choice is Bicillin-5, at a dose for adults - 1.5 million units (units of action) per day, and for children - 0.8-1.2 million/day.
If the patient has resistance to this drug or an allergic reaction, antibiotics from a number of macrolides (erythromycin), cephalosporins (ceftriaxone) or tetracyclines (doxycycline) are used.
Immunotherapy. It is used as an additional treatment in patients with an unfavorable prognosis for the outcome of the disease, with latent forms or severe concomitant pathologies. In this case, syphilis is treated with biogenic stimulants (aloe or placenta extract) in a dose of 1.0 when administered subcutaneously.
Physiotherapeutic procedures are ineffective, since the main reason why syphilis develops - treponema pallidum - is immune to them. Some methods can be used as symptomatic therapy, but they are prescribed extremely rarely.
Treatment of syphilis with folk remedies is strictly prohibited, because alternative medicine is not able to have the necessary effect on Treponema pallidum. Moreover, by eliminating individual symptoms of syphilis, you can significantly complicate the course of the disease and further diagnosis and delay the necessary treatment indefinitely.
If you notice the first possible signs of syphilis, you should immediately consult a doctor!
Syphilis can affect almost all organs and systems, so the list of possible consequences is quite large:
- The cardiovascular system:
- Arterial hypotension.
- Angina pectoris.
- Myocardial infarction.
- CNS:
- Meningitis.
- Hydrocephalus.
- Increased intracranial pressure.
- Speech impairment.
- Epileptic seizures.
- Organs of vision and hearing:
- Hearing loss.
- Anomalies in the structure of the pupils.
- Retinitis pigmentosa.
- Inflammation and atrophy of the optic nerve.
- Musculoskeletal system:
- Osteoarthritis.
- Respiratory system:
- Bronchitis.
- Pneumonia.
- Digestive tract:
- Yellow atrophy of the liver.
- Gastritis.
Individual preventive measures for syphilis include the following factors:
- Completely eliminate promiscuous extramarital sex.
- The use of contraceptives and subsequent hygiene procedures if you have sexual contact with a person you are not sure about.
- Contact a prevention center in the first few hours after potentially dangerous sexual intercourse.
What is syphilis? Chronic infectious pathology that develops when Treponema pallidum penetrates the body. The disease progresses rapidly, affects all systems and organs, and is accompanied by various complications.
Syphilis is transmitted when Treponema pallidum enters the body
Classification of syphilis
Syphilis (lues) is a sexually transmitted disease, the symptoms of which appear periodically, which often makes diagnosis difficult. To classify the disease, various criteria are used - the duration of infection, the degree of damage to internal organs.
How is syphilis classified:
- By period of infection– incubation, primary, secondary, tertiary.
- According to the duration of the disease. Early latent syphilis - infection occurred less than 2 years ago, the nervous system was not affected. Late latent syphilis - more than 2 years have passed since infection, pathogenic bacteria are present in the cerebrospinal fluid. Unspecified – the time of infection could not be determined.
- Along the path of infection– early and late forms of congenital disease, sexual, domestic, transfusion, headless acquired syphilis.
- Neurosyphilis– Treponema pallidum affects the vessels and membranes of the brain, then the tissues of the organ.
- Visceral syphilis– divide the disease depending on which organs are destroyed.
The main feature of syphilis is its wavy course. In the active form, the clinical picture is clearly expressed. The latent type of the disease is the remission phase, there are no signs of infection, the pathogen can only be detected using laboratory tests.
Incubation syphilis
The incubation period lasts on average 3–4 weeks, with strong immunity it can extend to 3 months, in people with a weakened body it is reduced to 9–11 days.
After infection, there are no clinical manifestations; after the end of the initial period, characteristic ulcers and erosions appear at the site of penetration of pathogenic bacteria - chancre, most often in the genital area, what it looks like can be seen in the photo.
The appearance of hard chancres on the skin is the first sign of syphilis in the incubation period
Primary period
Duration – 6–7 weeks. The first signs are a red spot that gradually thickens. A distinctive feature is that the rashes have a regular shape in the form of a circle or oval, the color resembles raw meat, the surface is polished, since little serous fluid is secreted.
Hard chancre can occur anywhere, but most often they are found on the genitals, mouth, mammary glands, and in the rectal area. The size of the erosion can reach the size of a ten-kopeck coin; usually no more than 5 pieces appear. After 4–8 weeks they disappear on their own, even without drug therapy; a slight scar may remain - this does not mean that the disease has become latent; the bacteria continue to actively multiply.
Types of chancre:
- Chancre felon- forms on the phalanx of the finger, is accompanied by swelling, redness, the ulcer has an uneven edge, a dirty gray coating accumulates in it, and in the advanced form, rejection of the nail is observed.
- Chancroid-amygdalitis- forms on one of the tonsils, the affected tonsil swells, turns red, thickens, pain occurs when swallowing, and a headache in the back of the head.
- Mixed chancre- the result of simultaneous infection with syphilis and chancroid, the disease can develop within 3-4 months.
At the secondary stage of the disease, pink syphilitic papules appear on the palms
After six months, the signs of the disease, spotted syphilide, disappear. In this form, the disease can persist until the end of life in 50–70% of patients; in other people it develops into tertiary syphilis. Secondary syphilis can be fresh and recurrent.
Tertiary syphilis
A slowly progressive inflammatory process that occurs after 5–10 years of illness. The pathology affects almost all internal organs, which causes death.
Signs:
- severe cardiovascular diseases, stroke, complete or partial paralysis;
- large single nodes (gummas) gradually turn into long-term non-healing ulcers, after which specific star-shaped scars remain;
- small group rashes on the lower legs, shoulder blades, and shoulders.
Specific scars that remain in place of large single nodes
In tertiary syphilis, the ulcers are deep, often destroy bone tissue, and form a hole between the nasal and oral cavities, which manifests itself in the form of a nasal voice.
Visceral syphilis
Syphilitic visceropathy– damage to internal organs by Treponema pallidum, develops in secondary and tertiary forms of syphilis, is diagnosed in every 5 patients.
Type of syphilis | What diseases develop | Main features |
Cardiovascular |
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Syphilitic hepatitis | Early and late hepatitis |
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Syphilis of the digestive tract |
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Meningovascular | The disease affects the membranes and blood vessels of the central nervous system |
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Syphilis of the lungs | Interstitial pneumonia | Cough, shortness of breath, chest pain. When tissues are damaged, syphilitic gummas and scars occur. On X-ray the disease is similar to tuberculosis |
Syphilis eye | Bacteria infect various parts of the organ of vision | Allergic reactions, inflammation, intolerance to bright light, increased lacrimation, blurred vision, optic nerve atrophy. |
A separate form of the disease is malignant syphilis, the disease develops quickly and is severe; it is diagnosed in people with weakened immune systems, HIV-infected people, diabetics, and in the presence of autoimmune pathologies.
Causes of the disease
The causative agent of syphilis is Treponema pallidum, a mobile spiral-shaped bacterium, anaerobic, absent nucleus, DNA without chromosomes. The pathogenic microorganism is poorly stained by dyes that are used in the diagnosis of sexually transmitted diseases.
Routes of infection:
- Sexual– the main route of infection, the cause of the disease is sexual intercourse with a carrier of the infection, you can also become infected through a kiss, if there are wounds in the mouth, bacteria can also be present in saliva.
- Intrauterine– congenital syphilis is considered the most dangerous form of the disease and causes the formation of various pathologies. The early type of the disease is diagnosed in a child under 2 years of age, the late type – in children over 3 years of age.
- Vertical– transmitted through milk to the baby during lactation.
- By everyday means- upon contact with a person on whose body there are open syphilitic rashes.
- Transfusion– infection occurred due to accidental transfusion of contaminated blood.
- Headless– bacteria enter the blood through cuts, syringe needles.
You can become infected with syphilis through an infected blood transfusion.
With transfusion and decapitated syphilis, pathogenic microorganisms penetrate directly into the blood, so chancroid does not occur, and signs of a secondary form of the disease immediately appear.
Which doctor should I contact?
If signs of syphilis appear, it is necessary to see a venereologist. After examination and identification of specific symptoms, it may be necessary. Some clinics have a syphilidologist - a specialist in syphilis.
It is possible to completely get rid of syphilis only in the early stages of the disease, when the pathological processes in the internal organs are still reversible; at the last stage, the disease cannot be treated and ends in death.
Diagnostics
Syphilis has a number of characteristic signs that allow a preliminary diagnosis to be made after an initial examination; the main criteria are the nature and location of the rash.
Types of skin manifestations and rashes with syphilis:
- roseola syphilide– round pink spots that appear on the legs, arms, in the area of the ribs, on the mucous membranes, and when pressed they noticeably turn pale;
- papular syphilides– small nodules, dense, with a clear border;
- pigment syphilide– appears six months after infection, a dark rash;
- acne syphilide– conical small pustules, covered with crusts, do not disappear for a long time;
- impetiginous syphilide– dry out quickly;
- smallpox syphilide– spherical small dense rashes;
- syphilitic ecthyma– a sign of late syphilis, a deep and large pustule, covered with a thick crust, after which purplish-blue ulcers and a scar remain on the skin;
- syphilitic rupee– single rashes, prone to scarring;
- pustular syphilides– acne-like syphilitic rash with purulent contents;
- syphilitic alopecia– the appearance of small bald spots on the head;
- syphilitic leucoderma– white spots, located on the neck, chest, lower back.
Other external manifestations are enlarged lymph nodes, an increase in temperature, a decrease in blood pressure, muscle pain, headache, and heart rhythm disturbances.
Lab tests
After the examination, the doctor gives directions for tests that can confirm the diagnosis, show the extent of the disease, and the presence of damage to internal organs. For laboratory tests, samples are taken from rashes on the skin and mucous membranes of the genital organs, in the anus, in the mouth, puncture of the lymph nodes and cerebrospinal fluid is performed.
Diagnostics:
- clinical analysis of urine and blood;
- dark field microscopy– use a special microscope, against a dark background you can clearly see the treponemes;
- direct fluorescence reaction– after treating the biomaterial with a special serum, pathogenic bacteria begin to glow;
- PCR– allows you to detect the presence of Treponema DNA in the blood and cerebrospinal fluid;
- VDRL– shows the presence of antibodies, is highly reliable, only this reaction becomes negative after complete recovery, unlike other serological research methods;
- Wasserman reaction– can be positive, negative, doubtful, weakly positive, strongly positive;
- REEF– detects the presence of antibodies produced by the immune system after infection;
- RPGA– when plasma and specially prepared red blood cells are mixed, the blood becomes granular; even after complete recovery, the reaction remains positive for life.
Almost all methods for diagnosing syphilis are based on blood tests in various specific ways
ELISA is one of the main methods for identifying various infectious pathologies; it allows you to determine the number of bacteria and indicate the time period of infection. 14 days after infection, IgA antibodies are present in the blood; after 4 weeks, the body produces immunoglobulins such as IgA and IgM. If IgG joins the two previous groups of antibodies, the disease is at its peak of exacerbation.
Why do false positive test results occur?
In diagnosing syphilis, several types of tests are always used, since false positive results often occur.
Main reasons:
- exacerbation of chronic infectious diseases;
- serious injuries;
- heart attack;
- any vaccination a few days before testing;
- intoxication due to food poisoning;
- pathological processes in connective tissues;
- tuberculosis, HIV, hepatitis B, C;
- kidney diseases;
- autoimmune diseases.
False-positive reactions to syphilis often occur in pregnant women - this is due to changes in the body at the hormonal and immune levels.
Is there a cure for syphilis?
Syphilis can only be treated with antibacterial drugs; all other means and methods are useless. In therapy, medications are used mainly in the form of injections; the dosage and duration of the course depend on the severity of the disease.
How to treat:
- Bicillin-1 - injections are given every 24 hours;
- Bicillin-3 – administered intramuscularly in the morning and evening;
- Bicillin-5 - injections are indicated 2-3 times a week;
- Tetracycline – twice a day;
- Ceftriaxone – once a day;
- Doxycycline - morning and evening;
- drugs in tablets - Rovamycin, Sumamed, Cefotaxime, Amoxicillin, you need to take them every 8 hours.
When treating syphilis, Ceftriaxone injections are given daily.
If a woman has a history of even completely cured syphilis, she is recommended to undergo preventive treatment during pregnancy to avoid infecting the child.
Consequences and complications of syphilis
In representatives of both sexes, the disease progresses and is treated the same, but complications are sometimes different. Men sometimes develop phimosis, which develops against the background of the formation of a hard chancre in the area of the foreskin. In women, chancroid can be in the vagina and cervix.
How dangerous the disease is - the consequences of the disease depending on the stage of the syphilitic process:
- Primary syphilis- an atypical hard chancre located in a hard-to-reach, unusual place in the mouth, on the tonsils. Hard chancre can cause the development of balanitis, balanoposthitis, and ulcerative-necrotic processes.
- Secondary syphilis– initial damage to the nervous system and internal organs, various types of rashes.
- Tertiary syphilis. In advanced forms of the disease, many gummas form on the outside and on the internal organs - lumps that can destroy bone and muscle tissue.
Treponema pallidum is able to bypass the human immune system; when the body begins to fight pathogens on its own, the bacteria transform into an armored form, in which they can remain for several months.
Prevention
To avoid contracting syphilis, it is necessary to use condoms when engaging in any type of sex; people who are sexually active and often change partners must be tested for STIs every six months.
The constant presence of an infected person nearby increases the risk of household transmission of the disease, to prevent this, it is necessary to exclude any bodily contact, allocate individual dishes to the sick person, bedding, bathtub and toilet must be regularly treated with antiseptics and disinfectants.
After unprotected sexual intercourse with a possible carrier of the infection, you must visit a venereologist within 48 hours, the doctor will select antibiotics for preventive treatment.
A condom reduces the likelihood of contracting syphilis, but infection cannot be completely excluded - if there are erosions and ulcers on the body, they contain a lot of treponemes.
Syphilis is a dangerous disease from which you can die, mainly transmitted through sexual contact. Treatment is effective only in the early stages of the disease, then irreversible processes begin to occur in tissues and internal organs.
Syphilis is the most severe venereal disease, characterized by a long-term course and affecting all human organs. Scientists believe that syphilis arose almost simultaneously with the advent of humans. The first mass disease in Europe was recorded in 1493, shortly after Columbus returned from America. Already in 1499, the disease appeared in Russia and even then caused great concern for the health of the country's population.
At first, syphilis was called “sexual plague,” a French and Chinese disease. The disease received its modern name after the shepherd Syphilus, whom the gods punished for immorality with damage to the genitals. The poem was written in 1530 by the Italian physician Fracastoro.
Causes of the disease
The causative agent of syphilis, a microorganism called Treponema pallidum, was discovered only in 1905. It gets its name from its faint coloration with aniline dyes used in microbiology. Treponema pallidum has the shape of a thin thread twisted into a spiral. Its dimensions are small - up to 14 microns. Due to its structure, treponema moves quickly and penetrates various organs of the human body.
In the environment, the causative agent of syphilis can live in the presence of moisture for several hours, but dies almost immediately when dried, exposed to high temperatures, or disinfectants. It remains viable when frozen for several days.
How is syphilis transmitted?
The main route of transmission of the disease is sexually, through contact between a healthy and sick person. Infection occurs through different types of sexual contact: oral-genital, anogenital, “traditional”.
If a sick person has ulcers in the mouth, he can spread the infection through household means. Infection with syphilis is possible through a kiss, a bite from such a person, as well as through objects that have been in his mouth or contaminated with saliva: a pipe mouthpiece, dishes, a toothbrush, a whistle, a cigarette, lipstick, and so on.
The most infectious patients are patients with primary and secondary periods of the disease. During the tertiary period, the concentration of Treponema pallidum in the patient’s secretions decreases sharply.
There are two more ways of transmitting the infection: through blood transfusion from an untested donor, as well as from mother to fetus during pregnancy. Syphilis during pregnancy contributes to spontaneous abortion, premature birth of a stillborn fetus at 5-6 months of gestation, or the birth of a sick child.
Having got from a sick person to the skin or mucous membranes of a healthy person, the pathogen penetrates through microscopic surface injuries and spreads throughout the body. In this case, complex immune processes occur. However, after treatment, stable immunity is not formed, so you can become infected with syphilis more than once.
Stages of syphilis
In its course, the disease goes through regular stages. After infection, the sick person feels completely healthy. However, this time of imaginary well-being lasts only 4-5 weeks. This is the so-called incubation period, during which microorganisms penetrate the body and multiply at the site of introduction.
How long does it take for the disease to manifest itself in an atypical course: in weakened patients suffering from alcoholism, drug addiction, tuberculosis, acquired immunodeficiency syndrome, and cancer, the period without clinical manifestations can be reduced to 2 weeks.
If, during incubation, a person was treated with antibacterial drugs for other diseases - concomitant gonorrhea (,), then the first signs of syphilis may appear only after a few months. All this time, the pathogen multiplies in the body, but the patient does not suspect it.
Symptoms of syphilis appear in waves, with episodes of exacerbations alternating with stages of a latent (hidden) course. With each new wave of exacerbation, the disease becomes more severe, affecting an increasing number of organs.
How does syphilis manifest?
Symptoms of the disease vary depending on the period. There are secondary and tertiary types of syphilis, or its periods.
The initial symptoms of the disease appear at the place through which the treponema entered the human body. A painless ulcer with dense edges forms there - a chancre. Most often it occurs in the genital area - on the skin or mucous membrane. A week after the formation of a skin lesion, first the inguinal and then all groups of lymph nodes enlarge. The duration of this period is one and a half months.
During the first month after the development of the first symptoms, standard serological reactions are still negative, that is, they do not confirm the diagnosis, although the person is already a source of infection. It is during this period that treatment of syphilis is most effective.
By the end of the primary period, weakness, poor health, pain in the limbs, and headache may appear.
Treatment
The answer to the question of how to treat syphilis depends on the goals of such treatment:
- specific therapy is prescribed to patients in order to rid them of the pathogen;
- preventive treatment is prescribed to the patient’s sexual partners if no more than 2 months have passed since contact;
- preventive medication is prescribed to sick pregnant women, and if these recommendations are not followed, to newborn children;
- A trial prescription of therapy is used when syphilis is suspected, when the diagnosis cannot be confirmed in the laboratory.
Syphilis treatment is most often carried out on an outpatient basis. Patients with tertiary syphilis, sick pregnant women and children, and persons with a complicated course of the disease, including those with allergies to antibiotics, are hospitalized in the venereology hospital.
Drugs
The main medicine against syphilis is benzylpenicillin in extended-release forms (Bicillin-1, Bicillin-5 and others).
Semi-synthetic penicillins (Ampicillin, Oxacillin), macrolides (Erythromycin), tetracyclines (Doxycycline), cephalosporins (Ceftriaxone) are also effective.
For neurosyphilis, prednisolone tablets are prescribed; for damage to the heart and other internal organs, appropriate medications are prescribed.
Is there a cure for syphilis? Of course, in modern conditions this is a curable disease. In the early stages, just a few injections of penicillin are enough to destroy the pathogen in the body. For preventive treatment of sexual partners, only one injection of extended-release benzylpenicillin is required.
Undesirable effects
After treatment with antibiotics, so-called expected complications often develop. They are associated with the massive death of treponemes in the body and the release of their breakdown products into the blood. In addition, penicillin preparations themselves have a short-term toxic effect on the body.
In a third of patients with primary syphilis, an exacerbation reaction occurs soon after administration of the antibiotic. It increases over several hours, but by the end of the first day it goes away. Patients complain of fever, chills, headache, weakness, and sweating. Their heart rate increases, shortness of breath appears, and blood pressure decreases. With secondary syphilis, the skin rash becomes brighter, its elements merge, they can also appear on previously undamaged areas of the skin.
This reaction usually does not cause significant harm to the body and does not require special treatment. However, it should be avoided in pregnant women, children, people with damage to the heart, eyes, or nervous system. To reduce the likelihood of exacerbation, prednisolone is prescribed.
After administration of long-acting forms of penicillin, some patients develop the so-called Hain's syndrome. It is accompanied by dizziness, pallor, fear of death, visual and sensory disturbances, temporary mental disorders and increased blood pressure. The last symptom makes it possible to distinguish Hain's syndrome from vascular collapse, in which the pressure drops sharply. The duration of such an attack does not exceed 30 minutes.
Nicolau syndrome is a rare complication after intra-arterial penicillin administration in children. It is accompanied by the formation of painful spots on the skin with the formation of blisters. Sometimes limb paralysis occurs.
Other side effects that may occur when using penicillins include:
- seizures (more often in children);
- increased edema in patients with concomitant chronic heart failure;
- allergic reactions that occur in every 10 patients;
- anaphylactic shock, accompanied by a sudden drop in blood pressure, decreased heart contractility, and impaired consciousness.
Treatment of children and pregnant women
Abortion for syphilis is not necessary, since timely treatment of the expectant mother leads to the birth of a healthy child. The decision on whether to continue or terminate the pregnancy remains with the parents of the unborn baby.
Treatment started before 32 weeks of pregnancy is considered timely. However, it is also carried out at a later date. Long-acting forms of penicillin are prescribed. After a course of specific therapy, prophylactic treatment is also carried out after some time. Penicillin preparations are not contraindicated during pregnancy.
If a woman has received full-fledged therapy, she gives birth in a regular maternity hospital, and the child is considered healthy and does not need any additional treatment.
Early and late congenital syphilis, as well as acquired syphilis in children, are treated with penicillin. Care must be taken in dosage so as not to cause severe complications or an allergic reaction.
If an expectant mother with syphilis did not receive timely, comprehensive therapy during pregnancy, the newborn, even without signs of the disease, is prescribed preventive treatment.
Criteria for treatment effectiveness
Within a year after the end of treatment for primary or secondary syphilis, non-treponemal tests, in particular the microprecipitation test, should become negative. If they remain positive, then there should be a decrease in the number of antibodies by at least 4 times.
2-3 years after completion of treatment, RIT becomes negative.
Tests such as RIF, ELISA and RPGA can remain positive for many years. This is not a criterion for unsuccessful treatment.
If symptoms or positive serological reactions (PSR) persist, they indicate ineffective treatment or delayed negativity of non-treponemal tests. In these cases, after additional examination, the issue of a second course of antibiotic therapy is decided.
Treatment of contact persons
If no more than 2 months have passed since sexual or close household contact, such people are given preventive treatment with antibiotics. If 2 to 4 months have passed since contact, they are limited to a double diagnostic test, and if more than 4 months, tests are done only once.
Disease Prevention
Prevention of syphilis is based on three principles.
- Health education.
- Screening survey of the population.
- Timely treatment of patients and contact persons.
Prevention of congenital syphilis includes the following measures:
- informing women about the need for early pregnancy registration;
- three-time examination of pregnant women for syphilis;
- when a disease is detected, timely and comprehensive treatment;
- if necessary, preventive treatment of newborns.
The basis for the personal safety of every person is compliance with the rules of intimate and household hygiene:
- lack of casual sex;
- using condoms with a new partner (read about the use of barrier contraception in our);
- in case of unprotected sexual intercourse - the use of special means (Miramistin and others).
Syphilis (Lues) is an infectious disease that has a long, undulating course. In terms of the extent of damage to the body, syphilis is classified as a systemic disease, and in terms of the main route of transmission it is considered a sexually transmitted disease. It affects the entire body: skin and mucous membranes, cardiovascular, central nervous, digestive, musculoskeletal systems.
What kind of disease is this, the first signs and causes of development, as well as what syphilis rashes look like on the skin of an adult, and what is prescribed as treatment - we will look further in the article.
What is syphilis?
Syphilis is the most severe venereal disease, characterized by a long-term course and affecting all human organs.
In the environment, the causative agent of syphilis can live in the presence of moisture for several hours, but dies almost immediately when dried, exposed to high temperatures, or disinfectants. It remains viable when frozen for several days.
The disease is highly contagious even during the incubation period
The symptoms of syphilis are so varied that it is quite difficult to understand them right away. As the disease develops, the manifestations change fundamentally: from a painless ulcer in the first stage to severe mental disorders in an advanced form. The same symptom differs in different patients depending on the immune system, place of occurrence, or even the gender of the person.
Classification
The course of syphilis is long-term, wave-like, with alternating periods of active and latent manifestations of the disease. In the development of syphilis, periods are distinguished that differ in the set of syphilides - various forms of skin rashes and erosions that appear in response to the introduction of pale spirochetes into the body.
Depending on the length of time that has passed since infection, there are:
- early syphilis - up to 5 years,
- more than 5 years - late.
According to typical symptoms, syphilis is divided into:
- primary (chancroid, scleradenitis and),
- secondary (papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis)
- tertiary (gummas, damage to internal organs, bone and joint systems, late neurosyphilis).
You can find out what syphilis looks like only after the incubation period has passed. The disease has four stages in total, each of which has its own symptoms. The long incubation period lasts 2-6 weeks, but sometimes the disease may not develop for years, especially if the patient took antibiotics or was treated for infectious colds. At this time, laboratory tests will not give a reliable result.
Primary syphilis
Lasts 6-8 weeks, characterized by the appearance of pale spirochetes of primary syphiloma or chancre at the site of penetration and subsequent enlargement of nearby lymph nodes.
Secondary stage
This stage of the disease lasts about 2 – 5 years. It is characterized by a wave-like course - the symptoms of syphilis appear and disappear. The main signs at this stage include the appearance of a rash. Rashes can form on various areas of the skin, including the torso, legs, arms and even the face.
With secondary syphilis, it is often possible to diagnose syphilitic roseola - these are peculiar rounded pale pink spots that can reach 10 mm in diameter. Such spots can appear on any part of the patient’s body.
A distinctive feature of syphilitic roseola is its gradual appearance of 10-12 spots per day for seven days. If you press on roseola, it disappears.
It should be noted that secondary syphilis can be of several varieties:
Tertiary stage
Tertiary syphilis manifests itself as focal destruction of the mucous membranes and skin, any parenchymal or hollow organs, large joints, and nervous system. The main signs are papular rashes and gummas, degrading with rough scarring. Rarely detected, it develops within 5-15 years if no treatment is provided.
Congenital form
Congenital syphilis can be divided into several types:
- The early form of the disease, as a rule, manifests itself already in the first two months of the baby’s life. The first signs of syphilis are the formation of a papular rash, as well as damage to the nasal mucosa. More serious complications include partial or complete destruction of the nasal septum, hydrocephalus, hepatosplenomegaly, and retardation in mental and physical development.
- The late form of congenital syphilis is characterized by the so-called Hutchinson triad. Such children have corneal lesions, dental pathologies, and labyrinthine deafness.
Incubation period
During the entire incubation period, no matter how long it was, a person is contagious. Therefore, after the patient is diagnosed, he should inform his sexual partners about this.
The duration of the incubation period varies under the influence of many factors. It is shortened for a number of reasons:
- Secondary infection after complete cure of a syphilitic infection (superinfection).
- Sexual infections (especially gonorrhea).
- Severe concomitant diseases (cirrhosis, tuberculosis, malaria).
- Drug and alcohol abuse.
- The presence of more than two foci of penetration of Treponema pallidum.
It lengthens due to the following factors:
- Old age (55-60 years). This is due to the withering of metabolic processes in the body.
- Long-term diseases that are accompanied by weakened immunity. Previous operations.
- Individually reduced susceptibility to spirochete bacteria. The reason for this phenomenon has not been established.
- Use of antibiotics (for pneumonia, sore throat, flu, sexually transmitted infections). This masks the disease and slows down the development of the pathogen.
How syphilis manifests itself: the first signs
The appearance of a syphilitic rash on the hands
The time between infection and the appearance of the first signs of syphilis depends on the person's immunity and on the method by which the bacteria were transmitted. As a rule, this occurs after a month, but manifestations may appear earlier or later, or be absent altogether.
The first signs you need to pay attention to:
- The very first visible symptom of syphilis is an ulcer, which appears in the place where the syphilitic bacteria have invaded.
- At the same time it becomes inflamed a lymph node located nearby, and behind it a lymphatic vessel. For doctors, this stage is distinguished in the primary period.
- After 6-7 weeks, the ulcer goes away, but the inflammation spreads to all lymph nodes, and a rash appears. This is how the secondary period begins. It lasts from 2 to 4 years.
One of the signs is the appearance of chancre on the face
In men, this is the appearance of a painless ulcer called chancre. Its location in almost all cases is on the genitals. A chancre can appear on the head, on the foreskin, on the penis itself, and can even appear on the scrotum.
The chancre itself is round and hard to the touch, covered with a white greasy coating on top. Its consistency is cartilage-like. In almost all cases there is only one, only occasionally several small ulcers may appear close to each other.
In women, skin manifestations are characterized by the appearance of hard chancre on the genitals. There have also been cases of the first signs of infection appearing in the form of a chancre on the lips or near the nipple on the chest. Sometimes there are several small ulcers, sometimes it is single.
Causes
The causative agent of the disease is a bacterial microorganism, Treponemapallidum (treponema pallidum). It enters the human body through microcracks, abrasions, wounds, ulcerations, from the lymph nodes it enters the general bloodstream, affecting mucous surfaces, skin, internal organs, the nervous system, and the skeleton.
The likelihood of infection depends on the number of bacteria entering the body, that is, regular contact with a sick person increases the risks.
Having got from a sick person to the skin or mucous membranes of a healthy person, the pathogen penetrates through microscopic surface injuries and spreads throughout the body. In this case, complex immune processes occur. However, after treatment, stable immunity is not formed, so you can become infected with syphilis more than once.
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 infection can occur not only through transfusion, but also through injury to the mucous membranes and skin.
How is syphilis transmitted?
Syphilis is transmitted in the following ways:
- sexual (95%) after contact with a sick partner;
- It is very rare to get sick with syphilis at home (this is due to the fact that the bacterium dies without the conditions it needs when it dries);
- in utero - this is how children become infected in the womb
- through breast milk from a sick mother to her child;
- during childbirth during the passage of the child through the birth canal;
- through blood used for transfusion.
The most contagious patients– patients with primary and secondary periods of the disease. During the tertiary period, the concentration of Treponema pallidum in the patient’s secretions decreases sharply.
Symptoms of syphilis
Syphilis is quite diverse in its manifestations. This depends on a number of factors, ranging from the state of immunity of the person affected by treponema, and ending with the number of pathogens penetrating the body.
The first symptoms of syphilis in most cases are characteristic enough to be seen and recognized. If you contact a venereologist at the first suspicion, you can avoid a lot of trouble and really quickly get rid of this disease.
There are skin manifestations of syphilis and internal lesions. Characteristic symptoms are:
- the appearance of chancre - a smooth, painless ulcer with rounded, slightly raised edges up to a centimeter in diameter, bluish-red in color, which can sometimes hurt;
- enlarged lymph nodes;
- headaches, malaise, muscle and joint pain;
- elevated temperature;
- decreased hemoglobin, increase in blood;
- indurative edema;
- panaritium - inflammation of the nail bed that does not heal for several weeks;
- amygdalitis - hard, swollen, reddened tonsils, difficulty swallowing.
What does syphilis look like on human skin: photo
This is what the rash on the palms looks like
Signs of the primary form of syphilis
- The initial symptoms of the disease appear at the place through which the treponema entered the human body. A painless ulcer with dense edges forms there - a chancre. Most often it occurs in the genital area - on the skin or mucous membrane.
- A week after the formation of a skin lesion, first the inguinal and then all groups of lymph nodes enlarge. The duration of this period is one and a half months.
5-6 weeks after its occurrence, the primary chancre heals spontaneously, even without treatment. This is one of the main dangers of syphilis - a person thinks that everything is fine, but the main clinical symptoms appear later.
Symptoms of secondary syphilis
The first rashes (papules or roseola) often occur with residual symptoms of chancre and scleradenitis. After 1-2 months they disappear without a trace, and the period of early latent syphilis begins. After a few weeks (months), a wave of generalized rashes (secondary syphilis) occurs, which lasts approximately 1-3 months.
Most often the rash occurs:
- roseola - in the form of rounded pink spots;
- papular - pink and then bluish-red nodules, resembling lentils or peas in shape and size;
- pustular - pustules located on a dense base, which can ulcerate and become covered with a dense crust, and when healing often leaves a scar.
Different elements of the rash, such as papules and pustules, may appear at the same time, but any type of rash contains a large number of spirochetes and is very contagious.
- The first wave of rashes (secondary fresh syphilis) is usually the brightest, most abundant, accompanied by generalized lymphadenitis.
- Later rashes (secondary recurrent syphilis) are paler, often asymmetrical, located in the form of arcs, garlands in places exposed to irritation (inguinal folds, mucous membranes of the mouth and genitals).
Despite the fact that during this period purely skin symptoms are observed, Treponema pallidum, which has seeded all tissues and organs, can cause various forms:
- meningitis,
- liver pathology (icteric or anicteric),
- lipoid nephrosis or other kidney diseases,
- syphilitic gastritis,
- as well as various lesions of bones and joints.
Symptoms at the tertiary stage
If a patient with syphilis has not been treated or the treatment has been inadequate, then several years after infection he will develop symptoms of tertiary syphilis. Serious violations of organs and systems occur, the patient’s appearance is disfigured, he becomes disabled, and in severe cases, death is likely.
The tertiary form is characterized by gummas - round, large, painless syphilides. They can appear both on the surface of the skin and on internal organs. This disrupts the functioning of the heart, kidneys, and digestive system.
One of the typical symptoms of late syphilis– destruction of the saddle of the nose, due to which the profile takes on a characteristic shape.
After some time, the infection of the nervous system begins to take its toll. Neurosyphilis leads to gradual degeneration of the entire nervous system:
- sensory disturbance,
- altered reflexes,
- sensory errors
- paralysis,
- change in character
- weakening of memory,
- dementia.
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.
Complications
The most serious consequences of syphilis are:
- First of all, damage to the central nervous system. This is fraught with the manifestation of neuritis.
- Very often, in patients with neurosyphilis, the functioning of the organs of hearing and vision is impaired.
- Quite often, osteoarthritis appears as a consequence of syphilis.
- The cardiovascular system is also subject to complications: sometimes syphilitic myocarditis appears, later the functioning of the aortic valves is disrupted, and attacks occur periodically. Due to impaired blood circulation, the patient suffers from myocardial infarction.
Diagnostics
If a rash or ulcer appears on the skin, you should consult a dermatologist. Patients often see a urologist or gynecologist. Doctors of all these specialties, after appropriate tests and detection of syphilis, refer the patient to a venereologist.
Laboratory diagnostic methods include:
- Test for syphilis. Treponema pallidum is detected under a microscope in the biomaterial taken (blood, cerebrospinal fluid, secretions from skin elements).
- Wasserman reaction, testing for rapid plasma reagins. The patient donates blood for syphilis, where the patient is found to have antibodies that are produced against certain parts of the treponema and tissues destroyed by the pathogen.
- PCR (polymerase chain reaction) is a laboratory diagnostic method that also allows one to identify treponema in material taken from the patient.
- Various types of serological tests: RPGA, RIBT, RIF, ELISA.
Treatment
The main method of treating syphilis is antibacterial therapy. At the moment, as before, penicillin antibiotics are used (short and long-acting penicillins or durable penicillin medications).
In the event that this type of treatment is ineffective, or the patient has an individual intolerance to this group of drugs, he is prescribed drugs from the reserve group (macrolides, fluoroquinolones, azithromycins, tetracyclines, streptomycins, etc.)
It should be noted that in the early stages of syphilis Antibacterial treatment is the most effective and leads to complete cure.
There are two main methods of treating syphilis: continuous (permanent) and intermittent (course). During the process, control tests of urine and blood are required; the well-being of patients and the functioning of organ systems are monitored. Preference is given to complex therapy, which includes:
- Antibiotics (specific treatment for syphilis);
- General strengthening (immunomodulators, proteolytic enzymes, vitamin-mineral complexes);
- Symptomatic drugs (painkillers, anti-inflammatory, hepatoprotectors).
The most commonly used tablets are:
- Rovamycin. The dose is determined by the doctor. Cannot be used for liver complications or pregnancy. An overdose may manifest itself in the form of vomiting or nausea.
- Sumamed. Negatively affects the liver and kidneys. Treatment is carried out at an early stage of syphilis, often used as an additional remedy to stronger drugs.
- Cefotaxime. Dosage varies depending on the stage of the sexually transmitted disease and the patient's response to the medication. Prohibited if you are allergic to penicillin.
- Amoxicillin. Weakly effective compared to penicillin and its derivatives. Do not take together with antibacterial drugs.
Prevention
It is impossible to ward off syphilis in advance. There is no vaccine or other active prevention methods against this disease. It is important to follow the rules of safe sex and refuse casual relationships.
Public prevention should be carried out in accordance with the general rules for the fight against sexually transmitted diseases. Components of such prevention:
- mandatory registration of all patients,
- examination of his family members and persons who were in close contact with him,
- hospitalization of infected people and monitoring them over the next few months,
- constant dispensary monitoring of the treatment of sick patients.
If you are forced into close contact with a person who has syphilis, it is important to take all measures to prevent the disease from spreading. To do this, it is enough to strictly follow all the rules of hygiene, as well as avoid close bodily contact with an infectious patient. If you follow all these rules, the risk of infection is significantly reduced.
Syphilis is a very dangerous infectious disease, both for the person himself and the people around him. It is important, when the first signs appear, to contact a dermatologist or venereologist to make an accurate diagnosis, take tests and begin proper treatment with medications.