Hidden syphilis. Latent or hidden syphilis: symptoms, diagnosis, treatment. How does latent syphilis manifest?
Syphilis is an insidious disease; usually, for three to four weeks, a person infected with a pale spirochete does not even know about the disease.
If during the normal course of the disease after the incubation period the first symptoms can be detected: chancroid, enlarged lymph nodes, then in the latent form it does not manifest itself in any way, but tests for syphilis give a positive result.
There are three forms of latent syphilis:
- Early;
- Late;
- Undifferentiated.
If less than two years have passed since infection, an early form is diagnosed. If the disease is detected after this period, then a late form is diagnosed. But when the infected person cannot accurately remember the moment of infection, and as a result of research it is impossible to determine early or late syphilis in the patient, then they speak of an undifferentiated form.
The most dangerous form of syphilis for others is considered to be early. During this period, the patient is an active source of infection. If the disease has progressed to a late form, then the risk of infecting others is significantly reduced, in most cases, completely absent.
In the early form of syphilis, the primary signs either do not appear at all or are expressed so implicitly that the person does not pay attention to them. This is often due to the fact that the patient took antibiotics to treat other diseases during the incubation period. In this case, doses of antibiotics do not destroy the pale spirochete, but only delay its development and distort the course of the disease.
Also, unfavorable environmental factors and self-medication also influence changes in spirochetes. Unfortunately, uncontrolled use of antibiotics has led to an increase in latent forms, which contributes to the spread of the disease.
Symptoms
With early latent syphilis, the manifestation of the first symptoms of the disease, such as the appearance of chancre, rashes, and enlarged lymph nodes, may be absent or be so small that the patient does not notice them. Usually, if symptoms appear, they go away on their own and quickly.
Sometimes a person mistakes this form of syphilis for another disease and begins to self-medicate, which aggravates the course of the disease.
You should consult a doctor if you have had casual sex within the last two years, after which:
- Small, hard abrasions and ulcers appear, completely clean and painless;
- Body temperature periodically rises to low-grade fever, but no obvious cold symptoms are observed. Usually this temperature lasts for several days;
- General malaise, anemia, asymptomatic weight loss, loss of strength;
- Headaches and bone pains that worsen during sleep;
- Enlarged lymph nodes that do not hurt or suppurate;
- The manifestation of an atypical reaction for you to penicillin drugs, such as vomiting, migraine, tachycardia, increased body temperature. In this case, the symptoms disappear after taking regular aspirin.
But even these manifestations cannot indicate the presence of the disease; laboratory tests are required to make a diagnosis. Very often, early latent syphilis is discovered completely by accident, when taking tests for a hospital, obtaining a medical certificate, or registering during pregnancy.
Diagnostics
To make a correct diagnosis, it is important to collect as complete an anamnesis as possible over the past two years. In this case, clarify the following from the patient:
- Have you done serological tests and what are their results?
- Have rashes, ulcers appeared on the genitals, on mucous surfaces in the mouth;
- Have you taken antibiotics?
- Have you been treated for .
A visual examination of the patient is carried out for the presence of hard chancre, residual effects of polyscleradenitis, and enlarged lymph nodes.
The Wasserman test is mandatory; if the result is positive, additional tests are performed. Because in some cases it can be positive even in the absence of disease. To confirm the diagnosis, a positive result from several serological tests is required. Such as:
- Enzyme-linked immunosorbent assay (ELISA);
- Poor trepanema immunization response (RIBT);
- Immunofluorescence reaction (RIF);
- Passive hemagglutination reaction (PHA).
Moreover, in early syphilis, most patients have very high titers. In almost all patients with this form of syphilis, the RIF reaction will be positive.
Sometimes in the early phase of latent syphilis, reactions may be negative if other signs are present. In this case, for timely recognition of the disease, a cerebrospinal fluid analysis is taken.
Treatment
The earlier latent syphilis is diagnosed, the higher the chances of a positive result. Treatment is carried out under strict medical supervision according to approved schemes and instructions. Usually the patient is admitted to a hospital, but treatment can also be carried out on an outpatient basis.
Therapeutic treatment includes taking antibiotics, immunomodulators, antipyretics, and anti-inflammatory drugs.
Prevention
To reduce the risk of disease, it is necessary to take a responsible approach to the choice of sexual partners. In case of casual relationships, do not allow sexual intercourse without using condoms. Do not use other people's personal hygiene items.
To prevent illness, it is important to closely monitor your health. Undergo medical examination once a year to study titers for syphilis. In case of a positive reaction, you should contact a venereologist as soon as possible. Do not use antibiotics without medical prescription.
If you have had sexual contact with a person with syphilis, you should consult a doctor within a week for preventive treatment. When a disease is detected, all sexual partners of the patient and their family members must be examined.
You should not engage in treatment yourself, as if the therapy is not selected correctly, the disease can become chronic. And then it will be very difficult to cure syphilis.
It is also important to be sure that there is no hidden form of the disease when planning pregnancy, since in most cases this causes miscarriage, premature birth, and the birth of babies with developmental anomalies and congenital syphilis.
A common sexually transmitted disease, syphilis, is caused by a microorganism called spirochete pallidum. It has several stages of development, as well as many clinical manifestations. In Russia, at the end of the 90s of the twentieth century, a real epidemic of this disease began, when 277 people out of 100 thousand people fell ill per year. The incidence is gradually decreasing, but the problem remains relevant.
In some cases, a latent form of syphilis is observed, in which there are no external manifestations of the disease.
Why does latent syphilis occur?
The causative agent of the disease, the pale spirochete, under normal conditions has a typical spiral shape. However, under unfavorable environmental factors, it forms forms that promote survival - cyst and L-forms. These modified treponemes can persist for a long time in the lymph nodes of an infected person, his cerebrospinal fluid, without causing any signs of illness. Then they are activated, and a relapse of the disease occurs. These forms are formed due to improper treatment with antibiotics, the individual characteristics of the patient and other factors. A particularly important role is played by patients’ self-medication for a disease that they consider gonorrhea, but in fact it is an early stage of syphilis.
The cyst form is the cause of latent syphilis. It also causes an extension of the incubation period. This form is resistant to many drugs used to treat this disease.
How is latent syphilis transmitted? In nine cases out of ten, the route of transmission is sexual. Much less common is the household route (for example, when using one spoon), transfusion (by transfusion of contaminated blood and its components), and also transplacental (from mother to fetus). This disease is most often detected by a blood test for the so-called Wassermann reaction, which is determined for each person admitted to the hospital, as well as during registration at the antenatal clinic for pregnancy.
The source of infection is only a sick person, especially in the secondary period.
Hidden period of syphilis
This is the time after a person is infected with Treponema pallidum, when there are positive serological tests (blood tests are changed), but symptoms are not determined:
- rash on the skin and mucous membranes;
- changes in the heart, liver, thyroid gland and other organs;
- pathology of the nervous system and musculoskeletal system and others.
Typically, changes in the blood appear two months after contact with the carrier. From this moment, the duration of the disease is counted in a latent form.
Early latent syphilis occurs within two years after infection. It may not immediately manifest itself, or it may be the result of regression of early symptoms of the disease, when an apparent recovery occurs. There are no clinical symptoms of latent syphilis; it is characterized by a negative cerebrospinal fluid (CSF) test. It is diagnosed using serological tests.
Latent late syphilis is characterized by sudden activation of the process after a period of imaginary well-being. It may be accompanied by damage to organs and tissues, the nervous system. Less contagious elements of the skin rash appear.
What is latent unspecified syphilis?
In this case, neither the patient nor the doctor can determine when the infection occurred, since there were no clinical symptoms of the disease, and it was most likely revealed as a result of a blood test.
There is also the possibility of a false positive result of the Wasserman reaction. This happens in the presence of chronic infection (sinusitis, caries, tonsillitis, pyelonephritis and others), malaria, liver diseases (hepatitis, cirrhosis), pulmonary tuberculosis, rheumatism. An acute false-positive reaction occurs in women during menstruation, in the third trimester of pregnancy, in the first week after childbirth, myocardial infarction, acute diseases, injuries and poisoning. These changes disappear on their own within 1-6 months.
If a positive reaction is detected, more specific tests are necessarily carried out, including a polymerase chain reaction that determines the Treponema pallidum antigen.
Early latent form
This form, in terms of timing, covers all forms from primary seropositive (chancroid) to secondary recurrent (skin rashes, then their disappearance - a secondary latent period, and relapses within two years), but there are no external signs of syphilis. Thus, the disease can be recorded in the period between the disappearance of chancre (the end of the primary period) until the formation of rashes (the beginning of the secondary period) or observed during remission in secondary syphilis.
At any moment, the latent course can give way to a clinically pronounced one.
Since all of the listed forms are contagious, due to the coincidence in time with them, the early latent variant is also considered dangerous for others and all required anti-epidemic measures are carried out (detection, diagnosis, treatment of contact persons).
How to detect the disease:
- the most reliable evidence is contact with a patient with active syphilis during the previous 2 years, with the probability of infection reaching 100%;
- find out the presence of unprotected sexual intercourse over the past two years, clarify whether the patient has had subtle symptoms, such as ulcers on the body or mucous membranes, hair loss, eyelashes, rash of unknown origin;
- to clarify whether the patient at this time consulted a doctor for any reason that bothered him, whether he took antibiotics, or whether he was transfused with blood or its components;
- examine the genitals in search of a scar left after chancre, assess the condition of the peripheral lymph nodes;
- Serological tests in high titer, but not necessarily, immunofluorescence analysis (ELISA), direct hemagglutination test (DRHA), immunofluorescence reaction (RIF) are positive.
Late latent form
The disease is most often discovered accidentally, for example, during hospitalization for another reason, when a blood test is taken (“unknown syphilis”). Typically these are people aged 50 years or older and their sexual partners do not have syphilis. Thus, the late latent period is considered non-infectious. In terms of timing, it corresponds to the end of the secondary period and the entire tertiary period.
Confirming the diagnosis in this group of patients is more difficult, because they have concomitant diseases (rheumatoid arthritis and many others). These diseases cause a false positive blood reaction.
To make a diagnosis, you should ask the patient all the same questions as with the early latent variant, only change the condition: all these events must occur more than two years ago. Serological tests help in diagnosis: more often they are positive, the titer is low, and ELISA and RPGA are positive.
When confirming the diagnosis of latent syphilis, ELISA and RPGA are of decisive importance, because serological tests (rapid diagnostics) can be false positive.
Of the listed diagnostic methods, the confirmatory reaction is RPGA.
For latent syphilis, puncture of the cerebrospinal fluid (CSF) is also indicated. As a result, latent syphilitic meningitis can be detected. Clinically, it does not manifest itself or is accompanied by minor headaches and hearing loss.
A study of cerebrospinal fluid is prescribed in the following cases:
- signs of changes in the nervous system or eyes;
- pathology of internal organs, the presence of gummas;
- ineffectiveness of penicillin therapy;
- association with HIV infection.
What consequences does late latent syphilis leave?
Most often, syphilis has an undulating course with alternating remissions and exacerbations. However, sometimes there is a long course without symptoms, ending several years after infection of the brain, nerves, or internal tissues and organs with syphilis. This option is associated with the presence in the blood of strong treponemostatic factors resembling antibodies.
How does the latent late period manifest itself in this case:
- rash on the outer integument of the body in the form of tubercles and nodules, sometimes with the formation of ulcers;
- bone damage in the form of osteomyelitis (inflammation of the bone substance and bone marrow) or osteoperiostitis (inflammation of the periosteum and surrounding tissues);
- changes in joints in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
- mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
- disruption of the brain and peripheral nervous system.
Pain in the legs with latent late syphilis can result from damage to bones, joints or nerves.
Latent syphilis and pregnancy
If a woman has a positive serological reaction during pregnancy, but there are no clinical signs of the disease, she must donate blood for ELISA and RPHA. If the diagnosis of “latent syphilis” is confirmed, she is prescribed treatment according to general regimens. Lack of therapy entails serious consequences for the child: congenital deformities, termination of pregnancy and many others.
If the disease is cured before 20 weeks of pregnancy, childbirth proceeds as usual. If treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many associated factors.
Treatment
Specific treatment is prescribed only after laboratory confirmation of the diagnosis. The sexual partners of the sick person are examined; if their laboratory tests are negative, then preventive treatment is not prescribed to them.
Treatment of latent syphilis is carried out according to the same rules as its other forms.
Long-acting medications are used - benzathine penicillin, as well as benzylpenicillin sodium salt.
Fever at the beginning of penicillin therapy is indirect evidence of a correctly established diagnosis. It accompanies the massive death of microorganisms and the release of their toxins into the blood. Then the patients’ well-being returns to normal. In the late form, such a reaction may be absent.
How to treat latent syphilis:
- in the early form, Benzathine penicillin G is administered at a dose of 2,400,000 units, two-step, into the muscle once a day, a total of 3 injections;
- in the late form: Benzylpenicillin sodium salt is injected into the muscle at 600 thousand units. twice a day for 28 days, two weeks later the same course is carried out for another 14 days.
If these antibiotics are intolerant, semisynthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.
Latent syphilis during pregnancy is treated according to general rules, since drugs of the penicillin group are not dangerous to the fetus.
Monitoring the effectiveness of treatment
After treatment of early latent syphilis, serological control (ELISA, RPGA) is carried out regularly until the indicators are completely normalized, and then twice more with an interval of three months.
For late latent syphilis, if RPGA and ELISA remain positive, the period of clinical observation is 3 years. Tests are carried out every six months, and the decision to deregister is made based on a set of clinical and laboratory data. Typically, in the late stages of the disease, the restoration of normal blood and cerebrospinal fluid parameters occurs very slowly.
At the end of the observation, the patient is once again fully examined by a therapist, neurologist, otorhinolaryngologist and ophthalmologist.
After all clinical and laboratory manifestations of the disease have disappeared, patients can be allowed to work in child care institutions and catering establishments. But once the disease has been suffered and cured, it does not leave lasting immunity, so re-infection is possible.
Latent syphilis: how to diagnose and treat, why it is dangerous - everything about diseases of the genital area, their diagnosis, operations, problems of infertility and pregnancy on the site
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Latent syphilis is a form of the disease that occurs without symptoms. It is dangerous because patients do not suspect that they are infected. At this time, the infection develops, affecting internal organs.
In the first two years after infection, patients pose a threat to others and sexual partners, since the disease is contagious. Infected people are always interested in how latent syphilis develops.
Why does the disease appear?
The development of latent syphilis is no different from the causes of infection with the classic form of the disease. Bacteria – Treponema pallidum – enter the patient’s body. Microorganisms begin to multiply. But after the incubation period, the latent form of the disease does not show symptoms.
The fact is that treponemes shed their membrane and penetrate through the membrane into the nucleus of phagocytes. These cells are responsible for human immune defense. It turns out that bacteria develop and infect internal organs, hiding behind the membrane of phagocytes. The immune system does not recognize bacteria and does not respond.
There are three types of latent syphilis:
- early view;
- late type of infection;
- unspecified type of disease.
Infection is possible after unprotected sex, through household methods (with constant use of the patient’s personal belongings), through saliva, breast milk (from mother to child), during childbirth and through blood (for example: during transfusion).
Are there symptoms?
The disease has no obvious symptoms. But after a thorough examination and history taking, doctors discover indirect signs of latent syphilis. It is similar to other diseases, which is why difficulties arise in diagnosing the infection.
Indirect symptoms of the early form of the disease include:
- short-term rashes on the skin, they go away on their own;
- in the place where the chancre should be located, there is a small scar;
- a former or current sexual partner has been diagnosed with syphilis;
- detection of gonorrhea or other sexually transmitted diseases - the infection often occurs together with other diseases.
In the late type, these symptoms are absent; serological tests show low reagin titers. Significant degenerative changes are detected in the cerebrospinal fluid.
Sometimes patients in both cases experience an unreasonable increase in temperature up to 38 degrees, weight loss, weakness and frequent ailments.
Early form of syphilis
The type of illness depends on how long ago the patient contracted the infection. Early latent syphilis is a disease in which infection occurred earlier than 24 months ago. The disease occurs without symptoms and is detected during routine medical examinations or during the treatment of other diseases.
The early variety is dangerous because the patient is contagious at this time. It puts sexual partners and family members at risk, since Treponema pallidum is also transmitted through household contact.
Sometimes patients recall that for a short period of time they had a rash of unknown etymology on their body. But the rash went away on its own after a short period of time. When examining the patient, it is revealed. And at the site of the rash, small scars (or syphilomas) are noticeable. To a greater extent, latent syphilis of the early form affects people under 40 years of age, who more often engage in casual sexual relationships.
Some patients with the early form of latent syphilis claim that over the past two years they have had erosive rashes in the mouth and genitals.
Late form of the disease
If the infection is detected when the infection occurred more than two years ago, then the patient is diagnosed with late latent syphilis. During latent development, Treponema pallidum affects internal organs and the nervous system. A person suffering from this type of disease is safe for others, since he is no longer contagious.
According to statistics, late infection is found in family people over 40 years of age. Partners of infected people usually also suffer from syphilis, and the disease also occurs in a latent form.
According to the test results, the Wasserman reaction shows a positive result in patients. Patients also have positive results from RIF and RIBT. Data from serological reactions are present in low titers, only in 10% of patients – in high titers.
Doctors carefully examine patients with a late form of infection, but there are no signs of rash on the skin, no scars, scars or syphilomas.
Unspecified type of infection
Latent, undetected syphilis is a form of the disease in which it is impossible to determine the period of infection of the patient. Doctors cannot find out the timing of infection, and the patients themselves do not know when and under what conditions they became infected. This question is important to determine whether a person is contagious to the people around him, or whether the dangerous period has already passed.
Sometimes doctors are able to find out the time of infection if the patient is treated with antibiotics from the long-acting penicillin series. In the early stages of the disease, taking antimicrobial drugs causes a sharp increase in temperature, and the patient experiences intoxication. If the old form of syphilis is not specified, then the use of antibiotics does not cause any reactions from the body.
How to identify the disease
Patients must undergo a general blood test. To detect Treponema pallidum, serological tests are carried out: RIBT (immobilization reaction) and RIF (immunofluorescence reaction). It is possible to carry out ELISA (enzyme-linked immunosorbent assay).
Based on all the results, the doctor makes a diagnosis, finds out whether the patient has an infection, and how long ago the infection occurred.
How is the treatment carried out?
Patients are always interested in questions about how to treat a hidden infection and whether it is possible to be completely cured. The therapy is carried out by venereologists. Each patient is prescribed individual treatment depending on the form of the disease, the patient’s condition, and possible contraindications.
Treatment of latent syphilis does not differ from the treatment regimen for the ordinary form of the disease. Treponema pallidum is a bacterium, it is sensitive to antibiotics, so therapy is carried out with antibacterial drugs. At the same time, the patient takes immunomodulators, vitamins and drugs that improve the functioning of the intestines and liver (antibiotics kill all microflora of the gastrointestinal tract).
The duration of treatment depends on the form of the disease; it can last from two to three months to several years.
Treatment with antibiotics
The most effective drugs are considered to be penicillin. They can be short, long (long) or medium acting. Penicillins are administered intramuscularly, in this way they are better absorbed and more active. Common drugs include: Bicillin 1, Benzathine penicillin G, Retarpen.
10% of people are allergic to penicillin antibiotics. In this case, the drugs are replaced with cephalosporin antibiotics. Ceftriaxone is considered one of the best drugs. For allergic reactions to these drugs, patients are prescribed:
- tetracyclines - “Doxycycline” or “Tetracycline”;
- macrolides – “Erythromycin”, “Susamed”;
- synthetic antibiotics - Levomycytin.
Conclusion
Latent syphilis can occur in three forms: early, late and unidentified. It is usually detected by chance, during a routine examination by doctors or during the treatment of other pathologies. Diagnosis is complicated by the fact that the infection occurs without symptoms.
Patients are unaware of the disease and live peacefully. At this time, microorganisms infect internal organs, and the infected themselves infect other people. Treatment of the disease is carried out under the supervision of a venereologist and depends on the form of the disease.
What is Latent syphilis
The development of latent syphilis is no different from the causes of infection with the classic form of the disease. Bacteria – Treponema pallidum – enter the patient’s body. Microorganisms begin to multiply. But after the incubation period, the latent form of the disease does not show symptoms.
Syphilis can also occur in a latent form.
This variant of the course of the disease is called latent syphilis. Latent syphilis from the moment of infection takes a latent course and is asymptomatic, but blood tests for syphilis are positive.
In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.
If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent unspecified syphilis; during examination and treatment, the diagnosis can be clarified.
Reasons for development
Latent syphilis develops for various reasons and can have several course options:
One of the main reasons for the prevalence of latent syphilis among ordinary people is the illiteracy of people and their not entirely adequate attitude towards their health.
The fact is that a person, suspecting that he has a cold or the initial stage of developing a sore throat, without prior consultation with a specialist, begins to uncontrollably take antibiotics.
But these medications hide the main symptoms of syphilis. In other words, syphilis is not cured, but heals and proceeds in a latent form.
According to some experts, the latent form of syphilis has become widespread due to the improper use of medications.
Antibiotics are often taken in high doses and without a doctor's prescription. Any antibacterial agent from the series of tetracyclines, penicillins, macrolides and fluoroquinolones can change the nature of the course of the disease and the natural alternation of its stages.
And in the absence of treatment, syphilis can have hidden periods, for example, in its secondary and tertiary forms. At certain periods of time, there are no clinical manifestations of infection.
Treponema pallidum is transmitted through unprotected sex. You can also become infected at home - by using shared utensils, hygiene items, and towels. The most contagious is a person who has signs of the primary and secondary forms of the disease.
Classification
The asymptomatic form of syphilitic infection is divided into 3 types depending on the duration of the disease. In accordance with this symptom, latent syphilis is distinguished:
Syphilis is divided into several periods of the disease:
- initial, or incubation;
- primary;
- secondary;
- tertiary.
Each period is divided into sub-periods. Latent syphilis refers to the secondary period of the disease.
Secondary is divided into three types:
It should be noted that the latent form of syphilis is divided into several subtypes:
- early latent syphilis;
- late;
- unspecified.
Typically, the early form of latent syphilis is detected within 2 years after infection. This form is considered the most dangerous, since an infected person poses a danger to others.
After all, not only his sexual partners, but also people living with him under the same roof can become infected with this disease.
This disease is mainly discovered during medical examinations or during an examination of a patient who has complaints of a completely different disease. The Wasserman reaction is carried out, however, this study does not always give an accurate answer, so the patient is also subjected to a number of other additional laboratory and clinical examinations.
During a clinical examination, enlarged and somewhat dense lymph nodes are often found on the patient’s body. During the consultation, patients suddenly begin to remember that at a certain period of time rashes appeared on their body, which went away on their own.
All these symptoms indicate the presence of the causative agent of latent syphilis in the patient’s body.
In some cases, early latent syphilis affects internal organs, such as:
- liver;
- stomach;
- thyroid;
- joints.
The central nervous system can also be affected by early latent syphilis. The nervous system, and in particular the lining of the brain and the walls of blood vessels, is affected within 5 years after the moment of infection.
There are late and early latent syphilis. The classification is approximate, because there are often cases when the disease cannot be attributed to any of the above types:
Symptoms of latent syphilis in the first case are the presence of a painless ulcerative formation in the genital area or on the mucous membranes of the oral cavity. Serological tests give a positive result. Wasserman's reaction over the past 3 years has been negative.
Early latent syphilis is also called if the rash appeared in the last year. The presence of erosions in the genital area may not be confirmed. If the result of the serological reaction is positive, in this case we are talking about latent secondary syphilis.
The late form of the disease is diagnosed if more than 3 years ago the patient had unprotected sexual contact with an infected Treponema pallidum. In this case, it is possible to establish the presence of an ulcerative defect in the genital area and skin rashes more than 4 years old.
In other cases, the diagnosis sounds like undifferentiated latent syphilis.
To confirm the stage, the patient must remember all unprotected sexual intercourse that has occurred over the past 8–10 years. It is mandatory to examine the partner and identify syphilitic rashes and gummas. If any, we are talking about an early form of infection.
With a trial administration of penicillin antibiotics, the disintegration of treponemes begins, accompanied by signs of intoxication of the body.
Typically, latent syphilis is classified into several forms depending on the severity of symptoms:
- Primary.
- Secondary.
- Secondary early hidden.
- Secondary late latent syphilis.
- Tertiary.
- Congenital.
Primary syphilis has the most pronounced property of being transmitted from sick people to healthy people through direct contact. Severe forms have a lower degree of infection, but changes in human systems are already becoming clearly visible.
Symptoms and signs of latent syphilis
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;
- causeless weight loss;
- psychological disorders depression, apathy;
- a state of weakness throughout the body;
- enlargement and hardening of lymph nodes.
Diagnostic methods
The absence of symptoms greatly complicates the diagnosis of latent syphilis. The diagnosis is most often made based on the results of appropriate tests and anamnesis.
The following information is of decisive importance when compiling an anamnesis:
- when did the infection occur?
- syphilis is diagnosed for the first time or the disease is repeated;
- what treatment the patient received, and whether there was any;
- whether antibiotics have been taken in the last 2–3 years;
- whether rashes or other changes in the skin were observed.
An external examination is also carried out to identify:
- syphilitic rashes throughout the body, including the scalp;
- scars after previous similar skin lesions;
- syphilitic leukoderma on the neck;
- changes in the size of lymph nodes;
- hair loss.
In addition, sexual partners, all family members, and other persons in close contact with the patient are examined for the presence of infection.
But the decisive factor for making a diagnosis is appropriate laboratory blood tests. In this case, diagnosis can be complicated by the possibility of obtaining a false positive or false negative result.
If the test results are doubtful, a spinal puncture is performed, examination of which may reveal the presence of latent syphilitic meningitis, characteristic of the late latent stage.
Upon final diagnosis of the disease, it is necessary to undergo examinations by a therapist and a neurologist. This is necessary to establish the presence or absence of concomitant (attached) pathologies.
Diagnosis of latent syphilis is carried out using the following serological methods:
Treponema pallidum immobilization reaction (TPIRT). For this analysis, the patient's blood serum and a suspension of Treponema pallidum are used.
They are mixed and see how the treponemes behave. Once in the blood of a person with syphilis, treponemes are immobile.
And once they enter the blood of a healthy person, they are active, swim for a long time, and are ready to infect. The accuracy of this testing is 95%.
Making a diagnosis of latent syphilis is not an easy task for a doctor, since there is the possibility of a false-positive reaction to syphilis.
- Indirect hemagglutination reaction (IPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
- Enzyme-linked immunosorbent assay (ELISA). A special enzyme is added to the prepared patient’s blood serum. If the serum changes color, the patient is recognized as having syphilis.
- RIF (immunofluorescence reaction). The presence of Treponema pallidum is indicated by a specific glow.
The unusual type of Treponema pallidum itself also helps in determining the presence of the syphilis virus in the blood. Under a microscope you can see that Treponema pallidum has the shape of a spiral.
The size of the curls towards the end of the treponema decreases, the spaces between the curls increase. Movement in liquid media is slow and graceful.
A peculiarity of Treponema pallidum is its ability to maintain its spiral shape even under the pressure of its environment. For elderly people, treatment for syphilis based on serological methods alone is not prescribed.
They undergo additional examinations by a neurologist, ophthalmologist and otolaryngologist.
The determination of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times.
When a disease is detected, specific therapy is carried out taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high risk of fetal infection, birth defects, miscarriage, or premature birth.
Before starting treatment for a latent form of syphilis, it is very important for a person suspected of having this disease to undergo a complete diagnosis. To do this, he needs to provide the venereologist with complete information about his sexual partners.
The doctor also needs to determine the presence of single erosions in the genital area, mouth or on the skin.
When diagnosing a disease, it is important to take into account the patient’s age and lifestyle.
When diagnosing, it is very important to examine not only the patient himself, but also his sexual partner. In this way, early latent syphilis can be detected. The main confirmation of the presence of the disease is serological reactions.
Diagnosis of the latent course of treponemal infection is based not only on laboratory testing of blood and smears, but also on a complete interview with the patient, clarifying the smallest details of all diseases in recent years.
First of all, the venereologist clarifies the circle of people with whom the patient had contact, sexual relations or contact in everyday life and family, finds out the scope of activity, work, which is extremely important for medical personnel.
Often, patients are referred to a venereologist after latent syphilis is detected during an annual medical examination or admission to a antenatal clinic. After the first positive analysis - the Wasserman reaction - additional methods for determining treponemes in the blood are indicated.
Currently, the diagnosis of syphilis is made only after receiving at least three positive test results from the following list: RIF immune reaction, RIBT reaction to exclude false results, immunoblot to determine the titer of antibodies to the causative agent of treponema, PCR test to detect cellular material and DNA of the causative agent of syphilis .
In case of neurological symptoms, the cerebrospinal fluid is additionally examined. If there are signs of damage to internal organs, blood biochemistry, kidney and liver tests, a cardiogram, and a study of the heart and blood vessels are indicated.
Pathology in obvious forms is clearly visible, it is easy to identify it and guess what kind of illness is tormenting the patient. In their absence, serodiagnostic studies come to the rescue (recognizing the reaction when mixing the blood serum of an infected person and a reagent).
Methods for diagnosing latent syphilis are usually divided into:
The first include microscopy, infection of rabbits with material, culture, and PCR diagnostics. Several types of methods are used per patient, each individually cannot give an accurate result.
They have their drawbacks: they take a long time, cannot be detected at certain stages, or they are expensive. Therefore, serological techniques are used.
This includes various reactions of human blood to the proposed reagents. None of the indirect methods can give an accurate answer to the presence of a microbe, and therefore diagnosis is made only after two or more methods have been carried out.
Where can I get tested for latent syphilis and who should I contact?
It is no coincidence that the latent course of syphilis is the cause of the epidemiologically dangerous and rapid spread of the disease. Prevention of infection consists not only of medical examinations, but also of promptly contacting doctors if you suspect infection with syphilis.
Treatment
The latent form of syphilitic infection is treated with the same methods as any type of syphilis - exclusively with antibiotics (systemic penicillin therapy). The duration of treatment and dosage of the drug are determined by the duration of the disease and the degree of damage to the body:
- for early latent syphilis, 1 course of penicillin injections lasting 2–3 weeks is sufficient, which is carried out at home (outpatient) (the course is repeated if necessary);
- for late latent syphilis, 2 courses lasting 2–3 weeks each are required, with treatment performed in an inpatient setting, since this form is characterized by a high probability of developing complications.
At the beginning of treatment of the early form, an increase in temperature should appear, which indicates the correct diagnosis.
Pregnant women with latent syphilis must be hospitalized for appropriate treatment and constant monitoring of the condition of the fetus.
Since the infection has an extremely negative impact on the child’s condition and can lead to his death, it is necessary to notice a frozen pregnancy in time and provide timely assistance to the woman.
During the treatment period, all patient contacts are significantly limited. He is prohibited from kissing, having sex in any form, using shared utensils, etc.
Patients are always interested in questions about how to treat a hidden infection and whether it is possible to be completely cured. The therapy is carried out by venereologists. Each patient is prescribed individual treatment depending on the form of the disease, the patient’s condition, and possible contraindications.
Today, treating syphilis is not difficult for doctors. But one point should be understood.
When they talk about treating latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformities, cardiovascular disorders, nervous system disorders.
At the current stage of development of medicine, this is impossible to do.
Antibacterial drugs are used to treat latent syphilis. The treatment regimen is selected individually, taking into account the stage of the disease and concomitant pathology. Additionally, medications are prescribed that boost immunity, since syphilis weakens it.
Approximate treatment regimens for latent syphilis are presented in the table:
Taking any medications is possible only after consulting a doctor. Self-medication is unacceptable! The frequency of taking medications and the duration of therapy are determined by the treating doctor.
Treatment of latent syphilis should begin only after the diagnosis has been confirmed. It is carried out using antibiotics of the penicillin group.
If treatment began at the initial stage of the disease, then somewhere by the end of the second course of therapy, an improvement is noticeable. It is much more difficult to treat more advanced forms.
A significant increase in body temperature at the beginning of treatment only indicates the effectiveness of therapy. Fever is a sign that harmful microorganisms are being destroyed at a rapid pace. Over time, this unpleasant symptom also passes.
After completing the course of treatment, you must continue to undergo complete examinations with a doctor. It is very important to carry out serological monitoring and this will last until the indicators of this analysis return to normal.
The treatment regimen is to prevent the progression of syphilis to a severe form.
When the infection lasts for less than two years, treatment is aimed at eliminating the transition of syphilis to the secondary form and eliminating the epidemiological danger to others, family members and partners.
In cases where the patient has been infected for more than two years, and doctors determine late latent syphilis, the treatment regimen is aimed at eliminating all pathologies of the internal organs and preventing the most severe complications - neurosyphilis, heart attacks and strokes.
The main treatment for syphilis is systemic antibiotic therapy with penicillins or drugs of other groups for allergies and lack of sensitivity to treponemes.
The treatment regimen is also developed depending on the severity of organ damage, manifestations of symptoms from the heart and nervous system. In addition, drugs are used to correct the protective properties of the immune system.
Important. The bacterium that causes this disorder remains one of the few microorganisms that cannot protect itself from penicillin.
Therefore, therapy with this substance works great in our time. Taking the right dose of medicine over a long period of time helps to completely rid the body of the infection.
Erythromycin is another drug with the same effect, it is used for patient allergic reactions to penicillin drugs.
Treatment of late latent syphilis is carried out with penicillin in combination with antibacterial drugs, which are administered into the muscles and orally.
For latent syphilis, treatment is prescribed only after an accurate diagnosis has been established using laboratory methods. Intimate partners of the infected person also need to be examined, and if their tests are negative, therapy is not prescribed.
Treatment of latent syphilis should be carried out according to a scheme that must correspond to the type of disease and timing of infection.
Syphilis is a disease that takes a long time to treat. Latent syphilis is treated according to the same rules and schemes as other forms of syphilis. All family members must undergo examination and undergo a complex of treatment for prevention.
Syphilis is a tricky disease. Each period of development of this infection has such individual symptoms that doctors previously considered them to be different diseases. Syphilis disguises itself as many diseases: from a common cold to severe damage to the kidneys and liver. Treponema pallidum, which is the causative agent of syphilis, secretes an anesthetic substance, so the infected person does not feel any itching or pain.
Treponema pallidum feels comfortable in a humid environment and at a temperature of 36.8 degrees. Under unfavorable conditions, it hides in a capsule, the so-called cyto-forms and L-forms. In this state, syphilis is not active, does not reproduce, it sleeps. Waits for favorable changes in the environment. But it is not affected by harmful factors. This is what he is - syphilis, the insidious enemy of humanity. Often the causes of latent syphilis are self-medication or infection with syphilis during antibiotic treatment for another infectious disease.
Types of syphilis
Syphilis is divided into several periods of the disease:
- initial, or incubation;
- primary;
- secondary;
- tertiary.
Each period is divided into sub-periods. Latent syphilis refers to the secondary period of the disease.
Secondary is divided into three types:
- Syphilis is fresh. Characterized by bright rashes and other clinical manifestations.
- Hidden (latent) syphilis. There are no external signs of his presence. It is asymptomatic and can only be determined by laboratory tests.
- Recurrent syphilis. The rash reappears on the patient’s body after the previous disappearance of all symptoms.
In a patient with latent syphilis, the incubation and primary periods, due to the use of antibiotics and good immunity, are mild. A person does not experience any discomfort; he lives and works, infecting others. A latent form of syphilis is often discovered by chance when undergoing mandatory medical tests at a clinic. Regular examinations by a gynecologist allow you to recognize the disease in time and begin adequate treatment.
Latent syphilis is divided into three stages according to timing:
- Early latent syphilis. The duration of the disease is up to 24 months.
- Late latent syphilis. The duration of the disease is more than 24 months.
- Unspecified (ignored) latent syphilis. The doctor cannot determine the time when the patient became infected with syphilis.
When treated with non-extended-release penicillins, it is possible to determine the timing of syphilis infection. If a person has early latent syphilis, his temperature will rise and there will be general signs of intoxication. They will be caused by the remains of destroyed Treponema pallidum. In late stages of latent syphilis, there is no increase in temperature and there are no signs of intoxication.
Why is it necessary to establish the timing of syphilis infection?
Establishing the timing of syphilis disease is of practical importance. Those sick with early latent syphilis are contagious and are active carriers of infection, included in the epidemiological risk group. It is necessary to examine all those who have been in contact with the infected person and identify possible carriers of the disease. Patients with late latent syphilis are not dangerous epidemiologically.
Identification of persons with whom the infected person came into contact, as well as their testing for syphilis, is also necessary in the case of an unspecified latent form.
When syphilis attacks the human body, its goal is to penetrate. Treponema pallidum sheds its membrane membrane, which allows it to pass through the capillaries and enter the nucleus of phagocytes. How amazing nature is! Phagocytes are our protection. They catch and eat foreign bacteria and viruses. And syphilis attacks them. Checkmate to the immune system! In latent (latent) syphilis, the treponema is hidden in the membrane membrane of phagocytes. That is, the virus destroys the phagocyte itself and walks around in its “clothes.” The body’s immune forces are not activated, since such a treponema is mistaken for one of their own and is not recognized.
Signs of latent syphilis
Although no rashes or ulcers are observed on the skin and mucous membranes, syphilis penetrates at this stage into the internal organs, nervous system, and bones. Pathological processes occur in them. Patients with suspected asymptomatic syphilis are examined especially thoroughly in order to make such a diagnosis or refuse it.
Indirect signs of early latent syphilis are:
- the presence in the medical history of early rashes of an undiagnosed nature;
- treatment of other STIs (the diseases often go together);
- detection of active syphilis in a sexual partner;
- enlarged lymph nodes in the groin area;
- finding a scar at the site of the supposed chancre;
- When analyzing the cerebrospinal fluid, inflammatory reactions are detected.
Indirect signs of late latent syphilis:
- analysis of the cerebrospinal fluid revealed degenerative changes;
- low titer of reagins with sharply positive results according to classical serological reactions.
Indirect signs of latent syphilis for both early and late types also include:
- temporary or prolonged increase in temperature up to 38 degrees, the cause of which has not been established;
- weight loss, depressed mood, general weakness and other signs of intoxication;
- enlargement of peripheral lymph nodes: they become dense and round, but there is no discomfort when palpating the lymph nodes.
Diagnosis of latent syphilis
Diagnosis of latent syphilis is carried out using the following serological methods:
Treponema pallidum immobilization reaction (TPI). For this analysis, the patient's blood serum and a suspension of Treponema pallidum are used. They are mixed and see how the treponemes behave. Once in the blood of a person with syphilis, treponemes are immobile. And once they enter the blood of a healthy person, they are active, swim for a long time, and are ready to infect. The accuracy of this testing is 95%.
Making a diagnosis of latent syphilis is not an easy task for a doctor, since there is the possibility of a false-positive reaction to syphilis.
- Indirect hemagglutination reaction (IPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
- Enzyme-linked immunosorbent assay (ELISA). A special enzyme is added to the prepared patient’s blood serum. If the serum changes color, the patient is recognized as having syphilis.
- RIF (immunofluorescence reaction). The presence of Treponema pallidum is indicated by a specific glow.
The unusual type of Treponema pallidum itself also helps in determining the presence of the syphilis virus in the blood. Under a microscope you can see that Treponema pallidum has the shape of a spiral. The size of the curls towards the end of the treponema decreases, the spaces between the curls increase. Movement in liquid media is slow and graceful.
A peculiarity of Treponema pallidum is its ability to maintain its spiral shape even under the pressure of its environment. For elderly people, treatment for syphilis based on serological methods alone is not prescribed. They undergo additional examinations by a neurologist, ophthalmologist and otolaryngologist.
The determination of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times. When a disease is detected, specific therapy is carried out taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high risk of fetal infection, birth defects, miscarriage, or premature birth.
Treatment
Today, treating syphilis is not difficult for doctors. But one point should be understood. When they talk about treating latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformities, cardiovascular disorders, nervous system disorders. At the current stage of development of medicine, this is impossible to do.
Antibacterial drugs are used to treat latent syphilis. The treatment regimen is selected individually, taking into account the stage of the disease and concomitant pathology. Additionally, medications are prescribed that boost immunity, since syphilis weakens it.
Approximate treatment regimens for latent syphilis are presented in the table:
Taking any medications is possible only after consulting a doctor. Self-medication is unacceptable! The frequency of taking medications and the duration of therapy are determined by the treating doctor.
Taking a vitamin complex. Help fight infection
Pyrotherapy. The patient is given special drugs that increase body temperature. A slight fever is beneficial. At a temperature not exceeding 38.5 degrees, blood circulation improves, the work of the immune defense increases, and the bacteria weakens, making it easier for medications to cope with it.
Risk group:
- drug users using injections;
- HIV-infected;
- people who have multiple sexual partners.
Prevention
To avoid various infections, you must follow some rules.
- Be selective in choosing sexual partners.
- Use condoms during sex.
- Use only your own personal hygiene items.
- Do not rely on false positive results, but consult a doctor at the first signs of illness.
Remember that syphilis is not only a private matter of a citizen. If a person knows about his syphilis disease, he hides it and infects another, then he may incur criminal liability.
conclusions
You cannot use antimicrobial drugs yourself. This can cause microorganisms to hide, form capsules, or penetrate cells. Syphilis takes on a latent form.
Latent syphilis is a difficult disease to diagnose. Only a doctor can prescribe the correct treatment based on complex tests. You should not fall for articles on pseudo-medical sites that describe how syphilis can be cured with sage flowers and other herbs.
Treatment of syphilis at home does not lead to recovery. On the contrary, serious complications may arise. Every third person with late latent syphilis dies from syphilitic heart disease.