Causes syphilis. Symptoms and signs of syphilis in women and men

WITH Iphilis is marching steadily across RUSSIA: in 1996, the incidence of syphilis per thousand people was 213.6, under Soviet rule - 5.3 people per 1000).

And there are many reasons for this:

Natural fluctuations in disease growth

Collapse of the Soviet venereology system

Devaluation of cultural and moral values ​​(decline of morals)

And... oddly enough, the emergence of private venereologists.

There are four stages in the development of the disease: the first incubation stage begins its countdown from sexual contact until the appearance of chancre. Lasts about one month. If, for example, you used antibiotics after infection, then incubation may take up to 2 months or more. So, God forbid, you have a chancre. A hard chancre is an ulcerative defect, with smooth edges like a “tea saucer”, a bottom the color of fresh meat, and it is characteristic that this most disgusting chancre does not cause any PAINFULNESS or ITCHING in the affected person, and this does not prompt the patient to consult a doctor. Without treatment, chancre disappears on its own after 2-6 weeks, moving into the second stage, usually manifested by various rashes on the skin and mucous membranes. The body of patients is covered with a profuse rash that covers the chest, back, and forearms. In a third of patients, it progresses to the third stage - severe damage to the heart, blood vessels, internal organs, and brain.

Diagnostics: Blood from a vein taken on an empty stomach is examined. Research methods are different. The most common in Russia is the Wasserman reaction, which becomes positive, on average, 4 weeks after infection. Modern methods - ELISA, TPHA, RPR begin to “work” after 2 weeks. Diagnose syphilis You can do it at home using special strips. TREATMENT: It is carried out only under the guidance of a doctor with penicillin antibiotics. Long-acting antibiotics are now available. When used, after 2-3 injections the disease is completely cured. To be successful in treatment, it must be carried out under the supervision of a physician. After treatment, monitoring of cure is mandatory.

SYPHILIS AND PREGNANCY: Pregnancy that occurs against the background of syphilis or, conversely, syphilis that occurs during pregnancy can lead to tragic results. If the infection occurs at the very beginning of pregnancy, a miscarriage is likely to occur. In most cases, infection of the fetus occurs in the mother's womb through the cord connecting the child to the mother at 5-6 months of pregnancy /34-35 weeks/, then the baby is born with congenital syphilis, with massive damage to the skin. Such babies, if precautions are not followed, may well lead to syphilis infection among maternity ward staff. What is the fate of such children? Some of them die on the first day after birth, and some show signs of organ damage. How to protect the unborn child from such an unenviable lot? There are two types of solutions to the issue: The Moscow School of Obstetricians and Gynecologists recommends maintaining the pregnancy, having determined the duration of infection, and conducting intensive therapy in the first trimester - with penicillin drugs and ampicillin. In the second trimester - erythromycin. Which drug to choose can only be decided by a doctor and only by him, because some antibiotics can cause irreparable harm to a child /with properly selected treatment there will be practically no harm from antibiotics/. This technique, according to Moscow obstetricians, allows one to cure the mother and prevent infection of the child.
St. Petersburg doctors, on the contrary, believe that the pregnancy should be urgently terminated, treated, and for 3 years after recovery not set the goal of having a child, because there is a high risk of infection for the little man.

Prevention:

1. Using condoms treated with antiseptic Nonoxynol - 9
2. Avoiding casual sex
3. Use antiseptics such as Gibitan, Miramistin and Tsidipol within 2 hours after sexual intercourse.

Syphilis is classified as a classic sexually transmitted disease (sexually transmitted disease). The causative agent is Treponema pallidum ( Treponema pallidum). Syphilis is characterized by a slow progressive course. In later stages, it can lead to severe damage to the nervous system and internal organs.

Syphilis infection

In most cases, syphilis is contracted through sexual contact in the vagina, mouth or rectum. Patients with primary syphilis (with ulcers on the genitals, mouth or rectum) are most contagious. In addition, it is possible to transmit the infection from a sick mother to the fetus during pregnancy, as well as infection through blood transfusion.

Household infection is extremely rare. Most cases that are associated with domestic infection are in fact unproven cases of sexual infection. This is due to the fact that Treponema pallidum ( Treponema pallidum) quickly dies outside the human body.

The probability of infection during one-time sexual contact without a condom with a patient with syphilis

The probability of infection from one-time sexual contact with a patient with syphilis is about 30%.

Incubation period of syphilis

The incubation period for syphilis is usually 3-4 weeks (2 to 6 weeks).

Symptoms of syphilis

The symptoms of syphilis are very varied. They vary depending on the stage of the disease. There are three stages of syphilis:

Primary syphilis occurs after the end of the incubation period. At the site where the pathogen enters the body (genital organs, oral mucosa or rectum), a painless ulcer with a dense base (chancroid) appears. 1-2 weeks after the onset of the ulcer, the nearest lymph nodes enlarge (if the ulcer is localized in the mouth, the submandibular nodes enlarge; if the genital organs are affected, the inguinal ones become enlarged). The ulcer (chancroid) heals on its own within 3-6 weeks. after occurrence.

Fig 1 Syphilis, photo. © Illustration provided with permission from BINOM publishing house

Secondary syphilis begins 4-10 weeks after the appearance of the ulcer (2-4 months after infection). It is characterized by a symmetrical, pale rash over the entire body, including the palms and soles. The appearance of a rash is often accompanied by headache, malaise, and fever (as with the flu). Lymph nodes throughout the body enlarge. Secondary syphilis occurs in the form of alternating exacerbations and remissions (asymptomatic periods). In this case, hair loss on the head is possible, as well as the appearance of flesh-colored growths on the genitals and in the anus (condylomas lata).

Tertiary syphilis occurs in the absence of treatment many years after infection. This affects the nervous system (including the brain and spinal cord), bones and internal organs (including the heart, liver, etc.).

If infected during pregnancy, the child may develop congenital syphilis.

Complications of syphilis

According to scientific research, in the absence of treatment, about a third of patients develop tertiary syphilis. About a quarter of patients die because of it.

Congenital syphilis can cause severe damage or death to the child.

Diagnosis of syphilis

Diagnosis is based on blood tests for syphilis. There are many types of blood tests for syphilis. They are divided into two groups - non-treponemal (RPR, RW with cardiolipin antigen) and treponemal (RIF, RIBT, RW with treponemal antigen).

For mass examinations (in hospitals, clinics), non-treponemal blood tests are used. In some cases, they can be false positive, that is, they can be positive in the absence of syphilis. Therefore, a positive result of non-treponemal blood tests must be confirmed by treponemal blood tests.

To assess the effectiveness of treatment, quantitative non-treponemal blood tests are used (for example, RW with cardiolipin antigen). Treponemal blood tests remain positive after syphilis for life. Therefore, treponemal blood tests (such as RIF, RIBT, RPGA) are NOT used to assess the effectiveness of treatment.

Treatment of syphilis

Treatment of syphilis should be comprehensive and individual. Antibiotics are the mainstay of treatment for syphilis.

In some cases, treatment is prescribed that complements antibiotics (immunotherapy, restorative drugs, physiotherapy, etc.).

Prevention of syphilis

You can read about ways to reduce the risk of infection in the section How to protect yourself from sexually transmitted diseases.

For preventive treatment within a few days after contact, see the section Prevention after casual relationships.

Sexual partners

If you are cured but your sexual partner is not, you can easily become infected again.

It is very important to tell your sexual partners about the disease, even if they are not worried, and to encourage them to get tested and treated. After all, being asymptomatic does not reduce the risk of complications.

The incubation period lasts about 3-4 weeks, which makes it difficult to determine the carrier of the disease, however, if a person for some reason takes antibacterial drugs, the period can last up to six months or be shortened to 2 weeks otherwise.

The important point is that that the infection can actively develop in the body, the manifestations are not yet visible and laboratory tests cannot detect the disease within 2-4 weeks after the start of the primary period. Based on this, all sexual partners after infection have a high chance of becoming infected and must undergo laboratory testing.

To accurately determine the disease, photos from textbooks or the Internet are not suitable, because a beginning chancroid can easily be confused with a large pimple or an allergic rash, but how soon you discover the disease in yourself depends on how the treatment process will proceed. We advise you to immediately consult a doctor at the first signs of illness, who can accurately diagnose.

Periods of syphilis

• Before selecting the correct treatment for syphilis, it is worth knowing at what stage of the disease the disease develops.
• The disease itself has 4 stages – let’s look at them in more detail.
• Treatment of the disease is quite possible at each of its stages, with the exception of the last, when all organs and systems are affected and cannot be restored - the only difference is the duration and intensity of the course.

Incubation period

Symptoms of syphilis during its incubation, latent period do not manifest themselves as such - in this case, the disease is diagnosed not by its external manifestations, but based on the results of tests carried out using the PCR technique. The duration of the incubation period is 2-4 weeks, after which the disease passes to the stage of primary syphilis.

Syphilitic sore throat

One of the reasons for the development of tonsillitis is syphilis, or rather, one of the external manifestations of infection with Treponema pallidum is symptoms that are characteristic of tonsillitis, but have certain differences.

For example, against the background of a sore throat, enlarged tonsils, lymph nodes and dry mouth, patients will experience the following signs of infection: an inflammatory process in only one tonsil, the manifestation of erosions followed by transition to small red wounds, absence of temperature, painlessness of the lymph nodes , gray plaque in the oral cavity and the presence of one or more large ulcers with smooth edges.

• In addition, one of the first signs that it was treponema that caused the patient’s condition, similar to a sore throat, is the duration of the disease, which in this case lasts several times longer than a regular sore throat.
• The first manifestations of syphilitic tonsillitis can only be observed in people who engage in oral sex, since treponema pallidum first manifests itself at the site of the entrance gate.
• Another method of infection is the use of the patient’s personal belongings for oral hygiene.

The smell of syphilis

Women may often experience a sign of infection such as an unpleasant odor in the discharge. This is especially typical for the second period of the disease, when the amount of hostile microflora is greatest.

Therefore, if a woman’s discharge begins to have a strong odor without any obvious reasons, for example, failure to observe basic personal hygiene, leading to mixing of the secretions of the sebaceous glands, uterine mucus and vaginal discharge, then herpes, chancroid or syphilis begin to be suspected, which inflame the tissue.

• In this case, in addition to the unpleasant odor, a change in the consistency of the discharge itself and a change in its color will also be observed.
• Such discharge can cause pain, burning and herpes.
• However, infection with treponema does not always lead to a combination of all these external manifestations of the disease, so no matter what signs, in addition to an unpleasant odor, are observed, it is worth contacting a gynecologist or virologist for advice and timely detection of the infection.

Pain

Pain is rare, especially in the initial stages of disease progression. The appearance of the first pain is usually a sign of the transition of the disease from the first period to the second. In this case, episodic headaches and joint pains appear a week before the first signs of the second period of spirochete infection. In later stages of infection, pain is usually associated with damage to the musculoskeletal system and ulceration of the gumma on the skin and mucous membranes of internal organs.

• If we are talking about musculoskeletal pain, the first manifestations can be observed in the primary period of infection in the form of aches and pains at night and in the evening, which are usually complained of by people with rheumatism.
• In the second period, bone damage may occur in the form of periostitis of the cranial or tibial obliques.
• Although joint damage occurs after infection, it usually does not lead to pain.

A sign of infection in the second stage may be calcific growths on the tubular bones on an x-ray, but only in case of repeated recurrent development of the disease. During primary infection, such changes are absent on x-rays.

Definition of disease

The severity of the disease depends on how much time passes after infection until the first correct diagnosis is made. However, the problem remains - how to determine syphilis? The problem of definition is associated not only with the variety of symptoms in the initial and other stages, but also with the frequency of infection, as well as the tendency of many citizens to self-medicate instead of seeing a doctor. It is easier to identify other diseases, but infection with Treponema pallidum is not so simple.

• Once the first signs appear, they may remain invisible or may be mistaken for another disease.
• In the second case, self-medication usually begins, the visible result of which is the disappearance of external signs of the disease, which should be associated not with healing, but with the body’s immune response to the pathogens of the disease.
• The person, being fully confident that he was treated correctly, calms down, and when after some time other signs appear, they are no longer associated with chancroid.
• Therefore, you should not try to identify skin infections on your own; it is better to immediately contact a specialist so as not to miss the onset of a serious infection.

Itching with syphilis

It is also worth considering what signs are not characteristic of spirochete infection. For example, if, based on a “diagnosis” made independently using a reference book or after an authoritative statement from “Nyura’s neighbor,” it was established that the cause of the rash is secondary syphilis, you should not rush to your suitcases in a panic and pack your things to the venereal dispensary. The first thing you need to do is contact a specialist, answer his questions and, if necessary, take the appropriate tests.

Before that, you can calm down and think whether all the manifestations and their nature correspond to infection with spirochetes.

So, if a person’s rash itches, it’s worth thinking about whether syphilis itches?

And having searched for more detailed information on this issue, find out that rashes caused by spirochetes cannot be accompanied by itching, which means that itching is a clear sign of the absence of treponema pallidum in the body.

Therefore, if “syphilis itches,” then it is not syphilis and you can calm down.

Lymph nodes with syphilis

The first signs of syphilis are not limited to the formation of hard chancre at the entrance gate. Following this, regional inflammation of the lymph nodes should appear. In this case, the lymph nodes almost always become inflamed and increase in size, while remaining mobile and painless.

• Their size can reach a large walnut.
• As the first signs of syphilis, photos of inflamed lymph nodes will show a person with a large lump, not far from the site of infection, while the skin in the area above the nodes will not change its color.
• Such changes in the lymph nodes are associated with foci of spirochete proliferation in them.

Enlargement of all lymph nodes or their soreness indicates another type of infection, not associated with pallidum treponema.

Buboes or inflamed lymph nodes have been considered the main signs of syphilis since the Middle Ages, when it was believed that they simply could not exist without each other. However, due to people taking various medications in the last decade, the number of cases in which the presence of Treponema pallidum in the body was not accompanied by regional lymphodermitis has increased.

Detection of syphilis

• Testing for syphilis is an important stage in making a diagnosis, monitoring the quality of treatment, as well as mandatory regular monitoring for several years after successful therapy.
• Considering what the first signs of syphilis may be in a patient and how similar they are to the manifestations of other diseases, even experienced doctor will not be able to make a diagnosis without undergoing an examination aimed at identifying treponema pallidum.
• In the course of identifying the causes of symptoms that appeared suspicious and atypical to the doctor, important role Anamnesis is collected, which will help clarify the number of sexual partners, the possible time of infection, as well as the presence or absence of factors that could give a false positive or false negative result when examining the patient.

Since diagnosis and treatment for treponema infection is a serious task, several studies are usually carried out at once, designed to complement and verify the data of other tests.

During the treatment process, repeated studies are designed to determine the success of therapy and, if necessary, adjust it to obtain a better result.
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Signs of primary syphilis

The following signs of primary syphilis can be distinguished:

Primary syphilis in its normal course appears three to four days after the treponema enters the body. This stage lasts on average for five to six weeks.

Currently, venereologists are noticing changes in the course of primary syphilis. If years earlier syphilis manifested itself through a single chancre on the patient’s body, now there are two or more such ulcers on the body. Also, if previously it was possible to feel a clearly defined compaction of chancre, now this compaction may not appear.

Primary

Naturally, people are primarily interested in the question of what are the first signs of syphilis. This information is really important, because the sooner you notice changes in your own body, the sooner you will see a doctor and receive appropriate help.

• In fact, there is a certain pattern according to which syphilis develops in most cases. The stages of the disease are as follows: primary, secondary and tertiary forms of the disease, which follow one after another. Moreover, each of these stages has a very characteristic clinical picture and is accompanied by a unique set of symptoms.
• First, treponema penetrates the body and migrates to the lymph nodes, where it begins to actively multiply. As a rule, the first manifestation of syphilis occurs four weeks after infection - this is the incubation period. At the site where microorganisms invade, a so-called chancre is formed, which opens as the disease progresses, forming a small ulcer. In this case, pain practically does not bother the sick person.
• Most often, chancre appears in the area of ​​the external genitalia. For example, in men it is often located on the head of the penis. However, the ulcer can be found on the skin of the thighs, abdomen, and sometimes near the anus. It is worth noting that sometimes chancre forms on the mucous membrane of the rectum, the cervix, or even on the tonsils - in such places it is almost impossible to detect it on your own, so infected people simply do not go to the doctor.

After some time, you can replace the enlarged lymph nodes next to the chancre - most often the infection invades the nodes located in the groin area. In most cases, a person himself can detect an enlarged node, which is usually hard to the touch. In some cases, due to impaired lymphatic drainage, swelling of the labia, foreskin, scrotum, and tonsils appears (depending on the location of the infection).

This stage of the disease lasts about 2 – 3 months. If left untreated, chancre disappears. Of course, this does not indicate recovery - the disease moves to a new, more dangerous level.

The first signs of syphilis of the secondary form

It should be noted that secondary syphilis can be of several varieties:

• Fresh- this type of syphilis is a consequence of the primary form. Symptoms - small polymorphic rash and chancre;
• Hidden- even the incubation period of syphilis does not manifest itself in any way externally, but can be detected through serological tests;
• Recurrent- with this form of secondary syphilis, relapses alternate, and during each relapse a rash appears on the body.

  But unlike fresh syphilis, the rash during relapses is less abundant, the spots are larger, and foci of rashes can be identified.

Secondary form of the disease: main symptoms of syphilis

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.

By the way, the rash in this case can be different.

• Most often it looks like small spots of red or pink color with clear edges. The formation of papules or pustules is also possible.
• Sometimes another bacterial infection is associated with syphilis - in such cases, pustules can form on the skin.
• In any case, the rashes, as a rule, do not cause physical discomfort - there is no itching, no pain, no fever.
• Therefore, sick people rarely seek help from a specialist, which, naturally, allows the disease to progress further.

As for the other signs, when a rash appears on the scalp, partial alopecia develops - the hair in these areas falls out. In addition, the patient may notice an increase in certain lymph nodes.

By the way, in some patients, a rash appears on the body only at the initial stage - over the next years they do not show any visible signs of syphilis. At the same time, other patients suffer from relapses constantly - rashes appear and disappear. It is believed that weakening of the disease may provoke a new outbreak of the disease. immune system, frequent stress, hypothermia, exhaustion of the body, etc.

Tertiary syphilis

• The third stage of the disease, as a rule, begins 3 to 10 years after infection. It is accompanied by the appearance of so-called gummas. These are infiltrative tubercles with clear boundaries, formed on the tissues of internal organs. They are prone to decay and scarring.
• In fact, gummas can affect almost any organ system, leading to dangerous complications. For example, if such tubercles “grow” on bone tissue, then a person develops arthritis, periostitis or another disease.
• Damage to the intra-abdominal lymph nodes leads to the development of mesadenitis, which is accompanied by severe pain.
• No less dangerous are gummas in the central nervous system, since their appearance often leads to damage to certain parts of the brain and gradual degeneration of the personality.

If left untreated, syphilis is fatal.

If left untreated, tertiary syphilis develops in 30% of people with secondary syphilis. Tertiary syphilis kills one fourth of those infected. It is extremely important to recognize the signs of syphilis in women and men at least at this stage.

Signs of tertiary syphilis:

• In men, tertiary syphilis is diagnosed through the appearance of tubercles and gummas. The tubercles are quite small in size and quite a lot of them form on the body. Gummas are rare, quite large and located deep in the tissues. Inside these formations there is not such a large number of treponemes, so the risk of infecting another person is much lower than with secondary syphilis.
• In the tertiary form, the first signs of syphilis in women are tubercles and gummas as in men. Both tubercles and gummas eventually turn into ulcers, which will leave scars after healing. These scars have a detrimental effect on the condition of organs and tissues, severely deforming them. Gradually, organ functions are impaired, which can ultimately lead to death. If syphilis infection occurred from a partner through sexual contact, then the rash will primarily be in the genital area (on the vagina, etc.).
• In children, tertiary syphilis affects the skin, internal organs and nervous system with special tubercles - syphilides. Syphilides are formed due to the development of increased sensitivity of the child’s body to treponemes, which are contained in excess in the child’s body.

Tertiary syphilis can last for decades. The patient may suffer from the development of mental insanity, deafness, loss of vision, and paralysis of various internal organs. One of the most important signs of tertiary syphilis is significant changes in the patient’s psyche.

If previously a person was quite calm, then as a result of prolonged exposure to syphilis on the body, a person begins to panic, suffers from paranoia, attacks of rage and depression, which are followed by periods of euphoria.

Often at this stage of the development of the disease, the patient experiences hallucinations - this occurs as a result of the destruction of brain tissue.

Congenital form of the disease

As already mentioned, infection can also occur during pregnancy, since bacteria can easily penetrate fetal tissue through the placental circulatory system. As a rule, transmission of the pathogen occurs after the end of the first trimester. That is why pregnant women are strongly recommended to get tested for syphilis. The earlier the disease is detected, the easier it will be to eliminate the threat to the child’s health.

Of course, an infection can lead to disruption of the normal development of the fetus - in some cases, doctors even hold a consultation regarding termination of pregnancy. On the other hand, the child may be born quite viable. 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.

In some cases, syphilis in children causes extremely severe complications, including death. However, if the presence of infection is determined in time and adequate treatment is started, the prognosis for the child can be favorable. Therefore, you should never ignore symptoms or self-medicate.

Signs of syphilis in men, women and children: how different types of syphilis manifest

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 syphilis pathogens penetrating the body.

The following types of syphilis and their symptoms in men and women can be distinguished:

Atypical syphilis manifests itself in the form of an atypical chancre. These may be indurative edema, chancrapanaricium, chancre on the tonsils and paraphimosis. Indurative edema is characterized by development in the area of ​​the labia and preputial sac, and such edema is not accompanied by pain. The chancre looks like a rather large ulcer, dense when palpated.

• The skin takes on a purplish hue. Another sign of syphilis in men and women in an atypical form is chancre-felon, which can be found near the nail phalanx on the fingers.
• At the same time, the ulcer has uneven edges, creating painful sensations on the affected phalanx. At the same time, the lymph nodes in the elbows enlarge, but do not hurt. When hard chancre appears on the tonsils, erosion and ulcers occur, and the tonsil increases in size.
• Patients do not experience pain from an ulcer on the tonsil. Paraphimosis in atypical syphilis is an inflammation of the preputial sac that develops when the head of the penis is exposed. Long-term paraphimosis without proper treatment can lead to necrosis of the head.

Congenital syphilis

Congenital syphilis- a transplacentally transmitted disease, that is, infection of the fetus with syphilis through the mother’s blood. This disease is distinguished in two forms - early and late. The early form of congenital syphilis begins with fetal development and continues until early childhood. Late congenital syphilis manifests itself after the child has reached the age of 15, and before that it can be assumed that the child is healthy - the disease does not show itself in any way.

If syphilis affects the fetus (usually this occurs in the fifth month of pregnancy), then treponema begins to destroy the child’s internal organs and skeletal system. The chances of such a child surviving are negligible. According to official statistics, if a pregnant woman is sick with secondary form of syphilis, then in 90% of cases the pregnancy will end in the birth of a stillborn child or the death of the fetus.

• Signs of congenital syphilis are diagnosed in the fetus: they may be an increased weight of the placenta (1:3 instead of the norm 1:6), and the placenta itself increases in size and is easily ruptured. The amount of amniotic fluid decreases. The organs and tissues of the fetus are affected.
• If a child with syphilis is born and survives, the newborn will have loose and wrinkled skin (similar to senile skin), body disproportion (enlarged head), and specific rhinitis and other diseases will develop. Children with congenital syphilis lag behind their peers in development.

One of the varieties of syphilis, when the brain tissue, its membranes and blood vessels are affected by gumma. Neurosyphilis can be latent (diagnosed only through special studies, no external signs are observed), early (develops against the background of primary or secondary syphilis, affects the blood vessels and membranes of the brain, accompanied by syphilitic meningitis and meningomyelitis), late (occurs seven years after infection with treponema and develops against the background of tertiary syphilis, accompanied by tabes dorsalis , progressive paralysis and syphilitic gumma of the brain).

Neurosyphilis manifests itself through the following symptoms:

• syphilitic meningitis - syphilis is accompanied by meningeal symptoms (severe headaches, aversion to light, nausea and vomiting, high fever);
• syphilitic meningoencephalitis - essentially it is syphilitic meningitis, which is accompanied by mental disorders (hallucinations may occur);
• tabes dorsalis - with this manifestation, neurosyphilis affects the spinal cord, so the patient loses sensitivity in the limbs, has difficulty seeing, and has problems with urination and defecation;
• progressive paralysis - with neurosyphilis, a patient with paralysis loses reading and writing skills, develops dementia and complete personality collapse.

Hidden syphilis

Hidden syphilis- a type of syphilis when the disease is completely asymptomatic. Such syphilis can only be detected through laboratory tests. Diagnosis of latent syphilis is quite complex - it is a set of procedures based on the body’s specific reactions to syphilis.

Venereologists suggest that the development and spread of latent syphilis in the world is associated with the widespread use of antibiotics: patients mistake the symptoms of syphilis for signs of another sexually transmitted disease and try to cure it with an antibiotic. The drug suppresses the symptoms of syphilis, and the disease begins to be asymptomatic.

Latent syphilis can be early or late. Early latent syphilis is the period from primary syphilis to secondary syphilis, which usually corresponds to two years.

• Despite the fact that latent syphilis does not manifest itself in any way externally, a person infected with it is dangerous to others.
• Late latent syphilis is diagnosed more than two years after infection with treponema. Such patients are not dangerous to others.
• Most often in medical practice, latent syphilis is unspecified - the patient does not have any information about the expected date of infection with syphilis.

Household syphilis

Household syphilis can be obtained non-sexually. This usually occurs as a result of poor personal hygiene or lack thereof. It is enough for a person to use someone else’s towel or toothbrush, drink water from someone else’s glass - and treponema penetrates the body. In general, treponema is quite tenacious only at low temperatures - its ability to infect can persist for several years. However, at temperatures above 45-50 degrees, treponema dies.

Corresponding to the signs of sexually acquired syphilis, the differences are only in the location of the hard chancre on the body of the infected person: with sexual infection, the chancre most often appears in the genital area, and with domestic infection it can be found on any other part of the body.

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Other types of disease

Today in medicine there are several forms of this disease. The classic type of the disease is easy to notice and, accordingly, cure. But there are more dangerous types of syphilis that you also need to know about.

• Latent syphilis today is considered one of the main problems in venereology. Why? The fact is that in some people, treponema pallidum does not cause any visible symptoms after entering the body. In 90% of cases, this form of syphilis is discovered completely by accident, for example, during a routine examination or screening during pregnancy. At the same time, an infected person is not even aware of his problem, as a result of which he becomes a source of pathogenic microorganisms for everyone around him.
• There is another, no less dangerous type of the disease - sero-resistant syphilis. This form is spoken of in cases where, after a course of treatment, treponema is still present in the tests. Patients with a similar diagnosis require an additional course of antibacterial therapy. Unfortunately, it is not always possible to cure the resistant form of infection. And in some cases, the infected status remains with the person throughout his life.

Diagnostic methods

Today, there are many studies in which it is possible to determine the presence of treponema in the human body. When the first symptoms appear, you should go to the doctor. After a visual examination, the venereologist will decide which tests will be needed.

In case of primary syphilis, as a rule, bacterioscopic methods are informative, for which fluid from a chancre or a biopsy obtained from a lymph node is used as a test sample. A serological test for syphilis is considered no less accurate, during which the presence of a specific immunoglobulin IgM can be detected in the body. But it is worth considering that these tests are carried out only at the primary stage of the disease.

• Secondary and tertiary syphilis require other studies.
• In particular, the most popular is the Wasserman test (RW analysis) - this is the test that is used in clinics for mass examination of patients.
• Such testing makes it possible to determine the presence of bacteria at any stage of the disease.
• However, the possibility of a false negative or false positive result cannot be excluded.

The most accurate method today is considered to be the immunofluorescence reaction (RIF). This method allows you to identify even hidden forms of the disease. Naturally, there are other methods of laboratory research. For example, in some cases, to obtain more information, the doctor will refer the patient for a spinal tap, after which samples of the cerebrospinal fluid will be sent to the laboratory.

Modern methods of therapy

Treatment of syphilis is a long process.

At one time, a single injection of large doses of penicillin was used to eliminate the infection. Now such a treatment regimen is considered incorrect.

Only the attending physician can select medications for the patient. Moreover, the sick person is obliged to follow all the specialist’s recommendations and strictly follow the intake schedule. In most cases, the presence of such an infection requires taking fairly large doses of antibiotics - most often substances of the penicillin series (penicillin, erythromycin, tetracycline) are used for this purpose. Patients who are allergic to these antibiotics receive other antibacterial drugs.

• Since the doses of drugs in this case are really large, it is extremely important that treatment of syphilis takes place in a hospital setting under the constant supervision of medical personnel.
• In addition to antibiotics, immunomodulatory drugs are used.
• If there is a rash, the doctor may prescribe a special ointment that speeds up the healing process.
• To protect microflora, it is recommended to take products containing live strains of beneficial microorganisms.

If one of the sexual partners is diagnosed with syphilis, the other is also required to get tested and undergo a full course of treatment. Even if no signs of Treponema pallidum have been detected in the body, so-called preventive therapy is carried out. Compliance with this condition helps to avoid re-infection.

Primary and secondary syphilis is treated, as a rule, in 1.5 - 3 months. The tertiary stage of the disease requires longer therapy, which often lasts more than a year.

Course of antibiotic treatment

Each patient, man and woman, is prescribed antibiotics during the course of treatment - the causative agent of this infectious disease is sensitive to them. So the drug itself, the duration of its use and dosage are prescribed by the doctor on an individual basis, taking into account all the tests and results of the patient’s examination.

The disease is sensitive to the following groups of drugs:

• drugs containing penicillin.
• macrolides and the antibiotic ceftriaxone.

Thus, antibiotics containing penicillin act very effectively during treatment, having a detrimental effect on the causative agent of the pathology. When diagnosing primary syphilis, they provide excellent treatment dynamics. Today, dermatovenerologists do not practice the first method. loading dose administration of penicillin - a more effective method is to administer the drug intramuscularly at intervals of every 3 hours, which ensures its constant concentration in the body.

PENICILLIN (A REMEDY FROM SOME TYPES OF MOLD)

Thus, drugs containing penicillin are excellent in combating the early stages of neurosyphilis, but so far the nervous system has not undergone irreversible changes in its functioning, and also given the congenital nature of syphilis damage to the body.

If the third stage of syphilis is diagnosed, before taking penicillin you should undergo 2 weeks of therapy with drugs such as tetracycline or erythromycin.

AZITHROMYCIN – A NEW GENERATION DRUG

Syphilis and its treatment with azithromycin, a new generation drug (antibiotic), and macrolides also show good results, being as effective as antibiotics of the penicillin group. At the same time, the side effects and negative effects from the drug are minimal.

• The only limitation for prescribing azithromycin is the diagnosis of HIV infection in the patient.
• Daily intake 2 g . Azithromycin allows you to cure even late forms of syphilis in a six-month course of treatment, but the congenital form of the disease is not treated with this drug.

Treatment of syphilis with a drug such as ceftriaxone also gives its positive results and dynamics - it is prescribed even to pregnant women and in especially advanced cases. All compounds that are part of this drug suppress the internal synthesis of division and growth of Treponema pallidum cells. The treatment regimen is simple - 1 injection per day, course of treatment for at least six months. The only limitation is that doctors do not treat the congenital form of syphilis with this drug.

If the doctor diagnoses a latent form of syphilis, the treatment regimen and medications are similar, supplemented by a course of immunostimulants and physiotherapeutic procedures.

To date, doctors and scientists have not yet invented special vaccines that are effective in preventing syphilis. If the patient has previously had this sexually transmitted infection, he can become infected and get it again. As a result, only preventive measures will help avoid infection and thereby prevent damage to the internal organs and systems of the body.

• First of all, it is worth excluding promiscuous sexual relations with an untested partner, especially without a condom. If you have had such sex, immediately treat your genitals with an antiseptic and visit a doctor for a preventive examination and examination.

• It is enough to understand that not every person knows that he is this moment acts as a carrier of the infection and, if the patient has a regular sex life, doctors recommend regular examinations by highly specialized doctors and tests for STDs, thereby identifying the disease in the early stages of its course.tvojajbolit.ru

Disease prevention

Unfortunately, today there is no vaccine that can permanently protect against such a disease. People who have had syphilis can become infected again. Therefore, the only effective preventative measure is to prevent infection. This means that you should avoid promiscuous sexual intercourse, especially without using condoms. If unprotected sex does occur, you should treat your genitals with an antiseptic solution and make an appointment with a doctor.

It should be understood that not all carriers of the infection are aware of their own problem. Therefore, doctors recommend that people who are sexually active regularly get tested for STDs, as this helps to identify the disease in the early stages and, accordingly, eliminate the likelihood of the infection spreading. In addition, the disease is much easier to cure in the initial stages.
syl.ru

What is chancre?

Chancre in syphilis is a specific local reaction of the body to the penetration of Treponema pallidum. It all starts with a slight redness with clear edges, in place of which a painless scaly papule (nodule) appears, and later an erosion or ulcer (a deeper defect) forms, this is a chancre (that’s what ulcers were called in the old days).

Chancre has a number of features: it does not hurt, has a dense base, smooth edges, gentle walls (they resemble a saucer), and a red shiny surface. The size of the chancre is variable - from millimeters to centimeters, and the shape of the formation can also be different (round, oval, resembling a crack).

Primary syphiloma usually persists on the body for several weeks. Then the healing process begins, without any treatment. Features of healing depend on the type of chancre. So, after erosion, traces may not remain, but an ulcer always leaves a scar.

• The disappearance of primary syphiloma does not at all indicate recovery.
• The disease simply moves to the next stage, that is, secondary syphilis develops, during which the infection spreads to the internal organs.

Atypical forms of primary syphilomas

Chancre is a typical manifestation of syphilis. However, there are other clinical forms of primary syphiloma. These include:

1. Chancroid felon is an inflammation of the extreme phalanx of the finger.
2. Indurative edema is dense swelling of the genitals.
3. Chancroid-amygdalitis is an enlargement and hardening of one palatine tonsil, but there are no ulcers, erosions or plaques on the lymphatic formation.

These manifestations of syphilis are very similar to diseases of a completely different nature, so doctors have a hard time making the correct diagnosis. Regional lymphadenitis prompts them to think about syphilis in such situations.

In addition, syphilis in the initial stages may not manifest itself at all or may have a smoothed clinical picture and a longer incubation period (for example, if a person takes antibiotics). Therefore, to clarify the diagnosis, a number of laboratory tests are always carried out.

infmedserv.ru

How is syphilis transmitted?

You can become infected with syphilis through direct contact with a syphilitic sore during vaginal, anal, or oral sex. You may find sores on or around the penis, vagina, anus, rectum, or on the lips and mouth. Syphilis can be transmitted from an infected mother to her fetus.

Image of a primary syphilitic ulcer.

How does syphilis manifest?

Syphilis is divided into several stages (primary, secondary, latent and tertiary) with different signs and symptoms associated with each stage. In a person with primary syphilis There is usually pain or ulcers at the original site of infection. Ulcers usually occur on or around the genitals, around the anus or rectum, or in or around the mouth. The ulcers are usually (but not always) firm, round, and painless. Symptoms secondary syphilis include skin rash, swollen lymph nodes and fever. Signs and symptoms of primary and secondary syphilis may be subtle and may not be noticed. During latent stage there are no signs or symptoms. Tertiary syphilis associated with serious health problems. A doctor can usually diagnose tertiary syphilis with several tests. It can affect the functioning of the heart, brain, and other organs of the body.

What are the signs and symptoms of syphilis?

Symptoms of syphilis in adults vary depending on the stage:

Primary stage

During the primary stage of syphilis, you may notice one or more sores. An ulcer is where syphilis entered your body. The ulcers are usually (but not always) firm, round, and painless. Because the ulcer is painless, it is easy to miss. The ulcer usually lasts 3 to 6 weeks and goes away whether or not you receive treatment.

Even after the ulcer goes away, you should still get treatment. This will stop your infection from progressing to the secondary stage.

Secondary stage

During the secondary stage, you may develop a rash and/or mucosal lesions. Mucosal lesions are ulcers in the mouth, vagina or anus. This stage usually begins with the appearance of a rash on one or more areas of the body. The rash may appear while the primary ulcer is healing or several weeks after it has healed. The rash may appear as rough red or red-brown spots on the palms of the hands and/or soles of the feet. The rash is usually not itchy, and sometimes it is so mild that you may not notice it. Other symptoms you may experience include fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle pain and fatigue. The symptoms of this stage will go away whether or not you receive treatment. But without proper treatment the infectious disease will go into latent, and possibly into the late stage of syphilis.

Syphilitic rash on the body in the secondary period.

Hidden stage

The latent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. If you don't get treatment, you may continue to have syphilis for many years without showing any signs or symptoms.

Tertiary stage

For most people, untreated syphilis does not progress to the tertiary stage. However, when it does, it can affect many organ systems. These include the heart and blood vessels, as well as the brain and nervous system. Tertiary syphilis is very dangerous and can begin 10 to 30 years after infection. At the tertiary stage of syphilis, the disease affects internal organs and can lead to death.

Neurosyphilis and eye syphilis

Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis) or to the eye (ocular syphilis). This can happen at any of the stages described above.

Symptoms of neurosyphilis include:

• severe headache;
• difficulty coordinating muscle movements;
• paralysis (inability to move certain parts of the body);
• numbness; and
• dementia (mental disorder).

Symptoms of ocular syphilis include blurred vision and even blindness.

Dark-field micrographic image of a pallid spirochete ( Treponema pallidum).

Can syphilis be cured?

Yes, syphilis can be cured with antibiotics prescribed by your doctor. However, treatment may not correct the damage already done by the infection.

https://www.cdc.gov/std/russian/stdfact-syphilis-russian.htm

Causes of primary syphilis

The causative agent of the disease is Treponema pallidum. The route of transmission of infection is predominantly sexual, through unprotected sexual intercourse with a sick person or a carrier of the infection. The disease refers to sexually transmitted diseases or sexually transmitted infections. A hematogenous route of transmission of infection is possible, through blood transfusions, also among injection drug addicts when using other people's syringes, or when using other people's razors and toothbrushes in everyday life.

The household route of infection is very rare, as it requires close contact with a person sick with tertiary syphilis. Possible intrauterine infection and infection through mother's milk.

Symptoms of primary syphilis

The first symptoms appear 10–90 days after infection. The site of infection appears as a hard chancre; most often, its appearance is typical on the glans penis in men, the labia or on the mucous membrane of the cervix and vagina in women. There is also an extragenital location of the chancre, for example, on the thighs, fingers, abdomen, lips, on the mucous membrane of the anus, pubis, and in the oral cavity.

Diagnosticsprimary syphilis

The doctor interviews and examines the patient, analyzes his life history and medical history. To confirm the diagnosis, a bacteriological examination of the chancre discharge is performed to detect the causative agent - treponema pallidum. Sometimes a biopsy of the lymph node is performed, and a number of serological tests are also performed (RIBT, RIF, RPR test).

Treatment of primary syphilis

Therapy must be completed by both sexual partners at the same time; during the treatment period, the possibility of any sexual contact is excluded. During drug treatment, antibacterial agents of the penicillin series are prescribed. If an allergy to penicillin develops, tetracycline or doxycycline is prescribed.

After necessary treatment all patients with seronegative primary syphilis are subject to mandatory clinical observation for a period of 12 months, and those with seropositive primary syphilis are under medical supervision for at least 3 years. The most common complications are: balanoposthitis, balanitis, phimosis, paraphimosis, gangrene.

Preventionprimary syphilis

In order to prevent infection, you should avoid casual sexual contact and, if necessary, use barrier methods of contraception. General recommendations include observing the rules of intimate and personal hygiene, maintaining healthy image life.

https://www.obozrevatel.com/health/bolezni/pervichnyij-sifilis.htm

is a sexually transmitted disease that has a long, wave-like course and affects all organs. The clinical picture of the disease begins with the appearance of hard chancre (primary syphiloma) at the site of infection, enlargement of regional and then distant lymph nodes. Characteristic is the appearance of syphilitic rashes on the skin and mucous membranes, which are painless, do not itch, and occur without fever. In the future, all internal organs and systems can be affected, which leads to irreversible changes and even death. Treatment of syphilis is carried out by a venereologist; it is based on systemic and rational antibiotic therapy.

General information

(Lues) is an infectious disease that has a long, wave-like 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. Syphilis affects the entire body: the skin and mucous membranes, the cardiovascular, central nervous, digestive, and musculoskeletal systems. Untreated or poorly treated syphilis can last for years, alternating periods of exacerbations and latent periods. During the active period, syphilis manifests itself on the skin, mucous membranes and internal organs; during the latent period, it practically does not manifest itself in anything.

Syphilis comes first among all infectious diseases(including STIs), according to the level of morbidity, contagiousness, degree of harm to health, certain difficulties in diagnosis and treatment.

Features of the causative agent of syphilis

The causative agent of syphilis is the microorganism pale spirochete (treponema - Treponema pallidum). The pale spirochete has the appearance of a curved spiral and is capable of movement. different ways(translationally, rotationally, bendingly and wavy), propagated by transverse division, painted with aniline dyes in a pale pink color.

The pale spirochete (treponema) finds optimal conditions in the human body in the lymphatic tract and lymph nodes, where it actively multiplies, and appears in the blood in high concentrations at the stage of secondary syphilis. The microbe persists for a long time in a warm and humid environment (optimum t = 37°C, in wet underwear for up to several days), and is also resistant to low temperatures (in the tissues of corpses - viable for 1-2 days). The pale spirochete dies when dried, heated (55°C - after 15 minutes, 100°C - instantly), when treated with disinfectants, solutions of acids, alkalis.

A patient with syphilis is contagious during any period of illness, especially during periods of primary and secondary syphilis, accompanied by manifestations on the skin and mucous membranes. Syphilis is transmitted through contact of a healthy person with a sick person through secretions (sperm during sexual intercourse, milk - in nursing women, saliva during a kiss) and blood (through direct blood transfusion, during operations - from medical staff, using a shared straight razor, a shared syringe - from drug addicts). The main route of transmission of syphilis is sexual (95-98% of cases). Less common is an indirect household route of infection - through wet household items and personal belongings (for example, from sick parents to children). There have been cases of intrauterine transmission of syphilis to a child from a sick mother. A necessary condition infection is the presence in the patient’s secretions of a sufficient number of pathogenic forms of pale spirochetes and a violation of the integrity of the epithelium of the mucous membranes and skin of his partner (microtraumas: wounds, scratches, abrasions).

Periods of syphilis

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.

• Incubation period

It begins from the moment of infection and lasts on average 3-4 weeks. Pale spirochetes spread through the lymphatic and circulatory tract throughout the body, multiply, but clinical symptoms do not appear. A person with syphilis is unaware of his illness, although he is already contagious. The incubation period can be shortened (up to several days) and extended (up to several months). Extension occurs when taking medications that somewhat inactivate the causative agents of syphilis.

• 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 syphilis

Can last from 2 to 5 years. Internal organs, tissues and systems of the body are damaged, generalized rashes appear on the mucous membranes and skin, and baldness occurs. This stage of syphilis occurs in waves, with periods of active manifestations followed by periods of absence of symptoms. There are secondary fresh, secondary recurrent and latent syphilis.

Latent (latent) syphilis does not have skin manifestations of the disease, signs of specific damage to internal organs and the nervous system, and is determined only by laboratory tests (positive serological reactions).

• Tertiary syphilis

It is now rare and occurs in the absence of treatment years after the lesion. Characterized by irreversible damage to internal organs and systems, especially the central nervous system. It is the most severe period of syphilis, leading to disability and death. It is detected by the appearance of tubercles and nodes (gummas) on the skin and mucous membranes, which, when disintegrating, disfigure the patient. They are divided into syphilis of the nervous system - neurosyphilis and visceral syphilis, in which internal organs are damaged (brain and spinal cord, heart, lungs, stomach, liver, kidneys).

Symptoms of syphilis

Primary syphilis

Primary syphilis begins from the moment when primary syphiloma, chancre, appears at the site of introduction of pale spirochetes. A chancre is a single, round-shaped erosion or ulcer, which has clear, smooth edges and a shiny bluish-red bottom, painless and non-inflamed. The chancre does not increase in size, has scanty serous contents or is covered with a film or crust; a dense, painless infiltrate is felt at its base. Hard chancre does not respond to local antiseptic therapy.

Chancre can be located on any area of ​​the skin and mucous membranes (anal area, oral cavity– lips, corners of the mouth, tonsils; mammary gland, lower abdomen, fingers), but most often located on the genitals. Usually in men - on the head, foreskin and shaft of the penis, inside the urethra; in women - on the labia, perineum, vagina, cervix. The size of the chancre is about 1 cm, but can be dwarf - the size of a poppy seed and gigantic (d = 4-5 cm). Chancres can be multiple, in the case of numerous small lesions of the skin and mucous membranes at the time of infection, sometimes bipolar (on the penis and lips). When a chancre appears on the tonsils, a condition resembling a sore throat occurs, in which the temperature does not rise and the throat almost does not hurt. The painlessness of chancre allows patients not to notice it and not attach any importance. Soreness is distinguished by a slit-like chancre in the fold of the anus, and a chancre - felon on the nail phalanx of the fingers. During the period of primary syphilis, complications (balanitis, gangrenization, phimosis) may occur as a result of the addition of a secondary infection. Uncomplicated chancre, depending on the size, heals after 1.5 - 2 months, sometimes before signs of secondary syphilis appear.

5-7 days after the onset of chancre, uneven enlargement and thickening of the lymph nodes closest to it (usually inguinal) develops. It can be unilateral or bilateral; the nodes are not inflamed, painless, have an ovoid shape and can reach the size of a chicken egg. Towards the end of the period of primary syphilis, specific polyadenitis develops - an enlargement of most subcutaneous lymph nodes. Patients may experience malaise, headache, insomnia, fever, arthralgia, muscle pain, neurotic and depressive disorders. This is associated with syphilitic septicemia - the spread of the causative agent of syphilis through the circulatory and lymphatic system from the lesion throughout the body. In some cases, this process occurs without fever or malaise, and the patient does not notice the transition from the primary stage of syphilis to the secondary stage.

Secondary syphilis

Secondary syphilis begins 2-4 months after infection and can last from 2 to 5 years. Characterized by generalization of infection. At this stage, all systems and organs of the patient are affected: joints, bones, nervous system, hematopoietic organs, digestion, vision, hearing. The clinical symptom of secondary syphilis is rashes on the skin and mucous membranes, which are widespread (secondary syphilides). The rash may be accompanied by body aches, headache, fever and may feel like a cold.

The rash appears in paroxysms: after lasting 1.5 - 2 months, it disappears without treatment (secondary latent syphilis), then appears again. The first rash is characterized by abundance and brightness of color (secondary fresh syphilis), subsequent repeated rashes are paler in color, less abundant, but larger in size and prone to merging (secondary recurrent syphilis). The frequency of relapses and the duration of latent periods of secondary syphilis vary and depend on the body’s immunological reactions in response to the proliferation of pale spirochetes.

Syphilides of the secondary period disappear without scars and have a variety of forms - roseola, papules, pustules.

Syphilitic roseolas are small round spots of pink (pale pink) color that do not rise above the surface of the skin and epithelium of the mucous membranes, which do not peel and do not cause itching; when pressed on, they turn pale and disappear for a short time. Roseola rash with secondary syphilis is observed in 75-80% of patients. The formation of roseola is caused by disturbances in the blood vessels; they are located throughout the body, mainly on the torso and limbs, in the face - most often on the forehead.

A papular rash is a rounded nodular formation protruding above the surface of the skin, bright pink in color with a bluish tint. Papules are located on the body and do not cause any subjective sensations. However, when pressing on them with a button probe, acute pain appears. With syphilis, a rash of papules with greasy scales along the edge of the forehead forms the so-called “crown of Venus.”

Syphilitic papules can grow, merge with each other and form plaques, becoming wet. Weeping erosive papules are especially contagious, and syphilis at this stage can easily be transmitted not only through sexual contact, but also through handshakes, kisses, and the use of common household items. Pustular (pustular) rashes with syphilis are similar to acne or chicken rash, covered with crust or scales. Usually occur in patients with reduced immunity.

The malignant course of syphilis can develop in weakened patients, as well as in drug addicts, alcoholics, and HIV-infected people. Malignant syphilis is characterized by ulceration of papulopustular syphilides, continuous relapses, impaired general condition, fever, intoxication, and weight loss.

Patients with secondary syphilis may experience syphilitic (erythematous) tonsillitis (severe redness of the tonsils, with whitish spots, not accompanied by malaise and fever), syphilitic seizures in the corners of the lips, and oral syphilis. There is a general mild malaise that may resemble the symptoms of a common cold. Characteristic of secondary syphilis is generalized lymphadenitis without signs of inflammation and pain.

During the period of secondary syphilis, disturbances in skin pigmentation (leukoderma) and hair loss (alopecia) occur. Syphilitic leukoderma manifests itself in the loss of pigmentation of various areas of the skin on the neck, chest, abdomen, back, lower back, and armpits. On the neck, more often in women, a “Venus necklace” may appear, consisting of small (3-10 mm) discolored spots surrounded by darker areas of skin. It can exist without change for a long time (several months or even years), despite antisyphilitic treatment. The development of leukoderma is associated with syphilitic damage to the nervous system; upon examination, pathological changes in the cerebrospinal fluid are observed.

Hair loss is not accompanied by itching or flaking; its nature is:

• diffuse - hair loss is typical of normal baldness, occurring on the scalp, in the temporal and parietal region;
• small focal - a clear symptom of syphilis, hair loss or thinning in small patches located randomly on the head, eyelashes, eyebrows, mustache and beard;
• mixed - both diffuse and small-focal are found.

With timely treatment of syphilis, the hairline is completely restored.

Skin manifestations of secondary syphilis accompany lesions of the central nervous system, bones and joints, and internal organs.

Tertiary syphilis

If a patient with syphilis was not treated or the treatment was incomplete, then several years after infection he develops 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. Recently, the incidence of tertiary syphilis has decreased due to its treatment with penicillin, and severe forms of disability have become rare.

There are tertiary active (if there are manifestations) and tertiary latent syphilis. Manifestations of tertiary syphilis are a few infiltrates (tubercles and gummas), prone to decay, and destructive changes in organs and tissues. Infiltrates on the skin and mucous membranes develop without changing the general condition of patients; they contain very few pale spirochetes and are practically not infectious.

Tubercles and gummas on the mucous membranes of the soft and hard palate, larynx, and nose ulcerate and lead to disorders of swallowing, speech, breathing (perforation of the hard palate, “failure” of the nose). Gummy syphilides, spreading to bones and joints, blood vessels, and internal organs, cause bleeding, perforations, scar deformities, and disrupt their functions, which can lead to death.

All stages of syphilis cause numerous progressive lesions of internal organs and the nervous system, the most severe form of which develops with tertiary (late) syphilis:

• neurosyphilis (meningitis, meningovasculitis, syphilitic neuritis, neuralgia, paresis, epileptic seizures, tabes dorsalis and progressive paralysis);
• syphilitic osteoperiostitis, osteoarthritis,

  Diagnosis of syphilis

  Diagnostic measures for syphilis include a thorough examination of the patient, taking an anamnesis and conducting clinical studies:

  1. Detection and identification of the causative agent of syphilis by microscopy of serous discharge from skin rashes. But in the absence of signs on the skin and mucous membranes and in the presence of a “dry” rash, the use of this method is impossible.
  2. Serological tests (nonspecific, specific) are performed with serum, blood plasma and cerebrospinal fluid - the most reliable method for diagnosing syphilis.

  Nonspecific serological reactions are: RPR - rapid plasma reagin reaction and RW - Wasserman reaction (compliment binding reaction). Allows the determination of antibodies to spirochete pallidum - reagins. Used for mass examinations (in clinics, hospitals). Sometimes they give a false-positive result (positive in the absence of syphilis), so this result is confirmed by performing specific tests.

  Specific serological reactions include: RIF - immunofluorescence reaction, RPHA - passive hemagglutination reaction, RIBT - immobilization reaction of treponemal pallidum, RW with treponemal antigen. Used to determine species-specific antibodies. RIF and RPGA are highly sensitive tests that become positive at the end of the incubation period. Used in the diagnosis of latent syphilis and to recognize false-positive reactions.

  Serological reactions become positive only at the end of the second week of the primary period, therefore the primary period of syphilis is divided into two stages: seronegative and seropositive.

  Nonspecific serological reactions are used to assess the effectiveness of treatment. Specific serological reactions in a patient who has had syphilis remain positive for life; they are not used to test the effectiveness of treatment.

  Treatment of syphilis

  Treatment for syphilis begins after a reliable diagnosis is made, which is confirmed by laboratory tests. Treatment of syphilis is selected individually, carried out comprehensively, recovery must be determined in a laboratory. Modern methods of treating syphilis, which venereology has today, allow us to talk about a favorable prognosis for treatment, subject to correct and timely therapy that corresponds to the stage and clinical manifestations of the disease. But only a venereologist can choose a therapy that is rational and sufficient in terms of volume and time. Self-medication of syphilis is unacceptable! Untreated syphilis becomes a latent, chronic form, and the patient remains epidemiologically dangerous.

  The treatment of syphilis is based on the use of penicillin antibiotics, to which the pale spirochete is highly sensitive. If the patient has allergic reactions to penicillin derivatives, erythromycin, tetracyclines, and cephalosporins are recommended as an alternative. In cases of late syphilis, iodine and bismuth preparations, immunotherapy, biogenic stimulants, and physiotherapy are additionally prescribed.

  It is important to establish sexual contacts of a patient with syphilis, and be sure to carry out preventive treatment of possibly infected sexual partners. At the end of treatment, all previously patients with syphilis remain under dispensary observation with a doctor until the result of a complex of serological reactions is completely negative.

  In order to prevent syphilis, examinations are carried out among donors, pregnant women, workers in children's, food and medical institutions, and patients in hospitals; representatives of risk groups (drug addicts, prostitutes, homeless people). Blood donated by donors must be tested for syphilis and canned.