Latent syphilis (early, late): photos, causes and treatment. How to treat and what are the dangers of latent forms of syphilis

What is Latent syphilis
Symptoms of Latent Syphilis
Diagnosis of Latent Syphilis
Treatment of Latent Syphilis
Which doctors should you contact if you have Latent syphilis?

What is Latent syphilis

Syphilis can also occur in a latent form.

This variant of the course of the disease is called latent syphilis. Hidden syphilis From the moment of infection, it 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.

What causes Latent syphilis

The causative agent of syphilis is Treponema pallidum, belonging to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically, treponema pallidum (pale spirochete) differs from saprophytic spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under a microscope, Treponema pallidum is a spiral-shaped microorganism that resembles a corkscrew. It has on average 8-14 uniform curls of equal size. The total length of the treponema varies from 7 to 14 microns, thickness - 0.2-0.5 microns. Treponema pallidum is characterized by pronounced mobility, in contrast to saprophytic forms. It is characterized by translational, rocking, pendulum-like, contractile and rotatory (around its axis) movements. Using electron microscopy, the complex morphological structure of Treponema pallidum was revealed. It turned out that the treponema is covered with a thick cover of a three-layer membrane, a cell wall and a mucopolysaccharide capsule-like substance. Under the cytoplasmic membrane there are fibrils - thin filaments that have a complex structure and cause diverse movement. Fibrils are attached to the terminal turns and individual sections of the cytoplasmic cylinder using blepharoplasts. The cytoplasm is finely granular, containing a nuclear vacuole, nucleolus and mesosomes. It was established that various influences of exo- and endogenous factors (in particular, previously used arsenic preparations, and currently antibiotics) had an impact on Treponema pallidum, changing some of its biological properties. Thus, it turned out that pale treponema can turn into cysts, spores, L-forms, grains, which, when the activity of the patient’s immune reserves decreases, can reverse into spiral-shaped virulent varieties and cause active manifestations of the disease. The antigenic mosaic nature of Treponema pallidum has been proven by the presence of multiple antibodies in the blood serum of patients with syphilis: protein, complement-fixing, polysaccharide, reagin, immobilisin, agglutinin, lipoid, etc.

Using an electron microscope, it was found that treponema pallidum in lesions is most often located in intercellular spaces, periendothelial space, blood vessels, nerve fibers, especially in early forms of syphilis. The presence of pale treponema in the periepineurium is not yet evidence of damage to the nervous system. More often, such an abundance of treponemes occurs during septicemia. During the process of phagocytosis, a state of endocytobiosis often occurs, in which treponemes in leukocytes are enclosed in a multimembrane phagosome. The fact that treponemes are enclosed in polymembrane phagosomes is a very unfavorable phenomenon, since, being in a state of endocytobiosis, treponema pallidums persist for a long time, protected from the effects of antibodies and antibiotics. At the same time, the cell in which such a phagosome has formed seems to protect the body from the spread of infection and progression of the disease. This precarious balance can persist for a long time, characterizing the latent (hidden) course of a syphilitic infection.

Experimental observations by N.M. Ovchinnikov and V.V. Delectorsky are consistent with the works of the authors who believe that when infected with syphilis, a long-term asymptomatic course is possible (if the patient has L-forms of Treponema pallidum in the body) and “accidental” detection of infection in the stage of latent syphilis (lues latens seropositiva, lues ignorata), i.e. e. during the presence of treponemes in the body, probably in the form of cyst forms, which have antigenic properties and, therefore, lead to the production of antibodies; this is confirmed by positive serological reactions to syphilis in the blood of patients without visible clinical manifestations of the disease. In addition, in some patients, stages of neuro- and viscerosyphilis are detected, i.e., the disease develops as if “bypassing” the active forms.

To obtain a culture of Treponema pallidum, complex conditions are required (special media, anaerobic conditions, etc.). At the same time, cultural treponemes quickly lose their morphological and pathogenic properties. In addition to the above forms of treponema, the existence of granular and invisible filterable forms of pale treponema was assumed.

Outside the body, treponema pallidum is very sensitive to external influences, chemicals, drying, heating, and exposure to sunlight. On household items, Treponema pallidum retains its virulence until it dries. A temperature of 40-42°C first increases the activity of treponemes and then leads to their death; heating to 60°C kills them within 15 minutes, and to 100°C kills them instantly. Low temperatures do not have a detrimental effect on treponema pallidum, and currently, storing treponemes in an oxygen-free environment at temperatures from -20 to -70 ° C or frozen dried is a generally accepted method for preserving pathogenic strains.

Pathogenesis (what happens?) during Latent syphilis

The reaction of the patient's body to the introduction of Treponema pallidum is complex, diverse and insufficiently studied. Infection occurs as a result of the penetration of Treponema pallidum through the skin or mucous membrane, the integrity of which is usually compromised. However, a number of authors admit the possibility of the introduction of treponema through an intact mucous membrane. At the same time, it is known that in the blood serum of healthy individuals there are factors that have immobilizing activity against Treponema pallidum. Along with other factors, they make it possible to explain why infection is not always observed upon contact with a sick person. Domestic syphilidologist M.V. Milich, based on his own data and analysis of the literature, believes that infection may not occur in 49-57% of cases. The variation is explained by the frequency of sexual intercourse, the nature and localization of syphilides, the presence of an entrance gate in the partner and the number of pale treponemas that have penetrated the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the tension and activity of which varies depending on the degree of virulence of the infection. Therefore, not only the possibility of no infection is being discussed, but also the possibility of self-healing, which is considered theoretically acceptable.

Symptoms of Latent Syphilis

In practice, we have to deal with patients in whom the presence of syphilis is established only on the basis of positive serological reactions in the absence of any clinical data (on the skin, mucous membranes, internal organs, nervous system, musculoskeletal system) indicating the presence in the body of a patient with a specific infection. Many authors provide statistical data according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis is detected in 90% of patients during preventive examinations, in antenatal clinics and somatic hospitals. This is explained by both a more thorough examination of the population (i.e., improved diagnosis) and a true increase in the number of patients (including due to the widespread use of antibiotics by the population for intercurrent diseases and manifestations of syphilis, which are interpreted by the patient himself not as symptoms of a sexually transmitted disease, but as, for example, the manifestation of allergies, colds, etc.).

Latent syphilis is divided into early, late and unspecified.

Latent late syphilis (syphilis lateus tarda) in epidemiological terms, it is less dangerous than earlier forms, since when the process is activated, it manifests itself either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of low-infectious tertiary syphilides (tubercles and gummas).

Early latent syphilis in time corresponds to the period from primary seropositive syphilis to secondary recurrent syphilis inclusive, only without active clinical manifestations of the latter (on average up to 2 years from the moment of infection). However, these patients may experience active, contagious manifestations of early syphilis at any time. This forces patients with early latent syphilis to be classified as an epidemiologically dangerous group and vigorous anti-epidemic measures to be carried out (isolation of patients, thorough examination of not only sexual but also household contacts, compulsory treatment if necessary, etc.). Like the treatment of patients with other early forms of syphilis, the treatment of patients with early latent syphilis is aimed at quickly sanitizing the body from a syphilitic infection.

Diagnosis of Latent Syphilis

The following data can help in diagnosing this form of syphilis:
1. anamnesis, which should be collected carefully, paying attention to the presence in the past (within 1-2 years) of erosive and ulcerative efflorescences on the genitals, in the oral cavity, various rashes on the skin, taking antibiotics (for “sore throat”, “flu-like condition” ), treatment of gonorrhea (without examining the source of infection), if preventive treatment was not given, etc.;
2. results of the confrontation (examination of the person who had sexual contact with the patient and identification of an early form of syphilis);
3. detection of a scar or compaction at the site of primary syphiloma, enlarged (usually inguinal) lymph nodes, clinically corresponding to regional scleradenitis;
4. high titer of reagins (1:120, 1:360) with sharply positive results of all serological reactions (in patients treated for gonorrhea or self-medicated, it may be low);
5. temperature reaction of exacerbation at the beginning of penicillin therapy;
6. rapid decrease in reagin titer already during the first course of specific treatment; serological reactions are negative by the end of the 1st-2nd courses of treatment;
7. sharply positive result of RIF in these patients, although RIBT in some patients may still be negative;
8. the age of patients is usually up to 40 years;
9. possibility of normal cerebrospinal fluid; in the presence of latent syphilitic meningitis, rapid sanitation is noted in the process of antisyphilitic treatment.

Sick late latent syphilis are practically considered harmless from an epidemiological point of view. However, in these cases it is especially easy to mistake positive serological blood reactions for a manifestation of syphilis, while they can be false positive, i.e. non-syphilitic, due to many reasons (past malaria, rheumatism, chronic diseases of the liver, lungs, chronic purulent processes, age-related changes in the body’s metabolic processes, etc.). Establishing this diagnosis in venereology is considered the most difficult and very responsible and should not be made without confirmation of RIF, RITT and RPGA (sometimes such studies are carried out again with a break of several months, as well as after the rehabilitation of foci of chronic infection or appropriate treatment of intercurrent diseases).

All patients are consulted by a neurologist or therapist to exclude specific damage to the central nervous system and internal organs.

The diagnosis of late latent syphilis is facilitated by:
1. medical history data (if the patient indicates that he could have become infected from some source more than 2 years ago);
2. low titer of reagins (1:5, 1:10, 1:20) with sharply positive results for classical serological reactions (CSR) or weakly positive results for CSR (with confirmation in both cases by RIF, RITT and RPGA);
3. negativity of serological reactions towards the middle or end of specific treatment, as well as often the absence of negativity of CSR, RIF, RITT, despite vigorous anti-syphilitic treatment using non-specific agents;
4. absence of an exacerbation reaction at the beginning of penicillin therapy (it is preferable to begin treatment of such patients with preparation - iodine preparations, bioquinol);
5. pathology in the cerebrospinal fluid (latent syphilitic meningitis), observed in these patients more often than with early latent syphilis, and very slow sanitation of the cerebrospinal fluid.

In addition, late latent syphilis is also found in sexual partners or (much more often) they do not have any manifestations of a syphilitic infection (they are practically healthy, and preventive treatment should not be carried out on them as sexual contacts of patients with early latent syphilis). The main goal of specific treatment of patients with late latent syphilis is to prevent the development of late forms of visceral syphilis and syphilis of the nervous system.

Latent (unknown, unspecified) syphilis diagnosed in cases where neither the doctor nor the patient knows when and under what circumstances the infection occurred. In connection with the division of latent syphilis into early and late, this has been observed less and less recently. Establishing such a diagnosis in the absence of clinical and anamnestic data on syphilis confirms the possibility of an asymptomatic latent course of syphilis from the very beginning.

Latent syphilis is a sexually transmitted disease that occurs without obvious clinical signs. History data, the results of a thorough examination and positive specific reactions help to diagnose it. The disease can be recognized by detecting pathological changes in the cerebrospinal fluid. The need for multiple studies and repeated diagnostics after a course of therapy is associated with a high probability of obtaining false-positive reactions.

What is latent syphilis

The diagnosis of “latent syphilis” is made to patients if antibodies to the pallidum spirochete are detected in the laboratory in the absence of specific symptoms characteristic of sexually transmitted infections. Pathology is often discovered during examinations related to other diseases.

The spiral-shaped pale spirochete, when exposed to external unfavorable factors, begins to change to forms that promote survival. The causative agents of syphilis can remain in the lymph nodes and cerebrospinal fluid for a long time without causing any symptoms. When activated, the asymptomatic period is replaced by an exacerbation with a deterioration in the patient’s well-being.

The cause of the formation of cyst forms of spirochetes (treponema) is the incorrect use of antibacterial drugs. Patients often carry out treatment with this group of medications on their own, without a doctor’s prescription, when they notice signs of gonorrhea or other sexually transmitted infections.

The latent form of syphilis has a long incubation period and high resistance to drugs used in the treatment of sexually transmitted diseases. A common route of infection is sexual.

Syphilis can be transmitted through household contact or through the placenta from a woman to her fetus.

Why is it dangerous?

With latent syphilis, the patient can infect a partner during sexual intercourse. The danger lies in the high risk of infection of others when using dishes and cutlery, towels and other hygiene products on which biological fluids can be left. Syphilis detected at the wrong time causes infection of all members of the patient's family.

As the infection progresses, the pathogen spreads through the lymphatic system to the tissue of the liver, brain, and digestive tract, causing serious damage to organs. Pronounced signs of disturbances develop during the transition of the latent phase to the active one. Serious changes occur in the absence of timely treatment against the background of a decrease in the body's defenses. With strong immunity, the patient becomes a carrier of infection.

Classification and forms of latent syphilis

In medical practice, it is customary to classify the disease into the following forms:

Early. It is diagnosed when an infection occurred no more than two years ago.
Late. It is established in case of infection, which has a statute of limitations of ten years.
Unspecified. Placed when it is impossible to determine the time of infection.
Congenital. This form of the disease is determined if the child was infected from a mother with a medical history of diagnosed syphilis, which is asymptomatic.

The latent nature of the infection can take the following forms:

primary, developing without specific symptoms in patients whose therapy was timely but ineffective;
secondary, which occurs during re-infection and does not have specific symptoms;
tertiary, which is given to patients who have suffered an active form of the third phase of syphilis.

Early period

Doctors consider the disease in the early period to be the most dangerous, since uncontrolled infection of the people around the patient, who does not know about his infection, occurs.

The pale spirochete can enter the body of a healthy person not only through sexual contact, but also through household contact.

It is possible to detect an early form of latent syphilis during a preventive examination. A blood test (Wassermann reaction) is performed not only during medical examinations, but during hospitalization for various pathologies. Such studies make it possible to determine the latent form of syphilis. The serological reaction does not show correct results in all cases, and there is a need for other laboratory tests.

During the examination of patients, if an early form of the disease is suspected, the doctor identifies enlarged lymph nodes with characteristic compactions, a rash on the skin, which went unnoticed by patients due to its short duration. These signs may indicate infection with Treponema pallidum. The presence of a pathogenic pathogen in the body is often accompanied by changes in the thyroid gland, liver, joints, and digestive tract. Many patients have symptoms of dysfunction of the nervous system, since microorganisms damage the walls of blood vessels and the structures of the membranes of the brain.

Late period

Late latent syphilis is said to occur when an infection with Treponema pallidum occurred more than two years ago. At this stage, the disease is considered safe for people around the patient. In the late period, no rashes are detected on the skin, while the infection leads to the destruction of internal organs and the nervous system. In many cases, late suppressed syphilis is detected in elderly patients suffering from rheumatoid arthritis, cardiac ischemia or myocarditis.

The disease is indicated by a rash similar to ulcers, signs of osteomyelitis, impaired brain function, changes in the gastrointestinal tract and lungs. Patients may complain of joint pain. Neurosyphilis is diagnosed when the nervous system is affected.

The consequence of late latent disease in the absence of therapy is severe damage to organs and systems that threatens disability.

Symptoms and signs of latent syphilis

Latent forms of syphilis may not affect human health for a long time. The presence of a pathogenic pathogen in the body should be suspected if the following symptoms are present:

Body hyperthermia, which occurs periodically.
Enlarged lymph nodes. Their compaction is observed.
Presence of depressive syndrome for a long time.
The patient's visceral fat decreases and weight loss occurs without obvious reasons.

The primary form of the disease is indicated by the presence of scars and seals on the genitals, the residual phenomenon of polyscleradenitis. Serological studies show positive results in 70% of patients. Low titers are observed in 25% of patients. They decrease after therapy with antibacterial drugs.

During treatment with penicillin drugs, a third of patients experience a Herxheimer-Jarisch reaction, which manifests itself in the form of a sudden increase in temperature, headaches and muscle pain, nausea and tachycardia. This symptomatology occurs due to the massive death of pathogenic microorganisms and decreases when taking aspirin. When meningitis associated with latent syphilis occurs, an increase in protein and a positive reaction to globulin fractions are observed.

Diagnostics

The anamnestic method helps doctors diagnose the latent form of syphilis. When collecting data, the following are taken into account:

suspicious sexual contacts;
the presence in the past of single erosions in the genital area or oral cavity;
rash on the skin;
the use of antibacterial drugs associated with the detection of any disease similar to syphilis;
patient's age.

Difficulties may arise when making a diagnosis. Sometimes patients hide and misinform the doctor due to secrecy. Often the symptoms are similar to other diseases. Obtaining false-positive results can also cause difficulty in diagnosing latent syphilis. A detailed anamnesis plays a big role in determining the form of the disease.

Carrying out specific tests, obtaining indicators of enzyme immunoassay, immunofluorescence reactions help determine the presence of syphilis pathogens in the patient’s body.

The examination includes a consultation with a gastroenterologist, neurologist and proctologist. It is necessary to confirm or exclude damage to organs and systems.

Treatment and prevention

Therapy for latent forms of syphilis is carried out only after obtaining laboratory test data.

Examinations are prescribed to the patient’s sexual partners.

If test results are negative, prophylactic treatment is not required.

Therapy is carried out using the same method as for other forms of syphilis. It is carried out on an outpatient basis with long-acting drugs: benzathine penicillin and benzylpenicillin sodium salt. The occurrence of hyperthermia during treatment with antibacterial drugs means that the disease has been correctly diagnosed. After the temperature rises and the infection dies, the condition of patients usually improves. If the form of syphilis is late, such a reaction is not observed.

Drug dosages:

Penicillin benzathine is prescribed for early latent disease at a dosage of 2.4 million units. once a day. The course is three injections.
The sodium salt of benzylpenicillin is administered when late latent syphilis is detected at a dosage of 600 thousand units. twice a day for a course of 4 weeks. After 14 days, the treatment is repeated.

If the patient exhibits signs of poor tolerance to drugs from the penicillin group, the doctor prescribes tetracycline antibacterial drugs, macrolides, and cephalosporins. Pregnancy is not a contraindication for the use of penicillins, as they are considered safe for the fetus. Therapy during this period is necessary, since congenital syphilis can cause the development of pathologies in a child.

It is important to remember that after a disease has been suffered and completely cured, stable immunity is not developed. To prevent re-infection, preventive measures must be followed. All sexual contacts must be protected. Chaotic intimate life can lead to infection with syphilis and other sexually transmitted diseases. It is necessary to use only personal hygiene items and wash your hands regularly. Every year, doctors recommend donating blood for tests and being examined by a therapist, urologist, gynecologist, or neurologist.

How is the effectiveness of therapy monitored?

At the end of the course of antibacterial drugs, specific tests are performed. Examinations are carried out repeatedly until normal results are obtained. Subsequently, control is carried out two more times after 90 days.

If the disease has a late form and tests show positive results, the period of medical observation is at least three years. The patient undergoes tests once every six months. Deregistration is carried out after receiving normal laboratory test results. With a late latent form of the disease, the results become normal over a long period of time. The patient’s observation ends with a full examination, including not only tests, but also a consultation with a neurologist, ophthalmologist, therapist, and gynecologist.

Permission to work in a child care facility and catering establishment is given only after the complete disappearance of all symptoms and clinical signs of the disease.

Latent syphilis is a dangerous disease that leads to disruption of the functioning of many systems and organs. If suspicious symptoms appear, you should consult a doctor.

Timely detection of infection helps prevent the development of complications.

To avoid infection with syphilis and other sexually transmitted diseases, it is important to follow the rules of prevention.

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 believe is, in fact, 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...

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 RPGA. 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, a complete examination of the patient is carried out again, 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.

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 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.

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.

What is latent unspecified syphilis?

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

At any moment, the latent course can give way to a clinically pronounced one.

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

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.

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?

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

Treatment

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.

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.

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

At the end of the observation, a complete examination of the patient is carried out again, examined by a therapist, neurologist, otorhinolaryngologist and ophthalmologist.

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 condition when, in the absence of clinical manifestations of the disease, positive serological reactions are detected in the patient’s blood. Treatment of such patients is aimed at serological negativity (obtaining negative serological reactions) and preventing the development of relapses of the disease.

Latent (latent) syphilis occurs in patients who in the past had active manifestations of the disease, which resolved independently or under the influence of specific treatment.

In some cases, this condition represents a special form of asymptomatic syphilis from the moment the patient is infected. A correctly collected anamnesis (history of the disease) and a number of other indirect signs provide significant assistance in making a diagnosis.

Rice. 1. Manifestations of the disease in women during the primary period of the disease are multiple hard chancre (photo on the left) and hard chancre in the form of inductive edema (photo on the right).

Current state of the problem

According to some authors, the number of patients with latent forms of syphilis has increased 2-5 times in the last decade. Increasingly, it becomes difficult for a doctor to determine the timing of the disease, and the patient’s sexual relations are often random. The only method for detecting syphilis in such cases remains serological diagnosis.

In our country, a method is used to actively identify patients with syphilis during preventive examinations in clinics and hospitals, antenatal clinics and blood transfusion centers, for which a number of treponemal tests are also used. Thanks to this work, up to 90% of patients with latent forms of the disease are identified during preventive examinations.

Reasons for the increase in the number of patients:

a true increase in the number of patients with latent syphilis;
improvement of serological diagnostic methods;
widespread uncontrolled use of antibiotics in the treatment of various diseases.

The possibility of asymptomatic syphilis is now recognized.

Serological reactions for latent forms of the disease are the only criterion for confirming the diagnosis.

Rice. 2. Manifestations of the disease in men in the primary period are a single hard chancre (photo on the left) and multiple hard chancre (photo on the right).

Forms of latent syphilis

If, from the moment of infection, syphilis takes a latent (latent) course (is asymptomatic), but with positive specific serological reactions, they speak of a latent form of the disease. Latent syphilis in most cases is detected accidentally when performing specific serological tests. In some cases, the doctor manages to find out which period of the disease it belongs to:

if the patient had previously recorded chancroid, but did not appear, then they speak of the latent period of primary syphilis;
the latent period identified after the appearance of secondary syphilides and in the case of recurrent syphilis refers to the secondary period of the disease;
there is also a hidden period.

Such a division of latent periods of the disease is not always possible, therefore in venereological practice it is established to distinguish between early, late and unspecified latent periods.

Diagnosis early latent syphilis is established if more than 2 years have not passed since the infection. From an epidemiological perspective, this category of patients poses the greatest danger.
Diagnosis late latent syphilis is established if more than 2 years have passed since the infection.
Latent unspecified syphilis- this is a condition when, in the absence of anamnestic data and clinical manifestations of the disease, positive serological reactions are detected in the blood of a previously untreated patient.

Rice. 3. Manifestations of the disease in the secondary period - papular syphilide on the face and palms.

Early latent syphilis

Early latent syphilis includes the period from the moment of infection until the secondary relapse period (on average up to two years). During this period, patients may experience manifestations of a highly contagious disease. A number of anti-epidemic measures are being taken against them. The main ones:

isolation of the patient,
examination of sexual partners and household contacts,
compulsory treatment (according to indications).

Who is sick

Early latent syphilis is recorded mainly in persons under the age of 40 years. Most of them have no control over their sexual desire. They are prone to numerous casual sexual relationships, which in epidemic conditions leads to the inevitable development of the disease. Absolute proof of a case of latent syphilis is the establishment of an active form of the disease in a sexual partner.

What to find out during the survey

When carefully collecting anamnesis, it is necessary to pay attention to erosive-ulcerative rashes on the genitals, lips, mouth, skin, episodes of hair loss on the head, eyebrows and eyelashes, and the appearance of age spots on the neck over the past 2 years. It is also necessary to find out whether the patient took antibiotics or not, whether or not he was treated for gonorrhea.

Signs and symptoms of early latent syphilis

A scar or lump on the genitals revealed during a clinical examination and often the presence of enlarged regional lymph nodes, as well as residual effects of polyscleradenitis, may indicate a history of primary syphilis.
In 75% of patients in the latent early period of the disease, sharply positive serological reactions are observed (1:160), a low titer (1:5:20) is observed in 20% of patients. In 100% of cases, a positive RIF is noted. In 30 - 40% of cases, a positive RIBT is noted. When treating concomitant diseases with antibiotics, the titers of serological reactions decrease.
In 1/3 of patients treated with penicillin, a Herxheimer-Jarisch reaction is observed, which is characterized by a sudden increase in body temperature, headache and muscle pain, vomiting, and tachycardia. This phenomenon is due to the massive death of pathogens. Symptoms are quickly relieved with aspirin.
In the case of the development of latent syphilitic meningitis, an increased amount of protein, (+) reactions to globulin fractions and cytosis are noted in the cerebrospinal fluid. With specific treatment, the cerebrospinal fluid is quickly sanitized.

Treatment of early latent syphilis

Treatment of early latent syphilis is carried out according to approved instructions and is aimed at quickly destroying pathogens in the patient’s body. With specific treatment, negativity of seroreactions occurs quite quickly. The extinction and complete negation of specific serological reactions in latent syphilis are the only criterion for confirming the effectiveness of the treatment.

Timely identification of patients during the period of early latent syphilis and adequate comprehensive treatment have a beneficial effect on the prognosis of the disease.

Rice. 4. Manifestations of the disease in the secondary period - syphilitic roseola.

Late latent syphilis

The diagnosis of late latent syphilis is established in patients whose infection is more than 2 years old, there are no clinical manifestations of the disease and positive serological reactions are recorded. Basically, such patients are identified during preventive examinations (up to 99%), including during examination to identify a patient with late forms of syphilis in the family (1%).

Who is sick

The disease is detected mainly in people over 40 years of age (up to 70%). Of these, about 65% are married.

What to find out when interviewing a patient

When interviewing the patient, it is necessary to find out the timing of possible infection and the presence of signs indicating manifestations of infectious syphilis in the past. Often the anamnesis remains uninformative.

Signs and symptoms of late latent syphilis

During the examination, it is not possible to identify traces of previously resolved syphilides. During the examination, there are no signs of specific damage to internal organs and the nervous system.
When diagnosing late latent syphilis, serological reactions such as RIF, ELISA, RPGA and RITT are used. The reagin titer is usually low and ranges from 1:5 to 1:20 (in 90% of cases). In rare cases, high titers are observed - 1:160:480 (in 10% of cases). RIF and RIBT are always positive.

Sometimes serological tests have to be repeated after several months.

In patients with late latent syphilis, whose age ranges from 50 to 60 years, there are a number of concomitant diseases that cause the appearance of false-positive serological reactions.

There is no Herxheimer-Jarisch reaction to antibiotics.
Late latent meningitis is rare in such patients. In the cerebrospinal fluid, when specific meningitis is detected, a weakly expressed inflammatory component is noted - low cytosis and protein level, signs of a degenerative component predominate - a positive Wasserman reaction and Lange reaction. During the period of specific treatment, sanitation of the cerebrospinal fluid occurs slowly.

Treatment of late latent syphilis

Treatment of late latent syphilis is carried out according to approved instructions and is aimed at preventing the development of specific damage to internal organs and the nervous system. Patients should be consulted by a neurologist and therapist. During the period of specific treatment, the negativity of seroreactions occurs extremely slowly. In some cases, after full-fledged specific treatment, serological reactions remain positive.

The extinction and complete disappearance of specific serological reactions in latent syphilis is the only criterion for confirming the effectiveness of the treatment.

Rice. 5. Manifestations of the disease in the tertiary period are gumma of the face and gummatous infiltration of the hand.

Latent unspecified syphilis

In the absence of information about the circumstances and timing of infection and the presence of positive results of serological tests, a diagnosis of latent unspecified syphilis is established. Such patients are subject to thorough clinical and serological examination, often multiple times. Testing RIF, RIF-abs and RIBT, ELISA and RPGA are mandatory.

You should be aware that in patients with late and unspecified syphilis, false-positive nonspecific serological reactions are often detected. Antibodies-reagins produced against the cardiolipin antigen appear in the blood of patients with collagenosis, hepatitis, kidney disease, thyrotoxicosis, cancer and infectious diseases such as leprosy, tuberculosis, brucellosis, malaria, typhus and scarlet fever, during pregnancy and menstrual cycles, when taken fatty foods and alcohol, in patients with diabetes, myocardial infarction and concussion. It has been noted that the number of false-positive reactions increases with age.

Rice. 6. Gummous infiltration of the buttock and parapapillary zone in the tertiary period of the disease.