Latent syphilis - symptoms of the disease, prevention and treatment of Latent syphilis, causes of the disease and its diagnosis on EUROLAB. How to treat and what are the dangers of latent forms of 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, 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, and the diagnosis can be clarified during the examination and treatment.

What provokes / Causes of 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 an average of 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. i.e. during the period of presence of treponema 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 filtering forms of pale treponema was assumed.

Outside the body, pale treponema is very sensitive to external influences, chemicals, drying, heating, and exposure to sunlight. On household items, Treponema pallidum retains its virulence until it dries. The temperature of 40-42°C first increases the activity of treponemas, 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 storage of treponemas in an anoxic environment at -20 to -70°C or dried from a frozen state is currently the accepted method of preserving pathogenic strains.

Pathogenesis (what happens?) during Latent syphilis:

The reaction of the patient's body to the introduction of pale treponema is complex, diverse and insufficiently studied. Infection occurs as a result of the penetration of pale treponema through the skin or mucous membrane, the integrity of which is usually broken. However, a number of authors admit the possibility of introducing treponema through an intact mucosa. At the same time, it is known that in the blood serum of healthy individuals there are factors that have immobilizing activity in relation to pale treponema. Along with other factors, they make it possible to explain why contact with a sick person does not always cause infection. Domestic syphilidologist M.V. Milic, 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 latent syphilis:

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.;
results of the confrontation (examination of the person who had sexual contact with the patient and identification of an early form of syphilis);
detection of a scar or compaction at the site of primary syphiloma, enlarged (usually inguinal) lymph nodes, clinically corresponding to regional scleradenitis;
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);
temperature reaction of exacerbation at the beginning of penicillin therapy;
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;
a sharply positive result of RIF in these patients, although RIBT in some patients may still be negative;
the age of patients is often up to 40 years;
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:

medical history data (if the patient indicates that he could have become infected from some source more than 2 years ago);
low titer of reagins (1:5, 1:10, 1:20) with strongly positive results according to classical serological reactions (CSR) or weakly positive results according to CSR (with confirmation in both cases by RIF, RITT and RPGA);
negation of serological reactions towards the middle or end of specific treatment, as well as often the absence of negation of CSR, RIF, RITT, despite vigorous antisyphilitic treatment using nonspecific agents;
absence of an exacerbation reaction at the beginning of penicillin therapy (it is preferable to start treatment of such patients with preparation - iodine preparations, bijoquinol);
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.

Hidden (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.

Treatment of Latent Syphilis:

According to existing instructions and treatment regimens for syphilis, all patients with early latent syphilis undergo the same treatment. In cases where, through history or confrontation data, it is possible to establish how long ago the infection has existed, the outcome of the disease can be predicted (naturally, the shorter the duration of the disease, the more favorable the prognosis and outcome of therapy).

Which doctors should you contact if you have Latent syphilis:

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Latent syphilis is a dangerous disease that has recently been detected in more people. The greatest danger of this disease is that a person does not know that he is infected with this terrible disease until the most active manifestation of the disease. At the same time, his health does not deteriorate and he continues to lead an active lifestyle, while the disease in his body is actively progressing.

It is difficult to diagnose latent syphilis. It is mainly detected during a medical examination or when a patient comes to the doctor with complaints of a disease of a completely different nature.

Latent syphilis is a very insidious disease, which in its symptoms is similar to such unsafe and common sexually transmitted diseases for human health as chlamydia or gonorrhea. Often, a person infected with a latent form of syphilis exhibits signs characteristic of stomatitis, sore throat or a common cold.

Causes

One of the main reasons for the prevalence of latent syphilis among ordinary people is the illiteracy of people and their not entirely adequate attitude towards their health. The fact is that a person, suspecting that he has a cold or the initial stage of developing a sore throat, without prior consultation with a specialist, begins to uncontrollably take antibiotics. But these medications hide the main symptoms of syphilis. In other words, syphilis is not cured, but heals and proceeds in a latent form.

The main causative agent of the disease is pale treponema. If you observe it under a microscope, you can see that this microorganism has the shape of a spiral. This organism is very mobile and is capable of making pendulum-like, translational movements or movements around an axis.

A person becomes infected mainly through unprotected sexual contact, but many cases of infection have also been registered through domestic means.

Currently, the latent form of syphilis is becoming increasingly popular. Like many other sexually transmitted diseases, this type of disease is characterized by an incubation period that does not manifest itself in any way. The clinical picture does not change even after its completion. The only option for determining the presence of this disease in the human body is serological tests with a positive response. Also, some people with latent syphilis may develop some skin rashes.

Classification

It should be noted that the latent form of syphilis is divided into several subtypes:

early latent syphilis;
late;
unspecified.

Typically, the early form of latent syphilis is detected within 2 years after infection. This form is considered the most dangerous, since an infected person poses a danger to others. After all, not only his sexual partners, but also people living with him under the same roof can become infected with this disease.

This disease is mainly discovered during medical examinations or during an examination of a patient who has complaints of a completely different disease. The Wasserman reaction is carried out, however, this study does not always give an accurate answer, so the patient is also subjected to a number of other additional laboratory and clinical examinations.

During a clinical examination, enlarged and somewhat dense lymph nodes are often found on the patient’s body. During the consultation, patients suddenly begin to remember that at a certain period of time rashes appeared on their body, which went away on their own. All these symptoms indicate the presence of the causative agent of latent syphilis in the patient’s body.

In some cases, early latent syphilis affects internal organs, such as:

liver;
stomach;
thyroid;
joints.

The central nervous system can also be affected by early latent syphilis. The nervous system, and in particular the lining of the brain and the walls of blood vessels, is affected within 5 years after the moment of infection.

Late form

The form of syphilis detected in a person after 2 years from the moment of infection is usually called late. This type of latent syphilis does not pose such a strong danger to the environment as the early form. Basically, late syphilis affects internal organs and in most cases does not manifest itself as skin rashes.

Most often, the late form of the disease described is diagnosed in people 50 years of age and older. However, it is somewhat difficult for doctors to make such a diagnosis in this group of people, since the accompanying diseases in this case are rheumatoid arthritis and many others. These diseases are the main reasons why blood reactions are false positive.

People infected with the late form of latent syphilis often complain of symptoms characteristic of heart or heart disease, and these are:

aortitis;
myocarditis;
ischemic disease.

Latent late syphilis is mainly manifested by the following symptoms:

the presence of a rash on the skin in the form of tubercles or ulcers;
impaired functioning of the brain or the entire nervous system;
the presence of diseases such as osteomyelitis or osteoperiostitis;
pathology of the intestines, lungs or stomach;
clinical manifestations of hepatitis.

A person with late latent syphilis often experiences severe pain in the lower extremities associated with damage to the skeletal system.

Neurosyphilis or syphilis of the nervous system mainly manifests itself in the form of syphilitic meningitis, which does not differ in particular symptoms. Sometimes a person experiences headaches or hearing loss. However, if left untreated, it can soon develop into more severe forms.

An unspecified form of latent syphilis is a type of disease when the time of infection cannot be determined.

All of the above forms of the disease still manifest themselves with a clear clinical picture over time.

Diagnostics

Before starting treatment for a latent form of syphilis, it is very important for a person suspected of having this disease to undergo a complete diagnosis. To do this, he needs to provide the venereologist with complete information about his sexual partners. The doctor also needs to determine the presence of single erosions in the genital area, mouth or on the skin.

When diagnosing a disease, it is important to take into account the patient’s age and lifestyle.

When diagnosing, it is very important to examine not only the patient himself, but also his sexual partner. In this way, early latent syphilis can be detected. The main confirmation of the presence of the disease is serological reactions.

Sometimes it is very difficult for health workers to identify diseases due to recent bronchitis, chronic cystitis, hepatitis, pulmonary tuberculosis or rheumatism.

A patient with a suspected latent form of syphilis is advised not only by a venereologist. The patient needs to contact a neurologist and gastroenterologist to exclude the possibility of damage to internal organs or the presence of disorders of the central nervous system.

Symptoms

Latent syphilis does not manifest itself in any way. However, latent syphilis has several common signs that accompany the course of the disease:

constant increase in body temperature;
swollen lymph nodes;
constant weakness;
apathy;
unreasonable weight loss.

Probably, it is not worth reminding that all these symptoms can indicate the presence of other diseases.

Treatment methods

Treatment of the latent form of syphilis should be started only after the diagnosis has been confirmed. It is carried out using antibiotics of the penicillin group. If treatment began at the initial stage of the development of the disease, then somewhere by the end of the second course of therapy, an improvement is noticeable. It is much more difficult to treat more advanced forms.

A significant increase in body temperature at the beginning of the course of treatment speaks only about the effectiveness of therapy. Fever is a sign that harmful microorganisms are rapidly being destroyed. Over time, this unpleasant symptom also passes.

After completing the course of treatment, it is necessary to continue to undergo full examinations with a doctor. It is very important to carry out serological control and this will last until the indicators of this analysis return to normal.

Complications and prevention

Latent syphilis is also dangerous due to its possible serious complications. Untimely treatment of this disease can lead to an even greater spread of infection throughout the body and damage to internal organs. If there is a temporary improvement, the disease continues to progress in its development.

Complications of the early form of syphilis are:

severe damage to the optic and auditory nerves occurs, which leads to blindness and deafness;
the functionality of many internal organs is impaired.

If the late form of syphilis is not treated, the following may occur:

sclerosis of lung tissue;
suppurative process in the lungs.

Preventing syphilis is one of the effective ways to avoid infection.
You should choose your partner carefully and very carefully. It is recommended in any case to use protective equipment.

If contact does occur, after sexual intercourse the contact areas should be treated with an antiseptic or antibiotic. Also, do not use general hygiene products.

Be healthy!

In our country, the spread of syphilis was first noted in the mid-15th century. This was due to insufficient medical care and illiteracy of the people.

Classification

Typically, latent syphilis is classified into several forms depending on the severity of symptoms:

Primary.
Secondary.Tertiary.
- Secondary early hidden.
- Secondary late latent syphilis.
Congenital.

Primary syphilis has the most pronounced property to be transmitted from sick people to healthy people through direct contact. Severe forms have a lower degree of infection, but changes in human systems are already becoming clearly visible.

How is it transmitted

Syphilis is a sexually transmitted disease. As a rule, transmission is carried out from a sick person to a healthy person through sexual contact, but there are other ways. The main factors for the existence of a microorganism are humidity, anaerobicity and the required temperature. It is quite possible to get infected through the blood when it gets on the mucous membranes of another person or when it is transfused.

Important. Infection can also occur when using common dishes, towels and other household items, if a person has ulcers on the body. Bacteria are not detected in urine or sweat tests.

Stages of development

From the moment of infection to the appearance of the first symptoms, a little less than a month passes. There are four stages in the development of a microbe and the immune response to it:

Incubation.
Primary.
Secondary.
Tertiary.

The period of reproduction of microorganisms does not reveal itself in any way; symptoms begin to clearly manifest themselves from the primary stage of development.

Note. This time is four weeks, but it can decrease or increase depending on the amount of the source of infection. The bacterium divides once every 30 hours, which explains the rather long period before pathology manifests itself. In addition, the use of antibiotics can increase this time.

Hard chancre (ulcers that do not cause discomfort) are a sign of the primary stage of development of the disease. This period lasts 6-7 weeks. In addition to the appearance of chancre and rashes, patients have enlarged lymph nodes and vessels that conduct lymph in places close to the source of penetration.

Hard chancre - the primary stage of development of syphilis

The stage of reproduction of syphilis is usually divided into:

gray-negative;
sero-positive.

They differ in the manifestations of the Wasserman reaction and enzyme immunoassay, respectively negative or positive.

At the second stage of development, the disease affects the nervous system, and a rash on the skin and mucous membranes is also noted.

Here they highlight:

early;
returnable;
latent syphilis.

At an early stage, the pathogen manifests itself as a rash. But at this time, other organs are also damaged: liver, kidneys, bones, central nervous system.

Spots on the skin indicate that the body is fighting the infection, but cannot be completely cured, which leads to a latent form of syphilis.

Important. This period is different in that obvious symptoms disappear, patients with latent syphilis look healthy, but there are still bacteria inside them; the development of a relapse will occur as soon as the immune system fails even a little.

If proper treatment has not been carried out for one to two decades, the third and final form begins to develop. All organs and systems are affected here. Externally it manifests itself in the form of syphilitic gummas (nodules in tissues that irreversibly destroy them and can form both on the skin and in internal organs, as well as bones). Manifestations are cyclical, it depends on the immune system. As a rule, when the body becomes hypothermic, it decreases, and at such moments the disease manifests itself. The microbe is often localized in one of the systems or organs.

In the late stage of latent syphilis, all organs and systems of the patient are affected

Thanks to the use of antibiotics, the tertiary stage has become increasingly rare. It also happens that it does not occur at all after the usual passage of the first and second phases. Strong immunity may indicate this. Over a certain period of time, the immune system is able to remove the infection from the body, so that conventional research methods are not able to detect it due to the insignificant amount of harmful microorganisms in the tissues. But with a slight deviation in immunity, the infection will begin to manifest itself again. Such a person becomes its carrier.

Symptoms of latent syphilis

Signs of the disease depend on the length of time the microbe remains inside the body and on the correctness of the treatment. Each phase is very different from each other.

Primary phase

It is characterized by the appearance of painless ulcers in the area closest to the source of bacterial penetration. As a rule, they are dense, regularly rounded, single, and do not increase in volume or diameter. This symptom is part of a defense mechanism against infection. There are other options for symptoms:

Indurative edema. Occurs in case of sexual transmission. Changes in size and skin color occur in men - on the scrotum, in women - in the vagina. The epidermis in such areas becomes blue, and pain does not occur when pressed. The phenomenon may persist for a month. It occurs much more often in women than in men. Edema can also form in other diseases, which makes diagnosis difficult. A blood test and examination of the patient for an increase in the number of lymphocytes can help with this.
Chancre-felon. It is an abscess on the fingers near the nails. It most often occurs among physicians operating on patients. This type of peculiar ulcer causes a lot of inconvenience, in addition to aesthetic ones, it hurts. A sick doctor can no longer work. In addition, there is a tendency for the formation to spread to the organs responsible for reproduction.
Chancroid-amygdalitis. Pathology forms in the oral cavity - this is an increase in one of the accumulations of lymphoid tissue. In addition, the patient suffers from fever and, naturally, pain when swallowing. Unlike tonsillitis, only one side is affected and the mucous membrane remains smooth.

There are other types of surface formations. For example, when simultaneously infected with another virus, chancre takes on a different appearance. They may bleed, have an uneven frame and bottom. In such a situation, it is difficult to understand the origin of education. But there is always a sign of enlarged lymph nodes, which you should pay attention to when testing your blood for the presence of a microorganism.

Enlarged lymph nodes may be a sign of latent syphilis.

At the end of the stage, external symptoms go away, a person may feel general malaise, fever, and weakness.

Secondary

Characterized by skin rashes. Lymph nodes are cold, enlarged, dense. Here the patient feels the usual symptoms for an infectious disease. It also happens that there are no rashes, and even worse if the stage does not manifest itself at all. In this case, outwardly the patient will look like he has a cold, and the main virus will become chronic.

The latent period of syphilis lasts several days, rarely up to 7-14 days. After which the symptoms disappear.

Important. In the first two to three years, the manifestation of early syphilis begins with damage to the central nervous system. Pathological changes occur in the upper layers of the brain and blood vessels. When the immune system acts, a barrier is created in the meninges and thickening of the layers of blood vessels by growing their inner wall. At the same time, nodular, collapsing tissues form in them.

Inflammation in the head and impaired reaction of the eyes to light are often detected. Less commonly - neuritis, polyneuritis, meningoencephalitis. With latent syphilis, there may be a disturbance in the eye's reaction to light.

Diagnosis of this stage is complicated by the similarity of symptoms with other infections.

Tertiary

It is distinguished by the absence of external signs. The person is a carrier of the infection, but he himself looks healthy.

Important. The stage of late syphilis can last more than two decades. But sooner or later the disease makes itself known: with a multitude of destructive pathologies in different systems, which are gummas.

This period was classified in the mid-twentieth century:

Asymptomatic.
Syphilitic meningitis.
Meningovascular.
Cerebral.
Spinal.
Parenchymatous.
Progressive paralysis.
Tabes dorsalis.
Taboparalysis.
Optic nerve atrophy.
Gummy.
Gumma of the brain.
Gumma of the spinal cord.

The most common is the asymptomatic late form, spreading to the central nervous system. It accounts for more than 30 percent of cases. The second most common condition is spinal sicca.

All the types given above develop after a long stay in the body of an infection that does not reveal itself in any way. Meningitis develops after two years, the rest - 15 years or more.

The clinical course is different, but there are similarities: dysfunction of the central nervous system, decreased memory and attention, inability to think logically, paralysis, paresis.

Latent syphilis during pregnancy

If latent syphilis is not properly treated during pregnancy, it can be transmitted to the child. In a newborn, changes occur at the stage of formation of vital tissues, so the body does not recover. The following signs are noted:

parenchymal keratitis;
deafness;
Hutchinson's teeth.

Important. In other cases, either early birth or death occurs in utero.

Diagnostic methods

Pathology in obvious forms is clearly visible, it is easy to identify it and guess what kind of illness is tormenting the patient. In their absence, serodiagnostic studies come to the rescue (recognizing the reaction when mixing the blood serum of an infected person and a reagent).

Methods for diagnosing latent syphilis are usually divided into:

Direct.
Indirect.

The first include microscopy, infection of rabbits with material, culture, and PCR diagnostics. Several types of methods are used per patient, each individually cannot give an accurate result. They have their drawbacks: they take a long time, cannot be detected at certain stages, or they are expensive. Therefore, serological techniques are used.

This includes various reactions of human blood to the proposed reagents. None of the indirect methods can give an accurate answer to the presence of a microbe, and therefore diagnosis is made only after two or more methods have been carried out.

Treatment

Important. The bacterium that causes this disorder remains one of the few microorganisms that cannot protect itself from penicillin. Therefore, therapy with this substance works great in our time. Taking the right dose of medicine over a long period of time helps to completely rid the body of the infection.

Erythromycin is another drug with the same effect, it is used for patient allergic reactions to penicillin drugs.

Penicillin is the most effective treatment for syphilis.

Treatment of late latent syphilis is carried out with penicillin in combination with antibacterial drugs, which are administered into the muscles and orally.

Note. In the head section, as mentioned above, a barrier is formed that seems to protect the brain from the virus, but this same formation does not allow the healing substance to penetrate into the desired areas. This is facilitated by additional medications that are administered endolumbarally. But there is a problem - a shortage of specialized doctors.

How to treat latent syphilis if triponema is resistant to antibacterial drugs? It is allowed to use hard-to-reach mixtures with bismuth or arsenic.

Forecast

With the methods of treatment and prevention offered now, the disease is completely curable. But do not delay this, because after a certain period of time, the changes may be irreparable. The same prognosis applies to women during pregnancy with latent syphilis. After all, already in the womb, the baby receives pathological changes that remain with him forever.

Syphilis is an insidious disease, usually within three to four weeks a person infected with a pale spirochete does not even know about the disease.

If during the normal course of the disease after the incubation period the first symptoms can be detected: chancroid, enlarged lymph nodes, then in the latent form it does not manifest itself in any way, but tests for syphilis give a positive result.

There are three forms of latent syphilis:

Early;
Late;
Undifferentiated.

If less than two years have passed since infection, an early form is diagnosed. If the disease is detected after this period, then a late form is diagnosed. But when the infected person cannot accurately remember the moment of infection, and as a result of research it is impossible to determine early or late syphilis in the patient, then they speak of an undifferentiated form.

The most dangerous form of syphilis for others is considered to be early. During this period, the patient is an active source of infection. If the disease has progressed to a late form, then the risk of infecting others is significantly reduced, in most cases, completely absent.

In the early form of syphilis, the primary signs either do not appear at all or are expressed so implicitly that the person does not pay attention to them. This is often due to the fact that the patient took antibiotics to treat other diseases during the incubation period. In this case, doses of antibiotics do not destroy the pale spirochete, but only delay its development and distort the course of the disease.

Also, unfavorable environmental factors and self-medication also influence changes in spirochetes. Unfortunately, uncontrolled use of antibiotics has led to an increase in latent forms, which contributes to the spread of the disease.

Symptoms

With early latent syphilis, the manifestation of the first symptoms of the disease, such as the appearance of chancre, rashes, and enlarged lymph nodes, may be absent or be so small that the patient does not notice them. Usually, if symptoms appear, they go away on their own and quickly.

Sometimes a person mistakes this form of syphilis for another disease and begins to self-medicate, which aggravates the course of the disease.

You should consult a doctor if you have had casual sex in the past two years, after which:

Small hard abrasions and sores appear, completely clean and not painful;
Periodically, the body temperature rises to subfebrile, while no obvious catarrhal symptoms are observed. Usually this temperature lasts for several days;
General malaise, anemia, asymptomatic weight loss, loss of strength;
Headaches and bone pains that worsen during sleep;
Enlarged lymph nodes that do not hurt or suppurate;
The manifestation of an atypical reaction for you to penicillin drugs, such as vomiting, migraine, tachycardia, increased body temperature. In this case, the symptoms disappear after taking regular aspirin.

But even these manifestations cannot indicate the presence of the disease; laboratory tests are required to make a diagnosis. Very often, early latent syphilis is discovered completely by accident, when taking tests for a hospital, obtaining a medical certificate, or registering during pregnancy.

Diagnostics

To make a correct diagnosis, it is important to collect as complete an anamnesis as possible over the past two years. In this case, clarify the following from the patient:

Have you done serological tests and what are their results?
Have rashes, ulcers appeared on the genitals, on mucous surfaces in the mouth;
Have you taken antibiotics?
Have you been treated for .

A visual examination of the patient is carried out for the presence of hard chancre, residual effects of polyscleradenitis, and enlarged lymph nodes.

The Wasserman test is mandatory; if the result is positive, additional tests are performed. Because in some cases it can be positive even in the absence of disease. To confirm the diagnosis, a positive result from several serological tests is required. Such as:

Enzyme-linked immunosorbent assay (ELISA);
Poor trepanema immunization response (RIBT);
Immunofluorescence reaction (RIF);
Passive hemagglutination reaction (PHA).

Moreover, in early syphilis, most patients have very high titers. In almost all patients with this form of syphilis, the RIF reaction will be positive.

Sometimes in the early phase of latent syphilis, reactions may be negative if other signs are present. In this case, for timely recognition of the disease, a cerebrospinal fluid analysis is taken.

Treatment

The earlier latent syphilis is diagnosed, the higher the chances of a positive result. Treatment is carried out under strict medical supervision according to approved schemes and instructions. Usually the patient is admitted to a hospital, but treatment can also be carried out on an outpatient basis.

Therapeutic treatment includes taking antibiotics, immunomodulators, antipyretics, and anti-inflammatory drugs.

Prevention

To reduce the risk of disease, it is necessary to take a responsible approach to the choice of sexual partners. In case of casual relationships, do not allow sexual intercourse without using condoms. Do not use other people's personal hygiene items.

To prevent illness, it is important to closely monitor your health. Undergo medical examination once a year to study titers for syphilis. In case of a positive reaction, you should contact a venereologist as soon as possible. Do not use antibiotics without medical prescription.

If you have had sexual contact with a person with syphilis, you should consult a doctor within a week for preventive treatment. When a disease is detected, all sexual partners of the patient and their family members must be examined.

You should not engage in treatment yourself, as if the therapy is not selected correctly, the disease can become chronic. And then it will be very difficult to cure syphilis.

It is also important to be sure that there is no hidden form of the disease when planning pregnancy, since in most cases this causes miscarriage, premature birth, and the birth of babies with developmental anomalies and congenital syphilis.

A common sexually transmitted disease, syphilis, is caused by a microorganism called spirochete pallidum. It has several stages of development, as well as many clinical manifestations. In Russia, at the end of the 90s of the twentieth century, a real epidemic of this disease began, when 277 people out of 100 thousand people fell ill per year. The incidence is gradually decreasing, but the problem remains relevant.

In some cases, a latent form of syphilis is observed, in which there are no external manifestations of the disease.

Why does latent syphilis occur?

The causative agent of the disease, the pale spirochete, under normal conditions has a typical spiral shape. However, under unfavorable environmental factors, it forms forms that promote survival - cyst and L-forms. These modified treponemes can persist for a long time in the lymph nodes of an infected person, his cerebrospinal fluid, without causing any signs of illness. Then they are activated, and a relapse of the disease occurs. These forms are formed due to improper treatment with antibiotics, the individual characteristics of the patient and other factors. A particularly important role is played by patients’ self-medication for a disease that they 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.

Usually 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 a 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 test of cerebrospinal fluid (cerebrospinal fluid). It is diagnosed using serological tests.

Latent late syphilis is characterized by a 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 revealed, most likely, 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 terms, 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 its long course without symptoms is observed, ending several years after infection with syphilis of the brain, nerves, or internal tissues and organs. 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 substance of the bone 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 may result from damage to the 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 definitely donate blood for ELISA and RPHA. If the diagnosis of "latent syphilis" is confirmed, she is prescribed treatment according to general schemes. Lack of therapy entails serious consequences for the child: congenital deformities, abortion and many others.

If the disease is cured before 20 weeks of pregnancy, childbirth proceeds as usual. If treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many associated factors.

Treatment

Specific treatment is prescribed only after laboratory confirmation of the diagnosis. The sexual partners of the sick person are examined; if their laboratory tests are negative, then preventive treatment is not prescribed to them.

Treatment of latent syphilis is carried out according to the same rules as its other forms.

Long-acting medications are used - benzathine penicillin, as well as benzylpenicillin sodium salt.

Fever at the beginning of penicillin therapy is indirect evidence of a correctly established diagnosis. It accompanies the massive death of microorganisms and the release of their toxins into the blood. Then the patients’ well-being returns to normal. In the late form, such a reaction may be absent.

How to treat latent syphilis:

in the early form, Benzathine penicillin G is administered at a dose of 2,400,000 units, two-step, into the muscle once a day, a total of 3 injections;
in the late form: Benzylpenicillin sodium salt is injected into the muscle at 600 thousand units. twice a day for 28 days, two weeks later the same course is carried out for another 14 days.

If these antibiotics are intolerant, semisynthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.

Latent syphilis during pregnancy is treated according to general rules, since drugs of the penicillin group are not dangerous to the fetus.

Monitoring the effectiveness of treatment

After treatment of early latent syphilis, serological control (ELISA, RPGA) is carried out regularly until the indicators are completely normalized, and then twice more with an interval of three months.

For late latent syphilis, if RPGA and ELISA remain positive, the period of clinical observation is 3 years. Tests are carried out every six months, and the decision to deregister is made based on a set of clinical and laboratory data. Typically, in the late stages of the disease, the restoration of normal blood and cerebrospinal fluid parameters occurs very slowly.

At the end of the observation, the patient is once again fully examined by a therapist, neurologist, otorhinolaryngologist and ophthalmologist.

After all clinical and laboratory manifestations of the disease have disappeared, patients can be allowed to work in child care institutions and catering establishments. But once the disease has been suffered and cured, it does not leave lasting immunity, so re-infection is possible.