Latent syphilis (early, late): photo, causes and treatment. How to treat and why hidden forms of syphilis are dangerous

What is Latent Syphilis
Symptoms of Latent Syphilis
Diagnosis of latent syphilis
Treatment of Latent Syphilis
Which Doctors Should You See 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. Latent 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 causes latent syphilis

The causative agent of syphilis is pale treponema (Treponema pallidum) belonging to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically pale treponema (pallid spirochete) differs from saprophytic spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under the microscope, treponema pallidum is a spiral-shaped microorganism resembling 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, the thickness is 0.2-0.5 microns. Pale treponema 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 structure of the morphological structure of pale treponema was revealed. It turned out that treponema is covered with a powerful cover of a three-layer membrane, cell wall and mucopolysaccharide capsule-like substance. Fibrils are located under the cytoplasmic membrane - thin threads that have a complex structure and cause diverse movement. Fibrils are attached to the terminal coils and individual sections of the cytoplasmic cylinder with the help of blepharoplasts. The cytoplasm is finely granular, containing the nuclear vacuole, nucleolus, and mesosomes. It has been established that various influences of exogenous and endogenous factors (in particular, previously used arsenic preparations, and currently antibiotics) had an effect on treponema pallidum, changing some of its biological properties. So, it turned out that pale treponemas can turn into cysts, spores, L-forms, grains, which, with a decrease in the activity of the patient's immune reserves, can reverse into spiral virulent varieties and cause active manifestations of the disease. Antigenic mosaicity of pale treponemas is proved by the presence of multiple antibodies in the blood serum of patients with syphilis: protein, complement-fixing, polysaccharide, reagins, immobilisins, agglutinins, lipoid, etc.

With the help of an electron microscope, it was found that pale treponema in lesions is more often located in intercellular gaps, 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 treponema occurs with symptoms of septicemia. In the process of phagocytosis, a state of endocytobiosis often occurs, in which treponemas in leukocytes are enclosed in a polymembrane phagosome. The fact that treponemas are contained in polymembrane phagosomes is a very unfavorable phenomenon, since, being in a state of endocytobiosis, pale treponemas persist for a long time, protected from the effects of antibodies and antibiotics. At the same time, the cell in which such a phagosome was formed, as it were, protects the body from the spread of infection and the progression of the disease. This unsteady balance can be maintained for a long time, characterizing the latent (hidden) course of a syphilitic infection.

Experimental observations of N.M. Ovchinnikov and V.V. Delektorsky are consistent with the works of the authors, who believe that when infected with syphilis, a long asymptomatic course is possible (in the presence of L-forms of pale treponema in the patient's body) and "accidental" detection of infection in the stage of latent syphilis (lues latens seropositiva, lues ignorata), t i.e. during the presence of treponema in the body, probably in the form of cysts, which have antigenic properties and, therefore, lead to the production of antibodies; this is confirmed by positive serological reactions for syphilis in the blood of patients without visible clinical manifestations of the disease. In addition, in some patients, the stages of neuro- and viscerosyphilis are found, that is, the disease develops, as it were, “bypassing” the active forms.

To obtain a culture of pale treponema, complex conditions are necessary (special media, anaerobic conditions, etc.). At the same time, cultural treponemas 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 up to 60°C kills them within 15 minutes, and up to 100°C - 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 scatter is explained by the frequency of sexual contacts, the nature and localization of syphilides, the presence of an entrance gate in a partner, and the number of pale treponemas that have entered the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the intensity and activity of which varies depending on the degree of virulence of the infection. Therefore, not only the possibility of the absence of infection is discussed, but also the possibility of self-healing, which is considered theoretically acceptable.

Symptoms of Latent Syphilis

In practice, one has 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, from the internal organs, nervous system, musculoskeletal system) indicating the presence of in the body of a patient with a specific infection. Many authors cite statistical data, according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis in 90% of patients is detected during preventive examinations, in antenatal clinics and somatic hospitals. This is explained both by 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 the manifestation 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 early 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-contagious tertiary syphilides (tubercles and gums).

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 develop active, contagious manifestations of early syphilis at any time. This makes it necessary to classify patients with early latent syphilis as an epidemiologically dangerous group and to carry out vigorous anti-epidemic measures (isolation of patients, a thorough examination of not only sexual, but also household contacts, if necessary, compulsory treatment, etc.). Like the treatment of patients with other early forms of syphilis, the treatment of patients with early latent syphilis is aimed at the rapid sanitation of the body from syphilitic infection.

Diagnosis of latent syphilis

The following data can help in the diagnosis of 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 skin rashes, taking antibiotics (for "tonsillitis", "flu condition" ), treatment of gonorrhea (without examination of the source of infection), if preventive treatment was not given, etc.;
2. the results of the confrontation (examination of a person who had sexual contact with the patient, and the identification of an early form of syphilis in him);
3. detection of a scar or seal at the site of primary syphiloma, enlarged (usually inguinal) lymph nodes, clinically consistent with 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. a rapid decrease in the titer of reagins already during the first course of specific treatment; serological reactions are negative by the end of the 1st-2nd course of treatment;
7. sharply positive result of RIF in these patients, although RIBT in a number of patients may still be negative;
8. the age of patients is more often 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 practically considered harmless in epidemiological terms. However, in these cases, it is especially easy to mistake positive blood serological reactions for the manifestation of syphilis, while they can be false-positive, i.e., non-syphilitic, due to many causes (past malaria, rheumatism, chronic diseases of the liver, lungs, chronic purulent processes, age-related changes in the metabolic processes of the body, etc.). The establishment of this diagnosis in venereology is considered the most difficult and very responsible and should not be carried out without confirmation of RIF, RITT and RPHA (sometimes such studies are repeated with an interval of several months, and also after the rehabilitation of foci of chronic infection or appropriate treatment of intercurrent diseases).

All patients are consulted by a neuropathologist, a general practitioner to rule out a specific lesion of the central nervous system and internal organs.

Diagnosis of late latent syphilis is facilitated by:
1. history data (if the patient indicates that he could have been 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 tests (CSR) or weakly positive results for CSR (with confirmation in both cases by RIF, RITT and RPHA);
3. negative serological reactions by the middle or end of specific treatment, as well as often the absence of negative CSR, RIF, RITT, despite vigorous antisyphilitic treatment using non-specific agents;
4. the absence of an exacerbation reaction at the beginning of penicillin therapy (it is preferable to start treatment of such patients with preparation - iodine preparations, biyoquinol);
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 of them as sexual contacts of patients with early latent syphilis should not be carried out). 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 in them.

Latent (unknown, unspecified) syphilis It is diagnosed in those cases when 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 recently been observed less and less. The establishment of 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. Diagnosis is helped by history data, the results of a thorough examination and positive specific reactions. It is possible to recognize the disease by detecting pathological changes in the cerebrospinal fluid. The need for multiple studies and re-diagnosis 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 in the case of detection of antibodies to pallidum spirochete in the laboratory in the absence of specific symptoms characteristic of sexually transmitted infections. Often, pathology is detected during examinations associated with other diseases.

The spiral-shaped pale spirochete, under the influence of external adverse factors, begins to change to forms conducive to survival. The causative agents of syphilis can be in the lymph nodes and cerebrospinal fluid for a long time without any manifestations. When activated, the asymptomatic period is replaced by an exacerbation with a deterioration in the patient's well-being.

The reason for the formation of cysts-forms of spirochetes (treponema) is the improper use of antibacterial drugs. Often, patients are treated with this group of drugs on their own, without a doctor's prescription, when they notice signs of gonorrhea or other sexual infections.

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

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

What is dangerous?

With a latent course of syphilis, a patient can infect a partner during sexual intercourse. The danger lies in the high risk of infecting others when using dishes and cutlery, towels and other hygiene products on which biological fluids can be left. Not timely detected syphilis becomes the cause of infection of all members of the patient's family.

As the infection progresses, the pathogen spreads through the lymphatic system to the tissues 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. She is diagnosed with an infection that occurred no more than two years ago.
Late. It is established in case of infection, which has a statute of limitations - ten years.
Unspecified. It is set 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 who has 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, arising from re-infection and not having specific signs;
tertiary, which is placed in patients who have had 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 occurs by the patient, who is unaware of his infection, and the people around him.

Pale spirochete can enter the body of a healthy person not only through sexual contact, but also through everyday life.

It is possible to detect an early form of latent syphilis during a preventive examination. A blood test (Wasserman reaction) is carried out 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 the correct results in all cases, and there is a need for other laboratory tests.

During the examination of patients with suspicion of an early form of the disease, the doctor reveals enlarged lymph nodes with characteristic seals, a rash on the skin, which went unnoticed by patients due to its short duration. These signs may indicate infection with pale treponema. The presence of a pathogenic agent in the body is often accompanied by changes in the thyroid gland, liver, joints, and digestive tract. Many patients have symptoms of disruption of the nervous system, since microorganisms violate the walls of blood vessels, the structures of the meninges.

Late period

Late latent syphilis is spoken of when infected with pale treponema that occurred more than two years ago. At this stage, the disease is considered safe for the people around the patient. In the late period, rashes on the skin are not detected, while the infection leads to the destruction of internal organs, the nervous system. In many cases, late silent syphilis is detected in elderly patients suffering from rheumatoid arthritis, cardiac ischemia, or myocarditis.

The disease is evidenced by a rash that looks like ulcers, signs of osteomyelitis, impaired functioning of the brain, changes in the gastrointestinal tract and lungs. Patients may complain of joint pain. "Neurosyphilis" is placed in case of damage to the nervous system.

The consequence of a late latent disease in the absence of therapy is severe disorders of organs and systems that threaten disability.

Symptoms and signs of latent syphilis

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

Hyperthermia of the body, which occurs periodically.
Enlarged lymph nodes. Their compaction is observed.
Presence for a long time of a depressive syndrome.
The patient has reduced visceral fat, weight loss occurs for no apparent reason.

The presence of scars and seals on the genitals, the residual phenomenon of polyscleradenitis testify to the primary form of the disease. Serological studies show positive results in 70% of patients. In 25% of patients, low titers are observed. They decrease after antibiotic therapy.

Against the background of treatment with penicillin drugs, a third of patients observe the Herxheimer-Jarish 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 mass death of pathogenic microorganisms and decreases when taking aspirin. When meningitis occurs, associated with latent syphilis, there is an increase in protein, a positive reaction to globulin fractions.

Diagnostics

The anamnestic method helps doctors in diagnosing a latent form of syphilis. Data collection takes 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.

When making a diagnosis, difficulties may arise. Sometimes patients hide and misinform the doctor because of secrecy. Often the symptoms are similar to other diseases. Obtaining false positive results can also make it difficult to diagnose latent syphilis. A detailed history plays an important role in determining the form of the disease.

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

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

Treatment and prevention

Therapy of the latent form of syphilis is carried out only after receiving laboratory data.

Examinations are assigned to the sexual partners of the patient.

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

Therapy is carried out in the same way as in other forms of syphilis. It is carried out on an outpatient basis with drugs with prolonged action: benzathine penicillin and benzylpenicillin sodium salt. The occurrence of hyperthermia during treatment with antibacterial drugs means that the disease is diagnosed correctly. After an increase in temperature and the death of the infection, the condition of patients usually improves. If the form of syphilis is late, such a reaction is not observed.

Dosages of drugs:

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 has signs of poor tolerance to drugs from the penicillin group, the doctor prescribes antibacterial drugs of the tetracycline series, macrolides, cephalosporins. Pregnancy is not a contraindication to 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 completely cured disease, stable immunity is not developed. Preventive measures must be taken to prevent re-infection. All sexual contacts must be protected. A disorderly intimate life can lead to infection with syphilis and other sexually transmitted diseases. It is necessary to use only personal hygiene items, wash hands regularly. Every year, doctors recommend donating blood for tests and being examined by a general practitioner, urologist, gynecologist, and neurologist.

How is the effectiveness of therapy monitored?

At the end of the course of antibacterial drugs, specific tests are carried out. Examinations are carried out repeatedly until normal results are obtained. In the subsequent control is made two more times in 90 days.

If the disease has a late form and the tests showed positive results, the period of medical observation is at least three years. Patients are tested every six months. Deregistration is made after receiving normal indicators of laboratory research. With a late latent form of the disease, the results become normal for a long time. The observation of the patient ends with a complete examination, including not only the delivery of tests, but also a consultation with a neurologist, ophthalmologist, therapist, gynecologist.

Admission to work in a children's institution and a public catering enterprise is given only with the complete disappearance of all symptoms and clinical signs of the disease.

Latent syphilis is a dangerous disease that disrupts the functioning of many systems and organs. If you have any suspicious symptoms, 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 - pale spirochete. It has several stages of development, as well as many clinical manifestations. In Russia, in the late 90s of the twentieth century, a real epidemic of this disease began, when out of 100,000 people fell ill per year, 277 people. Gradually, the incidence is decreasing, but the problem is still relevant.

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

Why does latent syphilis occur?

The causative agent of the disease - pale spirochete - under normal conditions has a typical spiral shape. However, under adverse environmental factors, it forms forms that promote survival - cysts and L-forms. These modified treponemas 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 there is a relapse of the disease. These forms are formed due to improper antibiotic treatment, the individual characteristics of the patient and other factors. A particularly important role is played by self-treatment of patients for a disease that they consider to be, but in fact it is an early stage of syphilis.

The cyst form is the cause of latent syphilis. It also causes a lengthening 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 (with the transfusion of infected blood and its components), and transplacental (from mother to fetus). This disease is detected most often during a blood test for the so-called Wasserman reaction, which is determined for each admitted to the hospital, as well as when registering with a antenatal clinic for pregnancy.

The source of infection is only a sick person, especially during.

Latent period of syphilis

This is the time after infection of a person 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 the musculoskeletal system, and others.

Usually changes in the blood appear two months after contact with the carrier. From this moment, the period of the disease is counted in a latent form.

Early latent syphilis occurs within two years of infection. It may not appear immediately, 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 can be accompanied by damage to organs and tissues, the nervous system. There are low-contagious elements of the skin rash.

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 a 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 antigen of pale treponema.

Early latent form

This form covers all forms by terms from primary seropositive (hard chancre) to secondary recurrent (skin rashes, then their disappearance - a secondary latent period, and relapses for two years), but there are no external signs of syphilis. Thus, the disease can be recorded in the period between the disappearance of the hard chancre (end of the primary period) until the onset of the formation of rashes (the beginning of the secondary period) or be observed at the moments of remission in secondary syphilis.

At any time, the latent course can be replaced by 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 the prescribed anti-epidemic measures (identification, diagnosis, treatment of contact persons) are carried out.

How to detect the disease:

the most reliable evidence is contact with a patient with active syphilis during the previous 2 years, while the probability of infection reaches 100%;
to find out the presence of unprotected sexual intercourse over the past two years, to clarify whether the patient had subtle symptoms, such as sores on the body or mucous membranes, hair loss, eyelashes, a rash of unknown origin;
to clarify whether the patient did not go to the doctor at that time for any reason that worried him, whether he took antibiotics, whether he received blood or its components;
examine the genitals in search of a scar left after a hard chancre, assess the condition of the peripheral lymph nodes;
serological tests in high titer, but not necessarily, immunofluorescent analysis (ELISA), direct hemagglutination test (DPHA), immunofluorescence test (RIF) are positive.

late latent form

The disease is detected most often by chance, for example, during hospitalization for another reason, when a blood test is taken (“unknown syphilis”). Usually these are people aged 50 years and older, their sexual partners do not have syphilis. Thus, the late latent period is considered non-contagious. In terms of timing, it corresponds to the end of the secondary period and the entire Tertiary.

Confirmation of the diagnosis in this group of patients is more difficult, because they have concomitant diseases (rheumatoid arthritis and many others). These diseases are the cause of 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 have occurred more than two years ago. Serological tests help in the diagnosis: more often they are positive, the titer is low, and ELISA and RPHA are positive.

When confirming the diagnosis of latent syphilis, ELISA and RPHA are of decisive importance, because serological tests (rapid diagnostics) can be false positive.

Of these diagnostic methods, the confirmatory reaction is RPHA.

With latent syphilis, a 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, hearing loss.

The 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 gums;
ineffectiveness of penicillin therapy;
association with HIV infection.

What are the consequences of late latent syphilis?

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 hidden 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);
joint changes in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
violation of the activity 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 the treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many concomitant factors.

Treatment

Specific treatment is prescribed only after confirmation of the diagnosis by a laboratory method. The sexual partners of the patient are examined, if they have negative laboratory tests, then they are not prescribed treatment for the purpose of prevention.

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

Long-acting drugs 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 mass death of microorganisms and the release of their toxins into the blood. Then the state of health of patients is normalized. With a late form, such a reaction may be absent.

How to treat latent syphilis:

in the early form, Benzathine penicillin G is injected at a dose of 2,400,000 units, two-stage, into the muscle once a day, only 3 injections;
with a 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.

In case of intolerance to these antibiotics, semi-synthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.

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

Monitoring the effectiveness of treatment

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

With late latent syphilis, if RPHA and ELISA remained positive, the follow-up period is 3 years. Tests are carried out every six months, the decision to deregister is made on the basis of a set of clinical and laboratory data. Usually, in the late period of the disease, the restoration of normal blood and cerebrospinal fluid is very slow.

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

After the disappearance of all clinical and laboratory manifestations of the disease, patients can be allowed to work in children's institutions and public catering establishments. But once transferred and cured, the disease does not leave stable immunity, so re-infection is possible.

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

Why does latent syphilis occur?

The causative agent of the disease - pale spirochete - under normal conditions has a typical spiral shape. However, under adverse environmental factors, it forms forms that promote survival - cysts and L-forms. These modified treponemas 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 there is a relapse of the disease. These forms are formed due to improper antibiotic treatment, the individual characteristics of the patient and other factors. Especially important is the self-treatment of patients for a disease that they consider gonorrhea, but in fact it is an early stage of syphilis.

The cyst form is the cause of latent syphilis. It also causes a lengthening 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.

Latent period of syphilis

This is the time after infection of a person 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 the musculoskeletal system, and others.

Usually changes in the blood appear two months after contact with the carrier. From this moment, the period 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 antigen of pale treponema.

Early latent form

At any time, the latent course can be replaced by 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, while the probability of infection reaches 100%;
to find out the presence of unprotected sexual intercourse over the past two years, to clarify whether the patient had subtle symptoms, such as sores on the body or mucous membranes, hair loss, eyelashes, a rash of unknown origin;
to clarify whether the patient did not go to the doctor at that time for any reason that worried him, whether he took antibiotics, whether he received blood or its components;
examine the genitals in search of a scar left after a hard chancre, assess the condition of the peripheral lymph nodes;
serological tests in high titer, but not necessarily, immunofluorescent analysis (ELISA), direct hemagglutination test (DPHA), immunofluorescence test (RIF) are positive.

late latent form

When confirming the diagnosis of latent syphilis, ELISA and RPHA are of decisive importance, because serological tests (rapid diagnostics) can be false positive.

Of these diagnostic methods, the confirmatory reaction is RPHA.

The 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 gums;
ineffectiveness of penicillin therapy;
association with HIV infection.

What are the consequences of late latent syphilis?

How does the hidden 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);
joint changes in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
violation of the activity 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

Treatment

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

Long-acting drugs are used - Benzathine penicillin, as well as Benzylpenicillin sodium salt.

How to treat latent syphilis:

in the early form, Benzathine penicillin G is injected at a dose of 2,400,000 units, two-stage, into the muscle once a day, only 3 injections;
with a 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 penicillin drugs are not dangerous to the fetus.

Monitoring the effectiveness of treatment

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

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

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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. The 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 have had active manifestations of the disease in the past, resolved on their own or under the influence of specific treatment.

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

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

The 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 is serological diagnosis.

In our country, the method of active detection of patients with syphilis is used during preventive examinations in clinics and hospitals, antenatal clinics and at blood transfusion points, 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 detected 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 in 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 - a single hard chancre (photo on the left) and multiple hard chancres (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. The latent syphilis in most cases comes to light incidentally at statement of specific serological reactions. In some cases, the doctor manages to find out what period of the disease he belongs to:

if the patient had previously recorded a hard chancre, but did not appear, then they talk about the latent period of primary syphilis;
the latent period identified after the appearance of secondary syphilis and in the case of recurrent syphilis refers to the secondary period of the disease;
there is also a latency period.

Such a division of the latent periods of the disease is not always possible, therefore, in venereological practice, it has been 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 moment of infection. In epidemiological terms, this category of patients is the most dangerous.
Diagnosis late latent syphilis established if more than 2 years have passed since the moment of 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 syphilis on the face and palms.

Early latent syphilis

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

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

Who is sick

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

What you need to find out in the survey

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

Signs and symptoms of early latent syphilis

A scar or induration 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 primary syphilis.
In 75% of patients in the latent early period of the disease, sharply positive serological reactions (1:160) are noted, 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, positive RIBT is noted. In the treatment of antibiotics concomitant diseases titers of serological reactions are reduced.
In 1/3 of patients treated with penicillin, the Herxheimer-Yarish reaction is observed, which is characterized by a sudden increase in body temperature, headache and muscle pain, vomiting, tachycardia. This phenomenon is due to the mass death of pathogens. Symptoms are quickly relieved by aspirin.
In the case of the development of latent syphilitic meningitis, an increased amount of protein is noted in the cerebrospinal fluid, (+) reactions to globulin fractions and cytosis. With specific treatment, the cerebrospinal fluid is quickly sanitized.

Treatment of early latent syphilis

Treatment of early latent syphilis is carried out in accordance with approved instructions and is aimed at the fastest destruction of pathogens in the patient's body. With specific treatment, negative seroreactions occur quite quickly. The extinction and complete negativity of specific serological reactions in latent syphilis are the only criterion for confirming the effectiveness of the treatment.

Timely detection of patients in the period of early latent syphilis and adequate adequate treatment have a positive 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 duration exceeds 2 years, there are no clinical manifestations of the disease, and positive serological reactions are recorded. Basically, such patients are detected during preventive examinations (up to 99%), including examinations for the identification of a patient with late forms of syphilis in the family (1%).

Who is sick

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

What you need to find out when interviewing a patient

When interviewing a 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 determine the traces of previously resolved syphilides. During the examination, there are no signs of a specific lesion of internal organs and the nervous system.
In the diagnosis of late latent syphilis, serological tests such as RIF, ELISA, TPHA and RITT are used. The reagin titer is usually low and is 1:5 - 1:20 (in 90% of cases). In rare cases, high titers are noted - 1:160:480 (in 10% of cases). RIF and RIBT are always positive.

Sometimes serological studies have to be repeated after a few months.

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

There is no Herxheimer-Yarish reaction to the administration of antibiotics.
Late latent meningitis is rare in these patients. In the cerebrospinal fluid, when specific meningitis is detected, a mild inflammatory component is noted - low cytosis and protein levels, signs of a degenerative component predominate - a positive Wassermann reaction and a Lange reaction. During the period of specific treatment, the sanitation of cerebrospinal fluid occurs slowly.

Treatment of late latent syphilis

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

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

Rice. 5. Manifestations of the disease in the tertiary period - gumma of the face and gummous 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 studies, a diagnosis of latent, unspecified syphilis is established. Such patients are subject to careful clinical and serological examination, often repeated. Setting RIF, RIF-abs and RIBT, ELISA and RPHA are mandatory.

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

Rice. 6. Hummous infiltration of the buttocks and peripapillary zone in the tertiary period of the disease.