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 why hidden forms of syphilis are dangerous

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 provokes / Causes of 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 pale treponema, 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 in the blood serum of patients with syphilis of multiple antibodies: 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) epidemiologically, 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-infectious 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 (up to 2 years on average 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 a latent form of 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 skin rashes, taking antibiotics (for "tonsillitis", "influenza state"), treatment of gonorrhea (without examination of the source of infection), if preventive treatment was not given, etc.;
• 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);
• detection of a scar or seal at the site of primary syphiloma, enlarged (usually inguinal) lymph nodes, clinically consistent with 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;
• 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;
• a sharply positive result of RIF in these patients, although RIBT in a number of patients may still be negative;
• the age of patients is more often up to 40 years;
• the possibility of normal liquor; 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 tests 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 carried out repeatedly 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:

• 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 sharply positive results for classical serological tests (CSR) or weakly positive results for CSR (with confirmation in both cases by RIF, RITT and RPHA);
• 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;
• 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);
• 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 is 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 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.

Treatment of Latent Syphilis:

According to existing guidelines and treatment regimens for syphilis, all patients with early latent syphilis are treated the same way. In those cases when, by means of anamnesis or according to confrontation, it is possible to establish the prescription of the existence of an infection, the outcome of the disease can be predicted (of course, 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 lies in the fact that a person, until the most active manifestation of the disease, does not know that he is infected with this terrible 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.

Diagnosing latent syphilis is difficult. Basically, it is 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 shows signs characteristic of stomatitis, tonsillitis, or a common cold.

The reasons

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 to their health. The fact is that a person, having suspected a cold or the initial stage of the development of a sore throat, without prior consultation with a specialist, begins to take antibiotics uncontrollably. But these medications hide the main symptoms of syphilis. In other words, syphilis is not cured, but healed and proceeds in a latent form.

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

A person becomes infected mainly through unprotected sexual contact, but many cases of infection have been registered in the household way.

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 way to determine the presence of this sore in the human body is serological reactions 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 subspecies:

• early latent syphilis;
• late;
• unspecified.

Usually, an 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 other people. 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 detected during medical examinations or during 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, therefore the patient is subjected to a number of other additional laboratory and clinical examinations.

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

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

• liver;
• stomach;
• thyroid;
• joints.

The central nervous system can also suffer from early latent syphilis. The nervous system, and in particular the membrane 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 found in a person after 2 years from the moment of infection is usually called late. This kind of latent syphilis does not pose such a strong danger to the environment as an early form. Basically, late syphilis affects the internal organs and in most cases is not manifested by skin rashes.

Most often, the late form of the described disease 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 tests turn out to be false positive.

People infected with a late form of latent syphilis often complain of signs characteristic of heart disease or heart vessels, and these are:

• aortitis;
• myocarditis;
• ischemic disease.

Latent late syphilis is mainly manifested by the following symptoms:

• the presence on the skin of a rash 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 has 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 special symptoms. Sometimes a person is bothered by headaches or his hearing is impaired. However, if left untreated, it can soon become more severe.

An unspecified form of latent syphilis is a type of disease when it is not possible to determine the time of infection.

All of the above forms of the disease over time still manifest a vivid clinical picture.

Diagnostics

Before starting treatment for a latent form of syphilis, it is very important for a person with a suspicion of this disease to undergo a complete diagnosis. To do this, he needs to provide the venereologist with complete information about 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 age of the patient and his lifestyle.

When diagnosing, it is very important to examine not only the patient himself, but also his sexual partner. Thus, early latent syphilis can be detected. The main confirmation of the presence of the disease are 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 consulted not only by a venereologist. The patient should consult a neurologist and a 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 with the use of 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 disappears.

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 for 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 as follows:

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

If the late form of syphilis is not treated, then:

• sclerosis of lung tissues;
• suppurative process in the lungs.

Prevention of syphilis is one of the effective ways to avoid infection.
Choose a partner carefully and very carefully. In any case, it is recommended to use protective equipment.

If, however, contact has occurred, after intercourse, the contact areas should be treated with an antiseptic or antibiotic. Also, do not use common hygiene products.

Be healthy!

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

Classification

Usually, latent syphilis is classified into several forms, depending on the severity of the 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 venereal 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 and sweat tests.

Stages of development

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

• Incubation.
• Primary.
• Secondary.
• Tertiary.

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

Note. This time is equal to 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 the manifestation of pathology. In addition, the use of antibiotics can increase this time.

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

Hard chancres - the primary stage in the development of syphilis

The stage of reproduction of syphilis is usually divided into:

• gray-negative;
• gray 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 are distinguished:

• early;
• returnable;
• hidden syphilis.

At an early stage, the pathogen manifests itself as a rash. But at this time, other organs are also violated: the 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 the 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 or two decades, the third and last form begins to develop. All organs and systems are affected here. Outwardly, it manifests itself in the form of syphilitic gums (nodules in tissues that irreversibly destroy them can form both on the skin and in internal organs, as well as bones). Manifestations are cyclical, it depends on immunity. As a rule, when the body is hypothermic, it decreases, at such moments the disease manifests itself. Often there is a localization of the microbe in one of the systems or organ.

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

Thanks to the use of antibiotic agents, the tertiary stage has become less and less common. It also happens that it did not come at all after the usual passage of the first and second phases. Strong immunity may indicate this. For a certain 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 negligible amount of harmful microorganisms in the tissues. But with a slight deviation of immunity, the infection will begin to manifest itself again. Such a person becomes its carrier.

Symptoms of latent syphilis

The signs of the disease depend on the period the microbe has been 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 penetration of the bacteria. As a rule, they are dense, regular rounded, solitary, do not increase either in volume or in diameter. This symptom is part of the defense mechanism for infection. There are other options for symptoms:

• Inductive edema. Occurs when sexually transmitted. Changes in size, skin color occurs in men - on the scrotum, in women - in the vagina. The epidermis in such areas becomes blue, pain does not occur when pressed. The phenomenon can persist for a month. It occurs much more frequently in women than in men. Edema can also form in other diseases, which makes it difficult to diagnose. This can be helped by a blood test, examining the patient for an increase in the number of lymphocytes.
• Chancre panaritium. It is an abscess on the fingers near the nails. Most often occurs in physicians operating on patients. This type of peculiar ulcer causes a lot of inconvenience, in addition to aesthetic, it hurts. The sick doctor can no longer work. In addition, there is a tendency to spread education on the organs responsible for reproduction.
• Chancre-amygdalite. Pathology is formed in the oral cavity - this is an increase in one of the accumulations of lymphoid tissue. In addition, the patient is tormented by fever and, of course, pain when swallowing. Unlike angina, only one side is affected and the mucosa remains smooth.

There are other types of surface formations. For example, when passing infection with another virus, chancres take on a different look. They can 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 an increase in lymph nodes, which should be paid attention to when analyzing 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 disappear, a person may feel general malaise, fever, 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 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 or 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. Under the action of the immune system, 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 are formed in them.

Often there is inflammation in the head and a violation of the reaction of the eyes to light. Less often - neuritis, polyneuritis, meningoencephalitis. With latent syphilis, there may be a violation of the reaction of the eyes to light.

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

Tertiary

Differs in 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 felt: a lot of destructive pathologies in different systems, which are gummas.

This period was classified in the middle of the twentieth century:

• Asymptomatic.
• Syphilitic meningitis.
• Meningovascular.
• Cerebral.
• Spinal.
• Parenchymal.
• progressive paralysis.
• Dorsal dryness.
• Taboparalysis.
• Atrophy of the optic nerve.
• Gummy.
• Gum of the brain.
• Gum of the spinal cord.

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

All the species listed above develop after a long stay in the body of an infection that does not give itself away. Meningitis develops after two years, the rest - 15 years or more.

The clinical course is different, but there are similar points: a violation of the central nervous system, a decrease in memory and attention, the inability to think logically, paralysis, paresis.

Latent syphilis during pregnancy

If proper treatment of latent syphilis during pregnancy is not carried out, it can be transmitted to the child. In a newborn, changes are formed at the stage of formation of vital tissues, so the body is not restored. In this case, 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 with obvious forms is perfectly noticeable, it is easy to identify it and suggest what kind of ailment the patient is tormented by. In their absence, serodiagnostic studies come to the rescue (recognition of the reaction when mixing the blood serum of the infected and the reagent).

Methods for diagnosing latent syphilis are usually distinguished into:

• Direct.
• Indirect.

The first ones include microscopy, infection with rabbit material, culture, and PCR diagnostics. The methods use several types per patient, each individually cannot give an accurate result. They have their drawbacks: long duration, impossibility of detection at certain stages, or they are expensive. Therefore, serological methods are used.

This includes various reactions of human blood to the proposed reagents. None of the indirect methods can also give an accurate answer to the presence of a microbe, and therefore the 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 organisms that cannot defend itself against penicillin. Therefore, therapy with this substance works great in our time. Taking the right dose of the drug for a long time helps to completely rid the body of the infection.

Erythromycin is another drug with the same effect, it is used for allergic reactions of the patient 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 that are injected into the muscles and orally.

Note. In the head section, as mentioned above, a barrier is formed that, as it were, protects 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 endolumbally. But there is a problem - the lack of specialized doctors.

How to treat latent syphilis if triponema is resistant to antibacterial drugs? Here 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, in the ordinary course of the disease, after the incubation period, the first symptoms can be detected: hard chancre, swollen 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 from the moment of infection, then an early form is diagnosed. If the disease is detected after this period, then a late form is diagnosed. But when an 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 a patient, then they speak of an undifferentiated form.

The most dangerous form of syphilis for others is considered early. During this period, the patient is an active source of infection. If the disease has passed into a late form, then the risk of infecting others is significantly reduced, in most cases, generally 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. Often this is due to the fact that the patient during the incubation period took antibiotics to treat other diseases. In this case, doses of antibiotics do not destroy the pale spirochete, but only delay its development and pervert the course of the disease.

Also, adverse environmental factors and self-medication have a change in spirochetes. Unfortunately, the 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 a hard chancre, rashes, swollen lymph nodes, may be absent or be so small that the patient does not notice them. Usually, if symptoms appear, they pass on their own and quickly.

Sometimes a person takes 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, fever. In this case, the symptoms disappear after taking regular aspirin.

But even these manifestations cannot indicate the presence of a disease; laboratory tests are required to make a diagnosis. Very often, early latent syphilis is discovered quite by accident, when taking tests for a hospital, obtaining a medical certificate, and 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, the patient is asked the following:

• Did serological tests and what are their results;
• Whether there were rashes, ulcers on the genitals, on the mucous surfaces in the mouth;
• Have you taken antibiotics?
• Have you self-treated for .

A visual examination of the patient is carried out for the presence of hard chancres, residual effects of polyscleradenitis, and an increase in lymph nodes.

Be sure to do the Wasserman reaction, with a positive result, additional tests are carried out. Since in some cases it can be positive even in the absence of the disease. A positive result for several serological tests is required to confirm the diagnosis. Such as:

• Immunoassay (ELISA);
• Immunization reaction of poor trepanemas (RIBT);
• Immunofluorescence reaction (RIF);
• The reaction of passive hemagglutination (RHA).

At the same time, 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 the timely recognition of the disease, an analysis of the cerebrospinal fluid 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 placed in a hospital, but they can also be treated on an outpatient basis.

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

Prevention

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

To prevent the disease, it is important to carefully monitor your health. Once a year, undergo a medical examination with a study of titers for syphilis. In case of a positive reaction, it is necessary to contact a venereologist as soon as possible. Do not use antibiotics without medical prescription.

If there was sexual contact with a patient with syphilis, you should consult a doctor for preventive treatment within a week. When a disease is detected, it is mandatory to conduct a survey of all sexual partners of the patient and their family members.

You should not engage in treatment on your own, since in the case of improperly selected therapy, 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 latent form of the disease when planning pregnancy, since in most cases this causes miscarriage, premature birth, the birth of babies with developmental anomalies and congenital syphilis.

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 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 are taken (identification, 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, 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 hidden 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.