How does syphilis start? How syphilis is manifested and transmitted, its stages, diagnosis and treatment

The question of whether syphilis can be cured is very relevant in our time and worries many people, especially young people. So, under syphilis it is necessary to understand a disease that leads to the formation of a large number of pathological processes in organism. If left untreated, syphilis can lead to the development huge amount complications and even death. The main route of transmission is considered to be sexual. We will talk about how syphilis is treated and what features of its course are in the presented article.

Key Aspects

The causative agent of syphilis is pale treponema (Treponema pallidum), it is capable of rapid spread and penetration into various internal organs. Cured individuals do not have immunity, so the risk of re-infection remains quite high.

The first cases of the disease were recorded as early as 1495, among the soldiers of the French army. After that pathological condition quickly spread throughout Europe. Although the disease did not differ high level mortality, it was considered terrible, because it was accompanied by the formation of genital ulcers (chancres), which led to the appearance of pain and had a rather repulsive appearance. Over time, their transformation into abscesses was observed, and ulcerative processes spread over the surface of the entire body.

In the vast majority of cases, chancre is formed on the vulva, anus, vagina or rectum, but its appearance on the mucous membranes of the oral cavity and on the lips is no exception.

Transmission of the pathogen occurs during vaginal, anal or oral intercourse.

Syphilis, as a disease, is considered dangerous also because it clinical manifestations appear not immediately, but only after a few weeks. During this period of time, a sick person can infect a large number of of people. If you do not diagnose the disease in time and do not get rid of syphilis, it can cause male and female female infertility, the formation of pathological processes in the internal organs and even lethal outcome.

When a pregnant woman is infected, infection of the fetus is possible in 70% of cases. As a result, the child may die or have a congenital form. this disease.

IN medical practice it is customary to divide syphilis:

Depending on the stage at which the pathological condition is located: into primary, secondary and tertiary.
Depending on the route of infection - congenital or acquired over time.
Depending on the period of diagnosing the pathological process, late and early.

Taking into account the above aspects, the choice of scheme is carried out and effective way treatment.

Clinical picture

The causative agent of syphilis, having penetrated into the cavity of the human body, spreads by the hematogenous or lymphogenous route. The incubation period can be up to four months, but the first symptoms may appear as early as 2 weeks after infection. The manifestations of the disease will depend on what stage of the course it is at.

Primary syphilis is characterized by: the formation of a chancre at the site of the introduction of the pathogen; over time, hyperemic ulcerative processes begin to appear, which have clear boundaries; the absence of pain; swelling of the tissues at the site of the introduction of the pathogen.
Manifestations secondary syphilis. With absence adequate therapy the disease passes into the second stage, this happens after about 2-3 months. This pathological condition is characterized by: the appearance of elements of an erythematous, papular or pustular rash; hair loss; dysfunction internal organs.
Symptoms of tertiary syphilis. This type The disease is formed 3-5 years after infection. It manifests itself: the appearance of tubercles and nodes in the thickness of the skin; the formation of seals in the areas of penetration of treponema.

Signs of syphilis

Quite often, people do not realize that they are sick, because they do not pay much attention to the appearance of a rash. Over time, it disappears, and therefore any worries seem unfounded, but it must be remembered that the disease is gaining momentum at this time. Patients complain about:

swelling and hardening of the foreskin;
the formation of ulcerative processes and erosions on the genitals or anus.

Ulcers (chancres) can be localized in other places, they are rounded and painted red.

After a week, there may be an increase in lymph nodes and an increase in temperature. Due to the fact that the symptoms of this period are not expressed too clearly, patients are in no hurry to seek medical help.

The appearance of rash elements on the skin indicates secondary syphilis, this is a kind of evidence that destructive processes have begun. In the absence of treatment, over time, the organs will cease to function normally.

Diagnostics

First of all, it is necessary to focus on the fact that in no case should you diagnose yourself on your own (after analyzing the information provided on the Internet), and even more so carry out self-treatment. This is explained by the fact that syphilis has a large number of symptoms similar to other diseases, and this causes an incorrect diagnosis even by doctors. To make a diagnosis, you need:

Get checked out by a dermatologist. The doctor conducts general inspection patient, collecting anamnesis and complaints.
Pass tests for direct immunofluorescence reaction, PCR.
Undergo serological examinations that allow you to detect the presence of antibodies to treponema in the human body. This may be the Wasserman reaction, VDRL, rapid plasma reagent test.
In some cases, the doctor directs the patient to instrumental examinations, such as ultrasound, MRI, CT, X-ray. They allow you to identify gummas.

Choice of tactics

Due to the fact that the disease belongs to the group of serious diseases, the doctor who treats syphilis must be very careful. The scheme of therapy, its duration will depend on the stage of the course of the pathological condition, its severity and general condition patient. Therefore, it is customary to use not only antibacterial drugs, but also various treatment regimens for syphilis, depending on each specific case. Used:

specific treatment. It is an option of choice for those patients who have an accurate diagnosis.
Perventative or in other words preventive. It is intended for persons who have been in contact with a person with syphilis. In this case, the contact will be considered not only sexual intercourse but also household. This method treatment is also used for those individuals whose lifestyle is considered antisocial. A positive effect of such treatment will be observed if contact with a sick person took place no earlier than two months. Otherwise, you can not hope for a positive result from the therapy. The contact person undergoing treatment must undergo regular check-ups for another six months.
Preventive. It is carried out during the bearing of a child by a woman. Its implementation is necessary not only to alleviate the condition of the woman, but also to dull the progression of the pathological condition in the fetus. This type of therapy is actually prescribed to all, without exception, pregnant women with a history of syphilis and who have undergone full course treatment (regardless of the age of the case). In a situation where a pregnant woman does not have time to be treated completely before childbirth, then therapy is prescribed after that for both the woman and the baby.
Trial course. It is used to treat those individuals in whom syphilis is at an advanced stage of development. Treatment using this method is carried out even in the case when the presence of the disease is not confirmed by laboratory. This is explained by the fact that syphilis in the third stage is quite difficult to diagnose, and there is no time to lose. This drug therapy received such a name due to the fact that the causative agent of the pathological condition is unknown according to the results of the analysis, however, all the characterizing symptoms of syphilis are present. During the treatment, the patient's condition and changes in his body are monitored. If present positive effect, then in this case, the trial treatment switches to specific.
Epidemiological. This type of therapy is carried out in cases where there are clinical manifestations of the disease, an asocial lifestyle or sexual contacts, as well as positive results examinations for syphilis. The main difference of this type of treatment is that it is carried out only on the basis of a history of suspicious sexual relations, without laboratory confirmation of the diagnosis.

Types of treatment

As already noted, syphilis is cured by using antibacterial drugs, basically the choice stops on Penicillin and its derivatives. With how to cure syphilis with antibacterial drugs, we will now try to understand in more detail.

Drugs with an antibacterial effect are classified depending on the duration therapeutic effect for drugs: long-acting, medium, short.

Antibacterial drugs of long and medium action are endowed with the ability to accumulate in muscle tissue and gradually enter the body. Due to this feature, the interval between the administration of drugs is lengthened. Medicines that belong to this group are used for therapy directed at syphilis of all types, except late.

Funds from short action do not have such an opportunity, but they are more likely to spread throughout the body and are able to easily overcome any natural barriers. That is why drugs of this type can cure late syphilis, because during the course of this pathological condition, the pathogen is localized in hard-to-reach tissues and internal organs. Drugs are administered intravenously or intramuscularly.

Treatment with penicillin

In ancient times, the treatment of syphilis was ineffective, because it was carried out by applying mercury ointment to the affected areas. This method of treatment led to the formation of a large number of adverse reactions, which manifested themselves in the form of: neuropathy, kidney failure, ulcerative processes in oral cavity, tooth loss.

Such treatment for syphilis caused patients to die not from the disease itself, but from mercury poisoning, which was in the medicinal preparation.

Another attempt to cure syphilis was the use of potassium iodide in combination with mercury and various metals, but, unfortunately, this method was not effective.

It was possible to recover from syphilis only when an antibacterial drug called Penicillin appeared. Even until now, this medication is the main way to quickly eliminate the disease. It is recommended to be used to eliminate the symptoms of congenital syphilis, neurosyphilis and syphilis during pregnancy.

This is explained by the fact that spirochete pallidum almost never survives after proper treatment Penicillin. positive side it is also considered that the pathogen does not become resistant to the drug even in the case of improper therapy.

The most commonly used treatment regimens are:

For secondary or primary syphilis, benzathine benzylpenicillin is used, it is administered once at a dose of 2.4 IU intramuscularly.
With early syphilis covert treatment carried out according to the previous scheme.
Late latent syphilis. In this case, Benzathine benzylpenicillin is administered three times a day with an interval of 7 days. The amount of the drug for one intramuscular injection should be 2.4 MO.

Please note that syphilis cannot be treated with oral Penicillin.

The use of other groups of antibacterial drugs

There are cases when the patient's body does not perceive medications penicillin series. In such situations, the treatment regimen for syphilis consists of prescribing other antibiotics.

The course of treatment with Penicillin and its analogues is contraindicated in patients who have a history of allergic reactions on these drugs, because they can cause death. Such patients are also prohibited from prescribing cephalosporin drugs. This is explained by the fact that they have almost identical chemical structure with penicillins. However, this medicine can be used in the form of tablets. With the question of how to treat syphilis for these individuals, we will now deal with it.

Persons who do not tolerate penicillin drugs are prescribed

macrolides - Erythromycin, Sumammed;
derivatives of the tetracycline series - Tetracycline, Doxycycline;
antibiotics synthetic origin- Levomycetin.

Women who are diagnosed with a disease during childbearing can only be treated by prescribing macrolides.

Treatment of women during childbearing

Without exception, all women who are diagnosed with syphilis during pregnancy should be treated. Its scheme and type will depend on the stage of development of the disease. With how to treat syphilis for pregnant women, we will now understand in more detail.

If a pathological condition is detected late in pregnancy, then even the administration of the recommended dose of penicillin in 30% of cases leads to the death of the fetus or the birth of a sick child. That is why, when diagnosing a primary or secondary case of the disease at an early stage in a woman during childbearing, it is recommended to treat with a double injection of Penicillin at a dose of 2.4 IU for seven days.

There is no need to take any additional measures, especially if there is no clinical and serological evidence of a new infection.

Some doctors are inclined to treat pregnant women with Erythromycin, but it should be noted that this drug not the most effective in the fight against syphilis and does not penetrate the transplacental barrier.

When treating pregnant women, it must be remembered that there may be a complication in the form of the Jarisch-Herxheimer reaction. According to the observations, it was noted that a similar process can be observed in almost half of the pregnant women receiving treatment. This reaction appears as:

chills
fever;
ailments;
pain in the head;
pain in the joints;
pain in the muscles;
nausea;
the formation of elements of a rash on the skin.

In addition to taking antibacterial drugs, pregnant women should rest and drink as much fluid as possible. Pain in the pelvic area and uterine spasms can be eliminated with the appointment of Acetaminophen.

Please note that a woman who is sick with syphilis is allowed to feed her child, but only if the infection of the mother occurred no earlier than six months ago. In all other cases, the application to the breast of the mother of a newborn baby is prohibited.

If a child has a congenital form of syphilis, then Penicillin 50,000 units per kilogram of body weight is prescribed twice a day. Such a treatment regimen should be performed in the first week of a child's life, then the drug is administered every 8 hours for 10 days.

Treatment at home

First of all, it is necessary to focus on the fact that it is impossible to cure syphilis by folk methods, it requires medication and physiotherapy, which will be controlled by a qualified doctor. The drugs of choice are antibiotics, as well as immunomodulators, vitamins, biogenic stimulants and pyrogenic substances.

Syphilis can be cured quite quickly, but only if therapy was started even before the formation of complications. However, it must be understood that supplements can make the treatment more effective and faster. plant origin in combination with traditional methods treatment. Recommend to use:

amino acids;
vitamin C;
bioflavonoids;
zinc;
colloidal silver;
coenzyme Q10.

It should be noted that a considerable amount of herbal supplements is found in apricots, garlic, pine nuts, Canadian goldenseal, red clover.

Special attention turn to biological additives with zinc. This is explained by the fact that it ensures the restoration of cellular metabolism, maintains the health of organs. reproductive system body, and also helps wounds heal faster and generally improves immunity.

Summing up, it is necessary to focus on the fact that the use of recipes from folk sources will not be able to alleviate the condition of a person, it is likely to cause the progression of the disease and the formation of various complications.

The use of physiotherapy procedures

To consolidate the therapeutic effect, such methods of physiotherapeutic treatment are prescribed as:

Inductothermy. This procedure refers to electrotherapy, a high-frequency magnetic field is used.
Magnetotherapy. During this procedure, the location of the inductors along the spinal column is carried out.
Microwave therapy. Helps restore normal functional ability nervous system, stimulates blood circulation and metabolic processes. On the first day, the procedure is performed on the epigastric and thyroid gland, the next - in the epigastric and adrenal glands.
Laser therapy. Helps to restore the functional ability of cellular and humoral immunity.

Local treatment

Since syphilis is accompanied by the formation of a hard chancre, wide condylomas and pustular-ulcerative syphilides, it becomes necessary to carry out their treatment too. For this purpose, lotions with 0.05% chlorhexidine, 50-70% dimexide solution are used. It is recommended to apply them until epithelialization or scarring of syphilitic ulcerative processes occurs.

Lymphoid infiltrates of a dense consistency are recommended to be lubricated with heparin ointment or an agent prepared from Podophyllin, a solution of dimethyl sulfoxide and glycerin in a ratio of 1: 5: 5. Their resorption occurs quite quickly when using a helium-neon laser.

The essence of pathogenetic therapy

Treatment should be comprehensive and include antibiotic, immuno- and enzyme therapy, local therapy and elimination of chronic pathological processes that are localized in the organs of the genital area. It is these activities that help improve the effectiveness of therapy directed against syphilis.

Increasing the stability of human immunity makes it possible to suppress the formation of new foci of infection, to remove toxic substances from the body that were formed during the destruction of bacteria. For this purpose, apply:

Pyrogens. The drugs of choice, which are endowed with the ability to stimulate the patient's immunity, are Pyrogenal and Prodigiosan.
The preparations are made on the basis of interferon. The appointment of these drugs is considered justified, because syphilis is accompanied by a violation of the production of interferon, it decreases by 2-5 times. Most often, a remedy called Amiksin is prescribed.
Means that are endowed with the ability to stimulate lymphocytes and phagocytes to perform their functional duties. This group includes Timalin, Taktivin, Timogen, Immunomax and Imunofan.
Phagocytosis stimulators - Polyoxidonium, Likopid, Golovata, Methyluracil, Levamisole.
Enzyme preparations that have the ability to stimulate microcirculation and tissue nutrition, excretion toxic substances. Additionally, they also help to concentrate the highest concentration of antibacterial drugs in those areas where foci of inflammation are localized. The drugs of choice are Wobenzin, Phlogenzym, Vobe-mugos E.
Vitamins. Particular attention is paid to ascorbic acid and B vitamins.
Adaptogens - Pantocrine, Extract of radiola rosea and eleutherococcus, tincture of ginseng and lemongrass. These medicines help to increase the body's resistance
Biogenic stimulants. Endowed with the ability to improve defensive forces organism, metabolic processes and regeneration processes. Most often, the choice is stopped at such means as FIBS, Placental Extract, Plasmol, Splenin, Polybiolin.

How long can it take to heal

Individuals diagnosed with the disease are interested in how much syphilis is treated. It is immediately necessary to tune in to the fact that, regardless of the case, treatment continues for a considerable amount of time, even when the disease is diagnosed for early stages it can last 2-3 months. All this time, medication should be taken.

As for the second stage, its treatment can last two or even more years. All this time it is forbidden to have sexual relations.

If a pathological condition is detected in a sexual partner, syphilis treatment should be carried out for both persons. In addition, preventive medication will need to be carried out by all family members of a sick person. Preventive treatment is also called primary. It is carried out to those persons who had sexual or domestic contact with a sick person, but they do not have clinical signs illness. However, it must be remembered that such treatment will be necessary and effective only if three months have not passed since the moment of contact.

Such therapeutic therapy for syphilis should last two weeks, it is carried out using water-soluble penicillins or novocaine salt penicillin. In the vast majority of cases, it is carried out on an outpatient basis, the following medications are used:

Extencillin or Retarpen. Its single dose should be 2.4 IU, injections are carried out once every seven days. The course of treatment consists of three injections.
Bicillin-1,2,3. The course of treatment consists of four injections, each two of which must be carried out within seven days. single dose Bicillin-1 and 5 is 1.5 IU Bicillin-3 - 1.8 MO.

Penicillins are also prescribed, such treatment continues for 6 months.

If more than three months have passed since the infection, then in this case it is necessary to undergo several examinations with an interval of two months. If six months have passed since infection, a single examination is performed. As for treatment, it is carried out only when the diagnosis is confirmed.

Follow-up of people who have been treated

In a situation where, after contact with a person with syphilis, a period of time from 3 to 6 months has passed, for contact person control is established by carrying out a complex of serological reactions, RIT or RIF. It is necessary to conduct research twice with an interval of 60 days. In parallel with this, examinations related to general clinical are carried out.

If six months have passed since the contact, then the examination is carried out once. Patients who received transfusions infected blood or its components are examined every three months during the year. Persons who have been in close enough contact with a sick person and have undergone a course of primary treatment are examined once every 90 days and are not subject to follow-up.

Prevention and complications

Fast enough is the treatment of early syphilis, if it was diagnosed in a timely manner. As for the examination, it can be done in any hospital, and in some clinics even anonymously.

Syphilis, which is considered secondary, can be cured if seeking help is not too late. The duration of treatment is several weeks, but situations in which it lasts up to a year are no exception. If medical therapy is not carried out, then the formation of late complications can be observed. The late form of syphilis without proper treatment can be fatal, because there is damage to the internal organs, brain and spinal cord.

Even if the infection was one-time, and the treatment of syphilis was successful, then this is not evidence that the infection will not occur again. That is why it is very important to follow preventive measures to prevent re-infection.

Use barrier methods of contraception.
Avoid casual sex.
Seek medical attention after casual sex.

In the event of the appearance of elements of a rash on the genitals or atypical discharge of them, it is necessary to urgently consult a doctor for advice. During this period, it is forbidden to have intimate contacts.

Please note that douching and washing the genitals after intercourse are not able to protect against infection with syphilis and other STDs.

Patients who are being treated for syphilis should abstain from sexual intercourse, especially unprotected intercourse, until it is completed. Since syphilis can be transmitted transplacental way from a sick mother to a fetus, perinatal screening must be carried out.

Complications

As already noted, the pathological condition we are talking about is considered a dangerous recurrent disease, because without treatment for syphilis, a large number of complications can form. It can be:

organ damage of cardio-vascular system and disruption of their functioning;
ulcerative processes of a destructive nature on the skin and bones;
the formation of neurosyphilis;
myelopathy of syphilitic origin, which is accompanied by muscle weakness and the appearance of discomfort in the muscle fibers;
syphilitic meningitis.

That's practically all the basic information about how the treatment is carried out, and what you need to remember when going through a therapeutic course. In any case, you need to be very attentive to your health and careful, because even a cured person can get sick again.

According to statistics from the Ministry of Health, In Russia, there are 30 syphilis patients per 100,000 inhabitants. These figures are not indicative, as big number infected people do not seek medical treatment. Thus, the risk of infection remains high.

A little about syphilis

Syphilis is a sexually transmitted infection. Pathogen this disease is a pale treponema, which is a bacterium that is capable of movement.

How does syphilis appear on the skin?

Syphilitic manifestations are very diverse and cause difficulties in differential diagnosis syphilis with others skin diseases. Morphological elements that appear on the skin with syphilis vary depending on the stage of the process.

The incubation period of this disease is on average from 2 weeks to 2 months. Shortening of the terms occurs in people with reduced immunity who have had infectious diseases, with a history of oncological diseases, tuberculosis, HIV infection.

During these periods, the pathogen is in the human body, but its concentration is not enough to cause symptoms of the disease. There are no skin manifestations.

After the specified time period, when there was an accumulation of pale treponema, the stage of primary syphilis develops. It is characterized by the only, but most contagious skin manifestation- hard chancre.

It is formed, as a rule, at the site of penetration of pale treponema (with genital contact - in the genital area, with oral - genital contact - in the mouth, lips, etc.).

The formation of the chancre occurs in several stages:

the formation of a spot of small size, pink-red;
formation of an erosive defect;
erosion bottom compaction, color change to bright red. Erosion is covered with a transparent or brown film.

With timely treatment or, conversely, the transition to next stage syphilis, the chancre again passes into the spot stage, and then completely disappears. As a rule, such a neoplasm does not cause discomfort in an infected person. There may be mild itching in the area of erosion.

classified according to the following criteria:

by number (single, multiple);
according to the depth of the skin lesion (erosive - affects only the surface layers, ulcerative - the lesion affects the deep layers of the skin);
in size (dwarf - less than 10 mm, medium - 10-20 mm, giant - more than 40 mm).

There are also atypical forms of chancres, which are extremely rare.

These include:

chancre-amygdalid: hard chancre, located on the tonsil (with ulcerative form this process affects a single tonsil, it is compacted and the formation on the surface of a bright red focus of ulceration with smooth edges; with an angina-like form, a tissue defect is not formed, the tonsil is dense, painless, pale treponemas are found on its surface);
chancre felon(the clinical picture is similar to streptococcal panaritium, however, with a syphilitic nature acute inflammation does not develop)
indurated edema manifests itself in the genital area in the form of a sharp swelling, changes in tissue turgor.

As a rule, the diagnosis of a typical hard chancre does not cause much difficulty. His distinctive feature is an increase in regional lymph nodes, which remain dense and painless throughout the duration of the primary stage.

Hard chancre is an extremely dangerous infectious agent, as it contains a very high concentration of pale treponema under the erosive film. If the chancre is damaged and erosion is opened, it is realized contact way transmission of infection.

Complications of hard chancre:

balanitis;
balanoposthitis;
phimosis;
paraphimosis;
phagedenism;
gangrene.

Photo

The photo shows typical shape hard chancre. A clear delimitation of this formation from healthy skin, hyperemic erosion surface, covered with a thin transparent film.

Secondary syphilis

In the absence of adequate treatment, primary syphilis passes into the next stage. The period from the moment of infection to the onset of manifestations of secondary syphilis is 10 weeks. Secondary syphilis is characterized by the spread of treponema by the hematogenous route, and therefore the process affects not only the area of direct infection, but the entire body as a whole.

Hard chancre disappears, develops general weakness, fever up to 38C, headaches, pain in muscles and joints. There are no manifestations on the skin, therefore, during this period it is extremely difficult to suspect a syphilitic infection.

When skin rashes appear, the general condition, as a rule, returns to normal. Secondary syphilis is characterized by true polymorphism. The main morphological elements are roseola and papules (roseolous-papular rash), and pustules and vesicles may also appear.

There is a wide variety of forms of skin lesions in secondary syphilis:

spotted syphilis (the most common form, represented by a roseolous rash);
papular syphilide;
wide warts;
pustular syphilis;
acne-like pustular syphilide;
pox-like syphilis;
impetiginous syphilis;
ecthymatous pustular syphilis;
rupioid pustular syphilis;
syphilitic leukoderma;
syphilitic alopecia.

Necklace of Venus (syphilitic leukoderma)

It is a specific sign of syphilis. It is formed in the neck and is a light, rounded lesions on the skin, outwardly resembling a necklace.

Photo

The photo shows a large number of light spots on the brown surface of the patient's skin with the formation of a characteristic pattern venus necklaces.

Photo

The photograph shows a patient with roseola rash- a characteristic manifestation of secondary syphilis.

Third stage of syphilis

Develops in the absence of adequate treatment 6-10 years or more after infection. Main morphological elements this stage - syphilitic gum, syphilitic tubercle. As a rule, at this stage, patients are concerned about severe aesthetic defects, formed during the active course of syphilis.

Elements of the third stage of syphilis:

Tubercular syphilide It is a dense tubercle of a cyanotic hue, which can be necrotic according to the coagulation type, as a result of which an area of tissue atrophy is formed. With colliquation necrosis, an ulcerative defect is formed on the surface of the tubercle, at the site of which, during the healing process, dense sinking scars form. Along the periphery of resolving tubercles, new tubercles are formed that do not merge with each other.
Gummous syphilide is a node that is formed in the subcutaneous fat. In the center of the node, a focus of tissue fusion is determined, an opening is formed on the surface of the skin, through which exudate is released from the center of the gum. The dimensions of the presented hole gradually increase, as necrotic processes are activated, and a gummous core is formed in the center of the focus. After its rejection, the ulcer regenerates with the formation of a deep retracted scar.

Photo

The photo shows stellate scar in the nose, formed after the healing of an ulcer in the tertiary period of syphilis.

The first signs of syphilis appear 3-4 weeks after infection with the disease. Pathology has a wave-like course. Treponemas actively multiply in the body and eventually affect all internal organs and systems. The sooner the symptoms of syphilis are detected, the easier it will be for the doctor to eliminate the consequences of syphilis.

Incubation period

It is impossible to establish the exact duration of treponema incubation. How long it will last depends on individual characteristics and states immune system. If a person takes any drugs during infection (for the treatment of another disease or for the purpose of prevention), then the incubation period is significantly increased.

The first signs of syphilis may appear up to 190 days after infection.

If the infection gets into several places at once, then the period of development of the disease will be reduced to 1-2 weeks. The incubation stage ends when the first symptoms of the disease appear. This may be a general malaise, inflammation of the lymph nodes, the appearance of a rash or hard chancre.

If treponema quickly entered the bloodstream and spread throughout the body, then the asymptomatic period of the course of syphilis will move to the secondary stage of the development of the disease, bypassing the first.

During the incubation period, microorganisms multiply. Getting into the human body, treponemas begin to divide, this process occurs 1 time in 30 hours. There are no symptoms at this stage of the development of the disease. The primary stage of development of syphilis begins after the first signs of a violation appear. If from the moment of infection to primary stage only a few weeks have passed, it will be easier for the doctor to detect microorganisms and prescribe an effective treatment.

How does primary syphilis manifest?

If you know how syphilis proceeds on different stages, then you can detect it in time and consult a doctor, this minimizes the risk of negative consequences. Venereal disease has a primary, secondary and tertiary form. Signs of a violation depend on the stage of development of the disease. Explicit characteristic signs allow doctors to make a diagnosis based only on the patient's condition and appearance.

Once in the body, treponemas move to the area of the lymph nodes and continue the process of division there. In most patients, the incubation period ends at 4 weeks after infection. In the place where the penetration of organisms has occurred, a hard chancre is formed. Over time it will turn into open sore from which liquid or blood will be released. The patient does not experience pain or discomfort.

Compacted areas appear in the genital area or oral cavity. Also, ulcers can occur on the abdomen, thighs and near anus. IN rare cases ulcerative formations are formed on the mucous membranes (the area of \u200b\u200bthe rectum, tonsils or cervix). It is impossible to independently detect a seal in such a place, since it does not cause discomfort and is single during primary syphilis.

In this regard, the infection continues to develop, and the person leads habitual image life, comes into contact with other people and puts them in serious danger.

With primary syphilis, the lymph nodes that are located near the chancre increase in size. The patient is able to detect this symptom of the disease himself. With an increase and hardening of the lymph nodes in the groin area, the outflow is disturbed, due to which the labia, scrotum or foreskin become inflamed. Primary syphilis lasts no more than 3 months.

The first symptoms of secondary syphilis

In the absence of treatment of primary syphilis or a violation of the rules for taking medications, a secondary form of infection appears. How it will be expressed depends on the discovered variety. There are 3 types of syphilis:

Fresh. It occurs as a result of primary syphilis. Symptoms are pronounced, so it is possible to detect the disease early.
Hidden. Doesn't have external manifestations. Usually it is detected as a result of tests.
Recurrent. Regularly appearing rashes and symptoms disappear even without treatment. Signs of syphilis do not have the same vivid expression as during the fresh form. Such relapses adversely affect the condition of the internal organs and systems of the patient.

The second stage of the disease lasts for several years (no more than 6). It will be expressed in the sudden onset of symptoms of syphilis and their equally abrupt disappearance. On different parts of the skin, the patient develops a rash. It can be found not only throughout the body, but also on the face, scalp.

The appearance of the rash and other signs depend on the type of this symptom. During secondary syphilis, there may be:

papules, spots have a rich pink or red color, have clear edges and do not cause discomfort;
pustules are diagnosed in the presence of concomitant diseases, usually bacterial infections.

In the photo on the right, you can see how the rash appears during secondary syphilis. At this stage, acute pain, itching or peeling is not observed, so patients do not seek help from a doctor, but mistakenly believe that this is just food allergy or the body's response to new things.

After a rash, scars may remain on the skin.

Large seals in the oral cavity (especially on the tongue) lead to speech defects. A rash during secondary syphilis that appears on the scalp leads to complete or partial baldness. Hair growth is restored a few weeks after the completion of a course of antibiotics.

In men, during secondary syphilis, there are symptoms of a cold. There is a temperature up to 39 degrees, weakness and headache.

The first symptoms of tertiary syphilis

From the moment of infection to the appearance of the tertiary form of syphilis, it can take from 5 to 10 years. At this stage, gummas begin to form on the skin and internal organs. Infiltration accumulates at the site of compaction, after which the process of decay and scarring begins.

Gummas are able to influence any system in the human body. For example, if they appear on bone tissue, then arthritis or periostitis will occur. At the third stage of the development of syphilis, treponemas have a destructive effect on cartilage. The most common complication is nasal collapse. It will be possible to correct the consequences of an infectious disease only by surgery.

The development of syphilis will continue due to the occurrence of mesodenitis. During this process, the lymph nodes located in the fold of the peritoneum become inflamed, general intoxication of the body begins and the patient feels sharp pain in the abdomen.

It is impossible to predict exactly where the gummas will form, so the diagnosis of syphilis must be carried out before the onset of the tertiary period. Damage to the nervous system or brain will lead to degeneration of the patient. In doing so, it will be observed inappropriate behavior, aggression, hallucinations, etc.

If left untreated, the patient may die.

How to recognize latent syphilis

With an asymptomatic course of the disease, doctors diagnose latent syphilis. It is determined by laboratory tests, which turn out to be positive. Latent syphilis may be late or early. In the first case, it is assumed that the infection was more than 2 years ago, and in the second case, it is less than the specified period.

Patients usually detect latent syphilis during preventive examinations. The late form of the disease is considered less dangerous, since when treponema is activated, minor lesions of the internal organs are observed. In a small amount, syphilides form on the body, face and lips, they are not contagious, so the patient can easily communicate with other people.

Early latent syphilis has a more destructive effect on the body, especially if the patient continues to be sexually active. In this case, there is a high risk of serious complications. In addition, the person becomes contagious. Treatment involves isolating him immediately and testing all people with whom he came into contact or entered into sexual relations sick.

Diagnostics

The complex of diagnostic measures is determined by the doctor. The method of detecting syphilis depends on the stage of its development. To confirm the primary form of infection, hard chancres are examined, usually there is a high concentration of treponema. At the next stage, all affected areas and mucous membranes are subjected to diagnostics.

During the third period, several methods can be used at once. Usually preference is given to the analysis of ORC, RIF, RPGA or the Wasserman reaction. In the presence of concomitant diseases or under the influence of other factors, laboratory tests may be ambiguous. In this case, the patient is scheduled for another examination. In addition to the venereologist, the patient should be examined by other specialized specialists. This will eliminate complications and determine how much syphilis has progressed.

For the diagnosis of an infectious disease early stage You need to have a complete health check-up every year. In case of unprotected intercourse or suspicion of infection, a person should contact a dermatovenerologic dispensary for urgent examination and preventive measures. After the end of treatment, the patient will be observed in the hospital for another 3-4 years. The absence of relapse means that the person is healthy.

Latent syphilis is a strange thing: the disease itself is there, but there are no symptoms in it.

Latent or latent syphilis is such a “mode” of the disease, in which the infected person does not have any external manifestations of ill health: there are no syphilitic rashes, no subcutaneous formations and signs of damage to internal organs.

However, it is important to understand that such dormant syphilis is only a temporary condition. Sooner or later, the disease will activate and a period of rashes will begin, and then more serious consequences.

The diagnosis of "latent syphilis" cannot be made from a photo or external survey- it is put only on the basis of tests.

Why the infection goes unnoticed, what is the danger of the latent form of syphilis and what to do about it - let's figure it out.

When does latent syphilis occur?

There are several scenarios in which syphilis can go unseen. The latent form of this infection is divided into groups, based on the duration of infection and the characteristics of the human body. Let's see when this can happen.

Classification of latent syphilis

Depending on how long ago a person became infected, latent syphilis is divided into the following groups.

early latent syphilis - if the infection occurred less than two years ago;
late latent syphilis - if the infection occurred more than two years ago;
hidden unspecified syphilis - if it is not known exactly when the infection occurred.

Depending on how long syphilis has been in the body, the degree of damage to internal organs, as well as necessary period treatment. The longer the infection proceeded, the higher the likelihood of damage to the nervous, cardiovascular and skeletal systems, and therefore, the longer and more serious the treatment will be.

Latent syphilis occurs in several cases:

As a variant of the primary period
This happens if pale treponema (the causative agent of syphilis) enters directly into the blood - for example, with blood transfusions, injections, cuts. Then a hard chancre (the very first sign of syphilis) does not appear on the skin and the disease develops unnoticed by the patient. Such syphilis is called "headless" or "syphilis without a hard chancre."
As part of the secondary and tertiary period of the disease
These periods are characterized by an undulating course: the stages of rashes (the stage of active syphilis) are replaced by stages of temporary external well-being (the stage of latent syphilis).
As a variant of the atypical (asymptomatic) course of syphilis
The disease proceeds without external signs at all. If this variant of syphilis is not diagnosed by tests, then the disease will manifest itself only at a late stage - in the form of serious lesions of the skin and internal organs. This asymptomatic syphilis usually lasts about two years.

How common is latent syphilis?

Latent syphilis is now quite common. For example, about 10% of all cases of syphilis are atypical form no symptoms. In addition, it is worth remembering about decapitated syphilis and temporary periods of calm in patients in the primary period.

The reason is due to two factors:

Why is this happening?

Ordinary syphilis develops when pale treponemas, the causative agents of this disease, enter the human body. During their activity, the patient develops symptoms of syphilis: rash, bumps, gummas, and so on.

At the same time, the patient's immunity does not stand aside: as with any infection, it secretes antibodies ( protective proteins), and also sends cells of the immune system to the breeding sites of bacteria. Thanks to these measures, the majority of pale treponemas die. However, the most tenacious bacteria remain, which change their shape so that the immune system no longer recognizes them.

In the cystic form, pale treponema cannot be active, but it can multiply

This type of "masked" pale treponema is called cystic forms or L-forms. In this form, pale treponema cannot be active, but it can multiply. As a result, when the immune system "loses its vigilance", secretly bred bacteria enter the bloodstream and harm the body again.

The same thing happens with improper treatment of syphilis. If the antibiotic is chosen incorrectly or in the wrong dose, not all pale treponemas die - the survivors are masked and remain invisible until better times.

How is latent syphilis transmitted?

Whether latent syphilis is contagious is a completely natural question. It would seem that since the patient has no manifestations, then it is impossible to get infected from him. But this is a false conclusion. In reality, things are not so simple.

On the one hand, the most contagious manifestations of syphilis are, indeed, skin rashes early period(hard chancre and secondary syphilides). And if they are not on the patient’s body, then it is almost impossible to get infected from him with syphilis during normal contact.

However, there are other routes of infection:

sexual way (any kind of sex);
through saliva;
through breast milk;
through the blood.

Therefore, you still need to be on your guard if your friend has been diagnosed with latent syphilis. In this case, syphilis is especially contagious, which occurs during the first 2 years. After - the risk of infection is significantly reduced.

If latent syphilis is found in an employee of a socially significant profession (educator, teacher, salesman, etc.), then for the duration of treatment he is suspended from work and issued a sick leave. After recovery, a person can return to his work again - he will no longer be dangerous to others.

Read more about who should not work with syphilis in a separate article.

How long does a person with latent syphilis live?

The life expectancy of a person with undiagnosed syphilis depends on how long ago they became infected and whether they received timely treatment. The longer the latent infection lasts in the body, the more harm she inflicts.

For example, a late latent infection can lead to:

to paralysis;
dementia;
blindness
hepatitis and cirrhosis;
heart failure.

And it's not yet full list the consequences that late latent syphilis leaves. With the development of complications, the quality and life span of a person are greatly reduced and depend on each specific case.

And yet, these are extreme situations.

If latent syphilis is detected in time and treatment is started, a person can be cured completely, and the disease will not affect the duration and quality of life in any way.

How to diagnose syphilis?

Diagnosis of latent syphilis is very difficult process because there are no signs of latent syphilis. The doctor has to rely only on the results of the tests and communication with the patient - perhaps the disease manifested itself earlier, until it went into a latent form.

In this situation, it is important to correctly evaluate all the data, because tests can sometimes give false results, and making a diagnosis of syphilis is a serious step for both the doctor and the patient.

What is important for an accurate diagnosis?

The doctor should act almost like a real detective - every little thing is important to him. Usually, the examination of the patient is carried out according to the scheme "survey - examination - test results".

When questioning the patient, they reveal: the estimated time of infection, whether he had syphilis before, whether he was previously treated, whether the patient took antibiotics over the past 2 to 3 years, whether the person noticed skin rashes or formations, whether they went to the doctor, and so on.

Despite the absence of external manifestations, the doctor must examine the patient, as he may notice something that the person himself did not see: rashes on the back, in the hair, scars after fresh rashes, syphilitic leukoderma on the back of the neck, baldness, loss of eyelashes or eyebrows. All these are signs of syphilis that once manifested, which could then turn into a latent form.

And yet, the basis for the diagnosis of latent syphilis are the results of the tests. Pluses in the Wasserman reaction or in others primary analyzes, where a treponema substitute is used, is not yet guaranteed accurate diagnosis. These tests must be confirmed by 1 - 2 treponemal (i.e., tests using real treponema). Only if both types of tests indicate a disease does this mean that the patient has latent syphilis.

What to do if the diagnosis is doubtful?

Difficulties arise when one of the tests for latent syphilis shows a negative result.

In this case, it is important to consider different reasons. For example, if there is no syphilis, then one of the tests may just be false positive - showing the disease in someone who is actually healthy. Or vice versa - if there is syphilis, but it is already in a late stage, and even hidden, then non-treponemal tests become negative.

To better explain how the results of analyzes are evaluated when latent syphilis, here is the diagram:

Tests	Diagnosis	What's next?
1 positive non-treponemal test ( RV /RMP /RPR) + 2 positive treponemal tests ( ELISA And RPGA)	"Hidden syphilis"	The patient is given treatment
1 negative non-treponemal test (

The bacterial causative agent of syphilis - pale treponema - got its name due to the fact that when staining the material with special dyes, it is not visible when viewed with a light microscope. It looks like a thread twisted into a spiral. Outside the body, it quickly dies when dried. Also destructive to bacteria is heat and disinfectants, but she tolerates the cold perfectly.

Infection occurs in a large number of cases during unprotected intercourse, when there are open foci of infection in the area of contact. IN Lately there has been an increase in oral infections. Also, the microorganism can enter the bloodstream immediately (transfusion from an infected person, repeatedly used syringes from drug addicts). There are frequent cases of infection during pregnancy, when the disease passes from mother to child. household way infection is unlikely - pale treponema quickly dies outside the human body. However, the transmission of infection is possible with close prolonged contact with the patient, when pale treponemas from the affected areas fall on towels or dishes.

There are also forms of congenital syphilis.

What happens when you get infected?

After 3-4 weeks, a hard chancre appears at the site of the introduction of the pathogen - painless ulcer bright red color, having a dense base. It heals after a while, which does not mean the death of the infection. On the contrary, at the same time there is an active reproduction of pale treponema and its movement through the body along lymphatic vessels. The affected person may feel headache, fever, general malaise, but most often during this period, the symptoms of the disease are almost absent.

Later, syphilis manifests itself with small ulcers on the palms, a rash on the skin, mucous membranes and soles. If you let the disease take its course, it can flare up and fade for several years, and rashes can either appear or disappear without a trace. The person feels healthy. With the distance from the onset of the disease, the quiet intervals become longer. People who are not familiar with the features of syphilis even think that they recover completely. However, such well-being is imaginary, since pathogens are already present in all tissues and organs, and begin to affect them.

Causes

The causative agent of the disease bacterial microorganism, Treponemapallidum (pale treponema). It enters the human body through microcracks, abrasions, wounds, ulcerations, from the lymph nodes enters the general bloodstream, affects the mucous surfaces, skin, internal organs, nervous system, skeleton. Bacteria multiply rapidly, division occurs every 33 hours, it is on this time period that the treatment of syphilis is based.

The likelihood of infection depends on the number of bacteria that have entered the body, that is, regular contact with the patient increases the risks.

Classification

The staging of syphilis is based on the method of first contact, i.e. this is the stage of the disease at which the patient first noticed the first symptoms of syphilis and sought medical attention.

Stages of syphilis:

Primary sero-negative is characterized by the formation of a specific wound - a hard chancre, ulceration is not painful, round shape with definite borders and a deepening in the middle. It mainly affects the external genital organs, however, it can also be localized in other places on the skin, mucous surfaces, and in the internal organs. Appears after 3-6 weeks from the moment of infection and disappears after the same period of time after the onset.
Primary sero-positive - positive sero-reactions are detected.
Primary latent leaks without standard clinical picture.
Secondary fresh appears 4-10 days after the appearance of ulceration, i.e. from the onset of the disease takes from 2 to 4 months. Symptoms of syphilis at this station are characteristic rashes on the skin and mucous membranes. The patient feels weakness, malaise, headaches, fever. Clinical tests reveal positive seroreactions, accelerated ESR, anemia, etc. in human blood. Damage to internal organs is noted: digestive tract, cardiovascular system, lungs.
Secondary recurrent. Appears after a period of relative calm. The first symptoms of syphilis at this stage are the reappearance of a rash that merges into continuous foci, the formation of papules. Each relapse can last up to several months. In general, this form of the disease manifests itself for up to three years.
The secondary latent form, in which there are no symptoms characteristic of syphilis, and it can only be determined using clinical tests. Patient with latent form disease is highly contagious.
The tertiary active stage is extremely rare today. Appears in people who have not received treatment, or who have not been sufficiently treated. Occurs in a time interval from 3 to 10 years after the onset of the disease (cases of fixation of up to 60 years after the alleged contact infection are described!) It is characterized by severe forms of diseases of the internal organs, the membranes of the brain and nervous system, bones of the skeleton articular cartilage. The surface of the epidermis is affected by cicatricial atrophies, peculiar gummas are formed. This stage can be fatal for the patient.
The tertiary latent stage proceeds latently, without a clinic of typical manifestations.
The latent form of the disease is asymptomatic, but tests for syphilis are positive. This group also includes patients whose treatment was started with unspecified form diseases.
An early congenital form is transmitted to the fetus in utero, through the blood of a sick mother. Usually such children are not viable, but if the child survives, he has numerous violations of all functional systems. Such children lag behind in development, are weakened and often get sick.
Late congenital stage practically does not manifest itself until the age of 15-16, followed by symptoms of tertiary syphilis.
Hidden congenital, which includes all categories of children's ages.

What are the symptoms of syphilis?

The symptomatic picture of syphilis is polyvariant, depending on the nature of the course of the disease, its form. There are three phases of the disease that determine the symptoms and treatment of syphilis:

Primary:

The first symptom of the disease is the appearance of a hard chancre, localized to a greater extent on the genitals or having a different location. A hard chancre is a dense round ulcer with a diameter of up to 20 mm. She doesn't bleed, doesn't have purulent discharge and absolutely painless. A week after the appearance of the chancre near the affected area, the patient begins to enlarge the lymph nodes. The difficulty in diagnosing syphilis at this stage is the lack of severe symptoms. In addition, there is a possibility of infection of the ulcer, when swelling and redness appear around the chancre, pus begins to be released. As a result correct setting diagnosis can be difficult.

Spontaneous healing of ulceration (hard chancre) in the next 3-6 weeks.

What are the characteristics of the secondary form of the disease:

Formation at 4-10 weeks after the primary hard chancre of a characteristic pale rash, located symmetrically over the body.
Deterioration of the patient's well-being - headaches, general malaise, fever.
The lymph nodes in the zone and outside the zone of lesions are increased.
characteristic loss hairline ladder or patchy alopecia which involves eyebrows, eyelashes, hairy part heads.
Wide condylomas of beige color appear on the skin and mucous membranes of the genital organs, in the anus.
The repeatability of this picture of symptoms with intervals of bursts and absolute attenuation.

What are the symptoms of tertiary syphilis:

The brain (both brain and spinal), nervous and cardiovascular systems are affected.
Bones, joints and internal organs are affected.
Changed skin with visible scarring.
Characteristic granulomas, gummas, tubercles and bumps appear.

Diagnostics

Activities for the diagnosis of syphilis include the study of anamnesis, examination and assessment of the overall clinical picture, conducting clinical blood tests. The main goal is to identify what symptoms are observed in the patient and confirm the presence of pathology. All diagnostic measures are divided into two groups: treponemal and non-treponemal.

Non-treponemal tests are performed in mass studies, sometimes they can give a false positive result in the absence of the disease. Upon receipt of such an answer, treponemal tests are additionally prescribed. They are also used to assess the success of ongoing treatment in dynamics.

Treponemal tests for the detection of antibodies that remain in the body of a person who has recovered from syphilis forever cannot be used to evaluate the effectiveness of treatment, but they can be used to detect hidden forms diseases.

Treatment of syphilis

After carrying out the procedures that revealed the first signs of syphilis and establishing the diagnosis, an adequate treatment protocol is prescribed, which can be quite long - from 2-4 months, and in some cases advanced disease- more than two years. Depending on the general condition of the patient, treatment is carried out in a hospital, rarely on an outpatient basis. All the time until complete cure confirmed clinical analyzes sex life is prohibited. In addition, all members of the patient's family undergo examinations and preventive treatment.

Antibiotic therapy is the only effective method in the treatment of syphilis, since pale treponema is highly sensitive to penicillin drugs, which are most effective in combating the microorganism. Water-soluble penicillins are injected into the patient's body for 24 days every three hours stationary conditions is the most efficient method.

In the presence of an allergy to penicillin, the patient is prescribed antibiotics from a number of cephalosporins or macrolides - in tablets or intramuscularly. Active Forms diseases are treated in stationary conditions, latent - through outpatient therapy. The duration of treatment is determined by the stage of the disease and can reach several years.

It is necessary to treat syphilis with simultaneous support of the body's internal reserves, which is carried out with the help of immunostimulating complexes, vitamins, etc.

It is very important to inform all sexual partners of the presence of the disease and encourage them to undergo necessary research, even in the absence of symptoms - such a course of pathology does not reduce the risk of complications. In the event that the patient is cured, but his sexual partner is not, re-infection is very likely.

Complications

On different stages symptoms and treatment of syphilis can give a multiple picture of complications, due to the stage of the disease.

The primary period is characterized by:

Examination of all pregnant women, passing tests for serological reactions three times to avoid cases of congenital syphilis.
Mandatory preventive treatment for pregnant women who were previously registered, but were removed from it after the cure.
Regular examinations for those at risk (drug addicts, prostitutes).
It is imperative to examine everyone who had close contact with the sick person, necessarily for family members.
Hospitalization of persons with a positive reaction, after treatment - dispensary observation.

Prevention and prognosis for recovery

It is impossible to reflect syphilis in advance. There is no vaccine or other active prevention against this disease. It is important to follow the rules of safe sex, to refuse casual relationships.

Public prevention should be carried out in accordance with general rules fight against venereal diseases. The components of such prevention are the mandatory registration of all patients, examination of his family members and persons who were in close contact with him, hospitalization of the infected and monitoring them over the next few months, constant dispensary control monitoring of the treatment of sick patients.

Prognosis for clinical cure of syphilis early stages favorable. The earlier the disease is diagnosed and treated, the more favorable the prognosis.

On late stages With the help of treatment, it is possible to significantly improve the patient's condition.

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