Latent or latent syphilis: symptoms, diagnosis, treatment. Late syphilis latent

With latent syphilis, there are no characteristic signs of pathology, and the disease can be suspected when performing specific laboratory tests. Despite the fact that there are no obvious manifestations of infection, the disease progresses slowly and leads to irreversible consequences. Basically, the asymptomatic course is associated with the widespread use of antibacterial drugs without prior accurate diagnosis of the disease. Patients, believing that they are sick with another venereal pathology (chlamydia, gonorrhea, trichomoniasis), start the wrong therapy. It only suppresses the growth of the causative agent of syphilis - Pale treponema, contributing to the latent course of the infection.

The frequent detection of a latent course is due to mass preventive examinations for syphilis in healthcare.

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  The causative agent of the infection

  The cause of the infection is Treponema pallidum (Treponema pallidum). It is surrounded by a specific protective sheath that protects it from exposure to hazardous environmental factors: antibiotics, antibodies.

  Treponema exists in several forms:

  • typical spiral shape;
  • cyst;
  • L-shape.

  In the case of a typical spiral shape, the infection proceeds with vivid clinical manifestations. Diagnosing it is easy enough.

  Cysts and L-forms are special forms of treponema that the body cannot recognize and respond to; protected species of the pathogen do not cause the appearance of characteristic symptoms, but form a latent course of syphilis, which can only be detected in a laboratory study. Cysts, L-forms are simply found in human blood and are periodically activated when appropriate factors arise: reduced immunity, stress, etc.

  Features of the disease

  The main route of transmission of the infection is sexual - about 90% of cases. The household way is especially common in children, with kissing, breastfeeding. Sweat and urine from patients with syphilis are not contagious. Semen, blood, vaginal secretions, saliva, breast milk - contain the pathogen in large quantities and are very contagious. The source of infection is a person with syphilis who is able to transmit the disease in the first years of the disease. Main routes of transmission:

  • sexual;
  • domestic;
  • transfusion (through the blood);
  • transplacental (from mother to child in utero).

  Classification of the disease from the duration of the infection in the body:

  The typical course of syphilis is characterized by a classic change of stages:

  • incubation period.
  • primary syphilis.
  • Secondary syphilis.
  • Tertiary syphilis.

  

  stages

  Incubation period(time from infection to the onset of clinical symptoms) lasts 3-9 weeks. 24-48 hours after infection, treponemas make their way to the regional lymph nodes and the systemic infection process starts. At this stage, the principle and timing of personal prevention after casual sexual intercourse is formed, which consists in the treatment of the genital organs with disinfectant solutions within 2 hours after intercourse.

  Primary Period begins with the appearance of a hard chancre (painless ulcer) at the site of introduction of treponema. In that place, the nearest lymphatic vessels and nodes increase. The end of the primary period is accompanied by fever and malaise, this is a consequence of the generalization of the infection: treponemas are released into the blood.

  

  Hard chancre on the genitals

  ATtoric period lasts 3 to 4 years. It is characterized by the appearance of rashes on the skin and mucous membranes. The rash may look like:

  • bubbles;
  • papules;
  • spots;
  • pustules.

  

  Rashes of secondary syphilis

  The rash disappears after a few weeks and does not leave a trace. Without appropriate treatment, the rash reappears. In addition, there may appear: skin pigmentation disorders, local hair loss on the head and eyebrows, seizures.

  Tertiary syphilis refers to late manifestations of the disease. It is accompanied by damage to the internal organs, the brain and spinal cord. There are gummous (nodular) formations on the skin, bones, spine, internal organs, spinal cord and brain. These nodes lead to the destruction of the tissues surrounding them, followed by deformities, disability and death.

  

  Tertiary syphilis

  Some people, even when in contact with an infected person, remain resistant to treponema and do not get sick. Rarely, syphilis will clear up on its own without the use of specific antibiotics. This is due to the peculiarity of the human immune status.

  

  Manifestations of latent syphilis

  With a latent (latent) course, all of the above symptoms are absent. But this does not negate the presence of treponema in the blood of a person. They are detected only when performing special serological tests.

  Latent syphilis is periodically activated, but it can accompany a person all his life until his death, without waking up. A person with latent syphilis is usually not contagious. The latent course, like the usual one, is divided into early and late syphilis.

  Clinic of the disease:

  If the latent form of syphilis manifested itself in the first 2 years, this is a favorable fact. During this time, treponema infections do not yet have time to affect the internal organs and brain, the bacteria are easily treatable.

  The negative side of the onset of symptoms in the first 2 years is the high contagiousness of the patient. It becomes very contagious during this period, since in the hard chancre, in the rashes on the skin, there is a large number of active treponemas, which, upon contact with the skin or mucous membranes of a healthy person, begin to intrude into them.

  The latter fact defines patients with early latent syphilis as an epidemiologically dangerous group. Large-scale anti-epidemic measures should be carried out:

  • isolation of patients;
  • examination of the patient's sexual and household partners;
  • forced treatment.

  If the latent course lasts more than 2-3 years, syphilis is called late. A person during this period is not contagious. When the process is activated, more serious life-threatening manifestations manifest: damage to the liver, heart, kidneys, bones, body skin. But its most serious consequence is damage to the brain and spinal cord: dorsal tabes, progressive paralysis. This is the danger of the latent course of the disease: without showing itself in the first 2-5 years, the infection manifests itself with deformities and disabling consequences.

  Therefore, it is best to identify latent syphilis at a preventive examination and start its treatment on time. Currently, a blood test for syphilis is performed everywhere, including on a budgetary basis.

  Diagnostics

  To determine the presence of latent syphilis in a person, you can use the following data:

  • features of the anamnesis (presence of a sore in the patient on the body, on the genitals, rash, enlarged lymph nodes, fever);
  • examination of contacts (identification of a patient with syphilis in sexual partners);
  • sharply positive results of all serological tests (MRP, ELISA, RIF, RPGA);
  • rise in body temperature after the start of specific treatment;
  • decrease in antibody titer to pale treponema after 1 course of therapy.

  During the diagnosis of latent syphilis, false positive results can be obtained. They are most often due to:

  • previous malaria;
  • the presence in the human body of a focus of chronic infection (tonsillitis, sinusitis, pyelonephritis);
  • chronic liver pathology (cirrhosis, hepatitis, alcoholic hepatosis of the liver);
  • connective tissue disease (rheumatoid arthritis, scleroderma, systemic lupus erythematosus).

  In the examination for late syphilis, it is necessary to examine the cerebrospinal fluid to exclude damage to the nervous system by pale treponema. For this purpose, a lumbar puncture is taken from the patient.

  Treatment

  Therapy of the early latent course of syphilis should stop its transition to an active state. Therapy of the late course is aimed primarily at preventing its progression and the development of neurosyphilis.

  Specific treatment of syphilis is based on the use of systemic antibiotics of the penicillin series. At the beginning, a temperature reaction occurs, which indicates in favor of the presence of treponema in the body. The introduction of drugs is carried out in stationary conditions.

  The following antibiotics are used for therapy: Benzylpenicellin, Retarpen, Bicillin, Erythromycin, Clarithromycin, Ceftriaxone, Oxacillin. Doses and time of treatment are selected by a specialist individually for each patient, depending on the form of the disease and its severity. The average time of therapy for latent syphilis is 1 month.

  Retarpen - the main tool for the treatment of syphilis

  The result is evaluated no earlier than 3 months after the end of treatment according to repeated serological tests: a decrease in the titer of specific antibodies is detected. With early syphilis, cure is faster, negative tests for infection are soon achieved. Late course is more difficult to cure, positive tests can remain forever, sometimes this is also true for early syphilis.

  To deregister, you must:

  • full-fledged treatment taking into account all requirements;
  • optimal clinical examination data;
  • the results of a serological blood test (ELISA and RPHA may be positive with strictly negative MCI and CSR).

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, however, 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 can become infected with this disease, but also people living with him under the same roof.

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!

Treatment of latent syphilis is aimed at preventing the development or progression of late complications. Although clinical experience supports the effectiveness of penicillin for the treatment of this form of syphilis, there is little evidence for the choice of a specific treatment regimen. There is also little data on the use of non-penicillin drugs.

These regimens are used in patients without allergies and with normal CSF values ​​(if such a study was performed).

Early latent syphilis

Benzathine penicillin G 2.4 million units IM once

Late latent syphilis or latent syphilis of unknown duration

Benzathine penicillin G, total 7.2 million units, administered 3 times

2.4 million IU / m with a break of 1 week.

After the neonatal period, children diagnosed with syphilis should have a CSF examination to rule out neurosyphilis, as well as a careful history to determine whether the syphilis is congenital or acquired (see Congenital Syphilis). Older children with acquired latent syphilis are assessed as adults and given appropriate treatment regimens recommended for children (see Child Sexual Harassment or Rape). These regimens are used in children with acquired syphilis and normal CSF who are not allergic to penicillin.

Early latent syphilis

Benzathine penicillin G, 50,000 U/kg IM to adult dosage

2.4 million units once Late latent syphilis or latent syphilis of unknown duration

Benzathine penicillin G, 50,000 U/kg IM to adult dose of 2.4 million IU 3 times 1 week apart (total of 150,000 U/kg to adult dose of 7.2 million IU).

Other issues in the management of patients with latent syphilis

All patients with latent syphilis should be examined for signs of tertiary syphilis (aortitis, neurosyphilis, gumma, and iritis). In patients with syphilis, if one of the following criteria is met, CSF testing should be performed before treatment:

• neurological or ophthalmic symptoms or signs;
• Other evidence of active tertiary syphilis (eg, aortitis, gumma, iritis);
• Ineffective treatment;
• HIV infection in association with late latent syphilis or syphilis of unknown duration).

Under certain circumstances, and also at the request of the patient, it is possible to conduct a CSF examination in other patients who do not meet the above criteria. If CSF results indicate abnormalities consistent with neurosyphilis, the patient should be treated for neurosyphilis (see Neurosyphilis). All patients with syphilis should be tested for HIV.

Follow-up

Quantitative non-treponemal serological tests should be repeated after 6 and then after 12 months. There are limited data on treatment response in patients with latent syphilis. If titers are increased 4-fold, or if the initially high titers (t1:32) do not decrease by at least 4-fold (two dilutions) within 12 to 24 months, or the patient develops symptoms or signs consistent with syphilis, the patient should be screened for neurosyphilis and re-treated accordingly.

Special remarks

Allergy to penicillin

Men and non-pregnant women allergic to penicillin should be treated according to the following regimens.

Doxycycline 100 mg orally twice a day

or Tetracycline 500 mg orally 4 times a day.

Both drugs are used for 2 weeks if the duration of the infection is known to be more than 1 year; in all other cases - within 4 weeks.

Pregnancy

Pregnant patients allergic to penicillin should be treated with penicillin after desensitization (see Management of Penicillin Allergy and Syphilis in Pregnancy).

Many sexually transmitted infections do not cause symptoms for a long time. Among these is latent syphilis, a sexually transmitted disease that patients learn about during a random examination. However, the disease can be diagnosed by certain signs.

Syphilis is the causative agent

The causative agent of the disease is pale treponema. The microorganism belongs to spirochetes, under a microscope it looks like a spiral-shaped bacterium. On average, there are 8–14 turns in the structure, and the total length does not exceed 14 µm. With a latent course of a disease such as syphilis, the causative agent of infection is in an inactivated state for a long time, forming cysts, L-forms.

Such modifications of treponema are able to stay for a long time in the regional lymph nodes, cerebrospinal fluid of an infected person. Under favorable conditions for the pathogen (decreased immunity, chronic diseases), treponemas are activated and an active stage develops with a characteristic clinical picture and symptoms.

Syphilis - ways of transmission

To prevent infection, each person must imagine how pale treponema is transmitted. The main route is sexual, with unprotected intercourse. However, it is impossible to completely exclude the possibility of transmission of the pathogen by household means, when using hygiene items and cutlery alone with the patient. The penetration of the pathogen occurs through the mucous membranes, on the surface of which there are microabrasions, cracks. Among the rare ways of infection, venereologists call:

• transfusion (transfusion of infected blood and components to a patient);
• transplacental (during pregnancy and childbirth, from mother to child).

What is latent syphilis?

Hearing a similar term, patients are often interested in doctors if there is latent syphilis and what kind of disease it is. The definition of "latent syphilis" is used to denote a form of the disease in which there are no clinical manifestations, symptoms and signs of the disease, but the results of laboratory tests indicate the presence of the pathogen in the body. More often, changes in the blood are noticeable already 2 months after infection. Immediately from this time, the countdown of the duration of the latent period of syphilis begins.

In most cases, the detection of pathology occurs by chance, during the delivery of tests, which are mandatory during a preventive examination (blood on RW). In women, a gynecologist can suspect the disease during the next examination. However, in practice, a latent form of syphilis is detected when diagnosing changes in internal organs (heart, liver, thyroid gland, musculoskeletal system).

Is latent syphilis contagious?

Many mistakenly assume that the absence of signs of disease is the main criterion for absolute health. For this reason, a common question arises: is latent syphilis transmitted? Venereologists say that infection with this type of syphilis is possible. However, the transmission of the pathogen occurs only in two ways:

• with infected blood
• during sexual contact.

It should be noted that the risk of infection is maximum during the first two years after the onset of the disease. When diagnosing a disease in a sexual partner at this time, doctors advise to refrain from sexual intercourse and also undergo a comprehensive examination. Early diagnosis and timely initiation of therapy lead to a favorable outcome.

Hidden early syphilis

The term "early syphilis" is used to denote the period of the disease, which corresponds to the time from primary infection to recurrent secondary syphilis. Doctors talk about early syphilis, when two years have not passed since the infection. Patients at this stage have no manifestations of the disease, but they represent a potential danger in an epidemic sense.

At any time, the early latent form of syphilis can go into the active phase, which appears with skin rashes and general symptoms of intoxication. The elements of the rash contain a large number of pale treponema, the release of which can cause infection in contact with infected persons. It should be noted that early latent syphilis is more common in patients under 40 years of age who are promiscuous.

Late latent syphilis

Late latent syphilis is registered 24 months or more after infection. When the disease passes into the active phase, symptoms and clinic of tertiary syphilis are observed. With this form, there is always damage to the internal organs and nervous system (neurosyphilis). At the same time, low-infectious tertiary syphilides, tubercles, and gummas can be observed on the skin. If their integrity is violated, it is possible to isolate pale treponema, infection of others in contact with the patient.

Latent congenital syphilis

Rarely diagnosed in children. Infection comes from an infected mother. In this case, the woman herself can get sick before pregnancy or during the process of bearing a child. The pathogen enters the fetus through the umbilical vein or through the lymphatic slits. Pathological changes in the organs and tissues of the unborn baby can be recorded at 5-6 months of gestation, during an ultrasound scan.

However, more often the latent form makes itself felt in early childhood. Prior to this, the detection of pathology is possible through serological studies, analysis of biological material (cerebrospinal fluid). Often, the indication for a comprehensive examination of the child is the detection of a positive mother in the postpartum period or during pregnancy.

Latent unspecified syphilis

The diagnosis of "unspecified syphilis" is made if the patient has no information regarding the possible time of infection. At the same time, doctors also find it difficult to determine the duration of the disease. Patients are assigned a set of serological studies, during which, according to the morphological forms of treponema, assumptions are made regarding the type of disease. Unspecified latent syphilis can give false-positive non-specific serological reactions, so they are repeated before the final diagnosis.

Latent syphilis - signs

Symptoms of latent syphilis do not make themselves felt for a long time. On the mucous membranes and skin of ulcers, rashes are not observed, however, changes can be recorded in the internal organs, the nervous system, and the musculoskeletal system. Among the indirect signs of an early form of latent syphilis, doctors call:

1. The presence in the anamnesis of rashes, the nature of which could not be diagnosed earlier.
2. Treatment of STIs, previously.
3. The presence of an active form of syphilis in a sexual partner.
4. Inflammatory reactions in the analysis of cerebrospinal fluid.

It is customary to single out indirect signs indicating a late stage:

• degenerative changes in the spinal underlying fluid;
• positive result of serological tests.

In addition, the following phenomena may indicate syphilis:

• prolonged increase in body temperature up to 38 degrees of unknown origin;
• an increase in peripheral lymph nodes (no pain);
• weight loss;
• general weakness, depressed mood.

Diagnosis of latent syphilis

How to identify latent syphilis in a particular situation - doctors determine depending on the nature of suspicions, indirect signs. The final diagnosis is made on the basis of a comprehensive assessment of the results of the studies. Among the main diagnostic methods:

1. The reaction of indirect hemagglutination (IPHA)- prepared red blood cells are mixed with the patient's serum. With a positive result, the cells stick together.
2. (IFA)- a special enzyme is added to the patient's serum sample, which changes color with a positive result.
3. RIF (immunofluorescence reaction)– a characteristic glow is present in the sample of the patient's biomaterial.

How to treat latent syphilis?

In the treatment of latent syphilis, the main goal is to eliminate the cause of the disease. It takes more time to eliminate the consequences (bone deformities, disorders of the nervous system, heart), and some of them can no longer be corrected. Treatment of late latent syphilis is based on the use of antibiotics, which are selected taking into account the stage of the pathology. Above is a table that shows the treatment regimen for latent late syphilis, with drug names and dosages. However, it should be borne in mind that all appointments are made only by a doctor.

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

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

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

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

The current state of the problem

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

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

Reasons for the increase in the number of patients:

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

The possibility of asymptomatic syphilis is now recognized.

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

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

Forms of latent syphilis

If, from the moment of infection, syphilis takes a latent (latent) course (is asymptomatic), but with positive specific serological reactions, they speak of a latent form of the disease. The latent syphilis in most cases comes to light incidentally at statement of specific serological reactions. In some cases, the doctor manages to find out what period of the disease he belongs to:

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

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

1. Diagnosis early latent syphilis is established if more than 2 years have not passed since the moment of infection. In epidemiological terms, this category of patients is the most dangerous.
2. Diagnosis late latent syphilis established if more than 2 years have passed since the moment of infection.
3. Latent unspecified syphilis- this is a condition when, in the absence of anamnestic data and clinical manifestations of the disease, positive serological reactions are detected in the blood of a previously untreated patient.

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

Early latent syphilis

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

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

Who is sick

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

What you need to find out in the survey

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

Signs and symptoms of early latent syphilis

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

Treatment of early latent syphilis

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

Timely detection of patients in the period of early latent syphilis and adequate adequate treatment have a positive effect on the prognosis of the disease.

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

Late latent syphilis

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

Who is sick

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

What you need to find out when interviewing a patient

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

Signs and symptoms of late latent syphilis

1. During the examination, it is not possible to determine the traces of previously resolved syphilides. During the examination, there are no signs of a specific lesion of internal organs and the nervous system.
2. In the diagnosis of late latent syphilis, serological tests such as RIF, ELISA, TPHA and RITT are used. The reagin titer is usually low and is 1:5 - 1:20 (in 90% of cases). In rare cases, high titers are noted - 1:160:480 (in 10% of cases). RIF and RIBT are always positive.

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

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

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

Treatment of late latent syphilis

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

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

Rice. 5. Manifestations of the disease in the tertiary period - gumma of the face and gummous infiltration of the hand.

Latent unspecified syphilis

In the absence of information about the circumstances and timing of infection and the presence of positive results of serological studies, a diagnosis of latent, unspecified syphilis is established. Such patients are subject to careful clinical and serological examination, often repeated. Setting RIF, RIF-abs and RIBT, ELISA and RPHA are mandatory.

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

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