If a person, whose body was struck by pale treponemas, wants to frighten, he is shown what stage 3 syphilis looks like, a photo of which is especially terrible for its irreversible manifestations that occur both inside the body and with the person's appearance.
The third stage of syphilis begins 5-9 years after infection if the disease has not been treated at all or the therapy was not effective enough. The main difference between stage 3 syphilis and stage 2 is the locality of the manifestations of the disease, followed by destruction of organs and tissues in the place of their localization, and after treatment - the formation of scars on the affected area.
The defeat of the skin and mucous membranes in the third stage is no longer manifested by a rash, but has the form of gum or tubercles that appear in small quantities. Another distinguishing feature of the 3rd period is that although patients at this stage of the course of the disease may look just awful, they are much less infectious to others than those with stages 1-2. The low probability of contagion is associated with a small number of spirochetes remaining in the body and the fact that those few treponemas that enter the gum die during the decay of the infiltrate, without being transmitted to other people. A small number of pale treponemas at stage 3 of syphilis can cause a negative serological test, while the disease will destroy the body. Therefore, the main research methods at 3 stages of the course of the disease are RIF and RIBT analyzes.
Bumpy manifestations of the 3rd period of the disease are most often found on a small area of \u200b\u200bthe skin. At the same time, gummas in the third stage pose a serious danger to the lives of patients, squeezing and destroying the affected internal organs.
Tuberous manifestations of the third stage of development of syphilis are flat or hemispherical in shape with clear boundaries and the size of a cherry stone. Over time, the infiltration of the tubercles necrotizes, which leads to the formation of ulcers characteristic of the third period of syphilis. Healing, the ulcer leaves behind a grouped, slightly sunken scar, surrounded by a border of a different color. At the site of scar formation, repeated rashes of the third stage of syphilis no longer appear. The eruption of the tubercles occurs in jerks, therefore, in the photo of the same person, you can see the tubercle manifestations of the 3 periods of the disease, which are at different stages of development. Usually, the tubercles are located in a group, in the place of which a so-called mosaic scar is then formed. In some cases, there may be a serpiginous variant of the development of tubercles. Serpiginous manifestations of the third stage in the photo look like a patch of skin with solid tubercles fused together, which, after resolution, form one large scar. New tubercles will appear along the edges of the common scar, which, bursting, increase the area of \u200b\u200bthe affected area. However, the rarest manifestations of the third stage of syphilis are large areas in the form of a continuous plaque of interconnected tubercles or, conversely, a dwarf rash like a grain of dew.
Like most manifestations of the previous stages of the disease, stage 3 of syphilis usually does not cause subjective sensations in the patient during the months of its development.
Gummas, in contrast to the tubercles, which appear at the third stage of the progression of the disease, are formed not on the skin, but in the subcutaneous fatty tissue and represent a painless, walnut-sized knot not soldered to the surrounding tissues.
Along with external manifestations, destructive changes occur in internal organs, nerve cells, joints and bones, which can lead not only to weakness and shortness of breath, but also to memory and mental disorders.
A common sexually transmitted disease - syphilis - is caused by a microorganism - a pale spirochete. It has several stages of development, as well as many clinical manifestations. In Russia at the end of the 90s of the twentieth century, a real epidemic of this disease began, when out of 100 thousand of the population 277 people fell ill per year. The incidence is gradually decreasing, but the problem remains relevant.
In some cases, there is a latent form of syphilis, in which there are no external manifestations of the disease.
Why does latent syphilis occur?
The causative agent of the disease, the pale spirochete, under normal conditions has a typical spiral shape. However, with unfavorable environmental factors, it forms forms that promote survival - cysts and L-forms. These modified treponemas can persist for a long time in the lymph nodes of an infected person, his cerebrospinal fluid, without causing any signs of illness. Then they are activated, and a relapse of the disease occurs. These forms are formed as a result of improper antibiotic treatment, the individual characteristics of the patient and other factors. A particularly important role is played by patients' self-medication for a disease that they believe, but in fact it is an early stage of syphilis.
The cyst form is the cause of latent syphilis. It also causes a lengthening of the incubation period. This form is resistant to many drugs used to treat the condition.
How is latent syphilis transmitted? In nine cases out of ten, the route of transmission is sexual. Much less common is the household route (for example, when using one spoon), transfusion (when transfusing infected blood and its components), as well as transplacental (from mother to fetus). This disease is revealed most often during a blood test for the so-called Wasserman reaction, which is determined for each admitted to the hospital, as well as when registering with an antenatal clinic for pregnancy.
The source of infection is only a sick person, especially during.
Latent period of syphilis
This is the time after infection of a person with pale treponema, when there are positive serological tests (blood tests are changed), but the symptoms are not determined:
- rash on the skin and mucous membranes;
- changes in the heart, liver, thyroid gland and other organs;
- pathology of the nervous system and musculoskeletal system and others.
Changes in blood usually appear two months after exposure to a carrier. From this moment, the duration of the disease is counted in a latent form.
Early latent syphilis occurs within two years of infection. It may not appear immediately, or it may be the result of a regression of early symptoms of the disease, when an apparent recovery occurs. There are no clinical symptoms of latent syphilis, it is characterized by a negative sample of cerebrospinal fluid (cerebrospinal fluid). It is diagnosed using serological tests.
Latent late syphilis is characterized by a sudden activation of the process after a period of apparent well-being. It can be accompanied by damage to organs and tissues, the nervous system. Less infectious elements of the skin rash appear.
What is latent, unspecified syphilis?
In this case, neither the patient nor the doctor can determine when the infection occurred, since there were no clinical symptoms of the disease, but it was revealed, most likely, as a result of a blood test.
There is also the possibility of a false positive result of the Wasserman reaction. This happens in the presence of a chronic infection (sinusitis, caries, tonsillitis, pyelonephritis and others), malaria, liver diseases (hepatitis, cirrhosis), pulmonary tuberculosis, rheumatism. An acute false-positive reaction occurs in women during menstruation, in the third trimester of pregnancy, in the first week after childbirth, myocardial infarction, acute diseases, trauma and poisoning. These changes disappear on their own within 1-6 months.
If a positive reaction is detected, more specific tests are necessarily carried out, including the polymerase chain reaction, which determines the antigen of treponema pallidum.
Early latent form
This form in terms of time covers all forms from primary seropositive (chancre) to secondary recurrent (skin rashes, then their disappearance - a secondary latency period, and relapses within two years), but there are no external signs of syphilis. Thus, the disease can be registered in the period between the disappearance of the hard chancre (end of the primary period) to the onset of the formation of rashes (the beginning of the secondary period) or be observed at the moments of remission in secondary syphilis.
At any time, the latent course can be replaced by a clinically expressed one.
Since all of the listed forms are infectious, due to the coincidence in time with them, the early latent option is also considered dangerous for others and all the prescribed anti-epidemic measures are taken (identification, diagnosis, treatment of contact persons).
How to detect a disease:
- the most reliable evidence is contact with a patient with active syphilis during the previous 2 years, while the probability of infection reaches 100%;
- to find out the presence of unprotected sexual intercourse in the last two years, to clarify if the patient had subtle symptoms, such as sores on the body or mucous membranes, hair loss, eyelash loss, a rash of unknown origin;
- to clarify whether the patient did not go to the doctor at this time for any reason that worried him, whether he took antibiotics, whether he was transfused with blood or its components;
- examine the genitals in search of a scar left after a hard chancre, assess the condition of peripheral lymph nodes;
- serological tests in a high titer, but not necessarily, immunofluorescence analysis (ELISA), direct hemagglutination test (RPHA), immunofluorescence test (RIF) positive.
Late latent form
The disease is detected most often by accident, for example, during hospitalization for another reason, when a blood test is taken ("unknown syphilis"). Usually these are people aged 50 and over, their sexual partners do not have syphilis. Thus, the late latency period is considered non-contagious. In terms of time, it corresponds to the end of the secondary period and the entire tertiary.
Confirmation of the diagnosis in this group of patients is more difficult, because they have concomitant diseases (rheumatoid arthritis and many others). These diseases cause false positive blood reactions.
To make a diagnosis, the patient should be asked all those questions, as with the early latent option, only to change the condition: all these events should have occurred more than two years ago. Serological tests help in the diagnosis: more often they are positive, the titer is low, and ELISA and RPGA are positive.
When confirming the diagnosis of latent syphilis, ELISA and RPGA are of decisive importance, because serological tests (express diagnostics) can be false positive.
Of the listed diagnostic methods, the confirmatory reaction is RPHA.
With latent syphilis, a puncture of the cerebrospinal fluid (CSF) is also shown. As a result, latent syphilitic meningitis can be identified. Clinically, it does not manifest itself or is accompanied by minor headaches, hearing loss.
CSF research is prescribed in the following cases:
- signs of changes in the nervous system or eyes;
- pathology of internal organs, the presence of gum;
- ineffectiveness of penicillin therapy;
- association with HIV infection.
What are the consequences of late latent syphilis?
Most often, syphilis has an undulating course with alternating remissions and exacerbations. However, sometimes it is observed for a long period without symptoms, ending several years after infection of the brain, nerves or internal tissues and organs with syphilis. This option is associated with the presence in the blood of strong treponemostatic factors resembling antibodies.
How does the late late period manifest in this case:
- a rash on the outer integuments of the body in the form of tubercles and nodules, sometimes with the formation of ulcers;
- damage to bones in the form of osteomyelitis (inflammation of the bone and bone marrow substance) or osteoperiostitis (inflammation of the periosteum and surrounding tissues);
- joint changes in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
- mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
- violation of the activity of the brain and peripheral nervous system.
Leg pain with latent late syphilis can result from damage to bones, joints, or nerves.
Latent syphilis and pregnancy
If a woman has a positive serological reaction during pregnancy, but there are no clinical signs of the disease, she must definitely donate blood for ELISA and RPGA. If the diagnosis of latent syphilis is confirmed, she is prescribed treatment according to general schemes. Lack of therapy entails serious consequences for the child: congenital deformities, termination of pregnancy and many others.
If the disease is cured before 20 weeks of gestation, labor will proceed as usual. If the treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many accompanying factors.
Treatment
Specific treatment is prescribed only after the diagnosis is confirmed by a laboratory method. The sexual partners of the patient are examined, if their laboratory tests are negative, then treatment for the purpose of prevention is not prescribed to them.
Treatment of latent syphilis is carried out according to the same rules as for its other forms.
Long-acting drugs are used - Benzathine penicillin, as well as Benzylpenicillin sodium salt.
Fever at the beginning of penicillin therapy is an indirect evidence of a correctly established diagnosis. It accompanies the mass death of microorganisms and the release of their toxins into the blood. Then the state of health of patients is normalized. With a late form, such a reaction may be absent.
How to treat latent syphilis:
- in the early form, benzathine penicillin G is injected at a dose of 2,400,000 units, two-stage, into the muscle once a day, only 3 injections;
- in the late form: Benzylpenicillin sodium salt is injected into the muscle at 600 thousand units. twice a day for 28 days, two weeks later the same course is carried out for another 14 days.
In case of intolerance to these antibiotics, semi-synthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.
Latent syphilis during pregnancy is treated according to the general rules, since drugs of the penicillin group are not dangerous to the fetus.
Monitoring the effectiveness of treatment
After the treatment of early latent syphilis, serological control (ELISA, RPGA) is carried out regularly until the indicators are completely normalized, and then twice more with an interval of three months.
With late latent syphilis, if RPHA and ELISA remain positive, the period of dispensary observation is 3 years. Tests are carried out every six months, the decision to deregister is made on the basis of a set of clinical and laboratory data. Usually, in the late period of the disease, the restoration of normal blood and cerebrospinal fluid parameters is very slow.
At the end of the observation, a complete examination of the patient is carried out again, his examination by a therapist, neurologist, otorhinolaryngologist and ophthalmologist.
After the disappearance of all clinical and laboratory manifestations of the disease, patients can be allowed to work in children's institutions and catering establishments. But once transferred and cured, the disease does not leave persistent immunity, so re-infection is possible.
Syphilis is an inflammatory infectious disease caused by a pathogenic pathogen - treponema pallidum (spirochete). A distinctive feature of the disease is the periodic change of exacerbations and latent asymptomatic course.
The main insidiousness of the disease is the cyclical course and disguise of the infection as other diseases. Taken together, all this is confusing and most of those infected are unaware of the infection and attribute it to other diseases.
To diagnose the disease, it is necessary to study the enemy and disassemble all stages of the development of syphilis. Official medicine distinguishes between three stages in the development of the disease.
The initial stage of syphilis or its incubation begins to report from the moment the infection enters the body and ends after the first symptoms appear. This period is defined by medicine as asymptomatic, the disease does not manifest itself in any way and the infected person does not suspect of infection.
Treponema pallidum at this time adapts to the conditions of the body and concentrates mainly in the lymphatic system, since for its activation and reproduction it is the most optimal environment of the body. The incubation of the disease can last from 10-90 days, but the average manifestation period is 20-45 days. Such ambiguous terms depend on factors that accelerate or slow down the manifestation of the disease.
Factors that accelerate the reproduction of treponema pallidum and reduce the incubation period:
- too much of the pathogen has entered the body at one time;
- re-infection with treponema with a short period of time;
- several foci of penetration of bacteria into the body;
- the presence of concomitant sexually transmitted diseases;
- reduced immunity of the patient, as a result of chronic diseases and improper lifestyle.
Factors that slow down the development of pale treponema and increase the incubation period:
- taking medications from the group of antibacterial agents;
- the presence of concomitant diseases with the presence of a hyperthermic reaction;
- elderly age.
Pale treponema, during the incubation period, multiplies in the lymphatic system until the maximum concentration is reached, and then through the walls of small blood vessels it enters the bloodstream and begins to spread throughout the body. Even during the incubation period and without the presence of characteristic symptoms, the infected person poses a danger to others - he is a potential carrier of the infection.
Important. Infection with syphilis occurs: during sex, in the household, from mother to child during breastfeeding and during pregnancy, as well as with the ingress of contaminated blood into the body of a healthy person.
Incubation period diagnostics
Unfortunately, the minimum number of infected people go to the hospital during this period, since most of them do not even suspect about the disease. Those who suspect infection, for example, after questionable sexual intercourse, should be promptly examined.
But the difficulty of the incubation period is that treponema does not manifest itself in the body in most laboratory studies for a whole month after penetration into the body. The easiest way to diagnose is to check the sexual partner.
If this cannot be done, PCR diagnostics are prescribed, which detects the DNA of the pathogen in the body. The disadvantage of this method is the high price and not always reliable data in the early stages of infection.
Incubation therapy
A huge plus is the detection of syphilis during the incubation period, since a quickly started treatment will avoid health complications and can stop the manifestation of the first symptoms and the transition of the disease to the first stage. Therapy at the initial stage of the disease is carried out on an outpatient basis and does not require the use of injections; tablets are prescribed for taking drugs from the group of antibacterial agents.
Preference is given to drugs containing penicillin, to which the pathogen is most sensitive. The duration of treatment for the incubation period does not exceed two weeks.
The first stage of syphilis
Stage 1 of syphilis begins from the moment the pale treponema reaches a certain concentration in the blood, sufficient for the manifestation of the first symptoms. The primary symptom is the appearance of erosion at the site of infection.
If the infection was sexually transmitted, the neoplasm manifests itself in the genital area, rectum or oral cavity, depending on the type of sex in which the infection occurred. In case of household infection, the site of localization of erosion can be any area of \u200b\u200bthe skin.
Erosion is chancre or primary syphilis. It looks like a round ulcer with regular outlines, with a diameter of 4-10 mm, in rare cases, there is a giant chancre up to 15 mm in diameter.
Syphiloma develops gradually from a speck of red to a dense ulcer at the base. The dense part of the chancre resembles cartilaginous tissue to the touch, the surface of the chancre is smooth, covered with a transparent film, which is the highest concentration of bacteria.
Primary syphiloma does not cause discomfort (pain, itching) and, if located in hidden areas, can go unnoticed.
Hard chancre goes away on its own, at the first stage of the disease, without the use of therapy.
Classic or typical chancre is the most common, but in rare cases it may not have a typical shape:
- Chancre panaritium localized on the phalanx of the finger and looks like swollen inflamed skin with an internal ulcerative part with purulent contents. Panaritium has irregular outlines and a bluish tint. Unlike the typical painless hard chancre, it causes shooting pains. Most often, this type of chancre is found in doctors, as they become infected through the skin of the hands.
- Inductive edema, the main place of localization is the genitals, in women - the labia, in men - the foreskin. Atypical chancre looks like swelling, an enlarged area. On palpation - a characteristic hard consistency. Color - from red to bluish. Despite the active inflammatory process in the area of \u200b\u200binductive edema, the patient's condition remains stable, without hyperthermia and pain.
- Chancre amygdalite - atypical chancre with localization in the oral cavity - throat, tonsils, chancre is very similar to a common sore throat. A distinctive feature of amygdalitis from a common sore throat is unilateral inflammation (either the left side or the right).
Stage 1 syphilis also manifests itself as inflammation of the lymph nodes - regional lymphadenitis, which appears within 10-14 days after the onset of primary syphiloma. In medicine, there is a saying that "lymphadenitis is a faithful companion of chancre", since inflammation of the lymph nodes occurs only in the area of \u200b\u200blocalization of primary syphilis.
For example, syphiloma in the genital area is accompanied by inflammation of the inguinal lymph nodes, the chancre of the oral cavity is caused by an increase in the submandibular, and the chancre of the finger is the elbow.
In whatever area the inflammation occurs, there are characteristic features of the lymph nodes during the period of inflammation:
- size - from beans to flattering nut;
- dense to the touch;
- elastic and mobile;
- there is no adhesion with the surrounding tissues;
- do not cause painful sensations, even when pressed;
- do not change the structure of the skin in the area of \u200b\u200binflammation.
Important. With the localization of a hard chancre on the cervix or in the rectum, inflammation of the lymph nodes will pass imperceptibly, as it will proceed in the pelvic region.
At the end of the first period, all symptoms and primary chancre disappear, but pale treponema reaches its maximum concentration in the blood and more and more affects the body. The end of primary syphilis in 95% of patients is asymptomatic and only 5% of those infected can experience headache attacks, general malaise and hyperthermic reaction.
Diagnosis of primary syphilis
Syphilis in the early stages is very difficult to diagnose and causes difficulty, even for experienced specialists, since the disease with its main symptom - primary syphiloma is very similar to a number of other infectious and non-infectious diseases. And since at the beginning of the primary stage, laboratory tests may not give an accurate confirmation of the disease, they carry out differential diagnosis of syphilis with other diseases.
Table # 1. Differential diagnosis of syphilis and other diseases at the first stage of the disease:
| Photo | Symptom |
| The rash with genital herpes looks like small multiple small bubbles, but unlike syphilis, there is pronounced itching and burning. Herpes is not accompanied by inflammation of the lymph nodes. |
| Unlike syphilitic erosions, they have an irregular shape and a yellow coating on the surface, and also cause painful sensations. |
| Differs from chancre in pairwise arrangement of papules, itching. The rashes have no compaction at the base and the disease is not accompanied by inflammation of the lymph nodes. |
| Rash on the penis. They differ from syphilitic eruptions in irregular shape, combining the elements of the rash into one whole and lack of compaction at the base. The disease is accompanied by symptoms of the inflammatory process (hyperthermia, weakness). |
| The location of the rash on the body of the penis, which is rare in syphilitic infection. The difference between papules and syphilitic ones is the absence of ulcerative lesions and a depressed part of the papule in the center, there is no lymphadenitis. |
| Localized at the inlet of the uterus. Erosion of irregular shape with indistinct outlines. Has a long chronic course, in contrast to the rapidly passing primary syphilis. |
| Has a chronic course with the presence of tuberous erosion, which bleeds and has an expanded edge. |
| Similar in manifestation to atypical chancre amygdalitis. In both diseases, the temperature can be raised and symptoms of an acute inflammatory process are observed. A distinctive feature - amygdalitis chancre is characterized by unilateral lesion and inflammation of the submandibular lymph nodes. |
| Rashes with stomatitis are accompanied by painful sensations. |
The main methods of laboratory research of primary syphilis:
- microscopic examination of secretions from hard chancre;
- analysis of punctate from the lymph nodes (using puncture);
- serological diagnostics using RIF, RIBT, RPR studies;
- PCR diagnostics.
Primary syphilis therapy
Therapy of primary syphilis is carried out with antibacterial drugs from the penicillin group. They are most active against treponema pale, but have a significant disadvantage - frequent allergic reactions in patients and the need for frequent administration (quickly excreted from the body) to maintain the required therapeutic concentration. In case of intolerance to the penicillin series, alternative drugs from other groups are selected.
Table 2. The main treatment regimens with penicillin drugs and alternative drugs from other groups:
| A drug | Features of reception |
| Retarpen is the drug of choice for treating syphilis. 2.4 million units are assigned every seven days. Duration of treatment is two weeks. |
| 1.5 million units twice a week. Duration of treatment is 2.5 weeks. |
| 1.2 million units, once a day. The course of therapy is 10 days. |
| Replacement of the penicillin group in case of allergic reactions. Daily dose 0.5 g, course duration up to 10 days |
| Replacing penicillin in case of intolerance. Daily dose 0.5 g, course duration up to 10 days. |
| Alternative to the penicillin group. A daily dose of 0.2 g in two doses. The duration of therapy is at least 15 days. |
Important. 95% of infections occur through sexual contact. In this case, the type of sex (anal, vaginal, oral) does not play a role.
Second stage of syphilis
Stage 2 syphilis begins to appear three months after the onset of the primary symptom - a hard chancre and lasts from 2 to 7 years, depending on the individual characteristics of the organism. Secondary syphilis in most patients begins with symptoms of intoxication of the body and hyperthermia, as pale treponema reaches its maximum concentration in the body and begins to affect all systems and internal organs.
A distinctive feature of this period is the alternation of exacerbations and the latent course of the disease, which replace each other and last for several months.
14 days after the increase in body temperature, skin manifestations of the disease follow, as in the primary stage, but they have significant differences in their manifestation.
Skin lesions of the third stage of the disease:
- Syphilitic roseola - pink spots of a pale shade up to 1 cm in diameter. Their main localization is observed in the torso region, less often roseola affects the palms and feet. A distinctive feature is the appearance of 10 pieces per week. Roseola is the most common manifestation of stage II syphilis. It is observed in 80% of patients.
- Papular syphilis - papules of a minimum size up to 5 mm. They have a pink tint and a smooth surface. In the process of ripening, they can peel off around the circumference. After disappearance, they are replaced by skin pigmentation in this area. The localization of the rash can be ubiquitous, but mostly these are areas with the presence of sebaceous glands. When the rash is located in areas of increased sweating, the rash turns into wet erosion from which a secret with a high concentration of the pathogen is released. With such a rash, the patient is dangerous to others, since infection is possible not only during sexual intercourse, but also through common household items - in a household way.
- Pustular syphilis - pustular formations on the skin. They can be located everywhere. Very rare, advantage in immunocompromised patients.
- Syphilitic leukoderma or the crown of Venus - whitish spots, similar to skin pigmentation. The main localization is in the cervical region. They look like a lace collar, hence the name of the crown of Venus.
The cutaneous symptoms of secondary syphilis are very diverse, but still have similar characteristics:
- have a benign course and disappear with or without adequate treatment;
- the duration of the rash does not exceed several weeks and is replaced by a latent course;
- after disappearing do not leave marks on the skin;
- are not accompanied by hyperthermia and symptoms of an acute inflammatory process.
In addition to skin manifestations, the secondary period affects the mucous membranes of the body, which are manifested:
- Erythematous sore throat - inflammation in the tonsils, causing pain when swallowing.
- Papular sore throat - defeat papular rash of the tonsils with their enlargement. A distinctive feature of papules is the union during maturation into a single element of irregular shape.
- Pustular sore throat - defeat of the tonsils with characteristic symptoms of a common sore throat (temperature, intoxication of the body).
- Syphilitic alopecia - damage to the hairline occurs in 20% of patients. May have a focal manifestation - small spots with partial hair loss and diffuse - with a sharp decrease in the number of hairs and changes in their structure.
Another symptom of second stage syphilis is inflammation and enlargement of the lymph nodes, but not in a specific area, as in the primary stage, but throughout the body. The process involves the lymph nodes of the groin, cervical, axillary, and femoral regions. At the same time, they remain painless, do not cause discomfort and do not fuse with the surrounding soft tissue.
In the second period, pale treponema has already struck the bloodstream and begins to spread throughout the body, affecting the internal organs. Therefore, in the secondary period, functional disorders in the work of certain organs may appear.
Table No. 3. How are the lesions of the body manifest:
| Organ or system | Symptoms |
|
|
|
|
|
|
|
|
|
|
| Joint pain |
Important. During the second stage, there is still no pathological change in the somatic organs, and all the symptoms of treponema lesion disappear after the appointment of adequate therapy.
Diagnostics of the secondary period
Diagnosis of the second stage of syphilis is carried out using laboratory tests based on laboratory tests, since during this period, 98% of patients show positive serological reactions and only two percent of patients with a false negative reaction, which is affected by a high titer of antibodies in the blood.
Laboratory analyzes of the second period:
- RIBT;
- RPGA.
Since at the secondary stage there is a reaction from the somatic organs, the following can be additionally prescribed:
- Ultrasound of internal organs;
- gastroscopy;
- pharyngoscopy;
- bone x-rays;
- x-rays of light.
Due to the variety of skin manifestations of the second period, differential diagnosis is also carried out with diseases characterized by the manifestation of various rashes:
- rubella;
- typhoid fever;
- smallpox;
- toxicoderma;
- psoriasis;
- lupus;
- fungal skin lesions;
- candidiasis.
Second stage therapy
Treatment of the second stage of the disease is carried out with the use of antibacterial drugs, as in the first stage. These are antibiotics of the penicillin series or their alternative replacement for allergic reactions (see table 2).
When certain organs are damaged, symptomatic drugs are added to the therapy, but after consulting the necessary specialist (gastroenterologist, neurologist, etc.). Treatment of secondary syphilis should take place according to the scheme prescribed by the doctor and in a stationary setting.
Failure to adhere to adequate therapy leads to the transition of the disease to the tertiary period, which is dangerous not only for health, but also for life.
Important. The latent course of syphilis of the second stage is characterized by the complete absence of a clinical picture, but pale treponema continues to affect the body. The latency period can only be diagnosed using laboratory tests that detect the presence of antibodies to the pathogen.
Third stage of syphilis
Syphilis of the third stage, like the secondary, affects all systems and internal organs, but already with pathological and irreversible changes. In 25% of advanced tertiary syphilis, death is observed. This stage of syphilis is manifested by skin lesions, like the first two, but with serious damage.
Cutaneous manifestations of the tertiary stage are called tertiary syphilides, they appear as:
- Lumpy syphilis. This is a tubercle formation in the lower layers of the epidermis, a dense structure and up to 7 mm in diameter. They can be located both in groups and singly. In the process of maturation, they begin to protrude above the surface of the skin and become manifest, turning into open ulcers. This erosion can heal for several weeks, forming scar tissue after healing.
- Gummy knot, which is formed in the subcutaneous tissue layer. The gummy knot has the size of a nut with a diameter of up to 2 cm, a round regular shape and a dense structure, when it occurs, the skin acquires a purple hue. At the initial stage of development, it is mobile, with mechanical action it causes weak pain. In the process of further development, mobility is lost due to fusion with the surrounding soft tissue. At the final stage, it turns into an open ulcer with purulent contents. Healing occurs with the formation of a scar.
The tertiary stage of syphilis is characterized by pathological damage not only to the skin, but also to all soft, cartilaginous and bone tissues, as well as internal organs. The defeat occurs with the formation of syphilitic gum on them.
The most common lesion with gum is found on:
- Joints - fibrous gum affects the knee and elbow joints.
- Tongue - the gum of the language, enlarges and completely atrophies the language, leading to its complete destruction.
- Hard palate - the gum of the hard palate is localized in the oral cavity. During the growth process, it affects the bone tissue, which leads to the unification of the mouth and nose.
- Soft palate - The gum of the soft palate affects the pharynx and makes breathing difficult.
- Nose - the gum of the nose affects its back and leads to the destruction of bones, as a result of which the nose collapses.
- Liver - Liver gum causes liver failure, resulting in death.
- In the stomach - stomach gum disrupts its normal functioning.
Also, gumma damage to the brain and other organs occurs.
Important. In 90% of patients with tertiary syphilis, the cardiovascular system is disrupted and leads to myocarditis and aortitis, which are complicated by heart failure.
Diagnostics of the tertiary period
Since during the tertiary period, the concentration of treponemes in the body is significantly reduced RPR diagnosis gives a negative result, therefore, the study is carried out using RIF, RIBT studies. They give a positive result 98% of the time.
Diagnostics at the third stage is aimed at determining the degree of pathology of internal organs, therefore, the examination includes:
- Ultrasound of all internal organs;
- x-rays of the lungs and bones;
- rhinoscopy;
- gastroscopy;
- liver function tests;
- puncture of cerebrospinal fluid.
Tertiary syphilis therapy
How to treat stage 3 syphilis depends on the degree of damage to the body. The main direction, as in the first two stages, is the intake of antibacterial drugs, but according to a certain scheme, additional symptomatic treatment is prescribed, depending on the damaged organs.
The main treatment regimen for the tertiary stage with antibiotics to combat treponema pale is:
- Preparatory treatment for syphilis - taking tetracycline (in case of intolerance, replace with erythromycin). The duration of the course is at least 14 days.
- The course of treatment with penicillin drugs, the duration of treatment depends on the severity of the condition.
- Break in treatment for 14 days.
- The second course of therapy with penicillin drugs. Duration from the severity of the damage to the body.
- Taking medicines based on Bismuth. The duration and dosage are prescribed strictly according to an individual scheme, which depends on the severity of the condition, the individual characteristics of the organism and on the age category of the patient. The instruction prohibits taking drugs for patients with impaired liver and kidney function.
- The third course of penicillin drugs.
Additional treatment:
- taking symptomatic drugs to treat damaged organs;
- taking immunostimulating drugs to increase the body's resistance;
- taking fortified complexes;
- therapy of damaged skin
The fourth stage of syphilis
Official medicine distinguishes only three stages in the development of syphilis based on laboratory indicators, but according to symptomatic manifestations, there is another form of the disease that progresses over decades. This is stage 4 syphilis - the last stage in the development of the disease, which leads to death.
Table No. 4. Irreversible changes in the body during the fourth stage:
| Affected organ | Symptoms |
|
|
| Syphilitic hepatitis is the defeat of the gummy formations of the liver, which leads to liver failure and death. | |
| An aneurysm is a dissection of the vessel wall that ruptures the aorta. | |
| Pathologies of the musculoskeletal system |
|
Important. Can syphilis be cured in 4 stages? Definitely not, stage 4 syphilis cannot be treated, since pathological changes have occurred in the whole organism. Therapy of the fourth period is aimed at slowing down the process of destruction of the body and at alleviating the patient's condition.
The video in this article is a complication of all stages of syphilis.
Frequently asked questions to the doctor
Infection during oral sex
Hello, tell me, what is the probability of infection with syphilis during oral sex?
Good afternoon, infection with syphilis during oral sex is possible and the likelihood is the same as with anal and vaginal sex. Since saliva contains no less concentration of pale treponema than sperm and vaginal fluid.
External signs of syphilis
Good afternoon, is it possible to determine the presence of syphilis by the appearance of a person and what are the signs?
Hello, unfortunately, it is not always possible to visually determine the presence of a disease. For example, during incubation, the disease does not manifest itself in any way and during periods of latent course the symptoms are not visible. All kinds of defects on the skin and mucous membranes can indicate the presence of syphilis. It can be ulcers, pustular lesions, rash.
Syphilis (or Lewis) is an infectious disease transmitted through sexual intercourse. The cause of the development of the disease is pale treponema (spirochete) - a long thin spiral-shaped bacterium.
The reasons
- Unprotected sexual intercourse.
- The use of other people's household items (dishes, toothbrushes, towels, linen).
- Through donated blood; when sharing syringes.
- Infection of the fetus through the placenta or during childbirth from a sick mother.
- You can also get infected with a kiss, if a healthy partner has mucosal damage in the mouth.
Stages
The insidiousness of this disease lies in the fact that the spirochete can take on a temporary form of existence - a cyst, which has a protective shell.
In this form, the bacteria can exist for years.
Therefore, Lewis is characterized by such stages of the course of the disease as secondary and tertiary syphilis.
Primary
The disease begins with the appearance of a small ulcer - a hard chancre at the site of contact (genitals), less often on the oral mucosa, tonsils, tongue. It does not interfere, does not hurt, therefore, it is often not honored with attention. Even if left untreated, the chancre heals on its own. However, a person remains contagious to others, and the course of his illness enters a new stage.
Secondary
It develops 3-4 months after infection and can last for several years. At this time, the patient is very dangerous for others, even with household contacts! Spirochetes are distributed throughout the body. All lymph nodes are enlarged. Various types of rashes (syphilis) occur periodically. Women have a "necklace of Venus" - pale areas of skin on the back and side of the neck. There are symptoms typical for ARVI. Secondary Lewis has a latent form that escalates from time to time. Approximately 20% of patients report loss of hair and eyebrows. Without treatment, after 5 years the next period occurs.
Tertiary syphilis
It can lead to the death of the patient - about a quarter of them die. Depending on the localization of the infection, one or another organ is destroyed with the help of late syphilides - gum. They often occur on the palate, destroying its bones. It changes the voice, the nose may sink. The disease can have a latent nature, last for decades and be characterized by possible sad consequences: changes in the patient's psyche, up to insanity; deafness and blindness, complete or partial paralysis are possible.
Diagnostics
- patient survey;
- examination of the skin and lymph nodes;
- laboratory research.
Treatment
The disease is treated exclusively in a hospital.
This is not particularly difficult, but it takes a long period of time. It consists in taking a course of injections of water-soluble penicillins, which are given every 3 hours for 24 days, plus vitamins and immunostimulants. After that, the patient is registered and regularly tested. It is believed that syphilis is completely cured if, 5 years after the end of the course, there are no more manifestations of the disease. This disease cannot be treated on its own or by "folk" methods, because it can return.
Syphilis (outdated name - lues) is a systemic disease with a chronic course, related to sexually transmitted infections. It is accompanied by damage to the integumentary tissues and mucous membranes, nervous, musculoskeletal systems, as well as most internal organs. Depending on the characteristics of the course of syphilis and the stage of pathology, the clinical manifestations of infection can be very diverse.
According to the generally accepted (in the scientific world it is also called traditional) classification of syphilis, all its types can be conditionally divided into: primary, secondary (early and late), tertiary.
A special place is occupied by congenital syphilis, which is characterized by gross combined damage to the nervous, cardiovascular, respiratory and musculoskeletal systems.
At the initial stage, the symptoms of syphilis are associated only with dermatovenerological syndromes (and often go unnoticed by patients). The third stage of syphilis has much more dangerous and unpleasant health consequences. The features of the syphilitic process at all stages of the development of the disease are discussed in our review.
Causes and stages of the disease
The specific causative agent of syphilis is Treponema palidum (pale treponema) - a type of gram-negative spirochetes with an elongated shape and several curls.
Basically, the infection is transmitted sexually through unprotected sexual intercourse. However, blood and a number of other biological fluids are contagious, so there are frequent cases of infection with:
- transfusion of drugs made on the basis of donor blood (plasma, erythrocyte mass);
- the use of shared syringes and other medical instruments that come into contact with blood;
- using a common razor, toothbrush and other “bloody” household appliances;
- feeding the baby with breast milk.
The domestic route of spread of infection is possible only with prolonged contact with a patient with syphilis of the last (3) stage. At this stage, the pathogen is actively released from the syphilitic gum and can get on the damaged mucous membranes of a healthy person when kissing, using common utensils and household items. Infection of medical personnel often occurs during work with biological material, as well as autopsies of the corpses of patients (especially children with congenital forms of syphilis).
Note! According to the latest data, the incidence of this venereal infection in Russia remains quite high - 52.6 people per 100 thousand population. There is a significant (almost 7 times) increase in the number of people infected in comparison with the statistics obtained from the USSR.
With the standard development of the pathological process, the following periods of syphilis are distinguished:
- incubation;
- primary;
- secondary;
- tertiary.
All these types of syphilis are characterized by a different mechanism of development and characteristic features of the course.
Incubation period
On average, 20 days pass from the first entry of the pathogen into the body until the appearance of clinical signs of syphilis. However, in medicine, there have been cases of shortening the incubation period to several days and lengthening to 5-6 weeks. The first is characteristic of infection from several sources at the same time or with the development of a mixed infection (the combined action of several pathogens). Long-term course often develops while taking broad-spectrum antibiotics for the treatment of another disease.
At this stage of syphilis, Treponema palidum is introduced into the body and multiplies through division (every 28-32 hours, the number of microbial cells increases exponentially). There are no clinical, morphological and serological manifestations of the disease yet: the analysis of the incubation period and the possible route of penetration of the infection into the body is carried out after the appearance of its first signs.
This stage of the disease ends with the appearance of a primary injury (affect) - a hard chancre, which indicates the development of a clinic of primary syphilis.
Primary syphilis
The primary period of syphilis lasts about 6-7 weeks. For a long time, it was divided into two subtypes - seronegative, lasting up to three to four weeks, and characterized by a negative result of classical serological tests (Wasserman, Sachs-Vitebsky, Kahn, Kolmar reactions). When a positive result appeared from at least one of the tests, the disease turned into a seropositive form. However, due to the development of modern highly specific and highly accurate diagnostic methods (PCR, RIF, RIBT), this classification has lost its relevance. Today, specific avid antibodies to the antigens of the pathogen are detected no later than in the diagnosis of other infections.
Chancre is an important diagnostic sign
The main clinical manifestation of syphilis at an early stage is the appearance of a hard chancre (primary syphiloma). This formation is a dense, painless ulceration in the area of \u200b\u200bTreponema palidum penetration. The inflammatory infiltrate, the integrity of the skin or mucous membrane on the surface of which is damaged, has a rounded shape. Erosion with clear, even edges and a scarlet shiny surface can be covered with scanty transparent discharge, does not bleed. The dimensions of a standard primary syphiloma are 10-20 mm, however, there are small (2-5 mm) and giant (30-40 mm) chancres.
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The first symptoms of syphilis, how to recognize the disease?
Among the typical localizations of education:
- the head of the genital organ, the skin of the pubis, the scrotum;
- mucous membrane of the urethra and the external opening of the urethra;
- vulva and vestibule of the genital organ;
- anorectal region;
- stomach and hips;
- hands and forearms;
- mammary gland;
- chin, oral mucosa.
In appearance and other features, you can easily confuse primary syphiloma with chancre. Among the common features of these pathological formations, identical mechanisms for the development of affect are distinguished - the introduction of the pathogen through the skin or mucous membranes, the formation of a pustule and its transformation into an ulcer.
Typical differences are shown in the table below.
| Sign | Chancre | Chancroid |
|---|---|---|
| Disease and pathogen | Develops with syphilis caused by Treponema palidum | Develops with chancroid caused by Haemophilus ducreyi |
| The edges | Solid | Soft |
| Exudation | Absent or not abundant serous discharge | Gray or yellowish purulent discharge |
| Pain | Painless | Painful |
| Liquidation | Disappear on their own after 3-6 weeks (even without taking antibiotics) | Do not pass without specific treatment |
| Localization | Genital organs and extragenital localization | Predominantly genitals |
In addition, the syphilitic chancre does not contain dense adhesions with the surrounding tissues, does not tend to grow and form additional ulcers. Its formation reflects the body's immune (protective) response to the introduction of a bacterial agent into the patient's body.
According to the research of dermatovenerologists, atypical forms of the location of the primary affect are widespread. Among them:
- multiple chancre;
- chancre on the skin of the fingers;
- inductive (dense) edema;
- chancre-amygdalitis.
Multiple chancre is characterized by the formation of several dense infiltrates with ulceration near each other. Its formation is associated with the introduction into the body of a large number of pathogens and an active immune response.
Chancre-panaritium often develops in medical workers. In its clinical course, it practically does not differ from non-syphilitic purulent inflammation of the fingers, it usually affects the phalanges of 1-3 fingers of the right hand. Unlike the classic primary affect, it can be accompanied by painful sensations. Sometimes combined with syphiloma located on the skin of the genitals.
Inductive edema develops if the primary introduction of the pathogen occurred in the genital area. The scrotum in men or the area of \u200b\u200bthe labia in women increases in size, acquires a stagnant blue-violet color, intense in the center and less pronounced at the periphery of the lesion. On palpation of the skin, no pits or other signs of "classic" edema remain. As a rule, patients do not complain of pain, however, swelling and induration can cause them mild discomfort associated with wearing underwear and clothing. This variant of the primary stage of syphilis lasts 1-4 weeks.
Amygdalitis develops in cases where the oropharynx has become the site of infection. This primary affect is accompanied by a unilateral enlargement of the lymphoid tissue (tonsils), which acquires a denser consistency, protrudes significantly into the pharynx, and is accompanied by pain and discomfort when swallowing. The disease is differentiated from angina, which, as a rule, is characterized by bilateral enlargement of the palatine tonsils.
Note! Chancre-amygdalitis should be distinguished from the classic primary syphiloma located on the amygdala. Unlike her, it does not have an ulcer defect and causes a uniform increase in the palatine tonsil in volume.
In addition to primary syphiloma, both in the classical and atypical variants of the course, regional lymphadenitis attracts attention. In this case, the lymph nodes closest to the ulcer formation:
- increased in size;
- have a denser consistency;
- do not have fusion with surrounding tissues;
- "Cold" (no local temperature rise).
In addition, some patients complain of weakness, fatigue, a feeling of weakness - common signs of intoxication.
By the end of the initial period of pathology, all clinical manifestations, including primary syphiloma, disappear (even in the absence of anibacterial treatment). The second, bacteremic period of the disease begins.
Secondary syphilis
The second stage of syphilis manifests itself with the generalization of the infectious process and the penetration of treponema into the systemic (general) bloodstream. It is characterized by pathological changes not only at the site of Treponema palidum introduction, but also throughout the body.
The symptoms of syphilis in the second stage are varied. Meet:
- Dermatological lesions. Most often, a pale-spotted rash develops on the skin of the neck (“necklace of Venus), chest, abdomen. Many small subcutaneous hemorrhages may appear.
- Dry, brittle and hair loss (up to baldness).
- Lymphadenitis. At stage 2, not only regional, but also the main lymph nodes throughout the body are inflamed.
- Intoxication phenomena - subfebrile condition (often the temperature does not rise above 37-37.2 ° C), weakness, flu-like condition, accompanied by catarrh of the nasopharyngeal mucosa (runny nose, sore throat, cough), symptoms of conjunctivitis.