How to understand the history of syphilis denies. What is the latent form of syphilis and how to recognize it? Prevention of infection and complications

Syphilis is a tricky disease. Each period of the development of this infection has such individual symptoms that before doctors considered them different diseases. Syphilis is masked by many diseases: from a common cold to severe damage to the kidneys and liver. Pale treponema, which is the causative agent of syphilis, secretes an anesthetic substance, so the infected person does not feel itching or pain.

Pale treponema feels comfortable in a humid environment and at a temperature of 36.8 degrees. Under adverse conditions, it hides in a capsule, the so-called cytoforms and L-forms. In this state, syphilis is not active, does not multiply, it sleeps. Waiting for favorable environmental changes. But it is not affected by harmful factors. So here he is - a syphilis-insidious enemy of mankind. Often, the causes of latent syphilis are self-medication or syphilis infection during antibiotic treatment of another infectious disease.

Varieties of syphilis

Syphilis is divided into several periods of the course of the disease:

initial, or incubation;
primary;
secondary;
tertiary.

Each period is divided into sub-periods. Latent syphilis refers to the secondary period of the disease.

Secondary is divided into three types:

Syphilis is fresh. It is characterized by bright rashes and other clinical manifestations.
Hidden (latent) syphilis. There are no outward signs of his presence. It is asymptomatic, it is determined only in laboratory tests.
Recurrent syphilis. The rash reappears on the patient's body after the previous disappearance of all symptoms.

In a patient with latent syphilis, the incubation and primary periods, by virtue of taking antibiotics and good immunity, are mild. A person does not experience uncomfortable sensations, lives and works, infecting others. The latent form of syphilis is often detected by chance when passing mandatory medical tests in the clinic. Regular examinations by a gynecologist allow you to recognize the disease in time and begin adequate treatment.

Latent syphilis by time is divided into three stages:

Early latent syphilis. Duration of the disease is up to 24 months.
Late latent syphilis. The duration of the disease is over 24 months.
Unspecified (ignorant) latent syphilis. The doctor cannot set the time when the patient contracted syphilis.

In the treatment of prolonged penicillins, it is possible to establish the timing of syphilis infection. If a person has early latent syphilis, then his temperature will rise and there will be general signs of intoxication. They will be caused by the remains of the destroyed pale treponema. In the late stages of latent syphilis, an increase in temperature does not occur, there are no signs of intoxication.

Why is it necessary to establish the timing of syphilis infection?

Establishing the timing of syphilis is of practical importance. People with early latent syphilis are contagious and are active carriers of infection, which are part of the epidemiological risk group. It is necessary to conduct an examination of all those who came into contact with the infected and identify possible carriers of the disease. Patients with late latent syphilis are not dangerous from an epidemiological point of view.

Identification of persons with whom the infected contacted, as well as their test for syphilis, is also necessary if the latent form is unspecified.

When syphilis attacks the human body, its goal is to penetrate. Pale treponema throws off its membrane membrane, which allows it to pass through the capillaries and enter the nucleus of phagocytes. How amazing is nature! Phagocytes are our protection. They catch and eat foreign bacteria and viruses. And syphilis attacks them. Checkmate the immune system! With latent (latent) syphilis, treponema is hidden in the membrane membrane of phagocytes. That is, the virus destroys the phagocyte itself, and walks in its “clothes”. The immune forces of the body are not included, since such a treponema is taken for its own and will not be recognized.

Signs of latent syphilis

Although no rashes or ulcers are observed on the skin and mucous membranes, syphilis penetrates at this stage into the internal organs, nervous system, and bones. Pathological processes occur in them. Patients with suspected asymptomatic syphilis are examined particularly thoroughly in order to make such a diagnosis or refuse it.

Indirect signs of early latent syphilis are:

the presence in the history of the disease of early rashes of an undiagnosed nature;
treatment of other STIs (diseases often go together);
detection of active syphilis in the sexual partner;
swollen lymph nodes in the groin;
finding the scar in place of the alleged hard chancre;
in the analysis of cerebrospinal fluid, inflammatory reactions are detected.

Indirect signs of late latent syphilis:

analysis of cerebrospinal fluid revealed degenerative changes;
low titer of reagins with sharply positive results on classical serological reactions.

Indirect signs of latent syphilis for both the early and late species also include:

temporary or prolonged increase in temperature to 38 degrees, the cause of which has not been established;
weight loss, depressed mood, general weakness and other signs of intoxication;
enlargement of peripheral lymph nodes: they become dense and round, but there are no unpleasant sensations during palpation of the lymph nodes.

Diagnosis of latent syphilis

Diagnosis of the latent form of syphilis is carried out using the following serological methods:

Immobilization reaction of pale treponema (RIBT). For this analysis, use the patient's blood serum and a suspension of pale treponemas. They are mixed and watch how treponemas behave. Getting into the blood of a person with syphilis, treponema is motionless. And getting into the blood of a healthy person, they are active, swim for a long time, they are ready to infect. The accuracy of this test is 95%.

Diagnosing latent syphilis is not an easy task for a doctor, as there is the possibility of a false-positive reaction to syphilis.

Indirect hemagglutination reaction (RPHA). For this analysis, special red blood cells with antigens of the syphilis pathogen are prepared. These red blood cells are mixed with the patient's serum. If the patient is sick with syphilis, then the red blood cells stick together.
Enzyme-linked immunosorbent assay (ELISA). A special enzyme is added to the prepared blood serum of the patient. If the serum changes color, the patient is recognized as a patient with syphilis.
RIF (immunofluorescence reaction) The presence of pale treponema is indicated by a specific glow.

The unusual form of pale treponema itself helps in determining the presence of syphilis virus in the blood. Under the microscope, you can see that pale treponema looks like a spiral. The size of the curls towards the end of the treponema decreases, the gaps between the curls increase. Movement in liquid media is slow and graceful.

A feature of pale treponema is its ability to maintain its spiral shape even under pressure from its surrounding environment. For elderly people, treatment for syphilis on the basis of only serological methods is not prescribed. They undergo additional examinations by a neurologist, optometrist and otolaryngologist.

Of particular note is the definition of syphilis in pregnant women. During pregnancy, all women donate blood for syphilis three times. When a disease is detected, specific therapy is carried out taking into account the gestational age and stage of the disease. If syphilis is not treated, there is a high probability of infection of the fetus, the formation of birth defects, miscarriage, or premature birth.

Treatment

Today, treatment of syphilis is not difficult for doctors. But one thing should be understood. When talking about the treatment of latent syphilis, they mean the fight against infection, but not the consequences of syphilis: bone deformities, impaired cardiovascular activity, and a nervous system disorder. At the present stage of development of medicine, this is impossible.

In the treatment of latent syphilis, antibacterial drugs are used. The treatment regimen is selected individually, taking into account the stage of the disease and associated pathology. Additionally, drugs are prescribed that increase immunity, since syphilis weakens it.

Exemplary treatment regimens for latent syphilis are presented in the table:

Acceptance of any drugs is possible only after consultation with a doctor. Self-medication is unacceptable! The frequency of drug administration and the duration of therapy are determined by the attending physician.

Reception of a vitamin complex. Help fight infection

Pyrotherapy. The patient is administered special drugs that increase body temperature. A slight fever is beneficial. At a temperature not exceeding 38.5 degrees, blood circulation improves, the immune defense function increases, and the bacterium weakens, it is easier to cope with drugs.

Risk group:

injecting drug users;
HIV infected
people with many sexual partners.

Prevention

In order to avoid various infections, some rules must be followed.

Be selective in choosing sexual partners.
Use condoms for sex.
Use only your own personal hygiene items.
Do not rely on false positive results, but consult a doctor at the first sign of illness.

Remember that syphilis is not only a citizen’s private affair. If a person is aware of his syphilis, he hides it and infects another, then he can be held criminally liable.

conclusions

You can not use antimicrobials on your own. This can lead to the fact that microorganisms hide, forming capsules, or penetrate into the cells. Syphilis takes on a latent form.

Latent syphilis is a difficult to diagnose disease. Proper treatment can only be prescribed by a doctor based on complex tests. You should not succumb to articles in pseudo-medical sites that describe how syphilis is treated with sage flowers and other herbs.

Treatment of syphilis at home does not lead to recovery. On the contrary, serious complications can occur. Every third person with late latent syphilis dies from syphilitic heart disease.

Latent syphilis is a sexually transmitted disease that occurs without obvious clinical signs. Diagnose it with the help of anamnesis data, the results of a thorough examination and positive specific reactions. It is possible to recognize the disease when pathological changes in the cerebrospinal fluid are detected. The need for multiple studies and re-diagnosis after a course of therapy is associated with a high probability of receiving false-positive reactions.

What is latent syphilis

The diagnosis of latent syphilis is made to patients in case of detection of antibodies to pale spirochete in the laboratory in the absence of specific symptoms characteristic of sexually transmitted infections. Often, pathology is detected during examinations associated with other diseases.

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

The reason for the formation of cyst-forms of spirochetes (treponema) is the incorrect use of antibacterial drugs. Often, patients carry out treatment with this group of drugs on their own, without a doctor’s prescription, when they notice signs of gonorrhea or other genital infections.

The latent form of syphilis has an extended incubation period and high resistance to drugs used in the treatment of sexually transmitted diseases. A frequent route of infection is through the genital.

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

What is dangerous?

In the latent course of syphilis, the patient can infect a partner during sexual intercourse. The danger lies in the high risk of infection of others when using dishes and cutlery, towels and other hygiene products, on which biological fluids can be left. Untimely identified syphilis becomes the cause of infection of all members of the patient's family.

With the progression of the infection, the pathogen spreads through the lymphatic system to the tissues of the liver, brain, digestive tract, causing serious damage to organs. Pronounced signs of disturbances develop during the transition of the latent phase into the active one. Serious changes occur in the absence of timely treatment against the background of a decrease in the body's defenses. With strong immunity, the patient becomes a carrier of infection.

Classification and forms of latent syphilis

In medical practice, it is customary to classify a disease into the following forms:

Early It is diagnosed with an infection that occurred no more than two years ago.
Late. It is established in case of infection with a limitation period of ten years.
Unspecified It is set when it is impossible to identify the time of infection.
Congenital This form of the disease is determined if the child was infected from a mother who has a medical history of diagnosed syphilis, which is asymptomatic.

The latent nature of the infection can take the following forms:

primary, developing without specific symptoms in patients whose therapy was timely, but ineffective;
secondary, arising from repeated infection and not having specific signs;
tertiary, which is given to patients who have undergone the active form of the third phase of syphilis.

Early period

In the early period, doctors consider the disease to be the most dangerous, since uncontrolled infection occurs to patients who are unaware of their infection and the people around them.

Pale spirochete can enter the body of a healthy person, not only sexually, but also household.

It is possible to detect an early form of latent syphilis during a preventive examination. A blood test (Wasserman reaction) is carried out not only during medical examinations, but during hospitalization for various pathologies. Such studies allow us to determine the latent form of syphilis. The serological reaction does not always show the correct results, and there is a need for other laboratory tests.

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

Late period

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

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

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

Symptoms and signs of latent syphilis

Hidden forms of syphilis may not affect human health for a long time. Suspect the presence of a pathogenic pathogen in the body in the presence of the following symptoms:

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

The primary form of the disease is indicated by the presence of scars and seals on the genitals, a residual phenomenon of polysclerenitis. Serological studies show positive results in 70% of patients. 25% of patients have low titers. They decrease after treatment with antibacterial drugs.

On the background of treatment with penicillin-type drugs, a third of patients observe the Herxheimer-Yarish reaction, which manifests itself in the form of a sudden increase in temperature, headaches and muscle pains, nausea and tachycardia. This symptomatology occurs due to the mass death of pathogenic microorganisms and decreases with aspirin. When meningitis associated with latent syphilis occurs, an increase in protein is observed, a positive reaction to globulin fractions.

Diagnostics

The anamnestic method helps doctors diagnose the latent form of syphilis. When collecting data, the following are taken into account:

suspicious sex
the presence in the past of single erosion in the genital area or oral cavity;
rash on the skin;
the use of antibacterial drugs associated with the detection of any disease similar to syphilis;
age of the patient.

When making a diagnosis, complications may occur. Sometimes patients hide and misinform the doctor because of secrecy. Often, the symptoms are similar to other diseases. Obtaining false positive results can also cause difficulties in diagnosing latent syphilis. A detailed history plays a large role in determining the form of the disease.

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

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

Treatment and prevention

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

Examinations are prescribed to the sexual partners of the patient.

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

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

Dosages of drugs:

Penicillin benzatin is prescribed for an early latent disease in a dosage of 2.4 million units. once a day. The course is three injections.
Sodium salt of benzylpenicillin is administered in the detection of late latent syphilis in a dosage of 600 thousand units. twice a day in a course of 4 weeks. After 14 days, the treatment is repeated.

If the patient has signs of poor tolerance of drugs from the penicillin group, the doctor prescribes tetracycline antibiotics, macrolides, cephalosporins. Pregnancy is not a contraindication for the use of penicillins, since they are considered safe for the fetus. Therapy during this period is necessary, since congenital syphilis can cause the development of pathologies in the child.

It is important to remember that after suffering and completely cured of the disease, persistent immunity is not developed. To prevent re-infection, preventive measures must be followed. All sex should be protected. A hectic intimate life can lead to infection with syphilis and other sexually transmitted diseases. It is necessary to use only personal hygiene items, wash your hands regularly. Every year, doctors recommend taking blood tests and being examined by a therapist, urologist, gynecologist, neurologist.

How is the effectiveness of therapy controlled?

At the end of the course of antibacterial drugs, specific tests are carried out. Surveys are carried out repeatedly until normal results are obtained. Subsequently, control is carried out two more times after 90 days.

If the disease has a late form and tests have shown positive results, the period of medical observation is at least three years. The patient passes tests every six months. Deregistration is made after obtaining normal indicators of laboratory research. With a late latent form of the disease, the results become normal for a long time. The patient’s observation is completed with his full examination, including not only the delivery of tests, but also the consultation of a neurologist, optometrist, therapist, gynecologist.

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

Latent syphilis is a dangerous disease that leads to disruption of many systems and organs. If suspicious symptoms appear, consult a doctor.

Timely detection of infection helps prevent the development of complications.

To avoid infection with syphilis and other sexually transmitted diseases, it is important to follow the rules of prevention.

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.

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

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

Fig. 1. Manifestations of the disease in women in the initial period of the disease - multiple solid chancres (photo on the left) and solid chancre in the form of induction edema (photo on the right).

The current state of the problem

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

In our country, a technique is used to actively identify patients with syphilis 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, preventive examinations reveal up to 90% of patients with latent forms of the disease.

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 an asymptomatic course of syphilis is currently recognized.

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

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

Forms of latent syphilis

If, from the moment of infection, syphilis takes a latent (latent) course (asymptomatic), but with positive specific serological reactions, they talk about a hidden form of the disease. Latent syphilis in most cases is detected by chance during the formulation of specific serological reactions. In some cases, the doctor manages to figure out what period of the disease he belongs to:

if the patient previously had a solid chancre, but did not appear, then they talk about the latent period of primary syphilis;
the latent period detected 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 hidden period.

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

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

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

Early Hidden Syphilis

Early latent syphilis includes the period from the moment of infection to the secondary relapse period (on average up to two years). During this period, patients may experience manifestations of a disease of a high degree of infectivity. In relation to them, a number of anti-epidemic measures are being carried out. The main ones are:

patient isolation
examination of sexual partners and home 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 lack control over sexual desire. They are prone to numerous random sexual relationships, which in an epidemic leads to the inevitable development of the disease. Absolute proof of the case of latent syphilis is the establishment of an active form of the disease in the sexual partner.

What you need to find out during the survey

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

Signs and symptoms of early latent syphilis

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

Treatment for Early Latent Syphilis

Treatment of early latent syphilis is carried out according to approved instructions and is aimed at the quickest destruction of pathogens in the patient's body. With specific treatment, the negation of seroreactions occurs rather quickly. The extinction and complete negation of specific serological reactions with latent syphilis are the only criteria for confirming the effectiveness of the treatment.

Timely identification of patients during the period of early latent syphilis and the conduct of adequate full treatment favorably affect the prognosis of the disease.

Fig. 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 has been older than 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 when examining the identification of a patient with late forms of syphilis in the family (1%).

Who is sick

The disease is detected mainly in people over 40 years old (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 a possible infection and the presence of signs indicating the manifestations of contagious syphilis in the past. Often the history remains uninformative.

Signs and symptoms of late latent syphilis

During the inspection, it is not possible to determine the traces of previously resolved syphilis. During the examination there are no signs of a specific lesion of the internal organs and nervous system.
In the diagnosis of late latent syphilis, serological reactions such as RIF, ELISA, RPHA and RITT are used. The titer of reagins, as a rule, is 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 is from 50 to 60 years, there are a number of concomitant diseases that cause the appearance of false-positive serological reactions.

Herksheimer-Jarish reaction to the introduction of antibiotics is absent.
Late latent meningitis is rare in such patients. In the detection of specific meningitis in the cerebrospinal fluid, a mild inflammatory component is noted - low cytosis and protein level, signs of a degenerative component prevail - a positive Wasserman reaction and Lange reaction. During the period of specific treatment, the rehabilitation of the cerebrospinal fluid occurs slowly.

Treatment of latent latent syphilis

Treatment of latent latent syphilis is carried out according to approved instructions and is aimed at preventing the development of specific lesions of internal organs and the nervous system. Patients should be consulted by a neurologist and therapist. During the period of specific treatment, the negation of seroreactions occurs extremely slowly. In some cases, after a full-fledged specific treatment, serological reactions remain positive.

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

Fig. 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 the infection and the presence of positive results of serological studies, a diagnosis of latent unspecified syphilis is established. Such patients are subject to a thorough clinical and serological examination, often repeated. The staging of RIF, RIF-abs and RIBT, IFA and RPGA are mandatory.

You should know that in patients with late and unspecified syphilis, false-positive nonspecific serological reactions are often detected. Reagent antibodies produced against cardiolipin antigen appear in the blood of patients with collagenoses, hepatitis, kidney diseases, thyrotoxicosis, cancer and such infectious diseases as leprosy, tuberculosis, brucellosis, malaria, typhus and scarlet fever, during pregnancy and menstruation 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.

Fig. 6. Gummous infiltration of the buttock and paranasal zone in the tertiary period of the disease.

Latent syphilis is being diagnosed more and more often. This term means a condition in which there are no specific symptoms of the disease, and when blood and other biological fluids are examined, antibodies to pale treponema are detected.

Their presence is confirmed through several serological tests:

RIBT.

The causes of the disease

According to some experts, the latent form of syphilis is widespread due to improper use of drugs. Antibiotics are often taken in high doses and without a doctor's prescription. Any antibacterial agent from a series of tetracyclines, penicillins, macrolides and fluoroquinolones can change the nature of the course of the disease and the regular alternation of its stages. And if untreated, syphilis can have latent periods, for example, in its secondary and tertiary form. At certain intervals, clinical manifestations of infection are absent.

Treponema pale is transmitted by unprotected sexual intercourse. You can get infected in domestic conditions - when using common utensils, hygiene items, towels. The most contagious is a person who has signs of a primary and secondary form of the disease.

Disease classification

Late and early latent syphilis is distinguished. The classification is approximate, because there are often cases when the disease cannot be attributed to any of the above types:

Symptoms of latent syphilis in the first case are the presence of a painless ulcerative formation in the genital area or on the mucous membranes of the oral cavity. Serological tests at the same time give a positive result. Wasserman's reaction over the past 3 years has been negative.

Early latent syphilis is also called if rashes appeared in the last year. Evidence of erosion in the genital area may not be confirmed. With a positive result of the serological reaction in this case, we are talking about latent secondary syphilis.

The late form of the disease is diagnosed if more than 3 years ago the patient had unprotected sex with an infected pale treponema. In this case, it is possible to establish the fact of the presence of a ulcerative defect in the genital area and skin rashes with a duration of more than 4 years. In other cases, the diagnosis sounds like undifferentiated latent syphilis.

To confirm the stage, the patient should recall all unprotected sexual contacts that have occurred over the past 8–10 years. Mandatory is the examination of the partner and the identification of syphilitic rashes and gum. If any, this is an early form of infection.

With the test introduction of penicillin antibiotics, the breakdown of treponems begins, accompanied by signs of intoxication of the body.

How does latent syphilis manifest

The infection may not have any symptoms. Skin rashes and defects do not always appear, signs of damage to internal organs are also absent. Despite this, with primary and secondary syphilis, the patient is considered dangerous for the sexual partner. In the late form, it does not become infected. Any form of the disease is dangerous for a pregnant woman, which is associated with a high risk of intrauterine and perinatal infection of the fetus.

Symptoms of latent syphilis are most often non-specific.

Body temperature periodically rises to subfebrile values. All patients with this symptom, the causes of which remain undetermined, must be tested for antibodies to pale treponema.

Other manifestations of latent syphilis are:

general weakness and lethargy;
decreased appetite;
sudden weight loss associated with body poisoning.

Lymph nodes enlarge and take an oval shape and dense structure. They are not fused with soft tissues; pain does not occur during palpation of pain. The symptoms described above can occur with other pathologies that are not associated with infection with pale treponema.

How is an infection detected?

To clarify the type and time of occurrence of the disease, the venereologist collects an anamnesis. The medical history may contain an indication of dubious sexual intercourse and the presence in the past of syphilitic defects in the oral cavity and on the mucous membranes of the genitals. The doctor should find out if the patient had a skin rash, whether he took antibacterial drugs in connection with a disease reminiscent of syphilis. Take into account the age of the patient and the nature of his intimate life. When examining the skin and mucous membranes, scars or fading seals are formed that are formed after the disappearance of primary syphiloma.

Palpation of the lymph nodes reveals their fibrosis and an increase associated with syphilitic lymphadenitis. An important role in the diagnosis of the latent form of the disease is played by confrontation - the detection and examination of all sexual partners of the patient. Detection of at least one of them an early form of syphilis makes it possible to make an accurate diagnosis.

If the patient has a late type of disease, there may be no signs of infection in his sexual partners. In rare cases, late latent syphilis is detected.

The final diagnosis is made only after obtaining the results of serological tests. As a rule, a large number of antibodies to treponema are found in the blood. With antibacterial therapy, the titer may decrease.

The execution of the Wasserman reaction should be supplemented by PCR, ELISA and RIBT studies. With early syphilis, an RIF has a dramatically positive result, and an RIBT can give negative indicators. Diagnosing a latent form of the disease is considered a difficult task, because tests can have it. This may be due to:

previous malaria;
the presence of chronic foci of infection;
lesions of the liver;
rheumatoid arthritis;
tuberculosis.

Therefore, tests for syphilis are carried out repeatedly, intermittently, after the elimination of chronic diseases and foci of infection.

Additionally shown is a study of cerebrospinal fluid obtained by lumbar puncture. A change in the composition of the material indicates the presence of syphilitic meningitis and is often detected in tertiary latent syphilis. The patient should consult with specialists to exclude concomitant pathologies, syphilitic lesions of internal organs and nerve tissues.

Therapeutic measures

Treatment of latent syphilis is aimed at preventing its activation, which is dangerous for others. The main goal of therapy is the prevention of infection of the internal organs and central nervous system. The most effective against pale treponema are penicillin-type antibiotics. At the beginning of antibiotic therapy, an exacerbation may occur, accompanied by an increase in temperature. This symptom confirms a previously established diagnosis.

The effectiveness of antisyphilitic therapy is assessed by determining antibody titers. An important indicator is the normalization of the composition of the cerebrospinal fluid.

With early latent syphilis, the use of antibiotics contributes to the negative results of serological studies and the rapid purification of cerebrospinal fluid.

In the late latent form of the disease, the indicators become negative only after completion of therapy. In some cases, antibodies in the blood persist. Changes in the composition of the cerebrospinal fluid disappear slowly. Late with bismuth preparations and antibiotics.

Prevention of infection involves monitoring your health. Every year it is necessary to take tests for syphilis and save all their results. For any sexual contact, barrier methods of contraception should be used. After intercourse with an infected person, you must visit a medical institution and undergo preventive therapy.

Upon receipt of positive results, you need to be examined by a venereologist. Do not consider syphilis a non-dangerous disease and refuse treatment. However, you can not take antibacterial drugs without a doctor's prescription.

General prevention of syphilis implies regular screening of the population, the organization of lectures on the topic of STIs in educational institutions. For people who have undergone specific treatment, doctors should recommend annual serological tests. Some patients may require a consultation with a psychologist.

There are a number of certain diseases that occur without symptoms over a period of time. Such a course of the disease is called latent or latent, and is characterized by a period of reproduction of the pathogen in the human body, not against the background of good health. One of these diseases is latent syphilis: under certain circumstances, this dangerous infection can remain latent for years.

Currently, latent syphilis is less common due to modern programs for mandatory medical screening of the population in hospitals and clinics. Identification tests are included in the list of mandatory examinations for both men and women when applying for medical care, with annual medical examinations and registration of pregnant women.

Over the past 5 years, due to the introduction of so many methods for identifying and preventing the spread of the disease, the latent form of syphilis has become less common. However, such a tendency, when during a routine examination and blood donation for analysis, the result is positive, still exists.

The reason for the late detection of the disease at the stage of prolonged infection is the untimely appeal to doctors.

In this article, we are ready to answer all patient questions about what is latent syphilis and how to recognize it. We will also consider treatment regimens, talk about what effective treatment for early latent and syphilis exists at the stage of late detection, as well as what patients need to do to identify the infection on their own.

Finding a treponemal syphilitic infection in a latent form is not observed in all patients. The period of the first manifestations of the disease occurs at the end of the incubation period in 75% of cases. At the same time, in some patients, the infection is present years after infection, but there are no clinical symptoms of the disease. Such a flow is called hidden.

Currently, leading experts in the field of medicine and science believe that several factors affect the rate of development of the disease and the frequency of cases of transition to the latent course of the disease. First of all, this is the state of the immune system, the frequency of taking medications, antibiotics during the infection period and associated pathology.

It is proved that taking any lengthen the incubation period of syphilitic infection for different periods for each patient. When the first signs appear that may resemble a cold or flu-like condition, taking antibiotics can be a direct cause of the transition of syphilis to the latent stage.

What is latent syphilis?

With a latent course, the diagnosis of treponemal infection can be confirmed only after several laboratory tests, however, the term of infection cannot be established by analysis.

Venereologists divide the disease into stages, highlighting separately early latent and late latent syphilis. The presence of an early course of the disease is said when they suggest infection with treponemas no more than two years ago. In cases of the late course of the disease, the period after infection reaches two or more years.

Separately, it is possible to distinguish patients whose infection cannot be determined immediately after the examination, and then a diagnosis of latent unspecified syphilis is made with the appointment of additional tests, laboratory and physical. There may also be situations where the diagnosis of unspecified latent syphilis is made during the initial treatment, when the patient cannot even indicate the approximate time of his infection.

What is the danger of latent syphilis?

The latent course of syphilitic infection is characterized by an asymptomatic course. However, throughout the entire period, the patient who produces treponema is a source of infection for all people around him. The risk of infection is extremely high during sexual intercourse, the use of dishes and cutlery on which there are particles of saliva, when using common towels, underwear and hygiene items with residues of biological fluids and secretions from the genitals.

In cases where there are no symptoms of syphilis infection, infection of family members or partners can occur uncontrollably.

Early latent syphilis occurs for several years from the moment of infection, and in this period there is a transition from the primary stage of the disease to the secondary. Also, the early period of latent syphilis in the time interval corresponds to the period from the primary stage with a positive result of serological analysis for the detection of treponema to the period of disease recurrence during the transition to the secondary stage.

IT'S IMPORTANT TO KNOW!

As the disease progresses, the pathogen spreads throughout the body. penetrate through the lymph nodes into the heart, liver, stomach, intestines and brain, causing irreversible damage to the body as a whole.

Severe symptoms appear only when the disease transitions to the active phase, however, with regular medical examinations, syphilis can be detected even at the stage of the latent course.

With the timely detection of treponemal infection in the blood of patients, treatment of latent syphilis can be successful. Following the recommendations of venereologists, you can return to everyday life in a few months.

Late latent syphilis is determined during the course of the disease for more than two years. Without severe symptoms, such patients may not be contagious to others. However, with the transition of the disease in the tertiary period, the condition of the patients worsens. There is a general lesion of all organs, the circulatory system and the heart, nervous system. Pronounced skin symptoms also appear, which is not difficult to notice (which is what patients often go to medical institutions with).

From the foregoing, it follows that the treatment of syphilis, including the latent form, is vital. At the same time, it may turn out to be quite long, but with a comprehensive approach, the forecast is favorable.

Syphilis Diagnosis

Diagnosis of the latent course of treponemal infection is based not only on a laboratory study of blood and smears, but also on a complete survey of the patient with the specification of the smallest details of all diseases in recent years.

First of all, the venereologist specifies the circle of persons with whom the patient had contact, sexual intercourse or contact in the home and family, finds out the scope of work, work, which is extremely important for medical personnel. Often, patients are referred to a venereologist after revealing latent syphilis at an annual physical examination or placement in a antenatal clinic. After the first positive analysis - the Wassermann reaction - additional methods for determining treponemomas in the blood are shown.

Currently, syphilis is diagnosed only after receiving at least three positive test results from the following list: RIF immune response, RIBT reaction to exclude false results, immunoblot to determine the titer of antibodies to the treponema causative agent, PCR test to detect cellular material and DNA of the syphilis pathogen . With neurological symptoms, cerebrospinal fluid is additionally examined. With signs of damage to internal organs, blood biochemistry, renal and liver tests, a cardiogram, a study of the heart and blood vessels are indicated.

How is latent syphilis treated?

The treatment regimen is to prevent the transition of severe syphilis.

When the infection lasts less than two years, treatment is aimed at eliminating the transition and eliminating the epidemiological danger for others, family members and partners.

In cases where the patient is infected for more than two years, and doctors determine late latent syphilis, the treatment regimen is aimed at eliminating all pathologies of the internal organs and preventing the most serious complications - neurosyphilis, heart attacks and strokes.

The main treatment for syphilis is systemic antibiotic therapy with penicillins or drugs of other groups for allergies and a lack of sensitivity of treponem. The treatment regimen is also developed depending on the severity of the organ lesion, the manifestations of symptoms from the heart and nervous system. In addition, drugs are used to correct the protective properties of the immune system.

Where to take tests for latent syphilis and whom to contact?

The latent course of syphilis is no coincidence that causes epidemiologically dangerous and rapid spread of the disease. Prevention of infection consists not only in medical examinations, but also in timely contact with doctors if you suspect infection with syphilis.

If you don’t know what to do, contact the Venereology Guide. Our experts will quickly help you with the choice of a clinic and an experienced venereologist for examination and further counseling.

Contact the “Venereology Guide”, because we care about the health of each patient!

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