Manifestations of syphilitic skin lesions. Signs and symptoms of syphilis. Purulent wounds on the face

Skin manifestations of syphilis can occur on the upper or lower extremities of those infected if the disease has developed to a secondary form or has been transmitted by household means.

Multiple rash with syphilis

At the secondary or tertiary stage of infection, syphilis on the skin can appear as a multiple inflamed rash in the chest and upper limbs, causing itching, pain and burning.

Multiple syphilitic chancres on the body

Skin rashes with syphilis can take the form of multiple inflamed ulcers, from which lymph or purulent discharge constantly oozes.

Syphilitic rash in children

If the disease had an innate nature of penetration into the body, skin syphilis takes the form of a multiple rash in the neck and forearms of a sick person.

Chancres in the transitional stage of syphilis

It is worth noting that the primary skin rashes with syphilis look like a small amount of ulcerative lesions with smooth edges. These do not leave scars or scars after healing and do not cause any discomfort to the carrier of the infection.

Skin manifestations of syphilis photo ulcers

In rare cases, syphilis skin photo may be characterized by purple or purple spots with a dark blood bottom. These ulcers often exude blood or pus.

Skin manifestations of syphilis photo on the abdomen

IT'S IMPORTANT TO KNOW!

In some advanced cases, infection can provoke the so-called marbled skin with syphilis. This means that the lesions on the abdomen or back are crusted and combined into one large lesion, which is difficult to eliminate and cure.

Eruptions on the scrotum

With sexual transmission of syphilis, symptoms on the skin of an infected man may appear on the penis or scrotum in the form of a multiple or single rash, papules.

Purulent syphilitic eruptions

In addition to chancres and papules, the manifestations of syphilis on the skin also often take on the character of watery papules or abscesses that can be confused with a skin fungus or an allergic rash.

Chancres on hand

With a household method of infection, syphilis rashes on the skin often appear on the hands or in the mouth of the infected person. In this case, the wounds look like large purulent abscesses or blisters.

Nasal lesions in syphilis

Depending on the stage of development of syphilis, spots on the skin of the photo can take the form of deep purulent ulcers that are not easy to eliminate with medicinal or bactericidal effects.

Multiple rashes on the body

It is not uncommon for an infected person to have multiple acneiform rashes on the back or abdomen, which cause inflammation of the skin and can cause discomfort to the host.

Sexual syphilis

With sexual transmission, the infection often manifests itself in the genital area in the form of small purulent abscesses or round wounds of the correct form.

Weeping chancre

In rare cases, the initial signs of syphilis may release lymph or pus when they appear on the skin. This type of damage is dangerous and contagious to others.

Purulent wounds on the face

In the elderly, it can develop on the face and lead to deep skin lesions, purulent abscesses and wounds.

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Syphilis is one of the most widespread and terrible diseases of the 20th century. For a time, the disease was the cause of death of a large number of people. In Russia, entire counties suffered from the infection, and in the army, every fifth soldier was infected. This is a classic sexually transmitted disease, which is mainly transmitted sexually or in utero. But it is possible to get infected using personal hygiene items, from bites, during blood transfusion. The disease can proceed in a latent form for decades, gradually moving from one stage to another, terrifying with its symptoms and external manifestations.

The causative agent of the disease

Hard chancre, inflammation of syphilitic roseola (spotted nodes and pustules are just some of the external manifestations of primary and secondary syphilis. But the true culprit of damage to the skin, internal organs and systems is spirochete - pale treponema (Treponema pallidum). The microorganism was discovered only in 1905 It has an elongated shape of the body and fibril, due to which it is capable of spiral movements.That is, the pathogen can move freely inside the host organism, penetrating into intercellular junctions and affecting internal organs, blood vessels and tissues of a person.

Secondary syphilis

The disease has three stages. Primary syphilis is characterized by the gradual introduction of the pathogen into the body. At the site of the introduction of treponema, a hard chancre is formed - a painful ulcer. After 6-10 weeks after infection, a systemic lesion of the body occurs. All internal organs suffer (including bones, nervous, lymphatic system, hearing and vision). It was during this period that a repulsive rash appears on the body, one of the varieties of which is syphilitic roseola. Photos of patients whose skin is covered with rashes look unpleasant. The rash occurs because the microbe is partially destroyed under attack by cells of the immune system and releases endotoxin, a dangerous poison with angioparalytic properties. This symptom of syphilis is found in 80% of all cases in the secondary period.

The body usually manages to weaken the pathogen somewhat, as a result of which the disease passes into a latent (hidden) stage. The rash disappears for a while, only to reappear soon after. The reproduction of the microorganism is restrained, but the weakening of the immune system leads to relapses. This is because the immune system alone is not able to completely defeat the disease. In addition, the temperature of the human body is ideally comfortable for the life of the microbe. The secondary period can last from 2 to 4 years, flowing in waves and acquiring new clinical symptoms.

What skin diseases can be confused with?

Syphilitic roseola is similar to other pathologies of the skin, which are characterized by a pink rash:

Toxic dermatitis as a reaction to medication, food, household chemicals. The difference between allergic spots is that they tend to merge, itch, merge with each other.
appears as symmetrical round spots. This is a benign viral skin lesion that resolves on its own without treatment. In this case, there is always a maternal plaque (up to 1 cm in diameter), which is detected first and has a larger size. The remaining elements appear gradually, their shape and size can be different and different from each other.
Marbling of the skin can occur in response to hypothermia in absolutely healthy people. Expanded capillaries simply shine through the skin, giving it a marbled hue. Syphilitic roseola, after vigorous rubbing of the integument, becomes even brighter, and the marble pattern, on the contrary, disappears.
Pityriasis versicolor spots are also pink, but sometimes take on a shade of coffee with milk. They are located on the back, chest and more often on the upper half of the body. They originate from the mouths of the hair follicles, strongly flaky, in contrast to the manifestations of syphilis.
The presence of pubic lice is indicated by bite marks from flatheads. In the center of the spots of gray-violet color, you can always see a small dot. Traces do not disappear if you press on them.
With rubella, a rash is found not only on the body, but also on the face. It rises a little above the integument, strikes the pharynx and disappears on the third day. Body temperature rises, conjunctivitis occurs, lymph nodes increase.
Measles is also characterized by high fever, swelling of the eyelids, inflammation of the lining of the upper respiratory tract, difficulty breathing, and conjunctivitis. The rash is large, prone to confluence, white dots are visible on the mucous membranes of the mouth and gums.
The typhus and typhoid fever proceeds with a strong general intoxication of the body, fever and weakness. If you smear the spots with an alcohol solution of iodine, they become darker.

Syphilitic roseola: differential diagnosis

Roseola caused by syphilis must be distinguished (differentiated) from other types of spotted rash that are similar in appearance. And also from insect bites, allergies, infectious diseases (herpes, gonorrhea). The causes of other rashes are completely different, as are the features of the manifestation, appearance, general symptoms and methods of treatment.

Using laboratory methods, it can be determined that the rash is syphilitic roseola. Dif. diagnosis is carried out on the basis of blood by detecting antigens and antibodies to the pathogen. A 100% result is given by the analysis of the RIF. To do this, the blood of a rabbit infected with a pathogen and a special serum are added to the patient's blood taken for research. When observed in the presence of treponema in the body, it confirms the reflection - fluorescence. The absence of infection is manifested in a yellowish-green glow.

An interesting fact: if a patient is injected intravenously with 3 to 5 ml of nicotinic acid (0.5% solution), then the spots become brighter. Also of great importance for the diagnosis is the presence of other symptoms of secondary syphilis. As well as the formation of a hard chancre at the stage of primary syphilis.

Other symptoms of the disease

Spots of pink or red color of a round shape manifest syphilitic secondary syphilis also include:

small-focal or diffuse alopecia (occurs in 20% of patients and disappears with the start of therapy);
"necklace of Venus" in the neck, rarely on the shoulders, limbs and lower back;
papular syphilis;
pustular syphilide;
damage to the vocal cords and a hoarse voice.

Rash symptoms

Syphilitic roseola, photos of which are presented in large numbers on the Internet, is characterized by certain features:

sizes of individual spots up to 1 cm;
rashes have unclear contours;
the surface of the spots is smooth, asymmetrical;
the outlines are rounded and asymmetrical;
there are no elements merged with each other;
spots do not protrude above the level of the skin;
do not grow on the periphery;
when pressed, a slight lightening of the shade is possible, but not for long;
there is no pain, peeling and itching.

Roseola that does not pass for a long time can acquire a yellow-brown hue. By themselves, rashes are not harmful and do not pose a danger. However, they are a signal to the body that it needs urgent help.

Syphilitic roseola: localization of the rash

The favorite places for spots are the limbs and the lateral surfaces of the body (chest, abdomen). May be on the folds of the limbs, affect the upper part of the legs. Roseola rarely occurs on the feet, hands and face. The distribution of the rash is disordered and profuse. It appears gradually, reaching the final development for 8-10 days. Syphilitic roseola has varieties depending on the appearance of the spots.

Types of syphilitic roseola

There are the following types of roseola:

fresh (appears for the first time), the most abundant rash of bright color;
urticaria, or edematous (similar to urticaria);
ring-shaped syphilitic roseola is characterized by spots in the form of rings or half rings, arcs and garlands;
with recurrent or confluent roseola, the size of the spots is usually much larger, and the color is more intense, but their number is less.

Very rarely, patients develop scaly roseola, covered with lamellar scales, and also similar to blisters, rising above the skin.

On the mucous membranes, erythematous often develops. On the throat, confluent erythema of a dark red color, sometimes with a bluish tint, appears. Their contours sharply border on healthy integuments of the mucous membrane. The patient does not feel pain, he does not have a fever, and the general condition is practically not disturbed.

Treatment

If you suspect the syphilitic nature of the rash, it is important to consult a doctor as soon as possible. The diagnosis is made by a dermatologist or venereologist.

The rash disappears spontaneously after a few days (sometimes months), gradually changing the shade. Subsequently, no traces remain on the skin. It is not the rashes that need to be treated, but their causes. Fortunately, the causative agent of syphilis is a rare microorganism that has not yet developed resistance to antibiotics. Syphilitic roseola, which is treated with conventional penicillin (sodium salt), is prone to exacerbation. Already after the introduction of the first intramuscular injections, the rash acquires a rich red hue. The patient may have a fever. Moreover, spots are formed on those parts of the body where they were not previously. As part of complex therapy, as decades ago, intravenous infusions of arsenic compounds (Novarsenol, Miarsenol) are used. Solutions of iodine salts and other auxiliary preparations are also used. Treatment necessarily takes place in stationary conditions, which allows you to constantly monitor the patient's health.

Features of therapy

Treatment should be carried out in courses, alternate with breaks and be long. The treatment regimen is selected individually, taking into account the clinical features of the disease. To eliminate the rash, lubrication with mercury ointment, washing with saline solutions, as well as careful hygienic skin care are prescribed.

Recovery prognosis

Syphilis is successfully treated in healthy and young people with a strong body. It is always difficult to predict a positive result in children and the elderly. The patient's condition can be aggravated if he has serious heart damage, diabetes mellitus, kidney disease, liver disease, rickets in history. In addition, the patient should stop drinking alcohol and limit smoking during treatment.

Consequences of infection

It is important to understand that syphilitic roseola is a rash that appears when the disease is already becoming serious. If treatment is not started at this stage, this will lead to irreparable consequences, irreversible damage to the brain and spinal cord, circulatory system and other internal organs. Syphilis will smoothly and imperceptibly move into the third stage, which is absolutely not amenable to therapy. With tertiary syphilis, which develops in 40% of patients, it is only possible to maintain the vital functions of the body and stabilize the condition. Like many sexually transmitted diseases, syphilis often ends in disability or death.

Prevention

Syphilis is a serious disease that can only be treated in its early stages. A rash - syphilitic roseola - testifies to systemic lesions, when therapy is less and less effective every day. The description of preventive measures is standard for all types of sexually transmitted infections. First of all, you should avoid promiscuity, casual sexual contacts. The barrier method of contraception is still the main method of precaution. Using condoms, a person not only protects himself from infection, but also protects his sexual partner from possible infection. After all, not every person is 100% sure that he is completely healthy, given that some diseases have a long incubation period without any symptoms.

Syphilis refers to severe systemic infections transmitted by sexual contact, household contact or blood transfusion. By and large, the causative agent of the disease, the microorganism pale treponema, is quite sensitive to quite standard antibacterial drugs from the group of penicillins, tetracyclines.

The main thing is to clearly observe the dosage and duration of administration. However, in the absence of therapy, there is a high risk of pathology transition to a chronic, relapsing form. A syphilis rash occurs already at the secondary stage of the process, so this symptom is a serious reason for contacting a venereologist as soon as possible.

Unlike most dermatoses, rashes with pale treponema are characterized by a number of signs:

there is no definite localization of lesions of the epidermal cover, the only exception is a hard chancre specific to primary syphilis, which forms at the site of the introduction of treponema into the skin or mucous membranes;
there is no predisposition to the fusion of foci of rashes, as a rule, the foci have a clearly defined border, although their shape may be different;
with a long course of the disease, a rash can appear on the body for no apparent reason and also spontaneously disappear without any treatment;
there are no additional symptoms, syphilitic rashes are not characterized by itching, peeling, general well-being remains within the normal range, with rare exceptions, after the disappearance of the rash, no traces appear on the skin;
the shade of the lesions varies from pale flesh at the initial stage to red-brown to black;
the simultaneous presence of several types of rash (for example, spots and papules) is possible;
rapid disappearance with the selection of the appropriate course of therapy.

It is worth noting

A person with a similar clinical picture of pathology is extremely contagious.

In addition, a clear periodicity is characteristic of skin manifestations of syphilis. The disease begins with an incubation period. Its duration varies in different patients from 2-3 weeks to several months. Pathology manifests itself with the appearance of a hard chancre. Often there are systemic manifestations (temperature, deterioration in general condition, etc.). And only then, after a few weeks, a rash occurs with syphilis. It persists (including periods of remission and exacerbation) until the disease is completely cured.

It is worth noting

Approximately from the moment of infection to the appearance of lesions on the body, it takes up to 10-15 weeks. However, in some cases (for example, when treponema enters the body during a blood transfusion from a patient), rashes appear even earlier.

A person does not immediately learn about infection with syphilis, since the disease begins with an incubation period. Its duration depends on the state of the immune system, the presence of concomitant diseases, the parallel use of antibiotics (standard dosages for the treatment of the vast majority of bacterial infections are not fully effective in combating treponema). The primary form of syphilis is characterized by the appearance of the so-called hard chancre. Outwardly, it looks like a rounded ulcer surrounded by a raised roller.

The inner surface is flat and smooth. However, such a skin lesion is painless, when rubbed with clothes or pressure, an ichor can be released. As a rule, a hard chancre is formed on an area of the body that has been in direct contact with infected secretions. Usually these are the genitals, during medical manipulations or after unprotected oral sex - the mucous membrane of the nasopharynx. Less commonly, a similar sign of syphilis is formed on the abdomen, inner thighs. In such cases, the size of the chancre can be up to 40-50 mm or more.

Most often, erosive damage to the body cover is of a single nature, but sometimes manifestation of multiple ulcerations is possible. A rare atypical form of primary syphilis is a chancre - panaritium. Its distinguishing feature is localization, atypical for this disease - on the palms, fingers. In this case, in addition to the ulcer, swelling, local hyperthermia, and redness are observed.

In most patients, by the beginning of the secondary period of syphilis, the chancre heals even without the use of any external or oral preparations. However, it is this stage that is characterized by the appearance of various kinds of rashes. Previously, the pathogenesis of such a course of syphilis was associated with the activity of the treponema themselves. But in the course of clinical studies, scientists have found that the main physiological cause of the formation of certain symptoms, reflecting the stages of pathology, is the response of the body.

That is why for different patients the timing of the various periods of syphilis, and its external manifestations, and the alternation of exacerbation - remission differ. During the initial introduction of treponemes, the human immune system reacts with the formation of a dense infiltrate. Then, under the influence of ever-increasing changes (according to the mechanism of development, they resemble an allergic reaction), the nature and appearance of the skin lesion changes. The end result of the pathological process is gumma, specific for tertiary syphilis, with skin necrosis.

Syphilitic roseola

In appearance, such a formation is a spot that is no different from the surrounding skin except for color. Hue can vary from pale flesh or slightly yellowish to bright red. However, in the vast majority of cases, syphilitic roseola does not have a very contrasting color.

It is worth noting

In the same person, the shade of the spots sometimes differs.

The shape of the rash is variable: the spots may be round or have fuzzy borders. They are located at a distance from each other, do not merge together. The size of each individual lesion varies from a few millimeters to one and a half centimeters. Itching, peeling, inflammation of the surrounding tissues is absent.

In the cold, roseola spots become more distinct, the same symptoms are noted at the beginning of penicillin antibiotic therapy. When pressed, the rash disappears, but after some time it returns again. A distinctive feature of this syndrome is the acquisition of a more intense color when injecting a solution of vitamin PP.

Papular syphilis

A similar form of the disease is characterized by the appearance of various dense papules. On the body, they can be located separately from each other or in small groups. By itself, the rash does not cause any discomfort, but when pressed, acute pain occurs. As a rule, papules remain on the body for up to 2 months, after which peeling occurs, then the rashes disappear. Pigmentation areas remain in their place for some time.

There are such forms of papular syphilis:

lenticular, appears most often, outwardly similar rash resembles small nodular formations, up to half a centimeter in size. At the initial stage, the outside of the papule is smooth, and then covered with transparent scales. The occurrence of such manifestations of secondary syphilis on the face is often accompanied by seborrhea, so the papules are covered with a denser coating. With a recurrent course, lenticular papular syphilis is characterized by the merging of rashes into groups of various shapes - a semicircle, an arc ring, etc.
Miliary, with this form of syphilis, papules do not exceed a few millimeters, they form only around the hair follicles (including the vellus) or the ducts of the sebaceous glands. By consistency, the formations are quite dense, sometimes covered with horny plaque. As a rule, miliary syphilis is localized on the arms and legs. Such formations may be accompanied by itching, are prone to a long course, and are poorly amenable to standard therapy.
coin-like, differs in the large size of papules (up to 2.5 cm) of a fairly characteristic color (from dark brown to purple-red). Usually there are relatively few rashes, in addition, this form of syphilis tends to be combined with other types of rashes. Often, the lesion resembles fireworks - several small ones are located around a large spot (a similar phenomenon is called a blasting or corimbiform syphilide). After the disappearance of the coin-shaped papule, areas of impaired pigmentation remain. Often, such formations are localized in the region of the inguinal folds, between the buttocks. In this case, they are often damaged, wet, constantly eroded.

Sometimes the so-called palmar and plantar syphilis is formed. In appearance, they can resemble corns or subcutaneous hematomas, which, as it were, “shine through” through the epidermal cover.

Pustular syphilis

This form of the disease proceeds with the formation of filled exudates of vesicles of various sizes and localizations. According to experts, it occurs very rarely, in a maximum of 10 patients out of 100, it is more typical for patients with a weakened immune system, against the background of alcohol and drug abuse. Often such a rash is accompanied by a severe fever.

Depending on external manifestations, the following forms of pustular syphilide are distinguished:

acne. Manifests in the form of a small seal, in the middle of which an accumulation of pus quickly appears. Usually they have a bright color, as a rule, they are localized in the area where the sebaceous glands are located (on the face, back, hair growth zone on the head).
Smallpox. It is characterized by the rapid disintegration of the pustule into a papule surrounded by inflammatory skin. Subsequently, it is covered with a dense keratinized crust, it soon disappears, and a small depression remains. The rashes are not prone to confluence, outwardly resemble chickenpox, therefore, for differential diagnosis, a number of studies are required.
Impetiginous. At the initial stage, a characteristic pustule appears, which gradually collapses in the central part, forming a fairly large abscess. The rash has a bright red color, after the rupture of the abscess, a yellowish or brown dense crust forms.
Ectima. It is characterized by the depth of the process, the pathology covers not only the epidermis, but also the dermis. Differs in large size (up to 10 cm), often covered with a dense crust. Soon it disappears, exposing the ulcerative surface, limited by raised skin. After healing, a scar forms at the site of the ecthyma.

Another variety of pustular syphilis is the rupee. It is prone to a long course and complex healing processes, in which drying crusts are layered on top of each other, forming something like a shell rising above the surface of the skin.

Herpetiform syphilis

In external manifestations, it is very similar to pustular, however, in terms of pathogenetic changes, it is more similar to the symptoms of tertiary syphilis. Serves as a sign of a severe pathology, usually occurs in weakened patients prone to immunodeficiency, excessive alcohol consumption, drug addiction, against the background of undertreated syphilis. In appearance (this is very noticeable in the photo), herpetiform syphilide is a plaque (their size varies from 1 to 6 cm) of bright color. From above, they are covered with small bubbles, which looks very much like herpes. However, after a few days they burst, and the pustules are covered on top with small sores.

Pigmentary syphilide

This form of the disease is also called leukoderma. Usually, its manifestations occur six months after infection. Pigmentary syphilis is localized in the neck, so it is often called the necklace of Venus. At first, foci of increased pigmentation with uneven outlines appear on the skin, then they brighten. They are not prone to change in size and fusion, they are more often formed in women, as a rule, they are difficult to treat. Often, such pigmentation disorders are accompanied by the penetration of pathogens into the cerebrospinal fluid.

Skin manifestations of the late period of the disease

Tertiary syphilis occurs against the background of long-term inflammatory processes in the epidermis and dermis. One of the manifestations of the late period of the disease is gumma - a neoplasm that is quite dense in consistency, its size can reach a walnut. When pressed, there is no pain.

Gumma is formed in the epidermis, therefore it easily moves under the skin, usually formed on the shins, can be single or merge together. After some time, tissue fluid is released from the middle of the formation. Gradually, the gap grows, which leads to the formation of ulceration, combined with necrosis.

Such lesions can remain on the skin for a long time (sometimes up to several years). After healing, a scar or depression on the skin may form. Tubercular syphilis is another manifestation of tertiary syphilis.

It is accompanied by the formation of formations of a specific bluish hue collected in groups. Depending on the individual characteristics of the patient, they can dissolve or flow into ulcers, followed by scarring.

Clinical picture of congenital syphilis

An infant infected in utero with syphilis has a high probability of death, especially with an early manifestation of the pathology. If the disease develops in the first months after birth, symptoms typical of secondary syphilis occur. For congenital syphilitic roseola, peeling, the appearance of scales, and the appearance of a bright red hue are characteristic. Papular syphilis in children occurs with thickening of the skin on the soles and palms, buttocks. Then the surface of such a formation becomes shiny, and begins to peel off strongly.

With the formation of symptoms of syphilis in the mouth area as a result of sucking, crying, deep cracks appear, their healing is accompanied by scarring. If such rashes are in the nose, a runny nose occurs. In some cases, there is a risk of complete destruction of the nasal septum.

It is worth noting

If syphilis manifested itself at a later age, its manifestations are no different from the course of the secondary form of infection in adults.

Syphilitic rash: are there any differences in the course in men and women, methods of diagnosis and therapy

Many manifestations of secondary syphilis do not differ in either men or women. However, the representatives of the weaker sex are more likely to form leukoderma (“necklaces of Venus”). In addition, there is a certain difference in the localization of acne-like pustular syphilis, since in men the secretory activity of the sebaceous glands is increased. There are quite definite differences in the location of lesions in the genital area.

In men, the initial manifestations of pathology (chancre) are located on the head of the penis, in women - on the mucous membranes of the genitals. In addition, infection in the fairer sex is dangerous in terms of the risk of pregnancy against the background of the active course of the infectious process. With intrauterine infection of the developing fetus, the risk of death of the child is high, a similar probability persists in the postpartum period.

It is worth noting

As a rule, skin manifestations of a syphilitic infection are not accompanied by severe itching. It appears extremely rarely and only during the healing or scarring period.

Some symptoms of treponema pallidum are quite specific, but treatment is not started without confirmation of the diagnosis. Syphilitic rash should be differentiated from other dermatoses.

This is possible with the help of microscopy of the discharge and specific enzyme immunoassays, hemagglutination reaction, Wasserman. They can give an unreliable result in the initial stages of the disease, but when skin manifestations occur, such techniques are very specific.

A syphilitic rash is quite amenable to therapy, but the main condition is a timely visit to a doctor. The doctor prescribes a long course of antibiotics from the group of tetracyclines, penicillins, macrolides. In some cases, antihistamines are indicated. Sometimes anti-inflammatory external ointments and gels are used. However, you should not try to cope with the infection on your own, the treatment of syphilis requires a professional approach.

Outwardly, syphilis is manifested by such skin symptoms as chancre, ulcers, small rash, white spots. The influence of pale treponema also extends to the internal organs, which leads to severe consequences if you visit a doctor late or if there is no treatment at all. If there are suspicious rashes, it is necessary to undergo an examination.

What does a chancre look like with syphilis

Syphilitic chancre has the appearance of a red spot, which eventually begins to transform into erosion. It can be single or multiple. Erosions are formed not only on the skin, but also on the mucous membranes. The ulcerative process occurs in them after the ingestion of pale treponema, the causative agent of syphilis. Often, damage also affects muscle tissue.

Hard chancres do not cause any particular inconvenience to the patient: there is no pain in the area of the defect, there is no itching. Sometimes patients do not notice such formations at all. When pressed, a liquid begins to be released from the syphiloma, which has a transparent yellowish tint. It contains a large number of treponema.

Chancre with syphilis develops in patients in the first stage of this sexually transmitted disease.

The incubation period is not accompanied by skin manifestations and often goes unnoticed. The initial stage of syphilis rarely causes symptoms. Laboratory blood tests do not always reveal an infection. When a positive result is obtained using non-specific tests, confirmation of the diagnosis using more expensive treponemal methods is required.

Stages of hard chancre in men and women

Not always syphilis is manifested by a rash or ulcerative formations on the skin. In some cases, a venereal disease occurs in a latent form, gradually destroying the tissues of internal organs and causing irreversible impairment of their functions. When a person suffering from chronic pathologies and reduced immunity is infected, the likelihood of a hard chancre is extremely high.

Initially, redness occurs on the skin, which does not cause discomfort to the patient. After 2-3 days, a bumpy formation forms from the speck with further transformation into a papule. When exfoliating the epithelium from the chancre, a person may feel pain. Further, the syphiloma enlarges, a dense crust forms on its surface, under which an ulcer begins to form. After rejection of the hard layer, the patient develops a chancre.

Hard chancre with syphilis

Chancre has an elevated appearance and a rounded shape with a clear border. Its upper part is smooth and has a red tint. In some cases, a gray coating is observed. Syphilomas have a specific morphological feature, but may vary in shape:

Nodules. Such chancres have clear boundaries. They are able to grow into the deep layers of tissues and maintain clear boundaries. The area of localization of the hard chancre is the penis, its foreskin.
Rounded formations resembling coins. They are located on the surface of the skin. Scrotum, labia, shaft of the penis - these areas are prone to the appearance of chancres.
Leaf sores. They are characterized by clear boundaries and are localized on the head of the penis.

The formation of a hard chancre begins after contact with the skin or mucous membranes of the causative agent of syphilis.

Pale treponema can get not only with unprotected intercourse, but also with a kiss, using someone else's thing.

Infection in rare cases occurs when using non-sterile instruments in medical clinics and beauty parlors. Pale treponema can enter the organ during blood transfusion and surgical procedures.

Dimensions

Syphilomas can have different sizes:

small, sometimes called "dwarf" (less than 1 cm in diameter);
medium - from 2 to 5 cm;
large - from 5 cm and more.

Chancroid

The appearance of a soft chancre is associated with the penetration into the body of pathogenic pathogens - streptobacilli. The formation itself does not contain spirochetes. Chancroid differs from a syphilitic ulcer in that it has soft edges and lacks a solid base. It can hurt, peel off, merge with other rashes and form a large inflammatory focus.

The active spread of infection through the circulatory system contributes to the development of symptoms of intoxication in the patient: vomiting, headaches, dizziness, muscle weakness. In the inflammatory process, hyperthermia of the body occurs.

A soft chancre is transmitted only through sexual contact. As it heals, scar tissue appears in its place. It occurs due to severe inflammation of the superficial lymph nodes and the development of a bubonic ulcer. Syphilomas caused by pale treponema do not leave marks on the skin after healing.

In the absence of therapy, ulcers caused by streptobacilli exist for 3-4 weeks. Complications are manifested in the form of phimosis, paraphimosis. In severe cases, the genitals undergo necrotic processes, and gangrene of the penis develops.

With timely examination and treatment, chancroids disappear in a week. The patient is prescribed a complex of drugs for internal and external use. At the end of therapy, the patient should be observed by a venereologist for another 6 months.

Condoms help prevent infection with streptobacilli. During sexual intercourse with an infected partner without barrier protection, sulfonamides are required in the first hours after contact.

Localization of ulcers

Primary hard chancre in 95% of patients is localized in the genital area (pubis, testis, upper inner thighs, abdomen).

This arrangement is due to the fact that most of the infections occur during sexual contact. Ulcers can also form near the anus. They look like assemblies, folds and cracks. Patients feel pain during defecation. It is possible to secrete thick, colorless mucus.

Often in the representatives of the stronger sex, chancres appear on the fingers and have the appearance of panaritium. You can distinguish a syphilitic formation by thickening the tissue, swelling of the finger and increasing it in size.

Hard chancre on the genitals

In male patients, ulcers occur mainly on the head and body of the penis, in female patients, in the region of the posterior commissure of the labia majora, the uterine cervix.

On the penis and head

Ulcer formation can appear in men on the frenulum of the penis. It has an oval shape and is capable of bleeding during erections. If a chancre develops in the urethral canal, it becomes painful and indurated. Despite the frightening photos of syphilitic chancres, some patients simply do not notice them or take them for ordinary inflammation on the skin. An ulcer on the head of the penis may look like a small erosion, have a gray coating and often not be felt at all.

On the labia, photo

A woman infected with pale treponema may not notice that defects have appeared on the labia. On the mucous membranes of the vagina, ulcers with syphilis develop extremely rarely. Much more often they occur on the cervix and cervical canal. They should be differentiated from ordinary erosions. With a syphilitic infection, scleradenitis does not affect external lymph nodes, but internal ones located in the small pelvis. They are not amenable to palpation, but are clearly visible in the implementation of computed tomography.

Hard chancre on the lip and in the mouth

Syphilitic ulcers can occur in patients and in the mouth. When located on the lips and mucous membranes of the oral cavity, they are similar to erosions that develop with candidiasis. Chancres can be distinguished from a fungal infection by reddish and dense edges and diffuse perifocal inflammation. When formed in the corner of the mouth or in the zone of the red border of the lips, they are covered with yellow crusts. In this case, small cracks appear on the surface of the skin.

If pale treponemas get into the mouth, then the tongue is affected. The development of the chancre begins with a dense papule (tubercle), which has a smooth surface. Later it ulcerates and erosion appears. Much less often, the chancre occurs next to the cracks of the tongue and acquires a stellate or slit-like shape.

The zone of the lower lip and the tip of the tongue is most often affected by pale treponema. Chancres rarely form on the gums, hard and soft palate, pharynx and tonsils. They have a shape clearly limited from healthy skin, a compacted edge and bottom. A syphilitic infection is sometimes confused with acute tonsillitis. When the oropharynx is affected by treponema, the patient has asymmetry of the tonsils, an unpleasant feeling and pain when swallowing, a feeling of a lump in the throat. When a pronounced indurative tissue edema is attached, the patient may complain of breathing difficulties that occur during walking and physical exertion.

Syphilitic manifestations in the area of the conjunctiva, eyelids and eyelashes are observed infrequently. Usually they develop in the inhabitants of the Arab countries, in which during sexual caresses it is customary to contact the tongue with these areas.

Healing and treatment

Uncomplicated chancres heal in 1 to 2 months, often before secondary syphilis develops. At this stage of a sexually transmitted disease, their appearance may have a paroxysmal character: ulcers remain on the skin and mucous membranes for about 45 days, and then disappear on their own, later reappearing.

The main task of doctors is to completely cure the infection, prevent complications and the spread of syphilis.

During the diagnosis, it is necessary to differentiate a sexually transmitted infection, manifested by the formation of ulcers and other rashes, from acute tonsillitis, herpes, fungal disease, tuberculosis, and traumatic erosions. If syphilis is suspected, the doctor issues a referral for a blood test using non-specific tests (Wassermann reaction, PRP). Upon receipt of a positive result, additional specific treponemal diagnostics are carried out, which helps to identify antibodies to microorganisms.

The causative agents of the disease are highly sensitive to antibacterial drugs from the group of penicillins, tetracyclines and macrolides. Patients are often prescribed doxycycline, ceftriaxone, azithromycin. During therapy with these drugs, the patient should regularly donate blood for control studies. Testing is necessary to evaluate the effectiveness of prescribed drugs.

Therapy is carried out to all persons who have had sexual intercourse with the patient without the use of condoms. A man and his partner should not come into contact during the treatment period if the location of hard chancres is genital. With the formation of syphilitic ulcers in the oral cavity and on the skin of the fingers, it is necessary to use individual cutlery, dishes, toothbrushes, pastes, towels, linen.

Chancre therapy begins with the use of oral antibacterial drugs. Along with drugs, topical agents with antiseptic and anti-inflammatory effects are also prescribed.

Therapy regimen

Treatment of chancre includes the use of the following medications:

Extencillin. It is the main drug used to treat venereal disease. It is intended for intramuscular injection and is administered twice. Dosage 2.4 million units. mixed with novocaine 0.5% (calculation of 100 thousand units per ml). If seronegative syphilis has a primary form, the drug is administered once. Injections are placed in the gluteal muscle.
Bicillin. It is administered to the patient at a dosage of 3 million units. twice: once every 5 days.
Erythromycin. It is prescribed at a dosage of 0.5 mg four times a day. Tablets are taken on an empty stomach half an hour before a meal, if it is impossible to drink the drug on an empty stomach - 1.5 hours after a meal.
For the disinfection of a syphilitic ulcer, dimexide and benzylpenicillin are used in the form of baths and lotions. Such methods help the active substances of the drugs to get deep into the damaged tissues. Patients may be prescribed applications using an ointment based on mercury or heparin. To accelerate the healing of chancres with the presence of secretions, agents with erythromycin are used. Synthomycin, mercury-bismuth ointments are highly effective.
Rinsing the oral cavity in the presence of syphilitic ulcers on its mucous membranes is recommended to be carried out with a furacillin solution mixed with gramicidin or boric acid. The proportions for diluting the components will be indicated by the venereologist.
With the addition of fungal infections during therapy with antibacterial agents, the patient is prescribed antiprotozoal drugs (metronidazole, tinidazole).
After the end of treatment with erythromycin, bicillin, the patient is prescribed probiotic agents that help restore the microflora of the digestive tract (linex, bifiform).
To maintain the normal function of the immune system and improve the general condition, the doctor prescribes a course with a multivitamin complex (vitrum, alphabet, duovit).

All drugs are prescribed to patients individually. The doctor takes into account the presence of combined infections, chronic diseases, the body's sensitivity to antibacterial agents. If the patient is prone to allergic reactions, antihistamines are prescribed.

If side effects occur from taking antibiotics, the patient should contact the attending physician, who will select more suitable dosages or replace the drug with a suitable one.

Complications of syphilitic chancre

When a hard chancre occurs, there are a number of dangers associated with the penetration of other pathogenic organisms into it. As a result, the ulcer not only begins to itch, but also cause pain due to the development of the inflammatory process and the accumulation of purulent fluid.

There are several reasons that provoke penetration into the hard chancre of infection:

accidental injury;
lack of hygiene measures;
tuberculosis.

The presence of a syphilitic ulcer in women can lead to the development of infectious vaginitis, inflammatory bartholinitis, endocervicitis of the uterine neck. In men, complications of chancre are balanitis, balanoposthitis, phimosis of the foreskin, necrotic processes of the glans penis.

The consequences of the presence for a long period of time in the body of pale treponema and chancre can be serious changes in bone tissue. Such violations lead to the loss of the patient's ability to live a normal life. With untimely treatment or its absence, the development of neurosyphilis is possible, in which the infection affects the central nervous system, causing meningitis, paralysis, and meningomyelitis. In the absence of therapy, death occurs.

Hard chancre appears at the first or second stage of syphilis and often goes unnoticed by the patient himself.

The danger of the presence of such ulcerative formations on the skin and mucous membranes is associated not only with a high risk of contracting other infections, but also with a high probability of transmission of pale treponema to healthy people during sexual and household contacts.

Timely diagnosis of a sexually transmitted disease allows you to cure the patient as soon as possible and prevent the spread of pathogenic microorganisms.

A rash with syphilis is one of the main symptoms. The disease is caused by treponema pale. The causative agent of infection enters the human body through injured mucous membranes or skin. It is possible to transmit syphilis during fetal development and during blood transfusion.

Syphilis on the skin is the primary sign of the disease, indicating the active reproduction of bacteria at the site of penetration. During this period, a hard chancre is formed. With further spread of treponema, the immune system begins to produce antibodies. It is because of this that secondary rashes appear.

The tertiary form of the disease develops several years after infection. There is a loss:

skin;
bones;
nervous system.

A rash is one of the most common manifestations of tertiary syphilis. Each phase of the rash has its own characteristics.

Rash in primary syphilis

The first symptoms of infection appear after the end of the incubation period, which lasts 14–60 days. A large defect appears on the skin, called a hard chancre. It has a rounded shape and a smooth bottom (see photo). Itching and pain are absent, the ulcer has a dense base, resembling cartilage. Syphilitic erosion is similar to an ulcer, but patients rarely pay attention to it. Such rashes are of a single nature, with a severe course of the disease, several elements are formed.

Small ulcers appear on the mucous membranes of the female genital organs. Large chancres affect the skin:

abdomen
hips;
faces;
groin area.

They are found most often in men. Hard chancre may appear on the lip or tongue, after healing, a star-shaped scar remains. The elements contain a large amount of the infectious agent, so a person with a primary form of the disease is considered extremely dangerous for others. An ulcer on the skin with syphilis is present for 2 months, after which tissue scarring occurs.

An atypical manifestation of a sexually transmitted disease - affecting the fingers. The phalanx swells and turns red, pain appears. A deep ulcer is visible. Skin manifestations of syphilis are accompanied by an increase in regional lymph nodes.

Signs of a secondary form

During this period, the following types of rash occur:

Spots can appear anywhere on the skin. Despite the variety of types, all secondary syphilides have common features. The color in the first days is bright pink, then gradually turns into brown. The elements of the rash do not spread and do not merge with each other. Itchy rashes with syphilis do not appear, they disappear even in the absence of treatment. The skin affected by syphilis does not become inflamed. The introduction of penicillin antibiotics contributes to the rapid disappearance of spots, papules and vesicles. All secondary syphilides are extremely contagious.

Abundant rashes appear after the end of the primary period, which lasts about 10 weeks. Red spots or pimples are found on the skin, having a symmetrical arrangement. With the recurrence of the disease, syphilides appear in smaller quantities, affect limited areas of the skin, forming rings and garlands.

What does a syphilitic rash look like at this stage? In most cases, papular rashes or roseola are found. The latter consists of rounded spots of small size with uneven borders. They have a pale pink color that brightens when pressed. Merging or peeling of the elements of the rash is not observed. In density and height, they do not differ from healthy skin. If left untreated, roseola disappears after 3 weeks, after which it reappears a few months later.

The appearance of papular rashes is promoted by the inflammatory process in the upper layers of the skin. The elements have clear boundaries and slightly rise above the surface. Under the influence of certain factors, they can merge. The rashes have a smooth shiny surface and a pale pink color. Before disappearing, they are covered with scales, leaving behind areas of hyperpigmentation. Papules do not affect the palms and feet, most often they are found on the back of the head, forehead and lips.

Pustules occur in a small proportion of patients with secondary syphilis. Their appearance contributes to a decrease in immunity. Outwardly, they resemble acne, impetigo and other dermatological diseases. When diagnosing, it is necessary to pay attention to the presence of a dark rim. Pimples are small in size and have a dense base, later covered with crusts. Healing is not accompanied by tissue scarring.

Impetigious syphilide has the appearance of a papule with a suppurating center, which eventually becomes covered with a multi-layered crust.

Ecthyma is a large ulcer surrounded by a purple rim. During the healing process, a crust forms in the form of a shell. Healing is accompanied by the appearance of scars.

A rare symptom of the secondary form of the disease is herpetiform syphilide, resembling herpetic eruptions. Its occurrence indicates a malignant course of infection.

Skin manifestations of tertiary syphilis

This stage begins 4-5 years after the penetration of pale treponema into the body. There have been cases of the occurrence of a tertiary rash after 10–20 years. The transition of syphilis to this form is facilitated by improper treatment. The rashes look like gummy infiltrates and tubercles. Re-activation of bacteria in the affected areas leads to their appearance. During this period, a person is not dangerous to others. Rashes can spread around the periphery.

A dense knot of large size, which rises above the skin. The main symptom of rashes in tertiary syphilis is the absence of pain. Single lesions most often affect the lower extremities. In the future, the gum begins to break down, resulting in the formation of a large ulcer. It has dense edges, uneven borders and a deep bottom, represented by dead tissues. Healing is accompanied by the formation of star-shaped scars. In some cases, the gumma does not ulcerate, but turns into a subcutaneous scar.

Tubercular syphilide is a small bluish-colored elevation that can ulcerate and contribute to the appearance of deep defects. Such rashes persist for several months. The congenital form of syphilis has special skin manifestations. The formation of papular syphilis may be accompanied by infiltration. The skin turns red, thickens and swells. The rash appears on the arms, buttocks, feet and. Subsequently, diverging cracks are formed, the healing of which is accompanied by the formation of a scar.

Syphilitic pemphigus is another characteristic sign of the congenital form of the disease. Rashes look like bubbles filled with transparent contents. They affect the upper limbs, are not prone to fusion and increase. Syphilis affects the internal organs, due to which the appearance of a rash is accompanied by a deterioration in the general condition of the body. In the late period, gummas are formed, characteristic of the tertiary period of the disease. How to define and?

Therapeutic activities

An experienced dermatologist can make a diagnosis after the initial examination. To establish the syphilitic origin of the rash, laboratory tests are carried out (immunofluorescence reaction, passive hemagglutination). Identification of an infection can present some difficulties; it is impossible to decipher the test results on your own.

Therapy should not be aimed at eliminating the rash, but at destroying the pathogen. Pale treponema is sensitive to penicillin antibiotics. The substance after the introduction begins to act quickly, but it does not stay in the body for a long time. Bicillin - a modified penicillin is used as intramuscular injections 2 times a day. The modern drug Bicillin-5 can be administered once every 3 days, therefore it is often used for outpatient treatment of syphilis.

Tetracycline is prescribed for severe infections. The drug can not be used to eliminate the disease in children and pregnant women. Macrolides are considered safer, for example,. It is taken once a day for 2 weeks. With the introduction of drugs, the syphilitic rash quickly disappears. To prevent allergic reactions to antibiotics, antihistamines (Claritin) are used. In the presence of gums and ulcers, antibacterial ointments are used. Early treatment for syphilis helps to avoid the formation of rough scars on the skin.