Syphilis is the first sign of what to treat. Rash with syphilis - a photo of rashes at different stages of the disease. With syphilitic angina

The disease proceeds in waves: periods of exacerbation with severe symptoms are replaced by latent phases when signs of syphilis are absent, and only positive blood tests indicate the presence of infection.

What symptoms and signs in women speak of syphilis in the early stages and later? Find out from this article.

More than 50% of syphilis cases in women are diagnosed in the early childbearing period, between the ages of 18 and 29... Up to 100% of newborns from sick mothers are infected, and 30% are still born.

Infection with syphilis mainly occurs through sexual contact and through kissing, much less often - with close household contact, through household items. Since the causative agent of syphilis retains its pathogenicity for some time in a humid environment, you can become infected through dental and hairdressing instruments, endoscopic devices, enema tips.

Symptoms of syphilis in women appear, on average, after 3 - 4 weeks from the moment of infection, this is how long the incubation period lasts.

Symptoms of syphilis in women: the very first signs

When and how is it manifested? Usually one month after infection, sometimes this period is reduced to 9 days or lengthened to six months.

The disease begins with the formation of a flat, compacted papule at the site of penetration of the pathogen:

on the oral mucosa;
facial skin;
in the corners of the lips;
on the nipples of the mammary glands;
on the genital mucosa: cervix, vagina, vulva, clitoris.

Often, the disease in women is diagnosed only in the secondary period.if a chancre appears on the cervix and in the vagina.

Since syphiloma is painless, women usually do not feel it when it is located inside the vagina and hidden from view.

Some time after the first signs of syphilis in women, the papule turns into a round or oval ulcer, the color of red meat, up to 2 cm in diameter. It is moist, firm and painless to the touch.... In the center, the ulcer has a dirty yellow color, resembling a purulent mass.

Caution! Photo not for the faint of heart - symptoms of primary syphilis in women

Symptoms of the progression of the primary form

In about a week after the formation of a hard chancre in patients, lymph nodes increase in places of localization of syphiloma. With the formation of a chancre on the genitals, pelvic lymph nodes increase, on the oral mucosa - submandibular, on the mammary glands - axillary. The nodes are mobile and painless, and can grow to the size of a walnut.

But only 3 to 4 weeks after the onset of syphiloma, an RW blood test shows a positive result.

In the absence of treatment, the course of the primary period ends with a general malaise of the body:

increased body temperature;
febrile manifestations;
bone and joint pain;
inflammation of the lymph nodes.

These symptoms indicate the spread of pale tryponemes throughout the body, to other tissues and organs. From this moment, the secondary period begins.

Secondary period of the disease

Secondary syphilis develops 2 months after the formation of a hard chancre and is characterized by rashes on the skin and mucous membranes. There are the following types of rash:

All elements of the rash, with the exception of roseola, have clear boundaries and are randomly located. Most often, rashes affect the skin of the trunk, but can occur on the scalp, face, neck and palms.

After 2 to 3 weeks, the rash disappears suddenlywithout leaving behind spots and scars. The secondary period of syphilis lasts up to 5 years, during this time, rashes periodically occur, which disappear on their own after a while.

The first wave of the rash is characterized by a brighter course: multiple skin lesions, elements have a bright color. Subsequently, papules have darker pigmentation, localized in separate areas of the skin, often forming in groups.

Photo of secondary syphilis in women

Tertiary infection

Due to the annual medical examination, in which the RW blood test is mandatory, tertiary syphilis is rarely diagnosed.

The tertiary period of the disease develops after 4 - 5 years from the moment Treponema pallid enters the body. This period characterized by damage to the skin, mucous membranes, bones, internal organs.

It is manifested by the appearance of tubercles, plaques and nodules, often solitary, brown or reddish-brown in color on the arms, back and face.

The plaque has the wrong borders, slightly raised above the skin and covered with ulcers and crusts.

With a later course, an isolated gum is formed in the subcutaneous tissue - a hard node, the size of a walnut, with an ulcer in the center.

Most often occurs on the scalp, chest, face... Gummas and tubercles, localized on the mucous membrane of the mouth, larynx and nose, lead to tissue destruction, deformation of the soft palate. Against their background, the following complications develop:

destruction of the nasal septum, deformation of the nose;
hoarseness and hoarseness;
violation of the mobility of the tongue.

Spreading to other tissues and organs, syphilis affects the nervous, vascular and skeletal systems, manifesting itself as syphilitic meningitis, hydrocephalus, and progressive paralysis.

Internal organs (liver, kidneys, lungs, heart) are deformed, their function is impaired.

Photo of tertiary syphilis in women

Dysfunction of internal organs is observed in 25% of patients in the secondary period of syphilis.

Diagnostics, which doctor to contact

If a painless ulcer on the genitals is found or if the lymph nodes in the pelvic region are enlarged, a woman should visit a gynecologist in a antenatal clinic.

He will conduct a diagnostic examination, and, if syphilis is suspected, he will write out directions for blood tests using ELISA and RW methods and send him for further examination to a dermatovenerologist.

In case of rashes, you should immediately seek the advice of a dermatovenerologist. Laboratory diagnostics will be carried out:

serological blood tests by ELISA, RIF, RPGA, RV;
diagnostics of the contents of the chancre and elements of the rash for the detection of pale treponema by microscopy in a dark field;
study of syphilides by PCR;
examination of cerebrospinal fluid, with suspected neurosyphilis.

If positive results are obtained, the patient will be immediately sent to a specialized institution for treatment of the disease.

Among the many sexually transmitted diseases, syphilis occupies a special place. The causative agent of the disease is a pale spirochete (treponema). The characteristic rash with syphilis is the first manifestation of the disease. Below is detailed information on syphilis rash, early signs of illness, treatment, and how to prevent illness.

Syphilis is a dangerous venereal disease characterized by treponema affection of all organ tissues. Transmission of infection can occur through sexual, contact-household way (in contact with an open wound or mucous membranes of the patient), during blood transfusion in a hospital. There is a possibility of transmission of the disease to the fetus through the placenta. The symptoms of the disease are different, depending on the stage of the disease. There are 4 main periods of the disease:

When examining a patient, a venereologist determines the disease by how the rash looks. Usually skin lesions appear on the abdomen, the skin of the genitals. The rash spreads to the scalp covered with hair, to the skin under the mammary glands in women. The genital skin lends itself to the defeat of ulcers (if infected after sexual contact): the penis of a man, in a woman - the cervix, vagina, labia.

Since the disease has vivid characteristic manifestations, a specialist can easily determine the diagnosis. Timely access to a doctor and surgical treatment of the disease in the early stages lead to a quick cure for the disease.

Typical signs of syphilitic rash

Sometimes, when infected with syphilis, a skin rash is accompanied by symptoms of a cold, rarely flu. Syphilitic rashes on the skin have certain characteristic features:

there is no specific localization of rashes, their concentration;
lesions on the skin do not hurt, do not itch, do not peel off;
lesions have a dense surface, rounded;
the rash does not always stick together;
rashes can be pinkish, red, bluish;
the rash itself disappears without a trace.

The timely start of treatment with mandatory follow-up treatment until the disease is completely eliminated is of great importance. The advanced stages of the disease are terrible in their complications, difficult to cure. You can completely cure the disease if you start treatment at the first or second stages of the development of the disease.

Manifestations of syphilitic eruptions

A rash on the body with syphilis, which has arisen at the primary stage, is manifested by medium-sized reddish spots, which after a short period of time transform into small bumps. In their place, wounds with dense edges are formed. The lymph nodes of a sick person become enlarged. The duration of the period reaches seven weeks. The primary stage ends with sepsis (blood infection), joint pain, fever, and general weakness.

Secondary stage of the disease

The disease in the secondary stage can manifest itself in different ways. Therefore, the doctor can not always accurately diagnose. Syphilitic eruptions are easily confused with other skin diseases. There are distinctive features of the manifestation of a rash caused by syphilis, which are characteristic of the disease precisely in the secondary stage:

the rash does not hurt or itch;
neoplasms have fairly dense clear edges;
the bumps have a rich red tint;
rashes appear suddenly, passing without a trace.

A rash with spots turns into the formation of abscesses, which entail a general infection of the body. Pus from the wounds is saturated with the causative agent of the disease, it can be contagious to the people around.

The manifestations of a rash that appeared in the secondary stage of the disease have the following features:

Tertiary stage of syphilis

At the tertiary stage of the course of the disease, the papules are of a medium size, their structure is determined by the doctor during palpation by the color of the skin over the papule (the color is reddish-bluish). The tubercles are grouped on the skin. Papules turn into small wounds, after which scars and scars remain.

Tertiary syphilis is difficult to treat and usually cannot be completely cured. There are complications of the disease, disability, transmission of infection from mother to child. With serious complications, the death of the sick person can occur.

All stages of the disease can provoke the development of other serious diseases. Complications of the tertiary stage can be:

meningitis (inflammation of the meninges);
neuritis (inflammation of the peripheral nerves);
osteoarthritis (degenerative-dystrophic joint disease);
osteoperiostitis (inflammation of the bone walls of the orbit);
aortitis (inflammation of the aortic wall);
myocarditis (inflammation of the heart muscle);
gastritis (inflammation of the stomach lining);
hepatitis (inflammatory liver disease);
necrosis (tissue necrosis);
blindness.

Diagnostics of the syphilitic infection

After examining the external manifestations of the disease, the attending physician must prescribe a blood test for syphilis. One analysis (Wasserman reaction) will not fully reveal the picture of the disease. The task of the conducted study of a blood sample is to detect special antibodies that the body of an infected person produces in the presence of syphilis in the blood. For the study, blood is taken from a vein on an empty stomach - so the analysis will be the most objective. If the test is positive, the diagnosis is confirmed. If negative, there is no syphilis, the cause of the skin rash is investigated.

A blood test for syphilis can give a false result. This may be due to:

early illness (several days have passed after infection);
the disease is in the secondary or tertiary stage (the amount of contained protective antibodies is significantly reduced).

With a positive result, blood tests for syphilis are repeated. False test results are common.

Therapy for syphilitic phenomena

Syphilitic rashes occur with repeated relapse (in the primary and secondary stages of syphilis). At the initial stage, a hard chancre appears - a red wound with smooth rounded edges. The resulting erosion is not subject to local treatment, its size does not increase.

Infection with the disease often occurs through sexual contact, but contact and household are possible. The mode of infection often determines what kind of rash with syphilis manifests itself in an infected person. In the areas of the skin where there was contact with the sick person, the first manifestations of the infection will appear there.

Erosion in the primary stage of the disease affects the mucous membranes of the oral cavity, tonsils, anus, the skin of the hands, in the lower abdomen, under the mammary glands in women.

In males, the foreskin of the penis, its entire skin, and the urethra are affected by infection. For female representatives - the surface of the labia, perineum, anus. The vagina and cervix are affected by ulcers. The neoplasms pass on their own after two months without complications.

Seven days after the appearance of the first chancre, an increase in the size of the lymph nodes (often in the groin) occurs, accompanied by a general weakening of the body, muscle and joint pain. These phenomena indicate the spread of syphilis throughout the patient's body.

In the secondary stage of the disease, rashes occur 2-4 months after infection. Ulcers are localized in the area of \u200b\u200bmucous membranes and on the skin, after 1.5-2 months they are eliminated, reappearing. The secondary stage of the disease lasts a long time - from 2 to 7 years. Syphilis affects all organs, tissues, fluids in the human body, causing irreparable harm. It is quite difficult to treat advanced forms of the disease. Launching the development of a disease means risking your life. If irreversible processes occur, syphilis cannot be cured.

The first time the rash occurs profusely, has an expressive red tint. All subsequent appearances of the rash each time have a paler color, fewer ulcers.

Treatment of the disease should be carried out in a timely manner with the manifestation of the general picture of the disease, preventing the development of complications of the disease. A specialist, based on the examination of the patient, the results of blood tests, will determine an accurate diagnosis. The method of treatment will depend on the individual characteristics of the patient's body, the intensity of the course of the disease.

Treatment of syphilis is carried out in a comprehensive manner, including elimination of infection from the body, therapy of the main external problem - a rash. Treatment is carried out with the introduction of antibiotics to prevent reproduction, spread of infection, and destruction of the causative agent of the disease. Water-soluble penicillin is often used, but in case of individual intolerance (allergy), another effective antibiotic is prescribed. Depending on the stage of the disease, its intensity, immunostimulating therapy is carried out.

Preventive measures

Syphilis does not appear immediately after infection. After sexual contact without protection, it is recommended to treat the external genital organs, skin in places of contact with soap and an antiseptic. You can use antiseptic solutions: Chlorhexidine, Miramistin. Women douche the vagina with a drug, males inject an antiseptic into the urethra.

The method can reduce the likelihood of entry of pathogens by 70%. It is not always possible to carry out procedures in a timely manner, and the risk of infection is too great even after treatment with antiseptics. During sexual intercourse, even with proven partners, it is recommended to protect yourself with condoms. This will save not only women from unwanted pregnancy, but also from a number of dangerous sexually transmitted infections.

After accidental unprotected sexual intercourse, it is recommended to visit a doctor no earlier than 2-3 weeks. Before this period, the infection will not appear.

All damaged skin surfaces of an infected person are contagious. Short-term contact can be dangerous. To prevent the transmission of syphilis from a sick person to his healthy family members, you need to adhere to sanitary and hygienic rules. The sick person, if possible, should be isolated, have separate dishes, bedding, and personal hygiene items. Contact with the patient should be limited, the infected person remains infectious until he fully recovers.

Syphilis is a common sexually transmitted disease that is primarily sexually transmitted. The disease is accompanied by a characteristic rash, which is the main sign of infection. When treating an ailment, timely access to a doctor is of great importance. The disease is successfully treated in the early stages. A neglected disease is difficult to treat. With the activation of irreversible processes in the body, treatment does not help, a lethal outcome occurs.

- an infectious venereal disease caused by Treponema pallidum bacteria. It is transmitted through sexual contact with an infected partner, through blood transfusions and when a pathogen enters through wounds. Since the discovery of penicillin in the mid-20th century, the spread of the disease has been largely controlled, but efforts to eradicate the disease have not yet been crowned with success.

Physician-therapist: Azalia Solntseva ✓ Article reviewed by a doctor

Syphilis in women - 4 stages

Without treatment, the disease progresses and goes through 4 stages: primary, secondary, latent and tertiary. It can be acquired or congenital (the route of transmission is in utero from an infected mother).

Syphilis manifests itself in many different ways and can mimic many other infections and immunologic processes in its later stages. That is why he earned the nickname "the great impostor".

The causative agent of the disease Treponema pallidum (treponema pale) can hardly survive outside the body. The transmission of the microbe requires direct contact with the carrier of the infection; the microorganism is exclusively a human pathogen.

Treponema cannot withstand drying or exposure to disinfectants; therefore, household transmission (for example, sharing toilets) is almost impossible. Unprotected sex is a major risk factor for infection.

Syphilis remains a common ailment in many developing countries and in parts of North America, Asia and Europe, especially in its eastern part. Most of the new cases occur in women aged 20-29.

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How does the disease manifest - signs

How does syphilis manifest in women? After the initial stage, the symptoms of which are the appearance of a painless ulcerating chancre (node) at the site of infection, and enlargement of the lymph nodes, the next stage of the disease begins.

Secondary syphilis manifests itself in different ways. It usually presents as a skin rash that appears within 2-10 weeks after the primary chancre. The rash is most pronounced 3-4 months after infection. Lesions are also mild: 25% of patients may not be aware of skin changes.

Typical is a localized or widespread mucous rash (usually non-itchy and symmetrical bilaterally) with systemic, nonintense enlargement of lymph nodes. Irregular baldness and condylomatosis may also occur.

Common symptoms of syphilis in women are present: malaise, migraine, anorexia, nausea, bone pain and fatigue, as well as fever and spasm of the occipital muscles. A small number of those infected develop acute syphilitic meningitis (inflammation of the lining of the brain) and deafness.

Other less common manifestations include hepatitis, nephropathy, proctitis, arthritis, and optic neuritis.

The stage of latent syphilis in women, which follows the secondary phase, can last from several years (up to a maximum of 25). Patients can recall the symptoms of the primary and subsequent stages of the disease.

In the latent phase, there are no symptoms, and the disease is detected only by serological tests. At the stage of late latent syphilis, women can transmit the disease intrauterinely to the fetus.

During the tertiary phase, the disease progresses slowly, can spread in the body and affect any organ. At this stage, the disease is usually not considered infectious (capable of infecting others).

How does the disease manifest itself:

chest pain, back pain, stridor (noisy and wheezing), or other symptoms associated with aortic aneurysms;
balance disorder, sensitivity disorders (paresthesia), urinary incontinence;
neurological problems, including hearing loss and vision loss;
dementia.

Lesions usually develop within 3-10 years after infection. Symptoms of damage to the central nervous system depend on the area affected: headache, dizziness, psycho-emotional reactions in the form of mood swings, spasm of the neck muscles, blurred vision, weakness of the muscles of the shoulder girdle and limbs.

In some patients, behavioral changes and other signs of dementia appear 10-20 years after infection, indicating paresis.

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The first symptoms of syphilis on the genitals

How long does syphilis manifest? The initial signs of syphilis in women appear 10-90 days after the bacteria enter the body. The first symptoms appear mainly on the vulva or cervix.

Ten percent of syphilitic lesions are found around the anus, in the mouth, on the fingers, tongue, nipples, or other non-genital organs. The invasion is followed by a local, unexpressed enlargement of the lymph nodes (lymphadenopathy).

Lesions (chancres) usually begin as solitary, raised, hard and red papules (nodules) up to several centimeters in diameter. They collapse, creating a crater with slightly raised edges around the central ulcer and a red border. It usually heals with rough scars within 4-8 weeks, regardless of treatment.

Although genital chancres are often solitary, some patients may have multiple chancres. They sometimes appear as "kissing lesions" on opposite skin surfaces, such as the labia.

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How much does the disease manifest

After contact with a carrier and entering the body, bacteria quickly penetrate into unaffected mucous membranes or microscopic skin abrasions and, within several hours, end up in the lymphatic system and bloodstream, contributing to the development of systemic infection.

The incubation time from exposure to the development of primary lesions that appear at the site of entry of pathogens into the body is on average 3 weeks, but can vary from 10 to 90 days.

Research shows that spirochetes (the order of bacteria that treponemas belong to) can be found in the lymphatic system as early as 30 minutes after initial insertion. This suggests that syphilis is a systemic disease from the very beginning.

Primary syphilis in women is characterized by the development of a painless chancre (hard nodule) at the site of infection after 3-6 weeks of the incubation period.

The incubation period of the secondary stage, i.e. how long the disease develops is 4-10 weeks after the onset of the initial lesion. At this stage, the spirochetes multiply and spread throughout the body.

The central nervous system (CNS) becomes infected early in the infection; studies show that in the secondary stage, more than 30% of patients have abnormal results in the cerebrospinal fluid. During the first 5-10 years after the onset of the disease, lesions of the meninges, tissue and blood vessels are found, which leads to neurosyphilis.

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Allocations for this pathology

An atypical phenomenon in this disease. It is important to understand that the female body normally secretes secretions from the genital tract, which are designed to maintain the constancy of the environment and flora of the genital organs, as well as to ensure the physiological functions of the body.

In the case of the location of the primary focus (chancre), on the genitals, there are unexpressed mucous discharge, transparent, without an unpleasant odor. A change in these parameters may indicate the addition of another infection, such as chlamydia or candidiasis.

With ulceration of a chancre located in an area rich in blood vessels, blood streaks may appear.

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Rash in the fair sex

In the primary phase, a single, painless nodule (papule) usually appears, which quickly collapses and hardens. The edge and base of the ulcer have a cartilaginous consistency to the touch.

While classic chancres are painless, they can be uncomfortable if contaminated with bacteria or located in the anal canal. Non-genital chancres occur most commonly over the neck, usually affecting the lips or mouth.

Secondary syphilis manifests itself in different ways in women, but usually includes a localized or diffuse mucosal rash. The exanthema can be spotty, nodular, or mixed.

The initial lesions are usually bilateral and symmetrical, pale red to pink (in fair-skinned individuals) or pigmented (in dark-skinned individuals).

The rash is separate, round, consists of evenly colored spots with a diameter of 5-10 mm, distributed over the body and limbs. After a few days or weeks, red nodules of 3-10 millimeters in size appear. The elements become necrotic (purulent) and often spread to the palms and feet.

10-15% of patients with secondary syphilis develop painless superficial erosions of the mucous membranes in the palate, pharynx, larynx, vulva, or in the anal canal and rectum.

These spots are round, silvery-gray defects with a red areola (border). They are a reservoir of treponema and a source of infection.

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Analyzes and diagnostics

Treponema pallidus cannot be cultured and is too small to be seen under a light microscope. Serological testing is considered the standard method for detecting all stages of the disease.

If acquired syphilis is suspected, the traditional approach is to first have a non-treponemal syphilis response, or a newly developed antigen test, and then a specific test.

A distinctive feature of laboratory diagnosis of syphilis in a woman is the absence of 100% of the results. The specificity of the development of microorganisms is cyclicity, even with obvious symptoms, the test can give a negative result. Therefore, regular examination by a gynecologist and laboratory check is recommended.

The sensitivity of the first analysis is 78-86% for detecting the primary phase, 100% for detecting the secondary and 95-98% for the tertiary process.

The specificity ranges from 85 to 99% and may be less in people with vascular collagen (connective tissue) diseases, pregnancy, intravenous drug use, tuberculosis and malaria. The test results become positive 1-2 weeks after the chancre has formed.

Due to the potential for false positive results, confirmation of any positive or ambiguous result of the above assay must be accompanied by a treponemal test, (eg, fluorescent antibody uptake). The sensitivity is 84% \u200b\u200bfor detecting primary infection and almost 100% for other stages.

Darkfield microscopy is a possible way to assess wet skin lesions such as chancre of primary syphilis or condyloma of secondary.

Confirmed patients are tested for other sexually transmitted diseases, including HIV infection.

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How to treat a disease

Penicillin has been developed as an effective remedy for fighting syphilis. It remains the foundation of treatment and the standard against which other therapies are judged.

How to treat syphilis in women while using penicillin:

Primary or secondary syphilis - benzathine penicillin 2.4 million units intramuscularly in a single dose.
The early latent stage is the same.
Late latent syphilis or unknown duration - benzathine penicillin 7.2 million units. It is administered in 3 doses of 2.4 IU at intervals of 1 week.

The principles of disease therapy include the following:

Penicillin is the main drug for treating ailments.
Doxycycline is the best alternative in the treatment of early and late latent stage of the disease. Syphilis in women associated with HIV infection does not require any enhanced antimicrobial therapy.
When treating the disease with weekly injections at a later stage, skipping a dose for 10-14 days does not require restarting the entire course of injections.
An interval of 7-9 days between medications may give the best results.

Surgery is intended to treat complications of tertiary syphilis (eg, aortic valve replacement).

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Correct disease prevention

The main goal is to limit the spread of syphilis. This entails advising people on safer sex practices and educating patients who abuse intravenous drugs. The latter should never share needles and are required to use clean syringes.

Identifying and treating sex partners and drug companions is of the utmost importance. Prevention also involves training health-care workers to take precautions when treating such people.

A single dose of 2.4 million units of benzathine penicillin intramuscularly is recommended for all individuals who have had sexual contact with a partner who tested positive for primary, secondary, or early latent syphilis within the previous 90 days.

Circumcision does not help prevent transmission, although it can help reduce the spread of other sexually transmitted diseases, such as HIV infection.

Syphilis (Syphilis) - a venereal infectious disease proceeding in a chronic form, in which the skin, mucous membranes, bones, many internal organs, as well as the immune and nervous systems are affected.

Other names for syphilis - lues.

The main cause of syphilis is infection of the body with the bacterium Treponema pallidum (treponema pale).

The main symptoms of syphilis are painless ulceration on the skin (hard chancres), a specific rash on the skin and mucous membranes, general malaise, weakness.

How is syphilis spread? Infection with syphilis occurs primarily through sexual contact. However, infection can also occur through blood, kissing, by household means, or from mother to child (congenital disease).

Is syphilis treated? Yes, modern medicine, with timely access to a doctor, is able to treat this disease. Of course, if a person does not respond to the disease and does not seek help, there is a high probability of death with multiple severe health disorders.

Syphilis development

The development of syphilis occurs over 4 periods (stages) - incubation, primary, secondary and tertiary. The pathogenesis of syphilis is based on the body's immune response to the presence of infection and its waste products, which are toxins (poison).

Let's consider the stages of syphilis in more detail.

Syphilis stages (periods)

Syphilis statistics

Syphilis is one of the most common sexually transmitted diseases (STDs).

Despite the ability of modern medicine to treat this disease, it is still officially found in developed countries in 20-30% of people.

In the territories of the former USSR, the epidemiological situation is also deteriorating. So, in 1991, in Russia, out of 100,000 people, syphilis was diagnosed in 7, and in 2009 there were already 52 patients.

Syphilis - ICD

ICD-10: A50-A53;
ICD-9: 090-097.

Syphilis - symptoms

Symptoms of syphilis largely depend on the duration of exposure to the infection, the person's health status and the stage of the disease, which we talked about above.

The first signs of syphilis (symptoms of primary syphilis)

The first symptoms of the disease (primary syphilis) appear several days, and sometimes months after contact with the infection. Among them are:

The appearance of a hard chancre (primary syphiloma);
Swollen lymph nodes (regional lymphadenitis, scleradenitis, or lymphangitis);
Inductive edema, which appears mainly in the genital area (due to the fact that it is here that the infection penetrates into the body) and is a slight increase in the form of a bulge with a changed skin color, also painless, persisting from 1 week to 1 month during primary syphilis ...
The formation of a hard chancre, which is a practically painless deep dense ulcer, similar in appearance to a fossa with a flat bottom, round in shape, without bleeding and a tendency to increase in diameter. Chancre can also be present on the body in the form of atypical forms - multiple chancre, amygdalitis chancre (appears on one of the tonsils in the oropharynx, resembles signs), panaritium chancre (appears on 1-3 fingers of the right hand);
Increased body temperature.

Secondary syphilis symptoms

The appearance of a generalized rash on the skin and mucous membranes (syphilitic rash);
On the head, hair falls out in places, up to baldness;
Enlarged lymph nodes, cold to the touch, no adhesions, painless or not painful (lymphadenitis);

In practice, the symptoms of the secondary stage of the disease resemble those of the usual one.

Symptoms of tertiary syphilis

Symptoms of tertiary syphilis in the first months, and sometimes tens of years, may be absent or minimal, and the patient remains a carrier of the infection.

After the disease worsens again, but it already affects almost all organs and systems, which is expressed in the following destructive processes:

Damage to the skin and mucous membranes;
The formation of gums, which are initially soft-tissue tumors, and then degenerate into fibrous scars;
Vascular lesions - syphilitic aortitis, syphilitic endarteritis;
Brain damage - progressive paralysis;
Damage to the musculoskeletal system;
The defeat of the nervous system is neurosyphilis.

Symptoms of neurosyphilis

At the end of the second stage, neurosyphilis begins to develop, the main symptoms of which are:

Damage to the blood vessels (, hyperplasia of the intima, where billions of gums are formed as a result) and the membranes of the brain and spinal cord;
The development of a syphilitic in a chronic form;
Argyll-Robertson symptom;
Among other, however, more rare signs, there are - syphilitic and meningoencephalitis;
Paresis, paralysis, ataxia;
The patient practically does not feel support under his feet;
Dizziness;
Visual impairment;
Mental disorders - forgetfulness, inattention, lethargy, etc.

Symptoms of congenital syphilis

It is transmitted from mother to baby during pregnancy, and due to the fact that at this time the child is just developing, then after birth, he has some of the following symptoms:

Congenital hearing loss (deafness);
Parenchymal;
Hypoplasia of dental tissues, or so-called. "Hutchinson's teeth".

After stopping the infection, congenital abnormalities usually remain, which worsens the patient's quality of life.

Complication of syphilis

Paralysis;
Syphilitic ecthymas, rupees, gummas;
Optic nerve atrophy, blindness;
Hearing loss;
Disability;
Miscarriage;
Diseases of the cardiovascular system:, vasculitis,;
Diseases of the musculoskeletal system -, reactive osteitis;
Fatal outcome.

Syphilis causes

The causative agent of syphilis - the bacterium "pale treponema" (lat. Treponema pallidum), the infection of which is the reason for this.

Infection with syphilis occurs in the following ways:

Through intercourse with the carrier of the infection (the infection is found both in the blood and in the semen of the patient, even if the carrier has no obvious signs);
Through kisses;
Through the placenta - from the infected mother to the fetus;
Through breastfeeding - the infection enters the child's body with infected milk;
Through blood, so that it usually happens - when infusing infected donated blood, using a syringe, razor, toothbrush, scissors and other items that the carrier of the infection has previously used;
Bodily contact with open ulcers on the patient during the tertiary phase of the disease, or his bedding and household items, for body care (including towels, bedding, spoons, dishes);
When carrying out medical and diagnostic measures;
For cosmetic procedures (manicure, pedicure), tattooing or dental services.

An exacerbation of the disease usually occurs against the background of a weakened immune system, which can be caused by the lack of proper rest and sleep, strict diets, insufficient intake of vitamins and (and) into the body, the presence of others.

According to the WHO, about 30% of patients with white treponema infected with high immunity reactivity recovered without the use of traditional methods of therapy for this disease.

The classification of syphilis is as follows:

Primary syphilis (Syphilis I)which could be:

Seronegative (Syphilis I seronegativa);
Seropositive (Syphilis I seropositiva);
Hidden, or latent (Syphilis I latens).

Secondary syphilis (Syphilis II)which could be:

Early (Syphilis II recens);
Recurrent (Syphilis II recidiva);
Hidden (Syphilis II latens).

Tertiary syphilis (Syphilis III)which could be:

Active (Syphilis III gummosa);
Hidden (Syphilis III latens).

Congenital syphilis (Syphilis congenita)which could be:

Early (Syphilis congenita praecox);
Late (Syphilis congenita tarda);
Hidden (Syphilis congenita latens).

In addition, there are special forms of syphilis, usually expressing special clinical manifestations:

Syphilis of the nervous system (neurosyphilis);
Progressive paralysis (Paralysis progressiva);
Dorsal tabes (Tabes dorsalis);
Syphilis of the brain (lues cerebri);
Visceral syphilis;
Unspecified syphilis.

Diagnosis of syphilis

Diagnosis of syphilis includes:

Visual examination, medical history;
Cerebrospinal fluid examination;
Serodiagnostics;
Polymerase chain reaction (PCR);
Enzyme-linked immunosorbent assay (ELISA);
Cardiolipin test in combination with ELISA;
Immunofluorescence reactions (RIF);
Direct hemagglutination reactions (RPHA);
Treponema pale immobilization reactions (RIBT);
Micro-precipitation reactions (MOP - micro-precipitation reactions).

Syphilis - treatment

How is syphilis treated? Treatment for syphilis includes the following therapies:

1. Drug treatment;
2. Physiotherapy procedures.

The primary stage of the disease is treated on an outpatient basis. Treatment in stationary conditions is carried out in the presence of complications, or when the patient develops a secondary stage.

1. Drug treatment of syphilis

Important! Before using medications, be sure to consult with your doctor!

1.1. Antibiotic therapy

As we already know, the causative agent of the infection is the bacterium "white treponema". In this regard, antibiotic therapy is used to stop the bacterial infection.

The most popular antibacterial substances against white treponema are penicillin, and in case of allergy to penicillin or with some resistance to it of another strain of bacteria, tetracycline and erythromycin are prescribed. Also against Treponema pallidum, more rarely, but cephalosporins are still used. Sulfonamides are not effective against white treponema.

An interesting fact is the almost complete absence of resistance of white treponema to penicillin and its derivatives. However, syphilis continues to spread throughout the world, especially in developed countries.

Treatment of neurosyphilis is carried out with the introduction of antibiotics - oral, intramuscular and endolumbar. In addition, to achieve maximum efficiency, the patient's body temperature is artificially increased (pyrotherapy - "Pyrogenal"), which leads to an increase in the blood-brain barrier.

Treatment of tertiary syphilis is carried out not only with the help of antibiotics, but also when the patient is in good condition - with the addition of drugs based on bismuth ("Biyohinol") and arsenic ("Miarsenol", "Novarsenol"). However, one must remember that these substances are very toxic to the body.

Antibiotics for syphilis: penicillins ("Ampicillin", "Amoxicillin", "Oxacillin"), prolonged forms of penicillin ("Bicillin", "Retarpen", "Extencillin"), tetracyclines ("", "Doxycycline"), erythromycin ("", "Clarithromycin" ), cephalosporins ("Cefotaxime", "", "Cefepim").

To prevent the spread of infection to people around, all things and objects in the patient's place of stay must be disinfected - dishes, plumbing, clothes, linen, etc.

1.2. Detoxification therapy

White treponema and its waste products, which are toxins (toxic substances) for the body, complicate the course of the disease. In addition, after the use of antibiotics, dead bacteria also poison the body. To remove toxins from the body, detoxification therapy is used, which includes:

Drink plenty of fluids, preferably with the addition of vitamin C;
Reception of sorbents: "Gemodez", "Atoxil", "Enterosgel", "Polysorb", "Smecta";
Intravenous infusion of glucose-saline solutions, the dosage of which depends on the degree of intoxication;
Hemosorption (blood purification);
Plasmapheresis (purification of blood through collection, purification and reflux);
ILBI (blood purification using intravenous laser irradiation);
UFO blood (blood purification using ultraviolet radiation);
Lymphosorption (lymph cleansing);
Hemodialysis (blood purification in case of renal failure).

1.3. Strengthening the immune system

The high reactivity of the immune system, which plays the protective role of the body, contributes to a faster recovery of a patient with syphilis.

The following drugs are used to stimulate the immune system: Laferon, Timalin, Timogen, Methyluracil, Likopid, Imunofan, Galavit, Pantokrin, Plazmol.

1.4. Vitamin therapy

2. Physiotherapy procedures

To improve the patient's condition, maintain the work of organs and systems and accelerate recovery, the use of physiotherapy is prescribed, from the methods of which can be distinguished:

Inductothermy;
Magnetotherapy;
UHF therapy;
Laser therapy.

Important! Before using folk remedies for syphilis, be sure to consult with your doctor!

Garlic, wine, jam, and apple juice. Pour 1 cup of strawberry jam with half a cup of water, put the mixture on the fire and bring to a boil. After simmering for 3-4 minutes over low heat, remove the product from the stove and add 2 cups of warm red wine and 1 cup of apple juice to it. Mix everything thoroughly, cool. Then add another 6-7 pounded cloves to the product, mix everything again and set the mixture aside for 3 hours to infuse. Then strain and drink 100 ml per day.

Garlic, apples, hawthorn and rose hips. Grate 2 Antonovka apples and mix with them 1 cup of fruit, 1 cup of fruit and 7 minced cloves of garlic. Pour the mixture with 2 liters of boiling water, stir, cover the bowl and set aside for a couple of hours to infuse. Then strain the product and drink it half a glass after meals, 3 times a day.

Sedge. Thoroughly peel and finely chop 20 g of sand sedge root, pour 600 ml of boiling water over it, put the mixture on low heat and simmer until the amount of liquid is half as much. Then set aside the product for a couple of hours for insisting and cooling, strain and drink 3-4 times a day.

Field Yarutka. Pour 1.5 tbsp. tablespoons of herbs and a field glass of boiling water and set aside the product for 4 hours to infuse. After the infusion, strain and drink 1 teaspoon 5 times a day.

Burdock. 1 tbsp. pour a spoonful of burdock root with a glass of boiling water, put the product on low heat, boil it for about 20 minutes, then set aside to cool, strain and drink 1 tbsp. spoon 4 times a day.

Hop. 2 tbsp. Spoons of ordinary hops pour 500 ml of boiling water, cover the container and let the product brew for 2.5 hours. After the remedy, you need to strain and drink half a glass 4 times a day.

Prevention of syphilis

Prevention of syphilis includes:

Refusal from promiscuous sex, especially with strangers;
Instilling in children the awareness that extramarital affairs are a prohibition, not only from the moral, but also from the spiritual side, because Fornication is Sin — Flee fornication; every sin that a person commits is outside the body, but the fornicator sins against his own body ”(1 Corinthians 6:18, Bible);
Washing the genitals after intimacy with soapy water;
Use of contraceptives, however, remember that contraceptives do not guarantee safety;
Timely visit to a doctor after the first signs of illness;
Avoid visiting lesser-known beauty salons and dental clinics;
Avoid tattoos on your body (by the way, according to the texts of the Holy Scriptures, tattoos on the body in ancient times were done for the sake of the dead);
Compliance.

Which doctor should you contact for syphilis?

Syphilidologist.
In some cases, additional treatment may be required from (women) and (men).

Syphilis - video

Secondary syphilis begins with the spread of pale treponema with blood throughout the body, which usually occurs 6 to 8 weeks after the appearance of a hard chancre or 9 to 10 weeks after the initial infection. In some patients, syphilitic polyadenitis persists in the initial period. In 60% of cases, patients have signs of primary syphiloma (hard chancre).

The massive release of bacteria into the bloodstream (syphilitic septicemia) is characterized by symptoms of intoxication - fever, severe headaches and muscle-joint pains, weakness, and general malaise. A rash appears on the skin and mucous membranes (secondary syphilides, secondary syphilomas), the internal organs, osteoarticular and nervous systems are involved in the pathological process. The periods of a pronounced clinical picture are replaced by a hidden, latent course. Each new relapse is characterized by fewer and fewer rashes. In this case, the rash is becoming larger and less intensely colored. At the end of the second stage of syphilis, mono-relapse occurs, when the clinical picture is limited to a single element. The state of health of patients suffers little. The duration of secondary syphilis is 2 to 5 years.

A rash with secondary syphilis generally resolves without a trace. Lesions of the internal organs, the musculoskeletal system and the nervous system are mainly of a functional nature. In most patients, classic serological reactions are positive.

The secondary period of syphilis is the most contagious. Secondary syphilides contain a huge number of pale treponemas.

Fig. 1. Symptoms of secondary syphilis - rash (papular syphilis).

Rash with secondary syphilis

Secondary syphilis is characterized by the appearance of a rash on the skin and mucous membranes - secondary syphilis. The rash with secondary fresh syphilis is profuse and varied (polymorphic): spotty, papular, vesicular and pustular. A rash can appear anywhere on the skin and mucous membranes.

The most profuse rash at the first rash, often symmetrical, the elements of the rash are small, always bright in color. Often, on its background, residual (solid chancre), regional lymphadenitis and polyadenitis can be found.
Secondary recurrent syphilis is characterized by less profuse rashes. They are often grouped together to form fanciful patterns of garlands, rings, and arcs.
The number of rashes in each subsequent relapse becomes less and less. At the end of the second stage of syphilis, mono-relapse occurs, when the clinical picture is limited to a single element.

Elements of a rash in secondary syphilis have some features: a high prevalence at the beginning of the secondary period, sudden appearance, polymorphism, clear boundaries, a peculiar color, lack of reaction of surrounding tissues, peripheral growth and subjective sensations, benign course (often the rash disappears spontaneously without scarring and atrophy), high infectivity of the elements of the rash.

Fig. 2. Manifestations of secondary syphilis - syphilitic seizure.

Syphilitic roseola

Syphilitic roseola of the skin

Syphilitic roseola (spotted syphilis) is the most common form of damage to the mucous membranes and skin in early secondary syphilis. It accounts for up to 80% of all rashes. Syphilitic roseola is spots from 3 to 12 mm in diameter, from pink to dark red, oval or round in shape, do not rise above the surrounding tissues, there are no perifocal growth and flaking, spots disappear with pressure, there is no pain and itching.

Roseola is caused by vascular disorders. In the dilated vessels, erythrocytes disintegrate over time, followed by the formation of hemosiderin, which causes the yellowish-brown color of old spots. Roseola, rising above the level of the skin, often flaky.

The main places of localization of roseola are the trunk, chest, limbs, abdomen, (often palms and soles) and sometimes the forehead. Often roseola are located on the mucous membrane of the oral cavity, rarely on the genitals, where they are hardly noticeable.

Towering, papular, exudative, follicular, confluent are the main forms of spotted syphilis. With relapses of the disease, the rash is more meager, less colored, prone to grouping with the formation of arcs and rings.

Spotted syphilis should be distinguished from bites of pubic lice, pink and infectious roseola, measles, rubella and marbled skin.

Fig. 2. Rash with syphilis of the secondary period - syphilitic roseola.

Fig. 3. Signs of secondary syphilis - syphilitic roseola on the skin of the trunk.

Syphilitic roseola of mucous membranes

Syphilitic roseola in the oral cavity is isolated, sometimes the spots merge, forming continuous areas of hyperemia in the tonsils (syphilitic tonsillitis) or the soft palate. The spots are red, often with a bluish tinge, sharply delimited from the surrounding tissue. The general condition of the patient rarely suffers.

When localized on the mucous membrane of the nasal passages, dryness is noted, sometimes crusts appear on the surface. On the genitals, syphilitic roseola is rare, always invisible.

Fig. 4. Syphilitic roseola in the oral cavity - erythematous tonsillitis.

Syphilitic roseola is a typical manifestation of early secondary syphilis.

Papular syphilis

Papular syphilis is a dermal papule that results from an accumulation of cells (cellular infiltration) located under the epidermis in the upper dermis. The elements of the rash are rounded, always clearly delimited from the surrounding tissues, of a dense consistency. Their main locations are the torso, limbs, face, scalp, palms and soles, oral mucosa and genitals.

The surface of the papules is smooth, shiny, smooth.
The color is pale pink, copper or cyanotic red.
The form of papules is hemispherical, sometimes spiky.
They are located in isolation. Papules located in the folds of the skin tend to grow peripherally and often fuse. Vegetation and hypertrophy of papules leads to the formation of wide warts.
With peripheral growth, the resorption of papules begins from the center, resulting in the formation of various shapes.
Papules located in the folds of the skin are sometimes eroded and expressed.
Depending on the size, miliary, lenticular and coin-shaped papules are distinguished.

Papular syphilides are extremely contagious, as they contain a huge number of pathogens. Patients with papules in the mouth, perineum and genitals are especially contagious. Handshaking, kissing, and close contact can transmit the infection.

Papular syphilides resolve after 1 to 3 months. When papules resorb, peeling is noted. At first, it appears in the center, then like "Biette's collar" - on the periphery. In place of the papules, a brown pigmented spot remains.

Papular syphilis is more common in recurrent secondary syphilis.

Fig. 5. Rash with syphilis of the secondary period - papular syphilis.

Miliary papular syphilis

Miliary papular syphilis is characterized by the appearance of small dermal papules - 1 - 2 mm in diameter. Such papules are located at the mouths of the follicles, they are round or cone-shaped, dense, covered with scales, sometimes horny spines. The trunk and limbs are their main localization sites. Resolution of papules is slow. A scar remains in their place.

Miliary papular syphilis should be distinguished from lichen scrofula and trichophytosis.

Miliary syphilis is a rare manifestation of secondary syphilis.

Lenticular papular syphilis

Lenticular papules are formed in 2-3 years of illness. This is the most common type of papular syphilis, found in both early and late secondary syphilis.

The size of the papules is 0.3-0.5 cm in diameter, they are smooth and shiny, rounded with a truncated apex, have clear contours, pink-red color, when pressed with a button-like probe, pain is noted. As the papules develop, they become yellowish-brown in color, flatten, and become covered with transparent scales. The marginal type of peeling is characteristic ("Biett's collar").

During early syphilis, lenticular papules can appear on different parts of the body, but most often they appear on the face, palms and soles. During the period of recurrent syphilis, the number of papules is less, they are prone to grouping, while bizarre patterns are formed - garlands, rings and arcs.

Lenticular papular syphilis should be distinguished from guttate parapsoriasis, lichen planus, psoriasis vulgaris, papulonecrotic.

On the palms and soles of the papules are reddish with a pronounced cyanotic shade, without clear boundaries. Over time, the papules acquire a yellowish color and begin to peel off. The marginal type of peeling is characteristic ("Biett's collar").

Sometimes papules take the form of corns (horny papules).

Palmar and plantar syphilis should be distinguished from eczema, athlete's foot, and psoriasis.

Lenticular papular syphilis occurs in both early and late secondary syphilis.

Fig. 6. Lenticular papules in secondary syphilis.

Fig. 7. Palmar syphilis in secondary syphilis.

Fig. 8. Plantar syphilide in secondary syphilis

Fig. 9. Secondary syphilis. Papules on the scalp.

Coin-shaped papular syphilis

Coin-shaped papules appear in patients during the period of recurrent syphilis, in a small amount, bluish-red, have a hemispherical shape, 2 - 2.5 cm in diameter, but may be larger. When resorbed, pigmentation or atrophic scar remains in place of the papules. Sometimes there are many small papules around the coin-shaped papules (blasting syphilis). Sometimes the papule is located inside the annular infiltrate, between it and the infiltrate there is a strip of normal skin (cockade type). When coin-shaped papules merge, plaque syphilis is formed.

Fig. 10. A symptom of syphilis of the secondary period - psoriasiform syphilis (photo on the left) and nummular (coin-shaped) syphilis (photo on the right).

Broad type of papular syphilis

The wide type of papular syphilis is characterized by the appearance of large papules. Their size sometimes reaches 6 cm. They are sharply delimited from healthy areas of the skin, covered with a thick stratum corneum, dotted with cracks. They are a sign of recurrent syphilis.

Seborrheic papular syphilide

Seborrheic papular syphilis often appears in places with increased sebum secretion - on the forehead ("crown of Venus"). Oily scales are located on the surface of the papules.

Fig. 11. Seborrheic papules on the forehead.

Weeping papular syphilis

Weeping syphilide appears on areas of the skin where there is increased moisture and sweating - the anus area, interdigital spaces, genitals, large folds of skin. Papules in these places undergo maceration, weeping, acquire a whitish color. They are the most contagious form among all secondary syphilides.

Weeping syphilis must be distinguished from folliculitis, contagious molluscum, hemorrhoids, chancre, pemphigus, and epidermophytosis.

Fig. 12. Secondary syphilis. Weeping and erosive papules, wide condylomas.

Erosive and ulcerative papules

Erosive papules develop in case of prolonged irritation of their localization sites. When a secondary infection is attached, ulcerative papules are formed. The perineum and the anus are frequent places of their localization.

Wide warts

Papules exposed to constant friction and oozing (anus, perineum, genitals, inguinal, less often axillary folds) sometimes hypertrophy (increase in size), vegetate (grow) and turn into wide warts. Vaginal discharge contributes to the appearance of genital warts.

Fig. 13. With the growth of papules, wide condylomas are formed.

Vesicular syphilis

Vesicular syphilis occurs in severe syphilis. The main places of localization of syphilis are the skin of the extremities and the trunk. On the surface of the formed plaque, which has a red color, there are many grouped small vesicles (bubbles) with transparent contents. The vesicles burst quickly. In their place, small erosions appear, when they dry, crusts form on the surface of the rash. When healed, a pigment spot with many small scars remains at the site of the lesion.

The rashes are resistant to therapy. With subsequent relapses, they reappear. Vesicular syphilis should be distinguished from toxidermia, simple and acute herpes.

Pustular syphilis

Pustular syphilis, like vesicular syphilis, are rare, usually in debilitated patients with low immunity and have a malignant course. With the disease, the general condition of the patient suffers. Symptoms such as fever, headache, severe weakness, joint and muscle pain appear. Often the classic ones give negative results.

Acne-like, smallpox, impetiginous, syphilitic ecthyma and rupee are the main types of pustular syphilis. Rashes of this type are similar to dermatoses. Their distinctive feature is the copper-red infiltrate located on the periphery in the form of a roller. The emergence of pustular syphilis is facilitated by diseases such as alcoholism, toxic and drug addiction, tuberculosis, malaria, hypovitaminosis, trauma.

Acne-like (acneform) syphilide

The rashes are small pustules of a round conical shape with a dense base, located in the mouths of the follicles. After drying, a crust forms on the surface of the pustules, which disappears after a few days. A depressed scar remains in its place. The hairy part of the head, neck, forehead, upper half of the body are the main locations of acne-like syphilis. A large number of elements of the rash appear during the period of early secondary syphilis, scanty rashes - during the period of recurrent syphilis. The general condition of the patient suffers little.

Acne syphilis should be distinguished from acne and papulonecrotic tuberculosis.

Fig. 14. Rash with syphilis - acne-like syphilis.

Smallpox syphilis

Ospenoid syphilis usually occurs in debilitated patients. Pea-sized pustules are located on a dense base, surrounded by a copper-red roller. When dry, the pustule becomes similar to a smallpox element. Brown pigmentation or atrophic scar remains in place of the crust that has fallen off. The rash is not profuse. Their number does not exceed 20.

Fig. 15. In the photo of the manifestation of secondary syphilis - smallpox syphilis.

Impetiginous syphilide

With impetiginous syphilis, a dark red papule the size of a pea or more appears first. A few days later, the papule suppurates and shrinks into a crust. However, the discharge of pustules continues to stand out on the surface and shrinks again, forming a new crust. Lamination can become large. The formed elements rise above the skin level. When syphilis merges, large plaques are formed. After peeling off the crusts, a juicy red bottom is exposed. The vegetative growths resemble raspberries.

Impetiginous syphilis, located on the scalp, nasolabial fold, beard and pubis, is similar to a fungal infection - deep trichophytosis. In some cases, the ulcers coalesce to form large lesions (corrosive syphilis).

Healing of syphilis is long. Pigmentation remains at the site of the lesion, which disappears over time.

Impetiginous syphilis must be distinguished from impetiginous pyoderma.

Fig. 16. The photo shows a variety of pustular syphilis - impetiginous syphilis.

Syphilitic ecthyma

Syphilitic ecthyma is a severe form of pustular syphilis. Appears 5 months after infection, earlier - in debilitated patients. Deep pustules are covered with thick crusts up to 3 centimeters or more in diameter, they are thick, dense, layered. The elements of the rash rise above the surface of the skin. They are round, sometimes irregular oval. After rejection of the crusts, ulcers with dense edges and a bluish rim are exposed. The number of ectim is small (no more than five). The main places of localization are the limbs (often the legs). Healing occurs slowly, over 2 weeks or more. Ecthymes are shallow and deep. Serological tests sometimes give negative results. Syphilitic ecthyma should be distinguished from ecthyma vulgaris.

Fig. 17. Secondary syphilis. A variety of pustular syphilis is syphilitic ecthyma.

Syphilitic rupee

A type of ecthyma is the syphilitic rupee. The rashes are 3 to 5 centimeters in diameter. They are deep ulcers with steep infiltrated edges, covered with a dirty bloody discharge, which dry out to form a cone-shaped crust. The scar heals slowly. It is often located on the shins. It spreads both along the periphery and inland. Combines with other syphilides. It should be distinguished from rupioid pyoderma.

Fig. 19. In the photo, the symptoms of malignant syphilis of the secondary period are deep skin lesions: multiple papules, syphilitic ecthymas and rupees.

Herpetiform syphilide

Herpetiform or vesicular syphilis is extremely rare and is a manifestation of severe syphilis of the secondary period in patients with a sharp decrease in immunity and severe concomitant diseases. The condition of the patients worsens significantly.