Syphilis appears after 20 years. How to live with treated syphilis or is the disease incurable? Is it possible to cure syphilis without seeing a doctor?

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There is hardly a single person in the world who has never heard of such a venereal disease as syphilis. Syphilis sounds threatening. This disease has truly become a threat to the whole world, as the number of people affected by syphilis increases every year. This disease is usually transmitted through sexual contact.
So, can't people protect themselves from dangerous sexual relationships? How far has a person fallen that he cannot think about his health in advance?
But syphilis is not just a dangerous, but a very dangerous disease. Its consequences are so extensive that not a single venereologist can foresee what will happen to you tomorrow.

What are the consequences of syphilis?

.site) will tell you right now.

Having penetrated the human body, treponema pallidum, primarily affects the central nervous system. The vessels and lining of the brain are primarily affected. As a result, a person becomes a “hostage” of such diseases as: meningitis, neuritis, hydrocephalus and some others. On at this stage the patient is concerned about the development of syphilis frequent headaches, increased intracranial pressure, nausea, vomiting, dizziness, tinnitus. Damage to blood vessels and the lining of the brain can cause the patient to develop epileptic seizures. Serious speech impairments are also quite common.

In addition to the brain, the organs of vision and hearing are also greatly affected. Most often, disturbances in the functioning of these organs make themselves felt in the form of hearing loss, pupillary abnormalities, retinitis pigmentosa, neuritis or optic atrophy. It is worth drawing your attention to the fact that the progression of syphilis will also contribute to increased disruption of the functioning of these organs, and, consequently, to the development of more serious diseases.

How does syphilis affect different organs and systems of the body?

In the presence of syphilis, the entire musculoskeletal system is affected. First, the lining of the musculoskeletal system is affected, causing a disease such as osteoarthritis. Then there is swelling of the joints, skin damage, and limitation of movements of both the upper and lower extremities. Most often, in the presence of this venereal disease, the joints of the knees, legs, collarbones, feet, and chest are affected.

Syphilis does not bypass the cardiovascular system, making itself felt in the form of shortness of breath, low blood pressure, heart murmur, disruption of the aortic valves, angina pectoris, circulatory disorders, as well as general weakness. Surely you understand that poor circulation will, without a doubt, cause the development of myocardial infarction.

Regarding syphilis respiratory system, then its development takes a fairly long period of time. The first symptoms of this type of syphilis are shortness of breath, wet cough and bronchitis. Then symptoms that are completely similar to the symptoms may make themselves known tuberculous pneumonia.

The liver is one of the vital organs that suffers greatly when exposed to Treponema pallidum. Long-term lack of treatment for syphilis leads to the development of acute yellow atrophy of the liver. The skin, conjunctiva, and mucous membranes become yellow, the size of the liver decreases significantly, convulsions, hepatic colic, and even hallucinations appear. In this case, the liver can be saved only in very rare cases. Most often it ends in hepatic coma, and, consequently, the death of the patient.

So we have reached the point where the gastrointestinal tract is affected by syphilis. At the very early stage of development of this venereal disease, the patient is bothered by symptoms characteristic of ordinary gastritis. Quite often, syphilitic gastritis is confused with a stomach tumor, which makes it impossible to begin the necessary treatment in a timely manner.

As you can see, the consequences of syphilis are truly terrible. That is why if a doctor has diagnosed you with syphilis, do not wait for the weather to come, start treatment immediately. And do not forget that in addition to all the medications and instructions that will be prescribed to you by your doctor, you must also maintain a healthy lifestyle and help your body cope with the infection by using special dietary supplements (dietary supplements).

Before use, you should consult a specialist.

Reviews

After many years, cerebrospinal fluid taken from the spine can definitely show that 20 years ago you had syphilis (tested on yourself.

If I understand correctly, then all these consequences if it is not treated. And if it is treated in a timely manner, although it was already stage 2, does it also have consequences? If yes, which ones? My mother had such a problem in 2001, now she is already 66 years old and began to have problems with her head, namely mild inadequacy, lack of feelings of resentment, lethargy and memory loss. Could all this be a consequence and how can it be treated and with what?

Can tests show that I had syphilis 40 years ago and was treated at the time?

Hello! I would like to know from you if I have had the 3rd stage of syphilis, will I be able to have children and will I get sick again?

How can you cure gonorrhea with an unknown statute of limitations. By the way, I didn’t even suspect that I had such an infection until they told me

After treatment of stage 2 syphilis, is it completely cured or healed? After 20 years it can manifest itself and how???

If I understand correctly, then all these consequences if it is not treated. My question is: does treated syphilis (and the blood has long since recovered) also have consequences? If so, what are they?

What is Secondary syphilis

Secondary syphilis

- the stage of syphilis that occurs after the primary period of syphilis and is characterized by the generalized spread of the causative agent of syphilis (treponema pallidum) throughout the body.

With secondary syphilis, the infection spreads in the body through the lymphatic and blood vessels; accordingly, the secondary period of syphilis is characterized by a variety of clinical manifestations in the form of localized or diffuse lesions of the skin and mucous membranes (roseola, papules, pustules), generalized lymphadenopathy and lesions internal organs- i.e. where the localization of spirochetes occurred.

It begins 3-4 months after infection and can continue for several years, alternating with latent early syphilis - rashes are observed within several months, which spontaneously disappear and reappear after some time.

What causes secondary syphilis

This is a preventative treatment. It is prescribed to persons who had contact (sexual or domestic) with a patient with syphilis when there was a possibility of infection. Drugs, timing and doses of treatment are prescribed depending on the duration of contact. If no more than two weeks have passed since possible infection, one course of treatment with penicillin or ecmonovocillin is prescribed. With more long term(from 2 to 4 months) treatment is carried out as for primary syphilis with a negative Wasserman reaction (primary seronegative syphilis).

Of particular importance is the so-called preventive treatment of pregnant women who previously had syphilis and completed treatment before pregnancy. Treatment is prescribed to them with the aim of maximizing the guarantee of birth healthy child. Preventive treatment is also carried out for children born to mothers who previously had syphilis, even if these children are practically healthy, with negative serological reactions to syphilis.

ETIOLOGY, EPIDEMIOLOGY, PATHOGENESIS AND PATHANATOMY

The main route of infection with sexually transmitted diseases is sexual. However, syphilitic infection is also characterized by household transmission of the pathogen, transplacental, transfusion and extrasexual.

Infection with syphilis occurs only after direct contact with the pathogen - treponema pallidum or spirochete, which can be isolated with any secretion from an infected person.

To a greater extent, infection with treponema occurs during unprotected sexual intercourse, when a live pathogen enters through injured areas in the skin or mucous membranes of the genital organs, oral cavity, or any part of the body where there is at least a minimal defect in the integrity of the skin.

Stages of syphilis

The course of the disease is undulating and gradual. Specific signs of syphilis after the manifest course spontaneously disappear, and then reappear, changing their color.

The primary period of syphilis begins with the appearance of primary syphiloma (hard chancre) and lasts until the appearance of secondary syphilomas - on average 6 - 7 weeks.

The secondary period is characterized by the appearance of various rashes on the skin and mucous membranes, damage to internal organs, bones, joints and the central nervous system.

The active period lasts from several weeks to several months. Then the rashes disappear without a trace even without treatment.

The latent phase of the disease begins. It lasts from several weeks to several years.

The undulating course of the disease is the most important sign of early syphilis.

After 3-4 years from the moment of infection, tertiary syphilis (late syphilis) develops, which is characterized by the appearance of gummas - late syphilides (nodes), irreversibly destroying the organs and tissues in which they are located. The disease often ends in severe disability and even death of the patient.

After 10 to 20 years, the fourth period of syphilis develops. The central nervous system is affected - tabes dorsalis, progressive paralysis, or a combination thereof develops.

Rice. 4. Signs of secondary syphilis - papular syphilide (photo on the left) and syphilitic roseola (photo on the right).

If you have the slightest suspicion of the initial stage of syphilis, run to the doctor as soon as possible. If the symptoms go away, this does not mean recovery! Syphilis has only passed into a latent form.

When treating syphilis, complex therapy is required, including:

antibiotics;
probiotics (to maintain intestinal microflora);
vitamins;
immunomodulators.

The doctor prescribes penicillin antibiotics intramuscularly or in tablets. In case of severe intolerance to penicillins, treatment with macrolides or cephalosporin antibiotics is possible.

Tertiary syphilis requires hospitalization of the patient, while the latent form is treated, as a rule, on an outpatient basis.

Symptoms and signs of syphilis

All secondary syphilides may present as macular lesions, papules or pustules, or also as patches of treponemal alopecia.

Spotted syphilides, or roseola, are formations up to 10 mm in diameter, bright, pink or red, round with clear edges, which can be found on any part of the body.

Also, spotted red formations can be found on the oral mucosa or palatine arches, larynx. The latter is regarded by experts as syphilitic tonsillitis (secondary syphilis in the oral cavity).

These rashes without specific treatment are observed for up to one month, which then disappear without leaving any traces on the skin. Roseolas are characteristic feature secondary course of the disease and are determined in more than 75% of patients.

As the disease progresses, the rashes are replaced by papular syphilides, which in most cases are a sign of relapse of the disease and direct evidence that the person has developed secondary recurrent syphilis.

In the secondary course of treponemal infection, syphilides are usually distinguished into small lenticular, coin-shaped, weeping, extensive condylomas or psoriatic syphilides, depending on the characteristic features.

Such papules are distinguished not only by their darker color and shape, but also by their denser consistency and elevated location on the skin. Syphilitic papules also do not cause discomfort, do not hurt or itch.

Spontaneous disappearance is observed within several months.

Also, some patients experience skin manifestations in the form of pustular syphilides, which can present as acne-like or smallpox-like formations on the skin.

A distinctive feature of these rashes is that after inflammation, the superficial pustules fester and dry out with crusts on their surface after 5-7 days.

After resorption, there are practically no scars left on the skin from secondary syphilides.

Separately, we should also highlight the progressive alopecia in patients against the background of treponemal infection, which can be clearly localized or diffuse, when the hair on the scalp or other parts of the body noticeably thins.

Due to the diversity of symptoms and clinical course of the disease in modern venereology, doctors are actively introducing new diagnostic methods and mandatory examination of the population for the early detection of sexually transmitted diseases.

Considering the danger of the latent course of syphilis, it is important to know that only with timely access to experienced doctors and serological tests, treatment of secondary treponemal infection can be successful.

The beginning of secondary syphilis is considered to be the appearance of various specific rashes on the skin and mucous membranes. The elements are diverse, but it is possible to identify a pattern in the appearance of the rash and its general properties:

the rash spreads everywhere, secondary syphilis is characterized by dissemination of the process;
benign course: the rash gradually disappears without destruction of the skin and mucous membranes;
no increase in body temperature;
the rash appears on healthy skin and is clearly demarcated from it;
the elements are not accompanied by subjective sensations (itching, pain, paresthesia);
red shades of the rash (cherry, copper-red, cyanotic and others);
difference in the shape and size of the rash;
high contagiousness of erosive and ulcerative elements, that is, the ability to infect other people;
spontaneous disappearance of rash lesions;
positive serological reactions (Wassermann reaction).

The course of the disease is undulating; there are three periods of secondary syphilis: fresh (early), recurrent (relapse), and latent period. In the absence of treatment, the rash disappears in 2-10 weeks, and after a while it appears again. As the process progresses, subsequent waves of rashes have characteristic features:

the amount of rash decreases with each new episode;
an increase in the size of the elements with each relapse;
elements of the rash are grouped to form various shapes;
the rash is localized mainly in areas of friction and pressure.

Elements of secondary syphilis of the skin and mucous membranes are called secondary syphilides and are divided into groups: papular, macular (roseolous) and pustular. In addition, with secondary syphilis, pigmentation disturbances and hair loss are observed.

During the incubation period, there are no clinical signs of the disease; the primary signs of syphilis are characterized by chancre, the secondary ones (lasting 3-5 years) are spots on the skin.

The tertiary active stage of the disease is the most severe and, if not treated promptly, leads to death. The patient's bone tissue is destroyed, his nose collapses, and his limbs are deformed.

Primary signs

After several weeks from the moment of infection, the first symptoms of syphilis appear, which include signs:

The secondary period of syphilis begins with the generalization of the infectious process. Various rashes (secondary syphilides) appear on the skin and mucous membranes; internal organs, the nervous system, joints and bones are less commonly affected.

The duration of secondary syphilis is 3 - 4 years. Periods of a pronounced clinical picture are replaced by a hidden, latent course.

Each new relapse is characterized by fewer and fewer rashes, each of which is larger and less intensely colored. At the end of the second stage of syphilis, monorelapses occur, when the clinical picture is limited to a single element.

The patients' well-being suffers little.

Patients in the second period of the disease are the most contagious.

It should be noted that secondary syphilis can be of several varieties:

If left untreated, tertiary syphilis develops in 30% of people with secondary syphilis. Tertiary syphilis kills one fourth of those infected. It is extremely important to recognize the signs of syphilis in women and men at least at this stage.

Signs of tertiary syphilis:

In men, tertiary syphilis is diagnosed through the appearance of tubercles and gummas. The tubercles are quite small in size and quite a lot of them form on the body. Gummas are rare, quite large and located deep in the tissues. Inside these formations there is not such a large number of treponemes, so the risk of infecting another person is much lower than with secondary syphilis.
In the tertiary form, the first signs of syphilis in women are tubercles and gummas as in men. Both tubercles and gummas eventually turn into ulcers, which will leave scars after healing. These scars have a detrimental effect on the condition of organs and tissues, severely deforming them. Gradually, organ functions are impaired, which can ultimately lead to death. If syphilis infection occurred from a partner through sexual contact, then the rash will primarily be in the genital area (on the vagina, etc.).
In children, tertiary syphilis affects the skin, internal organs and nervous system with special tubercles - syphilides. Syphilides are formed due to the development of increased sensitivity of the child’s body to treponemes, which are contained in excess in the child’s body.

Tertiary syphilis can last for decades. The patient may suffer from the development of mental insanity, deafness, loss of vision, and paralysis of various internal organs. One of the most important signs of tertiary syphilis is significant changes in the patient’s psyche.

The classic first manifestations of the disease are the appearance of chancre (primary syphiloma) and enlarged lymph nodes.

A chancre is an ulcer or lesion of round or oval shape with clear edges. It is usually red (colors raw meat) and secretes serous fluid, which is why it takes on a “varnished appearance.”

Discharge of chancre during syphilis contains many pathogens of syphilis, and they can be detected there even during a period when a blood test does not show the presence of the pathogen in the body.

Asked by: Olga, Korea

Female gender

Age: Zhulev Oleg Evgenievich

Chronic diseases: not specified

Hello, dear Oleg Evgenievich! Previously, I had syphilis (I got it from my husband, we went through treatment together). I am now 43 years old, I was ill 20 years ago. As I remember, we went through the full treatment (afterwards, all family members themselves took tests). I don’t remember how long they were registered. In subsequent years, I sometimes donated blood both for RW and from a vein (for syphilis), everything was negative. I divorced my husband, and after 7 years I got married again (and before that I had regular sexual partners and nothing bothered me or them). In my second marriage, my husband and I lived for 13 years, and so it turned out that the beard grew gray, as they say, and my husband went on a business trip to the Philippines and apparently had a good time there. And as it turned out, he infected me with trichomonas vaginalis (infected me in May) and was treated with pills. And since it was another country, they didn’t even ask the doctor about the infection. And literally a month and a half later he went on a business trip again and returned in mid-July (I was close to him). And a week later he leaves me himself. And here a lot of suspicions arose. And I went to the doctor and started asking what I was treated for in May. I was shocked by my husband's gift. And then I started to panic (I had enough experience in my youth). I passed all the tests for AIDS, syphilis, hepatitis C and a bunch of vaginal tests (everything came out negative). It was September 1, 2016. And in November my head began to itch and there were a lot of small pimples that burst and itched terribly. I thought private clinic You never know what they missed and went to the state. Hospital. This is very good. Big honey Centor. I took this whole bunch of tests again and everything came out negative, but syphilis was confirmed. The interrogations began with the doctors' biases. I told them how it was when I was young. And I asked them if I had an immune memory test because of this and its advantages. They can’t really explain what analysis frightened them (they only said one thing: the pros are off the charts. So I couldn’t get them to tell me where the pros on which analysis are off the charts) There’s also a language barrier. They asked where my husband was (I said he ran away). They said let him take tests for comparison. Oleg Evgenievich (I'm afraid to call him). Yes, he was the first to infect me with Trichomonas. What if it’s an immune memory that I was sick that scared them so much (or he brought me a new syphilis in addition. Please tell Oleg Evgenievich whether a relapse of treated syphilis 20 years ago could have occurred. Or is it a new syphilis. Although a month has passed since his partying when I took the test and it came out negative. To be sure, I took it again after two months and it came out. In different clinics, the interval is two months and such different tests. Thank you very much in advance. I’m looking forward to the answer. Otherwise, it’s not even possible to ask in another country whom. Their doctors are generally like in the army. Briefly and clearly, there is syphilis, injections of oplpt and that’s all. But there is nothing to say for the soul to calm the patient down.

Definition of disease. Causes of the disease

Syphilis- a chronic infectious disease caused by Treponema pallidum, with a course in the form of active manifestations, alternating with latent periods, which is transmitted predominantly sexually and is characterized by specific systemic damage to the skin, mucous membranes, nervous system, internal organs and musculoskeletal system .

WHO data states that 18 million cases of syphilis infection were reported worldwide in 2012, with an incidence rate of 25.7 cases per 100,000 population. Syphilis was associated with 350,000 adverse pregnancy outcomes, including 143,000 stillbirths, 62,000 neonatal deaths, 44,000 premature babies, and 102,000 infected infants. In 2015 in Russian Federation 34,426 new cases of syphilis were registered, with an incidence rate of 23.5 per 100,000 population.

The cause of the disease is infection with Treponema pallidum, a small spiral-shaped microorganism that under natural conditions can exist and reproduce only in the human body. Treponema pallidum dies almost instantly in the external environment due to drying out, and is easily destroyed by boiling and exposure to antiseptics and ethyl alcohol. In addition to the typical spiral shape, it exists in the form of cysts and L-forms, into which it is reorganized to survive in an unfavorable environment.

The infection is transmitted sexually (including through oral and anal sexual contact), transplacentally, transfusionally, and rarely through household contact. Cases have been described in which bites, kisses, and vaginal-digital contact led to infection with syphilis. Children can become infected with syphilis through close household contact if adult family members have the disease. The contact and household method of infection also includes the professional one - infection with syphilis is predominantly medical personnel when performing diagnostic and therapeutic procedures.

Three conditions under which infection occurs:

There are two points of view on the contagiousness of syphilis. According to some authors, infection occurs in 100% of cases, according to others - only in 60-80%, which is facilitated by a number of factors: intact skin and the acidic pH of its surface, viscous vaginal and urethral mucus, competing microflora of the genital organs, phagocytosis and others local defense mechanisms of the body.

The contagiousness of syphilis depends on the stage of the disease: as a rule, the primary and secondary forms are especially contagious; latent syphilis can spread transplacentally and transfusionally.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of syphilis

Primary syphiloma (chancre)- a symptom of the primary period of syphilis, a sign of which is erosion or ulceration that occurs at the site of penetration of pale treponema into the skin or mucous membranes. The formation of a chancre begins with the appearance of a small red spot, which after a few days turns into a nodule with a crust, when rejected, a painless erosion or ulcer of an oval or round shape with clear boundaries is exposed.

Based on their size, chancre is classified into:

ordinary - 1-2 cm in diameter;
dwarf - from 1 to 3 mm;
giant - from 2 to 5 cm.

Most often, chancre is single, but with repeated sexual intercourse with an infected partner, multiple rashes may appear. Multiple chancres include “bipolar” chancre, in which ulcers occur simultaneously on different parts body, and “kissing” chancre on contacting surfaces.

In 90-95% of cases, the chancre is located in any area of the genital organs. The fact that it is often found at the base of the penis indicates that the condom is not fully effective in preventing syphilis. Very rarely, chancre can appear inside the urethra, in the vagina and on the cervix. An atypical form of chancre in the genital area is indurative edema in the form of extensive painless thickening of the foreskin and labia majora.

Outside the genital organs, chancres are most often found in the mouth area (lips, tongue, tonsils), less often in the area of the fingers (chancres-felons), mammary glands, pubis, and navel. Casuistic cases of the appearance of chancre in the area are described chest and century.

Vollmann's syphilitic balanitis- this is a clinical variant of hard chancre, the sign of which is spots with scales on the head of the penis, combustiform chancre - reminiscent of a superficial burn, herpetiform chancre - in the form of a group of point microerosions, hypertrophic - simulating skin carcinoma.

Syphilitic lymphadenopathy- enlarged lymph nodes - is a symptom of the primary and secondary periods of syphilis.

Syphilitic roseola (spotted syphilide)- a manifestation of the secondary, early congenital and, less commonly, tertiary periods of syphilis, occurring in 50-70% of patients.

Late roseola (erythema) of Fournier is a rare manifestation of tertiary syphilis, usually occurring 5-10 years after infection. Characterized by the appearance of large pink spots, often grouped into bizarre shapes. Unlike roseola, with secondary syphilis it peels off and leaves behind atrophic scars.

A symptom of secondary and early congenital syphilis, it appears with relapse of the disease in 12-34% of cases. It is a rash of isolated dense nodules (papules) of a hemispherical shape with a smooth surface from pink-red to copper or bluish in color. There is no itching or pain, but if you press on the center of the papule, patients note sharp pain (Jadassohn's symptom).

Condyloma lata- observed in 10% of patients. The warty surface of the papules, which almost always merge into large conglomerates, is weeping, eroded and often covered with a gray foul-smelling coating. There is severe pain during sexual intercourse and defecation. In rare cases, condylomas lata can be located under the armpit, under the mammary glands, in the folds between the toes, or in the recess of the navel.

Pustular syphilide most often found in patients who abuse alcohol and drugs, are infected with HIV, and have hemato-oncological diseases.

Syphilitic alopecia (baldness)-this characterizes untreated secondary and early congenital syphilis. Usually appears in 4-11% of cases a few weeks after the appearance of the primary rash (fresh roseola) and spontaneously regresses after 16-24 weeks.

Pigmentary syphilide- change in skin color - the manifestation of secondary syphilis in the first 6-12 months after infection. Clinically, it is an alternation of pigment and depigment spots (mesh form), and at first only hyperpigmentation of the skin is noted. Depigmented (white) round spots with a diameter of 10-15 mm in the neck area (spotted form) are traditionally called the “necklace of Venus”, and in the forehead area - the “crown of Venus”. Without treatment, the rash spontaneously regresses within 2-3 months. More rare is the “marble” or “lace” form.

Syphilitic sore throat- a symptom of secondary syphilis, a sign of which is the appearance of roseola and (or) papules on the mucous membrane of the mouth, pharynx, and soft palate. If the papules are localized on the vocal cords, a characteristic “hoarse” voice appears. Sometimes syphilitic tonsillitis is the only clinical manifestation of the disease, and then it is dangerous in terms of the possibility of sexual (during oral sex) and domestic infection due to the high content of treponemes in the elements of the rash.

Syphilitic onychia and paronychia occur at all stages and with early congenital syphilis.

Tuberous syphilide (tertiary papule)- the main symptom of the tertiary period of syphilis, which can appear 1-2 years after infection. But as a rule, it occurs after 3-20 years. It is characterized by the appearance of isolated brownish-red seals up to 5-10 mm in size, which rise above the skin level and have a smooth and shiny surface. The outcome of the existence of a tubercle is always the formation of a scar.

Syphilitic gumma (gummy syphilide) characterizes the tertiary period and late congenital syphilis. In this case, a mobile, painless, often single node with a diameter of 2 to 5 cm appears in the subcutaneous tissue. Gummas can occur in muscle and bone tissue, and on internal organs. Most often they are localized in the mouth, nose, pharynx and pharynx, resulting in perforation of the hard palate with food entering the nasal cavity and a “nasal” voice, deformation of the cartilaginous and bone parts of the nasal septum with the formation of a “saddle” and “lornette” nose.

Symptoms of neurosyphilis:

Symptoms from internal organs (visceral syphilis) observed in patients with visceral syphilis and depend on the localization of the process. Yellowness of the skin and sclera occurs with syphilitic hepatitis; vomiting, nausea, weight loss - with “gastrosyphilis”; pain in muscles (myalgia), joints (arthralgia), bones - with syphilitic hydrarthrosis and osteoperiostitis; cough with sputum - with syphilitic bronchopneumonia; pain in the heart - with syphilitic aortitis (mesaortitis). Characteristic is the so-called “syphilitic crisis” - paroxysmal pain in the area of the affected organs.

Symptoms of early congenital syphilis:

syphilitic pemphigus;
syphilitic rhinitis;
diffuse papular infiltration;
osteochondritis of long bones;
Parrot's pseudoparalysis is a symptom of early congenital syphilis, in which there is no movement of the limbs, but nerve conduction is preserved;
Sisto's symptom - the constant cry of a child - is a sign of developing meningitis.

Symptoms of late congenital syphilis:

Parenchymal keratitis is characterized by clouding of the cornea of both eyes and is observed in half of the patients;
Clutton's joint (syphilitic drive) - bilateral hydrarthrosis in the form of redness, swelling and enlargement of the joints, most often the knees;
The buttock-shaped skull is characterized by enlargement and protrusion of the frontal and parietal tubercles, which are separated by a longitudinal depression;
Olympic forehead - an unnaturally convex and high forehead;
Ausitidian symptom - thickening of the sternal end of the right clavicle;
Dubois's sign - shortened (infantile) little finger;
Saber shin is a characteristic symptom of late congenital syphilis in the form of an anterior bend of the tibia, resembling a saber;
Hutchinson's teeth - dystrophy of the permanent upper middle incisors in the form of a screwdriver or barrel with a semilunar notch on the free edge;
Gaucher diastema - widely spaced upper incisors;
Corabelli's cusp is the fifth additional cusp on the chewing surface of the first upper molar.

Pathogenesis of syphilis

The introduction of Treponema pallidum occurs in damaged areas of human skin and mucous membranes. With the help of the adhesin protein, T. pallidum, interacting with fibronectin and other cellular receptors, “sticks” to various types host cells and migrates throughout the body through the lymphatic system and blood. Penetration into tissue is facilitated by treponema induction of the formation of matrix metalloproteinase-1 (MMP-1), which is involved in the destruction of collagen, as well as its spiral shape and high mobility. Fixed in lesions, treponemas cause endarteritis of blood vessels with the participation of lymphocytes and plasma cells, which during the development of the disease are replaced by fibroblasts, causing scarring and fibrosis. The antigenic structure of treponemes consists of protein, polysaccharide and lipid antigens. The body's response to the introduction of a pathogen is realized by cellular and humoral systems. Macrophages participate in the implementation of the cellular response, carrying out phagocytosis of spirochetes, T-lymphocytes - directly destroying the pathogen and promoting the production of antibodies, and B-lymphocytes, responsible for the production of antibodies. During the development of infection, fluoresceins (IgA) are first produced, then antibodies to protein antigens, then reagins (IgM), and as the disease progresses, immobilins (IgG) are produced. Important feature is the ability of Treponema pallidum, due to its unusual molecular architectonics, to “evade” the humoral and cellular immune response.

After the introduction of the spirochete, a latent (incubation period) begins - the period of time between the primary infection and the appearance of the first clinical symptoms, lasting from 9 to 90 days (on average 21 days). The lengthening of the incubation period, first of all, is facilitated by taking antibiotics in doses that are insufficient for cure.

In 90-95% of cases, at the end of the incubation period, a primary focus - syphilitic chancre - appears at the site of treponeme penetration. In 5-10% of cases, the disease initially occurs latently - without its formation (decapitated syphilis). After 7-10 days of chancre appearance, regional lymph nodes begin to enlarge. After 1-5 weeks, the chancre spontaneously regresses. The interval between the appearance of chancre and its disappearance is usually called the primary period of syphilis.

1-5 weeks after the formation of the primary chancre, due to the spread of treponemas throughout the body, a skin rash appears, which lasts for 2-6 weeks, after which it spontaneously disappears. Through certain time the rash may recur. This wave-like course of syphilis is associated with the activation of treponemas or the inhibition of their reproduction due to the body’s immune response. The interval between the first appearance of the rash and the appearance of tertiary syphilides is usually called the secondary period of syphilis, and the intervals between relapses are called the latent period of syphilis. Secondary syphilis with relapses is observed in 25% of patients.

It should be noted that in a sufficient number of cases, syphilis may initially exist in a latent form, transition into it after the primary period or after the first episode of secondary syphilis, and then proceed asymptomatically. In such cases, a distinction is made between early latent syphilis with a disease duration of less than two years and late latent syphilis with a disease duration of more than two years after infection. Secondary and latent syphilis can last for several years and even decades.

Approximately 15% of patients with untreated syphilis develop a skin rash in the form of tubercular or gummous syphilis 1-45 years after infection, which indicates the transition of the disease to the tertiary period. As with secondary syphilis, the rash can disappear and recur.

Neurosyphilis

In 25-60% of cases, the nervous system is affected already with primary and secondary syphilis. Neurosyphilis detected in the first 5 years after the onset of the disease is called early. In 5% of cases it occurs with symptoms - damage to the cranial nerves, meningitis, meningovascular disease, in 95% of cases no symptoms are observed. Neurosyphilis detected after 5 years after the onset of the disease is called late. In 2-5% of patients it occurs in the form of progressive paralysis, in 2-9% - in the form of tabes.

Visceral syphilis

With early visceral syphilis (up to 2 years from the moment of infection), only functional disorders develop, and with late visceral syphilis (over 2 years) - destructive changes in internal organs, bones and joints. In 10% of patients with late visceral syphilis, 20-30 years after infection, cardiovascular syphilis develops, which is the main cause of death from this disease.

Congenital syphilis

It occurs as a result of infection of the fetus through the umbilical vein and lymph nodes of the umbilical cord from a sick mother. Infection is possible as early as 10-12 weeks of pregnancy. It can occur latently or with clinical manifestations.

Classification and stages of development of syphilis

The International Classification of Diseases, 10th revision, divides syphilis into:

1. Early congenital syphilis:

early congenital syphilis with symptoms
early congenital latent syphilis;
early congenital syphilis, unspecified;

2. Late congenital syphilis:

late congenital syphilitic eye damage;
late congenital neurosyphilis (juvenile neurosyphilis);
other forms of late congenital syphilis with symptoms;
late congenital syphilis latent;
late congenital syphilis, unspecified;

3. Congenital syphilis, unspecified;

4. Early syphilis:

primary genital syphilis;
primary syphilis of the anal area;
primary syphilis of other localizations;
secondary syphilis of the skin and mucous membranes;
other forms of secondary syphilis;
early latent syphilis;
early syphilis, unspecified;

5. Late syphilis:

syphilis of the cardiovascular system;
neurosyphilis with symptoms;
asymptomatic neurosyphilis;
neurosyphilis, unspecified;
gumma (syphilitic);
other symptoms of late syphilis;
late or tertiary syphilis;
late latent syphilis;
late syphilis, unspecified;

6. Other and unspecified forms of syphilis:

latent syphilis, unspecified as early or late;
positive serological reaction to syphilis;
syphilis unspecified.

Complications of syphilis

The following complications are distinguished: primary syphilis:

At secondary syphilis complications may occur in the form of nodular syphilis, manifested by multiple nodes, and malignant syphilis, which most often occurs in HIV infection and is characterized by multiple pustules, ecthymas and rupees.

A serious complication of syphilis is abortion- in 25% of pregnant women there is fetal death, in 30% of cases there is death of newborns after childbirth.

HIV infection- Patients with syphilis are several times more likely to become infected with HIV.

Death from syphilis occurs due to damage to internal organs. The most common cause is aortic rupture due to syphilitic aortitis.

Diagnosis of syphilis

To diagnose syphilis, microscopic, molecular, immunohistochemical, serological and instrumental methods are used.

Material for research:

discharge from erosions, ulcers, eroded papules, blisters;
lymph obtained by puncture of lymph nodes;
blood serum;
cerebrospinal fluid (CSF), obtained by puncture of the spinal cord;
tissues of the placenta and umbilical cord.

Indications for examination:

Microscopic methods used to diagnose early forms and congenital syphilis with clinical manifestations. Two methods are used:

Research in dark field identifies living treponema in the discharge from erosions and ulcers and differentiates it from other treponemes.
Morozov's silvering method allows identifying treponema in tissue biopsies and lymph.

Molecular methods are based on identifying specific DNA and RNA of the pathogen using molecular biological methods (PCR, NASBA) using test systems approved for medical use in the Russian Federation.

Serological diagnostic methods are aimed at identifying antibodies produced by the body to Treponema pallidum antigens (non-treponemal and treponemal tests).

False-positive serological reactions for syphilis- positive results of serological reactions in persons who are not sick and have not previously had syphilis.

Acute false-positive reactions are observed up to 6 months and are associated with pregnancy, vaccination, infectious diseases, menstruation, some dermatoses, endemic treponematoses, Lyme disease.
Chronic ones are observed for more than 6 months and are most often associated with cancer, autoimmune diseases, diseases of the liver, lungs, cardiovascular and endocrine systems. They can also be observed in drug addiction and in old age.

False-negative serological tests for syphilis observed in secondary syphilis due to the “prozone phenomenon” and in persons with severe immunodeficiency and certain infections (HIV, tuberculosis).

Clinical assessment of serological reactions

To diagnose syphilis, a complex of serological reactions is used, which must include one non-treponemal test (usually RMP) and two confirmatory treponemal tests (in Russia, most often these are ELISA and RPGA). Based on the presence of a combination of positivity of these three tests, a diagnosis is made or rejected.

Cerebrospinal fluid examination is carried out to diagnose neurosyphilis and is indicated:

patients with syphilis with clinical neurological symptoms;
persons with latent and late forms of infection;
patients with secondary recurrent syphilis;
if congenital syphilis is suspected in children;
in the absence of negative non-treponemal serological tests after complete specific treatment.

The diagnosis of neurosyphilis is considered confirmed if the patient has syphilis, proven by serological tests, regardless of its stage, and a positive result of RMP with cerebrospinal fluid.

Seroresistance considered the absence of negativity or decrease in titers of non-treponemal tests within a year in persons who have received adequate treatment for primary or secondary syphilis, and for 2 years in persons who have received adequate treatment for latent early syphilis.

Treatment of syphilis

Benzylpenicillin and its derivatives are used in the treatment of syphilis. If intolerance to the drug is detected, alternatives are prescribed: semisynthetic penicillins (ampicillin, oxacillin), erythromycin, doxycycline and ceftriaxone

One of the most dangerous diseases from the group of STIs is syphilis. There are tens of thousands of patients in the world, most of whom are young people under the age of 40. Due to the easy transmission of the pathogen in various ways and the development of dangerous complications (paralysis, tabes dorsalis), this problem is very relevant.

Definition and types of disease

Syphilis is an infectious, slowly progressing venereal disease caused by Treponema pallidum.

Infecting sexual partners entails criminal liability. This disease mainly affects the sexually active part of the population. This is due to unprotected sexual intercourse.

The following types of syphilis are known:

primary;
tertiary;
early, latent and late neurosyphilis;
congenital.

The peculiarity of the disease is that it can last for decades, slowly destroying tissue. With this pathology, the process involves skin, mucous membranes, lymphatic, nervous systems, as well as many organs.

Risk factors for developing the disease

Syphilis in women and men occurs after Treponema pallidum enters the body. All people are highly susceptible to this infection. The main mechanisms of disease transmission are:

contact;
blood-contact;
artificial;
vertical.

Treponema is transmitted through sexual, transfusion, injection and indirect household routes. In 95–98% of cases, infection occurs during unprotected sex. The pathogen may be present in various biological secretions. Transmission factors for treponemas include seminal fluid, blood, sputum, saliva, hands, syringes, razors, medical instruments and wet household items.

Risk factors for developing the disease are:

The causative agent of the disease is Treponema pallidum. These are small spiral-shaped microorganisms. Treponema can survive for several days on damp objects and at low ambient temperatures. These microorganisms are sensitive to high temperatures, acids, alkalis and disinfectants. Many modern antibiotics do not act on Treponema.

First stage of the disease

At the early stage of syphilis, signs are poorly expressed. Asymptomatic (varies from 8 to 100 days. Most often, the first complaints appear 3–4 weeks after infection. The main ones are chancre and enlarged lymph nodes.

A typical chancre is most often localized in the genital area. In women, the process involves the labia, cervix and vagina, and in men, the glans penis and foreskin. Often chancre occurs on the mucous membrane oral cavity, in the abdomen and anus. Primary syphiloma is represented by a round red erosion. Classic chancre is painless and is about 1 cm in diameter.

This formation has raised edges and a saucer-shaped shape. In most patients, chancre is solitary. Weak people may have several erosions. A feature of chancre is the presence of a seal at the base. After 3-4 weeks it disappears, leaving no scars.

Atypical forms of syphiloma can occur in men and women. Sometimes indurative edema appears. It is localized in the area lower lip, foreskin or . This is a seal Pink colour. In some cases, chancre-amygdalitis appears with syphilis. The amygdala is involved in the process. The defeat is one-sided. At this state fever, sore throat and general malaise appear.

Atypical forms of primary syphilis include chancre-felon. It causes the nail bed to become inflamed. The person's finger swells, turns blue and becomes painful. Healing is slow. This venereal disease at an early stage leads to an increase in regional lymph nodes. They become dense, but there is no pain or inflammation.

Second period of the disease

Following primary syphilis, secondary syphilis develops. It lasts for 3–5 years and appears 3 months after infection. At the very beginning of primary syphilis, malaise, muscle and joint pain, headache and fever are possible. The main symptom of this period is a polymorphic rash.

A hard chancre may persist for some time, which gradually disappears. Following this, secondary syphilides appear. They are roseolous, papular, miliary, seborrheic, pigmented and pustular. Roseola occurs most often on the body. These are pale pink spots, which are localized mainly on the lateral surfaces of the body.

The elements of the rash do not exceed 1 cm in diameter. The process involves the limbs and torso. The rashes appear within a week in small groups of 10–12 pieces. When you press on the skin, the stain disappears. Some patients have specific roseola (raising and scaly).

The disease may manifest as papular exanthema. Papules are nodules that rise above the skin. They rarely exceed 5 mm in diameter. Typical sign rashes with secondary syphilis are peeling papules along the periphery. These rashes disappear, leaving behind areas of hyperpigmentation. In some cases, coin-shaped, oozing, psoriasiform and seborrheic papular syphilides are detected.

Regardless of the route of transmission of the pathogen, round white spots may appear on the human body. Most often they are localized on the neck. Much less often with secondary syphilis, pustules (pustules) form. These are inflammatory elements of the rash containing pus. They leave behind ulcers and scars.

Along with the skin, secondary syphilis affects the mucous membranes and internal organs. Pharyngitis, lymphadenitis, alopecia (baldness), meningitis, gastritis and dyskinesia develop. Patients become irritable. Already during this period, the central nervous system may be affected. This indicates the development of neurosyphilis.

Third stage of the disease

You need to know not only the causes of the disease, but also how it manifests itself. Today it is becoming less and less common due to early diagnosis and mass population surveys. Often this pathology develops in people who have completed an incomplete course of therapy. Patients often die from complications at this stage.

The main symptoms of syphilis are gummas and tubercles. They appear on the skin and mucous membranes 4–10 years after infection. Tuberous syphilides are infiltrative nodules up to 7 mm in size. They rise above the skin. The tubercles are located chaotically and do not merge with each other. Tertiary syphilides disappear over time.

In their place, smooth ulcers with a clean bottom are formed. Healing occurs over several months. Ulcers, areas of hyperpigmentation and atrophy remain on the skin. Instead of tubercles, gummas may appear in tertiary syphilis. These are painless nodules located deep under the skin. In the early stages of tertiary syphilis, these formations are mobile, but soon they grow together with the tissues. A hole is formed through which liquid is released.

Tertiary syphilides form not only on the skin, but also on the mucous membranes. If the nose is affected, rhinitis and difficulty breathing are observed. Possible deformation of the back due to damage to the cartilage tissue. If the tongue is damaged, glossitis develops. This makes it difficult for the patient to chew and speak. Along with these changes, the function of organs and systems is disrupted.

Manifestations of neurosyphilis

Syphilis is dangerous because at any stage it can cause damage to the nervous system. This occurs when treponemes penetrate the brain and spinal cord. There are early, latent and late neurosyphilis. In the first case, symptoms of central nervous system damage appear at stages 1 or 2 of the disease.

The process involves blood vessels and membranes of the brain. Meningitis or meningomyelitis develops (combined damage to the spinal and spinal column). Signs of meningitis:

nausea;
headache;
vomit;
dizziness;
noise in ears;
positive Kernig and Brudzinski symptoms;
stiffness of the neck muscles.

A change in a person’s personal qualities in combination with sleep disturbances, dizziness and headaches indicates damage to the blood vessels of the brain. If the patient is not treated in a timely manner, it develops. This is a type of late neurosyphilis that affects the dorsal cords and roots of the spinal cord.

The following symptoms are observed with tabes dorsalis:

If the disease is 10–20 years old, progressive paralysis may develop. It is characterized by personality changes, memory impairment, decreased intelligence, delusions, hallucinations, dysarthria, limb tremors and epileptic seizures. Dementia often develops.

Congenital form of the disease

You need to know not only what syphilis is, but also whether it is dangerous for the unborn child. Often women become infected before conceiving a baby, unaware of the disease. Syphilis can cause miscarriage in early gestation or fetal death in the 3rd trimester. This is due to the possibility of penetration of the infectious agent through the placenta.

There are early and late fetal syphilis. The early form occurs in a child in the first 2 years after birth. Such children often develop syphilitic pemphigus. The main signs of early congenital syphilis are:

tearfulness;
deformation of the skull bones;
gray skin color;
exhaustion;
runny nose with mucous discharge;
nasal deformity;
difficulty in nasal breathing;
the presence of a dense infiltrate on the chin, lips, palms, feet or buttocks;
bleeding and swelling of the lips;
decreased skin elasticity.

Develops in children over 2 years of age. Specific signs of this pathology are tubercular or gummous syphilides, eye damage such as keratitis, deformation of the lower extremities, changes in the upper incisors and damage to the labyrinth in the ear cavity.

Negative consequences of the disease

Complications with this pathology are very common. In the absence of proper treatment, the following consequences of syphilis are possible:

Some patients become disabled. The greatest danger to humans is tertiary and late neurosyphilis. The use of antibiotics in this case does not always achieve a complete cure. With tertiary syphilis, death in the absence of treatment is observed in 25% of cases.

The congenital form of infection is no less dangerous. Negative consequences early syphilis in children are myocarditis, glomerulonephritis, hepatitis, inflammation of the inner layer of the heart with valves, orchitis, hydrocele, hydrocephalus, meningoencephalitis, interstitial pneumonia and damage to tubular bones.

Patient examination plan

To clarify the diagnosis, the following studies will be needed:

Blood and syphilide discharge are used as biological material for analysis. Serodiagnosis is very informative. During the reactions, specific antibodies to the infectious agent are detected in the blood. They appear at the end of the incubation period. In the early stages of primary syphilis, the results may be negative.

If syphilis is suspected, an anamnesis must be taken and a physical and visual examination performed. The doctor must determine the possible mechanism and routes of transmission of the infection. In case of complications from internal organs, tomography, ultrasound, electrocardiography, angiography and radiography are performed. Consultation with an ophthalmologist, neurologist, cardiologist, pulmonologist and gastroenterologist may be required.

Treatment methods

Treatment of syphilis is predominantly drug-based. If Treponema pallidum is detected in the body, systemic antibiotics from the penicillin group (Bicillin-3, Bicillin-5, Benzylpenicillin sodium salt, Penicillin G) are prescribed. The dosage and duration of therapy are determined by the attending physician. Only those drugs that do not have a teratogenic (embryotoxic) effect are used.

In case of intolerance to penicillins with macrolides or tetracyclines. The latter cannot be used while carrying a baby. For secondary syphilis, symptomatic therapy is additionally carried out. If the temperature is very high, then antipyretics are prescribed. For trophic disorders, products that improve the condition of the skin and its appendages are indicated.

For late (tertiary) syphilis, the treatment regimen includes immunomodulators, bismuth and iodine preparations. Etiotropic (antibacterial) therapy is carried out in two courses.

In case of liver damage, hepatoprotectors are prescribed. During treatment, sexual intercourse and the use of antibiotics are excluded.

Forecast and preventive measures

You need to know not only which doctor treats syphilis, but also what the prognosis for this disease is. At stages 1 and 2 it is favorable. With late syphilis, the prognosis is worsened due to damage to vital organs. Not everyone knows how many years you can live with this diagnosis. This disease develops slowly. If left untreated, it can drag on for 10 years or more.

There is no specific prevention of syphilis. To reduce the risk of infection, you need to:

refrain from unprotected and casual sex;
drink vitamins;
exercise;
do not contact sick people;
be examined periodically;
do not use other people's towels, washcloths and razors;
give up tattoos.

Important aspects of prevention are blood quarantine, examination of donors and people at risk. Thus, infection with Treponema pallidum is not a death sentence. These microbes are sensitive to penicillins.