Symptoms and signs of syphilis. What is syphilis, how is the disease transmitted and manifested? Is it possible for the disease to recur?

Syphilis can be latent for a long time. In order to prevent the transmission of the disease, it is worth knowing how syphilis manifests itself, the features of its course, symptoms and treatment rules. Venereal diseases are dangerous pathologies which can lead to serious health complications. The fact is that many of them are not accompanied by symptoms at the initial stage, for this reason the disease can simply not be noticed, and at this time it gradually affects the internal organs. One such disease is syphilis. It can appear in women and men.

• The reasons
• Symptoms
• Rash with syphilis
• Forms
  • Primary
  • Secondary
  • Tertiary
• Diagnostics
• Features of treatment
• Prevention

The reasons

The development of syphilis can occur for various reasons, but sexual contact is considered the most important. Often, infection occurs during sex with an infected sexual partner. The causative agent of the disease - pale treponema, penetrates through the mucous membrane and damaged skin.

In the future, the bacteria quickly enter the structure of the lymph nodes, where they instantly multiply and, together with the blood flow, spread throughout the body. As a result, they settle in the internal organs, bones, joints and in the central nervous system.

The manifestation of syphilis can provoke other reasons:

• it can manifest itself in a woman and a man after using contaminated personal hygiene items - shower and bath products, towels, linen, brushes, washcloths, dishes with saliva particles;
• the risk of infection is increased during professional contacts. This disease can be picked up while working in the laboratory, in hospitals. Especially often, infection occurs with careless handling of medical instruments, cutting and stabbing objects, which can damage the skin of hands, fingers and come into contact with the dangerous microflora of the virus.

The disease is especially dangerous during pregnancy and for women who are planning childbirth. The fact is that an infection in the body (treponema pale) can develop for a long time without signs, at which time it can have Negative influence for the development of the unborn child.

Symptoms

The main danger of syphilis is that at the initial stage this disease does not manifest itself in any way and is not accompanied by symptoms. For this reason, many simply do not notice the presence of a pathological process, and in the meantime, the infection spreads to internal organs, systems, and bone tissue.

The incubation period of the disease is on average 2 to 6 weeks. However, sometimes it may not develop for years, this may be when taking antibiotic drugs, during the treatment of infectious colds. During this period, laboratory tests will not be able to give a reliable result.

Syphilis manifests itself as internal and superficial lesions. Common symptoms include the following conditions:

• hard chancre and enlarged lymph nodes - these symptoms are the most important. It is they who 100% confirm that the pathogen has entered the body. A hard chancre is a smooth, painless ulcer, a dense infiltrate. The formation has rounded slightly raised edges with a diameter of about 1 centimeter. Accompanied by a bluish-red color, may have pain. Within a week after the onset of chancre, an increase in lymph nodes is observed;
• headaches, symptoms of general malaise are observed;
• pain in the muscles and joints;
• temperature rise;
• reduced hemoglobin level;
• increase in leukocytes in the blood;
• induration edema may form;
• felon. Accompanied by inflammation of the nail bed. The condition may last for several weeks;
• amygdalitis may be present. During it, there is swelling of the reddened tonsils, difficulty in swallowing.

It is important to remember that syphilis infection can occur through any form of sexual intercourse. Therefore, oral sex, during which condoms are rarely used, is especially dangerous when infected.

So primary syphiloma is formed at the site of the introduction of pale treponema, with oral infection, the chancre will be located in the mouth or throat. Moreover, if a partner has a chancre in the oral cavity, you can get infected without sex, just through a kiss.

If the infection occurred during anal intercourse, the chancre is localized in the anus. At the same time, it often looks atypical, and, in shape, is not round, but slit-like.

For the penetration of infection, contact of the pathogen with the mucous membranes is not always necessary. The skin can also become an entrance gate for infection, especially if it is damaged. Hard chancre in such situations is often localized on the skin of the thighs, face or abdomen.

Rash with syphilis

Approximately 3-4 weeks after the incubation period, skin rashes may be observed. They are not accompanied by a sensation of itching, pain. Skin manifestations of syphilis have a dark red color, have a dense texture, straight edges without peeling.

The rash can be of different types:

1. Roseolous. During this type of rash, small patches of oval or round shape(about one and a half cm). They are located on the entire surface of the body, arms, legs. Their borders are not pronounced, do not blur and do not rise above the skin;
2. Papular. Round formations with a pale pink color. The size of the rashes is 1 centimeter. The surface is smooth, there are small peelings. The main locations are the area of ​​the soles of the feet, on the palms, on the surface of the mucous membranes of the genitals. Sometimes there is a pale rash all over the body;
3. Condylomas. These are connected papules that have ulcers;
4. Leucoderma. This condition is characterized by the appearance of white spots against the background of darkening of the skin. Over time, they acquire a brown-yellow color. Localized rashes on the neck, armpits, chest, arms;
5. Angina of an arthematous type. Eruptions appear on the area of ​​the oral mucosa, near the pharynx, on the surface of the hard palate. The pale treponema bacteria themselves are located inside the cavity of the papules;
6. Alopecia. On the surface of the scalp is formed a large number of rashes with a diameter of 1-2 mm. Over time, hair loss occurs in these places.

In order to understand how the varieties of the rash can manifest themselves and how they look, it is worth viewing the photo.

Forms

Syphilis can occur in several forms, and each of them can have distinctive features. For this reason, it is worth more carefully studying the manifestations of each.

Primary

The primary form is early latent syphilis. It usually occurs a few weeks after infection.

Patients with primary syphilis do not immediately notice its manifestations. For this reason, the disease can go to the internal organs, tissues, systems and cause serious health complications.

During the initial form of syphilis, symptoms appear:

• the appearance of specific ulcers with rounded shapes, which are also called chancres;
• after about 2 weeks, the chancres completely disappear. This means that pathogenic bacteria have entered the body;
• damage to the lymph nodes is manifested, and their increase is also observed;
• the primary form affects the internal organs and systems.

Secondary

At 11 weeks of infection, symptoms of secondary syphilis appear. This form is accompanied by the appearance of syphilitic infectious lesions in the form of spots, rashes, abscesses, nodes on the skin.

Formations do not have pain, discomfort. If timely treatment is not carried out, then they completely disappear over time. This means that the disease goes into a latent form. Over time, secondary syphilis may reappear, during which all characteristic signs may reappear.

The secondary stage can take up to 4 years. At the same time, it is accompanied by serious health complications.

Tertiary

Approximately 5 years after the secondary stage, the disease passes into the tertiary. It is considered the most severe, during which the following complications may occur:

• severe damage to internal organs;
• the appearance of foci (threshing floor) on the skin;
• foci can be observed on the mucous membranes and internal organs - on the heart, liver, lungs, brain. They also affect bones and eyes;
• often the disease affects the mucous layer of the nose. Lesions lead to the complete destruction of the nasal septum;
• at this stage dementia, progressive paralysis is manifested.

Diagnostics

Diagnosis should be carried out immediately, as the first symptoms of syphilis appeared. Of course, this ailment can proceed in a latent form for a long time, but still, if you start treating it at the initial stage, you can quickly eliminate all its unpleasant manifestations.

It is also worth starting an examination if you have recently had sexual contact with a carrier of the disease. In these cases, infection is most likely to be confirmed. And in order to get the most accurate results in laboratories, blood tests are carried out, which is taken from a vein.

Modern serological and immunological examinations of blood make it possible to identify the disease with maximum accuracy within a few weeks from the time of infection. The test allows you to identify the disease with an accuracy of 99.8-100%.

There are many types of tests that can detect the presence of a pathogen in the body. However, serological tests are usually diagnostic criteria for syphilis.

The principle of serological reactions is to detect antibodies to pale treponema in the blood. At the same time, if little time has passed since the moment of infection, the body may not yet have time to develop antibodies. Such syphilis is called primary seronegative and presents difficulties in diagnosis. In this case, in the presence of a hard chancre, a preliminary diagnosis is made on the basis of the clinical picture and interview data. In the future, the patient is required to retake tests to confirm the infection.

At the stage of tertiary syphilis, the body's immune response may be low. At the same time, standard research methods do not detect the presence of antibodies in the blood. This happens in about a third of cases of tertiary syphilis. Additional tests are required to establish an accurate and definitive diagnosis in this situation.

Types of studies for the diagnosis of syphilis

Diagnosis may require following studies blood:

• RPR and MP;
• Linked immunosorbent assay;
• Immunofluorescence reaction;
• Reaction of an immobilization of pale treponemas;
• The reaction of passive hemagglutination.

The previously popular classical Wasserman reaction is not used today due to its low efficiency in comparison with RPR. In the old fashioned way, this test may continue to be called the RW.

Tests are divided into non-treponemal (RPR and microprecipitation reaction) and treponemal (RIF, RIBT, RPHA, ELISA).

Non-treponemal, that is, not determining the presence of the pathogen itself, are cheaper than treponemal. However, such tests are less effective and, if positive, require additional testing. Consider the principles of each of the analyzes and the degree of their effectiveness for diagnosis.

RPR- screening research method. It is used to diagnose early asymptomatic forms of the disease. It is this study that is used in preventive tests.

RPR is not accurate enough to make a definitive diagnosis.

A positive RPR is not diagnostic and requires additional testing. In some cases, such an analysis can give false positive results:

• Diabetes;
• Tuberculosis;
• Malignant neoplasms;
• Alcohol and drug abuse;
• Viral hepatitis;
• Acute inflammatory diseases;
• recent vaccination;
• Pregnancy.

Eating fatty foods and alcohol before testing can also cause a false positive result.

ELISA- the most accurate analysis for seropositive forms of syphilis. It detects the presence of antibodies, which is a clear criterion for making a diagnosis.

REEF, or an immunofluorescence reaction detects the presence of pale treponemas themselves in the blood. This is a complex and expensive analysis, so it is used only when there is a clear indication. For example, with severe symptoms with negative RPR and ELISA.

RIBT- Another complex study that most accurately determines the presence of infection. With it, the blood is examined under a microscope for the presence of pathogens, which are previously immobilized with special antibodies.

RIBT is highly effective in syphilis. Apply it even if other tests did not give a positive result.

RPGA- an accurate treponemal test, quite often used to diagnose the disease. When it is carried out, sheep erythrocytes, processed in a special way, are introduced into the serum. Red blood cells stick together and settle to the bottom with a positive result.

Features of treatment

Syphilis that appears on the skin is usually treated with penicillin-based drugs. Treponema pale, unlike other bacteria, has not lost its sensitivity to this substance, for this reason penicillin and its derivatives are prescribed to treat this disease.

Treatment features:

• if the skin has ulcers with a hard frame, then penicillin preparations are prescribed. Daily injections;
• Injections are made immediately in two buttocks. First, injections of Penicillin are given, and then Bicillin-3;
• the use of antihistamines is additionally prescribed;
• in the primary form, injections are given within 16 days;
• during the secondary form, injections of water-soluble Penicillin or Doxycycline are prescribed, and Ceftriaxone is also recommended;
• in the secondary form, injections are made for 32 days, while antibiotics are taken.
• the tertiary form is treated with injections of Penicillin with Bioquinol. The course is long, it is set by the doctor.

Therapy of syphilis requires mandatory control.

The effectiveness of antibiotics is checked using ELISA - the criterion is a decrease in antibody titers to pale treponema.

If the titer does not decrease, this means that the antibiotic is ineffective against this strain of the pathogen. In this case, the attending physician changes the drug and treatment regimen.

After the end of the course of therapy, the patient retakes tests to confirm the absence of infection. Sometimes there are cases of so-called seroresistant syphilis. This is a form of the disease in which, against the background of a complete cure, serological tests remain positive. Such cases require special attention to the level of titers: if they are reduced by less than four times, additional treatment is required.

If, after six months of therapy, the tests show an infection, but the titer of reagins is reduced by four times or more, they speak of a slowdown in seroreactions. These patients are followed up for another six months.

At the discretion of the doctor, restorative treatment may be recommended. Generally complementary therapy with true or relative seroresistance, it can last from six months to one and a half years. In addition, such patients are consulted by an immunologist - seroresistant syphilis may be the result of pathologies of the immune system.

Prevention

Be sure to follow the prevention, which will help protect against this dangerous disease. This also applies to women who plan to have children, a successful pregnancy and childbirth depends on this. Otherwise, in the future we should expect congenital syphilis in children, which can cause serious harm to a fragile children's body.

The following preventive measures must be observed:

• personal hygiene;
• protected sexual intercourse, the use of barrier contraception (condoms);
• do not lead a promiscuous sex life;
• use of personal hygiene items;
• regular visits to the doctor.

Sexually active people are advised to take an RPR screening test for syphilis at least once every six months. Since there is a high risk of infection through unprotected oral sex, it is important to remember the need for barrier contraception during any sexual intercourse.

If the giving partner is male, regular condoms are used.

When it comes to a woman, you can use the so-called "female condoms". They are a thin latex napkin that covers the female genitalia during oral sex.

Emergency prevention of syphilis

In addition to early prevention, there is an emergency. It is aimed at preventing the development of the disease after a dangerous contact has taken place.

The primary stage of such prevention is a thorough washing and douching of the mucous membranes. For douching, antiseptic solutions are used, for example, Chlorhexidine and Miramistin.

The next stage requires antibiotic therapy and is carried out strictly according to the prescription of a venereologist. The specialist in this situation prescribes a loading dose of antibacterial drugs that are taken once. Treatment can be with pills or injections.

Remember! You can not take antibiotics on your own and without consultation.

A person without medical education does not know the exact and correct dosages of drugs. Not all antibiotics are effective against pale treponema. In addition, uncontrolled use of antibiotics is associated with the risk of developing allergic reactions and complications from their use.

Prevention of syphilis in pregnant women

If during pregnancy a woman was at risk of contracting syphilis, prophylaxis is essential. In this case, the possible negative effect of antibiotics on the fetus is lower than the potential harm of syphilis for the unborn child.

Taking antibiotics in this case is carried out strictly under the supervision of doctors. For the prevention of syphilis in pregnant women, drugs with the least toxic effect on the fetus are used.

Be sure to remember that syphilis is a dangerous disease that causes serious health problems. This disease can be cured at almost any stage, but the sooner the better. Moreover, in the early stages, the disease is eliminated with maximum accuracy without health problems.

The symptoms of syphilis are all its manifestations and signs that can be found in an infected person. Syphilis is an infectious disease that causes a specific pathogen in the human body, pale treponema. Getting into human body, the microorganism gradually spreads to all tissues, internal organs, is especially actively concentrated in the lymphatic vessels and lymph nodes, spreads through the circulatory system to all systems, and can even affect the bone apparatus.

Modern medicine distinguishes various types and forms of syphilis, depending on how strongly the syphilitic lesion is developed, and what concentration of pathogens is present in the patient. Each form, type or stage has its own characteristic symptoms.

The main classification of forms of the disease

What can be syphilis in humans? It is generally accepted to divide the disease into primary, secondary and tertiary forms - this typology reflects the stages of the formation of the disease at different times.

Primary syphilis begins from the moment the pathogen enters the human body, and can last up to 5-7 weeks. Further, the symptoms of the disease change, and this means the onset of the secondary stage. Secondary syphilis is longer - its duration is from 2 to 5 years. During this time, the symptomatology of the lesion has a wave-like character - it either regresses or becomes more active.

The tertiary stage of pathology is a rare phenomenon that is the result of untreated primary and secondary syphilis, incorrectly or insufficiently selected treatment. It occurs 5-7 years after the initial infection, can last for decades and even be fatal.

Reviews and scientific publications of some medical specialists indicate the presence of the so-called fourth stage of syphilis - advanced syphilis, in which all systems and organs, the bone apparatus, and the vascular system are affected.

In addition, the disease can be congenital, latent (asymptomatic), while the latter type is early or late.

Symptoms of the incubation period and the primary stage of the disease

The primary development of external manifestations of pathology is preceded by an incubation period - it begins from the moment when pale treponema enters the human body, and ends with the appearance of the first signs of syphilis. The incubation period lasts from a week to a month and a half. At this time, it is impossible to detect a lesion in the body by any sensations or manifestations - they simply do not exist. In addition, in the first few weeks after infection, primary syphilis is seronegative, that is, it does not appear in the results of serological tests.

The primary form, or stage 1, begins when the sick person discovers a hard chancre, which is otherwise called a syphilitic ulcer or primary syphiloma.

Chancres can be:

• single;
• multiple.

The formation of a chancre occurs at the site of penetration of the pathogen into the skin or mucous membranes. At first, it is designated as a red spot, gradually turning into a pronounced ulcer, at the base of which there is a solid infiltrative seal. The bottom of the ulcer looks like raw meat and has a bright red tint, and on top it is covered with a transparent shiny film. Usually a chancre of this type has a regular rounded shape, smooth edges. The seal at the base feels similar in structure to ear cartilage.

The chancre itself does not cause pain to its carrier, and after a while the ulcer heals and epithelizes, even if treatment is not applied.

In men, the appearance of a chancre is indicated mainly in the genital area - on the penis, for example, on the head, on the prepuntal sac. Neoplasm can also be found on the hips, pubis, abdomen. Extra-genital ulcers in infected guys form somewhat less often - they are determined on the lip, fingers or tonsils.

The formation of a chancre in women usually occurs on the labia - external and internal, as well as on the cervix, pubis, thighs, abdomen. Especially dangerous is the penetration of treponema through the cervix - such a chancre cannot be detected in the early stages of the disease, since the site of the lesion cannot be seen on its own. Syphilitic wounds in girls and women also occur in the mouth - on the gums, palate, tongue, less often - in the throat. In some cases, a lesion in women can cause a violation menstrual cycle, however, this syndrome is too nonspecific, so it is often associated with stress, travel, physical activity.

Primary syphilis in children can be formed only in the case of an acquired form of the disease, for example, if personal hygiene rules are not followed, if an infected person is present in the family, or when infected from a sick mother during or after childbirth. The signs of this stage of the lesion in children are similar to those in adults, and syphilis in them proceeds in the same way. A sick baby has a hard chancre, and after a while it passes.

At the initial stage of the development of the disease, it is rather difficult to determine it in a person, since even such a specific symptom as a chancre, the patient cannot always detect in himself due to the fact that they do not hurt and do not manifest themselves in any way.

The end of the primary period of development of the pathology is indicated by the appearance of a febrile syndrome, which is expressed by headaches, a feeling of aching joints, fever, weakness, dizziness. It is these symptoms, combined with the formed chancre, that signal that a person has contracted syphilis.

The usual course of the disease implies that the primary manifestations are indicated in the affected person already 3-6 days after the treponema enters the body.

Recently, doctors have noted some change in the characteristic primary symptoms in particular, an increase in the number of chancres. If earlier, single chancres appeared in patients, now, during the period of primary syphilis, two or more ulcers are increasingly forming in the affected. In addition, the chancres themselves have become more difficult to identify by touch, as they can appear without seals.

Secondary form of syphilis: how to detect

The second stage of the formation of a syphilitic lesion is characterized by the presence of several periods:

• fresh;
• hidden;
• recurrent or repeated.

Fresh secondary syphilis is a direct consequence of the development of the primary form of pathology, the main manifestations of which are a characteristic skin rash and a healing hard chancre.

Latent syphilis stage 2 is the period when syphilitic manifestations subside, and the person does not feel the presence of the disease. At this time, a lesion can only be detected through serological tests.

The latent form of secondary syphilis is replaced by a recurrent one, when the symptoms of the disease again begin to remind of themselves.

The clinical manifestations of this form of damage in men look like the flu - there is a high temperature, intense headache, feeling of weakness. Myalgia and arthralgia appear at night. Further, secondary lesions appear on the skin - a rash in the form of syphilis, the tissues of which contain a large number of treponemas, which is why such wounds pose a great danger to others. After epithelialization of these ulcers, no scars remain on the skin, and during healing they practically do not itch.

The appearance of secondary syphilides is often accompanied by baldness of some areas of the skin, and the hair falls out not only on the head, which is especially noticeable in men with intense hair on the arms, back, and legs. Patches of alopecia look like lichen or alopecia, and can cover large areas or be small.

In women, secondary syphilis appears 6-8 weeks after infection. The rashes are most pronounced in the genital area: on the labia, on the mucous tissue, a bright pink rash is found in the form of nodules, papules or roseola, the mucous tissue itself has a shiny, wet appearance.

In addition, syphilitic (wide) condylomas can form in the genital area and on the inner surface of the thighs - they grow together and form large formations that look like warts.

Papules of pink color, similar to acne, can be found in the oral cavity and pharynx, on the vocal cords, on the tongue, while the voice becomes hoarse.

A typical female manifestation of the disease in a secondary form is the "necklace of Venus" - pigmented syphilides on the neck, front and sides. The skin becomes discolored in the form of asymmetrical spots that wrap around the neck around, forming a kind of “necklace” - this can be seen especially well when studying photos of patients with secondary syphilis. "Necklace of Venus" appears in women about half a year after infection. In addition, leukoderma of syphilitic origin can be observed on the lower back, palms, and chest.

In children and adolescents, the transition of the disease to a secondary form is accompanied by the appearance of a profuse rash in the form of papules. Such a sign allows you to reliably find out about the presence of untreated syphilis in a baby, if it has not been noticed before. During this stage, the blood of a sick child contains a high concentration of pale treponema. In response to an infection attack, the immune system begins to intensively produce antibodies to it, and the rash gradually disappears, but this does not mean a cure for syphilis.

A pustular rash is extremely rare in patients, and is characterized by an abundant content of pus with a specific odor in the rashes. Then they dry up and form a yellowish crust. Syphilitic pustules usually appear in drug addicts, people diagnosed with tuberculosis, and alcoholics. It should be noted that general pain, swelling, itching or atypical discharge at this stage of the disease disturb the patient extremely rarely.

In patients with secondary syphilis with developing kidney damage, lipid nephrosis with severe proteinuria is noted, and the number of erythrocytes, leukocytes, and cylinders increases in the composition of urine.

Clinical picture of symptoms of the tertiary stage

Untreated syphilis, as well as a disease that has not been subjected to any medical treatment at all, passes into the tertiary stage of development.

The formation of the tertiary stage of the disease in men is accompanied by the appearance of syphilitic gums and tubercles. Small tubercles appear in large numbers throughout the body: on the face, on the scalp, on the upper and lower limbs, in the genital area, back, hips, abdomen. Gummas, unlike tubercles, are large in size, and are usually located singly. Both types of neoplasms contain inside the affected tissues and fluid, the concentration of treponema in which is lower than in secondary syphilis, so tertiary syphilis is considered less contagious.

Like men, women with advanced syphilis develop bumps that look like pimples, as well as gummas. Over time, these affected areas of the skin turn into difficult-to-heal ulcers. In place of the ulcers, scars will later remain, which greatly deform the tissues, skin and mucous membranes. This is especially noticeable on the face, as well as in the genital area.

Tertiary syphilis in children and adolescents contributes to the formation of tertiary syphilis throughout the body, as well as on the internal organs. This also affects the musculoskeletal system and the nervous system.

The main danger of tertiary syphilis lies precisely in the fact that the tubercles, gummas and scars after them cause the destruction of the cartilage of the nose, nerve tissues, bones, skin, mucous membranes of the mouth and genital organs. The third stage of the disease can last for decades. During this time, the patient may develop blindness and deafness, mental insanity, paralysis of organs and limbs.

In this case, the affected person experiences mental changes - he begins to periodically panic, bouts of depression and baseless rage, he develops paranoia, which is replaced by periods of euphoria. Also, a person may suffer from the appearance of hallucinations as a result of the destruction of brain tissue.

Local destruction of various parts of the body may be accompanied by bouts of pain in the damaged areas.

Congenital syphilis: characteristic manifestations

The congenital type of syphilis, depending on how it proceeds, as well as on the stage at which its symptoms appear, can develop in four forms.

Fetal syphilis is formed at the stage of being in the womb, for a period of at least five months. Its signs are an increase and a change in the structure of internal organs, especially the liver, pancreas, kidneys and spleen, as a result of the fact that they perform an infiltration function, passing a significant amount of infected contents through them. The presence of infiltrates in the lungs is the cause of the formation of the so-called white pneumonia of the fetus.

It is possible to determine the presence of a congenital lesion in the fetus by conducting an x-ray examination - its results will show the presence of specific changes.

Congenital syphilis of the fetus is one of the causes of premature birth, late miscarriages, the birth of a dead or sick child.

An early type of pathology is determined in a baby under the age of 2 years. It can be divided into infant syphilis or early childhood syphilis. In infants, the first symptoms of the disease may appear as early as 1-2 months after birth. The child develops a skin lesion, syphilitic pemphigus forms on it. In addition, the newborn is tormented by a constant syphilitic rhinitis, and the concomitant infiltration of Gochsinger. The runny nose has a prolonged character, accompanied by a pronounced edema of the mucous membrane, as well as a large amount of mucus discharge. The child experiences a noticeable difficulty in nasal breathing. The consequences of a nose lesion can be irreversible - the patient's bone and cartilage structures are deformed, and a saddle nose can form. Infiltration according to Gohzinger is the formation of a dense infiltrate in the area of ​​​​the chin and lips, as well as on the buttocks, palms, and soles. The child has characteristically thickened lips, they crack, swell and bleed. Affected skin loses elasticity and thickens.

Ulcerative lesion of the larynx is accompanied by hoarseness of voice.

Especially noticeable in such children are lesions of the skeletal system, osteochondritis, periostitis. In addition, congenital syphilis can be accompanied by extensive damage to somatic organs, when an infected person develops hepatitis, pericarditis, hydrocephalus, and diffuse pneumonia. Boys develop specific orchitis, in some cases - dropsy of the testicle.

The combination of all these birth defects quickly leads to the death of a child in early infancy.

In those babies who have already reached early childhood (older than a year), diseases of the organs of vision, lesions of the nervous system appear, and locally located large papules and wide condylomas can form on the skin. Congenital syphilis, which manifests itself in early childhood, is accompanied by a less pronounced lesion of the internal organs, and changes in the musculoskeletal system can only be determined by radiography.

The late type of congenital syphilis first makes itself felt after the child reaches two years, and most often this occurs at the age of 14-15 years. The clinical picture of manifestations is similar to the symptoms of tertiary syphilis - gummas and tubercles form in a teenager, covering the entire body, including the nasal mucosa, hard palate. As a result, affected structures are destroyed.

In addition, saber-shaped shins, specific drives, dystrophic pathologies, or so-called stigmas can form in adolescents. Such stigmas are not specific, as they can accompany other infectious diseases.

Unlike stigmas, Hutchinson's triad is a characteristic manifestation of late congenital syphilis - it is a combination of diffuse keratitis, syphilitic labyrinthitis, and Hutchinson's teeth.

The latent form can be detected in children of any age, it is dangerous due to the complete absence of any clinical symptoms.

It is determined only as a result of serological studies.

Can syphilis be asymptomatic, and how to determine it

Latent syphilis is sometimes called chronic, since in this case no obvious symptoms are observed in the patient. From the moment of infection in the body, active reproduction of the infection begins, it gradually moves to all internal structures and organs, but the infected person himself does not feel it. Although the disease in this case is asymptomatic, the presence of syphilis can be established by positive results serological reactions of blood, even in the absence of clinical manifestations from the internal organs, skin, nervous and musculoskeletal systems.

Latent (latent) syphilis is most often detected during preventive examinations, since it is impossible to detect it at home. This form of the disease can be of three types - early, late and unspecified.

The early one is more dangerous from the point of view of the epidemiological factor, since after it manifests itself, the concentration of treponema in the secret and skin rashes of the patient will be very high. Sexual, and even household contact with such a patient can cause infection. The late one immediately takes shape as tertiary syphilis, with specific gums and tubercles, which are slightly contagious.

The early latent form of the disease corresponds to the period from primary to secondary recurrent syphilis.

Unspecified is the type of latent syphilis, detected suddenly as a result of tests, when neither the duration of infection nor the route of infection into the body can be established.

The symptomatology of syphilis directly depends on what form the disease takes on over time, or because of the peculiarities of the reaction of the human body. In addition, the lesion can generally proceed without any external manifestations - in this case, it becomes even more dangerous for others.

The defeat of syphilis is manifested by a skin rash typical of most venereal and skin diseases (for example, gonorrhea), inflammation of the lymph nodes, as well as signs of general intoxication - feeling unwell. However, the most specific symptoms have a congenital form of syphilis, which is formed in children. An accurate diagnosis is possible only after passing special serological tests.

Speciality: infectious disease specialist, gastroenterologist, pulmonologist.

General experience: 35 years .

Education:1975-1982, 1MMI, San-Gig, highest qualification, infectious diseases doctor.

Science degree: doctor of the highest category, candidate of medical sciences.

every woman needs at least twice a year. In a woman's life, situations often arise when it is necessary to good advice obstetrician-gynecologist, answer to a question, consultation. But even if a woman has no complaints, it must be taken into account that the asymptomatic course of gynecological diseases, including sexually transmitted infections and gynecological tumors, has been very common lately. Even pathological discharge from the vagina with such diseases is not always the case. Without analysis, it is difficult to distinguish them from normal secretions. With the latent course of female diseases, there is no abdominal pain, bleeding, menstrual irregularities and other symptoms. Therefore, every woman needs preventive gynecological examinations and basic tests (general blood count, urine, smear on flora and cytology), the results of which allow to reveal the presence of hidden asymptomatic gynecological diseases and infections in the early stages. The number of preventive gynecological examinations depends on previous diseases and other factors.

When you need good advice from a doctor, you can come to a gynecological consultation at our gynecological clinic, ask the doctor your questions about your health, undergo an initial gynecological examination and, if necessary, further examination and treatment.

Consultation with a gynecologist for early diagnosis of pregnancy

A gynecological consultation and gynecological examination are also necessary for the early diagnosis of pregnancy. The first signs of pregnancy are inaccurate and often mislead women. During pregnancy, menstrual-like discharge from the vagina is possible, pregnancy tests can be false negative. For an accurate early diagnosis of pregnancy, it is necessary to consult a gynecologist, pelvic ultrasound and determine the level of hCG in a blood test.

A good gynecologist is, first of all, a good diagnostician. Diagnosis of gynecological diseases is based on experience and knowledge. The gynecologist during the initial gynecological examination will determine whether there is a need for more detailed diagnostics, consultations of other doctors. According to the indications, you will receive all the necessary recommendations for treatment and referrals for tests. This will dispel many fears and doubts, notice adverse changes in time. women's health, take measures to correct them, start treatment on time.

A woman is sometimes afraid or ashamed to come to a gynecologist's consultation and gynecological examination. She is frightened by the examination procedure, and even the appearance of the gynecological chair. Nevertheless, even a healthy woman should visit the gynecological clinic twice a year. The main task of an obstetrician-gynecologist in a gynecological clinic is to preserve the health of a woman, which is possible only with the prevention of gynecological diseases and their timely detection at the initial stages. At the appointment with a gynecologist in our gynecological clinic, you will forget about the fear of a gynecological examination. Polite clinic staff do their best to provide you with the necessary medical services quickly and efficiently.

Features of the consultation of a gynecologist. Gynecological examination

Every healthy woman should undergo a gynecological examination twice a year in order to maintain her health, prevent and detect gynecological diseases in the early stages. To avoid the development of sexually transmitted diseases, infectious diseases and gynecological tumors, it is better not to postpone a visit to the doctor, but to come for a preventive examination and consultation with a gynecologist.

The gynecologist must know individual characteristics your body, all gynecological diseases that you have suffered. Communication with the gynecologist at the appointment should be easy and trusting. Every woman should have her own obstetrician-gynecologist.

It is advisable to come to a gynecologist's consultation for the first time at the age of 15-16, especially if the girl has not yet begun her menstrual cycle. It is also necessary to visit a gynecologist if a woman has already started or plans to start having sex. Gynecologists advise not only to undergo a preventive gynecological examination twice a year, but also to take basic tests, especially when a new sexual partner appears, to do colposcopy and gynecological ultrasound, because the asymptomatic (hidden) course of gynecological diseases is very common and difficult to diagnose. Many gynecological diseases, if not treated in time, can lead to infertility, ectopic pregnancy or miscarriage.

Stages of gynecological consultation and gynecological examination

Questions for a gynecologist

You can come to a gynecologist's consultation and preventive gynecological examination if there are no complaints or already with certain complaints. A consultation with a gynecologist begins with a conversation. First, the gynecologist asks questions and fills out a medical record. By asking questions, the gynecologist will find out with what problem the woman came to the doctor's office. It is important for a gynecologist to know what diseases a woman has had throughout her life, which will tell him about her predisposition to certain diseases. Some questions may seem too intimate or unnecessary, but they must be answered with absolute honesty. Answer all the questions of the gynecologist and do not hesitate to ask him questions, because the state of your health depends on it.

External gynecological examination

A gynecologist's consultation may include procedures such as measuring pressure, determining weight, and examining the mammary glands. After that, the gynecologist proceeds to a gynecological examination of the female genital organs. For this, a woman needs to lie down in a special gynecological chair. The gynecologist conducts an external examination in order to identify possible discharges, irritations, rashes, warts, gynecological tumors and other pathological changes in the external female genital organs. Having finished the external gynecological examination, the gynecologist proceeds to the internal gynecological examination.

Internal gynecological examination

During an internal gynecological examination, an obstetrician-gynecologist inserts disposable plastic mirrors into the vagina to examine the cervix. At the same time, the gynecologist also evaluates the presence of secretions and other pathological processes. After removing the speculum from the vagina, the gynecologist conducts a vaginal examination. The fingers of one hand, dressed in sterile disposable gloves, are inserted into the vagina by a gynecologist. The gynecologist puts the other hand on the anterior abdominal wall. Thus, the doctor notes the size, shape, position, mobility, soreness of the uterus and appendages, draws attention to the presence of pathological volumetric formations in the small pelvis. If you experience pain during probing, you should immediately inform the gynecologist about this, as this may be a sign of an inflammatory or other gynecological disease. Sometimes a gynecologist may perform a rectal examination (for example, when examining virgins) when other examinations are insufficient.

Taking a smear for flora during an internal gynecological examination

A mandatory step in a preventive gynecological examination should be taking a smear. A bacteriological examination is a smear examination of gynecological secretions. In a smear, the number of leukocytes is counted and infectious agents are looked for. More than 10 white blood cells in the field of view may indicate the presence of a sexually transmitted infection or inflammation of the female genital organs. According to the results of the smear, you can detect fungi (candidiasis), "key cells" (bacterial vaginosis), a change in the normal flora in the discharge during vaginal dysbacteriosis. The gynecologist prescribes seeding of the discharge and PCR diagnostics of the discharge to clarify the causative agent of the infectious process, if the smear shows the presence of an infection, but does not reveal its pathogen.

Taking a smear for cytology during an internal gynecological examination

A cytological examination (cytology) is an obligatory stage in the early diagnosis of cervical diseases and a mandatory analysis carried out before its treatment. Even if the woman is not bothered by anything and the cervix seems unchanged to the naked eye, the woman should regularly (every year) undergo a cytological examination of the cervical scraping. A gynecologist takes a scraping during an internal gynecological examination. Scraping is taken with a little pressure, while scraping off the deeper layers of cells. This is a painless procedure. This is done because the malignant process begins with the lower layers of the epithelium of the cervix and progresses to the surface of the mucous membrane. Therefore, if only the surface layer gets into the analysis, the diagnosis can be made only when the disease is already at a late stage of development.

Colposcopy

Colposcopy is an examination of the cervix under a special microscope - a colposcope. The gynecologist uses colposcopy during an internal gynecological examination in order not to miss the initial signs of a malignant tumor, if the patient is not bothered by anything and the cervix seems unchanged to the naked eye.

Colposcopy is of great diagnostic value for suspected cervical cancer, for diagnostics erosion cervix, dysplasia, leukoplakia. Only extended colposcopy can help to make an accurate diagnosis of cervical disease in the early stages and determine its malignancy.

Extended colposcopy is an examination of the cervix after treatment with a 3% solution of acetic acid. The action of acetic acid lasts about 4 minutes. After studying the colloscopic picture of the cervix treated with acetic acid, the gynecologist conducts a Schiller test - lubricating the cervix with a cotton swab moistened with 3% Lugol's solution. The iodine contained in the solution stains glycogen in the cells of a healthy, unchanged squamous epithelium of the cervix in a dark brown color. Thinned cells (atrophic age-related changes), as well as pathologically altered cells in various dysplasias of the cervical epithelium (precancerous conditions) are poor in glycogen and do not stain with iodine solution. Thus, a gynecologist during colposcopy reveals areas of pathologically altered epithelium and, if necessary, designates areas for a biopsy of the cervix.

Ultrasound of the pelvis and fetus

In gynecology, ultrasound of the small pelvis complements the gynecological examination and is used very widely, because. with its help, with a high degree of reliability, it is possible to conduct an examination of the pelvic organs and monitor the development of pregnancy (fetus). Ultrasound of the small pelvis is a method of examination that allows the gynecologist to get an idea about all the organs of the small pelvis, including the uterus and ovaries, which is of great importance in the diagnosis of gynecological tumors and inflammation of the female genital organs, anomalies in the development of the uterus.

Ultrasound of the pelvis makes it possible to determine the causes of abnormal discharge, uterine bleeding, pain in the lower abdomen and menstrual irregularities that are not visible during a routine gynecological examination.

Ultrasound can determine the presence of pregnancy and abnormalities in the development of the fetus. Also, ultrasound plays a decisive role in the diagnosis of ectopic pregnancy and is always performed before the abortion procedure to confirm the presence of a fetal egg in the uterine cavity.

Consultation with a gynecologist based on the results of a gynecological examination and tests

To make a diagnosis, a gynecologist compares the results of a gynecological examination with anamnesis data (a woman's life and illness history), gynecological tests, complaints, and the results of other examinations. Therefore, in order to make a diagnosis or make sure that there are no gynecological diseases, a woman needs at least two consultations with a gynecologist.

At the first consultation, the gynecologist performs the above-described gynecological examination, colposcopy, pelvic ultrasound, and takes material for gynecological tests. If a woman has complaints and symptoms of gynecological diseases, the gynecologist during the first consultation recommends to the woman what tests (except smears) she needs to pass and prescribes symptomatic treatment to reduce the symptoms of the disease (pain in the lower abdomen, bleeding, itching, etc.).

A woman can pass many tests during the first gynecological examination, but for some tests she needs to come to the gynecologist again for fence material for analysis on a certain day of the menstrual cycle, after necessary training or on an empty stomach.

At the second visit, the gynecologist advises the woman on the results of smears and other tests, if they were taken during the first gynecological examination. The results of the tests may indicate the presence of a gynecological disease in the absence of its symptoms, confirm the preliminary diagnosis established at the first examination, or indicate the need for further examination to make a diagnosis.

A complete treatment regimen for a gynecological disease is signed by a gynecologist after a diagnosis is made. After the treatment, and sometimes during the treatment, a woman needs to come to a gynecologist's consultation and take gynecological tests repeatedly to monitor the results of treatment.

Preparing for a gynecological examination

A woman needs to visit a gynecologist's office several times a year if she cares about her health. For a preventive examination by a gynecologist, the most optimal period is after menstruation. One day before the consultation with a gynecologist, it is not recommended to have sexual intercourse. It is necessary to take a shower before a gynecological examination, but douching has a negative effect, because. the doctor needs to see the real condition of the vaginal secretions and take a swab. You don't need to shave your hair before seeing a gynecologist. If a woman has taken antibiotics and other medications, then it is necessary to warn the doctor about this. Sometimes testing for infections must take place no earlier than two weeks after the end of treatment in order to get the correct results. If you have to take tests for chronic infections, then it is better to do this before or immediately after menstruation.

An obstetrician-gynecologist consultation with an examination usually takes about 30 minutes. Try not to be nervous during the inspection. Answer all the doctor's questions and do not hesitate to ask him questions, because. your health depends on it.

It is imperative to visit a gynecologist in the following situations

Recently, the asymptomatic course of gynecological diseases, including sexually transmitted diseases, has been very common. There are vaginal discharges with such diseases, but more often they are the only symptom and appear periodically. Without analyzes it is difficult to distinguish them from normal secretions. Therefore, every woman needs a preventive examination by a gynecologist at least twice a year.

Pathological vaginal discharge is the main symptom of almost all gynecological diseases, including sexually transmitted diseases. When they appear, it is necessary to consult a gynecologist with an examination and analyzes for determining infections, including those transmitted sexually.

Uterine bleeding in the middle of the cycle, increased and prolonged bleeding during menstruation. Gynecological consultation with examination and ultrasound in this case are necessary to determine the source of bleeding. Bleeding that occurs during pregnancy requires immediate hospitalization.

Abdominal pain. In female gynecological diseases, it is most often observed in the lower abdomen. A consultation with a gynecologist with an examination, tests and other examinations are necessary to identify the cause of the pain.

Problems with conception. Conceiving a child requires preparation. Gynecological diseases can adversely affect pregnancy and the unborn baby. Therefore, it is very important to come for a consultation and examination to a gynecologist to identify and cure them before conception.

At pregnancy planning a woman needs to come for an examination and consultation with an obstetrician-gynecologist, be examined and pass in advance analyzes to identify infections, including - ureaplasmosis. Planning pregnancy and during a gynecological examination allows you to avoid complications and unpleasant surprises during pregnancy.

Diagnosis of pregnancy. The first signs of pregnancy before a missed period are inaccurate and often mislead women. During pregnancy, menstrual-like discharge is possible. In order to diagnose pregnancy in time, at the slightest suspicion, it is necessary to go to a consultation with a gynecologist, do an ultrasound scan and a blood test for hCG.

Termination of pregnancy (medical abortion). In the event of an unwanted pregnancy, an obstetrician-gynecologist will provide you with qualified advice on its termination. Medical abortion is the least traumatic for a woman.

Contraception. Each woman should choose with the help of a gynecologist the means of protection against unwanted pregnancy that is most suitable for her. This requires a consultation with a gynecologist with an examination, ultrasound, if necessary, a study of the hormonal background and other tests.

Hormonal disbalance. Often the main cause of diseases of the female reproductive system is hormonal changes (hormonal imbalance). At the consultation, the gynecologist will prescribe the necessary examinations for the diagnosis of hormonal disorders.

Menstrual disorders. Ovarian dysfunction is most often a symptom of serious gynecological diseases. Consultation with a gynecologist with an examination is necessary to identify these diseases.

From symptoms of premenstrual syndrome ninety percent of all women are affected. Before menstruation a woman can experience a lot of unpleasant and painful sensations, which normally should not be. A woman should not put up with these feelings and suffer in silence, it is necessary to come for a consultation with a gynecologist.

tides and painful intercourse are the most common symptoms of menopause. A gynecologist at a consultation will tell a woman how to alleviate the course of a pathological menopause. A very dangerous symptom is the appearance of bloody discharge from the genitals after menopause. When they appear, a woman should come for a consultation with a gynecologist with an examination immediately.

Cervical erosion. One of the most common diseases that may not manifest itself in any way and can only be detected during a preventive gynecological examination.

uterine fibroids. It may also not manifest itself in any way and be detected only during a preventive gynecological examination. Asymptomatic leakage can lead to severe node growth, bleeding and surgical intervention.

endometrial hyperplasia often asymptomatic, but more often manifested by dysfunctional uterine bleeding. Often, the diagnosis of endometrial hyperplasia is made when a woman comes to an appointment with a gynecologist about infertility.

Polyps of the uterus (endometrium) and cervix(cervical canal). In recent years, polyps of the body of the uterus and cervix are found even in adolescent girls. For a long time they do not manifest themselves in any way and over time can become malignant. For their timely detection, every woman needs a consultation with a gynecologist and a preventive examination twice a year.

Ovarian cyst. During a routine ultrasound examination, a gynecologist can detect an ovarian cyst in a woman. Some cysts may disappear on their own, but in many cases a course is required. hormonal treatment, and in some, surgical intervention is also required to get rid of the source of danger.

spikes are formed when an acute inflammatory process in the female genital organs becomes chronic and the healing process stretches over time. Adhesive disease is practically untreatable. Therefore, to avoid the formation of adhesions, when symptoms occur inflammation Go see your gynecologist right away.

cervicitis- inflammation of the mucous membrane of the cervix. It can be manifested by pathological discharge, burning, itching. With a latent course, it may not manifest itself in any way. Therefore, every woman at least twice a year needs a preventive consultation with a gynecologist with an examination. The causative agents of infection are often gonococci, Trichomonas.

Thrush (or vaginal candidiasis) caused by yeast-like fungi of the genus Candida. Often acquires a chronic course with improper self-treatment. To select the right treatment and identify infections that often accompany an exacerbation of thrush, which a woman may not even be aware of (including sexually transmitted ones), it is necessary to come to a gynecologist's consultation with an examination.

Dysbacteriosis of the vagina- This is a violation of the normal microflora of the vagina. Most women suffer from this disease, it is often the result of improper self-medication. Dysbacteriosis can lead to the development of inflammatory gynecological diseases. Before prescribing drugs to normalize the microflora of the vagina, a consultation with a gynecologist, examination and tests is necessary.

For examination for syphilis a woman can also come for a consultation and examination to a gynecologist . Syphilis is a chronic sexually transmitted disease that affects the skin, mucous membranes, many internal organs, bones, and the nervous system. Recently, it often proceeds completely asymptomatically. Used to diagnose syphilis, RW (Wassermann reaction) is often false positive and false negative and is very outdated.

Benefits of Demetra Gynecological Clinic

• Reception is conducted by highly qualified gynecologists with great experience work
• Given the frequent imitation of gynecological diseases in the pathology of other organs, close cooperation is carried out between gynecologists and the therapist for the benefit of patients
• Modern methods of diagnosis and treatment of diseases, incl. laboratory tests, pelvic ultrasound and pregnancy ultrasound, colposcopy
• Treatment of diseases without hospitalization (outpatient)
• Convenient location of the clinic in Kyiv: Darnytskyi district, near Poznyaki metro station
• Convenient opening hours by appointment only
• If you have any questions, call us, our employees will provide all the necessary information

Syphilis is one of the few sexually transmitted diseases that can cause criminal liability in case of infection of other people and sexual partner. In most cases, signs of the disease in women and men do not appear immediately, but some time after the direct fact of infection. This feature makes syphilis even more dangerous.

Syphilis also stands out against the background of other socially significant diseases (which can harm not only health, but also lead to death) by the fact that today in Russia the syphilis epidemic is acquiring a progressive trend. The growth rate of this disease has increased five-fold over the past decade. If left untreated, this pathology can lead to male or female infertility, and during the pregnancy of an infected woman, infection of the fetus is observed in 70% of cases. After infection, the fetus either dies or is born with congenital syphilis.

Syphilis is distinguished:

in terms of occurrence - late and early;

according to the stage of the disease - tertiary, secondary, primary;

by origin - acquired and congenital.

Diagnosis of the disease

In no case can one diagnose such a serious disease as syphilis “on the Internet”, simply by reading about the symptoms and treatment of the disease. You need to know that rashes and other visual changes can be copied from completely different diseases to such an extent that sometimes even doctors can make mistakes. That is why the diagnosis of the disease should be carried out according to all the rules of the clinic, starting with an examination by a doctor for characteristic signs and ending with laboratory tests:

examination by a dermatovenereologist. The doctor examines in detail the lymph nodes, genitals, skin and conducts a survey on the course of the disease;

detection of treponema itself or its DNA in the composition of syphilides, chancre, gumme PCR method, direct immunofluorescence reaction, dark-field microscopy;

serological tests: treponemal - search for antibodies of pale treponema (RIBT, immunoblotting, ELISA, RPHA, RIF); non-treponemal - the search for antibodies against tissue phospholipids, treponemal membrane lipids that are destroyed by the pathogen (rapid plasma reagin test, VDRL, Wasserman reaction). It is worth noting that the result may be false positive, that is, show the presence of syphilis in its actual absence;

instrumental studies: search for gums through x-rays, CT, MRI, ultrasound.

Exciter properties

The causative agent of syphilis is treponema pallidum spirochete. In the human body, treponema can multiply very quickly, which causes damage to internal organs. Among other things, there are a lot of these microorganisms on the mucous membranes. It is this property that is the reason for the high risk of transmission through sexual or domestic contact, for example, through personal hygiene items, shared utensils and other items that are in common use. Pale treponema does not apply to infections, having been ill with which the body receives strong immunity, therefore, if a sexual partner has been ill with syphilis, he runs the risk of contracting it again through unprotected sexual contact with a sick partner.

Treponema is unstable to the effects of the external environment and dies almost instantly when boiled. When exposed to a temperature of 55 degrees destroys treponema within 15 minutes. Also, the microorganism does not tolerate drying, but in a humid environment and low temperatures, the spirochete shows significant "survivability":

viability is maintained throughout the year, subject to freezing to -78 degrees;

survives on the dishes in the remnants of moisture for several hours;

even if a syphilitic patient dies, his corpse is able to infect others for another 4 days.

Methods of transmission of syphilis

Syphilis is transmitted through:

through saliva - this route of transmission is quite rare, mainly among dentists who work without protective gloves;

through household items, provided that the patient has open ulcers or decaying gums;

intrauterine transmission (congenital syphilis in a child);

through mother's milk (acquired syphilis in a child);

through blood (shared shaving accessories, toothbrushes, shared syringes for drug addicts, blood transfusions);

sexual contact (anal, oral, vaginal).

In case of unprotected, accidental sexual contact of any kind, for emergency prevention of the disease, it is necessary to carry out the following procedure (preferably performed no later than 2 hours after intercourse): first, thoroughly wash the inner surface of the thighs and external genitalia with soap and water with a Miramistin antiseptic solution or Chlorhexidine. In this case, women should syringe the vagina with this solution, and men should introduce an antiseptic into the urethra.

But it is worth noting that this method is an extremely emergency measure, which does not give a 100% guarantee (only 70%) and cannot be used constantly. The condom is today the best remedy protection against STIs, however, even when using a condom with an unreliable sexual partner, emergency preventive measures should be taken. Also, after accidental sexual contact, you should be examined by a venereologist for the presence of other infections, but it is worth remembering that in order to establish a diagnosis of syphilis, it is worth being examined after a few weeks, since, as mentioned above, the incubation period of the disease takes just such a time.

External ulcers, erosions, papules are highly contagious. If healthy person there are microtraumas of the mucous membrane, then in contact with the patient, he risks becoming infected. The blood of a person with syphilis is contagious from the first to the last day of the disease, so the transmission of the infection can occur not only during transfusion, but also when the mucous membranes and skin are injured with manicure and pedicure tools in cosmetic or medical salons that contain the blood of a sick person.

The incubation period of the disease

After entering the human body, pale treponema is sent to the lymphatic and circulatory systems, through which it quickly spreads throughout the body. However, a person who has just become infected continues to feel well and does not observe any manifestations of the disease. From the moment of infection to the onset of the first symptoms of syphilis, it may take from 8 to 107 days, but on average the incubation period takes 20-40 days.

Thus, for 3 weeks to 1.5 months after direct infection, syphilis may not manifest itself in any way, while there are not only external signs and symptoms, but even a blood test does not detect the disease.

The duration of the incubation period can be extended by:

taking medications: corticosteroids, antibiotics and others;

state of the body, which is accompanied for a long time high temperature body;

old age.

The reduction of the incubation period occurs in the presence of a massive infection, when at one moment a large number of treponemas enter the body.

It is worth remembering that a person, even at the stage of the incubation period, is contagious, however, at this time, infection of another person can occur only through the blood.

Syphilis Statistics

Syphilis in the early stages is perfectly treatable, however, even despite this fact, the disease confidently takes 3rd place among STDs, second only to trichomoniasis and chlamydia.

According to international official statistics, about 12 million new patients are registered annually on the planet, while it should be borne in mind that the numbers do not reflect the full scale of the incidence, since a large number of people are self-medicating.

Most often, people aged 15 to 40 become infected with syphilis, while the peak incidence falls on 20-30 years. Women are more susceptible to infection (due to the appearance of microcracks in the vagina during intercourse) than men, but recently men have come out on top in terms of the number of infected. This trend is explained by the increase in the number of homosexuals in the EU and the USA.

The Ministry of Health of the Russian Federation does not have a unified record of patients with syphilis in the country. In 2008, there were 60 cases of developing the disease per 100,000 people. At the same time, the bulk of those infected are people without a permanent place of residence, service workers, representatives of small businesses, people who have a low-paid job or do not have a permanent income.

Most cases of syphilis are registered in the Volga, Far East and Siberian districts. Recently, in some regions there has been an increase in the number of cases of neurosyphilis, which differs in that it cannot be treated. The number of registration of such cases increased accordingly from 0.12% to 1.1%.

The first signs of the disease - the stage of primary syphilis

If syphilis proceeds according to the classical scenario, then the main symptoms are enlarged lymph nodes and hard chancre. At the end of the primary period, patients are concerned about the following symptoms:

an increase in the number of leukocytes in the blood;

decrease in hemoglobin level;

high body temperature;

arthralgia, pain in the bones, muscles;

general malaise;

headache.

A hard chancre, or a typical hard chancre, is a smooth erosion or ulcer that has rounded, slightly raised edges and is up to 1 cm in diameter. The ulcer may be painful or not hurt at all, while it has a bluish-red color. At the moment of palpation of the chancre, a solid infiltrate is felt at its base, which became the reason for the name of this type of chancre. In men, a hard chancre is found in the area foreskin or head, and in women mainly on the labia or cervix. Also, a chancre may be present on the mucous membrane of the rectum or on the skin near the anus, in some cases, erosions are located on the hips, abdomen, pubis. In medical workers, the chancre can be located on the fingers, lips, tongue.

Erosion on the mucous membrane or skin can be either single or multiple, and most often manifests itself at the site of infection. In most cases, a week after the onset of the chancre, the lymph nodes begin to increase, but sometimes patients notice an increase in the lymph nodes before the chancre itself appears. After oral sexual contact, enlarged lymph nodes and chancre may resemble symptoms of lacunar tonsillitis or an exacerbation of chronic tonsillitis. This feature can lead to inadequate treatment of the disease. Also, "along the wrong path" can direct the anal chancre, since its signs resemble a crack in the anal fold without infiltration and with elongated outlines.

Even in the absence of therapy, the hard chancre disappears on its own after 4-6 weeks, and the dense infiltrate gradually resolves. Most often, after the disappearance of the chancre, no traces remain on the skin, however, with gigantic sizes of erosion, dark spots black or dark brown. Ulcerative chancres leave behind rounded scars that are surrounded by a pigment ring.

Usually, when such an ulcer appears, a patient with syphilis experiences a feeling of anxiety and concern about his health, therefore, the diagnosis of the disease is carried out in time and treatment is carried out in a timely manner. But in cases where the chancre remains invisible (for example, on the cervix), with deliberate ignoring of the ulcer or with self-treatment (treatment with brilliant green or potassium permanganate), it disappears after a month. The person calms down and forgets about the problem, but the danger from the disease remains, and it passes into the secondary stage.

Atypical chancre. In addition to the classic chancre, there are other varieties of it, so recognizing syphilis is a difficult task:

inductive edema. Large bluish-red or pale pink induration on the labia majora, foreskin, or lower lip that extends beyond the ulcer or erosion. Without adequate therapy, such a chancre can persist for several months;

felon. Chancre, which manifests itself in the form of a common inflammation of the nail bed, which is accompanied by almost identical symptoms of panaritium, namely: the finger is swollen, painful, purple-red. Quite often there is a rejection of the nail. The only difference is that such a chancre does not heal for several weeks;

amygdalitis. This is not just a hard ulcer on the tonsil, but a hard, reddened, swollen tonsil that makes swallowing difficult and painful. Usually, by analogy with the usual sore throat, amygdalitis causes an increase in body temperature, malaise, and general weakness. In addition, headaches may appear, mainly in the occipital region. A sign of syphilis may be a unilateral lesion of the tonsil and low productivity of treatment;

mixed chancre. A mixture of soft and hard chancre, which appears with parallel infection with these pathogens. In this case, a soft chancre ulcer initially appears, since it has a much shorter incubation period, after which a seal and symptoms inherent in a hard chancre appear. Mixed chancre is characterized by a delay in laboratory tests for 3-4 weeks and, accordingly, the appearance of signs of secondary syphilis.

Lymph nodes. Primary syphilis is accompanied by an increase in lymph nodes, mainly in the inguinal region. If the chancre is localized in the rectum or on the cervix, an increase in lymph nodes may go unnoticed, since they are located in the small pelvis, but if syphiloma appears in the mouth, then an increase in the submandibular and submental lymph nodes is difficult to miss. If the chancre appeared on the skin of the fingers, then there is an increase in the elbow lymph nodes. One of the main signs of male syphilis is a painless cord with periodic thickening that forms at the root of the penis. This condition is called syphilitic lymphadenitis.

Regional lymphadenitis (bubo). This is a mobile, painless, firm lymph node that is adjacent to a chancre:

chancre on the nipple - lymph node under the arm;

chancre on the tonsils - on the neck;

chancre on the genitals - in the groin.

Regional lymphangitis. This is a mobile, painless, dense cord, which is located under the skin between an enlarged lymph node and a hard chancre. On average, the thickness of such a formation is 1-5 mm.

Polyadenitis. Appears at the end of the primary period of syphilis. This is a seal and an increase in all lymph nodes. In general, from this moment the disease passes into the secondary stage.

Complications of primary syphilis

In most cases, the complication of the disease in the primary period occurs due to a decrease in the body's defenses or when a secondary infection is attached to the area of ​​the hard chancre. This may lead to:

phagedenization (a type of gangrene that penetrates in breadth and depth of a hard chancre. Such gangrene can cause rejection of part or even the entire organ);

gangrene;

paraphimosis;

narrowing of the foreskin;

inflammation of the vulva and vagina;

balanoposthitis.

Symptoms of secondary syphilis

Secondary syphilis appears 3 months after the moment of infection and, on average, the duration of this period of the disease is from 2 to 5 years. It is characterized by the presence of undulating rashes that disappear on their own after 1-2 months, while leaving no traces on the skin. In addition, the patient is not bothered by either an increase in body temperature or itching of the skin. Initially, the symptoms of secondary syphilis are:

Skin syphilis. Secondary syphilides are different types of skin rash, but they are all similar:

the rash does not hurt or itch;

different elements appear in different time;

the rash does not lead to fever and lasts for several weeks;

with appropriate treatment of syphilis, a benign course and rapid disappearance are characteristic.

Syphilis options:

pigmented (necklace of Venus) - leukoderma (white spots) on the neck;

pustular - multiple abscesses, which subsequently ulcerate and scar;

seborrheic - formations covered with greasy crusts or scales that form in areas with increased activity of the sebaceous glands (nasolabial folds, forehead skin), if such papules appear along the edge of hair growth, they are called the "crown of Venus";

miliary - cone-shaped, dense, pale pink. Disappears later than other elements of the rash, leaves behind a characteristic patchy pigmentation;

papular - multiple dry and wet papules, quite often combined with syphilitic roseola;

syphilitic roseola - an irregular or rounded spot of a pale pink color, which is more often present on the sides of the body.

Syphilis of the mucous membranes. First of all, these are pharyngitis and tonsillitis. Syphilides are able to spread to the oral mucosa, tongue, tonsils, pharynx, vocal cords. Most common:

pharyngitis. In the case of the development of syphilis in the region of the vocal cords, hoarseness may appear up to the complete disappearance of the voice;

pustular angina. Manifested by pustular lesions of the mucous membrane in the throat area;

papular angina. A large number of papules appear in the throat area, which begin to merge, and then ulcerate and become covered with erosions;

erythematous angina. Syphilides are present on the tonsils and soft palate as bluish-red erythema.

Baldness. There may be two types. Focal - is a small rounded areas without hair on the eyebrows, mustache, beard, head. Diffuse alopecia is a profuse loss of hair on the head. Hair grows back 2-3 months after the start of treatment for the disease.

Complications of secondary syphilis. The most severe complication of the secondary period of syphilis is the transition of the disease to the tertiary period, in which neurosyphilis and its accompanying complications develop.

Tertiary syphilis

After years or decades, after the end of the secondary period of syphilis, treponemas begin to transform into L-forms and cysts, gradually starting to destroy internal systems and organs.

Syphilides of the skin of the Tertiary period

Gummy is a sedentary node that has the size of a pigeon's egg or walnut and is located deep under the skin. Growing, the gumma begins to ulcerate, and after it heals completely, a scar appears on the skin. In the absence of adequate treatment, such a gumma may be present for several years.

Tubercular is a dense, painless, burgundy-colored tubercle that lies in the skin. In some cases, these bumps can group together, forming garlands that resemble scattered shot. After the disappearance of syphilis, scars remain.

Syphilis of the mucous membranes of the tertiary period

First of all, they are represented by a variety of gums, which ulcerate and destroy soft tissues, cartilage and bones, leading to persistent body deformities (malformations).

Gumma pharynx - accompanied by disorders and painful sensations, in which swallowing is difficult.

Gumma of the tongue - there are 2 main forms of pathologies of the tongue in tertiary syphilis: sclerosing glossitis - the tongue loses its mobility, becomes dense, after which it shrinks and completely atrophies (the ability to swallow and chew food is impaired, speech suffers); gummy glossitis - small ulcerations on the mucous membrane of the tongue.

Gumma soft palate. Gumma appears in the thickness of the sky, due to which it becomes motionless, dense and has a dark red color. Subsequently, there is a breakthrough of gumma in several places at the same time, ulcers that do not heal for a long time appear.

Nose gum. Destruction of the bridge of the nose or hard palate, causing deformation of the nose (falling through), leading to food entering the nasal cavity.

Complications of the tertiary period of syphilis:

The formation of gums on the internal organs (stomach, aorta, liver), which, when developed, cause severe failure or sudden death.

Neurosyphilis - accompanied by paresis, dementia, paralysis.

Features of the symptoms of syphilis in men and women

The secondary and tertiary period has almost the same symptoms. Differences in symptoms for men and women are present only in the primary period, when a hard chancre appears on the genitals:

chancre on the cervix. Signs of syphilis, with the location of a hard chancre on the uterus in women, are practically absent and can only be detected during a gynecological examination;

gangrenous chancre on the penis - there is a possibility of self-amputation of the distal part of the penis;

a chancre in the urethra is the first sign of syphilis in a male, which is manifested by discharge from the urethra, a dense penis and an inguinal bubo.

Atypical syphilis

This is latent syphilis. This form of the disease is characterized by an imperceptible course for the patient and can only be diagnosed with the help of tests, while the carrier can infect others.

Today, in the world, venereologists are increasingly faced with cases of latent syphilis, which is due to the widespread use of antibiotics in cases where the first signs of syphilis could not be diagnosed and the patient began to treat the disease on his own. In most cases, with the help of antibiotics, they begin to treat stomatitis, SARS, tonsillitis. Also, during the diagnosis, secondary infections (chlamydia, gonorrhea, trichomoniasis) can be detected, in such cases, the doctor prescribes antibiotics to treat these STDs. As a result, syphilis is not treated and goes into a latent form.

Transfusion. It is distinguished by the absence of a primary period and a hard chancre and begins with secondary syphilis, from the moment of transfusion of infected blood (2-2.5 months).

Erased. There are no symptoms of the secondary period of syphilis, or they are present, but almost invisible. After that, the disease turns into asymptomatic meningitis, neurosyphilis.

Malignant. The rapid course of the disease, which is accompanied by severe exhaustion, a decrease in hemoglobin and gangrene of the chancre.

congenital syphilis

A woman who is infected with syphilis can pass it on hereditarily, down to her grandchildren and great-grandchildren.

Early syphilis - earthy skin color, severe exhaustion, continuous crying, deformation of the baby's skull.

Late syphilis - manifested by the so-called Hutchinson triad: keratitis, labyrinth symptoms (dizziness, deafness), semilunar edges of the teeth.

Treatment of syphilis

Which doctor should be consulted about the treatment of syphilis?

The treatment of people with syphilis is carried out by a dermatovenereologist, and it is necessary to contact a dermatovenereological dispensary.

How long does it take to cure syphilis?

Syphilis requires long-term treatment. If the disease was detected at the primary stage, then the treatment will take about 2-3 months, while it should be noted that the treatment should be continuous. If syphilis was diagnosed at the secondary stage, then its treatment can take over 2 years. For the period of treatment, active sexual life is prohibited, and the whole family and close circle of the patient must undergo preventive treatment.

What are the folk remedies for the treatment of syphilis?

In the presence of syphilis, it is categorically contraindicated to engage in self-medication or treatment with folk remedies. Such a “treatment” is not only dangerous and ineffective, but also makes it difficult to diagnose the disease, blurring the clinical picture of the pathology. In addition, the effectiveness of therapy and the cure of the disease is determined not by the absence of symptoms, but by laboratory data. Also, in many cases it is required hospital treatment and not homemade.

What drugs are used to treat syphilis?

The most effective method of treatment is the introduction of water-soluble penicillins into the body. Such therapy is carried out in a hospital for 24 days with injections every 3 hours. The causative agent of syphilis is quite sensitive to antibiotics of the penicillin group, but there is a possibility of an allergic reaction to these drugs or the ineffectiveness of such therapy. In this case, penicillin is replaced with drugs of the tetracycline, macrolide, fluoroquinolone group. In addition to antibiotics, natural immunity stimulants, vitamins, and immunostimulants are also indicated for syphilis.

How is preventive treatment of the family of a patient with syphilis carried out?

Syphilis is a highly contagious infection that has a high probability of sexual transmission, but in the presence of skin manifestations of syphilis, the risk of infection increases significantly. Therefore, if there is a patient with syphilis in the house, it is necessary to minimize the risk of transmission of the disease in the household. For this, the patient must have individual dishes, linen and toiletries. It is also necessary to exclude bodily contacts of the patient with family members if the patient is at the stage of contagiousness.

How to plan a pregnancy if a woman has had syphilis?

To avoid congenital syphilis in a child, a pregnant woman should be examined by a doctor several times. If a woman planning a pregnancy has been successfully treated and suffered from syphilis, is no longer registered with a dermatovenerologic dispensary, you still need to consult a doctor and carry out preventive therapy.

Syphilis (syphilis) refers to infectious diseases transmitted in most cases sexually. The causative agent of syphilis is a spiral-shaped microorganism Treponema pallidum(pale treponema), is very vulnerable in the external environment, multiplies rapidly in the human body. Incubation period, that is time from infection to first symptoms, approximately 4-6 weeks. It can be shortened to 8 days or lengthened to 180 with concomitant sexually transmitted diseases (,), if the patient is weakened by an immunodeficiency state () or took antibiotics. In the latter case, the primary manifestations of syphilis may be absent altogether.

Regardless of the length of the incubation period, the patient at this time is already infected with syphilis and is dangerous to others as a source of infection.

How can you get syphilis?

Syphilis is transmitted mainly through sexual contact - up to 98% of all cases of infection. The pathogen enters the body through defects in the skin or mucous membranes of the genitals, anorectal loci, mouth. However, approximately 20% of sexual partners who have been in contact with patients with syphilis remain in good health. Risk of infection significantly reduced if there are no conditions necessary for the penetration of infection - microtrauma and a sufficient amount of infectious material; if sexual intercourse with a patient with syphilis was single; if syphilides (morphological manifestations of the disease) have a small contagiousness(the ability to infect). Some people are genetically immune to syphilis because their body produces specific protein substances that can immobilize pale treponema and dissolve their protective membranes.

It is possible to infect the fetus in utero or in childbirth: then congenital syphilis is diagnosed.

The everyday way - through any objects contaminated with infectious material, handshakes or formal kisses - is realized very rarely. The reason is the sensitivity of treponemas: as they dry, the level of their contagiousness drops sharply. Get syphilis through a kiss it is quite possible if one person has syphilitic elements on the lips, oral mucosa or throat, tongue containing a sufficient amount of virulent (that is, live and active) pathogens, and another person has scratches on the skin, for example, after shaving.

The causative agent of syphilis is Treponema pallidum from the Spirochete family.

Very rare routes of transmission of infectious material through medical instruments. Treponemas are unstable even under normal conditions, and when sterilized or treated with conventional disinfectant solutions, they die almost instantly. So all the stories about syphilis infection in gynecological and dental offices most likely belong to the category of oral folk art.

Transmission of syphilis with blood transfusions(blood transfusions) almost never occurs. The fact is that all donors must be tested for syphilis, and those who have not passed the test simply will not be able to donate blood. Even if we assume that there was an incident and there are treponemas in the donor blood, they will die during the preservation of the material in a couple of days. The very presence of a pathogen in the blood is also rare, because Treponema pallidum appears in the bloodstream only during treponemal sepsis» with secondary fresh syphilis. Infection is possible if enough virulent pathogen is transmitted with direct blood transfusion from an infected donor, literally from vein to vein. Given that the indications for the procedure are extremely narrowed, the risk of contracting syphilis through the blood is unlikely.

What increases the risk of contracting syphilis?

• Liquid secretions. Since treponemas prefer a humid environment, mother's milk, weeping syphilitic erosions and ulcers, semen, vaginal discharge contain great amount pathogens and therefore the most contagious. Transmission of infection through saliva is possible if there is syphilides(rash, chancre).
• Elements of dry rash(spots, papules) are less contagious, in abscesses ( pustules) treponema can be found only along the edges of the formations, and in pus they are not at all.
• Disease period. With active syphilis, nonspecific erosions on the cervix and head of the penis, herpetic rash vesicles and any inflammatory manifestations leading to defects in the skin or mucous membranes are contagious. In the period of tertiary syphilis, the possibility of infection through sexual contact is minimal, and papules and gummas specific for this stage are actually not contagious.

With regard to the spread of infection, latent syphilis is the most dangerous: people are unaware of their illness and do not take any measures to protect their partners.

• Accompanying illnesses. Patients with gonorrhea and other STDs are more easily infected with syphilis, since the mucous membranes of the genitals are already damaged by previous inflammations. Treponemas multiply rapidly, but the primary lues is "masked" by the symptoms of other venereal diseases, and the patient becomes epidemically dangerous.
• The state of the immune system. People who are debilitated by chronic diseases are more likely to contract syphilis; AIDS patients; in alcoholics and drug addicts.

Classification

Syphilis can affect any organs and systems, but the manifestations of syphilis depend on the clinical period, symptoms, duration of illness, age of the patient, and other variables. Therefore, the classification seems a little confusing, but in reality it is built very logically.

1. depending from time span elapsed since infection, distinguish early syphilis- up to 5 years, more than 5 years - late syphilis.
2. By typical symptoms syphilis is divided into primary(hard chancre, scleradenitis and lymphadenitis), secondary(papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis) and tertiary(gummas, damage to internal organs, bone and joint systems, late neurosyphilis).

chancre - an ulcer that develops at the site of introduction of the causative agent of syphilis

1. primary syphilis, according to blood test results, may be seronegative and seropositive. Secondary according to the main symptoms are divided into stages of syphilis - fresh and latent (recurrent), tertiary are differentiated as active and latent syphilis, when treponemas are in the form of cysts.
2. By preference damage to systems and organs: neurosyphilis and visceral (organ) syphilis.
3. Separately - fetal syphilis and congenital late syphilis.

Primary syphilis

After the end of the incubation period, the characteristic first signs appear. At the site of penetration of treponema, a specific rounded erosion or ulcer is formed, with a hard, smooth bottom, “tucked” edges. The sizes of formations can vary from a couple of mm to several centimeters. Hard chancres can disappear without treatment. Erosions heal without a trace, ulcers leave flat scars.

Disappeared chancres do not mean the end of the disease: primary syphilis only passes into a latent form, during which the patient is still contagious to sexual partners.

in the figure: chancres of genital localization in men and women

After the formation of a hard chancre, after 1-2 weeks begins local enlargement of lymph nodes. When palpated, they are dense, painless, mobile; one always bigger size than the rest. After another 2 weeks it becomes positive serum (serological) reaction to syphilis, from this point on, primary syphilis passes from the seronegative stage to the seropositive stage. The end of the primary period: the body temperature may rise to 37.8 - 380, there are sleep disturbances, muscle and headaches, aching joints. Available dense swelling of the labia (in women), head of the penis and scrotum in men.

Secondary syphilis

The secondary period begins about 5-9 weeks after the formation of a hard chancre, and lasts 3-5 years. Main symptoms syphilis at this stage - skin manifestations (rash), which appears with syphilitic bacteremia; wide warts, leukoderma and alopecia, nail damage, syphilitic tonsillitis. Present generalized lymphadenitis: the nodes are dense, painless, the skin above them is of normal temperature ("cold" syphilitic lymphadenitis). Most patients do not notice any special deviations in well-being, but the temperature may rise to 37-37.50, runny nose and sore throat. Because of these manifestations, the onset of secondary syphilis can be confused with a common cold, but at this time, lues affects all body systems.

syphilitic rash

The main signs of a rash (secondary fresh syphilis):

• The formations are dense, the edges are clear;
• The shape is correct, rounded;
• Not prone to merging;
• Do not peel off in the center;
• Located on visible mucous membranes and over the entire surface of the body, even on the palms and feet;
• No itching and soreness;
• Disappear without treatment, do not leave scars on the skin or mucous membranes.

accepted in dermatology special names for morphological elements of the rash that can remain unchanged or transform in a certain order. First on the list - spot(macula), may progress to stage tubercle(papula) bubble(vesicula), which opens with the formation erosion or turns into abscess(pustula), and when the process spreads deep into ulcer. All of the listed elements disappear without a trace, unlike erosions (after healing, a stain first forms) and ulcers (the outcome is scarring). Thus, it is possible to find out from trace marks on the skin what the primary morphological element was, or to predict the development and outcome of already existing skin manifestations.

For secondary fresh syphilis, the first signs are numerous pinpoint hemorrhages in the skin and mucous membranes; profuse rashes in the form of rounded pink spots(roseolaе), symmetrical and bright, randomly located - roseolous rash. After 8-10 weeks, the spots turn pale and disappear without treatment, and fresh syphilis becomes secondary. hidden syphilis flowing with exacerbations and remissions.

For the acute stage ( recurrent syphilis) is characterized by a preferential localization of the elements of the rash on the skin of the extensor surfaces of the arms and legs, in the folds (groin, under the mammary glands, between the buttocks) and on the mucous membranes. The spots are much smaller, their color is more faded. The spots are combined with a papular and pustular rash, which is more often observed in debilitated patients. At the time of remission, all skin manifestations disappear. In the recurrent period, patients are especially contagious, even through household contacts.

Rash with secondary acute syphilis polymorphic: consists simultaneously of spots, papules and pustules. Elements group and merge, forming rings, garlands and semi-arcs, which are called lenticular syphilides. After their disappearance, pigmentation remains. At this stage, the diagnosis of syphilis by external symptoms is difficult for a non-professional, since secondary recurrent syphilis can be similar to almost any skin disease.

Lenticular rash in secondary recurrent syphilis

Pustular (pustular) rash with secondary syphilis

Pustular syphilis is a sign of a malignant ongoing disease. More often observed during the period of secondary fresh syphilis, but one of the varieties - ecthymatous- characteristic of secondary exacerbated syphilis. Ecthymes appear in debilitated patients approximately 5-6 months from the time of infection. They are located asymmetrically, usually on the shins in front, less often on the skin of the trunk and face. Syphilides number 5 - 10, rounded, about 3 cm in diameter, with a deep abscess in the center. A gray-black crust forms above the pustule, below it there is an ulcer with necrotic masses and dense steep edges: the shape of the ecthyma resembles funnels. After that, deep dark scars remain, which eventually lose their pigmentation and become white with a pearly tint.

Necrotic ulcers from pustular syphilides, secondary-tertiary stages of syphilis

Ecthymes can go into rupioid syphilides, with the spread of ulceration and disintegration of tissues outward and deep. Centered rupees multilayer "oyster" crusts are formed, surrounded by an annular ulcer; outside - a dense roller of a reddish-violet color. Ecthymas and rupees are not contagious, during this period all serological tests for syphilis are negative.

Acne syphilides - abscesses 1-2 mm in size, localized in the hair follicles or inside the sebaceous glands. Rashes are localized on the back, chest, limbs; heal with the formation of small pigmented scars. Smallpox syphilides are not associated with hair follicles, they are lentil-shaped. Dense at the base, copper-red color. syphilis similar to impetigo- purulent inflammation of the skin. It occurs on the face and scalp, pustules are 5-7 mm in size.

Other manifestations of secondary syphilis

Syphilitic warts similar to warts with a wide base, often formed in the fold between the buttocks and in the anus, under the armpits and between the toes, near the navel. In women - under the breast, in men - near the root of the penis and on the scrotum.

Pigmentary syphilide(spotted leukoderma literally translated from Latin - " White skin"). White spots up to 1 cm in size appear on the pigmented surface, which are located on the neck, for which they received the romantic name "Venus' necklace". Leukoderma is determined after 5-6 months. after infection with syphilis. Possible localization on the back and lower back, abdomen, arms, on the front edge of the armpits. The spots are not painful, do not peel off and do not become inflamed; remain unchanged for a long time, even after specific treatment for syphilis.

Syphilitic alopecia(alopecia). Hair loss can be localized or cover large areas of the scalp and body. Small foci of incomplete alopecia are often observed on the head, with rounded irregular outlines, mainly located on the back of the head and temples. On the face, first of all, attention is paid to the eyebrows: with syphilis, the hairs first fall out from their inner part, located closer to the nose. These signs marked the beginning of visual diagnostics and became known as " omnibus syndrome". In the later stages of syphilis, a person loses absolutely all hair, even vellus.

Syphilitic angina- the result of damage to the mucous membrane of the throat. Small (0.5 cm) spotty syphilides appear on the tonsils and soft palate, they are visible as bluish-red foci of sharp outlines; grow up to 2 cm, merge and form plaques. The color in the center quickly changes, acquiring a grayish-white opal shade; the edges become scalloped, but retain the density and original color. Syphilides can cause pain during swallowing, a feeling of dryness and constant tickling in the throat. Occur along with a papular rash during the period of fresh secondary syphilis, or as an independent sign of secondary exacerbated syphilis.

manifestations of syphilis on the lips (chancre) and tongue

Syphilides on the tongue, in the corners of the mouth due to constant irritation, they grow and rise above the mucous membranes and healthy skin, dense, the surface is grayish in color. May become covered with erosions or ulcerate, causing pain. papular syphilis on the vocal cords initially manifested by hoarseness of voice, later a complete loss of voice is possible - aphonia.

syphilitic nail damage(onychia and paronychia): papules are localized under the bed and at the base of the nail, visible as reddish-brown spots. Then the nail plate above them becomes whitish and brittle, begins to crumble. With purulent syphilis, severe pain is felt, the nail moves away from the bed. Subsequently, depressions in the form of craters form at the base, the nail thickens three or four times compared to the norm.

Tertiary period of syphilis

Tertiary syphilis is manifested by focal destruction of the mucous membranes and skin, any parenchymal or hollow organs, large joints, and the nervous system. Main features - papular rashes and gummas degrading with rough scarring. Tertiary syphilis is rarely defined, develops within 5-15 years if no treatment has been carried out. Asymptomatic period ( latent syphilis) can last for more than two decades, is only diagnosed by serological tests between secondary and tertiary syphilis.

what can affect advanced syphilis

Papular elements dense and rounded, up to 1 cm in size. They are located in the depths of the skin, which becomes bluish-red above the papules. Papules appear at different times, grouped into arcs, rings, elongated garlands. Typical for tertiary syphilis focus rashes: each element is determined separately and in its stage of development. The disintegration of papular syphilomas begins from the center of the tubercle: rounded ulcers appear, the edges are sheer, there is necrosis at the bottom, and a dense roller along the periphery. After healing, small dense scars with a pigmented border remain.

Serpinginous syphilides are grouped papules that are in different stages of development and spread to large areas of the skin. New formations appear along the periphery, merge with the old ones, which at this time already ulcerate and scar. The sickle-shaped process seems to crawl to healthy areas of the skin, leaving a trail of mosaic scars and pigmentation foci. Numerous tubercular seals create a colorful picture true polymorphic rash, which is visible in the late periods of syphilis: different sizes, different morphological stages of the same elements - papules.

syphilitic gumma on the face

syphilitic gumma. At first it is a dense knot, which is located in the depth of the skin or under it, mobile, up to 1.5 cm in size, painless. After 2-4 weeks, the gumma is fixed relative to the skin and rises above it as a rounded dark red tumor. A softening appears in the center, then a hole forms and a sticky mass comes out. In place of the gumma, a deep ulcer is formed, which can grow along the periphery and spread along the arc ( serping gummy syphilis), and in the "old" areas there is healing with the appearance of retracted scars, and in the new ones - ulceration.

More often syphilitic gummas are located alone and are localized on the face, near the joints, on the legs in front. Closely located syphilides can merge to form gum pad and turn into impressive ulcers with compacted, uneven edges. In debilitated patients, with a combination of syphilis with HIV, gonorrhea, viral hepatitis, gum may grow in depth - mutilating or irradiating gumma. They disfigure the appearance, can even lead to the loss of an eye, testicle, perforation and death of the nose.

gummas in the mouth and inside the nose disintegrate with destruction of the palate, tongue and nasal septum. Defects appear: fistulas between the cavities of the nose and mouth (nasal voice, food can get into the nose), narrowing of the orifice(difficulty swallowing), cosmetic problems - failed saddle nose. Language first increases and becomes bumpy, after scarring it wrinkles, it becomes difficult for the patient to talk.

Visceral and neurosyphilis

At visceral tertiary syphilis, organ damage is observed, with the development neurosyphilis- symptoms from the central nervous system (CNS). During the secondary period, early syphilis of the central nervous system appears; it affects the brain, its vessels and membranes ( meningitis and meningoencephalitis). In the tertiary period, manifestations of late neurosyphilis are observed, these include atrophy of the optic nerve, dorsal tabes and progressive paralysis.

Dorsal tabes– Manifestation of syphilis of the spinal cord: the patient literally does not feel the ground under his feet and cannot walk with his eyes closed.

progressive paralysis It manifests itself as much as one and a half to two decades after the onset of the disease. The main symptoms are mental disorders, from irritability and memory impairment to delusional states and dementia.

optic nerve atrophy: with syphilis, one side is first affected, a little later vision deteriorates in the other eye.

Gummas affecting the head brain are rarely observed. According to clinical signs, they are similar to tumors and are expressed by symptoms of brain compression - increased intracranial pressure, rare pulse, nausea and vomiting, prolonged headaches.

bone destruction in syphilis

Among the visceral forms predominates syphilis of the heart and blood vessels(up to 94% of cases). Syphilitic mesaortitis- inflammation of the muscular wall of the ascending and thoracic aorta. It often occurs in men, accompanied by an expansion of the artery and phenomena of cerebral ischemia (dizziness and fainting after exercise).

Syphilis liver(6%) leads to the development of hepatitis and liver failure. The total proportion of syphilis of the stomach and intestines, kidneys, endocrine glands and lungs does not exceed 2%. Bones and joints: arthritis, osteomyelitis and osteoporosis, the consequences of syphilis - irreversible deformities and blockade of joint mobility.

congenital syphilis

Syphilis can be transmitted during pregnancy, from an infected mother to her baby at 10-16 weeks. Frequent complications are spontaneous abortions and fetal death before delivery. Congenital syphilis according to time criteria and symptoms is divided into early and late.

early congenital syphilis

Children with a clear lack of weight, with wrinkled and flabby skin, resemble little old people. Deformation skull and its facial part ("Olympic forehead") is often combined with dropsy of the brain, meningitis. Present keratitis- inflammation of the cornea of ​​​​the eyes, loss of eyelashes and eyebrows is visible. Children aged 1-2 years develop syphilitic rash, localized around the genitals, anus, on the face and mucous membranes of the throat, mouth, nose. A healing rash forms scarring: scars that look like white rays around the mouth are a sign of congenital lues.

syphilitic pemphigus- a rash of vesicles, observed in a newborn a few hours or days after birth. It is localized on the palms, the skin of the feet, on the folds of the forearms - from the hands to the elbows, on the trunk.

Rhinitis, the causes of its occurrence are syphilides of the nasal mucosa. Small purulent discharge appears, forming crusts around the nostrils. Breathing through the nose becomes problematic, the child is forced to breathe only through the mouth.

Osteochondritis, periostitis- inflammation and destruction of bones, periosteum, cartilage. It is most often found on the legs and arms. There is local swelling, pain and muscle tension; then paralysis develops. During early congenital syphilis, destruction of the skeletal system is diagnosed in 80% of cases.

late congenital syphilis

late form manifests itself in the age period of 10-16 years. The main symptoms are visual impairment with the possible development of complete blindness, inflammation of the inner ear (labyrinthitis), followed by deafness. Skin and visceral gummas are complicated by functional disorders of organs and scars that disfigure the appearance. Deformation of teeth, bones: the edges of the upper incisors have semilunar notches, the legs are bent, due to the destruction of the septum, the nose is deformed (saddle-shaped). Frequent problems with the endocrine system. The main manifestations of neurosyphilis are tabes dorsalis, epilepsy, speech disorders, progressive paralysis.

Congenital syphilis is characterized by a triad of signs Getchinson:

• teeth with an arched edge;
• cloudy cornea and photophobia;
• labyrinthitis - tinnitus, loss of orientation in space, hearing loss.

How is syphilis diagnosed?

Diagnosis of syphilis is based on clinical manifestations characteristic of different forms and stages of the disease, and laboratory tests. Blood take to conduct a serological (serum) test for syphilis. To neutralize teponems in the human body, specific proteins are produced - which are determined in the blood serum of an infected or sick person with syphilis.

RW analysis blood test (Wassermann reaction) is considered obsolete. Can often be false positive in tuberculosis, tumors, malaria, systemic disease, and viral infections. Among women- after childbirth, during pregnancy, menstruation. The use of alcohol, fatty foods, and certain drugs before donating blood for RW can also be the cause of an unreliable interpretation of the analysis for syphilis.

It is based on the ability of antibodies (immunoglobulins IgM and IgG) present in the blood of those infected with syphilis to interact with antigen proteins. If the reaction has passed - analysis positive, that is, the causative agents of syphilis are found in the body of this person. Negative ELISA - no antibodies to treponema, no disease or infection.

The method is highly sensitive, applicable for the diagnosis of latent - hidden forms - syphilis and checking people who have been in contact with the patient. positive even before the first signs of syphilis appear (according to IgM - from the end of the incubation period), and can be determined after the complete disappearance of treponema from the body (according to IgG). ELISA for the VRDL antigen, which appears during alteration (“damage”) of cells due to syphilis, is used to monitor the effectiveness of treatment regimens.

RPHA (passive hemagglutination reaction)- bonding of erythrocytes that have antigens on their surface Treponema pallidum with specific antibody proteins. RPHA is positive in case of illness or infection with syphilis. Remains positive throughout the patient's life even after complete recovery. To exclude a false positive response, RPHA is supplemented with ELISA and PCR tests.

Direct Methods laboratory tests help to identify the causative microorganism, and not antibodies to it. With the help, you can determine the DNA of treponema in the biomaterial. Microscopy smear from serous discharge syphilitic rash- a technique for visual detection of treponemas.

Treatment and prevention

Treatment of syphilis is carried out taking into account the clinical stages of the disease and the susceptibility of patients to drugs. Seronegative early syphilis is treated more easily, with late variants of the disease, even the most modern therapy is not able to eliminate consequences of syphilis- scars, organ dysfunction, bone deformities and disorders of the nervous system.

There are two main methods of treatment for syphilis: continuous(permanent) and intermittent(course). In the process, control tests of urine and blood are required, the well-being of patients and the work of organ systems are monitored. Preference is given to complex therapy, which includes:

• Antibiotics(specific treatment of syphilis);
• Restorative(immunomodulators, proteolytic enzymes, vitamin-mineral complexes);
• Symptomatic drugs (painkillers, anti-inflammatory, hepatoprotectors).

Assign nutrition with an increase in the proportion of complete proteins and a limited amount of fat, reduce physical exercise. Prohibit sex, smoking and alcohol.

Psychotrauma, stress and insomnia adversely affect the treatment of syphilis.

Patients with early latent and contagious syphilis undergo the first course of 14-25 days in the clinic, then they are treated on an outpatient basis. Treat syphilis with penicillin antibiotics- intramuscularly injected sodium or potassium salt of benzylpenicillin, bicillins 1-5, phenoxymethylpenicillin. A single dose is calculated according to the weight of the patient; if there are inflammatory signs in the cerebrospinal fluid (spinal fluid), then the dosage is increased by 20%. The duration of the entire course is determined according to the stage and severity of the disease.

permanent method: the starting course for seronegative primary syphilis will take 40-68 days; seropositive 76-125; secondary fresh syphilis 100-157.

course treatment: tetracyclines are added to penicillins ( doxycycline) or macrolides ( azithromycin), preparations based on bismuth - bismovrol, biyoquinol, and iodine - potassium or sodium iodide, calcium iodine. Cyanocobalamin (vit. B-12) and solution coamide enhance the action of penicillin, increase the concentration of the antibiotic in the blood. Injections of pyrogenal or prodigiosan, autohemotherapy, aloe are used as means of non-specific therapy for syphilis, which increase resistance to infection.

During pregnancy, syphilis is treated only with penicillin antibiotics, without drugs with bismuth salts.

Proactive(preventive) treatment: carried out as in the case of seronegative primary syphilis, if sexual contact with the infected was 2-16 weeks ago. One course of penicillin is used for medical prophylaxis of syphilis if the contact was no more than 2 weeks ago.

Prevention of syphilis- Identification of the infected and the range of their sexual partners, preventive treatment and personal hygiene after sexual intercourse. Surveys for syphilis of people belonging to risk groups - physicians, teachers, staff of kindergartens and catering establishments.

Video: syphilis in the program “Live healthy!”

Video: syphilis in the encyclopedia of STDs