home Calculators How does syphilis manifest and after how long? Unsuccessful sexual partner? What are the first signs of syphilis

How does syphilis manifest and after how long? Unsuccessful sexual partner? What are the first signs of syphilis

Signs of syphilis in humans appear only several weeks after infection, because the disease is characterized by a long incubation period. Without knowing about the disease, its carrier can continue to be sexually active, introducing the infection into the body of random partners, and not even realize it.

Symptoms of secondary syphilis

During the period of secondary syphilis, the disease, unlike the initial stage, spreads through the vessels of the whole body with blood and lymph and manifests itself various symptoms. The first signs of syphilis of the secondary period appear in people 40-50 days after the formation of chancre. It all starts with painless enlargement lymph nodes, which are cold and hard to the touch, while the person feels unwell and weak. A runny nose and cough, body temperature elevated to 37.5°C can also be considered the first signs of syphilis.

But the characteristic symptoms of the disease are specific formations: papillomas, nodules and spots (syphilides) on the mucous membranes of organs and skin. Most often with secondary fresh illness Roseola syphilide appears on the stomach and sides of a person’s body (round and smooth roseola spots, pale Pink colour). Syphilitic symptom is often hair loss on different areas scalp - alopecia, or baldness. After treatment of syphilis, the hairline is partially restored.

On the 60th day of the secondary period of syphilis, its signs (rash) disappear, because the immune system the body fights infection. But the disease continues to occur hidden. If a person catches a cold or experiences stress, a weak immune system will not be able to resist the disease, and a relapse will soon occur. It will manifest itself as one or more of the former syphilitic symptoms. They can be roseola on the body and mucous membranes of the palate or papular syphilide, the photo of which is below.

The last sign is hemispherical nodules (papules) with a smooth and later flaky surface. They are localized not only on the genitals, but also on the palms and soles of the patient. In the clinic (clinical picture) of syphilis at this time, chancre of the genital organs may occur (a sign more characteristic of its first period).

Other manifestations of secondary syphilis, which appear less frequently, include leucoderma (light, oval-shaped spots localized in the armpits and neck) and condylomas lata (warts) in the anus and genital area. People can have all these symptoms for several years; if nothing is done against them, tertiary syphilis develops in men and women.

Diagnosis and treatment

When diagnosing the disease early, doctors conduct an external examination of the person’s body and pay attention to the symptoms of syphilis (photo). Often at this time, doctors misdiagnose patients, because... many skin diseases have symptoms similar to syphilis. Doctors mistake ulcers and rashes in the genital area for signs of a dangerous infection.

For example, with basal cell skin cancer, a dense tumor ridge with a gray-brown crust in the center is formed, and with scabies ecthyma, the glans penis becomes ulcerated. These phenomena resemble (syphiloma).

Sometimes you can mistake, for example, primary syphiloma of the hard palate for manifestations of tonsillitis, and a chancre ulcer on the lip for herpes.

In the first and second periods of syphilis, if present on the human body visible signs For diseases, doctors use a diagnostic method such as microscopy, i.e. take smears from the surface of ulcers, papules and erosions and identify them under a microscope dark background Treponema pallidum- the causative agent of the disease. During the latent period of syphilis, such a study is not carried out.

The most common method for diagnosing the disease in its first stages is serological reactions of human blood serum for the presence of infection antibodies. The nonspecific Wasserman reaction is positive if, as a result of the test, white flakes appear in the test tube. This method is not always reliable, therefore laboratories additionally carry out a clarifying specific passive hemagglutination reaction (RPHA). It occurs only in the presence of Treponema pallidum antibodies in the blood.

In the tertiary period of syphilis, it is possible to carry out the diagnostic methods described above, but the presence of gummas (purulent compactions) on the human body indicates the presence of the disease in the body.

Properties of the pathogen

The causative agent of syphilis is a pale spirochete (treponema), which easily enters the body through skin lesions (wounds, ulcers). It has the shape of a spiral and can move both rotationally and flexibly. Once in the lymphatic vessels, the spirochete actively multiplies by division. Treponema pallidum accumulates in large quantities in the blood only in the second period of the disease, so only at this stage does a rash appear on the body and mucous membranes of a person.

In case of syphilis, this microorganism exhibits resistance to low temperatures for several days, and the best condition for its vital activity is a humid and warm environment (37°C). The spirochete dies under the influence of acidic and alkaline solutions, at a temperature of 55°C - after 15 minutes, and at 100°C - immediately.

Syphilis infection

Syphilis is an infection that is 97% transmitted from a sick person to a healthy person through sexual contact through semen. This disease can be contracted by kissing (through saliva), by using common hygiene items with a sick person (straight razor, Toothbrush) or one syringe, which is typical for drug addicts. IN medical institution Treponema infection is rare during direct blood transfusions.

Syphilis can be transmitted to an unborn child by a sick pregnant woman or a nursing mother while breastfeeding. Sometimes household cases of infection are recorded, which can occur through a handshake or sharing damp towel.

Complications

With each subsequent week after the first symptoms of syphilis appear, the infection penetrates into the body more and more. If a person does not pay attention to the appearance of a rash, ulcers in the area of the glans penis, etc., the untreated disease causes a number of complications. It leads to damage to the central nervous system(CNS). Over time, disorders occur in the musculoskeletal system, the organs of hearing, vision, and breathing suffer. Ulcers and syphilides leave scars for life.

Classification

After treponema enters the body, syphilis goes through several stages in its development:

Primary seronegative (incubation) and seropositive.
Secondary (fresh, hidden, recurrent).
Tertiary (active, latent, visceral, neurosyphilis).

The disease can be congenital. All stages of syphilis pass from one to another.

Incubation period of the disease

The period lasts from the moment of contracting the infection until the first sign of manifestation of the disease - chancre (2-6 weeks). If a person takes antibiotics, the incubation period increases to several months. Test results at this time will be negative.

Primary period clinic

The disease always manifests itself at the site of infection (in the mouth, on the genitals) as a round ulcer (chancre). Since the ulcer does not hurt, a person often does not notice it. After 5 weeks, the chancre heals, leaving a scar in its place. The bacteria then invade the lymph nodes, which enlarge in response. This sign means that the second period of syphilis is beginning.

Epidemiology of syphilis

In the 90s of the 20th century, a surge in the incidence of syphilis was observed in Russia. The highest rate of infection was recorded in 1997. It was 277.3 cases per 100,000 people. In those years, the number of prostitutes and drug addicts in the country increased, and those who became ill were self-medicating. Since 1998, the incidence began to decline sharply; 30% fewer cases were recorded in 2003-2004. From 2007 to 2013, this figure either increased or decreased. Now there are 20.4 registered cases of syphilis per 100,000 population of Russia, which is 10.4% more than in 2013.

Pathogenesis of syphilis

Syphilis is a long-term infection caused by Treponema pallidum and over time affects all human tissues and organs. The disease develops in the body in stages. The symptoms of the first period are the same for all patients (with slight variations); at other stages, the course of the infection varies individually. A feature of syphilis is the sequential change of active and latent stages.

Screening

Screening (examination of the population for infection) plays a positive role in identifying syphilis and reducing morbidity. It allows you to identify the disease early stage. Screening is carried out when applying for work in children's institutions and institutions Catering. It is mandatory for pregnant women (prevention of congenital syphilis) and donors. Specialists examine human blood by conducting serological reactions in laboratory conditions.

Reasons for development

Syphilis can be infected in different ways, but it develops in the body if a person does not treat the disease from the moment the first symptoms appear. This happens because many people are embarrassed to see doctors. They either self-medicate, which is not always correct, or ignore the disease.

A severe complication of infection is damage to the central nervous system (neurosyphilis), which can appear at any stage of the disease. The development of neurosyphilis occurs in the first few years from the moment of infection; later damage to the central nervous system is attributed to the 7-8th year of untreated syphilis. At this time there are progressive paralysis and tabes dorsalis.

Treatment of syphilis

On early stages illness does not require hospitalization. The infection is treated with antibiotics - Penicillin, Erythromycin. If neurosyphilis occurs, patients are given intramuscular antibacterial drugs and their body temperature is artificially increased. At the third stage of syphilis, not only antibiotics are used, but also bismuth-based drugs, and treatment is carried out only in a hospital setting. Together with the sick person, his sexual partners should be treated. Early contact with doctors guarantees a quick recovery.

The symptoms of syphilis are so varied that it is quite difficult to understand them right away. As the disease develops, the manifestations change fundamentally: from a painless ulcer in the first stage to severe mental disorders in an advanced form. The same symptom differs in different patients depending on the immune system, place of occurrence, or even the gender of the person.

It is further complicated by the fact that each symptom can be easily confused with manifestations of other diseases: among medical students, when studying syphilis, the part associated with differential diagnosis, takes up a significant part of the course.

How longer infection is in the body - the deeper it penetrates and the more serious the damage it causes. In the later stages, the consequences of the disease become irreversible. Knowing how syphilis manifests itself, you can save the life of both the patient and his loved ones.

The content of the article:

Development of symptoms by periods: what, where and when it appears

The time between infection and the appearance of the first signs of syphilis depends on the person's immunity and on the method by which the bacteria were transmitted. As a rule, this occurs after a month, but manifestations may appear earlier or later, or be absent altogether.

The very first visible symptom syphilis is an ulcer that appears in the place where syphilitic bacteria have invaded. At the same time, the lymph node located nearby becomes inflamed, and behind it - the lymphatic vessel. For doctors, this stage is distinguished in the primary period.

After 6−7 weeks the ulcer goes away, but the inflammation spreads to all lymph nodes, and a rash appears. This is how the secondary period begins. It lasts from 2 to 4 years.

Hard chancre on the genitals

During this time, periods with active manifestations of syphilis alternate undercurrent no symptoms. Rashes of various types and forms appear and disappear several times on the patient’s face and body, all lymph nodes become inflamed, and some internal organs are affected. If these manifestations continue to be ignored and the person does not receive treatment, then syphilis progresses to the final stage - tertiary.

In the tertiary stage the immune system is rebuilt: even a small amount of Treponema pallidum causes a violent reaction: the body surrounds the bacteria with connective tissue. As a result, capsules are formed - tubercles and gummas - the most destructive symptoms of syphilis. Unlike the rash of the previous stage, they no longer go away without a trace. The falling off nose from old jokes is just a gumma that appeared on the face and destroyed the cartilaginous tissue of the nose. Gummas occur both outside and inside the body, which is why many organ systems suffer: cardiovascular, musculoskeletal and others. If the causative agent of the disease penetrates the nervous system, neurosyphilis develops, first manifested by inflammation of the blood vessels in the brain, then by mental disorders and progressive paralysis.

But the disease does not always develop according to the classical scenario. For example, if syphilis bacteria enter the bloodstream bypassing the skin barrier, symptoms begin immediately in the secondary period. Very rarely, but it happens that the only manifestation of the disease immediately becomes the most terrible form - deep damage to the nervous system. Let us consider the features of each stage and possible deviations from the classical development of the disease.

Primary period

The initial symptoms of syphilis are usually manifested by the “classic triad”: a specific ulcer (chancroid), inflammation of the lymph node (lymphadenitis) and lymphatic vessel(lymphangitis). Lymphangitis and lymphadenitis can occur very violently, or they can be barely noticeable.

Chancre usually does not cause much concern in patients: it is painless, solitary, small, and disappears on its own after one and a half to two months. It first appears as a nodule and then turns into an ulcer. It can be any size from a few millimeters to one or two centimeters. Externally it has clear boundaries, round or oval shape, red color (the color of raw meat) and a smooth shiny bottom with scanty discharge.

Chancre can be detected:

on the genitals: penis, vulva, clitoris, cervix, rarely - vaginal walls
on the skin of the perineum, abdomen, thighs, near the anus, on the chest and nipples
on the lips, tongue, palate
on the fingers and toes - if the infection occurred through domestic means.

But any rule has exceptions: hard chancre can be multiple (if at the time of infection the infection entered through several wounds on the skin or mucous membrane), they can hurt (if they are located in the anal or urethra, on the tonsils or fingers, or if another infection is attached to them), their sizes can be gigantic (about the size of a child’s palm) or tiny (several millimeters).

If chancre does not appear or goes unnoticed, then at the primary stage the disease can only be suspected during an examination by a gynecologist (in women) or with a vigilant attitude to health. You should be wary of:

cases of primary syphilis occurs without chancre

unilateral painless sore throat,
painless swelling and redness of the labia,
inflammation of the periungual bed,
cracks in the corners of the mouth and between the fingers.

All this may be the primary manifestation of syphilis.

About a month and a half from the beginning of the primary period, all the patient’s lymph nodes enlarge, body temperature rises, pain in the bones, joints, weakness and malaise appear. This condition begins when many Treponema pallidums are released into the blood at once. A widespread rash appears soon after. This is how the secondary period is designated.

Secondary period

The most characteristic sign of this period is a rash all over the body. It has many forms and manifestations. The most common form is small pink spots or red-brown/pink nodules. The spots and nodules are small: from 1 millimeter to 1 centimeter. The nodules are usually clearly separated from healthy skin and often flake, resembling psoriasis. The spots may merge and have no clear boundaries.

The rashes can be located all over the body. The back, chest, abdomen and limbs are usually affected. Nodular rashes may appear on the palms, neck, nasolabial triangle and scalp. In the latter arrangement they resemble seborrhea.

Usually the first appearance of the rash is the brightest and most abundant. Subsequent attacks of rashes (relapses of the secondary period) are more scarce, often appearing in the form of nodules, baldness and pale spots. Abscesses and ulcers with syphilis appear only if the disease is severe - for example, in weakened patients. The weaker the immune system, the more serious the symptoms will be.

All types of rashes secondary period doctors united under a common name syphilides.

Signs of secondary syphilis Signs of secondary syphilis Signs of secondary syphilis Signs of secondary syphilis

In addition to the rash, the second important symptom is enlargement of all lymph nodes. Enlarged lymph nodes can be easily felt with your fingers: they do not hurt, they are not fused to each other or to the skin.

In addition to the common rash, syphilis can manifest itself:

Soft growths (condylomas lata) in the anus, mouth, armpits, or skin folds. They are shaped like hemorrhoids or warts.
Pustular skin lesions. It is rare, mainly in weakened people. The disease is similar to furunculosis or impetigo.
Baldness, which occurs in the second year of the disease. It is characterized by sudden onset, rapid progression and complete recovery after a few months. Hair thinning is possible on the entire head and throughout the body, and possibly in areas: on the back of the head, temples, eyebrows or eyelashes.
Necklace of Venus. It also appears in the second year of the disease, most often in women. You can recognize this “necklace” from the photo: it looks like a group of rounded yellow or white spots on the neck, up to a centimeter in size. It does not always look like a necklace, and can be located on the back, chest or even stomach. This symptom of syphilis does not immediately go away after treatment and lasts for several months.
Damage to the mucous membranes in the form of spots or nodules, up to a centimeter in size, covered with a whitish coating and often similar to small ulcers.

Internal organs can also be affected, although this is quite rare. Then a person may be bothered by:

night pain in bones ( tibia or skull);
swelling and pain in the joints;
pain in the right hypochondrium;
yellowing of the eyes and skin (with liver damage);
pain in the upper middle part of the abdomen (with damage to the stomach);
pain in the heart and interruptions in its work (with the development of myocarditis).

Defeats internal organs in the secondary period, they most often occur without complications and quickly disappear after treatment.

In the secondary period, it is rare, but damage to the nervous system also occurs: inflammation of the blood vessels and membranes of the brain. The doctor may suspect it during a neurological examination, and confirm it after a puncture of the cerebrospinal fluid.

In contrast to the very characteristic ulcer of the first stage, the signs of syphilis in the secondary period are quite extensive and can be easily confused with other diseases - both infectious and autoimmune. To confirm or refute suspicions, it is necessary to donate blood for the Wasserman reaction: the results of this test become sharply positive precisely at this stage of the disease.

Tertiary period

Symptoms of tertiary syphilis are tubercles and gummas. They appear on the face, torso, limbs and internal organs. When they break down and turn into ulcers, they leave behind rough scars, disfigure a person’s appearance and can destroy him from the inside. All formations of the tertiary period are called syphilomas. They received this name because of their round and relatively large size: “syphiloma” = syphil (syphilis) + oma (tumor). They have no connection with oncological formations - these are inflammatory growths connective tissue, which resemble a tumor only in appearance.

Among the damage to internal organs, the most serious are damage to the cardiovascular, skeletal and nervous systems.

The cardiovascular system

The aorta and aortic valve are most often affected. In the aorta, the wall becomes thinner and an aneurysm is formed - a sac-like protrusion of the wall. It is dangerous because the aneurysm can rupture at any moment and death can occur. An aneurysm is manifested by general weakness, dizziness, and pain in the head.

Damage to the aortic valve prevents its leaflets from closing completely - their shape is distorted. The person develops heart failure. Damage to the valve is manifested by pulsation of blood vessels in the neck, shaking of the head in time with this pulsation, shortness of breath and a “jumping” pulse.

Bone

In the tertiary period, it, like the skin, is affected by gummas. Gummas lead to the destruction of bone and the formation of cavities in it. Bones become brittle and the risk of fractures increases significantly.

Damage to the nervous system

In the tertiary period, it manifests itself in two diseases: tabes dorsalis and progressive paralysis. Both diseases have a severe course - the sensitivity of the limbs and joints are impaired, vision and hearing are affected, and various mental illnesses develop.

Can syphilis occur without symptoms?

Syphilis is characterized by a wave-like course: attacks of active manifestations are replaced by periods without symptoms. There are early (in the secondary period) and late (in the tertiary) latent syphilis. With this type of course, during times of calm, external signs of syphilis are completely absent.

Also, in addition to the classic course, when one period follows another, syphilis can occur without symptoms at all. This is rare and depends on the state of the immune system. If the immune system is very weakened, it “misses” the infection and does not try to protect itself from it. A person finds out that he is sick, either by chance during an examination, or already in the later stages.

It is very important to understand that there are no “frivolous” or “benign” forms of syphilis. The asymptomatic course is no better than the manifested one. In any case, the disease is very dangerous and must be treated! The longer the pathogen is present in the body, the more serious the internal damage will be.

If the symptoms of syphilis have passed, this does not mean that the person has recovered! Without treatment, symptoms will return and your overall health will steadily deteriorate.

Reversible and irreversible manifestations of syphilis

Almost all changes that occur in the body at the primary and secondary stages are reversible, even if they affect internal organs. But if treatment is delayed, the disease can progress to a late stage, at which all its manifestations become a serious problem and can lead to the death of the patient.

Reversible manifestations

These include symptoms of primary syphilis - chancre, as well as part of the secondary - spotted and nodular rashes, baldness, necklace of Venus. All these manifestations - regardless of their location - normally disappear after treatment and most often leave no traces. We can even cure meningitis of early neurosyphilis.

Irreversible manifestations

These include purulent manifestations secondary syphilis, as well as all the symptoms of tertiary syphilis. Purulent lesions vary in size and depth - from small pustules to large ulcers.

When the ulcers go away, they leave scars of the same size. Tubercles and gummas are more dangerous formations. When destroyed, they damage the surrounding tissue, disfigure the patient and can even make him disabled.

How not to confuse syphilis with other diseases

Syphilis occurs under the guise of many other diseases - and this is another danger of this infection. At every stage - even late - an insidious venereal disease can pretend to be something else.

Here is a list of diseases most similar to syphilis. But note: it is not complete at all. Differential diagnosis of syphilis (i.e., ways to distinguish it from other diseases) is a difficult task. For this purpose, the patient is interviewed in detail, a thorough examination is carried out, and most importantly, laboratory tests are prescribed.

It is impossible to independently make a diagnosis from photographs or descriptions of manifestations. For any suspicion you need to contact a venereologist- Nowadays this can be done anonymously.

Chancroid looks like:

	Characteristics of the disease
Chancroid	outwardly similar to its solid “brother”, but is caused by another sexually transmitted pathogen. Quite a rare disease.
Genital herpes	similar to small multiple chancre. But at the same time, itching is almost always observed, which does not occur with syphilitic ulcers.
Lymphogranuloma venereum	similar manifestations to chancroid, but much less common than syphilis
Furuncle	when a secondary infection occurs, the chancre suppurates and may resemble an ordinary boil in appearance
Genital trauma	externally looks like an ulcer and resembles a syphilitic ulcer if located in skin folds	Bartholinitis in women	manifests itself in the form of swelling and redness of the labia. Unlike primary syphilis - painful	Balanoposthitis or phimosis in men	manifestations are similar to ulcers and rashes that appear on the foreskin. This case differs from primary syphilis in its painless course.	Common panaritium	Unlike most manifestations of primary syphilis, chancre-felon is painful and very difficult to distinguish from ordinary felon	Angina	characterized by a unilateral painless course

Secondary syphilis can be confused with:

	Characteristics of the disease
Widespread rash over the entire body	allergic and infectious processes ( Infectious mononucleosis, measles, rubella, scarlet fever and others)
Psoriasis	widespread scaly plaques throughout the body, an autoimmune hereditary (non-contagious) disease
Lichen planus	very similar to psoriasis, also a non-contagious disease
Condylomas lata	resemble genital warts (viral disease) and hemorrhoids
Pustular syphilitic lesions	resemble common acne or pyoderma	Alopecia or baldness	multifactorial disease, often hereditary (in the latter case, it develops with age, gradually and does not recover on its own)	Angina	manifestation of syphilis with damage to the tonsils (bilateral damage)	Aphthous stomatitis	damage to the oral mucosa with the development of small ulcers may be a manifestation of secondary syphilis	Jams in the corners	have bacterial, viral or fungal cause appearance, and are also an element of secondary syphilis	Hoarseness of voice	classic manifestation of laryngitis, may appear with secondary syphilis when affected vocal cords

Tertiary syphilis is similar to:

How does syphilis manifest in men and women: gender differences

There are not so many features that depend on a person’s gender. Sex differences may be due to:

over time of detection;
with a risk of infection;
characteristics of the disease itself;
with complications;
as well as with different social significance of the disease in each gender.

How long it takes for syphilis to appear depends not on gender, but on the characteristics of a particular person’s body. But the disease is often diagnosed in women later - already in the secondary period, about 3 months or more after infection. This is due to the fact that the appearance of chancre in the vagina or cervix usually goes unnoticed.

We will consider the features of the course, complications and social significance for each gender separately.

Manifestations of syphilis in women are unusual. The patient may experience complications associated with chancroid. Female complications of primary syphilis:

swelling of the labia - dense, painless, occurs in the area where a hard chancre has formed;
vulvitis, vulvovaginitis - inflammation of the external genitalia in women; occur if another infection gets into the chancre;
bartholinitis - inflammation of the Bartholin glands; begins if a hard chancre appears next to them and another infection gets into it.

The symptoms of secondary syphilis in women are not much different. The first manifestations are bright and profuse rashes all over the body, which disappear without leaving traces, but appear again after a few months. The following rashes after the “break” are less bright and extensive.

Women are more likely than men to experience special symptom syphilis is the necklace of Venus. These are pale spots in the neck and shoulders, which may be a sign of syphilitic damage to the nervous system.

If we talk about social significance, then according to statistics, it is higher for women than for men. This means that society as a whole suffers more if women suffer from syphilis. This situation is associated with the maternal role of women. If a pregnant woman is infected, then in the primary or secondary periods the probability of transmitting the disease to the child is quite high. And congenital syphilis often leads to disability and death of children at an early age.

Symptoms of syphilis in men

The first symptoms of syphilis in men appear about a month after infection. “Standard” primary syphilis in men manifests itself without any peculiarities. But the complicated course of primary syphilis in men has its own nuances.

Male complications of primary syphilis:

swelling of the scrotum;
swelling of the foreskin;
balanitis and balanoposthitis (inflammation of the head and foreskin, if another infection has entered the chancre);
phimosis (inability to expose the head of the penis - a complication of balanoposthitis);
paraphimosis (when swollen and inflamed foreskin compresses the head of the penis).

Complications of syphilis on the penis and scrotum are directly related to chancre. Swelling and inflammation occur either as an excessive reaction of the body to the invasion of the treponemes themselves, or due to the fact that other bacteria enter the syphilitic ulcer. You can see what complicated syphilis looks like in men on the right - in the hidden photo gallery.

As for the social significance of syphilis in men, it is not as high as the significance of syphilis in women. But it is important to understand that any person who can become a spreader of sexually transmitted infections is responsible for the health of other people.

Latent syphilis is a strange thing: the disease itself is there, but there are no symptoms.

Latent or latent syphilis is a “regime” of the disease in which the infected person does not have any external manifestations of ill health: no syphilitic rashes, no subcutaneous formations and no signs of damage to internal organs.

However, it is important to understand that such dormant syphilis is only a temporary condition. Sooner or later, the disease will become more active and a period of rashes will begin, and then more serious consequences.

The diagnosis of “latent syphilis” cannot be made by photo or external examination - it is made only on the basis of tests.

Why the infection goes unnoticed, why the latent form of syphilis is dangerous and what to do about it - let's figure it out.

When does latent syphilis occur?

There are several scenarios in which syphilis can occur unnoticed. The latent form of this infection is divided into groups based on the duration of infection and the characteristics of the human body. Let's see when this might happen.

Classification of latent syphilis

Depending on how long ago a person was infected, latent syphilis is divided into the following groups.

early latent syphilis - if the infection occurred less than two years ago;
late latent syphilis - if the infection occurred more than two years ago;
latent unspecified syphilis - if it is not known exactly when the infection occurred.

Depending on how long syphilis was in the body, the degree of damage to internal organs, as well as the required period of treatment, differ. The longer the infection lasts, the higher the likelihood of damage to the nervous, cardiovascular and skeletal systems, and therefore, the longer and more serious the treatment will be.

Latent syphilis occurs in several cases:

As an option for the primary period
This happens if Treponema pallidum (the causative agent of syphilis) gets directly into the bloodstream - for example, through blood transfusions, injections, cuts. Then hard chancre (the very first sign of syphilis) does not appear on the skin and the disease develops unnoticed by the patient. Such syphilis is called “decapitated” or “syphilis without chancre.”
As part of the secondary and tertiary period of the disease
These periods are characterized by a wave-like course: the stages of rashes (the stage of active syphilis) are replaced by stages of temporary external well-being (the stage of latent syphilis).
As a variant of the atypical (asymptomatic) course of syphilis
The disease proceeds without any external signs at all. If this variant of syphilis is not diagnosed through tests, the disease will manifest itself only in a late stage - in the form of serious damage to the skin and internal organs. Such asymptomatic syphilis usually lasts about two years.

How common is latent syphilis?

Latent syphilis is now quite common. For example, about 10% of all cases of syphilis are atypical form no symptoms. In addition, it is worth remembering about headless syphilis and temporary periods of calm in patients in the primary period.

The reason is due to two factors:

Why does this happen?

Ordinary syphilis develops when Treponema pallidum, the causative agent of this disease, enters the human body. During their activity, the patient develops symptoms of syphilis: rash, bumps, gummas, and so on.

At the same time, the patient’s immunity does not stand aside: as with any infection, it secretes antibodies (protective proteins) and also sends cells of the immune system to the places where bacteria multiply. Thanks to these measures, most Treponema pallidums die. However, the most tenacious bacteria remain, which change their shape so that the immune system can no longer recognize them.

In its cystic form, treponema pallidum cannot be active, but it can reproduce

This type of “masked” treponema pallidum is called cystic forms or L-forms. In this form, treponema pallidum cannot be active, but it can reproduce. As a result, when the immune system “loses its vigilance,” secretly multiplying bacteria enter the bloodstream and repeatedly harm the body.

The same thing happens with improper treatment of syphilis. If the antibiotic is chosen incorrectly or in the wrong dose, not all Treponema pallidums die - the survivors disguise themselves and remain invisible until better times.

How is latent syphilis transmitted?

Is latent syphilis contagious? This is a completely natural question. It would seem that since the patient has no symptoms, then it is impossible to get infected from him. But this is a false conclusion. In reality, things are not so simple.

On the one hand, the most contagious manifestations of syphilis are, indeed, skin rashes early period (hard chancre and secondary syphilides). And if they are not on the patient’s body, then it is almost impossible to become infected with syphilis through normal contact.

However, there are other ways of infection:

sexual intercourse (any type of sex);
through saliva;
through breast milk;
through blood.

Therefore, you still need to be on your guard if your friend is diagnosed with latent syphilis. In this case, syphilis is especially contagious, which occurs during the first 2 years. Afterwards, the risk of infection is significantly reduced.

If latent syphilis is discovered in an employee of a socially significant profession (educator, teacher, salesperson, etc.), then for the duration of treatment he is suspended from work and given sick leave. After recovery, a person can return to his job - he will no longer be a danger to others.

Read more about who should not work with syphilis in a separate article.

How long does a person with latent syphilis live?

The life expectancy of a person with undiagnosed syphilis depends on how long ago he became infected and whether he received timely treatment. The longer it lasts in the body hidden infection, the more damage it causes.

For example, late latent infection can lead to:

to paralysis;
dementia;
blindness;
hepatitis and cirrhosis;
heart failure.

And this is not a complete list of the consequences that late latent syphilis leaves. With the development of complications, the quality and duration of a person’s life are greatly reduced and depend on each specific case.

Still, these are extreme situations.

If latent syphilis is detected in time and treatment is started, a person can be cured completely, and the disease will not affect the length and quality of life in any way

How to diagnose syphilis?

Diagnosing latent syphilis is a very difficult process because there are no signs of latent syphilis. The doctor has to rely only on test results and communication with the patient - perhaps the disease manifested itself earlier, until it went into a latent form.

In this situation, it is important to correctly evaluate all the data, because tests can sometimes give false results, and making a diagnosis of syphilis is a serious step for both the doctor and the patient.

What is important for an accurate diagnosis?

The doctor must act almost like a real detective - every little thing is important to him. Typically, a patient is examined according to the “questioning - examination - test results” scheme.

When interviewing the patient, the following is revealed: the estimated time of infection, whether he had syphilis before, whether he was previously treated, whether the patient took antibiotics over the last 2-3 years, whether the person noticed skin rashes or formations, whether he saw a doctor about them, and so on.

Despite the absence of external manifestations, the doctor must examine the patient, as he may notice something that the person himself did not see: rashes on the back, in the hair, scars after fresh rashes, syphilitic leukoderma on the back of the neck, baldness, loss of eyelashes or eyebrows. All these are signs of syphilis that once appeared, which could then turn into a latent form.

And yet, the basis for diagnosing latent syphilis is the test results. Advantages in the Wasserman reaction or in other primary tests that use a treponemal substitute do not guarantee an accurate diagnosis. These tests must be confirmed by 1 - 2 treponemal tests (i.e. tests using real treponema). Only if both types of tests indicate the disease, this means that the patient has latent syphilis.

What to do if the diagnosis is doubtful?

Difficulties arise when one of the tests for latent syphilis shows negative result.

In this case, it is important to consider different reasons. For example, if there is no syphilis, then one of the tests may be a false positive - showing the disease in someone who is actually healthy. Or vice versa - if there is syphilis, but it is already in a late stage, and even hidden, then non-treponemal tests become negative.

To better explain how test results for latent syphilis are assessed, we present the following diagram:

Tests	Diagnosis	What's next?
1 positive non-treponemal test ( RV /RMP /RPR) + 2 positive treponemal tests ( ELISA And RPGA)	"Hidden Syphilis"	The patient is prescribed treatment
1 negative non-treponemal test (

One of the most famous sexually transmitted infections is syphilis, the symptoms of which vary greatly, and clinical manifestations affect many body systems (skin and mucous epithelium, somatic organs and elements of the nervous system). The first signs of syphilis, although quite specific, are not very pronounced, which creates the preconditions for a late start of therapy and the development of serious complications of the disease. How to recognize an infection at an early stage? What do people with secondary and tertiary syphilis look like? And what methods are used to identify pathology? The answers to these questions are in our review.

Features of the disease

Syphilis is a systemic venereal disease, the causative agent of which is the bacterium Treponema pallidum (treponema pallidum) of the order Spirochetes. As syphilis progresses, the signs of the pathology change dramatically, so in its course it is customary to distinguish three successive stages - primary, secondary and tertiary. Besides, special place Congenital syphilis ranks in the classification.

Today, the prevalence of syphilis in the world remains quite high: in developing countries in Africa it can be more than 500 people per 100 thousand population. In Russia, this indicator is at the level of 48 people per 100 thousand.

The main route of transmission of infection is sexual – up to 90% of patients become infected. Behind last years the number of infections through non-traditional (oral, anal) sexual contacts has increased.

In addition, syphilis can spread if:

blood transfusions;
use of non-sterile medical instruments that come into contact with contaminated biological fluids;
sharing syringes among drug addicts;
sharing personal household items (toothbrush, razor);
breastfeeding;
autopsy (dissection) of corpses or working with contaminated biomaterial.

Some experts do not exclude household way transmission of infection, but it is rare. In order to become infected, close and prolonged contact with an infected person who has open ulcers of a syphilitic nature is necessary.

Primary form of infection

The first signs of syphilis do not appear immediately after infection, but after some time necessary for the proliferation of bacterial particles and the formation of the body’s immune response in response to their introduction. Duration incubation period ranges from 10 to 90 days, but averages 3 weeks.

Primary syphilis is classified as follows:

primary seropositive, accompanied by positive laboratory results;
primary seronegative, showing a negative result in serological studies;
primary hidden, asymptomatic. It can be either seropositive or seronegative. It often develops in patients who have not completed treatment started at an early stage.

Symptoms and course

The main manifestation of syphilis, the first signs of which may vary, is the appearance of primary syphiloma - chancre. This formation corresponds to the site of invasion of Treponema pallidum into the body through barrier tissues and, as a rule, is located in the genital area - the foreskin or distal part of the penis in men, the mucous membrane of the vulva, vagina or cervix in women. Extragenital localization of chancre is also possible - in the anus, on the skin of the chest, abdomen, pubis or thighs, in oral cavity, in the language. There are no other signs of syphilis infection at this stage.

In the classic version of the infection, chancre is a small (up to 1 cm in diameter) fleshy, spherical erosion with raised edges. Slight transparent secretions make its surface glossy, as if varnished. Due to the pronounced inflammatory infiltrate, the skin defect becomes very dense (hence the name - chancre). When primary signs of syphilis appear, the patient does not experience any discomfort: the erosion does not hurt or cause discomfort. After 5-6 weeks even without use medicines The chancre heals without leaving marks on the skin and mucous membranes.

According to venereologists, in recent years, cases of atypical course of primary syphilis, the symptoms of which are either absent or strikingly different from the classic version of the disease, have become more frequent. What do primary syphilomas look like in patients in this case?

Sometimes the disease manifests itself not as one, but as multiple chancre – 2, 3 or more. Cases of deep erosions appearing at the site of pathogen penetration have become more frequent - in this case, it drags on with the formation of a deep scar. Less common are atypical primary syphilomas:

Indurative edema - develops in the labia (major or minor) in women, foreskin, and scrotal skin in men. Characterized by a large affected area. The swelling is very pronounced; when pressed with a finger, no marks are formed.
Chancroid-amygdalitis is a unilateral painless tonsillar enlargement, colored bright brown-red.
Chancroid-felon - has similar symptoms to ordinary inflammation of the phalanx of the finger, but is distinguished by strong density and slight redness.

Atypical forms of the disease are difficult to diagnose and require highly qualified venereologists. The first signs of syphilis can be suspected due to pronounced regional lymphadenitis - inguinal, cervical or axillary - depending on the location of the primary affect.

Complications

The first symptoms of syphilis are mild and do not cause much discomfort. This fact, as well as some delicacy of the problem, may cause the patient to postpone a visit to the doctor. In most cases, chancroid goes away on its own (but this does not mean that the person has recovered); less often, the following complications may develop:

addition of super- or mixed infection (nonspecific or trichomonas, mycoplasma);
balanitis;
balanoposthitis;
narrowing of the foreskin, phimosis, paraphimosis;
necrotization, phagedenism.

Examination plan and differential diagnosis

The key point in diagnosing the disease is characteristic symptoms primary syphilis (syphiloma - chancre and atypical forms, enlargement of key groups of lymph nodes) and a history of unprotected sexual contact, which could cause infection.

The standard examination plan also includes microscopic and bacteriological examination of chancre discharge for the presence specific pathogen. IN serous fluid A large number of pale treponemas are detected. It is also possible to determine bacterial cells in the punctate obtained from a biopsy of the node.

Serological tests (RIBT, RIF, RPR), as well as the widely used Wasserman reaction, remain negative for 3-4 weeks from the onset of primary syphiloma. Therefore, at this stage they should not be considered as an important examination method.

Standard diagnosis of primary syphilis requires comparison and differentiation of symptoms of the disease with:

genital herpes (pathogen -), accompanied by the appearance of blistering rashes on the mucous membrane of the genital organs;
trichomoniasis, manifested by pain when urinating, discharge from the vagina in women and from the urethra in men;
gonorrhea, characterized by the development of vivid symptoms of urethritis;
balanoposthitis;
cervical erosion;
vulvar cancer.

Despite the similarity in the manifestations of sexually transmitted diseases, usually syphilis and its symptoms do not cause problems in diagnosis by a clinician. It is important to notice chancre - the first sign of syphilis and confirm the examination data with laboratory tests.

Current approaches to therapy

Once the diagnosis of primary syphilis is confirmed, treatment should begin immediately. The standard treatment plan includes the use of penicillin antibiotics(Benzylpenicillin or combined antimicrobial agents based on it). The selected drug is administered intramuscularly 3 times a day or according to the schedule provided for in the instructions for use. For allergies to penicillins, treatment is carried out with Tetracycline, Doxycycline. The selection of the dosage of the drug and the duration of therapy by the dermatovenerologist is carried out individually depending on the form of infection, the presence concomitant diseases at the patient.

Note! Treatment is prescribed to both sexual partners at the same time. During antibiotic therapy sex life must be stopped.

Despite the fact that syphilis has long been considered a “crippling”, “terrible” disease, today it does not pose a particular threat to health, especially if it was diagnosed at an early stage. Treatment of primary syphilis promotes complete eradication of the pathogen from the body and prevents the development of possible complications.

Secondary syphilis

Secondary syphilis is the stage of the disease following the primary, accompanied by the spread of infection through the bloodstream throughout the body. Characterized by a polymorphism of clinical manifestations: dermatological, somatic (with damage to most internal organs, bones, joints), neurological symptoms, as well as generalized hyperplasia of the lymph nodes.

How long does it take for secondary syphilis to replace healed chancroid? On average per distribution infectious process It takes 2-4 months from the onset of the disease. This stage lasts for at least 2-5 years.

Symptoms

Main external manifestation The secondary stage of infection is a rash. It is distinguished by a variety of shapes and sizes, but among its common features are revealed:

absence of pain, itching and other unpleasant sensations;
dark red, purple tint;
high density;
clear contours;
round form;
lack of tendency to merge elements;
absence of peeling (less often – sparse, finely lamellar peeling);
tendency to spontaneous resorption (without scars and atrophy).

Roseola

Roseola rash occurs in 75-80% of patients with secondary syphilis. It consists of syphilitic roseola - round pink or reddish-pink spots located at a distance from each other. The diameter of each of them ranges from 3 to 12 mm. The predominant localization is the skin of the torso. Less commonly, elements of the rash are located on the extremities, back of the hands, feet, and face. TO characteristic features roseola refers to a “flat” surface (the elements do not rise above the surface of the skin), the absence of peeling, itching and any other unpleasant sensations. If you press on the spot, it turns pale or even disappears completely for a few seconds.

Even without treatment, roseola disappears 2-5 weeks after its appearance. A second and third wave of rash is possible, while the nature of the rash elements changes somewhat: they become pale, few in number, and can merge to form cones or arcs.

Papular

Less commonly, patients are diagnosed with papular syphilides - flat, round-shaped nodules that rise above the surface of the skin. Depending on the size of the papules, they may resemble millet, lentil grains, coins, or large plaques. They can be located not only on the skin, but also on the mucous membranes - in the oral cavity, tongue, pharynx, palatine tonsils. They constantly spread in width and can even merge with each other.

If the formations are localized in places with increased friction - in the groin, intergluteal folds, between the fingers, under the breasts, weeping erosion may develop in their place. Her serous discharge is literally teeming with Treponema pallidum, so patients can easily infect others.

Other clinical manifestations of the disease include:

syphilitic hair loss (diffuse, focal);
spotted leukoderma - the appearance of round light spots with a diameter of 2-10 mm on the skin of the neck, chest, abdomen;
syphilitic lesion of the vocal cords, accompanied by hoarseness.

Skin symptoms are always accompanied by generalized lymphadenitis. Lymph nodes, whose size is significantly larger than normal, are painless, and do not pull surrounding tissues with them.

From the side of somatic organs, mainly functional disorders are determined. Patients may complain of tension, pain in the right hypochondrium caused by an increase in the size of the liver; signs of gastritis and biliary dyskinesia are often observed. Syphilitic kidney damage is accompanied by proteinuria and lipoid nephrosis. From the musculoskeletal system, the development of osteitis and periostitis is possible. Pathological changes in the nervous system are accompanied by irritability and insomnia.

Diagnostics

How to identify syphilis at this stage? Due to the polymorphism of clinical manifestations, specialized diagnostics of pathology is carried out in all patients with skin rash and enlarged lymph nodes. The examination plan for patients with suspected secondary stage venereal disease should include at least one of the following methods:

microscopic and bacteriological examination of serous discharge from the elements of the rash;
RPR (anticardiolipin) test;
RIBT;
RPGA.

According to indications, if it is necessary to confirm the diagnosis, a morphological examination of the biomaterial obtained after a lymph node biopsy or lumbar puncture is carried out. If you have symptoms of damage to somatic organs, you may need to consult specialized specialists: urologist, gynecologist, gastroenterologist and hepatologist, ophthalmologist, neurologist, otorhinolaryngologist.

Clinical ones are differentiated from viral and bacterial infections accompanied by a rash (rubella, chickenpox, typhus, measles during the rash period), dermatological problems (lichen planus, toxicerma), specific skin diseases(post-streptococcal impetigo, ecthyma vulgaris).

Principles of treatment

Secondary syphilis should be treated according to the same principles as primary syphilis. Additionally, the use of immunomodulatory and restorative agents is indicated. In the presence of functional disorders from the internal organs, their symptomatic correction is carried out.

Water-soluble penicillins are highly effective against treponema pallidum. Since to maintain therapeutic concentration medicinal substances they are needed in the blood intramuscular injection every 3 hours for at least 24 days, it is preferable to hospitalize the patient in a dermatovenerological hospital.

Note! The appearance of a rash in some cases is accompanied by flu-like symptoms - cough, sore throat, headache, aches throughout the body.

In general, the prognosis for patients with secondary syphilis remains favorable. If the conditions and duration of treatment are not met, the disease progresses, moving into its final, tertiary stage.

Tertiary syphilis

Tertiary syphilis is the final stage of the disease, developing in patients who have not received therapy or have not been fully treated. His clinical picture characterized by the appearance of widespread infiltrative formations (granulomas) in the skin, mucous membranes, internal organs and bone tissue. They deform and destroy healthy organs, which ultimately leads to death. This form of infection develops 8-10 years after infection. Today advanced syphilis in medical practice is extremely rare. Most patients receive treatment in the early stages of the disease.

Clinical manifestations

Tertiary syphilis is also characterized by skin manifestations, but they have significant differences from the elements of the rash in the secondary period. They develop over a long period of time (months, years) and just as slowly regress with the formation of scars and skin defects. At this stage, patients are not contagious and do not pose an epidemiological danger to others.

Tuberous syphilide

Tuberous syphilide is a small (5-7 mm in diameter) nodule with infiltration, forming on the surface of the epidermis and slightly protruding above the surface of the skin. It has a dense consistency and brownish color. After some time, it ulcerates with the formation of a round skin defect. Healing of the ulcer lasts weeks and even months, ending with the formation of a deep scar.

Typically, dermatological symptoms of tertiary syphilis are local in nature and appear in waves. This allows you to see in a limited area of skin a lot of tuberculate syphilides at different stages of their development.

Gummous syphilide

Gummy syphilide is a single painless nodule that develops in the subcutaneous fat. Common locations are the face (forehead), forearms, shins, and the area of large joints.

Immediately after formation, the size of the node is small; it is not fused with the surrounding tissues. As the syphilide grows, it loses its mobility. Then its surface ulcerates with the release of a thick gelatinous mass. Gradually, syphilide overgrows, forming a deep scar and tissue deformation.

After about 10-12 years, at the onset of the disease, the patient develops irreversible multiorgan changes. Up to 90% of patients experience pathology of the circulatory system (myocarditis, aortitis). Syphilitic damage to the musculoskeletal system (osteomyelitis, osteoporosis), liver (hepatosis, hepatomegaly), and stomach (gastritis, ulcer) is also common.

One of the most dangerous manifestations of the disease is neurosyphilis - an infectious lesion of the brain and spinal cord Treponema pallidum. It may be accompanied by:

acute meningitis - inflammation of the meninges;
meningovascular changes such as syphilitic endarteritis;
meningomyelitis - inflammation of the substance and membranes of the spinal cord;
– degenerative damage to the dorsal roots of the brain;
progressive paralysis - direct destruction of brain cells by Treponema pallidum;
syphilitic gumma of the base of the brain.

Common complications of the disease include aortic aneurysm, heart failure, acute heart attack myocardium, cerebral stroke, severe neurological disorders.

Principles of diagnosis and treatment

As in the early stages, a diagnosis of tertiary syphilis can be made based on clinical and laboratory data. The main role in examining patients at this stage is played by RIF and RIBT tests. RPR may show a false negative result in 24-32% of cases and is therefore not prescribed.

Violations of the functioning of internal organs can be identified using instrumental methods diagnostics:

ECG – for functional assessment heart function;
ECHOKS – for visual inspection of the condition of the heart muscle and heart valves;
aortography – for timely diagnosis a common complication is aneurysm;
pharyngoscopy - to identify syphilitic gummas in the pharyngeal cavity;
Ultrasound of the abdominal cavity;
gastroscopy;
X-ray (CT) of the chest;
Lumbar puncture.

If indicated, additional consultations with specialized specialists are carried out.

Treatment

Therapy for the final stage of syphilis is long-term and requires high patient adherence to the prescribed treatment. It is carried out in two stages: in the first, the patient undergoes a two-week preparatory course of taking Erythromycin or Tetracycline. Then he is prescribed several courses of penicillin therapy. For better effect and rapid eradication of the pathogen from the body, patients who have no contraindications take bismuth preparations. Additionally, restorative and symptomatic agents are used.

It is important to acknowledge that in the later stages of the infectious process, complete recovery of the patient is almost impossible. Degenerative-dystrophic processes in internal organs have irreversible nature and are not amenable to therapy. The main goal of treatment remains to cleanse the body of Treponema pallidum and prevent the progression of pathological processes.

Thus, the clinical manifestations of syphilis at each stage of the disease are strikingly different. Chancre - the primary focus of introduction of Treponema pallidum into the body is replaced by a skin rash and functional disorders in the functioning of internal organs, and then leads to irreversible pathological processes in the musculoskeletal and nervous systems. The sooner a patient is diagnosed with syphilis and a comprehensive antibacterial treatment, the higher his chances of a full recovery and return to active life.

Syphilism is one of the most common sexually transmitted diseases (STDs). The causative agent of the disease is the bacterium Treponema pallidum. Modern medicine This disease can be easily treated, but if the patient is not treated, he will face a slow and painful death with a wide range of symptoms.

According to 2014 data, 26 people per 100 thousand population of our country are sick with syphilis. The incidence of sexually transmitted diseases is decreasing at a slow pace, so the government is educating the population about STDs. Awareness about STD prevention helps to avoid serious problems with the health of both young people and adults.

Syphilitic infection symptoms

Once in the human body, the bacterium Treponema pallidum, the causative agent of syphilis, goes through an incubation period that lasts from 1 to 6 weeks. At this time, the person is unaware of the infection, as he has no signs of illness. Even most tests cannot detect the disease at this stage. Eat high probability that the patient will infect several sexual partners with syphilis, unaware of the consequences of his actions.
The first signs of the disease appear after the end of the incubation period with the onset of primary syphilis. They can be located on the skin in the form of hard chancre, multiple chancre, syphilitic rash, baldness (cutaneous syphilides) and on the mucous membranes - chancre in the mouth, on the genitals, rash on the mucous membranes (syphilides of the mucous membranes).

Symptoms of syphilitic infection in women

The end of the asymptomatic period is marked by the appearance of the first sign of infection (3-4 weeks after infection). A hard chancre forms where the bacterium enters. Its appearance indicates the primary stage of syphilis. Hard chancre is formed as an immune response to the introduction of Treponema pallidum. It is localized in the mouth, in the area of the external and internal genital organs, and in the anus.

A chancre is a round inflammatory growth with a flat base. In the initial stages of its appearance there is practically no pain. Appears at sites of infection. If treatment is not carried out, then a syphilitic rash is added to the chancre on visible parts of the body and on mucous membranes.

Signs of syphilism in men

In men, as in women, the first noticeable sign of infection appears in the form of a chancre. Ulcers often form on the penis, at its base and on the head. However, it can also appear in the oral cavity, on the scrotum, and in the anus. The symptoms and course of the disease are practically no different in the male and female parts of the population. Further description of syphilism will be given without division by gender.

How does sifak manifest in women?

The primary stage of sifak in women begins with the detection of hard chancre on the skin or mucous membranes. On initial stage it does not cause serious discomfort. Then a gradual inflammation of the chancre occurs, it takes on a red or bluish color, characteristic of a severe inflammatory process.
During the first week after the first symptoms appear, women begin to experience inflammation of the lymph nodes and vessels near the chancre (regional scleradenitis). The lymph nodes become inflamed in the form of balls, forming significant edema and swelling around the chancre. If the sore is localized in the oral cavity, it threatens with inflammation of one tonsil and swelling of the throat, making it difficult to swallow and breathe. The symptoms cause significant distress with verbal communication and eating. Scleradenitis in the genital area makes walking and defecation difficult.

Photo: Jarun Ontakrai/Shutterstock.com

The end of primary and the beginning of secondary syphilis is considered to be the appearance of a specific rash on the patient’s body. Modern methods diagnostics make it possible to detect syphilism immediately after the first symptoms appear. The most commonly used are enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). These tests are prescribed by a therapist at a clinic or a venereologist at a dermatovenereal dispensary. average cost analysis costs 500 rubles. It should be remembered that the analysis will be timely only at the stage of primary syphilis. Earlier tests will not show anything other than a seronegative reaction, indicating the absence of Treponema pallidum in the body.

Symptoms of secondary syphilis

The skin around the chancre becomes covered with spots and ulcers with a diameter of up to 15 mm. The rash can grow and unite into large areas on the skin and mucous surfaces, causing the patient severe discomfort. There are three types of syphilitic rash.
Roseola rash - pink or red spots with clear or blurred boundaries 5-50 mm in diameter. There are no cavities. Do not protrude above the skin.
Papular rash - small conical growths of pink color. May peel off at the top of the cone. This kind of cheese looks extremely unpleasant.
Pustular rash - growths with purulent cavities.
Along with the appearance of a rash, damage to the nervous system may begin. Degradation of nervous tissue negatively affects vision, memory, attention, and coordination of movements. Unfortunately, treatment of the disease will not lead to the restoration of lost functions of the central nervous system, but will only stop the process of further damage to the nervous tissue.
Signs of partial or complete baldness appear. Hair falls out, usually on the head. First, the quality of the hairline deteriorates: the hair splits, becomes thinner, and thins out. Then the hair thinning intensifies and large bald patches of skin appear. After recovery from syphilis, hair growth does not renew.

Stages of syphilis

Nowadays, every person infected with Treponema pallidum can quickly and efficiently receive adequate and effective treatment. Only a few go through all stages of syphilis. Without treatment, a person lives in terrible agony for 10 or even 20 years, after which he dies.
Below is short description stages of syphilis.
Incubation stage

Stage name	Temporal boundaries	Description of symptoms
Incubation period	From the moment of infection to 189 days.	During this period, there are objectively no manifestations in the patient’s body. If the infection gets into several places in the body at once, this shortens the incubation period to 1-2 weeks. If an infected person takes antibiotics, for example, for the flu or a sore throat, the incubation period can even last six months. Ending of this period occurs with the appearance of the first symptom – chancre and inflammation of the lymph nodes. If the pathogen enters directly into the blood, then the stage of primary syphilis does not appear and the disease goes directly to the secondary stage.

Stage of primary syphilis

Stage name	Temporal boundaries	Description of symptoms
Stage of primary syphilis	From the moment hard chancre appears until the appearance of a rash and inflammation of the lymph nodes in the chancre area	A chancre is a single solid formation that penetrates slightly deeper, but does not fuse with the tissues, caused by immune reaction for Treponema pallidum. It has a rounded shape and clearly defined edges. Localized in the area of infection (Genitals, oral cavity, anal area, fingers). Does not cause pain, but should cause serious concern and motivate the patient to stop all sexual intercourse and immediately consult a doctor to begin treatment before a syphilitic rash appears. At the end of the primary stage, multiple chancre may appear. The second symptom is the appearance of inflamed lymph nodes next to the chancre. At the end of the stage of primary syphilis, malaise, dizziness, and body temperature rise. At this stage, atypical symptoms sometimes occur, which will be described below in the corresponding section of the article.
Headless syphilis	Boundaries are difficult to define	Observed when infected through blood. There are no symptoms, the disease goes directly into the secondary or latent stage, bypassing the primary one.

Stage of secondary syphilis. It is divided into four stages of the disease. In the absence of adequate treatment, the order will be approximately as follows:

Course of secondary syphilis	Temporal boundaries	symptoms of secondary syphilis
Early (Lues secundaria recens)	From 60-70 days after infection. From 40-50 days after the appearance of chancre. Lasts from several days to 1-2 weeks	There are three types of rashes caused by an active immune response and the production of endotoxins that fight infection. The nervous system, internal organs, and bones suffer. The temperature rises to 37-37.5 °C, accompanied by malaise, cough, runny nose, and conjunctivitis. Extensive inflammation of the lymph nodes without pain and discomfort, which feel hard and cool to the touch. Hair often falls out, and complete baldness is possible.
Hidden	From 60 days after the appearance of chancre or later	At a certain point, the immune system blocks the action of the infection that destroys the body. The rash stops. Of course, the infection does not leave the organs and tissues; the patient lives in anxious anticipation of a second relapse.
Recurrent (recurrent)	After the hidden phase	With any weakening of the immune system (stress, cold, skipping meals, injury), a relapse can occur. It manifests itself in the appearance of a new rash, more extensive, with areas of skin hemorrhage. All symptoms characteristic of early syphilis. Multiple genital chancre often forms.
Early neurosyphilis	Starting from 2 years from the moment of illness	Associated with inflammation and damage to blood vessels and neurons of the brain, internal organs (almost always the heart and liver), as well as bones and joints. It manifests itself in the form of chronic meningitis, a violation of the ability of the pupils to constrict when exposed to light. Miliary gummas form inside the brain vessels, which increase intracranial pressure, worsening general health and causing headaches. Many symptoms interfere with higher mental functions, such as attention, memory, coordination of movements. The changes are irreversible.

Stage of tertiary syphilis. It is divided into three stages of the disease. In the absence of adequate treatment, the order will be as follows:

Name of stage of tertiary syphilis	Temporal boundaries	Description of symptoms
Hidden chronic stage	Lasts from 1 year to 20 years	About 70% of patients in the absence of treatment live as carriers of the infection, moving from the latent phase of tertiary syphilis to the recurrent phase. However, sooner or later the immune system fails. A person moves to the next stage with a high probability of disability or death.
Tertiary syphilis	With the onset of corresponding symptoms	Extensive damage occurs to all organs and tissues, bones and the nervous system. Gummas are formed in the most merciless way in many places. Gummas are characteristic purulent tumors, often bleeding and moist with lymph and pus. Often appear on the face. They heal very hard, forming ugly scars. Often gummas become infected with other bacteria, leading to serious complications: abscess and gangrene.
Late neurosyphilis	The final stage, leading to disability and inevitable death. 10-15 years from the onset of the disease.	Extensive damage to the central nervous system, leading to loss of vision, paralysis, and impairment of cognitive functions of the psyche. Infectious diseases of the brain develop - meningitis, gumma of the brain and bones.

Neurosyphilis begins towards the end of secondary syphilis. Usually manifests itself in the form of the following diagnoses:

Atypical syphilis

In addition to hard chancre, others, so-called, may also appear at the stage of primary syphilis. atypical chancre. That is why this variant of the development of the disease is called atypical syphilis. Atypical chancres are of the following types:

Indurative edema.
Looks like a change in color of the scrotum in men, the clitoris and labia in women. The color varies from scarlet to bluish in the center, turning pale at the edges of the swelling. Women are susceptible to this symptom more often than men. Usually the patient perceives indurative syphilitic edema as an infectious-inflammatory disease of a different kind, since a blood test at this stage of syphilis does not provide information about the real reason swelling. It can be distinguished from another infection by the absence of an inflammatory process in the blood and the presence of inflammation of the lymph nodes.
Chancre felon.
It may appear in people caring for patients with syphilis: medical personnel, relatives. Affects the thumb, index finger and middle fingers hands. This is a very painful attack. The skin pulls away from the fingers, revealing large areas of bleeding, similar to second-degree burns. Panaritium is also accompanied by swelling and inflammation of the fingers, which interfere with normal human functioning. Often appears together with chancre of the genital organs.
Chancroid-amygdalitis.
It manifests itself in the form of inflammation of one tonsil, and its surface is not disturbed and remains smooth. The oral cavity is subject to severe pain, and the swallowing process becomes difficult. The patient experiences a fever, as if he had a sore throat. The difference from a sore throat is that with amygdalitis, only one tonsil becomes inflamed.

Congenital syphilis

It is highly undesirable for a mother to suffer from illness during pregnancy. The fetus is exposed to Treponema pallidum, which leads to irreversible morphological consequences and disruption of intrauterine development.
Medicine knows three main symptoms:

- Parenchymal keratitis is a pathology of the external epithelium of internal organs and the eyeball. It manifests itself as severe redness and inflammation of the organ on the outside. Sometimes the inflammation penetrates a little deeper into the surface. After healing, scars remain and an eyesore may remain. The most common consequence for the eye is decreased visual acuity. Keratitis is accompanied by blurred vision, acute pain, lacrimation.
- Deafness from birth. The causative agent of syphilis actively destroys nerve tissue fetus during pregnancy. One of the options may be pathology auditory nerve, which leads to irreversible deafness.
- Congenital dental anomalies. Occur due to underdevelopment of tooth tissue during fetal development. This pathology is called Hutchinson's teeth. The teeth grow in the shape of a screwdriver with a rounded notch on the cutting edge, and are set sparsely. Sometimes teeth are not completely covered with enamel. Which leads to their early destruction and unflattering appearance.

A child who has had intrauterine syphilis has poor health, even if the mother has successfully completed treatment. If adequate treatment is not followed, the child will have severe deformities and remain disabled for life. If a mother is infected with syphilis, breastfeeding the baby should be stopped immediately, since syphilis is transmitted through mother's milk.

If a woman who has previously had syphilis wants to become pregnant, she should be tested for Treponema pallidum (ELISA or PCR). After receiving confirmation of the absence of the disease, you can safely decide to become pregnant.

The causative agent of syphilis

Treponema pallidum is a bacterium that causes syphilis. German scientists in 1905 discovered the cause of one of the most common venereal diseases. Having discovered the bacterial nature of the disease, microbiologists and pharmacists found the key to quickly curing syphilis, and the way was also opened for them to invent methods early diagnosis diseases.

Properties of the pathogen

The bacterium was called pale due to the fact that for a long time scientists could not examine it under a microscope. The transparent color of treponema is difficult to stain in other colors for subsequent research. For staining, the Romanovsky-Gizma and silver impregnation methods are used, which make it possible to detect bacteria under a dark-field microscope for subsequent study.
It was found that under favorable conditions (it should only be a human or animal body), Treponema pallidum divides every 30 hours. The weak point of Treponema pallidum is that it lives and reproduces only at a temperature of 37 °C. This explains the effectiveness of archaic methods of treating syphilis, when, by artificially increasing the patient’s body temperature to 41 °C with the help of malaria, some relief of the symptoms of the underlying disease occurred.
The length of the bacterium is 8-20 microns with a thickness of 0.25-0.35 microns. Relatively long, its body forms curls in the form of a ball. At the same time, it constantly changes the shape and number of curls due to the ability of the Treponema pallidum cell to contract.

Incubation period

Entering the body through microdamages of the skin and mucous membranes, the causative agent of syphilis begins the incubation period. Dividing at a rate of about once every 30 hours, it accumulates at the site of infection. None visible symptoms not visible. After about a month, a hard chancre forms on the body in combination with inflammation of the lymph nodes next to it. This means the transition from incubation to the stage of primary syphilis. The strength of immunity varies from patient to patient, which makes the length of the initial period of infection vary widely. It can last from 1-2 weeks to six months.

How is syphilis transmitted?

The process of transmission of the pathogen occurs in most cases through sexual contact. Infection is guaranteed through traditional, anal and oral sexual contact, even with a patient in the incubation period. Hard chancre forms where bacteria enter.

When caring for patients, infection is likely through contact with the patient's clothing, his personal belongings, and his body. In this case, chancre-felon appears, affecting the fingers and toes. This is one of the most painful symptoms in the stage of primary syphilis. Then hard chancre of the genital organs may appear.
Syphilis can also be transmitted through blood. When transfusing contaminated blood, when reusing a patient’s syringe, his razor, scissors, or utensils.

How to treat syphilis

Treatment should begin at the first signs of syphilis. This way the healing process will take place as quickly as possible. Since the 50s of the 20th century, antibiotics have been used in the treatment of syphilis. Penicillin-based drugs were used. Nowadays, drugs based on it are also used, since Treponema pallidum does not know how to adapt to this type of antibiotics. Sufficient doses of penicillin effectively fight the disease. To treat syphilis in patients with allergic reactions to penicillin, erythromycin or tetracycline is used.
If the course of the disease has progressed to neurosyphilis, then treatment becomes more complicated. Pyrotherapy (artificial increase in body temperature) and intramuscular administration of antibacterial drugs are added.

For tertiary syphilis, highly toxic bismuth-based drugs are used along with antibiotics. Treatment occurs strictly in a hospital with multi-level supportive therapy.

If a patient is diagnosed with primary syphilis, it is necessary to compulsorily treat all his sexual partners with whom he had contact during the last trimester.
If secondary syphilis is diagnosed, it is necessary to compulsorily treat all his sexual partners with whom he had contact during the past year.

It is necessary to disinfect all items in the house with which the patient had direct contact: plumbing fixtures, dishes, bedding and underwear, clothing, etc.
Hospitalization for initial stages Syphilis is not required, outpatient treatment is sufficient. Only in severe forms, starting from the secondary stage, the patient is admitted to the hospital. Treatment of syphilis under the compulsory medical insurance policy is free and anonymous.

Coping with illness folk remedies highly not recommended. Only well-designed treatment can defeat Treponema pallidum. Otherwise, there is a high probability of the disease progressing to more severe stages.

Which doctor treats sifak disease?

Since sifak is a disease transmitted primarily through sexual contact, treatment is carried out by a venereologist. The patient can contact a general practitioner and receive a referral to a venereologist. The option of direct contact with a skin and venereal disease clinic is possible.

After examination and receipt of test results, the patient is treated either by a venereologist himself, specializing in all STDs, or the patient is referred to a highly specialized specialist - a syphilidologist.

There is a syphilidologist in every major city at skin and venereal dispensaries. He can select the most effective dosages of medications and develop a treatment program that must be strictly followed. In case of complications in men (when the head of the penis is pinched), syphilis is treated together with a urologist.
In case of complications in women (chancre in the vagina, on the cervix), you need to go to a gynecologist.

How long to treat syphilis

The duration of treatment for the disease is determined solely by the doctor. Depending on the stage of the disease, complications and general condition body, healing may take from two weeks to six months.

It is very important to know that under no circumstances should you interrupt the course of treatment. If treatment is not completed, the patient will soon experience a relapse. Therefore, treatment must be taken extremely seriously.

How does syphilis manifest and after how long? Unsuccessful sexual partner? What are the first signs of syphilis

Symptoms of secondary syphilis

Diagnosis and treatment

Properties of the pathogen

Syphilis infection

Complications

Classification

Incubation period of the disease

Primary period clinic

Epidemiology of syphilis

Pathogenesis of syphilis

Screening

Reasons for development

Treatment of syphilis

Development of symptoms by periods: what, where and when it appears

Primary period

Secondary period

Tertiary period

Can syphilis occur without symptoms?

Reversible and irreversible manifestations of syphilis

How not to confuse syphilis with other diseases

Popular questions about other signs of syphilis:

How does syphilis manifest in men and women: gender differences

Symptoms of syphilis in men

When does latent syphilis occur?

Classification of latent syphilis

How common is latent syphilis?

Why does this happen?

How is latent syphilis transmitted?

How long does a person with latent syphilis live?

How to diagnose syphilis?

What is important for an accurate diagnosis?

What to do if the diagnosis is doubtful?

Features of the disease

Primary form of infection

Symptoms and course

Complications

Examination plan and differential diagnosis

Current approaches to therapy

Secondary syphilis

Symptoms

Roseola

Papular

Diagnostics

Principles of treatment

Tertiary syphilis

Clinical manifestations

Tuberous syphilide

Gummous syphilide

Principles of diagnosis and treatment

Treatment

Syphilitic infection symptoms

Symptoms of syphilitic infection in women

Signs of syphilism in men

How does sifak manifest in women?

Symptoms of secondary syphilis

Stages of syphilis

Atypical syphilis

Congenital syphilis

The causative agent of syphilis

Properties of the pathogen

Incubation period

How is syphilis transmitted?

How to treat syphilis

Which doctor treats sifak disease?

How long to treat syphilis