Latent syphilis treatment. Latent syphilis: symptoms, diagnosis and treatment of all forms

Hidden (latent) syphilis is an asymptomatic development syphilitic infection without any external signs or manifestations internal lesions. In this case, the pathogen is present in the body and is easily detected when appropriate laboratory research and as it becomes more active, it begins to manifest itself externally and internally, causing serious complications due to the advanced stage of the disease.

The increase in the incidence of latent syphilis is due to the active use of antibiotics at the early stage of undiagnosed syphilitic infection, the symptoms of which are mistaken for signs of other sexually transmitted, acute respiratory or colds. As a result, syphilis is “driven” inside and in 90% of cases is discovered by chance during medical examinations.

Latent syphilis develops for various reasons and can have several course options:

1. As a form of the primary period of the disease, in which infection occurs through direct penetration of the pathogen into the blood - through wounds or injections. With this route of infection, hard chancre does not form on the skin - the first sign of a syphilitic infection. Other names for this type of syphilis are decapitated.
2. As part of subsequent stages of the disease, which occur in paroxysms - with a periodic change of active and latent phases.
3. As a type of atypical development of infection, which is not diagnosed even with laboratory tests. Symptoms develop only when last stage when they happen severe lesions skin And internal organs.

The development of the classical is determined by the penetration certain type bacteria - Treponema pallidum. It is their active activity that leads to the appearance of symptoms of syphilitic infection - characteristic rashes, gum, other skin and internal pathologies. As a result of the attack immune system most pathogenic bacteria die. But the strongest survive and change shape, which is why the immune system ceases to recognize them. In this case, the treponemes become inactive, but continue to develop, which leads to the latent course of syphilis. When the immune system weakens, bacteria become active and cause a re-exacerbation of the disease.

How the infection is transmitted

Latent syphilis, unlike regular syphilis, is practically not transmitted by everyday means, because it does not manifest itself as the most contagious symptom of infection - a syphilitic rash. All other routes of infection remain, including:

• unprotected sexual intercourse of all types;
• breast-feeding;
• penetration of infected saliva and blood.

The most dangerous person in terms of infection is a person who has had latent syphilis for no more than 2 years. Then the degree of its infectivity decreases significantly.

At the same time, the asymptomatic course of the infection can make it hidden not only to others, but also to the patient himself. Therefore, he can be a source of infection without even knowing it and posing a great danger to those who come into close contact with him (especially sexual partners and family members).

If latent syphilis is detected in workers in those areas in which contact with big amount people, for the duration of treatment they are relieved of their duties with the issuance of sick leave. After recovery there are no restrictions on professional activity is not established, since the bangs do not pose a danger in terms of infection.

Types of latent syphilis

The asymptomatic form of syphilitic infection is divided into 3 types depending on the duration of the disease. In accordance with this symptom, latent syphilis is distinguished:

• early - diagnosed when a maximum of 2 years have passed since the bacteria entered the body;
• late - established after exceeding the specified 2-year period;
• unspecified - determined if the duration of infection is not established.

The duration of the infection depends on the degree of damage to the body and the prescribed course of treatment.

Early latent syphilis

This phase is the period between primary and repeated manifestations of infection. At this time, the infected person has no signs of the disease, but he can become a source of infection if his biological fluids (blood, saliva, sperm, vaginal secretions) penetrate the body of another person.

A characteristic feature of this stage is its unpredictability - the latent form can easily become active. This will lead to the rapid appearance of chancre and other external lesions. They become an additional and most open source of bacteria, which makes the patient infectious even with normal contact.

If a focus of early latent syphilis is detected, special anti-epidemic measures must be taken. Their goal is:

• isolation and treatment of the infected;
• identification and examination of all persons in contact with him.

Early latent syphilis most often affects people under 35 years of age who are promiscuous in sexual relations. Irrefutable evidence of infection is the detection of infection in a partner.

Late latent syphilis

This stage is determined if more than 2 years have passed between penetration into the body and detection of a syphilitic infection. At the same time, there are also no external signs illnesses and symptoms of internal lesions, but relevant laboratory tests show positive results.

Late latent syphilis is almost always detected during tests during a medical examination. The rest of those identified are relatives and friends of the infected person. Such patients do not pose a danger in terms of infection, since tertiary syphilitic rashes practically do not contain pathogenic bacteria, and those that do exist quickly die.

Signs of late latent syphilis are not detected during visual examination, and there are no complaints about deterioration in health. Treatment at this stage is aimed at preventing the development of internal and external lesions. In some cases, at the end of the course, test results remain positive, which is not a dangerous sign.

Unspecified latent syphilis

In situations where the subject cannot report the time and circumstances of infection, unspecified latent syphilis is diagnosed based on laboratory tests.

Clinical examination of such patients is carried out carefully and repeatedly. At the same time, false positive reactions, which is due to the presence of antibodies in many concomitant diseases - hepatitis, renal failure, cancer, diabetes, tuberculosis, as well as during pregnancy and menstruation in women, with alcohol abuse and addiction to fatty foods.

Diagnostic methods

The absence of symptoms greatly complicates the diagnosis of latent syphilis. The diagnosis is most often made based on the results of appropriate tests and anamnesis.

The following information is of decisive importance when compiling an anamnesis:

• when did the infection occur?
• syphilis is diagnosed for the first time or the disease is repeated;
• what treatment the patient received, and whether there was any;
• whether antibiotics have been taken in the last 2–3 years;
• whether rashes or other changes in the skin were observed.

An external examination is also carried out to identify:

• syphilitic rashes throughout the body, including scalp heads;
• scars after previous similar skin lesions;
• syphilitic leukoderma on the neck;
• changes in the size of lymph nodes;
• hair loss.

In addition, sexual partners, all family members, and other persons in close contact with the patient are examined for the presence of infection.

But the decisive factor for making a diagnosis is appropriate laboratory blood tests. In this case, diagnosis can be complicated by the possibility of obtaining a false positive or false negative result.

If the test results are doubtful, spinal tap, examination of which may reveal the presence of hidden syphilitic meningitis, characteristic of the late latent stage.

Upon final diagnosis of the disease, it is necessary to undergo examinations by a therapist and a neurologist. This is necessary to establish the presence or absence of concomitant (attached) pathologies.

Treatment of latent syphilis

The latent form of syphilitic infection is treated with the same methods as any type of syphilis - exclusively with antibiotics (systemic penicillin therapy). The duration of treatment and dosage of the drug are determined by the duration of the disease and the degree of damage to the body:

• for early latent syphilis, 1 course of penicillin injections lasting 2–3 weeks is sufficient, which is carried out at home (outpatient) (the course is repeated if necessary);
• for late latent syphilis, 2 courses lasting 2–3 weeks each are required, and treatment is performed in inpatient conditions, since this form is characterized high probability development of complications.

At the beginning of treatment early form an increase in temperature should appear, indicating correct positioning diagnosis.

Pregnant women with latent syphilis must be hospitalized for appropriate treatment and constant monitoring of the condition of the fetus. Since the infection has an extremely negative effect on the condition of the child and can lead to his death, it is necessary to notice a frozen pregnancy in time and provide timely assistance woman.

During the treatment period, all patient contacts are significantly limited. He is prohibited from kissing, having sex in any form, using shared utensils, etc.

The main goal of therapy for early latent syphilis is to prevent the development of the active stage, in which the patient becomes a source of infection. Treatment of late disease involves excluding complications, especially neurosyphilis and neurological lesions.

To evaluate treatment results, the following indicators are monitored:

• titers, which are reflected in test results and should decrease;
• cerebrospinal fluid, which should return to normal.

Normal indicators of all laboratory tests during antibiotic therapy with penicillin for early latent syphilis usually appear after 1 course. If it is delayed, it is not always possible to achieve them, regardless of the duration of therapy. Pathological processes in this case persist for a long time, and regression occurs very slowly. Often, to speed up recovery in late latent syphilis, preliminary therapy with bismuth preparations is first carried out.

Life forecast

Treatment results, duration and quality later life of a patient with latent syphilis are largely determined by the duration of the infection and the adequacy of its treatment. The sooner the disease is detected, the less harm it will have time to cause to the body.

Complications of late latent syphilis often include the following pathologies:

• paralysis;
• personality disorder;
• loss of vision;
• liver destruction;
• heart diseases.

These or others Negative consequences infections can cause a significant reduction in life expectancy, but the results always vary from person to person.

If latent syphilis is detected in a timely manner and carried out competent treatment, a person can be completely cured. Then the disease will not affect the duration and quality of life in any way. Therefore, at the slightest suspicion, you should immediately seek medical help.

In the video, the doctor talks about modern methods treatment of syphilis.

Latent syphilis is diagnosed in the absence of signs of the disease, and serological reactions in the blood are positive. This form occurs in patients who have had active diseases in the past that resolved on their own or as a result of specific treatment.

Table of contents:

Forms and periods of latent syphilis

Signs of early latent syphilis

1. A history of primary syphilis may be indicated by lumps or scars on the genitals and an increase in regional lymph nodes.
2. In 75% of cases, serological reactions are strongly positive. 20% of patients have a low titer. Positive RIF is observed in 100% of cases. Serological reaction titers decrease when concomitant diseases are treated with antibiotics.
3. When treated with penicillin, a third of patients experience increased body temperature, muscle pain, and. This is due to the massive death of the pathogen. Side effects are quickly eliminated.
4. With the development of latent syphilitic in the cerebrospinal fluid, an increase in protein, positive reactions to globulin fractions and cytosis are observed. Cerebrospinal fluid is quickly sanitized with specific therapy.

Treatment of early latent syphilis

Therapy is carried out according to. Its goal is to quickly destroy the pathogen in the patient’s body. Negative seroreactions occur quite quickly with specific treatment. The extinction or complete negation of seroreactions is the only confirmation of the effectiveness of treatment.

Timely diagnosis during the period of early latent syphilis and effective treatment give a favorable prognosis.

Late latent syphilis

In patients infected more than two years ago, who have no symptoms of the disease, and serological tests are positive, late latent syphilis is diagnosed. It is mainly detected during a preventive examination.

These patients are less dangerous epidemiologically, since tertiary syphilides are not so contagious. They contain a minimal amount of pathogen.

The disease is mainly detected in patients over 40 years of age. Moreover, approximately 65% ​​of them are married.

When interviewing the patient, they find out the timing of probable infection and the presence of symptoms indicating manifestations of infectious syphilis in the past.

Signs of late latent syphilis

1. During the examination, traces of previously resolved syphilides are not detected. On examination, signs specific lesion nervous system and internal organs are absent.
2. To diagnose late latent syphilis, the following serological reactions are used: RIF, RIBT, RPGA and ELISA. RIBT and RIF are always positive.

In some cases, serological tests are repeated several months later.

Treatment of late latent syphilis

Therapy of this form is carried out according to. The goal of treatment is to prevent the development of specific damage to internal organs and the nervous system. Patients need to consult a therapist and a neurologist. Negative seroreactions during the treatment period occur extremely slowly. In some cases, seroreactions remain positive after treatment.

Latent unspecified syphilis

Hidden unspecified syphilis diagnosed in the absence of information about the timing and circumstances of infection, as well as in the presence of a positive result of serological tests. These patients require careful clinical and serological evaluation. RPGA, RIF, RIF-abs, ELISA, RIBT are mandatory.

In patients with unspecified and late syphilis, false-positive nonspecific serological reactions are often detected.

When timely treatment external manifestations diseases disappear quickly enough. In the most advanced cases restoring health becomes almost impossible.

After past illness It is necessary to take a very responsible approach to the issue of pregnancy planning. It should be taken into account that for full recovery the health of future parents will take more than a year. Therefore, it is very important to take precautions to exclude the possibility of infection.

Latent syphilis is a form of the disease that occurs without symptoms. It is dangerous because patients do not suspect that they are infected. At this time, the infection develops, affecting internal organs.

In the first two years after infection, patients pose a threat to others and sexual partners, since the disease is contagious. Infected people are always interested in how latent syphilis develops.

Why does the disease appear?

The development of latent syphilis is no different from the causes of infection with the classic form of the disease. Bacteria – Treponema pallidum – enter the patient’s body. Microorganisms begin to multiply. But after incubation period the latent form of the disease does not show symptoms.

The fact is that treponemes shed their membrane and penetrate through the membrane into the nucleus of phagocytes. These cells are responsible for immune protection person. It turns out that bacteria develop and infect internal organs, hiding behind the membrane of phagocytes. The immune system does not recognize bacteria and does not respond.

There are three types of latent syphilis:

• early view;
• late type of infection;
• unspecified type of disease.

Infection is possible after unprotected sex, in a household way(with constant use of the patient’s personal belongings), through saliva, breast milk(from mother to child), during childbirth and through blood (for example: during transfusion).

Are there symptoms?

Bright severe symptoms the disease does not. But after a thorough examination and history taking, doctors discover indirect signs latent syphilis. It is similar to other diseases, which is why difficulties arise in diagnosing the infection.

Indirect symptoms of the early form of the disease include:

• short-term rashes on the skin, they go away on their own;
• in the place where the chancre should be located, there is a small scar;
• a former or current sexual partner has been diagnosed with syphilis;
• detection of gonorrhea or other sexually transmitted diseases - the infection often occurs together with other diseases.

In the late type, these symptoms are absent; serological tests show low reagin titers. IN cerebrospinal fluid significant degenerative changes are revealed.

Sometimes patients in both cases experience an unreasonable increase in temperature up to 38 degrees, weight loss, weakness and frequent ailments.

Early form of syphilis

The type of illness depends on how long ago the patient contracted the infection. Early latent syphilis is a disease in which infection occurred earlier than 24 months ago. The disease occurs without symptoms and is detected during routine medical examinations or during the treatment of other diseases.

The early variety is dangerous because the patient is contagious at this time. It puts sexual partners and family members at risk, since Treponema pallidum is also transmitted through household contact.

Sometimes patients recall that for a short period of time they had a rash of unknown etymology on their body. But the rash went away on its own after a short period of time. When examining the patient, it is revealed. And at the site of the rash, small scars (or syphilomas) are noticeable. To a greater extent, latent syphilis of the early form affects people under 40 years of age, who more often engage in casual sexual relationships.

Some patients with the early form of latent syphilis claim that over the past two years they have had erosive rashes in the mouth and genitals.

Late form of the disease

If the infection is detected when the infection occurred more than two years ago, then the patient is diagnosed with late latent syphilis. During latent development, Treponema pallidum affects internal organs and the nervous system. A person suffering from this type of disease is safe for others, since he is no longer contagious.

According to statistics, late infection is found in family people over 40 years of age. Partners of infected people usually also suffer from syphilis, and the disease also occurs in a latent form.

According to the test results, the Wasserman reaction shows a positive result in patients. Patients also have positive results from RIF and RIBT. Data from serological reactions are present in low titers, only in 10% of patients – in high titers.

Doctors carefully examine patients with a late form of infection, but there are no signs of rash on the skin, no scars, scars or syphilomas.

Unspecified type of infection

Latent, undetected syphilis is a form of the disease in which it is impossible to determine the period of infection of the patient. Doctors cannot find out the timing of infection, and the patients themselves do not know when and under what conditions they became infected. This question is important to determine whether a person is contagious to others, or dangerous period already passed.

Sometimes doctors are able to find out the time of infection if the patient is treated with long-acting antibiotics. penicillin series. On early stages illness reception antimicrobials causes sharp increase temperature, the patient experiences intoxication. If the old form of syphilis is not specified, then the use of antibiotics does not cause any reactions from the body.

How to identify the disease

Patients must take general analysis blood. To detect Treponema pallidum, serological tests are carried out: RIBT (immobilization reaction) and RIF (immunofluorescence reaction). It is possible to carry out ELISA (enzyme-linked immunosorbent assay).

Based on all the results, the doctor makes a diagnosis, finds out whether the patient has an infection, and how long ago the infection occurred.

How is the treatment carried out?

Patients are always interested in questions about how to treat hidden infection and is it possible to be completely cured? The therapy is carried out by venereologists. Each patient is prescribed individual treatment depending on the form of the disease, the patient’s condition, possible contraindications.

Treatment of latent syphilis does not differ from the treatment regimen for the ordinary form of the disease. Treponema pallidum is a bacterium, it is sensitive to antibiotics, so therapy is carried out with antibacterial drugs. At the same time, the patient takes immunomodulators, vitamins and drugs that improve the functioning of the intestines and liver (antibiotics kill all microflora of the gastrointestinal tract).

The duration of treatment depends on the form of the disease; it can last from two to three months to several years.

Treatment with antibiotics

The most effective drugs are considered to be of the penicillin series. They can be short, long (long) or medium acting. Penicillins are administered intramuscularly, in this way they are better absorbed and more active. Common drugs include: Bicillin 1, Benzathine penicillin G, Retarpen.

10% of people are allergic to penicillin antibiotics. In this case, the drugs are replaced with cephalosporin antibiotics. One of the best drugs Ceftriaxone is considered. At allergic reactions and for these drugs, patients are prescribed:

• tetracyclines - “Doxycycline” or “Tetracycline”;
• macrolides – “Erythromycin”, “Susamed”;
• synthetic antibiotics - Levomycytin.

Conclusion

Latent syphilis can occur in three forms: early, late and unidentified. It is usually discovered accidentally during scheduled inspection from doctors or in the treatment of other pathologies. Diagnosis is complicated by the fact that the infection occurs without symptoms.

Patients are unaware of the disease and live peacefully. At this time, microorganisms infect internal organs, and the infected themselves infect other people. Treatment of the disease is carried out under the supervision of a venereologist and depends on the form of the disease.

Syphilis can also occur in a latent form.

This variant of the course of the disease is called latent syphilis. Hidden syphilis from the moment of infection takes latent course, is asymptomatic, but blood tests for syphilis are positive.

In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.

If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent unspecified syphilis; during examination and treatment, the diagnosis can be clarified.

What provokes / Causes of Latent syphilis:

The causative agent of syphilis is Treponema pallidum, belonging to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically, treponema pallidum (pale spirochete) differs from saprophytic spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under a microscope, Treponema pallidum is a spiral-shaped microorganism that resembles a corkscrew. It has an average of 8-14 uniform curls equal size. The total length of the treponema varies from 7 to 14 microns, thickness - 0.2-0.5 microns. For treponema pallidum characterized by pronounced mobility in contrast to saprophytic forms. It is characterized by translational, rocking, pendulum-like, contractile and rotatory (around its axis) movements. Electron microscopy revealed complex structure morphological structure of Treponema pallidum. It turned out that the treponema is covered with a thick cover of a three-layer membrane, a cell wall and a mucopolysaccharide capsule-like substance. Under the cytoplasmic membrane there are fibrils - thin filaments that have a complex structure and cause diverse movement. Fibrils are attached to the terminal turns and individual sections of the cytoplasmic cylinder using blepharoplasts. The cytoplasm is finely granular, containing a nuclear vacuole, nucleolus and mesosomes. It was established that various influences of exo- and endogenous factors (in particular, previously used arsenic preparations, and currently antibiotics) had an impact on Treponema pallidum, changing some of its biological properties. Thus, it turned out that pale treponema can turn into cysts, spores, L-forms, grains, which, when the activity of the patient’s immune reserves decreases, can reverse into spiral-shaped virulent varieties and cause active manifestations of the disease. The antigenic mosaic nature of Treponema pallidum has been proven by the presence of multiple antibodies in the blood serum of patients with syphilis: protein, complement-fixing, polysaccharide, reagin, immobilisin, agglutinin, lipoid, etc.

By using electron microscope It has been established that treponema pallidum in lesions is more often located in intercellular spaces, periendothelial space, blood vessels, nerve fibers, especially in early forms of syphilis. The presence of pale treponema in the periepineurium is not yet evidence of damage to the nervous system. More often, such an abundance of treponemes occurs during septicemia. During the process of phagocytosis, a state of endocytobiosis often occurs, in which treponemes in leukocytes are enclosed in a multimembrane phagosome. The fact that treponemes are enclosed in polymembrane phagosomes is a very unfavorable phenomenon, since, being in a state of endocytobiosis, treponema pallidums persist for a long time, protected from the effects of antibodies and antibiotics. At the same time, the cell in which such a phagosome has formed seems to protect the body from the spread of infection and progression of the disease. This precarious balance can persist for a long time, characterizing the latent (hidden) course of a syphilitic infection.

Experimental observations by N.M. Ovchinnikov and V.V. Delectorsky are consistent with the works of the authors, who believe that when infected with syphilis, long-term asymptomatic(if there are L-forms of pale treponema in the patient’s body) and “accidental” detection of infection in the stage of latent syphilis (lues latens seropositiva, lues ignorata), i.e. during the presence of treponema in the body, probably in the form of cyst forms, which have antigenic properties and therefore lead to the production of antibodies; this is confirmed by positive serological reactions to syphilis in the blood of patients without visible clinical manifestations of the disease. In addition, in some patients, stages of neuro- and viscerosyphilis are detected, i.e. the disease develops as if “bypassing” active forms.

To obtain a culture of Treponema pallidum you need difficult conditions(special environments, anaerobic conditions, etc.). At the same time, cultural treponemes quickly lose their morphological and pathogenic properties. In addition to the above forms of treponema, the existence of granular and invisible filterable forms of pale treponema was assumed.

Outside the body, Treponema pallidum is very sensitive to external influences, chemicals, drying, heating, influence sun rays. On household items, Treponema pallidum retains its virulence until it dries. A temperature of 40-42°C first increases the activity of treponemes and then leads to their death; heating to 60°C kills them within 15 minutes, and to 100°C kills them instantly. Low temperatures do not have a detrimental effect on Treponema pallidum, and currently, storing Treponema in an oxygen-free environment at a temperature of -20 to -70 ° C or frozen dried is a generally accepted method for preserving pathogenic strains.

Pathogenesis (what happens?) during Latent syphilis:

The reaction of the patient's body to the introduction of Treponema pallidum is complex, diverse and insufficiently studied. Infection occurs as a result of penetration of Treponema pallidum through the skin or mucous membrane, the integrity of which is usually compromised. However, a number of authors admit the possibility of the introduction of treponema through an intact mucous membrane. At the same time, it is known that in the blood serum of healthy individuals there are factors that have immobilizing activity against Treponema pallidum. Along with other factors, they make it possible to explain why infection is not always observed upon contact with a sick person. Domestic syphilidologist M.V. Milich, based on his own data and analysis of the literature, believes that infection may not occur in 49-57% of cases. The variation is explained by the frequency of sexual intercourse, the nature and localization of syphilides, the presence of an entrance gate in the partner and the number of pale treponemas that have penetrated the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the tension and activity of which varies depending on the degree of virulence of the infection. Therefore, not only the possibility of no infection is being discussed, but also the possibility of self-healing, which is considered theoretically acceptable.

Symptoms of Latent syphilis:

In practice, we have to deal with patients in whom the presence of syphilis is established only on the basis of positive serological reactions in the absence of any clinical data (on the skin, mucous membranes, internal organs, nervous system, musculoskeletal system) indicating the presence in the patient's body specific infection. Many authors provide statistical data according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis is detected in 90% of patients during preventive examinations, in antenatal clinics and somatic hospitals. This is explained by both a more thorough examination of the population (i.e., improved diagnosis) and a true increase in the number of patients (including due to the widespread use of antibiotics by the population for intercurrent diseases and manifestations of syphilis, which are interpreted by the patient themselves not as symptoms venereal disease, but as, for example, the manifestation of allergies, colds, etc.).

Latent syphilis is divided into early, late and unspecified.

Hidden late syphilis(syphilis lateus tarda) in epidemiological terms, it is less dangerous than earlier forms, since when the process is activated, it manifests itself either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of low-infectious tertiary syphilides (tubercles and gummas).

Early latent syphilis in time corresponds to the period from primary seropositive syphilis to secondary recurrent syphilis inclusive, only without active clinical manifestations of the latter (on average up to 2 years from the moment of infection). However, these patients may experience active, contagious manifestations of early syphilis at any time. This makes it necessary to classify patients with early latent syphilis as epidemiologically dangerous group and carry out vigorous anti-epidemic measures (isolation of patients, thorough examination of not only sexual, but also household contacts, if necessary compulsory treatment and etc.). Like the treatment of patients with other early forms of syphilis, the treatment of patients with early latent syphilis is aimed at quickly sanitizing the body from a syphilitic infection.

Diagnosis of Latent syphilis:

The following data can help in diagnosing latent syphilis:

• anamnesis, which should be collected carefully, paying attention to the presence in the past (within 1-2 years) of erosive and ulcerative efflorescences on the genitals, in the oral cavity, various rashes on the skin, taking antibiotics (for “sore throat”, “flu-like condition”), treatment of gonorrhea (without examining the source of infection), if preventive treatment was not given, etc.;
• results of the confrontation (examination of the person who had sexual contact with the patient and identification of an early form of syphilis);
• detection of a scar or compaction at the site of primary syphiloma, enlarged (usually inguinal) lymph nodes, clinically corresponding to regional scleradenitis;
• high titer of reagins (1:120, 1:360) with sharply positive results of all serological reactions (in patients treated for gonorrhea or self-medicated, it may be low);
• temperature reaction of exacerbation at the beginning of penicillin therapy;
• rapid decrease in reagin titer already during the first course of specific treatment; serological reactions are negative by the end of the 1st-2nd courses of treatment;
• a sharply positive result of RIF in these patients, although RIBT in some patients may still be negative;
• the age of patients is often up to 40 years;
• possibility of normal cerebrospinal fluid; in the presence of latent syphilitic meningitis, rapid sanitation is noted in the process of antisyphilitic treatment.

Sick late latent syphilis are practically considered harmless from an epidemiological point of view. However, in these cases it is especially easy to mistake positive serological blood reactions for a manifestation of syphilis, while they can be false positive, i.e. non-syphilitic, due to many reasons (past malaria, rheumatism, chronic diseases of the liver, lungs, chronic purulent processes, age-related changes in metabolic processes body, etc.). Establishing this diagnosis in venereology is considered the most difficult and very responsible and should not be made without confirmation of RIF, RITT and RPGA (sometimes such studies are carried out again with a break of several months, as well as after the rehabilitation of foci of chronic infection or appropriate treatment of intercurrent diseases).

All patients are consulted by a neurologist or therapist to exclude specific damage to the central nervous system and internal organs.

The diagnosis of late latent syphilis is facilitated by:

• medical history data (if the patient indicates that he could have become infected from some source more than 2 years ago);
• low titer of reagins (1:5, 1:10, 1:20) with strongly positive results according to classical serological reactions (CSR) or weakly positive results according to CSR (with confirmation in both cases by RIF, RITT and RPGA);
• negation of serological reactions towards the middle or end of specific treatment, as well as often the absence of negation of CSR, RIF, RITT, despite vigorous antisyphilitic treatment using nonspecific agents;
• absence of an exacerbation reaction at the beginning of penicillin therapy (it is preferable to start treatment of such patients with preparation - iodine preparations, bijoquinol);
• pathology in the cerebrospinal fluid (latent syphilitic meningitis), observed in these patients more often than with early latent syphilis, and very slow sanitation of the cerebrospinal fluid.

In addition, late latent syphilis is also found in sexual partners or (much more often) they do not have any manifestations of a syphilitic infection (they are practically healthy, and preventive treatment should not be carried out on them as sexual contacts of patients with early latent syphilis). The main goal of specific treatment of patients with late latent syphilis is to prevent the development of late forms of visceral syphilis and syphilis of the nervous system.

Hidden (unknown, unspecified) syphilis diagnosed in cases where neither the doctor nor the patient knows when and under what circumstances the infection occurred. In connection with the division of latent syphilis into early and late, this has been observed less and less recently. Establishing such a diagnosis in the absence of clinical and anamnestic data on syphilis confirms the possibility of an asymptomatic latent course of syphilis from the very beginning.

Treatment of Latent Syphilis:

According to existing instructions and treatment regimens for syphilis, all patients with early latent syphilis undergo the same treatment. In cases where, through history or confrontation data, it is possible to establish how long ago the infection has existed, the outcome of the disease can be predicted (naturally, the shorter the duration of the disease, the more favorable the prognosis and outcome of therapy).

Which doctors should you contact if you have Latent syphilis:

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Latent syphilis is currently being diagnosed more and more often. This term refers to a condition in which no specific symptoms of the disease are observed, but when examining blood and other biological fluids, antibodies to Treponema pallidum are detected.

Their presence is confirmed through several serological tests:

• RIBT.

Causes of the disease

According to some experts, the latent form of syphilis has received wide use due to improper use medicines. Antibiotics are often taken in high doses and without a doctor's prescription. Any antibacterial agent from a series of tetracyclines, penicillins, macrolides and fluoroquinolones can change the nature of the course of the disease and the natural alternation of its stages. And in the absence of treatment, syphilis can have hidden periods, for example, in its secondary and tertiary forms. At certain intervals clinical manifestations there are no infections.

Treponema pallidum is transmitted through unprotected sex. You can also become infected at home - by using shared utensils, hygiene items, and towels. The most contagious is a person who has signs of the primary and secondary forms of the disease.

Classification of the disease

There are late and early latent syphilis. The classification is approximate, because there are often cases when the disease cannot be attributed to any of the above types:

Symptoms of latent syphilis in the first case are the presence of a painless ulcerative formation in the genital area or on the mucous membranes of the oral cavity. Serological tests give a positive result. Wasserman's reaction over the past 3 years has been negative.

Early latent syphilis is also called if the rash appears in Last year. The presence of erosions in the genital area may not be confirmed. If the serological reaction is positive in this case we're talking about about hidden secondary syphilis.

The late form of the disease is diagnosed if more than 3 years ago the patient had unprotected sexual contact with an infected Treponema pallidum. In this case, it is possible to establish the presence ulcerative defect in the genital area and skin rashes more than 4 years old. In other cases, the diagnosis sounds like undifferentiated latent syphilis.

To confirm the stage, the patient must remember all unprotected sexual intercourse that has occurred over the past 8–10 years. It is mandatory to examine the partner and identify syphilitic rashes and gummas. If any, we are talking about an early form of infection.

During trial administration penicillin antibiotics Treponema begins to disintegrate, accompanied by signs of intoxication of the body.

How does latent syphilis manifest?

The infection may not cause any symptoms. Skin rashes and defects do not always appear, there are also no signs of damage to internal organs. Despite this, with primary and secondary syphilis the patient is considered dangerous to the sexual partner. In the late form, it does not become infected. Any form of the disease is dangerous for a pregnant woman, which is associated with a high risk of intrauterine and perinatal infection of the fetus.

Symptoms of latent syphilis are most often nonspecific.

Body temperature periodically rises to subfebrile levels. All patients who have this sign, the causes of which remain unknown, should be tested for antibodies to Treponema pallidum.

Other manifestations of latent syphilis are:

• general weakness and lethargy;
• decreased appetite;
• sudden weight loss associated with poisoning of the body.

Lymph nodes enlarge and take on oval shape and dense structure. They are not soldered with soft tissues, there is no pain on palpation. The symptoms described above may also appear in other pathologies not associated with infection with Treponema pallidum.

How is infection detected?

To clarify the type and time of onset of the disease, the venereologist collects an anamnesis. The medical history may contain an indication of questionable sexual intercourse and the presence in the past of syphilitic defects in the oral cavity and on the mucous membranes of the genitals. The doctor must find out whether the patient has skin rash did he take antibacterial drugs due to a disease resembling syphilis. Take into account the patient's age and character intimate life. When examining the skin and mucous membranes, scars or fading seals formed after the disappearance of primary syphiloma are discovered.

Palpation of the lymph nodes reveals their fibrosis and enlargement associated with syphilitic lymphadenitis. Important role In the diagnosis of a latent form of the disease, confrontation plays a role - detection and examination of all sexual partners of the patient. The discovery of an early form of syphilis in at least one of them makes it possible to make an accurate diagnosis.

If the patient has a late type of the disease, his sexual partners may not have any signs of infection. IN in rare cases late latent syphilis is detected.

The final diagnosis is made only after receiving the results of serological tests. As a rule, it is found in the blood a large number of antibodies to treponema. When passing antibacterial therapy the titer may decrease.

The Wasserman reaction should be complemented by PCR, ELISA and RIBT studies. In early syphilis, RIF has a sharply positive result, while RIBT can give negative results. Diagnosing the latent form of the disease is considered a difficult task, because tests may have. This may be explained by:

• previous malaria;
• the presence of chronic foci of infection;
• liver damage;
• rheumatoid arthritis;
• tuberculosis.

Therefore, tests for syphilis are carried out repeatedly, intermittently, after elimination chronic diseases and foci of infection.

Additionally, a study of cerebrospinal fluid obtained by lumbar puncture is indicated. A change in the composition of the material indicates the presence of syphilitic meningitis and is often detected in tertiary latent syphilis. The patient should consult with specialists to exclude accompanying pathologies, syphilitic lesions of internal organs and nervous tissues.

Therapeutic measures

Treatment of latent syphilis is aimed at preventing its activation, which is dangerous for others. The main goal of therapy is to prevent infection of internal organs and the central nervous system. The most effective against Treponema pallidum are penicillin antibiotics. At the beginning of antibacterial therapy, an exacerbation may occur, accompanied by an increase in temperature. This symptom confirms the previously established diagnosis.

The effectiveness of antisyphilitic therapy is assessed by determining antibody titers. An important indicator is the normalization of the composition of the cerebrospinal fluid.

In case of early latent syphilis, the use of antibiotics contributes to the negation of the results of serological studies and quick cleansing cerebrospinal fluid

In late latent forms of the disease, indicators become negative only after completion of therapy. In some cases, antibodies in the blood remain. Changes in the composition of the cerebrospinal fluid disappear slowly. Late with bismuth preparations and antibiotics.

Preventing infection means monitoring your health. It is necessary to take tests for syphilis annually and save all their results. For any sexual contact you should use barrier methods contraception. After sexual intercourse with an infected person, you must visit medical institution and undergo preventive therapy.

Upon receipt positive results you need to be examined by a venereologist. You should not consider syphilis a harmless disease and refuse treatment. However, you should not take antibacterial drugs without a doctor's prescription.

Universal prevention of syphilis involves regular screening of the population, organizing lectures on STIs in educational institutions. Past specific treatment Doctors should recommend that people undergo serological tests annually. Some patients may need to see a psychologist.