Signs of the development of tertiary syphilis and its treatment. Third (3) stage of syphilis Treatment of syphilis stage 3

Syphilis is an infectious inflammatory disease caused by a pathogenic pathogen - treponema pallidum (spirochete). A distinctive feature of the disease is the periodic change of exacerbations and hidden asymptomatic course.

The main insidiousness of the disease is its cyclical course and the disguise of infection as other diseases. Taken together, all this is confusing and most infected people are unaware of their infection and attribute it to other diseases.

To diagnose the disease, it is necessary to study the enemy and analyze all stages of the development of syphilis. Official medicine distinguishes three stages in the development of the disease.

The initial stage of syphilis or its incubation begins from the moment the infection enters the body and ends after the first symptoms appear. Medicine defines this period as asymptomatic, the disease does not manifest itself in any way and the infected person does not suspect of infection.

Treponema pallidum at this time adapts to the conditions of the body and concentrates mainly in the lymphatic system, since this is the most optimal environment for the body for its activation and reproduction. Incubation of the disease can last from 10-90 days, but the average period of manifestation is 20-45 days. Such ambiguous timing depends on factors that accelerate or slow down the manifestation of the disease.

Factors that accelerate the reproduction of Treponema pallidum and reduce the incubation period:

• too much of the pathogen has entered the body at one time;
• re-infection with treponema over a short period of time;
• several foci of bacteria penetration into the body;
• presence of concomitant sexually transmitted diseases;
• reduced immunity of the patient, as a result of chronic diseases and poor lifestyle.

Factors that slow down the development of Treponema pallidum and increase the incubation period:

• taking medications from the group of antibacterial agents;
• the presence of concomitant diseases with the presence of a hyperthermic reaction;
• elderly age.

Treponema pallidum, during the incubation period, multiplies in the lymphatic system until a maximum concentration is reached, and then through the walls of small blood vessels it enters the bloodstream and begins to spread throughout the body. Even during the incubation period and without the presence of characteristic symptoms, the infected person poses a danger to others - he is a potential carrier of the infection.

Important. Syphilis infection occurs: during sex, through everyday contact, from mother to child during breastfeeding and during pregnancy, as well as through the entry of infected blood into the body of a healthy person.

Diagnostics of the incubation period

Unfortunately, the minimum number of infected people go to the hospital during this period, since most of them are not even aware of the disease. Those who suspect infection, for example, after questionable sexual contact, should be immediately examined.

But the difficulty of the incubation period is that treponema does not manifest itself in the body in most laboratory tests for a whole month after entering the body. The easiest way to diagnose is to check your sexual partner.

If this cannot be done, PCR diagnostics are prescribed, which detects the DNA of the pathogen in the body. The disadvantage of this method is the high price and not always reliable data in the early stages of infection.

Incubation period therapy

A huge plus is the detection of syphilis in the incubation period, since quickly started treatment will avoid health complications and can stop the manifestation of the first symptoms and the transition of the disease to the first stage. Therapy at the initial stage of the disease is carried out on an outpatient basis and does not require injections; tablets of drugs from the group of antibacterial drugs are prescribed.

Preference is given to medications containing penicillin, to which the pathogen is most sensitive. The duration of the treatment incubation period does not exceed two weeks.

First stage of syphilis

Stage 1 of syphilis begins from the moment treponema pallidum reaches a certain concentration in the blood, sufficient for the manifestation of the first symptoms. The primary symptom is the appearance of erosion at the site of infection.

If the infection occurs through sexual contact, the neoplasm appears in the genital area, rectum or mouth, depending on the type of sex during which the infection occurred. In case of domestic infection, the localization of erosion can be any area of ​​the skin.

Erosion is chancre or primary syphilide. It has the appearance of a round ulcer with regular outlines, with a diameter of 4-10 mm; in rare cases, a giant chancre up to 15 mm in diameter is observed.

Syphiloma develops gradually from a red spot to a dense ulcer at the base. The dense part of the chancre resembles cartilage tissue to the touch, the surface of the chancre is smooth, covered with a transparent film, which is the highest concentration of bacteria.

Primary syphiloma does not cause discomfort (pain, itching) and, if located in hidden areas, can go unnoticed.

Chancre goes away on its own, in the first stage of the disease, without the use of therapy.

Classic or typical chancre is the most common, but in rare cases it may have an atypical form:

1. Chancre felon is localized on the phalanx of the finger and looks like swollen, inflamed skin with an internal ulcerative part with purulent contents. The panaritium has irregular outlines and a bluish tint. Unlike the typical painless chancre, it causes pain of a shooting nature. This type of chancre is most often found among doctors, as they become infected through the skin of their hands.
2. Indurative edema, the main location is the genitals, in women – the labia, in men – the foreskin. An atypical chancre looks like a swollen, enlarged area. When palpated, it has a characteristic solid consistency. Color - from red to bluish. Despite the active inflammatory process in the area of ​​inductive edema, the patient’s condition remains stable, without hyperthermia and pain.
3. Chancroid amygdalitis- atypical chancre with a localization in the oral cavity - throat, tonsils, chancre is very similar to a regular sore throat. A distinctive feature of amygdalitis from ordinary sore throat is unilateral inflammation (either the left side or the right).

Stage 1 syphilis is also manifested by inflammation of the lymph nodes - regional lymphadenitis, which appears within 10-14 days after the appearance of primary syphiloma. There is a saying in medicine that “lymphadenitis is a faithful companion of chancre,” since inflammation of the lymph nodes occurs only in the area where primary syphilide is localized.

For example, syphiloma in the genital area is accompanied by inflammation of the inguinal lymph nodes, chancre of the oral cavity leads to enlargement of the submandibular lymph nodes, and chancre of the finger leads to enlargement of the ulnar lymph nodes.

No matter in which area the inflammation occurs, there are characteristic features of the lymph nodes during the period of inflammation:

• size - from bean to flattering nut;
• dense to the touch;
• elastic and movable;
• there is no adhesion to surrounding tissues;
• do not cause pain, even when pressed;
• do not change the structure of the skin in the area of ​​inflammation.

Important. When hard chancre is localized on the cervix or in the rectum, the inflammation of the lymph nodes will go unnoticed, as it will occur in the pelvic area.

At the end of the first period, all symptoms and primary chancre disappear, but treponema pallidum reaches its maximum concentration in the blood and increasingly affects the body. The end of primary syphilis in 95% of patients is asymptomatic and only 5% of those infected may experience attacks of headache, general malaise and a hyperthermic reaction.

Diagnosis of primary syphilis

Syphilis in the early stages is very difficult to diagnose and causes difficulty, even for experienced specialists, since the disease with its main symptom - primary syphiloma - is very similar to a number of other infectious and non-infectious diseases. And since at the beginning of the primary stage, laboratory tests may not provide accurate confirmation of the disease, differential diagnosis of syphilis with other diseases is carried out.

Table No. 1. Differential diagnosis of syphilis and other diseases at the first stage of the disease:

Basic methods of laboratory testing of syphilis in the primary period:

• microscopic examination of discharge from chancre;
• analysis of punctate from lymph nodes (using puncture);
• serological diagnosis using RIF, RIBT, RPR study;
• PCR diagnostics.

Treatment of primary syphilis

Treatment of primary syphilis is carried out with antibacterial drugs from the penicillin group. They are most active against treponema pallidum, but have a significant disadvantage - frequent allergic reactions in patients and the need for frequent administration (quickly eliminated from the body) to maintain the required therapeutic concentration. In case of penicillin intolerance, alternative drugs from other groups are selected.

Table No. 2. Basic treatment regimens with penicillin drugs and alternative drugs from other groups:

Important. 95% of cases of infection occur through sexual contact. In this case, the type of sex (anal, vaginal, oral) does not matter.

Second stage of syphilis

Stage 2 syphilis begins to appear three months after the appearance of the primary symptom – chancre and lasts from 2 to 7 years, depending on the individual characteristics of the body. Secondary syphilis in most patients begins with symptoms of intoxication of the body and hyperthermia, as treponema pallidum reaches its maximum peak concentration in the body and begins to affect all systems and internal organs.

A distinctive feature of this period is the alternation of exacerbations and latent course of the disease, which replace each other and last for several months.

14 days after the increase in body temperature, skin manifestations of the disease follow, as in the primary stage, but they have significant differences in their manifestation.

Skin lesions of the third stage of the disease:

1. Syphilitic roseola is pink spots of a pale shade with a diameter of up to 1 cm. Their main localization is observed in the torso area, less often roseola affects the palms and soles of the feet. A distinctive feature is the appearance of 10 pieces within a week. Roseola is the most common manifestation of stage 2 syphilis. It is observed in 80% of patients.
2. Papular syphilide – papules with a minimum size of up to 5 mm. They have a pink tint and a smooth surface. During the ripening process, they may peel off around the circumference. After disappearing, they are replaced by skin pigmentation in this area. The localization of the rash can be widespread, but mainly in areas with the presence of sebaceous glands. When the rash is located in areas of increased sweating, the rash turns into wet erosion from which a secretion with a high concentration of the pathogen is released. With such a rash, the patient is dangerous to others, since infection is possible not only through sexual intercourse, but also through common household items - through household means.
3. Pustular syphilide - pustular formations on the skin. Can be located everywhere. Very rare, advantageous in immunocompromised patients.
4. Syphilitic leukoderma or crown of Venus - whitish spots, similar to skin pigmentation. The main localization is in the cervical region. They look like a lace collar, hence the name crown of Venus.

The skin symptoms of secondary syphilis are very diverse, but still have similar characteristics:

• have a benign course and disappear with or without adequate treatment;
• the duration of the rash does not exceed several weeks and is replaced by a latent course;
• after disappearance they do not leave marks on the skin;
• are not accompanied by hyperthermia and symptoms of acute inflammatory process.

In addition to skin manifestations, the secondary period affects the mucous membranes of the body, which manifest themselves:

1. Erythematous sore throat– inflammation in the tonsil area, causing pain when swallowing.
2. Papular sore throat– damage to the tonsils by papular rash with their enlargement. A distinctive feature of papules is that they unite during maturation into a single element of irregular shape.
3. Pustular tonsillitis– damage to the tonsils with characteristic symptoms of a common sore throat (fever, intoxication of the body).
4. Syphilitic alopecia– hair loss occurs in 20% of patients. It may have a focal manifestation - small spots with partial hair loss and diffuse - with a sharp decrease in the number of hairs and a change in their structure.

Another symptom of stage two syphilis is an inflammatory process and enlargement of the lymph nodes, but not in a specific area, as in the primary stage, but throughout the body. The lymph nodes of the inguinal, cervical, axillary, and femoral areas are involved in the process. At the same time, they remain painless, do not cause discomfort and do not fuse with the surrounding soft tissue.

In the second period, treponema pallidum has already affected the bloodstream and begins to spread throughout the body, affecting internal organs. Therefore, in the secondary period, functional disturbances in the functioning of certain organs may appear.

Table No. 3. How damage to the body manifests itself:

Important. During the second stage, there are still no pathological changes in the somatic organs and all symptoms of Treponema pallidum lesions disappear after the administration of adequate therapy.

Diagnostics of the secondary period

Diagnosis of the second stage of syphilis is carried out using laboratory tests and is based on laboratory tests, since during this period 98% of patients show positive serological reactions and only two percent of patients with a false negative reaction, which is influenced by a high titer of antibodies in the blood.

Laboratory tests of the second period:

• RIBT;
• RPGA.

Since in the secondary stage there is a reaction from somatic organs, the following may additionally be prescribed:

• Ultrasound of internal organs;
• gastroscopy;
• pharyngoscopy;
• x-ray of bones;
• X-rays of light.

Due to the variety of skin manifestations of the second period, differential diagnosis is also carried out with diseases characterized by the manifestation of various rashes:

• rubella;
• typhoid fever;
• smallpox;
• toxicoderma;
• psoriasis;
• lupus;
• fungal skin infections;
• candidiasis.

Second stage therapy

Treatment of the second stage of the disease is carried out with the use of antibacterial drugs, as in the first stage. These are penicillin antibiotics or their alternative replacement for allergic reactions (see table No. 2).

If certain organs are affected, symptomatic drugs are added to therapy, but after consulting the necessary specialist (gastroenterologist, neurologist, etc.). Treatment of secondary syphilis should be carried out according to the regimen prescribed by the doctor and in a hospital setting.

Failure to comply with adequate therapy leads to the transition of the disease to the tertiary period, which is dangerous not only for health, but also for life.

Important. The latent course of syphilis of the second stage is characterized by a complete absence of clinical picture, but treponema pallidum continues to affect the body. The latent period can only be diagnosed using laboratory tests that detect the presence of antibodies to the pathogen.

Third stage of syphilis

The third stage of syphilis, like the secondary one, affects all systems and internal organs, but with pathological and irreversible changes. In 25% of advanced tertiary syphilis, death is observed. This stage of syphilis is manifested by skin lesions, like the first two, but with serious damage.

Skin manifestations of the tertiary stage are called tertiary syphilides, they manifest themselves in the form of:

1. Tuberous syphilide. This is a tubercular formation in the lower layers of the epidermis, dense structure and up to 7 mm in diameter. They can be located either in groups or individually. As they mature, they begin to protrude above the surface of the skin and ulcerate, turning into open ulcers. This erosion can take several weeks to heal, forming scar tissue after healing.
2. A gummous node that forms in the subcutaneous layer of tissue. The gummous nodule has the size of a nut with a diameter of up to 2 cm, a round regular shape and a dense structure; when it occurs, the skin acquires a purple tint. At the initial stage of development, it is mobile, and when subjected to mechanical action it causes mild pain. In the process of further development, mobility is lost due to fusion with the surrounding soft tissue. At the final stage it turns into an open ulcer with purulent contents. Healing occurs with the formation of a scar.

The tertiary stage of syphilis is characterized by pathological damage not only to the skin, but also to all soft, cartilage and bone tissues, as well as internal organs. The defeat occurs when syphilitic gummas form on them.

The most common lesions of gummas occur on:

1. Joints – fibrous gumma affects the knee and elbow joints.
2. Tongue – gumma of the tongue, enlarges and completely atrophies the tongue, leading to its complete destruction.
3. Hard palate - the gumma of the hard palate is localized in the oral cavity. During the growth process, it affects bone tissue, which leads to the union of the oral cavity and nose.
4. Soft palate – gumma of the soft palate affects the pharynx and makes breathing difficult.
5. Nose – gumma of the nose affects the back of the nose and leads to the destruction of bones, resulting in the collapse of the nose.
6. Liver – Liver gumma causes liver failure, leading to death.
7. In the stomach – gastric gum disrupts its normal functioning.

Gummas also damage the brain and other organs.

Important. In 90% of patients with tertiary syphilis, the functioning of the cardiovascular system is disrupted and leads to myocarditis and aortitis, which are complicated by heart failure.

Diagnosis of the tertiary period

Since during the tertiary period the concentration of treponemes in the body decreases significantly, RPR diagnostics give a negative result, therefore the study is carried out using RIF and RIBT studies. They give a positive result in 98% of cases.

Diagnosis at the third stage is aimed at determining the degree of pathology of internal organs, therefore the examination includes:

• Ultrasound of all internal organs;
• x-ray of lungs and bones;
• rhinoscopy;
• gastroscopy;
• liver tests;
• cerebrospinal fluid puncture.

Treatment of tertiary syphilis

How to treat stage 3 syphilis depends on the degree of damage to the body. The main direction, as in the first two stages, is to take antibacterial drugs, but according to a certain scheme, additional symptomatic treatment is prescribed, depending on the damaged organs.

The basic treatment regimen for the tertiary stage with antibiotics to combat Treponema pallidum:

1. Preparatory treatment of syphilis is taking tetracycline (if intolerant, replace it with erythromycin). The course duration is at least 14 days.
2. The course of treatment with penicillin drugs, the duration of treatment depends on the severity of the condition.
3. A break in treatment is 14 days.
4. Second course of penicillin therapy. The duration depends on the severity of the damage to the body.
5. Taking medications based on Bismuth. The duration and dosage are prescribed strictly according to an individual scheme, which depends on the severity of the condition, the individual characteristics of the body and the age category of the patient. The instructions prohibit the use of drugs by patients with impaired liver and kidney function.
6. Third course of penicillin drugs.

Additional treatment:

• taking symptomatic medications to treat damaged organs;
• taking immunostimulating drugs to increase the body's resistance;
• taking vitamin complexes;
• therapy for damaged skin

Fourth stage of syphilis

Official medicine distinguishes only three stages of syphilis development based on laboratory indicators, but based on symptomatic manifestations, there is another form of the disease that progresses over decades. This is stage 4 syphilis - the last stage of the disease, which leads to death.

Table No. 4. Irreversible changes in the body during the fourth stage:

Important. Is it possible to cure syphilis at stage 4? Definitely not, stage 4 syphilis cannot be treated, as pathological changes have occurred in the entire body. Therapy of the fourth period is aimed at slowing down the process of destruction of the body and alleviating the patient’s condition.

The video in this article is about complications of all stages of syphilis.

Frequently asked questions to the doctor

Infection during oral sex

Hello, tell me, what is the probability of contracting syphilis during oral sex?

Good afternoon, infection with syphilis during oral sex is possible and the probability is the same as with anal and vaginal sex. Since saliva contains no less concentration of Treponema pallidum than semen and vaginal fluid.

External signs of syphilis

Good afternoon, is it possible to determine the presence of syphilis by a person’s appearance and what are the signs?

Hello, unfortunately, it is not always possible to visually determine the presence of a disease. For example, during incubation the disease does not manifest itself in any way and during periods of latent course the symptoms are not visible. All sorts of defects on the skin and mucous membranes can indicate the presence of syphilis. These can be ulcers, pustular lesions, rashes.

Tertiary syphilis is a serious venereological pathology. This is the very last stage of the disease, in which complications from the internal organs develop. Possible death. Today, tertiary syphilis is diagnosed less and less, which is associated with early diagnosis and treatment of this pathology.

Tertiary syphilis is an infectious disease from the STI group. It develops 5–10 years after infection in people who have not consulted a doctor or who have not followed the treatment regimen. Initially, the primary and . Adults over 20 years of age are affected. The disease may develop in adolescents if they have previously been diagnosed with a congenital form of the disease.

Not everyone knows whether syphilis is contagious at this stage. The peculiarity of this period is that the patient does not pose a great danger to others. If at stages 1 and 2 easy transmission of the pathogen is possible, then in this case the treponemes are localized deep in the internal organs and are not released outside with biological secretions.

Causes and development of the disease

The tertiary period of syphilis develops several years after infection. Human infection occurs in the following ways:

• sexual;
• artificial;
• injection;
• contact and household.

Treponema pallidums are highly pathogenic. Human infection occurs when just a few microbial cells enter the body. For a long time the disease is asymptomatic. Predisposing factors for the development of tertiary syphilis are:

• chronic intoxication;
• alcoholism;
• addiction;
• immunodeficiency;
• exhaustion;
• non-compliance with the dosage of the medication during treatment;
• self-medication;
• unprotected sex during therapy;
• old age.

At the third stage of the disease, treponema spreads throughout the body, leading to the formation of granulomas in the internal organs and on the skin. Specific inflammation develops, which can lead to tissue destruction.

Characteristic symptoms

The signs of tertiary syphilis are very specific. The disease occurs with long asymptomatic periods. The main features are gummas and tubercles. These are types of tertiary syphilides that slowly regress and capture limited areas of tissue. After the disappearance of syphilides, scars remain. Most often, the third stage of syphilis is manifested by tuberculate subcutaneous rashes.

They have the following features:

The nodules appear in waves. Over time, they disappear, and in their place ulcerative defects with smooth edges appear. They take a long time to heal, often leading to tissue atrophy. Instead of tubercles, gummas may appear. These are single, painless formations that are localized in the forehead, limbs and joints.

In the early stages of tertiary syphilis, the gummas are not fused to the tissues. If left untreated, a hole appears in them through which secretions are released. After some time, a deep ulcer with crater-shaped edges forms. Sometimes gummas disappear without the formation of an ulcer. In this case, rough scar tissue appears. Gummas occur primarily on the skin and oral mucosa.

The nose is often affected, leading to bleeding. With tertiary syphilis, glossitis often develops. It makes speech and breathing difficult. If gumma forms on the palate, it may become perforated and food may enter the nasal cavity. The third period of the disease lasts 10 or more years. If patients are left untreated, neurosyphilis may develop.

Consequences of stage 3 syphilis

If the symptoms of syphilis are ignored, the following complications are possible:

A serious complication of the 3rd period of the disease is late neurosyphilis. It occurs as a type of gumma cerebri or progressive paralysis. The following symptoms are observed with dryness:

• back pain like radiculitis;
• ulcers;
• joint pain;
• loss of sensation;
• suppression of reflexes;
• decreased potency;
• constriction of the pupils;
• impaired coordination of movements.

A dangerous complication is progressive paralysis. It is characterized by dementia, memory loss, decreased intelligence, dysarthria, epileptic seizures, delusional ideas and indifference to what is happening.

Survey

The treatment regimen is determined after a comprehensive examination. To make a diagnosis you will need:

It is impossible to identify the disease from one photo of patients. Diagnosis of tertiary syphilis includes serological testing. Immunoglobulins are found in the blood of patients, which are produced in response to the introduction of microbes. Treatment of tertiary syphilis is recommended after testing the sensitivity of treponemes to antibiotics.

Principles of treatment

After a complete examination has been carried out, medications are prescribed. Semi-synthetic antibiotics are effective for syphilis. Most often prescribed:

• Penicillin G;
• Benzylpenicillin sodium salt;
• Bicillin-3;
• Bicillin-5.

Second line drugs are:

• tetracycline (Doxal);
• macrolides (Azithromycin Ecomed);
• cephalosporins (Ceftriaxone Kabi).

The course of treatment consists of 2 stages. First, second-line drugs are prescribed for 2 weeks, and then penicillins are used. 2 courses are required with a short interval. The treatment regimen for tertiary syphilis includes bismuth preparations. Additionally, symptomatic medications are prescribed. Immunostimulants and vitamins can be used to enhance immunity. After completion of treatment, control laboratory tests are carried out.

The prognosis for tertiary syphilis depends on the presence of complications. With the development of neurosyphilis, dangerous consequences are possible.

In this case, there is a risk of death. Thus, the third stage of the disease is the most dangerous due to total damage to organs by treponemes. Timely treatment allows you to avoid such complications and cure syphilis in the early stages of development.

Syphilis is an infectious disease that can be transmitted through sexual contact. The causative agent of the disease is a bacterium such as Treponema pallidum (spirochete), which affects internal organs, mucous membranes and skin.

To detect the disease, blood tests are used, and in some cases, cerebrospinal fluid. The results are indicated by pluses or crosses are used in quantities from 1 to 4.

Syphilis four crosses is considered the most dangerous stage for humans. The interpretation of the tests and the diagnosis is determined solely by the doctor.

Four stages of the disease and their characteristics

Determination of a sexually transmitted disease is carried out by studying blood for the presence of treponema.

This method of recognizing syphilis using a serological reaction is the most common of many tests.

The immunologist created a special system for characterizing the disease, in which crosses indicate the amount of antibodies. It is important to know that the disease itself does not contain them, but treponemas, ulcers, and a syphilitic rash.

An increase in antibody titer indicates active reproduction of the pathogen, and crosses are contained in any analysis with a positive assessment of the presence of antibodies. Let's consider the stages of the disease and their features.

Syphilis one cross

If there are crosses, syphilis is positive, but there are doubts even when observing antibodies in the blood to fight the disease.

Therefore, doctors call this test result questionable. Often the test result may indicate another disease.

A result of 1+ means that little time has passed since the infection stage. Plus may be present after full treatment, when antibodies remain.

Syphilis two crosses

Two crosses mean a positive result, which indicates the presence of treponema in the blood.

An increase in titer indicates a low concentration in the blood. So, it is necessary to examine the bacterium to confirm conclusion 2 plus before starting therapy.

Syphilis three crosses

A blood test with a three-cross score indicates a positive result and cannot be refuted. Repeated blood testing only confirms the diagnosis of 3 crosses, which is typical for the disease at the second stage of development.

Syphilis four crosses

The most unfavorable conclusion is the result of 4 crosses. But this does not mean at all that the disease cannot be cured.

This stage is characterized by a noticeable rash, hair loss, and increased body temperature. The number of antibodies is at a high level, so the conclusion is beyond doubt.

How is the examination carried out?

Recognition of syphilis is carried out in two stages, starting with examination of the patient and ending with the study of blood for antibodies.

The doctor examines the patient, and already determines the likelihood of the presence of the disease:

• detection of ulcers on the genitals or in the oral cavity;
• dermatological rashes, compactions;
• baldness in the scalp.

The doctor clarifies information from the patient, based on questions about the presence of suspicious sexual acts or treatment of a sexually transmitted disease.

Laboratory examinations

Today, a test to detect the disease syphilis 4 crosses can be taken in many ways, the most well-known are presented below:

• RPR is a test that detects antibodies in the blood to phospholipids of the cytoplasmic membrane;
• RIF (immunofluorescence reaction) is a more sensitive reaction, as it shows a positive result already at the first stage in 80% of patients;
• RW (method of the German immunologist Wasserman) is a fast and reliable research method that allows you to conduct an examination and prescribe effective pharmaceuticals;
• enzyme immunoassay of blood;
• the reaction is based on the phenomenon of immobilization of bacteria by antibodies such as immobilisins;
• passive hemagglutination shows the presence and amount of antibodies.

Today, syphilis can be treated at any stage. But it is much easier to tolerate treatment at the first manifestations of the disease, when the infection has not affected the entire body.

The duration of treatment and medications are prescribed by a venereologist based on the individual characteristics of the human body and the stage of the lesion.

Do not forget that the best prevention of syphilis is a close relationship with a regular partner, in whose health you are completely confident.

The third period of syphilis, developing in insufficiently treated patients or patients who have not undergone treatment at all. It manifests itself in the formation of syphilitic infiltrates (granulomas) in the skin, mucous membranes, bones and internal organs. Granulomas in tertiary syphilis compress and destroy the tissues in which they are located, which can lead to a fatal outcome of the disease. Diagnosis of tertiary syphilis includes a clinical examination of the patient, serological and immunological reactions, examination of affected systems and organs. Tertiary syphilis is treated with courses of penicillin-bismuth treatment with the additional use of symptomatic and restorative drugs.

General information

Currently, tertiary syphilis is a rare form of syphilis, since in modern venereology the detection and treatment of most cases of the disease occurs at the stage of primary or secondary syphilis. Tertiary syphilis can occur in patients who have undergone an incomplete course of treatment or who have received drugs in insufficient dosages. If syphilis is untreated (for example, due to undiagnosed latent syphilis), approximately one third of those affected develop tertiary syphilis. Factors predisposing to the occurrence of tertiary syphilis are concomitant chronic intoxications and diseases, alcoholism, senility and childhood.

A patient with tertiary syphilis is practically not contagious, since the few treponemes in his body are located deep inside the granulomas and die when they disintegrate.

Symptoms of tertiary syphilis

Previously, the literature indicated that tertiary syphilis develops 4-5 years after infection with Treponema pallidum. However, data from recent years indicate that this period has increased to 8-10 years. Tertiary syphilis is characterized by a long course with long latent periods, sometimes taking several years.

Skin lesions in tertiary syphilis - tertiary syphilides - develop over months and even years without signs of inflammation or any subjective sensations. Unlike elements of secondary syphilis, they are located in a limited area of ​​the skin and slowly regress, leaving behind scars. Manifestations of tertiary syphilis include tubercular and gummous syphilide.

Tuberous syphilide is an infiltrative nodule formed in the dermis, slightly protruding above the surface of the skin, having a size of 5-7 mm, red-brown color and dense consistency. Typically, with tertiary syphilis, rashes of nodules occur in waves and asymmetrically on a local area of ​​the skin, while individual elements are at different stages of their development and do not merge with each other. Over time, tubercular syphilide undergoes necrosis with the formation of a round ulcer with smooth edges, an infiltrated base and a smooth, clean bottom. Healing of a tertiary syphilis ulcer takes weeks and months, after which an area of ​​atrophy or a scar with hyperpigmentation along the edge remains on the skin. Scars that appear as a result of the resolution of several grouped tuberculate syphilides form a picture of a single mosaic scar. Repeated rashes of tertiary syphilis never occur in the area of ​​scars.

Gummy syphilide (syphilitic gumma) is more often single; the formation of several gummas in one patient is less common. Gumma is a painless node located in the subcutaneous tissue. The most common localization of tertiary syphilis gummas is the forehead, the anterior surface of the legs and forearms, and the area of ​​the knee and elbow joints. Initially, the node is mobile and not fused to adjacent tissues. It gradually increases in size and loses mobility due to fusion with the surrounding tissues. Then a hole appears in the middle of the node, through which the gelatinous fluid is separated. Slow enlargement of the hole leads to the formation of an ulcer with crater-shaped breaking edges. At the bottom of the ulcer a necrotic core is visible, after which the ulcer heals with the formation of a star-shaped retracted scar. Sometimes with tertiary syphilis, resolution of the gumma is observed without turning into an ulcer. In such cases, there is a reduction in the node and its replacement with dense connective tissue.

With tertiary syphilis, gummous ulcers can involve not only the skin and subcutaneous tissue, but also the underlying cartilaginous, bone, vascular, and muscle tissues, which leads to their destruction. Gummy syphilides can be located on the mucous membranes. Most often this is the mucous membrane of the nose, tongue, soft palate and pharynx. Tertiary syphilis infection of the nasal mucosa leads to the development of rhinitis with purulent discharge and impaired nasal breathing, then destruction of the nasal cartilage occurs with the formation of a characteristic saddle-shaped deformation, and nosebleeds are possible. When tertiary syphilis affects the mucous membrane of the tongue, glossitis develops with difficulty speaking and chewing food. Lesions of the soft palate and pharynx lead to a nasal voice and food entering the nose when chewing.

Disorders of somatic organs and systems caused by tertiary syphilis are observed on average 10-12 years after infection. In 90% of cases, tertiary syphilis occurs with damage to the cardiovascular system in the form of myocarditis or aortitis. Lesions of the skeletal system in tertiary syphilis can manifest as osteoporosis or osteomyelitis, liver damage - chronic hepatitis, stomach - gastritis or gastric ulcer. In rare cases, damage to the kidneys, intestines, lungs, and nervous system (neurosyphilis) is observed.

Complications of tertiary syphilis

The main and most dangerous complications of tertiary syphilis are associated with damage to the cardiovascular system. Thus, syphilitic aortitis can lead to an aortic aneurysm, which can gradually compress the surrounding organs or suddenly rupture with the development of massive bleeding. Syphilitic myocarditis can be complicated by heart failure, spasm of the coronary vessels with the development of myocardial infarction. Due to complications of tertiary syphilis, the death of the patient is possible, which is observed in approximately 25% of cases of the disease.

Diagnosis of tertiary syphilis

In tertiary syphilis, diagnosis is based primarily on clinical and laboratory data. In 25-35% of patients with tertiary syphilis, the RPR test gives a negative result, so blood tests using RIF and RIBT are of primary importance, which are positive in most cases of tertiary syphilis (92-100%).

Syphilis (or Lewis) is an infectious disease transmitted through sexual contact. The cause of the disease is treponema pallidum (spirochete), a long, thin, spiral-shaped bacterium.

Causes

1. Unprotected sexual contact.
2. Using other people's household items (dishes, toothbrushes, towels, linen).
3. Through donated blood; when using shared syringes.
4. Infection of the fetus through the placenta or during childbirth from a sick mother.
5. You can also become infected through a kiss if the healthy partner has damage to the mucous membrane in the mouth.

Stages

The insidiousness of this disease lies in the fact that the spirochete can take a temporary form of existence - a cyst, which has a protective shell.

In this form, the bacterium can exist for years.

Therefore, Lewis is characterized by such stages of the disease as secondary and tertiary syphilis.

Primary

The disease begins with the appearance of a small ulcer - a chancre at the site of contact (genital organs), less often - on the oral mucosa, tonsils, and tongue. It does not interfere, does not hurt, so it is often not given attention. Even if left untreated, the chancre will heal on its own. However, the person remains infectious to others, and the course of his illness enters a new stage.

Secondary

It occurs 3–4 months after infection and can last for several years. At this time, the patient is very dangerous to others, even during everyday contacts! Spirochetes spread throughout the body. All lymph nodes are enlarged. Various types of rashes (syphilides) occur periodically. In women, a “Venus necklace” appears - pale areas of skin on the back and side of the neck. There are symptoms characteristic of ARVI. Secondary Lewis has a latent form that worsens from time to time. Approximately 20% of patients report hair loss and eyebrow loss. Without treatment, after 5 years the next period occurs.

Tertiary syphilis

It can lead to the death of the patient - about a quarter of them die. Depending on the location of the infection, destruction of one or another organ occurs with the help of late syphilides - gummas. They often occur on the palate, destroying its bones. This changes the voice, the nose may become sunken. The disease can be latent, last for decades and be characterized by possible sad consequences: changes in the patient’s psyche, even to the point of insanity; Deafness and blindness, complete or partial paralysis are possible.

Diagnostics

• interviewing the patient;
• examination of the skin and lymph nodes;
• laboratory research.

Treatment

The disease is treated exclusively in a hospital.

This is not particularly difficult, but it takes a long period of time. It consists of taking a course of injections of water-soluble penicillin, which are given every 3 hours for 24 days, plus vitamins and immunostimulants. After this, the patient is registered and regularly undergoes tests. It is believed that syphilis has been completely cured if, 5 years after the end of the course, there are no more manifestations of the disease. This disease cannot be treated independently or with “traditional” methods, because it may return.