Despite successful laboratory experiments on infecting animals, under natural conditions animals are not susceptible to syphilis. Natural transmission of infection is possible only from person to person. As a source of infection, patients pose the greatest danger in the first 2 years of the disease. After 2 years of infection, the contagiousness of patients decreases, and infection of contact persons occurs less frequently. A necessary condition for infection is the presence of an entrance gate - damage (microtrauma) to the stratum corneum of the epidermis or the epithelium of the mucous membrane.

There are three ways of transmission of infection: contact, transfusion and transplacental. Most often, syphilis infection occurs through contact.

Contact path

Infection can occur through direct (immediate) contact with a sick person: sexual and non-sexual (household).

Most often, infection occurs through direct sexual contact. The direct non-sexual route of infection is rarely realized in practice (as a result of a kiss, a bite). In domestic conditions, young children are at particular risk of infection if their parents have active forms of syphilis. Preventive treatment of children who have been in close contact with patients with syphilis is mandatory. Cases of direct occupational infection of medical workers (dentists, surgeons, obstetricians-gynecologists, pathologists) during examination of patients with syphilis, carrying out medical procedures, contact with internal organs during operations, and autopsies are rare.

Infection can occur through indirect (mediated) contact - through any objects contaminated with biological material containing pathogenic treponemes. Most often, infection occurs through objects that come into contact with the oral mucosa - glasses, spoons, toothbrushes.

The risk of household infection with syphilis is real for people who are in close everyday contact with the patient: family members, members of closed groups. Indirect infection in medical institutions through reusable medical instruments is excluded if they are processed correctly.

A patient with syphilis is contagious during all periods of the disease, starting with incubation. The greatest danger is posed by patients with primary and especially secondary syphilis, who have weeping rashes on the skin and mucous membranes - erosive or ulcerative primary syphilomas, macerated, erosive, vegetative papules, especially when located on the mucous membrane of the mouth, genitals, and also in the folds of the skin.

Dry syphilides are less contagious. Treponemas are not found in the contents of papulopustular elements. Manifestations of tertiary syphilis are practically not contagious, since they contain only single treponemes located deep in the infiltrate.

The saliva of patients with syphilis is contagious in the presence of rashes on the oral mucosa. Breast milk, semen and vaginal secretions are contagious even in the absence of rashes in the breast and genital area. The secretion of the sweat glands, tear fluid and urine of patients do not contain treponemes.

In patients with early forms of syphilis, any nonspecific lesions that lead to disruption of the integrity of the skin and mucous membranes are contagious: herpetic rashes, cervical erosions.

Transfusion route

Transfusion syphilis develops during the transfusion of blood taken from a donor with syphilis, and in practice it occurs extremely rarely - only in the case of direct transfusion. Drug users expose themselves to a real risk of infection when sharing syringes and intravenous needles. When transmitted through transfusion, the pathogen immediately enters the bloodstream and internal organs, so syphilis manifests itself on average 2.5 months after infection with immediately generalized rashes on the skin and mucous membranes. However, there are no clinical manifestations of the primary period of syphilis.

Transplacental route

A pregnant woman with syphilis may experience intrauterine infection of the fetus with the development of congenital syphilis. In this case, treponemes penetrate through the placenta directly into the bloodstream and internal organs of the fetus. With congenital infection, chancre formation and other manifestations of the primary period are not observed. Transplacental infection usually occurs no earlier than the 16th week of pregnancy, after the formation of the placenta is complete.

The following variants of the course of syphilitic infection have been established: classic (staged) and asymptomatic.

Syphilis is characterized by a staged, wave-like course with alternating periods of manifestation and latent state. Another feature of the course of syphilis is progression, i.e. a gradual change in the clinical and pathomorphological picture towards increasingly more unfavorable manifestations.

Periods

During syphilis, there are four periods - incubation, primary, secondary and tertiary.

Incubation period. This period begins from the moment of infection and continues until the appearance of primary syphiloma - on average 30 - 32 days. The incubation period may be shortened or extended compared to the stated average duration. Incubation has been described to be shortened to 9 days and extended to 6 months.

When entering the body, already in the area of ​​the entrance gate, treponema meets the cells of the monocyte-macrophage system, however, the processes of recognition of a foreign agent by tissue macrophages, as well as the transfer of information by T-lymphocytes in syphilis, are disrupted for several reasons: glycopeptides of the cell wall of treponema are close in structure and composition to glycopeptides human lymphocytes; Treponemas secrete substances that slow down the recognition process; after introduction into the body, treponema quickly penetrates the lymphatic capillaries, vessels and nodes, thereby avoiding the macrophage reaction; even being phagocytosed, treponema in most cases does not die, but becomes inaccessible to the body’s defenses.

The early stages of syphilis are characterized by partial inhibition of cellular immunity, which promotes the reproduction and spread of pathogens throughout the body.

Already 2–4 hours after infection, the pathogen begins to move along the lymphatic tract and invades the lymph nodes. From the moment of infection, treponema begins to spread by hematogenous and neurogenic routes, and in the first day the infection becomes generalized. From this time on, bacteria are found in the blood, internal organs and nervous system, but in the tissues of the sick person during this period there is still no morphological response to the introduction of pathogens.

The humoral component of immunity is not able to ensure the complete destruction and elimination of Treponema pallidum. During the entire incubation period, pathogens actively multiply in the area of ​​the entrance gate, the lymphatic system and internal organs. At the end of incubation, the number of treponemas in the body increases significantly, so patients are infectious during this period.

Primary period. It begins with the onset of primary affect and ends with the appearance of generalized rashes on the skin and mucous membranes. The average duration of primary syphilis is 6–8 weeks, but it can be reduced to 4–5 weeks and increased to 9–12 weeks.

A few days after the onset of the primary affect, an increase and thickening of the lymph nodes closest to it is observed. Regional lymphadenitis is an almost constant symptom of primary syphilis. At the end of the primary period, approximately 7 to 10 days before its end, groups of lymph nodes remote from the area of ​​the entrance gate of infection increase and thicken.

During the primary period of syphilis, intensive production of antitreponemal antibodies occurs. First of all, their number in the bloodstream increases. Circulating antibodies immobilize treponemes, form membrane-attacking immune complexes, which leads to the destruction of pathogens and the release of lipopolysaccharide and protein products into the blood. Therefore, at the end of the primary – beginning of the secondary period, some patients experience a prodromal period: a complex of symptoms caused by intoxication of the body with substances released as a result of the massive death of treponemes in the bloodstream.

The level of antibodies in tissues gradually increases. When the amount of antibodies becomes sufficient to ensure the death of tissue treponemas, a local inflammatory reaction occurs, which is clinically manifested by widespread rashes on the skin and mucous membranes. From this time on, syphilis enters the second stage.

Secondary period. This period begins from the moment the first generalized rash appears (on average 2.5 months after infection) and lasts in most cases for 2 to 4 years.

The duration of the secondary period is individual and determined by the characteristics of the patient’s immune system. Recurrences of secondary rashes can be observed 10–15 years or more after infection, while at the same time in weakened patients the secondary period can be shortened.

In the secondary period, the undulation of the course of syphilis is most pronounced, that is, the alternation of manifest and latent periods of the disease. During the first wave of secondary rashes, the number of treponemas in the body is greatest - they multiplied in huge numbers during the incubation and primary periods of the disease.

The intensity of humoral immunity at this time is also maximum, which causes the formation of immune complexes, the development of inflammation and the massive death of tissue treponemas. The death of some pathogens under the influence of antibodies is accompanied by a gradual cure of secondary syphilides within 1.5 - 2 months. The disease enters a latent stage, the duration of which may vary, but on average is 2.5 - 3 months.

The first relapse occurs approximately 6 months after infection. The immune system again responds to the next proliferation of pathogens by increasing the synthesis of antibodies, which leads to the cure of syphilides and the transition of the disease to a latent stage. The undulating course of syphilis is due to the peculiarities of the relationship between Treponema pallidum and the patient’s immune system.

The further course of the syphilitic infection is characterized by a continuing increase in sensitization to treponema with a steady decrease in the number of pathogens in the body.

After an average of 2 - 4 years from the moment of infection, the tissue response to the pathogen begins to proceed according to the Arthus phenomenon type, followed by the formation of a typical infectious granuloma - an infiltrate of lymphocytes, plasma, epithelioid and giant cells with necrosis in the center.

Tertiary period. This period develops in patients who have not received treatment at all or have not been treated sufficiently, usually 2 to 4 years after infection.

The balance that exists between the pathogen and the controlling immune system during the latent course of syphilis can be disrupted under the influence of unfavorable factors - injuries (bruises, fractures), weakening the body of the disease, intoxication. These factors contribute to the activation (reversion) of spirochetes in any part of a particular organ.

In the later stages of syphilis, cellular immune reactions begin to play a leading role in the pathogenesis of the disease. These processes occur without a sufficiently pronounced humoral background, since the intensity of the humoral response decreases as the number of treponemes in the body decreases.

Malignant course of syphilis

Severe concomitant diseases (such as tuberculosis, HIV infection), chronic intoxication (alcoholism, drug addiction), poor nutrition, heavy physical labor and other reasons that weaken the patient’s body affect the severity of syphilis, contributing to its malignant course. Malignant syphilis in each period has its own characteristics.

In the primary period, ulcerative chancre is observed, prone to necrosis (gangrenization) and peripheral growth (phagedenism), there is no reaction of the lymphatic system, the entire period can be shortened to 3–4 weeks.

In the secondary period, the rash tends to ulcerate, and papulopustular syphilides are observed. The general condition of the patients is disturbed, fever and symptoms of intoxication are expressed. Manifest lesions of the nervous system and internal organs are common. Sometimes there is a continuous recurrence, without latent periods. Treponemas are difficult to detect in the discharge of rashes.

Tertiary syphilides in malignant syphilis can appear early: a year after infection (galloping course of the disease). Serological reactions in patients with malignant syphilis are often negative, but can become positive after the start of treatment.

Re-infection with syphilis

True, or sterile, immunity does not develop with syphilis. This means that a person who has been ill can become infected again, just like a person who has never had this disease before. Repeated infection with syphilis in a person who previously had the disease and was completely cured is called reinfection. The latter is considered as convincing evidence that syphilis is completely curable.

With syphilis, the patient’s body develops so-called non-sterile, or infectious, immunity. Its essence is that a new infection is impossible as long as treponema pallidum remains in the body.

Primary period

The primary period of syphilis is characterized by the following set of clinical symptoms: primary syphiloma, regional lymphadenitis, specific lymphadenitis, specific polyadenitis, prodromal phenomena.

Primary syphiloma is the first clinical manifestation of the disease, occurring at the site of penetration of Treponema pallidum through the skin and mucous membranes (in the area of ​​the entrance gate).

The appearance of an erosive or ulcerative defect is preceded by the appearance of a small hyperemic inflammatory spot, which after 2–3 days turns into a papule. These changes are asymptomatic and are not noticed by either the patient or the doctor. Soon after the appearance of the papule, the epidermis (epithelium) covering it undergoes disintegration, and an erosion or ulcer is formed - the primary syphiloma itself. The depth of the defect depends on the severity and nature of the tissue reaction to the introduction of the pathogen.

Clinical signs of typical primary syphiloma.

1. Primary syphiloma is an erosion or superficial ulcer.

2. Primary syphilomas are single or single (2 - 3 elements).

3. Primary syphiloma has a round or oval shape.

4. Primary syphiloma usually has a size of 5 – 15 mm. There are also dwarf primary affects with a diameter of 1 – 3 mm. Giant chancre with a diameter of up to 4–5 cm or more are ulcerative, covered with serous-hemorrhagic or purulent-hemorrhagic crusts and have extragenital or perigenital localization.

5. Having reached a certain size, primary syphiloma does not tend to grow peripherally.

6. The boundaries of primary syphiloma are smooth and clear.

7. The surface of primary syphiloma has a bright red color (the color of fresh meat), sometimes covered with a dense coating of grayish-yellow color (the color of spoiled lard).

8. The edges and bottom of erosive syphiloma lie at the same level. The edges and bottom of the ulcerative chancre are separated from each other by the depth of the defect.

9. The bottom of primary syphiloma is smooth, covered with scanty transparent or opalescent discharge, giving it a peculiar mirror or varnish shine.

10. At the base of primary syphiloma there is a dense elastic infiltrate, clearly demarcated from the surrounding tissues and extending 2 - 3 mm beyond the syphiloma.

11. Primary syphiloma is not accompanied by subjective sensations. Soreness in the area of ​​primary affect appears when a secondary infection is attached.

12. There are no acute inflammatory changes in the skin around the primary syphiloma.

Localization of primary syphilomas: primary syphilomas can be located on any area of ​​the skin and mucous membranes where conditions have developed for the introduction of treponemes, i.e. in the area of ​​the entrance gate of infection. Based on localization, primary syphilomas are divided into genital, perigenital, extragenital and bipolar.

Atypical primary syphilomas. In addition to primary affects with a typical clinical picture and its many varieties, atypical chancre may be observed that does not have the characteristic features inherent in typical syphilomas. These include indurative edema, chancre-felon, chancre-amygdalitis. Atypical forms of syphiloma are rare, have a long course and often cause diagnostic errors.

Indurative edema is a persistent specific lymphangitis of small lymphatic vessels of the skin, accompanied by symptoms of lymphostasis.

It occurs in the genital area with a richly developed lymphatic network: in men the foreskin and scrotum are affected, in women - the labia majora and very rarely - the labia minora, clitoris, and cervical pharynx lips.

The chancre felon is localized on the distal phalanx of the finger and is very similar to the common felon. It is characterized by the formation of an ulcer on the dorsal surface of the terminal phalanx of the finger. A deep - down to the bone - ulcer with uneven, tortuous and undermined edges, crescent-shaped or horseshoe-shaped. The bottom of the ulcer is pitted, covered with purulent-necrotic masses, crusts, there is copious purulent or purulent-hemorrhagic discharge with an unpleasant odor.

Chancroid-amygdalitis is a specific unilateral enlargement and significant thickening of the tonsil without a defect on its surface. The tonsil has a stagnant red color, but is not accompanied by diffuse hyperemia.

The following complications of primary syphiloma are distinguished:

1) impetiginization. A hyperemic corolla appears along the periphery of syphiloma, the tissues acquire pronounced swelling, the brightness of the element increases, the discharge becomes abundant, serous-purulent or purulent, a burning sensation and pain appear in the area of ​​syphiloma and regional lymph nodes;

2) balanitis and balanoposthitis - in men, vulvitis and vulvovaginitis - in women. High humidity, constant temperature, and the presence of a nutrient medium in the form of smegma in the preputial sac contribute to the proliferation of microorganisms and the development of clinical manifestations of balanitis - inflammation of the skin of the glans penis. In women, secondary infection contributes to the occurrence of vulvovaginitis;

3) phimosis. In men who have not undergone circumcision, the inflammatory process of the skin of the preputial sac, due to the developed lymphatic network, often leads to phimosis - a narrowing of the ring of the foreskin. Inflammatory phimosis is characterized by bright diffuse hyperemia, mild swelling and an increase in the volume of the foreskin, as a result of which the penis takes on a flask shape and becomes painful;

4) paraphimosis, which is the infringement of the head of the penis by a narrowed ring of the foreskin, pulled towards the coronal sulcus. It occurs as a result of forced exposure of the head during phimosis. This leads to disruption of blood and lymph flow, worsening swelling of the preputial ring and severe pain in the penis;

5) gangrenization. Syphiloma undergoes necrotic decay, which is clinically expressed by the formation of a dirty gray, brown or black scab, tightly fused to the underlying tissues and painless;

6) phagedenism, which begins with the appearance of a necrosis area of ​​greater or lesser magnitude against the background of an ulcer. But the necrotic process is not limited to the chancre and extends not only into the depths, but also beyond the boundaries of syphiloma.

Regional lymphadenitis. It is an enlargement of the lymph nodes draining the site of primary syphiloma. This is the second clinical manifestation of primary syphilis.

Specific lymphangitis. It is an inflammation of the lymphatic vessel from the chancre to the regional lymph nodes. This is the third component of the clinical picture of primary syphilis.

Specific polyadenitis. At the end of the primary period of syphilis, patients experience specific polyadenitis - an increase in several groups of subcutaneous lymph nodes remote from the area of ​​the entrance gate of infection.

Prodromal syndrome. Approximately 7–10 days before the end of the primary period and during the first 5–7 days of the secondary period, general symptoms are observed due to intoxication as a result of the massive presence of treponemes in the bloodstream. It includes fatigue, weakness, insomnia, decreased appetite and performance, headache, dizziness, irregular fever, myalgia, leukocytosis and anemia.

Secondary period

The secondary period of syphilis is characterized by a complex of clinical manifestations such as spotted syphilide (syphilitic roseola), papular syphilide, papulopustular syphilide, syphilitic alopecia (baldness), syphilitic leucoderma (pigmented syphilide).

Spotted syphilide, or syphilitic roseola. This is the most common and earliest manifestation of the secondary period of the disease. The roseate rash appears gradually, in spurts, 10 to 12 elements per day. The rash reaches full development in 8 - 10 days, lasts on average 3 - 4 weeks without treatment, sometimes less or more (up to 1.5 - 2 months). The roseate rash resolves without leaving a trace.

Syphilitic roseola is a hyperemic inflammatory spot. The color of roseola varies from pale pink to deep pink, sometimes with a bluish tint. Most often it has a pale pink, faded color. Long-existing roseola acquires a yellowish-brown tint. The size of the spots ranges from 2 to 25 mm, with an average of 5 – 10 mm. The outlines of roseola are round or oval, the boundaries are unclear. The spots do not grow peripherally, do not merge, and are not accompanied by subjective sensations. There is no peeling.

The roseate rash is localized mainly on the lateral surfaces of the torso, chest, and upper abdomen. Rashes can also be observed on the skin of the upper thighs and the flexor surface of the forearms, and rarely on the face.

In addition to the typical roseola syphilide, its atypical varieties are distinguished: elevated, confluent, follicular and scaly roseola.

Elevating (rising) roseola, urticarial roseola, exudative roseola. With this form, the spots appear slightly raised above the skin level and become similar to the urticarial rash of urticaria.

Plum roseola. Occurs when there is a very abundant rash of spots, which, due to their abundance, merge with each other and form continuous erythematous areas.

Follicular roseola. This variety is a transitional element between roseola and papule. Against the background of the pink spot there are small follicular nodules in the form of dotted copper-red granules.

Flaky roseola. This atypical variety is characterized by the appearance on the surface of spotted elements of lamellar scales, reminiscent of crumpled tissue paper. The center of the element appears somewhat sunken.

Papular syphilide. Occurs in patients with secondary recurrent syphilis. Papular syphilide also occurs with secondary fresh syphilis; in this case, papules usually appear 1 to 2 weeks after the onset of roseola rash and are combined with it (maculopapular syphilide). Papular syphilides appear on the skin in spurts, reaching full development in 10–14 days, after which they exist for 4–8 weeks.

The primary morphological element of papular syphilide is a dermal papule, sharply delimited from the surrounding skin, regularly round or oval in outline. It can be hemispherical in shape with a truncated apex or pointed. The color of the element is initially pink-red, later becoming yellowish-red or bluish-red. The consistency of the papules is densely elastic. The elements are located in isolation; only when localized in folds and irritation is there a tendency towards their peripheral growth and fusion.

There are no subjective sensations, but when pressing on the center of a newly appeared papule with a blunt probe, pain is noted.

Depending on the size of the papules, four types of papular syphilide are distinguished.

Lenticular papular syphilide. This is the most common variety, which is characterized by a rash of papules with a diameter of 3–5 mm, observed both in secondary fresh and recurrent syphilis.

Miliary papular syphilide. This variety is extremely rare; its appearance is considered evidence of a severe course of the disease.

The morphological element is a cone-shaped papule of dense consistency with a diameter of 1–2 mm, located around the mouth of the hair follicle. The color of the elements is pale pink, as a result of which they stand out slightly against the surrounding background.

Nummular papular syphilide. This manifestation of the disease occurs mainly in patients with secondary recurrent syphilis. The rashes appear in small numbers and are usually grouped. The morphological element is a hemispherical papule with a flattened apex with a diameter of 2 - 2.5 cm. The color of the elements is brownish or bluish-red, rounded in outline. When nummular papules resolve, pronounced skin pigmentation remains for a long time.

Plaque papular syphilide. It occurs very rarely in patients with secondary recurrent syphilis. It is formed as a result of peripheral growth and fusion of nummular and lenticular papules exposed to external irritation. Most often, plaque-like syphilide forms in the area of ​​large folds - on the genitals, around the anus, in the inguinal-femoral fold, under the mammary glands, in the armpits.

Papulopustular syphilide. It is observed in weakened patients suffering from alcoholism, drug addiction, and severe concomitant diseases, and indicates a severe, malignant course of syphilis.

The following clinical types of papulopustular syphilide are distinguished: acne-like (or acneiform), smallpox-like (or varioliform), impetigo-like, syphilitic ecthyma, syphilitic rupee. Superficial forms of papulopustular syphilide - acne-like, smallpox-like and impetigo-like - are most often observed in patients with secondary fresh syphilis, and deep forms - syphilitic ecthyma and rupiah - are observed mainly in secondary recurrent syphilis and serve as a sign of the malignant course of the disease. All varieties of pustular syphilides have an important feature: at their base there is a specific infiltrate. Pustular syphilides arise as a result of the disintegration of papular infiltrates, so it is more correct to call them papulopustular.

Syphilitic alopecia. There are three clinical types of alopecia: diffuse, finely focal and mixed, which is a combination of finely focal and diffuse types of baldness.

Diffuse syphilitic alopecia is characterized by acute general hair thinning in the absence of any skin changes. Hair loss usually begins at the temples and spreads to the entire scalp. In some cases, other areas of the hairline also experience baldness - the area of ​​the beard and mustache, eyebrows, and eyelashes. The hair itself also changes: it becomes thin, dry, dull. The severity of diffuse alopecia varies from barely noticeable hair loss, slightly exceeding the size of the physiological change, to complete loss of all hair, including vellus hair.

Small focal syphilitic alopecia is characterized by the sudden, rapidly progressive appearance on the scalp, especially in the area of ​​the temples and the back of the head, of many randomly scattered small foci of hair thinning with a diameter of 0.5 - 1 cm. Bald spots have irregularly rounded outlines, do not grow along the periphery and do not merge with each other. The hair in the affected areas does not fall out completely, only a sharp thinning occurs.

Syphilitic leukoderma, or pigment syphilide. This is a kind of skin dyschromia of unknown origin that occurs in patients with secondary, mainly recurrent, syphilis. A typical localization of leukoderma is the skin of the back and sides of the neck, less often - the anterior wall of the armpits, the area of ​​the shoulder joints, the upper chest, and back. Diffuse yellowish-brown hyperpigmentation of the skin first appears on the affected areas. After 2–3 weeks, whitish hypopigmented spots with a diameter of 0.5 to 2 cm of round or oval shape appear on the hyperpigmented background. All spots are approximately the same size, located in isolation, and are not prone to peripheral growth and fusion.

There are three clinical varieties of pigment syphilide: spotted, reticulate (lace) and marbled. In macular leukoderma, hypopigmented spots are separated from each other by wide layers of hyperpigmented skin, and there is a pronounced difference in color between hyper- and hypopigmented areas. In the reticular form, hypopigmented spots are in close contact with each other, but do not merge, remaining separated by thin layers of hyperpigmented skin. In this case, narrow areas of hyperpigmentation form a network.

With marbled leukoderma, the contrast between hyper- and hypopigmented areas is insignificant, the boundaries between white spots are unclear, and the overall appearance of dirty skin is created.

Damage to the nervous system. Neurosyphilis is usually divided into early and late forms depending on the nature of the pathomorphological changes observed in the nervous tissue. Early neurosyphilis is a predominantly mesenchymal process affecting the meninges and vessels of the brain and spinal cord.

It usually develops in the first 5 years after infection. Early neurosyphilis is characterized by a predominance of exudative-inflammatory and proliferative processes.

Damage to internal organs. Syphilitic lesions of internal organs during early syphilis are inflammatory in nature and are similar in morphological picture to the changes occurring in the skin.

Damage to the musculoskeletal system. Lesions of the skeletal system, mainly in the form of ossalgia, less often - periostitis and osteoperiostitis, are localized mainly in the long tubular bones of the lower extremities, less often - in the bones of the skull and chest.

Tertiary period

Damage to the skin and mucous membranes in tertiary active syphilis is manifested by tuberculate and gummous rashes.

Tuberous syphilide. It can be located on any part of the skin and mucous membranes, but typical places for its localization are the extensor surface of the upper limbs, torso, and face. The lesion occupies a small area of ​​skin and is located asymmetrically.

The main morphological element of tubercular syphilide is a tubercle (a dense, hemispherical, cavityless formation of a round shape, dense elastic consistency). The tubercle is formed in the thickness of the dermis, sharply demarcated from apparently healthy skin, and has a size from 1 mm to 1.5 cm. The color of the tubercles is first dark red or yellowish-red, then becomes bluish-red or brownish. The surface of the elements is initially smooth and shiny, later fine-plate peeling appears on it, and in the case of ulceration, a crust appears. There are no subjective sensations. Fresh elements appear around the periphery of the hearth.

The following clinical types of tubercular syphilide are distinguished: grouped, serpiginating (creeping), tubercular syphilide with a platform, dwarf.

Grouped tubercular syphilide is the most common type. The number of tubercles usually does not exceed 30 - 40. The tubercles are at different stages of evolution, some of them have just appeared, others have ulcerated and become crusty, others have already healed, leaving scars or cicatricial atrophy.

Due to the unequal growth of the tubercles and the different depths of their occurrence in the dermis, individual small scars differ in color and relief.

Serpiginating tubercular syphilide. The lesion spreads over the surface of the skin either eccentrically or in one direction when fresh tubercles appear at one pole of the lesion.

In this case, the individual elements merge with each other into a dark red horseshoe-shaped ridge, 2 mm to 1 cm wide, raised above the level of the surrounding skin, along the edge of which fresh tubercles appear.

Tuberous syphilide platform. Individual tubercles are not visible; they merge into plaques 5–10 cm in size, of bizarre shape, sharply demarcated from the unaffected skin and rising above it.

The plaque has a dense consistency, brownish or dark purple color. Regression of tubercular syphilide by a platform occurs either by dry means with the subsequent formation of cicatricial atrophy, or through ulceration with the formation of characteristic scars.

Dwarf tubercular syphilide. Rarely observed. It has a small size of 1 – 2 mm. The tubercles are located on the skin in separate groups and resemble lenticular papules.

Gummy syphilide, or subcutaneous gumma. This is a node that develops in the hypodermis. Typical localization sites for gummas are the legs, head, forearms, and sternum. The following clinical types of gummous syphilide are distinguished: isolated gummas, diffuse gummous infiltrations, fibrous gummas.

Isolated gumma. Appears in the form of a painless node measuring 5–10 mm, spherical in shape, densely elastic consistency, not fused to the skin. Gradually increasing, the subcutaneous gum adheres to the surrounding tissue and skin and protrudes above it in the form of a hemisphere.

The skin over the gumma first becomes pale pink, then brownish-red, purple. Then a fluctuation appears in the center of the gumma, and the gumma opens. When opened, 1–2 drops of sticky, yellow liquid with crumbly inclusions are released from the gummosa node.

Gummous infiltration. They arise independently or as a result of the merger of several gummas. The gummous infiltrate disintegrates, the ulcerations merge, forming an extensive ulcerative surface with irregular large scalloped outlines, healing with a scar.

Fibrous gummas, or periarticular nodules, are formed as a result of fibrous degeneration of syphilitic gummas. Fibrous gummas are localized mainly in the area of ​​the extensor surface of large joints in the form of spherical formations, very dense consistency, ranging in size from 1 to 8 cm. They are painless, mobile, the skin over them is unchanged or slightly pinkish.

Late neurosyphilis. It is a predominantly ectodermal process involving the neural parenchyma of the brain and spinal cord. It usually develops 5 years or more from the moment of infection. In late forms of neurosyphilis, degenerative-dystrophic processes predominate. The actual late forms of neurosyphilis include: tabes dorsalis - the process of destruction of nervous tissue and replacement of its connective tissue, localized in the dorsal roots, dorsal columns and membranes of the spinal cord; progressive paralysis - degenerative-dystrophic changes in the cerebral cortex in the area of ​​the frontal lobes; Taboparalysis is a combination of symptoms of tabes dorsalis and progressive paralysis. In the tertiary period, lesions of the meninges and blood vessels may still be observed.

Late visceral syphilis. In the tertiary period of syphilis, limited gummas or diffuse gummous infiltrations may occur in any internal organ, as well as various degenerative processes may be observed. The morphological basis of lesions in late visceral syphilis is infectious granuloma.

Damage to the musculoskeletal system. In the tertiary period, the musculoskeletal system may be involved in the process.

The main forms of bone damage in syphilis.

1. Gummous osteoperiostitis (damage to spongy bone):

1) limited;

2) diffuse.

2. Gummy osteomyelitis (damage to spongy bone and bone marrow):

1) limited;

2) diffuse.

3. Non-gummous osteoperiostitis.

Most often the tibia bones are affected, less often - the bones of the forearm, collarbone, sternum, skull bones, and vertebrae. Damage to muscles in the form of gummous myositis and joints in the form of acute or chronic synovitis or osteoarthritis are rare in the tertiary period.

Latent syphilis is diagnosed on the basis of positive results of serological reactions in the absence of active manifestations of the disease on the skin and mucous membranes, signs of specific damage to the nervous system, internal organs, and musculoskeletal system.

Latent syphilis is divided into early (with a disease duration of up to 1 year), late (more than 1 year) and unspecified or unknown (it is not possible to determine the timing of infection). This time division is determined by the degree of epidemiological danger of patients.

Congenital syphilis occurs as a result of infection of the fetus during pregnancy through the transplacental route from a mother with syphilis. A pregnant woman with syphilis can transmit Treponema pallidum through the placenta, starting from the 10th week of pregnancy, but usually intrauterine infection of the fetus occurs in the 4th - 5th month of pregnancy.

Congenital syphilis is most often observed in children born to sick women who were not treated or received inadequate treatment. The likelihood of congenital syphilis depends on the duration of the infection in the pregnant woman: the fresher and more active the mother’s syphilis, the more likely the unfavorable end of pregnancy for the unborn child. The fate of a fetus infected with syphilis can be different. Pregnancy can end in stillbirth or the birth of a live child with manifestations of the disease occurring immediately after birth or somewhat later. It is possible to give birth to children without clinical symptoms, but with positive serological reactions, who subsequently develop late manifestations of congenital syphilis. Mothers who have had syphilis for more than 2 years can give birth to a healthy baby.

Syphilis of the placenta

With syphilis, the placenta is hypertrophied, the ratio of its weight to the weight of the fetus is 1: 4 - 1: 3 (normally 1: 6 - 1: 5), the consistency is dense, the surface is lumpy, the tissue is fragile, flabby, easily torn, the color is motley. It is difficult to find treponema in placental tissue, so to detect the pathogen, material is taken from the umbilical cord, where treponema is always found in large quantities.

Fetal syphilis

The changes that have occurred in the placenta make it functionally defective, unable to ensure normal growth, nutrition and metabolism of the fetus, resulting in its intrauterine death in the 6th – 7th month of pregnancy. The dead fruit is expelled on the 3rd - 4th day, usually in a macerated state. A macerated fetus, compared to a normally developing fetus of the same age, is significantly smaller in size and weight. The skin of stillborns is bright red, folded, the epidermis is loosened and easily slides off in large layers.

Due to the massive penetration of Treponema pallidum, all internal organs and the skeletal system of the fetus are affected. A huge number of treponemas are found in the liver, spleen, pancreas, and adrenal glands.

Early congenital syphilis

If a fetus affected by a syphilitic infection does not die in utero, then the newborn may develop the next stage of congenital syphilis - early congenital syphilis. Its manifestations are detected either immediately after birth or during the first 3 to 4 months of life. In most cases, newborns with severe manifestations of early congenital syphilis are not viable and die in the first hours or days after birth due to functional inferiority of internal organs and general exhaustion.

Clinical signs of early congenital syphilis are detected from the skin, mucous membranes, internal organs, musculoskeletal system, nervous system and generally correspond to the period of acquired syphilis.

The appearance of a newborn with early congenital syphilis is almost pathognomonic. The child is poorly developed, has low body weight, the skin is flabby and folded due to the lack of subcutaneous tissue. The baby's face is wrinkled (senile), the skin has a pale sallow or yellowish color, especially on the cheeks. Due to hydrocephalus and due to premature ossification of the skull bones, the size of the head is sharply increased, the fontanelle is tense, and the cutaneous veins of the head are dilated. The child's behavior is restless, he often screams, and develops poorly.

Lesions of the skin and mucous membranes can be represented by all types of secondary syphilides and special symptoms characteristic only of early congenital syphilis: syphilistic pemphigoid, diffuse skin infiltrates, syphilitic rhinitis.

Massive bone deposits on the anterior surface of the tibia as a result of repeatedly recurrent osteoperiostitis ending in ossification leads to the formation of a crescent-shaped protrusion and the formation of false saber-shaped tibias. Periostitis and osteoperiostitis of the skull bones can lead to various changes in its shape. The most typical are the buttock-shaped skull and the Olympic forehead.

Patients with early congenital syphilis may experience various forms of damage to the nervous system: hydrocephalus, specific meningitis, specific meningoencephalitis, cerebral meningovascular syphilis.

The most typical form of damage to the organ of vision is damage to the retina and choroid - specific chorioretinitis. During ophthalmoscopy, small light or yellowish spots, alternating with pinpoint pigment inclusions, are found mainly along the periphery of the fundus. The child's visual acuity does not suffer.

Late congenital syphilis

This form occurs in patients who previously had signs of early congenital syphilis, or in children with a long asymptomatic course of congenital syphilis. Late congenital syphilis includes symptoms that appear 2 years or more after birth. Most often they develop between 7 and 14 years; after 30 years they rarely occur.

The clinical picture of active late congenital syphilis is generally similar to tertiary acquired: tubercular and gummous syphilis, damage to the nervous system, internal organs, and musculoskeletal system can be observed, as in tertiary syphilis. But along with this, with late congenital syphilis, there are special clinical signs that are divided into reliable, probable and dystrophies.

Reliable signs of late congenital syphilis, resulting from the direct impact of treponemes on the child’s organs and tissues, include parenchymal keratitis, specific labyrinthitis and Hutchinson’s teeth.

Possible signs of late congenital syphilis include radial perioral striae of Robinson - Fournier, true saber shins, saddle nose, buttock-shaped skull, syphilitic gonitis. Probable signs are taken into account in combination with reliable ones or in combination with data from a serological examination and anamnesis.

Dystrophies (stigmas) arise as a result of the indirect effect of infection on the child’s organs and tissues and are manifested by their abnormal development. They acquire diagnostic significance only when the patient simultaneously exhibits reliable signs of late congenital syphilis and positive serological reactions. The most characteristic dystrophies are the following: the Ausitidian sign - thickening of the thoracic end of the clavicle, usually the right one; axiphoidia (Keir's symptom) – absence of the xiphoid process of the sternum; Olympic forehead with very prominent frontal ridges; high (Gothic) hard palate; Dubois-Hissar symptom, or infantile little finger, is shortening and curvature of the little finger inward due to hypoplasia of the fifth metacarpal bone; hypertrichosis of the forehead and temples.

Main diagnostic criteria:

1) clinical examination of the patient;

2) detection of treponema pallidum in the serous discharge of weeping syphilis of the skin and mucous membranes by examining the native preparation, a crushed drop, using dark-field microscopy;

3) results of serological tests;

4) confrontation data (examination of sexual partners);

5) results of trial treatment. This diagnostic method is rarely used, only in late forms of syphilis, when other methods of confirming the diagnosis are impossible. In early forms of syphilis, trial treatment is unacceptable.

Early forms of syphilis are completely curable if the patient receives therapy that is adequate to the stage and clinical form of the disease. When treating late forms of the disease, in most cases clinical recovery or stabilization of the process is observed.

Specific treatment can be prescribed to a patient only if the diagnosis of syphilis is clinically justified and confirmed in accordance with the criteria listed above. There are the following exceptions to this general rule:

1) preventive treatment, which is carried out in order to prevent the development of the disease to persons who have had sexual or close household contact with patients with early forms of syphilis, if no more than 2 months have passed since the contact;

2) preventive treatment prescribed to pregnant women who are sick or have had syphilis, but have not been deregistered, in order to prevent congenital syphilis in a child, as well as children born to mothers who did not receive preventive treatment during pregnancy;

3) trial treatment. It can be prescribed for the purpose of additional diagnostics if late specific damage to internal organs, the nervous system, sensory organs, or the musculoskeletal system is suspected in cases where it is not possible to confirm the diagnosis with laboratory tests, and the clinical picture does not exclude the possibility of a syphilitic infection.

Antibiotics of the penicillin group currently remain the drugs of choice for the treatment of syphilis:

1) durant (long-lasting) penicillin preparations – the group name of benzathine benzylpenicillin (retarpen, extencillin, bicillin-1), ensuring that the antibiotic stays in the body for up to 18 – 23 days;

2) drugs of medium duration (procaine-benzylpenicillin, novocaine salt of benzylpenicillin), ensuring that the antibiotic remains in the body for up to 2 days;

3) preparations of water-soluble penicillin (benzylpenicillin sodium salt), ensuring that the antibiotic remains in the body for 3–6 hours;

4) combination preparations of penicillin (bicillin-3, bicillin-5), ensuring that the antibiotic remains in the body for 3–6 days.

The most effective are water-soluble penicillin preparations, which are treated in a hospital in the form of round-the-clock intramuscular injections or intravenous drips. The volume and duration of therapy depend on the duration of the syphilitic infection. The therapeutic concentration of penicillin in the blood is 0.03 U/ml or higher.

In case of intolerance to drugs of the penicillin group, patients with syphilis are treated with reserve antibiotics that have a wide spectrum of action - semisynthetic penicillins (ampicillin, oxacillin), doxycycline, tetracycline, ceftriaxone (rocephin), erythromycin.

Specific treatment for syphilis should be complete and vigorous. Medicines must be prescribed in strict accordance with the approved instructions for the treatment and prevention of syphilis - in sufficient single and course doses, observing the frequency of administration and course duration.

At the end of treatment, all patients are subject to clinical and serological monitoring. During observation, patients undergo a thorough clinical examination and serological examination every 3 to 6 months.

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and has a characteristic periodization during its course. Syphilis is prone to chronic and recurrent course, affecting all organs and systems.

Currently, the incidence of syphilis has increased so much that it is again considered a common infection. A particular difficulty in diagnosis is the erased and atypical forms of the disease, which have become widespread due to the use of various antibacterial drugs by patients for self-medication.

ETIOLOGY, EPIDEMIOLOGY, PATHOGENESIS AND PATHANATOMY

The causative agent of syphilis is Treponema pallidum, which belongs to the genus Treponema, family Spirochetacea— penetrates the human body through damaged skin or mucous membranes. The source of infection is a sick person. Patients with primary and secondary (fresh and recurrent) syphilis, as well as early congenital and early latent syphilis are considered infectious. The pathogen is especially actively released during primary syphilis - from the bottom of ulcers with chancre. The main route of infection is direct sexual contact with a patient, but currently the number of cases of household syphilis (infection through household items) has increased. Various biological fluids - saliva, sweat, urine, tears, breast milk, blood - are contagious in patients with early syphilis, because syphilitic foci may be located in the places where the secretion is formed and along their path, from where Treponema pallidum penetrates into the secretion. Congenital syphilis has a transplacental route of infection.

Treponemas (from the Latin treponema - a type of spirochete) are thin and flexible cells with 12-14 curls. They do not have an axial filament or axial ridge visible under a microscope. The ends of the treponemes are pointed or rounded. The size of treponemes is 10-13 microns in length and 0.13-0.15 microns in width.

Treponemas are mobile (have rotational, translational, flexion and wave-like movements) and do not perceive dyes well. According to the Romanovsky-Giemsa method, they are painted pale pink; this is explained by the insignificant content of nucleoproteins in their body.

Treponema pathogenic for humans include:

1. treponema pallidum, causing venereal and congenital syphilis in humans in all countries of the world and bejel (non-venereal syphilis) in the southeast of the Mediterranean zone;
2. treponema pertenu, causing yaws in tropical Africa, Southeast Asia, the Western Pacific Islands, and tropical South America;
3. treponema carateum, causing pinta, or karate, in Mexico, Central America, tropical countries of South America, the West Indies and Cuba.

Under the influence of environmental factors and medicinal drugs, treponemes in some cases curl into balls, forming cysts covered with an impenetrable mucin-like membrane; they can remain in a latent state in the patient’s body for a long time; under favorable conditions, cysts turn into grains and then into typical spiral-shaped treponemes. Cyst formation is one of the protective forms of the existence of treponemes, allowing them to resist the effects of drugs used to treat patients with syphilis.

Intact skin and mucous membranes are impermeable to Treponema pallidum. Their introduction into the body usually occurs through minor damage to the skin and oral cavity, as well as other areas (very rarely). Damage to the skin on the hands is dangerous for medical personnel, especially dentists, surgeons and obstetricians-gynecologists. It is recommended to cover such minor damage with adhesive tape.

Treponema pallidum spreads throughout the body through the blood and lymph, actively multiplies and periodically enters various organs and tissues, which causes a variety of clinical manifestations of the disease. Over time, sensitization of the body increases, which causes a violent reaction even in the presence of a small number of pathogens. Sensitization reactions determine the dynamics of symptoms during a long course of the disease.

During syphilis, primary, secondary and tertiary periods are distinguished; They also distinguish latent and visceral syphilis and syphilis of the nervous system (progressive paralysis and tabes dorsalis).

The incubation period averages 20-40 days. At the site where the treponema is introduced, a small erosion forms - the so-called chancre. There are no clinical symptoms indicating infection.

Primary period- the period from the appearance of hard chancre to the appearance of the first rash. The duration of the primary period is 6-7 weeks. Typically, a week after the appearance of chancre, regional lymph nodes enlarge. Some patients experience inflammation of the lymphatic tract running from the chancre to the enlarged lymph nodes (syphilitic lymphangitis). There are no other symptoms. Sometimes general malaise, weakness, moderate fever, and anemia are observed.

Chancre (primary syphiloma) also called primary sclerosis; it has the appearance of a dense infiltrate with superficial erosion or an ulcer at the site of treponema penetration, the bottom and edges of the ulcer have a cartilaginous consistency. By the end of the primary period, all lymph nodes are enlarged (syphilitic polyadenitis).

Primary syphilis is divided into:

• primary seronegative- the first 3-4 weeks after the appearance of chancre, when serological reactions are still negative;
• primary seropositive- the next 3-4 weeks, when the reaction is already positive;
• latent period.

In addition to the typical ones, there are also asymptomatic forms, which subsequently lead to late nervous and visceral manifestations of the disease.

In the secondary period Various rashes appear on the skin and mucous membranes, which may disappear; the rash in some patients can be abundant and bright, in others it can be weak and invisible. In addition to the skin and mucous membranes, bones, internal organs, and the nervous system can be affected. Lymph nodes are enlarged. Serological reactions are positive in almost all patients. The duration of the secondary period is three years.

During the secondary period of syphilis, secondary fresh syphilis (the first outbreak of the rash), secondary recurrent syphilis (repeated outbreaks of the rash) and latent, or hidden, syphilis are distinguished. With secondary syphilis, a generalization of the process is observed with a rash on the skin and mucous membranes of syphilides (roseola, papules, pustules, condylomas lata).

Tertiary syphilis (gummy) not observed in all patients. It is characterized by the presence of lesions in any organs and tissues, which lead to severe dysfunction. The course of tertiary syphilis is long. In the skin, subcutaneous tissue, and internal organs, papules, tubercles, gummas or gummous infiltrates are formed that are prone to decay.

There are active tertiary syphilis and latent tertiary syphilis. The serological test is often negative. Tertiary syphilis is characterized by the formation of solitary gummas and gummous infiltrates in one or more organs. The initial parts of the aorta are especially often affected. The transition of the inflammatory process from the aortic wall to the aortic valves leads to the formation of syphilitic aortic defect.

Late manifestations of syphilis are characterized by damage to the nervous system - neurosyphilis - in the form of tabes dorsalis and progressive paralysis, when treponemes are localized in large quantities in the brain tissue, causing profound organic and functional changes in the central nervous system. Many scientists refer to these concepts as quaternary syphilis.

Congenital syphilis occurs during intrauterine (transplacental) infection of the fetus and is divided into early and late. In early congenital syphilis, cutaneous syphilides (diffuse papular rashes) are combined with destructive osteochondritis and interstitial inflammation of internal organs with the appearance of “miliary gummas” in them. In this case, the liver becomes brown and dense (“silica liver”, the lungs become dense and white (“white pneumonia”). Changes in late congenital syphilis are similar to those in acquired tertiary syphilis.

CLINICAL PICTURE

The clinical classification of syphilis identifies the following forms:

• primary seronegative syphilis;
• primary syphilis seropositive;
• secondary fresh syphilis;
• secondary recurrent syphilis;
• tertiary active syphilis;
• tertiary latent syphilis;
• latent syphilis;
• fetal syphilis;
• early congenital syphilis;
• late congenital syphilis;
• latent congenital syphilis;
• visceral syphilis;
• syphilis of the nervous system.

There are several variants of the course of syphilis:

• normal course;
• malignant course, which is characterized, in addition to a pronounced rash, by various disorders of the general condition (anemia, cachexia, headaches);
• erased course, when there are no secondary relapses, and skin manifestations are limited only to chancre and roseola;
• latent syphilis (long-term asymptomatic course) - cases of the disease that occur without visible phenomena, but give positive serological reactions;
• syphilis without chancre, or transfusion syphilis: if the infection is introduced into the blood, it manifests itself after 2-2.5 months as rashes of the secondary period.

A few hours after the introduction of treponemes into the skin or mucous membrane, they enter the lymphatic and blood vessels and quickly spread throughout the body. At the same time, the lymphatic system also serves as a place of intensive reproduction of treponemes. Despite the rapid dissemination of the pathogen, the disease does not manifest itself clinically for a long time.

The duration of the incubation period depends on many factors, such as the age of the patient, concomitant chronic diseases, intoxication, treatment with drugs of the imidazole and arsenic group, treatment with corticosteroids and small doses of antibiotics; In addition, the clinic may be distorted.

Currently, there is a slight prolongation of the incubation period, especially when treating with antibiotics any concurrent diseases (sore throat, pneumonia, etc.). A shortening of the incubation period is observed with massive seeding, when there are 2 or more entrance gates.

Primary syphilis

The primary period is characterized by the presence of hard chancre and damage to the lymph nodes. Some people experience general symptoms: fever, anemia, leukocytosis. The beginning of the primary period of syphilis is characterized by the appearance of a primary affect at the site of penetration of Treponema pallidum through the skin or mucous membranes. Its development begins with the appearance of a reddish inflammatory spot, which then infiltrates and takes the form of a papule. Then its surface is eroded.

Hard chancre can develop in any area of ​​the skin or mucous membranes, but only at the site of infection. Formed chancre is a smooth, painless erosion or ulcer with regular round or oval outlines of a bluish-red color. Under it, upon palpation, a dense elastic infiltrate is felt. It is similar in size to lentils. The bottom of the erosion is smooth, shiny, the edges are raised above the skin level. In approximately 40% of patients, erosion transforms into a more or less deep ulcer with dense edges and a bottom covered with a dirty gray coating; there is copious discharge mixed with pus.

There are different types of chancre based on location — sexual And extrasexual; in count — single And multiple; to size — dwarf (1-3 mm) And giant (1.5-2 cm); according to outline — round, oval, semilunar, slit-shaped and herpetic; by the nature of the surface — erosive, ulcerative and crusting.

The size, shape and depth of the ulcer depend to a large extent on the state of the macroorganism, the presence of concomitant pathology and the localization of the primary affect.

There is a hidden chancre. In men it is localized in the urethra, on the glans penis, foreskin, in the scaphoid fossa, and its symptoms resemble subacute gonorrhea. Discharge the color of meat slop, enlarged inguinal lymph nodes, and hardening of the penis help establish the diagnosis. Among women chancre is most often localized on the cervix and labia, without causing any sensation. Usually there is an enlargement of the deep pelvic lymph nodes. However, perigenital and perianal localization is possible, as well as localization on the skin of the face, chest, etc.

In addition to the typical hard chancre, there are also atypical chancre:

• indurative edema when the compaction under erosion extends far beyond its limits, the usual localization is the lower lip, foreskin, labia majora;
• chancre felon, externally resembling a panaritium. Localized on the distal phalanx of the index finger - it swells, becomes purplish-red, the soft tissues are densely infiltrated. Chancroid-felon has the appearance of a deep ulcer with uneven edges and a bottom, covered with a dirty gray coating. The resemblance to felon is enhanced by pain;
• chancre-amygdalitis localized on the tonsils, the latter swell, turn red, become thicker, the temperature rises, symptoms of intoxication appear, and the lymph nodes enlarge. And only the density of the tonsils, the characteristic appearance of the lymph nodes, and the ineffectiveness of treatment used for angina allow a diagnosis to be made;
• mixed chancroid develops more often with simultaneous infection with syphilis and chancroid. As a result of the difference in the duration of the incubation period of both infections, a chancroid ulcer first develops, which, starting from the 4-5th week, gradually thickens; it is cleaned, its edges are leveled and take on the appearance characteristic of chancroid, and after a week the characteristic accompanying backgrounds appear. The development of signs of secondary syphilis is delayed by 3-4 months, the same may be true serologically.

When a secondary purulent infection is attached, chancre may be complicated by the development of acute inflammation along the periphery. With the introduction of fusospirillosis symbiosis, necrosis of the bottom and edges occurs (gangrenization of chancre). Repeated gangrenization (phagedenism) is usually observed in alcoholics and leads to significant tissue destruction.

Extragenital localization of chancre represents the greatest epidemic danger for domestic infection, in addition, it is difficult to diagnose. For example, chancre felon is practically no different from a banal felon.

Regional (concomitant bubo) is a constant sign of primary syphilis. It always develops in lymph nodes close to the location of the chancre. For example, when the chancre is localized on the genitals, the bubo develops in the groin areas, and when localized on the nipple, in the armpit. Lymph nodes are enlarged, painless, dense, mobile, the skin is not changed. The accompanying bubo may suppurate.

Severe regional lymphadenitis develops 5-8 days after the appearance of chancre. Lymph nodes may be enlarged to varying degrees, but always remain painless. Recently, the number of cases of the disease without pronounced regional lymphadenitis has increased (up to 10%). On the other hand, hyperergic reactions were also noted - a sharp increase in lymph nodes, the formation of their conglomerates, the phenomenon of periadenitis, and severe pain.

With regional lymphangitis, between the hard chancre and the accompanying bubo, a dense, mobile and painless cord is felt under the unchanged skin. Its thickness ranges from the thickness of a string to a goose feather. Its usual location is the dorsum of the penis.

nowadays it is very rare, inflammation of the lymphatic vessels from the chancre to the regional lymph node occurs in only 8% of patients. Most often, it can be detected in men when a hard chancre is localized on the head of the penis in the form of a dense elastic cord, painful on palpation, on the back of the penis (dorsal lymphangitis).

Syphilitic polyadenitis- after the appearance of the bubo, all lymph nodes gradually increase in size. Lymph nodes are dense, mobile, painless. Polyadenitis fully develops by the end of the primary period. This is one of the most important signs of secondary syphilis, when there is a moderate increase in all groups of lymph nodes, accompanied by mild general symptoms - low-grade (rarely febrile) temperature, general weakness, malaise, and increased fatigue.

Secondary syphilis

The secondary period is characterized by the presence of rashes. More often they are superficial, their appearance is not accompanied by an increase in temperature, the rashes appear gradually, over several weeks, and have a copper-red or “ham” color. With fresh secondary syphilis, the number of eruptive elements is large, they are located symmetrically and outside the sites of irritation, and do not merge; during relapses there are fewer of them, they are located asymmetrically, forming bizarre figures in the form of rings, arcs, garlands.

Syphilides of the secondary period of the skin and mucous membranes are spotted (roseolous), nodular (papular), pustular (pustular), pigmented (leukoderma); Baldness (alopecia) also occurs.

- these are pale pink spots the size of lentils, irregular or round in shape, not rising above the skin. When pressed they disappear and do not peel off. They are located on the side surfaces of the body, stomach, back, and can be drained. The elements last for 2-3 weeks, then disappear. Without treatment, they can recur repeatedly. There are several types of roseola: fresh rising, draining, granular, flaky, recurrent.

Papular syphilide occurs in the form of dry and wet papules. Dry papules, in turn, are lenticular (lenticular), sharply demarcated, dense to the touch and raised above the skin.

Papular miliary syphilide- cone-shaped, dense, pale pink papules the size of a poppy seed to a pinhead with small scales on the surface. After treatment, pigment spots remain. Seborrheic papules are found in areas of the skin rich in sebaceous glands: on the skin of the forehead, in the nasolabial and chin folds. After disappearance, brown spots and peeling also remain. Localized on the lateral surfaces of the torso, chest, abdomen and genitals; if the papules are localized on the forehead, the lesion is called the “crown of Venus.” Rash may occur on the palms and soles.

Among wet syphilides, weeping papular syphilide is of great importance. It looks like a papule when localized in natural folds of the skin (genital organs in women, scrotum, armpits, anal skin). The papule is blue in color, with copious serous discharge. Without treatment it lasts a long time.

Syphilitic papules often, depending on the location, the surface structure changes (on the mucous membranes - erosions, calluses, with peeling on the palms and soles, growing in the folds of the genital organs and anus - condylomas lata).

Syphilitic pustules(pustular syphilide) are currently quite rare, appear in the form of pustules of various sizes on a dense base, tend to ulcerate or are covered with purulent crusts. Pustular syphilide develops in weakened and exhausted people.

Elements of syphilis are prone to purulent melting. Syphilides can be localized on the mucous membranes of the pharynx and larynx. There is an erythematous syphilitic sore throat, it manifests itself as sharply demarcated bluish-red erythema, the surface is very rich in treponemes and is therefore infectious.

Papular syphilitic tonsillitis- papules in the pharynx and on the soft palate grow, merge, and therefore greatly bother patients. Hoarseness and aphonia may occur.

Syphilitic leucoderma- patchy or “lacey” hypopigmentation of the skin of the neck. Leucoderma is more common in women. Whitish round and oval formations develop on the lateral surfaces of the neck.

Syphilitic alopecia- rapidly developing small-focal or diffuse thinning of hair, including eyebrows, eyelashes, mustache, beard without the presence of inflammatory changes in the skin. Alopecia occurs during the first year of the disease. Round bald spots the size of a coin appear on the head.

When internal organs are damaged, the liver, kidneys, stomach, bones, and joints are often involved in the process. In some cases, the development of periostitis, osteoperiostitis (night pain in the bones, most often the legs), polyarthritic synovitis with hydratroses, hepatitis, nephritis, gastritis with their characteristic nonspecific symptoms, polyneuritis and meningovascular syphilis is noted.

Throughout secondary syphilis, serological reactions are positive. However, seronegative forms of the disease also occur. Significant difficulties in diagnosis are erased and asymptomatic forms of secondary syphilis.

Secondary syphilis without treatment lasts 3-4 years and is characterized by an undulating course. The rash usually goes away on its own after 2-3 months, after which a latent period begins for an indefinite period. After various provoking moments - physical or nervous stress, parallel current illnesses, various types of injuries - the rashes appear again. A relapse of secondary syphilis begins, which is then again replaced by a latent period.

Between the secondary and tertiary periods there is a hidden stage of the disease - a latent period when treponemes in the body exist in the form of cystic forms.

Tertiary syphilis

Tertiary syphilis can affect any organs and tissues, but most often the vascular and nervous system, skin and bones.

The tertiary period of syphilis occurs in the absence of adequate treatment in the 4-5th year of the disease and lasts until the end of life. However, most often it develops much later. With an asymptomatic course, tertiary syphilis can be detected 30 years or more from the moment of infection. In 97% of cases, there is a latent period between secondary and the onset of tertiary syphilis. The manifestations of tertiary syphilis are the most severe, but recently a more favorable course has been noted.

Unlike secondary, tertiary syphilis has some features:

• the rashes are not widespread;
• rashes ulcerate and lead to tissue destruction;
• damage to vital organs is noted;
• after healing, scars remain;
• there is no symmetry of the rashes.

The tertiary period of syphilis has a number of characteristic features. First of all, it is an undulating course with rare relapses and long-term latent periods. Another feature is that syphilides of the tertiary period are little contagious, since they contain a very small amount of pale treponema. Tertiary syphilides develop and regress slowly (months and years). There are no acute inflammatory phenomena, and no subjective sensations either. Tertiary syphilides are localized mainly in places of injury.

Tertiary syphilides are tubercular and nodular. Tuberous syphilide- accumulation of cellular infiltrate in the thickness of the dermis. It protrudes above the surface of the skin, has a hemispherical shape and a densely elastic consistency, its size is from a millet grain to a pea. The color of the tubercles ranges from dark red (at first) to brown. The surface is initially smooth, then flaky or crusty. Resolution of tubercular syphilides occurs as resorption or ulceration followed by scarring. The scars have a characteristic mosaic appearance with depigmentation at the edges. Patients have no subjective sensations, which allows them not to see a doctor.

The following are distinguished: types of tubercular syphilide: grouped, platform and dwarf creeper.

Syphilitic gumma- a painless node in the thickness of the subcutaneous tissue. Gummas are usually single, most often localized on the head, legs and forearms, but several gummas of different localization can also occur.

The following stages are distinguished in the development of gummous syphilide: development and growth, softening, adhesion to the skin, ulceration, melting and rejection of the gummy core with subsequent scarring. The gumma reaches a significant size (up to a walnut), when adhered to the skin, it acquires a bluish color, then ulceration occurs in the center with the separation of a small amount of sticky liquid and the formation of a necrotic gumma core.

The gummous ulcer is painless, has clear boundaries and ridge-like edges. The gummy core is represented by gray-yellow necrotic tissue; after its rejection, the ulcer is cleared, and a very persistent, star-shaped scar is formed, retracted in the center. Sometimes gumma can be affected by a secondary pyogenic infection. In some cases, gummas can merge with each other to form gummous infiltrates - foci with clearly demarcated edges, developing in the same way as a single gumma. After some time, the ulcer clears, thickens and heals with a round scar, which then becomes colorless (star-shaped).

Often ulcers involve not only the skin, but also muscles, periosteum, bones, and blood vessels, causing their destruction. Or, conversely, gummas from deep tissues irradiate into the skin. It happens that gumma resolves.

Among gummous syphilides of the mucous membranes, gummas of the nose, soft palate, tongue and pharynx are distinguished. With gumma of the nose, the gumma process begins from the nasal septum. Mucous discharge increases, which then becomes purulent and turns into massive, sharp-smelling, difficult-to-remove crusts. Breathing through the nose is difficult, and nosebleeds occur when the crusts are removed. The vomer is destroyed, and a saddle-shaped nose with a depressed wide bridge of the nose is formed.

Gumma of the soft palate is observed in the form of thickenings of the soft palate with a change in color, followed by disintegration and the formation of perforated holes, which occurs unexpectedly.

Gummous lesions of the tongue come in two forms:

• gummous glossitis in the form of a single node;
• sclerosing glossitis, in which the tongue completely hypertrophies, becomes dense and tuberous.

Then the tongue shrinks and decreases in size. Speech and chewing become difficult. A nasal voice occurs, and when swallowing, food enters the nasal cavity.

The posterior wall of the pharynx is affected by pharyngeal gummas. Gumma causes pain when swallowing during the period of ulceration, after which a scar appears. Deformations of the pharynx are formed, swallowing becomes difficult.

Tertiary syphilis of internal organs is characterized by the most severe damage to internal organs, the nervous system, bones and joints. Damage to internal organs can be combined with damage to the skin and mucous membranes. Most often, the cardiovascular system suffers, blood vessels are affected, which leads to irreversible consequences. The middle membrane of the ascending thoracic aorta is damaged (mesaortitis). It develops 10-12 years after infection, more often in men. Of the digestive organs, the liver is affected. This also manifests itself after 10-12 years in the form of gumma or chronic hepatitis. The stomach, intestines, lungs, kidneys, testicles, bones can be affected - in the form of osteoporosis, osteomyelitis, etc.

Lesions of internal organs in tertiary syphilis currently in 90% of cases turn out to be lesions of the cardiovascular system. 4-6% of cases are rare late liver lesions, other organs account for 1-2%.

With cardiovascular syphilis, the following are noted: syphilitic aortitis, myocarditis and their complications - aortic aneurysm and stenosis of the coronary artery ostia.

Uncomplicated syphilitic aortitis is a rather late manifestation of visceral syphilis. Patients may complain of general weakness, shortness of breath, palpitations, pain and a feeling of pressure behind the sternum and in the heart area. An objective examination reveals a systolic murmur in the aorta, an accent of the second tone, and a “ringing” metallic tone. Percussion determines the expansion of the boundaries of the ascending aorta - to the right of the sternum in the II-III intercostal spaces, dullness of the percussion sound 1-2 cm away from the sternum. Nonspecific inflammatory reactions occur in the blood. Possible increased temperature. Standard serological tests for syphilitic aortitis are positive in 50-75% of cases. For timely diagnosis (before complications develop), the family doctor must remember the possibility of syphilitic damage to the cardiovascular system.

Syphilitic aortitis can be complicated by stenosis of the coronary artery ostia. These manifestations occur when the process spreads to the heart area. When the aortic valves are involved, their insufficiency develops. Unlike atherosclerotic lesions, with syphilis the process does not involve the entire length of the coronary arteries, being limited only to their mouths. However, in some cases this lesion can lead to intramural infarctions. The leading clinical symptom is persistent angina pectoris, which is not amenable to traditional treatment with coronary arteries. Heart failure can often occur, usually of the left ventricular type.

Aortic aneurysm, the most severe complication of aortitis, is currently less common. In 2/3 of cases, the aneurysm is localized in the ascending aorta. It has a pouch shape. Often patients do not show any complaints. Sometimes there may be complaints of shortness of breath and chest pain. Symptoms depend on the size and location of the aneurysm. The following may be observed: pulsation in the intercostal spaces to the right of the sternum, percussion enlargement of the boundaries of the aorta, a difference in the pulse (less filling and lag of the pulse wave on the side of the aneurysm), as well as symptoms of compression of the mediastinal organs.

In addition to compression of vital organs, an aneurysm can cause it to rupture into the trachea, bronchi, lungs, pleural cavity, mediastinal cavity, or esophagus, which usually leads to rapid death. Excessive physical activity often leads to aneurysm rupture.

With uncomplicated aortitis, the prognosis is favorable, especially with adequate antisyphilitic therapy, which can prevent the development of complications.

Syphilitic myocarditis can develop independently or against the background of previous aortitis. Patients complain of general weakness, shortness of breath, and mild pain in the heart area. Nonspecific symptoms make diagnosis difficult. Myocardial gummas are usually single and extremely rare. Trial antisyphilitic treatment with a pronounced clinical effect is of very important diagnostic value. The outcome of gumma can be the formation of a cardiac aneurysm or scar.

Neurosyphilis

Manifestations of late neurosyphilis include late syphilitic meningitis, meningovascular syphilis, cerebral syphilis, tabes dorsalis (tabes), progressive paralysis, gummas of the brain.

Syphilitic meningitis occurs with scanty complaints (usually minor headache, tinnitus, hearing loss and dizziness). Diagnosis is based on medical history and pathological changes in the cerebrospinal fluid in combination with other manifestations of tertiary syphilis.

Diffuse meningovascular syphilis usually forms after existing syphilitic meningitis. Meningeal symptoms in patients are not pronounced; manifestations similar to the symptoms of a hypertensive crisis and transient cerebrovascular accidents are more often observed. Damage to the cranial nerves, sensory disturbances, reflex disorders, the appearance of pathological reflexes, hemiparesis, epileptiform seizures, alternating syndrome, speech and memory disorders, and general asthenia may occur.

Tabes (tabes dorsalis, tabes dorsalis). The localization of the lesion is the dorsal roots and columns, as well as the membranes of the spinal cord. There may be isolated damage to the cervical (rare) and lumbar regions, as well as their combined damage. Pathogenesis is caused by simultaneous processes of destruction of nervous tissue and proliferation of connective tissue in its place. Destructive changes are irreversible.

Patients complain of drilling, dagger-like pain lasting up to several days, paresthesia in certain areas of the body (the patient clearly indicates the location). Pelvic disorders are noted - disturbances in urination, defecation, impotence in men. Paresis of the cranial nerves (ptosis, strabismus, deviation of the tongue), anisocoria or miosis are noted.

The Argyll-Robertson sign is a pathognomonic sign of tabes: the absence or very sluggish reaction of the pupils to light with a preserved convergence reaction. Often it can be the only symptom of tabes. Optic nerve atrophy usually progresses and leads to complete blindness within a few months.

Ataxia, instability in the Romberg position, disturbances during finger-to-nose and heel-knee tests, as well as disorders of deep muscle-articular sensation are noted - the patient cannot determine the direction of passive movements in the toes. Violations of tendon reflexes are pronounced - they can be increased, decreased, uneven or completely absent.

Trophic disorders associated with tabes include painless perforated foot ulcers. Standard serological tests in 20-50% of patients with tabes dorsalis are negative, and the cerebrospinal fluid is not affected.

Currently, the Tabes clinic described above almost never occurs, but it is necessary to remember this form of tertiary syphilis due to the steady increase in the incidence of this infection. The clinical manifestations of tabes have softened significantly; now among these patients there are no bedridden patients. Classic symptoms of modern low-symptomatic tabes include pupillary anisocoria, Argyle-Robertson symptom, mild ataxic phenomena, impaired tendon reflexes and optic nerve atrophy.

Progressive paralysis can be detected 15-20 and even 40 years after infection. It is based on damage to the brain substance caused by inflammatory changes in small vessels, most often the capillaries of the brain. Ultimately, atrophy of the cortical cells develops.

The clinic is dominated by severe mental disorders, leading to complete collapse of the personality. Along with them, various neurological symptoms occur (pupillary, Argyll-Robertson, disorders of the motor and sensory spheres, anisoreflexia, epileptiform seizures). In 90% of cases there are positive serological reactions in the blood and in 100% of cases in the cerebrospinal fluid.

Currently, cases of progressive paralysis are extremely rare, however, it should be borne in mind that sudden changes in the psyche (character, behavior, memory, speech) of patients, in which it is possible to trace the time of onset (relatives can name the date and month from which “the person seemed to be replaced "), may indicate the onset of progressive paralysis. The prognosis for early penicillin therapy is favorable. In advanced cases, the disease is irreversible.

Gumma of the brain and spinal cord is currently practically not found. The gumma of the brain can be either single or multiple. Typically, clinically there are signs of increased intracranial pressure; neurological symptoms depend on the location and size of the gumma. Positive serological reactions are usually detected in the blood. The possibility of the development of brain gummas should be considered in differential diagnosis with space-occupying processes of other etiologies.

The spinal cord gumma manifests itself with various neurological symptoms depending on the level of its localization and size. It usually develops from the meninges and causes radicular symptoms and paresthesia. Then sensory and motor disorders develop and increase. Within a few months, a clinical picture of complete transverse spinal cord lesions may develop.

Congenital syphilis

Syphilis is inherited. The mother is the source of infection; treponema enters the fetus through the placenta in the 4-5th month of pregnancy. Syphilis is a common cause of arbitrary termination of pregnancy due to the death of the fetus in the womb.

Infection occurs transplacentally from a mother with syphilis. Treponema pallidum from the affected placenta enters the fetus through the umbilical veins or lymphatic slits of the umbilical vessels. A normal, intact placenta is impenetrable to Treponema pallidum.

Clinical manifestations of congenital syphilis are varied. There are fetal syphilis, early congenital and late congenital syphilis.

Fetal syphilis can lead to early fetal death (at 3-4 months), mainly from damage to the maternal part of the placenta. Such fruits are discarded in a macerated state. Death occurs from malnutrition. Typical changes are observed only in fetuses older than 5 months; a large number of treponemas are found in their internal organs, the liver is more often affected (enlarges), changes occur in the spleen, lungs, and pancreas.

With early congenital syphilis, the appearance of newborns is typical: they are thin, frail, the voice is weak, the face is wrinkled, sallow, flabby, the limbs are blue, the skull is deformed. But sometimes a child is outwardly normal, but the symptoms of the disease appear later. Most often, the first signs of the disease appear in the first 2 months of a child’s life. There is no chancre. There are specific rashes on the skin, pustular and papular syphilides.

The skin on the face, chin, lips, soles, and buttocks thickens, is tense, and red in color. Eyebrows and eyelashes fall out. Syphilitic pemphigus is characterized by the presence of blisters on the palms and soles the size of lentils, the liquid in them is first clear, then yellowish.

Syphilitic rhinitis is characterized by mucous discharge that turns into pus, which dries into crusts; breathing and sucking are difficult. The process proceeds to the cartilage, resulting in the formation of a saddle nose.

Nails become brittle and take on an almond shape. Bone damage is also noted. Wegner's osteochondritis (endochondral ossification disorder) is accompanied by constant crying, intensifying at night, Parrot's paralysis develops, the arms and legs do not move, and when raised they fall as if paralyzed. The liver and spleen are affected - they become enlarged, thickened, and their edges are rounded. In addition, facial asymmetry develops: Olympic forehead, buttock-shaped skull.

In children aged 1-2 years, manifestations are scant. Weeping and erosive papules appear around the anus, genitals, and corners of the mouth. Internal organs and nervous system are affected. Serologically there may be negative answers.

Late congenital syphilis appears between the ages of 6 and 15 years. It is diagnosed either in patients who in the past had symptoms of early congenital syphilis, or in patients in whom the disease previously did not produce clinical symptoms and was latent.

Clinically, this is manifested by symptoms on the skin, mucous membranes and internal organs identical to the manifestations that are observed in adult patients with tertiary syphilis. Patients may develop gummas or tuberculate syphilides on the skin and mucous membranes. Bones, joints, internal organs and the nervous system are often affected.

The unconditional signs of late congenital syphilis include Hutchinson’s triad: the presence of teeth in the shape of a screwdriver; photophobia and corneal clouding; damage to the labyrinth - dizziness, tinnitus, weakened hearing up to deafness. Main features: high “Gothic” palate, thickening of the sternal end of the clavicle, radial Robinson-Fournier scars, various dental dysplasia.

A buttock-shaped skull, a deformed nose, saber-shaped shins, scars on the skin around the corners of the mouth, lips and chin, and a saddle nose are also possible. Damages to the nervous system manifest themselves in the form of epilepsy, speech disorders, and tabes dorsalis. The results of serological tests help make a diagnosis.

Congenital syphilis can be observed in the third generation; cases of syphilis in the fourth generation have been described.

COMPLICATIONS

Complications of chancre are most often balanitis, phimosis and paraphimosis.

Balanitis is inflammation of the glans penis, balanoposthitis is inflammation of the glans and inner layer of the foreskin. In women, vulvitis and vulvovaginitis are observed, respectively. Phimosis is a narrowing of the opening of the preputial sac. With syphilis, phimosis is a consequence of balanoposthitis: the foreskin swells and cannot be retracted behind the head of the penis, creamy or liquid pus is released from the preputial sac. With phimosis, it is not always possible to feel the hard chancre under the foreskin.

With paraphimosis, the foreskin with the opening narrowed as a result of phimosis, being forcibly pushed back, does not return to its normal position, causing pinching of the head and its swelling.

DIAGNOSTICS AND DIFFICULTY DIAGNOSTICS

Diagnosis of syphilis is based on clinical manifestations and the results of confrontation (examination of the suspected source), however, without laboratory confirmation, the diagnosis has no legal force. They use the classic Wasserman reaction and express methods, but the immunofluorescence reaction, which is positive in all stages of the disease, and the immobilization reaction of treponema pallidum, which is positive in secondary and tertiary syphilis, are more accurate and specific. Screening, expert and reference schemes for enzyme-linked immunosorbent diagnostics of syphilis are used.

Repeated positive serological reactions in the absence of clinical manifestations make it possible to identify hidden (latent) syphilis. Neurosyphilis is detected through a thorough neurological examination. With fresh syphilis, the diagnosis can be confirmed by the detection of pale treponema in the discharge of chancre and punctate of regional lymph nodes.

Differentiating chancre from other lesions of the genital organs is difficult, since there are many diseases with different etiologies that are similar to syphilis.

Any erosive or ulcerative lesions on the genitals, perineum and oral cavity require laboratory tests to exclude the syphilitic nature of the disease.

Syphilis is differentiated from the following diseases: eczema, neurodermatitis, itching of various localizations, lichen planus, blastomycosis, herpes simplex, genital warts, aphthae, tuberculous ulcers, etc.

The diagnosis is made on the basis of analysis, examination, clinical manifestations, and bacteriological confirmation. It is not always possible to isolate Treponema pallidum the first time, so if the analysis is negative, a bacteriological examination should be performed again.

Differential diagnosis of the secondary period is carried out with pink lichen, toxicoderma, urticaria, measles, rubella, typhoid and typhus, brucellosis.

In case of diffuse meningovascular syphilis, differential diagnosis is carried out with transient cerebrovascular accidents against the background of atherosclerosis (it is based on the instability of symptoms and a favorable course of syphilis, since syphilitic vascular infiltrates go away without treatment, ischemic phenomena do not lead to subsequent thrombosis, i.e. strokes do not occur ).

Syphilis of cerebral vessels also requires differential diagnosis with hypertension and atherosclerotic lesions of cerebral vessels. Only blood vessels are involved in the process, so no pathological reactions of the cerebrospinal fluid are observed. In diagnosis we have to rely only on blood reactions. Without appropriate therapy, persistent changes in neurological status develop: mono-, para- and hemiplegia, aphasia, cranial nerve lesions of ischemic origin, paresthesia, pathological reflexes, various psycho-emotional disorders, epileptiform seizures (minor or generalized). Syphilis of the cerebral vessels can often be combined with other forms of neurosyphilis, in particular with tabes.

TREATMENT

The condition for the recovery of patients is early and skillfully carried out strictly individual treatment, taking into account the tolerability of drugs. A combination of specific and nonspecific therapy is advisable; in addition, stimulating therapy is used.

One of the oldest antisyphilitic drugs are mercury preparations, the treatment methods of which were described by Fracastoro back in the 16th century. At the beginning of the 19th century, iodine preparations began to be used to treat syphilis, and in the 20th century - arsenic and bismuth.

Currently, antibiotics, bismuth and iodine preparations are mainly used.

From the group of penicillins, benzylpenicillin, oxacillin, ampicillin, and carbenicillin are mainly used. These drugs are well absorbed into the blood and are quickly eliminated. To constantly maintain the concentration of the antibiotic in the blood, the drug is administered intramuscularly every 3 hours. Long-acting penicillin preparations are used - bicillin (single dose in adults - 1.2 million units, which is administered over 6 days). A single dose of bicillin-1 is administered in half the amount separately into both buttocks in the form of a suspension in a sterile dose or saline solution. Bicillin-3 is administered at a dose of 100 thousand units once every 3-4 days. Bicillin-5 - 3 million units once every 5 days. 30 minutes before the first injection, antihistamines (diphenhydramine, diazolin, suprastin, tavegil, pipolfen) are prescribed.

Erythromycin is prescribed 0.5 g 4 times a day 30 minutes before or 1-1.5 hours after meals. The total dose of the drug is determined by the doctor.

Tetracyclines should be taken with or after meals, 0.5 g 4 times. Long-acting tetracyclines include doxycycline, which is taken depending on the stage of the disease.

Oletetrin is prescribed 0.5 g 4 times a day. The total dose is determined by the doctor.

For patients with syphilis, antibiotics are selected that are suitable for the patient, taking into account their tolerability. Antibiotics should not be used by patients with syphilis, asthma, urticaria, hay fever and other allergic conditions.

Bicillin should not be prescribed to patients with hypertension, who have had a myocardial infarction, diseases of the gastrointestinal tract, diseases of the endocrine glands, hematopoietic system, or tuberculosis. It is not recommended for weakened patients, persons over 55 years of age and children to use a single dose of more than 1.2 million units.

Currently, new generation antibiotics and antiseptics are widely used.

Doxylan blocks protein synthesis in the cells of sensitive microbes. Used internally. Adults and children weighing more than 50 kg are prescribed 200 mg in 1-2 doses on the first day, then 100-200 mg per day for at least 10 days.

Retarpen is an antibacterial agent. Blocks the synthesis of the cell membrane of microbes, causing their death. It is used intramuscularly, for children under 12 years of age - 1.2 million ME every 2-4 weeks, for adults - 2.4 million ME once a week. For primary seropositive and secondary fresh syphilis - 2.4 million IU twice, with an interval of 1 week. For secondary recurrent and latent early syphilis, the first injection is made in a dose of 4.8 million ME (2.4 million ME in each buttock), the second and third injections - 2.4 million ME with an interval of 1 week, for newborns and young children age - 1.2 million ME.

Rovamycin is a macrolide antibiotic. Stops protein synthesis. For adults, the daily dose for oral administration is 6-9 million IU, for children weighing more than 20 kg - 1.5 million IU/10 kg per day in 2-3 doses. Children weighing up to 10 kg - 2-4 bags of granules of 0.375 million ME per day, 1-20 kg - 2-4 bags of 0.75 million ME, over 20 kg - 2-4 bags of 1.5 million ME. Prescribed intravenously only to adults. The contents of the bottle are dissolved in 4 ml of water for injection and administered over 1 hour in 100 ml of 5% glucose.

Cephobid is the third generation of cephalosporins. It is used intramuscularly and intravenously. Adults - 2-4 g/day, children - 50-200 mg/kg body weight, the dose is administered in 2 doses (every 12 hours). Adults should avoid drinking alcohol during treatment.

Cefrivid is used intramuscularly (dissolved in 2-2.5 ml of water for injection or 0.25-0.5% procaine solution), intravenously (in a 5% glucose solution, 0.9% NaCl solution) . Prescribe 1 g 2-4 times a day for 7-10 days. The maximum dose is 6 g. For children - 20-40 mg/kg, for severe infection - up to 100 mg/kg per day.

Cefotaxime is prescribed intravenously and intramuscularly at 1-2 g 2 times a day (maximum daily dose - 12 g), for newborns and children - 0.005-0.1 g / kg per day.

Extensillin is prescribed intramuscularly, deeply, by dissolving the powder in water for injection. For the treatment of syphilis - every 8 days, 2.4 million units. Injections are repeated 2-3 times.

Unidox Solutab blocks ribosomal polymerase and inhibits protein synthesis in microorganisms. It is used orally during meals; the tablet can be swallowed whole or diluted in water in the form of syrup (20 ml) or suspension (100 ml). Adults and children weighing no more than 50 kg should start taking 200 mg on the first day in one or two doses, then 100 mg once daily for up to 10 days (for severe cases, up to 300 mg). Children over 8 years old weighing less than 50 kg - on the first day at a rate of 4 mg/kg in one dose, then 2 mg/kg once daily. In severe cases - up to 4 mg/kg per day during the entire course of treatment. Do not combine with penicillin, cephalosporins and drugs containing metals (antacids, iron-containing preparations) due to their ability to bind tetracyclines to form inactive compounds. In patients with impaired skin function, reduced doses are used. When administered, the drug is carried by the bloodstream, deposited and retained for a long time in the internal organs, causing irritation of their nerve receptor zones.

The most popular drug is bioquinol. It needs to be warmed and shaken before use. Administer at the rate of 1 ml per day for 3 days. The course is 40-50 ml intravenously and intramuscularly.

Bismoverol is a combination preparation of bismuth. Apply 1 ml every other day intramuscularly. The course dose is 16-20 ml. Complications are possible after bismuth preparations: the presence of bismuth anemia, nephropathy, stomatitis, jaundice.

Iodine preparations are most often used in the form of potassium iodide, 2-3 tbsp. l. after meals, washed down with milk. Iodine tincture is used in increasing doses - from 50 to 60 drops in milk 3 times a day after meals. Sayodin is prescribed 1-2 tablets. 3 times a day after meals. The tablets must be chewed before taking.

Muramistin is an antiseptic. Increases the permeability of the cell membrane of microorganisms and leads to cytolysis. In addition, it also affects fungi and stimulates a nonspecific immune response. It is used topically, for individual prophylaxis, by injecting 2-5 ml of solution into the urethra 2-3 times; on the day after sexual intercourse, you must urinate, wash your hands and genitals, and spray the skin of the pubic area, thighs, and external genitalia with a stream of solution. After insertion into the urethra, do not urinate for 2 hours. For women, the drug is additionally administered into the vagina in a dose of 5-10 ml.

In addition to the specific drugs listed above, patients are also prescribed nonspecific treatment. This applies to patients with latent and late forms of the disease (neurovyscerosyphilis, congenital syphilis). Nonspecific therapy is prescribed to patients with infectious forms of syphilis.

These methods include: pyrotherapy, vitamin therapy, ultraviolet irradiation, injections of biogenic stimulants (aloe extract, placenta, vitreous), immunomodulators (levamisole, methyluracil, pyrroxane).

Pyrotherapy is a method that enhances heat production, improves blood and lymph circulation in affected organs and tissues, and enhances phagocytosis.

Pyrogenal is prescribed intramuscularly, the initial dose is up to 50-100 MTD, then it is increased. Administered every 2-3 days, 10-15 injections in total. After administration, body temperature rises after 1-2 hours and lasts up to 10-15 hours. The dose of prodigiosan is selected individually, the drug is administered 2 times a week in increasing doses.

Sulfazin is administered intramuscularly, starting with 0.5-2 ml and adding 2 ml to 7-8 ml.

Immunotherapy is prescribed to patients with a malignant course of the disease, latent forms of syphilis, and the presence of concomitant pathology. Biogenic stimulants: aloe extract, placenta, vitreous body. Prescribed subcutaneously at 1.0 ml for 15-20 days.

Levamisole is prescribed in cycles of 150 mg for 3 days with weekly breaks, a total of 2-3 cycles.

Methyluracil is prescribed 0.5 g 4 times a day for 2 weeks, then after a 5-7 day break the dose is repeated.

Diucifon is prescribed 0.1 g 3 times a day for 6 days. Carry out 2-3 cycles. You can administer 0.4 ml intravenously every other day.

Pyrroxan is a detoxifying agent. Prescribe 0.0015 g 3 times a day in a 10-day cycle. Vitamins C and group B are required as anti-syphilitic treatment for pregnant women and children.

Other nonspecific drugs are also prescribed: potassium orotate, pantocrine, eleutherococcus extract.

It is not advisable to carry out external therapy in the presence of highly effective methods. It is resorted to only in isolated cases.

Local treatment comes down to hygienic maintenance of the affected areas. If the patient has ulcerative chancre with an infiltrate at the base, warm baths, lotions with a solution of benzylpenicillin in dimexide, and application of Acemin, yellow, mercury, and heparin ointments can be prescribed. To speed up the regeneration of weeping papules on the genitals and near the anus, powders and applications in half with talc, ointments with antibiotics are recommended; for long-term non-healing gummoid ulcers, 3-5-10% mercury and mercury-bismuth ointments are prescribed, 1-3% - erythromycin, 5% levorin, 5-10% syntomycin, mercury patch, local baths.

If there are rashes in the oral cavity, rinse with solutions of furatsilin (1: 10,000), 2% boric acid or 2% gramicidin.

In people of retirement age or with varicose veins, gummas on the legs develop torpidly. Prescribe dressings with powdered sugar or a dressing with zinc-gelatin ointment according to Keifer for several weeks.

PREVENTION

The doctor’s task is regular educational work, since recent sociological studies have shown how little the population (especially young people) knows about sexually transmitted diseases. It is necessary to talk with young people and girls about barrier contraception as often as possible. Using a male condom protects against the disease by 90%. Personal hygiene is the prevention of sexually transmitted diseases. The technique is as follows.

I. A man (after sexual intercourse) washes his hands, releases urine, and washes the penis, scrotum, thighs and perineum with warm water and soap. The same areas are wiped with a cotton swab moistened with a solution of sublimate in a ratio of 1:1000. A 2-3% solution of protargol and a 0.05% solution of hibitan are injected into the urethra using an eye pipette and do not urinate for 2-3 hours.

II. The woman washes her hands, releases urine, and washes her genitals, thighs, and perineum with warm water and soap. The same organs are treated with a solution of sublimate at a dilution of 1: 1000. Douching of the vagina with a solution of potassium permanganate (1: 6000) with the introduction of a 1-2% silver preparation into the urethra. Lubricating the cervix and vaginal mucosa with the same solution. You can administer a 0.05% aqueous solution of hibitan. Personal prevention can be carried out independently by a person who fears contracting sexually transmitted diseases as a result of casual sexual intercourse. If it is not possible to carry out the above preventive measures, it is recommended to douche the genitals, urethra and vagina in women with a strong saline solution.

Syphilis is a chronic venereal disease caused by Treponema pallidum.

SYNONYMS OF SYPHILIS

Lues, lues venerea.

ICD-10 CODE A50 Congenital syphilis. A51 Early syphilis. A52 Late syphilis. A53 Other and unspecified forms of syphilis.

EPIDEMIOLOGY OF SYPHILIS

Syphilis is considered a socially significant infection. More than 270 thousand patients with syphilis are registered in Russia every year. The number of cases in Russia has increased over the past 10 years by more than 30 times.

PREVENTION OF SYPHILIS

Prevention consists of avoiding casual sexual contact, using condoms if there is a possible risk of infection, and using personal protective equipment (chlorhexidine ©, miramistin ©, etc.). Preventive measures to reduce the incidence of syphilis also include informing the patient’s partners about her condition and convincing her of the need for treatment.

SCREENING

Hospital patients, pregnant women, medical workers, workers in child care institutions, trade and public catering are subject to mandatory screening for syphilis using serological methods. Identification and examination of persons who have had sexual contact with the patient is carried out depending on the stage of the disease and the expected timing of infection: for primary syphilis - in the last 90 days, for secondary syphilis - in the last 6 months, in the absence of clinical symptoms - for 2 or more years. In case of household contacts, persons living in the same living space with the patient should be examined. If syphilis is detected in employees of children's or medical institutions, all persons in contact with him must be examined. If syphilis is detected, an emergency notification is sent to the territorial dermatovenerological institution (form 089/ukv).

CLASSIFICATION OF SYPHILIS

The following classification is currently used.

Acquired syphilis.

• Early syphilis: ♦primary; ♦secondary; ♦early latent (acquired less than a year ago).
• Late syphilis: ♦ late latent (acquired more than a year ago); ♦tertiary (including gummous, cardiovascular, neurosyphilis).

Congenital syphilis:

• early (first 2 years of life);
• late (manifests at a later age).

ETIOLOGY (CAUSES) OF SYPHILIS

PATHOGENESIS OF SYPHILIS

Syphilis infection usually occurs through direct sexual contact, and the contagiousness in this case is 10%. Non-sexual transmission of infection can occur through close contact with a patient (kissing) or through personal hygiene items (toothbrush, towel, razor). The facts of infection of medical personnel with syphilis from patients, and, conversely, by doctors of their patients, are described. Syphilis infection can occur through a transfusion of fresh infected blood (the pathogen dies when the blood is stored in the refrigerator after 3–4 days).

The fetus can become infected from a sick mother transplacentally. Entry gates for infection: skin and mucous membranes. The pathogen quickly enters the body through minor injuries, followed by spread and damage to internal organs.

CLINICAL PICTURE OF SYPHILIS IN WOMEN

Signs of syphilis appear after an incubation period of 10 to 90 days (average 3–4 weeks) in the form of primary syphiloma ( primary syphilis). Syphiloma is a small (1 cm in diameter), single, dense, painless node, located at the site of treponema penetration, on the surface of which an ulcer with a clean bottom appears - a chancre. The most common localization of chancre is the anogenital zone (penis, vulva, cervix, anus), less often hard chancre is found on the lips and tongue. Sometimes ulcers are atypical: multiple, painful, purulent, extragenital (chancripanaricium, chancramygdalitis, Folman's balanitis). Primary syphiloma regresses on its own within a few weeks with or without scar formation.

3–6 weeks after the formation of chancre, as a result of bacteremia, signs of secondary syphilis appear in the form of widespread rashes (syphilides) on the skin (usually on the palms and soles) and mucous membranes. The rash may be roseola, papules, vesicles or pustules. Elements of the rash are contagious; any contact with damaged skin or mucous membranes of the patient can lead to the development of the disease. The rash disappears without treatment within a few weeks or months. Other manifestations of secondary syphilis include low-grade fever, headaches, sore throat, alopecia areata, generalized lymphadenopathy, uveitis (ocular syphilis), meningitis, hepatitis, glomerulonephritis. There is an alternation of periods of disease activity with latent ones.

Latent syphilis is characterized by the presence of positive serological reactions to syphilis without clinical manifestations.

The development of tertiary syphilis occurs 3–6 years after infection. The morphological basis of this period is considered to be granulomatous inflammation. Damage to the skin and mucous membranes is manifested by the formation of nodes, plaques or ulcers (gummy syphilis), the cardiovascular system - the development of angina pectoris, stenosis of the coronary artery ostia, valvular lesions (usually aortic), aneurysms of the thoracic aorta, the musculoskeletal system - the development of arthritis. Neurosyphilis is observed in 3–7% of patients who are not treated in the early stages of the disease. It can occur as meningitis (fever, headache, stiff neck) or meningovascular lesions (muscle weakness, loss of sensation, blurred vision). In the later stages of the disease, parenchymal neurosyphilis occurs (progressive paralysis, tabes spinal cord), which can last for many years. There is also an asymptomatic course of neurosyphilis. Tertiary syphilis leads to mental and neurological disorders, blindness, severe damage to the heart and blood vessels, and death.

DIAGNOSIS OF SYPHILIS

Diagnosis of syphilis is based on medical history (contact with a patient with syphilis), physical examination that reveals clinical signs of the disease, and, above all, laboratory testing.

Currently, serological diagnostic methods are widely used to detect antibodies to various Treponema Ags. In this case, blood, cerebrospinal fluid, and biopsy material are examined. Depending on the Ag used, serological tests are divided into non-treponemal and treponemal. Non-treponemal tests include precipitation microreaction, VDRL and RPR tests. They are used for screening examinations due to their technical simplicity and quick results. However, in the first 2–4 weeks of the disease and with late syphilis, these reactions can give a negative result. Treponemal reactions (direct hemagglutination reaction, microhemagglutination reaction, enzyme-linked immunosorbent assay, immunofluorescence reaction with absorption) are used to confirm non-treponemal tests, since these serological reactions are highly specific. The causes of false-positive results of serological reactions to syphilis can be concomitant infectious diseases: infectious mononucleosis, measles, chicken pox, malaria, herpes virus infection, tuberculosis, treponematoses, as well as cancer, liver diseases, connective tissue diseases, pregnancy.

For microscopic detection of the pathogen, methods of dark-field microscopy, direct immunofluorescence using monoclonal antibodies to treponema and PCR are used. The material for the study is the discharge from the surface of syphilomas and syphilides, as well as punctate of regional lymph nodes, cerebrospinal and amniotic fluid.

Lumbar puncture to examine the cerebrospinal fluid is indicated for congenital and tertiary syphilis, for suspected syphilitic damage to the central nervous system, for concomitant HIV infection and in the absence of a tendency to reduce the AT titer in previously treated patients. A screening test to exclude syphilitic damage to the heart and blood vessels is chest x-ray.

DIFFERENTIAL DIAGNOSIS OF SYPHILIS

Differential diagnosis is carried out with skin diseases, diseases of the central nervous system, cardiovascular, musculoskeletal systems, visual organs, as well as with diseases that give positive serological reactions to syphilis. In addition, primary syphiloma should be distinguished from a boil, and when located on the cervix, from erosion.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

The diagnosis of syphilis is made by a dermatovenerologist in a specialized institution. If damage to internal organs and the central nervous system is suspected, neurologists, therapists, cardiologists, and ophthalmologists may be involved for consultation.

All patients diagnosed with syphilis should be screened for other STIs.

TREATMENT OF SYPHILIS IN WOMEN

TREATMENT GOALS

Treatment of syphilis is aimed at destroying the causative agent of the disease. The treponemocidal effect must be maintained in the blood, and in the case of neurosyphilis and in the cerebrospinal fluid, for at least 7–10 days. As the duration of the disease increases, courses of treatment should be longer.

DRUG TREATMENT OF SYPHILIS

Specific treatment is carried out in the presence of a clinical picture of syphilis, confirmed by positive laboratory tests. Preventive treatment is indicated in the absence of clinical and laboratory signs for patients whose history includes indications of sexual or other close physical contact within a period of no later than 2 months with a patient with an early form of syphilis. Preventive treatment is given to pregnant women who have been treated for syphilis in the past and still have positive serological tests or who become infected with syphilis during pregnancy. Treatment ex juvantibus is prescribed in the absence of obvious abnormalities according to laboratory methods, when the patient has lesions in the internal organs, presumably of syphilitic etiology.

In the Russian Federation, regularly updated treatment regimens for syphilis have been developed, last revised in 1999.

Treatment options for primary syphilis:

• benzathine benzylpenicillin 2.4 million units intramuscularly once a week, 2 injections per course;
• Bicillin1© 2.4 million units intramuscularly 3 times with an interval of 5 days;
• Bicillin3 © 1.8 million units intramuscularly 2 times a week, 5 injections in total;
• Bicillin5 © 1.5 million units intramuscularly 2 times a week, 5 injections in total;
• Benzylpenicillin procaine 1.2 million units intramuscularly daily for 10 days;
• Benzylpenicillin procaine 600 thousand units intramuscularly 2 times a day for 10 days;

• doxycycline 100 mg orally 2 times a day for 15 days;
• tetracycline 500 mg orally 4 times a day for 15 days;
• oxacillin 1.0 g intramuscularly 4 times a day for 14 days;
• ampicillin 1.0 g intramuscularly 4 times a day for 14 days.

Treatment options for secondary and early latent syphilis:

• Benzathine benzylpenicillin 2.4 million units intramuscularly once a week, 3 injections per course;
• Bicillin1© 2.4 million units intramuscularly 6 times with an interval of 5 days;
• Bicillin 3© 1.8 million units intramuscularly 2 times a week, 10 injections in total;
• Bicillin5© 1.5 million units intramuscularly 2 times a week, 10 injections in total; or benzylpenicillin procaine 1.2 million units intramuscularly daily for 10 days;
• benzylpenicillin procaine 600 thousand units intramuscularly 2 times a day for 20 days.

Alternative treatment regimens:

• doxycycline 100 mg orally 2 times a day for 30 days;
• ceftriaxone 0.5 g intramuscularly once a day for 10 days;
• oxacillin 1.0 g intramuscularly 4 times a day for 28 days;
• ampicillin 1 g intramuscularly 4 times a day for 28 days.

If the disease lasts more than 6 months and malignant syphilis is prescribed:

• benzylpenicillin procaine 1.2 million units intramuscularly daily for 20 days.

Treatment options for early neurosyphilis (carried out in a hospital):

• benzylpenicillin 10 million units intravenously in 400 ml of isotonic sodium chloride solution 2 times a day (administered over 1.5–2 hours) for 14 days;
• benzylpenicillin (benzylpenicillin sodium salt©) 2–4 million units intravenously 6 times a day for 14 days.

Treatment options for early visceral syphilis (carried out in a hospital):

• benzylpenicillin (benzylpenicillin sodium salt©) 1 million units intramuscularly 4 times a day for 20 days;
• benzylpenicillin procaine 600 thousand units intramuscularly once a day for 20 days;
• benzylpenicillin procaine 1.2 million units intramuscularly once a day for 20 days.

Treatment options for tertiary and late latent syphilis:

• benzylpenicillin procaine 1.2 million units intramuscularly once a day for 20 days, after a 2-week break, repeat the course for 10 days;

Treatment of late visceral syphilis:

• benzylpenicillin procaine 600 thousand units intramuscularly 2 times a day for 28 days, after a 2-week break, repeat the course for 14 days.

Treatment of late neurosyphilis: the regimens are the same as for early neurosyphilis, but with an additional repeated course after a 2-week break.

Alternative regimen for late latent neurosyphilis:

• Ceftriaxone 1.0–2.0 g intramuscularly daily for 14 days.

Specific treatment of tertiary syphilis can be supplemented by the prescription of symptomatic drugs (for example, NSAIDs).

Primary treatment of syphilis in pregnant women is carried out immediately after diagnosis, regardless of the duration of pregnancy. Specific treatment for pregnant women up to 18 weeks of pregnancy is the same as for non-pregnant women.

For more than 18 weeks of pregnancy, the following treatment regimens for syphilis are recommended.

Primary syphilis:

• benzylpenicillin procaine 1.2 million units intramuscularly daily for 10 days;

Secondary and early latent syphilis:

• benzylpenicillin procaine 1.2 million units intramuscularly daily for 20 days;
• benzylpenicillin procaine 600 thousand units intramuscularly 2 times a day for 20 days.

Preventive treatment of syphilis:

• benzylpenicillin procaine 1.2 million units intramuscularly daily for 10 days.

Prevention of congenital syphilis is carried out starting from 16 weeks of pregnancy.

Preventive treatment:

• benzathine benzylpenicillin 2.4 million units intramuscularly once;
• Bicillin 3© 1.8 million units intramuscularly 2 times a week;
• Bicillin5© 1.5 million units intramuscularly 2 times a week;
• benzylpenicillin procaine 1.2 million units intramuscularly daily for 7 days;
• benzylpenicillin procaine 600 thousand units intramuscularly 2 times a day for 10 days.

For patients who received infected blood no later than 3 months ago from a donor, preventive treatment is carried out according to the same regimens as for primary syphilis. In other cases, serological tests are indicated. Some patients, such as those infected with HIV, do not respond to usual doses of treatment, which may require changes to treatment regimens.

The patient ceases to be infectious within 24 hours after the start of treatment.

FOLLOW-UP

Patients receiving treatment for syphilis should undergo periodic serological control tests for 2 years according to the following schemes:

• after treatment of primary, secondary, early latent and congenital syphilis, control periods for the study: 1st, 3rd, 6th, 12th, and 24th months after the end of the course of specific therapy;
• after treatment of late latent and tertiary syphilis - 12th and 24th months after completion of the course of specific therapy;
• after treatment of neurosyphilis - 6th, 12th, and 24th months after completion of the course of specific therapy;
• for HIV-infected people - 1st, 3rd, 6th, 12th, and 24th months after completing a course of specific therapy and then annually.

An adequate response to full treatment is considered to be a decrease in AT titers (non-treponemal tests) by at least 4 times within a year after the end of treatment. If AT titers increase in non-treponemal tests without existing syphilis reinfection, it is necessary to re-examine the patient with a mandatory examination of the cerebrospinal fluid. Patients with neurosyphilis require repeated examinations and spinal punctures within 2 years after treatment and supervision by a neurologist. If, after treatment of neurosyphilis, a repeat examination of the cerebrospinal fluid after 6 and 12 months does not indicate positive dynamics (recovery), a second course of treatment is necessary.

Treatment is mandatory for all identified partners of the patient with whom he has had sexual contact within the last 90 days, regardless of the results of the serological test. The question of the need to treat partners with whom sexual contact was more than 90 days ago is decided in accordance with the results of a serological examination.

PATIENT INFORMATION

To prevent the disease, casual sexual intercourse should be avoided. Persons who are not in long-term monogamous relationships are advised to use protective equipment (condoms, chemicals) during sexual intercourse or go to 24-hour emergency STI prevention centers.

FORECAST

The prognosis is favorable for primary and secondary syphilis. Late stages of the disease lead to severe damage to the cardiovascular and nervous systems, blindness, mental disorders and death.

To make an accurate diagnosis, assess the severity of the patient’s condition and determine the timing of infection, specialists developed and approved a classification of syphilis. Thanks to the division of syphilis into varieties, the doctor can compare data on the incidence of patients, as well as differentiate the nature of the course and symptoms of the disease.

The classification of syphilis is used by venereologists to make a correct diagnosis, determine the timing of infection, and also to distinguish the course and clinical manifestations of the disease.

Syphilis: classification

Not all forms and types of syphilis occur with pronounced symptoms, by which the presence of pathology, its form can be determined and appropriate measures can be taken. The success of treatment depends on the timely detection of infection and determination of its type. Types of syphilis differ in timing, nature, severity of clinical manifestations, localization, spread of syphilitic infection and other factors.

Early form of syphilis

Any infectious disease has a certain period, during which the infection does not manifest itself in any way and actively develops in the body. In this case, a person is a carrier of treponema, infecting his sexual partners and others through close contact. Only specific tests can determine this form of the disease. Routine examinations do not reveal this type of pathology.

According to the accepted classification, the early form of syphilis is considered the most dangerous due to the absence of any symptoms. If this form can be diagnosed, treatment will not be difficult.

Primary form of syphilis

From the moment of infection to the onset of symptoms of the disease, as a rule, 3-5 weeks pass. The first sign of syphilis is a hard chancre (syphiloma), which forms at the site of penetration of the spirochete (in 85% of cases this is the genitals). Many infected people do not pay attention to this form of the disease, since it is asymptomatic and does not cause any discomfort.

The primary form of pathology can be diagnosed using specific tests and additional studies. If the infection is detected in a timely manner, primary syphilis can be easily cured without consequences for the body.

Secondary form of the disease

It develops if the primary form was not diagnosed and treatment was missed. Signs of secondary syphilis are manifested by rashes that periodically appear and disappear. Some types of syphilis rashes may resemble allergies and other skin diseases.

In the classification of sexually transmitted infections, this type of disease is given a special place. During this period, almost any laboratory blood test can detect the presence of a syphilitic infection. As a rule, this occurs during a routine examination or screening of pregnant women.

Tertiary form of syphilis

Not only external, but also internal damage to the body occurs. This form is characterized by the ability to infect others, but not all studies show that the person himself is sick. According to the medical classification, the tertiary form of syphilis is among the most dangerous, since internal disorders are similar to the signs of other diseases. At the same time, a person can be treated for a long time for cardiac, endocrine and other pathologies, without knowing about the true disease.

The tertiary form is the most difficult to treat therapeutically. It is accompanied by irreversible changes in internal organs. It is completely impossible to cure tertiary syphilis. In this case, therapy is aimed at stopping the progression of the infection, reducing the severity of clinical manifestations of the disease and preventing the development of severe complications.

Hidden form of syphilis

This type of infection is also considered quite dangerous. It has no external symptoms, but is contagious. In addition, the latent form does not exclude the possibility of damage to internal organs and body systems.

Most often, a latent form of pathology is diagnosed during a regular or preventive examination. The infection can also be detected when a sexual partner is diagnosed with syphilis. In such a situation, the risk that the partner suffers from a hidden type of disease cannot be excluded.

Late form of syphilis

A similar classification is used when a mother infected with syphilis gives birth to a seemingly strong child. However, tests show that everything is normal. The mother and the doctors think that the treatment during pregnancy was effective and the newborn was not infected. However, the consequences of syphilis suffered by a future mother may not appear immediately. For example, deafness, vision problems and other health problems can occur during adolescence.

No classification is able to establish the time period after which a woman who has had syphilis is able to give birth to an uninfected child. The late type of pathology can develop either a year or decades after birth. This is what makes this form the most unpredictable among all existing ones.

Chronic syphilis

Syphilitic infection symptoms often come and go intermittently. In this case, the pathological process in the body can last for many years. In such a case, they speak of a chronic course of the disease. As a rule, treatment begins after the infection is accidentally detected during a routine examination or screening of pregnant women.

The chronic form of syphilis can last for months. In the absence of timely treatment, it progresses for several years, remaining in the human body for life. According to research, chronic syphilis that is not treated within the first 6-8 months most often becomes incurable.

Sulfur-resistant variety of syphilis

A sulfur-resistant form of the disease is spoken of when complex therapy for early types of syphilis was successful, but the results of laboratory diagnostics indicate the presence of Treponema pallidum in the body. Syphilis is also called seroresistant if six months have passed since treatment and the test results remain positive. Usually in such a situation an additional course of therapy is indicated.

If, over the next 6 months of treatment, tests again show the presence of a spirochete in the body, the patient is diagnosed with “true seroresistance” and prescribed a course of antibacterial treatment. After a year of therapy, regardless of the diagnostic results, the patient is removed from the register. People with this type of syphilis are registered with an immunologist for life for dynamic monitoring and timely correction of detected disorders.

Regardless of the form, stage and type of syphilis, it is recommended to start therapy as early as possible. Only early detection of infection and well-chosen treatment will avoid the development of severe forms of the disease and prevent the formation of adverse complications.

Treponema pallidum can affect all organs and systems of the human body, so it is better to adhere to the standards of individual and public prevention.