Old latent syphilis symptoms and treatment. Latent syphilis: how to recognize it? Reception of a vitamin complex

Beethoven, Baudelaire, Lincoln, Nietzsche... Not only the level of world fame, but also the general diagnosis of syphilis gives us the right to mention these sonorous names in the same row. Infection has been attacking humanity for centuries, regardless of rank and title, age and social environment. All the fault - pale treponema. A spiral microorganism is recognized by uniform curls and specific movements of a rotational-translational, wavy and flexion character. The causative agent of syphilis is reproduced during the transverse division into several elements, which later grow into an adult. The microorganism does not tolerate drying, prolonged exposure to conditions high temperatures. Decomposes under the influence of ethyl alcohol. Prolong the life of pale treponema can low temperature conditions.

Incidence

Over the past 10 years, syphilis has been steadily breaking records in the growth in the number of new victims. According to some reports, the army of patients with an unpleasant diagnosis has doubled over the specified period. In our country, despite the downward trend in the total number of infected people, the incidence rate is still an order of magnitude higher than in Europe. "Spoiled" the statistics mainly by representatives of young people leading an asocial lifestyle.

The risk of contracting syphilis increases exponentially for those who:

• prefers unprotected sex;
• seeks to replenish the "piggy bank" of contacts with unfamiliar sexual partners;
• has homosexual preferences (leading positions (about 60%) among all infected are confidently held by men with non-traditional sexual orientation);
• is in constant contact with a sick person;
• not averse to indulging in injecting drugs.

How is syphilis transmitted?

Pale treponema lies in wait for its victims in a variety of situations and easily enters the body of a new host:

1. Sexual way. Any unprotected sexual contact is made by the initiator at his own peril and risk. "One time" - traditional, anal or oral - is enough for the causative agent of syphilis to penetrate with sperm (vaginal secretions) into the flowering body of a healthy partner and begin to actively multiply there. At the same time, it doesn’t matter how bad things are for a lover who knows how to keep his secrets. Syphilis is highly contagious at any stage of its development.
2. Household way. Not the easiest way for a pathogen to find a new home. Pale treponema will not be able to exist for a long time outside the human body. However, provided that a sufficient level of humidity is maintained, the pathogen has an amazing “survivability”: if the elementary rules of personal hygiene are not followed, syphilis is transmitted from a sick partner to a healthy one through a kiss, the use of “one for two” unwashed toothbrush, spoon, cup. 3. By transfusion. One of the "working schemes" of infection through the blood is to pass a common injection syringe in a circle in the company of lovers of experiments with narcotic substances. In practice, there are also cases when the "culprit" of the transmission of the pathogen was an unscrupulous donor, for some reason who did not pass the established procedure for testing for the presence of sexually transmitted diseases.
3. through the placenta. Congenital syphilis is transmitted to the baby through the maternal placenta. Often this fact becomes the cause of intrauterine death of the fetus. It is also possible infection of the newborn during breastfeeding. In the presence of such a risk factor, doctors prescribe a caesarean section and recommend switching to an artificial feeding regime for the baby.

incubation period for syphilis

I didn’t think - I didn’t guess, but I was already sick and contagious - this is how the development of syphilis occurs in the early stages. Usually, the first alarm signals appear 10 days after treponema enters the body. However, the patient can learn bad news about himself much later - in the worst case, after six months, if he takes a course of antibiotics that suppress the destructive activity of the infection.

The causative agent of syphilis is capable of producing a substance that disrupts the process of recognizing the "intervention" by the body's defenses. Under conditions of suppression of cellular immunity, treponema actively multiplies and quickly spreads through the lymphatic tracts and internal organs. From the first days of infection, there is a risk of infecting other people.

Primary syphilis

This stage lasts up to 8 weeks and leads to a noticeable increase in the lymph nodes and the formation of a hard chancre. In the bloodstream, there is an increase in the number of special antibodies that immobilize treponema and form immune complexes. The body's struggle with the causative agents of syphilis ends with the release of lipopolysaccharide and protein products into the blood. The destruction of tissue treponemas is accompanied by a local inflammatory reaction in the form of multiple rashes on the skin and mucous membranes, which signal the onset of the second stage of syphilis.

Chancre

It is formed in the foci of entry of pale treponema into the body. Usually, the patient finds a neoplasm on the skin or mucous membranes of the genital organs, less often on the lips, tongue, eyelids, finger, abdomen, in the oral cavity or in any other place where the infectious agent enters. Hard chancre is an erosion with clearly defined rounded contours (in the form of a saucer) of a “varnished” red color. At the base of the neoplasm, a dense elastic seal is palpated, which does not cause pain. Recently, experts have increasingly noted the occurrence of several chancres.

Clinical manifestations

A week after the formation of a hard chancre, an increase in nearby lymph nodes is noted, inflammatory processes in the lymphatic vessels are likely. Almost a quarter of patients by the end of primary syphilis have symptoms confirming the fact of generalization of the infection: a significant increase in body temperature, night headaches, discomfort in bone tissues and joints, lack of appetite, loss of strength.

Secondary syphilis

The approximate starting point of this stage is the milestone of 2.5 months after infection. The average duration is 3 years. As part of the stage, fresh (early), recurrent and latent syphilis is isolated. The formation of immune complexes is in full swing, which leads to the development of inflammatory processes and provokes the mass death of treponema. Syphilis goes into a latent phase lasting up to three months. However, six months after infection, the first relapse occurs. Activation of the synthesis of antibodies becomes a response to the newly begun reproduction of pathogens. Thus, the wave-like nature of the course of the disease reflects the essence of the specifics of the interaction between the infectious agent and the body's immune system. The pathological process from the skin and mucous membranes passes to other organs and systems. Sometimes there are symptoms of intoxication. The patient poses a high degree of danger to the close environment, since the risk of infection is maximum.

Fresh (early)

This period lasts from two to four months from the moment of infection. It is manifested by the appearance of a rash on the skin and mucous membranes, which is a sure sign secondary syphilis. The rashes are numerous, brightly colored, but do not cause concern to the patient (occasionally complaints of itching are recorded in the medical history), persist for several weeks and suddenly disappear. In some cases, hair loss is noted.

Recurrent

The period of short-term "return" of the characteristic symptom of the disease: a few groups of large rashes appear, forming rings and arcs.

Usually relapses occur no more than four times.

Hidden

The average duration of this period is 3 months. External clinical manifestations are not observed. Diagnosis is possible if there is data from a professional examination (scars at the site of former foci of rashes, enlarged lymph nodes), as well as special studies.

Tertiary syphilis

It occurs in the absence of professional treatment of the existing disease and in 25% of cases leads to death. The tertiary period (stage 3 of syphilis) stretches for decades. The defeat of the majority is noted internal organs(brain and spinal cord, liver, kidneys, stomach, intestines, genitals), as well as the nervous and cardiovascular systems. Vision and hearing deteriorate sharply. Patients experience sudden changes in mental states: from bouts of depression, paranoia to euphoria, hallucinations.

A typical skin manifestation of syphilis at this stage is the formation of infectious granulomas (gummas), which are subcutaneous groups of cells in tissues in the form of nodes that develop into ulcers. Neoplasms affect not only soft tissues, but also the skeletal system, leading to irreversible deformities (for example, nose depression). The last stage of syphilis is not as contagious as the previous ones, but certainly the most unfavorable in terms of prognosis.

Syphilitic endarteritis (damage to the cardiovascular system)

It occurs in the first years after the disease with syphilis, develops gradually (over weeks and months) and is characterized by the simultaneous manifestation of cerebral and focal symptoms. So, the patient begins to complain of attacks of severe headache, vomiting, memory lapses. The nature of focal symptoms is due to the localization of the infectious lesion:

1. Basin of the middle cerebral artery: the occurrence of hemiplegia (paralysis of one half of the body) or monoplegia (paralysis of one limb), aphasia, sensory disturbances, apractoagnostic syndrome (manifested in the form of spatial disorders) with damage to the parietal lobe.
2. Vertebrobasilar vascular pool: occurrence of alternating syndromes (motor and sensory disorders),
   loss of visual fields, bulbar syndrome (impaired swallowing and speech functions). Possible comatose forms of stroke with acute cerebral symptoms. Repeated thrombotic strokes are observed.

Different vascular pools can be included in the process of disease development. If the vessels supplying the subcortical nodes are damaged, the risk of parkinsonism, a neurological syndrome in which the patient is unable to perform voluntary movements, is not excluded.

Dorsal tabes

Desperate Boy Disease: Men suffer from this clinical variant of neurosyphilis approximately 5 times more often than women. The first signs of the disease occur, as a rule, in middle-aged patients 15–20 years after the entry of pale treponema into the body. The reason is a violation of the work of the rear sections spinal cord. Characteristic details of the clinical picture: the predominance of paroxysmal pain (in the form of an acute seizure), sensitivity disorders, distortion of the normal reaction of the pupil, impaired coordination of movements.
According to statistics, this form of syphilis is now rare.

Damage to the musculoskeletal system

About 85% of patients diagnosed with early congenital syphilis suffer from pathological changes in the skeletal system. Osteochondritis is symmetrical and extensive.

Against the background of the development of late congenital syphilis, lesions of the skeletal system are observed more often than in secondary and tertiary syphilis, but less often than in the early congenital form and are diagnosed on average in 40% of patients. Traditionally, the pathology is localized in the region of the skull and tibia.

Organ damage

In the early stages of the disease in clinical picture there are only a few violations in the work of the affected organs. However, after some time, syphilis reveals its presence in more serious diagnoses, including at the level of:

• stomach: acute gastritis, the formation of characteristic ulcers and erosions;
• kidney: asymptomatic dysfunction, glomerulonephritis, nephrosis;
• heart: cardiovascular syphilis;
• liver: various forms hepatitis A.

Diagnostics

In order to avoid making an erroneous diagnosis of "syphilis", a whole range of measures is required:

1. Questioning the patient. The nature of the complaints and the lifestyle of the patient are important for identifying the nature of pathological processes. Various signs can indicate syphilis, including types of secretions from the mucous membranes, under what circumstances "dubious" sexual acts were performed, whether there are special preferences in sex, whether there are malfunctions in the work of internal organs.
2. Inspection. The presence of rashes on the patient's skin, a hard chancre, and an increase in lymph nodes allow the venereologist to navigate the nature of the disease.
3. Laboratory research. A reliable method of testing for infectious syphilis is the study of the contents of hard chancre, ulcers and skin rashes.
4. Blood analysis. Detects the presence of antibodies produced by the body to fight the pathogen.
5. Immunofluorescence reaction (RIF). The essence of the study lies in the fact that the serum of an infected patient, when interacting with the administered pale treponemas, glows yellow-green light in a special microscope. The discharge of a healthy organism, participating in such a reaction, does not give a glow.

Treatment

The patient undergoes an individual therapeutic course under the supervision of a specialist in a hospital or on an outpatient basis. In this case, sexual contacts are completely excluded. Therapy is based on the use of antibacterial drugs. The treatment of primary syphilis prescribed by a venereologist is designed for several weeks, secondary (including late latent) - for a period of two years or more.

Syphilis, including repeated, is a curable disease. The patient must urgently go to the nearest clinic at the first suspicion of a problem.

congenital syphilis

It is transmitted to the fetus by a transplacental route. It happens early (intrauterine period, chest and early childhood) and late (after 15 years). Requires special approaches to diagnosis and treatment.

Development mechanism

Infection of the fetus occurs in the fifth month of pregnancy when pale treponema enters through the placenta. The disease disrupts the functioning of internal organs and affects the skeletal system. The child's chances of survival are estimated to be extremely low.

Some babies transplacenally infected with the infection survive, but the peculiarities of intrauterine development do not pass without a trace.

Symptoms of early congenital syphilis

A child with such a diagnosis is weakened, slowly developing mentally and physically. Syphilis in newborns is characterized by damage to the eyes, brain, skin, bones, cartilage, teeth, impaired functioning of the liver, spleen, and cardiovascular system.

At the age of 1 to 2 years often appear:

1. Skin rashes. Localized in the genital area, buttocks, larynx, face, palms. Characteristic scars, located radially along the contour of the mouth, will remain for life.
2. Rhinitis. A small patient breathes through his mouth due to inflammation caused by a rash on the nasal mucosa.
3. Bone damage. Usually, swelling and soreness occur directly in the area of ​​​​infection.

In the case of latent congenital syphilis, the diagnosis is clarified using a blood test and cerebrospinal fluid.

Symptoms of late congenital syphilis

The disease manifests itself in adolescence (15-16 years) with lesions of the eyes (including to complete blindness), the inner ear, tumors in the tissues of internal organs and skin, a semilunar notch along the edge of the incisors.

Among the signs of infection are also called “saber-shaped” shins, scars around the lips, a “saddle-shaped” nose, and a “buttock-shaped” skull.

Diagnostics

The pathogen can be detected through microscopic analysis of the cerebrospinal fluid. But negative result does not guarantee the absence of a hidden form. In the presence of skin rashes, it is advisable to examine their discharge for the presence of pale treponema.

To make a final diagnosis, high-precision serological blood tests are carried out, as well as data from additional consultations of narrow specialists (pulmonologist, neurologist, nephrologist, ophthalmologist, and others) are used.

Treatment of congenital syphilis

Pale treponema still retains high sensitivity to antibiotics. Accordingly, patients are prescribed a long course of antibiotic therapy.

Prevention of syphilis

Contrary to popular belief, condoms do not guarantee 100% protection against infection, since there is a possibility of infection not only sexually, but also through household contact. In this regard, you should take additional personal security measures:

• use antiseptics for the full treatment of the oral cavity and genital organs after the completion of sexual intercourse;
• urgently (within two hours) seek help from a venereologist if you did not use protection during spontaneous sex with an unfamiliar partner;
• do not neglect the basic rules of personal hygiene;
• give preference to artificial feeding of a baby whose mother is a carrier of the infection.

Can you get syphilis through kissing? Easily! Getting rid of adversity is much more difficult. Self-medication is strictly contraindicated, since it does not lead to recovery, but it can significantly affect the course of pathological processes, which will further complicate the diagnosis. Your health should be entrusted to experienced professionals.

A common sexually transmitted disease - syphilis - is caused by a microorganism - pale spirochete. It has several stages of development, as well as many clinical manifestations. In Russia, in the late 90s of the twentieth century, a real epidemic of this disease began, when out of 100,000 people fell ill per year, 277 people. Gradually, the incidence is decreasing, but the problem is still relevant.

In some cases, there is a latent form of syphilis, in which there are no external manifestations of the disease.

Why does latent syphilis occur?

The causative agent of the disease is spirochete pallidum normal conditions has a typical spiral shape. However, under adverse environmental factors, it forms forms that promote survival - cysts and L-forms. These modified treponemas can persist for a long time in the lymph nodes of an infected person, his cerebrospinal fluid, without causing any signs of illness. Then they are activated, and there is a relapse of the disease. These forms are formed due to improper antibiotic treatment, the individual characteristics of the patient and other factors. Especially important is the self-treatment of patients for a disease that they consider gonorrhea, but in fact it is an early stage of syphilis.

The cyst form is the cause of latent syphilis. It also causes a lengthening of the incubation period. This form is resistant to many drugs used to treat this disease.

How is latent syphilis transmitted? In nine cases out of ten, the route of transmission is sexual. Much less common is the household route (for example, when using one spoon), transfusion (with the transfusion of infected blood and its components), and transplacental (from mother to fetus). This disease is detected most often during a blood test for the so-called Wasserman reaction, which is determined for each admitted to the hospital, as well as when registering with a antenatal clinic for pregnancy.

The source of infection is only a sick person, especially in the secondary period.

Latent period of syphilis

This is the time after infection of a person with treponema pallidum, when there are positive serological tests (blood tests are changed), but symptoms are not determined:

• rash on the skin and mucous membranes;
• changes in the heart, liver, thyroid gland and other organs;
• pathology nervous system and musculoskeletal system and others.

Usually changes in the blood appear two months after contact with the carrier. From this moment, the period of the disease is counted in a latent form.

Early latent syphilis occurs within two years of infection. It may not appear immediately, or it may be the result of regression. early symptoms disease, when there is an apparent recovery. There are no clinical symptoms of latent syphilis, it is characterized by a negative test of cerebrospinal fluid (cerebrospinal fluid). It is diagnosed using serological tests.

Latent late syphilis is characterized by a sudden activation of the process after a period of imaginary well-being. It can be accompanied by damage to organs and tissues, the nervous system. There are low-contagious elements of the skin rash.

What is latent unspecified syphilis?

In this case, neither the patient nor the doctor can determine when the infection occurred, since there were no clinical symptoms of the disease, and it was revealed, most likely, as a result of a blood test.

There is also the possibility of a false positive result of the Wasserman reaction. This happens in the presence of a chronic infection (sinusitis, caries, tonsillitis, pyelonephritis and others), malaria, liver diseases (hepatitis, cirrhosis), pulmonary tuberculosis, rheumatism. An acute false-positive reaction occurs in women during menstruation, in the third trimester of pregnancy, in the first week after childbirth, myocardial infarction, acute diseases, injuries and poisoning. These changes disappear on their own within 1-6 months.

If a positive reaction is detected, more specific tests are necessarily carried out, including a polymerase chain reaction that determines the antigen of pale treponema.

Early latent form

This form covers all forms by terms from primary seropositive (hard chancre) to secondary recurrent (skin rashes, then their disappearance - a secondary latent period, and relapses for two years), but there are no external signs of syphilis. Thus, the disease can be recorded in the period between the disappearance of the hard chancre (end of the primary period) until the onset of the formation of rashes (the beginning of the secondary period) or be observed at the moments of remission in secondary syphilis.

At any time, the latent course can be replaced by a clinically pronounced one.

Since all of the listed forms are contagious, due to the coincidence in time with them, the early latent variant is also considered dangerous for others and all the prescribed anti-epidemic measures (identification, diagnosis, treatment of contact persons) are carried out.

How to detect the disease:

• the most reliable evidence is contact with a patient with active syphilis during the previous 2 years, while the probability of infection reaches 100%;
• to find out the presence of unprotected sexual intercourse over the past two years, to clarify whether the patient had subtle symptoms, such as sores on the body or mucous membranes, hair loss, eyelashes, a rash of unknown origin;
• to clarify whether the patient did not go to the doctor at that time for any reason that worried him, whether he took antibiotics, whether he received blood or its components;
• examine the genitals in search of a scar left after a hard chancre, assess the condition of the peripheral lymph nodes;
• serological tests in high titer, but not necessarily, immunofluorescent analysis (ELISA), direct hemagglutination test (DPHA), immunofluorescence test (RIF) are positive.

late latent form

The disease is detected most often by chance, for example, during hospitalization for another reason, when a blood test is taken (“unknown syphilis”). Usually these are people aged 50 years and older, their sexual partners do not have syphilis. Thus, the late latent period is considered non-contagious. In terms of timing, it corresponds to the end of the secondary period and the entire Tertiary.

Confirmation of the diagnosis in this group of patients is more difficult, because they have concomitant diseases (rheumatoid arthritis and many others). These diseases are the cause of a false positive blood reaction.

To make a diagnosis, you should ask the patient all the same questions as with the early latent variant, only change the condition: all these events must have occurred more than two years ago. Serological tests help in the diagnosis: more often they are positive, the titer is low, and ELISA and RPHA are positive.

When confirming the diagnosis of latent syphilis, ELISA and RPHA are of decisive importance, because serological tests (rapid diagnostics) can be false positive.

Of these diagnostic methods, the confirmatory reaction is RPHA.

With latent syphilis, a puncture of the cerebrospinal fluid (CSF) is also indicated. As a result, latent syphilitic meningitis can be detected. Clinically, it does not manifest itself or is accompanied by minor headaches, hearing loss.

The study of cerebrospinal fluid is prescribed in the following cases:

• signs of changes in the nervous system or eyes;
• pathology of internal organs, the presence of gums;
• ineffectiveness of penicillin therapy;
• association with HIV infection.

What are the consequences of late latent syphilis?

Most often, syphilis has an undulating course with alternating remissions and exacerbations. However, sometimes its long course without symptoms is observed, ending several years after infection with syphilis of the brain, nerves, or internal tissues and organs. This option is associated with the presence in the blood of strong treponemostatic factors resembling antibodies.

How does the hidden late period manifest itself in this case:

• rash on the outer integument of the body in the form of tubercles and nodules, sometimes with the formation of ulcers;
• bone damage in the form of osteomyelitis (inflammation of the substance of the bone and bone marrow) or osteoperiostitis (inflammation of the periosteum and surrounding tissues);
• joint changes in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
• mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
• violation of the activity of the brain and peripheral nervous system.

Pain in the legs with latent late syphilis may result from damage to the bones, joints, or nerves.

Latent syphilis and pregnancy

If a woman has a positive serological reaction during pregnancy, but there are no clinical signs of the disease, she must definitely donate blood for ELISA and RPHA. If the diagnosis of "latent syphilis" is confirmed, she is prescribed treatment according to general schemes. Lack of therapy entails serious consequences for the child: congenital deformities, abortion and many others.

If the disease is cured before 20 weeks of pregnancy, childbirth proceeds as usual. If the treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many concomitant factors.

Treatment

Specific treatment is prescribed only after confirmation of the diagnosis by a laboratory method. The sexual partners of the patient are examined, if they have negative laboratory tests, then they are not prescribed treatment for the purpose of prevention.

Treatment of latent syphilis is carried out according to the same rules as its other forms.

Long-acting drugs are used - Benzathine penicillin, as well as Benzylpenicillin sodium salt.

Fever at the beginning of penicillin therapy is indirect evidence of a correctly established diagnosis. It accompanies the mass death of microorganisms and the release of their toxins into the blood. Then the state of health of patients is normalized. With a late form, such a reaction may be absent.

How to treat latent syphilis:

• in the early form, Benzathine penicillin G is injected at a dose of 2,400,000 units, two-stage, into the muscle once a day, only 3 injections;
• with a late form: Benzylpenicillin sodium salt is injected into the muscle at 600 thousand units. twice a day for 28 days, two weeks later, the same course is carried out for another 14 days.

In case of intolerance to these antibiotics, semi-synthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.

Latent syphilis during pregnancy is treated according to general rules, since the drugs of the penicillin group are not dangerous to the fetus.

Monitoring the effectiveness of treatment

After treatment of early latent syphilis, serological control (ELISA, RPHA) is carried out regularly until the indicators are completely normal, and then twice more with an interval of three months.

With late latent syphilis, if RPHA and ELISA remained positive, the follow-up period is 3 years. Tests are carried out every six months, the decision to deregister is made on the basis of a set of clinical and laboratory data. Usually, in the late period of the disease, the restoration of normal blood and cerebrospinal fluid is very slow.

At the end of the observation, a complete examination of the patient is carried out again, examination by a therapist, a neurologist, an otorhinolaryngologist and an oculist.

After the disappearance of all clinical and laboratory manifestations of the disease, patients can be allowed to work in children's institutions and public catering establishments. But once transferred and cured, the disease does not leave stable immunity, so re-infection is possible.

Latent syphilis: how to diagnose and treat, what is dangerous - all about diseases of the genital area, their diagnosis, operations, problems of infertility and pregnancy to the site

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Syphilis is an insidious disease, usually within three to four weeks a person infected with a pale spirochete does not even know about the disease.

If, in the ordinary course of the disease, after the incubation period, the first symptoms can be detected: hard chancre, swollen lymph nodes, then in the latent form it does not manifest itself in any way, but tests for syphilis give a positive result.

There are three forms of latent syphilis:

• early;
• late;
• Undifferentiated.

If less than two years have passed from the moment of infection, then an early form is diagnosed. If the disease is detected after this period, then a late form is diagnosed. But when an infected person cannot accurately remember the moment of infection, and as a result of research it is impossible to determine early or late syphilis in a patient, then they speak of an undifferentiated form.

The most dangerous form of syphilis for others is considered early. During this period, the patient is an active source of infection. If the disease has passed into a late form, then the risk of infecting others is significantly reduced, in most cases, generally absent.

In the early form of syphilis, the primary signs either do not appear at all or are expressed so implicitly that the person does not pay attention to them. Often this is due to the fact that the patient during the incubation period took antibiotics to treat other diseases. In this case, doses of antibiotics do not destroy the pale spirochete, but only delay its development and pervert the course of the disease.

Also on the change in the spirochete, adverse factors also have environment and self-medication. Unfortunately, the uncontrolled use of antibiotics has led to an increase in latent forms, which contributes to the spread of the disease.

Symptoms

With early latent syphilis, the manifestation of the first symptoms of the disease, such as the appearance of a hard chancre, rashes, swollen lymph nodes, may be absent or be so small that the patient does not notice them. Usually, if symptoms appear, they pass on their own and quickly.

Sometimes a person takes this form of syphilis for another disease and begins to self-medicate, which aggravates the course of the disease.

You should consult a doctor if you have had casual sex in the past two years, after which:

• Small hard abrasions and sores appear, completely clean and not painful;
• Periodically, the body temperature rises to subfebrile, while no obvious catarrhal symptoms are observed. Usually this temperature lasts for several days;
• General malaise, anemia, asymptomatic weight loss, loss of strength;
• Headaches and bone pains that worsen during sleep;
• Enlarged lymph nodes that do not hurt or suppurate;
• The manifestation of an atypical reaction for you to penicillin drugs, such as vomiting, migraine, tachycardia, fever. In this case, the symptoms disappear after taking regular aspirin.

But even these manifestations cannot indicate the presence of a disease; laboratory tests are required to make a diagnosis. Very often, early latent syphilis is discovered quite by accident, when taking tests for a hospital, obtaining a medical certificate, and registering during pregnancy.

Diagnostics

To make a correct diagnosis, it is important to collect as complete an anamnesis as possible over the past two years. In this case, the patient is asked the following:

• Did serological tests and what are their results;
• Whether there were rashes, ulcers on the genitals, on the mucous surfaces in the mouth;
• Have you taken antibiotics?
• Have you self-treated for .

A visual examination of the patient is carried out for the presence of hard chancres, residual effects of polyscleradenitis, and an increase in lymph nodes.

Be sure to do the Wasserman reaction, with a positive result, additional tests are carried out. Since in some cases it can be positive even in the absence of the disease. A positive result for several serological tests is required to confirm the diagnosis. Such as:

• Immunoassay (ELISA);
• Immunization reaction of poor trepanemas (RIBT);
• Immunofluorescence reaction (RIF);
• The reaction of passive hemagglutination (RHA).

At the same time, in early syphilis, most patients have very high titers. In almost all patients with this form of syphilis, the RIF reaction will be positive.

Sometimes in the early phase of latent syphilis, reactions may be negative if other signs are present. In this case, for the timely recognition of the disease, an analysis of the cerebrospinal fluid is taken.

Treatment

The earlier latent syphilis is diagnosed, the higher the chances of a positive result. Treatment is carried out under strict medical supervision according to approved schemes and instructions. Usually the patient is placed in a hospital, but they can also be treated on an outpatient basis.

Therapeutic treatment includes taking antibiotics, immunomodulators, antipyretic, anti-inflammatory drugs.

Prevention

To reduce the risk of the disease, it is necessary to take a responsible approach to the choice of sexual partners. In casual relationships, do not allow sexual intercourse without the use of condoms. Do not use other people's personal hygiene items.

To prevent the disease, it is important to carefully monitor your health. Once a year, undergo a medical examination with a study of titers for syphilis. In case of a positive reaction, it is necessary to contact a venereologist as soon as possible. Do not use antibiotics without medical prescription.

If there was sexual contact with a patient with syphilis, you should consult a doctor for preventive treatment within a week. When a disease is detected, it is mandatory to conduct a survey of all sexual partners of the patient and their family members.

You should not engage in treatment on your own, since in the case of improperly selected therapy, the disease can become chronic. And then it will be very difficult to cure syphilis.

It is also important to be sure that there is no hidden form of the disease when planning pregnancy, since in most cases this causes miscarriage, premature birth, the birth of babies with developmental anomalies and congenital syphilis.

Latent syphilis is a sexually transmitted disease that occurs without obvious clinical signs. Diagnosis is helped by history data, the results of a thorough examination and positive specific reactions. It is possible to recognize the disease by detecting pathological changes in the cerebrospinal fluid. The need for multiple studies and re-diagnosis after a course of therapy is associated with a high probability of obtaining false positive reactions.

What is latent syphilis

The diagnosis of "latent syphilis" is made to patients in the case of detection of antibodies to pallidum spirochete in the laboratory in the absence of specific symptoms characteristic of sexually transmitted infections. Often, pathology is detected during examinations associated with other diseases.

The spiral-shaped pale spirochete, under the influence of external adverse factors, begins to change to forms conducive to survival. causative agents of syphilis long time can be found in the lymph nodes and cerebrospinal fluid without any manifestations. When activated, the asymptomatic period is replaced by an exacerbation with a deterioration in the patient's well-being.

The reason for the formation of cysts-forms of spirochetes (treponema) is the improper use of antibacterial drugs. Often treated with this group medicines patients spend on their own, without a doctor's prescription, when they notice signs of gonorrhea or other sexual infections.

The latent form of syphilis has a long incubation period and high resistance to drugs used in the treatment of sexually transmitted diseases. The most common route of infection is sexual.

Syphilis can be transmitted through household contact or through the placenta from a woman to her fetus.

What is dangerous?

With a latent course of syphilis, a patient can infect a partner during sexual intercourse. The danger lies in the high risk of infecting others when using dishes and cutlery, towels and other hygiene products on which biological fluids can be left. Not timely detected syphilis becomes the cause of infection of all members of the patient's family.

As the infection progresses, the pathogen spreads through the lymphatic system to the tissues of the liver, brain, and digestive tract, causing serious damage to organs. Pronounced signs of disturbances develop during the transition of the latent phase to the active one. Major changes occur when there is no timely treatment against the background of a decrease in the body's defenses. With strong immunity, the patient becomes a carrier of infection.

Classification and forms of latent syphilis

In medical practice It is customary to classify the disease into the following forms:

1. Early. She is diagnosed with an infection that occurred no more than two years ago.
2. Late. It is established in case of infection, which has a statute of limitations - ten years.
3. Unspecified. It is set when it is impossible to determine the time of infection.
4. Congenital. This form of the disease is determined if the child was infected from a mother who has a medical history of diagnosed syphilis, which is asymptomatic.

The latent nature of the infection can take the following forms:

• primary, developing without specific symptoms in patients whose therapy was timely, but ineffective;
• secondary, arising from re-infection and not having specific signs;
• tertiary, which is placed in patients who have had an active form of the third phase of syphilis.

Early period

Doctors consider the disease in the early period to be the most dangerous, since uncontrolled infection occurs by the patient, who is unaware of his infection, and the people around him.

Pale spirochete can enter the body healthy person not only sexually, but also domestically.

It is possible to detect an early form of latent syphilis during a preventive examination. A blood test (Wasserman reaction) is carried out not only during medical examinations, but during hospitalization for various pathologies. Such studies make it possible to determine the latent form of syphilis. The serological reaction does not show the correct results in all cases, and there is a need for other laboratory tests.

During the examination of patients with suspicion of an early form of the disease, the doctor reveals enlarged lymph nodes with characteristic seals, a rash on the skin, which went unnoticed by patients due to its short duration. These signs may indicate infection with pale treponema. The presence of a pathogenic agent in the body is often accompanied by changes in the thyroid gland, liver, joints, digestive tract. Many patients have symptoms of disruption of the nervous system, since microorganisms violate the walls of blood vessels, the structures of the meninges.

Late period

Late latent syphilis is spoken of when infected with pale treponema that occurred more than two years ago. At this stage, the disease is considered safe for the people around the patient. In the late period, rashes on the skin are not detected, while the infection leads to the destruction of internal organs, the nervous system. In many cases, late silent syphilis is detected in elderly patients suffering from rheumatoid arthritis, cardiac ischemia, or myocarditis.

The disease is evidenced by a rash similar to ulcers, signs of osteomyelitis, impaired functioning of the brain, changes in gastrointestinal tract and lungs. Patients may complain of joint pain. "Neurosyphilis" is placed in case of damage to the nervous system.

The consequence of a late latent disease in the absence of therapy is severe disorders of organs and systems that threaten disability.

Symptoms and signs of latent syphilis

Latent forms of syphilis may not affect human health for a long time. The presence of a pathogen in the body should be suspected in the presence of the following symptoms:

1. Hyperthermia of the body, which occurs periodically.
2. Enlarged lymph nodes. Their compaction is observed.
3. Presence for a long time of a depressive syndrome.
4. The patient has reduced visceral fat, weight loss occurs for no apparent reason.

The presence of scars and seals on the genitals, the residual phenomenon of polyscleradenitis testify to the primary form of the disease. Serological studies show positive results in 70% of patients. In 25% of patients, low titers are observed. They decrease after antibiotic therapy.

Against the background of treatment with penicillin drugs, a third of patients observe the Herxheimer-Jarish reaction, which manifests itself in the form of a sudden increase in temperature, headaches and muscle pain, nausea and tachycardia. This symptomatology occurs due to the mass death of pathogenic microorganisms and decreases when taking aspirin. When meningitis occurs, associated with latent syphilis, there is an increase in protein, a positive reaction to globulin fractions.

Diagnostics

The anamnestic method helps doctors in diagnosing a latent form of syphilis. Data collection takes into account:

• suspicious sexual contacts;
• the presence in the past of single erosions in the genital area or oral cavity;
• rash on the skin;
• the use of antibacterial drugs associated with the detection of any disease similar to syphilis;
• patient's age.

When making a diagnosis, difficulties may arise. Sometimes patients hide and misinform the doctor because of secrecy. Often the symptoms are similar to other diseases. Obtaining false positive results can also make it difficult to diagnose latent syphilis. A detailed history plays an important role in determining the form of the disease.

Carrying out specific tests, obtaining enzyme immunoassay indicators, immunofluorescence reactions help determine the presence of syphilis pathogens in the patient's body.

The examination includes a consultation with a gastroenterologist, a neurologist and a proctologist. It is necessary to confirm or exclude damage to organs and systems.

Treatment and prevention

Therapy of the latent form of syphilis is carried out only after receiving laboratory data.

Examinations are assigned to the sexual partners of the patient.

If the test results are negative, prophylactic treatment is not required.

Therapy is carried out in the same way as in other forms of syphilis. It is carried out on an outpatient basis with drugs with prolonged action: benzathine penicillin and benzylpenicillin sodium salt. The occurrence of hyperthermia during treatment with antibacterial drugs means that the disease is diagnosed correctly. After an increase in temperature and the death of the infection, the condition of patients usually improves. If the form of syphilis is late, such a reaction is not observed.

Dosages of drugs:

1. Penicillin benzathine is prescribed for early latent disease at a dosage of 2.4 million units. once a day. The course is three injections.
2. The sodium salt of benzylpenicillin is administered when late latent syphilis is detected at a dosage of 600 thousand units. twice a day for a course of 4 weeks. After 14 days, the treatment is repeated.

If the patient has signs of poor tolerance to drugs from the penicillin group, the doctor prescribes antibacterial drugs of the tetracycline series, macrolides, cephalosporins. Pregnancy is not a contraindication to the use of penicillins, as they are considered safe for the fetus. Therapy during this period is necessary, since congenital syphilis can cause the development of pathologies in a child.

It is important to remember that after a completely cured disease, stable immunity is not developed. Preventive measures must be taken to prevent re-infection. All sexual contacts must be protected. A disorderly intimate life can lead to infection with syphilis and other sexually transmitted diseases. It is necessary to use only personal hygiene items, wash hands regularly. Every year, doctors recommend donating blood for tests and being examined by a general practitioner, urologist, gynecologist, and neurologist.

How is the effectiveness of therapy monitored?

At the end of the course of antibacterial drugs, specific tests are carried out. Examinations are carried out repeatedly until normal results are obtained. In the subsequent control is made two more times in 90 days.

If the disease has a late form and the tests showed positive results, the period of medical observation is at least three years. Patients are tested every six months. Deregistration is made after receiving normal indicators of laboratory research. With a late latent form of the disease, the results become normal for a long time. The observation of the patient ends with a complete examination, including not only the delivery of tests, but also a consultation with a neurologist, ophthalmologist, therapist, gynecologist.

Admission to work in a children's institution and a public catering enterprise is given only with the complete disappearance of all symptoms and clinical signs of the disease.

Latent syphilis is a dangerous disease that disrupts the functioning of many systems and organs. If you have any suspicious symptoms, you should consult a doctor.

Timely detection of infection helps prevent the development of complications.

To avoid infection with syphilis and other sexually transmitted diseases, it is important to follow the rules of prevention.

With latent syphilis, there are no characteristic signs of pathology, and the disease can be suspected when performing specific laboratory tests. Despite the fact that there are no obvious manifestations of infection, the disease progresses slowly and leads to irreversible consequences. Basically, the asymptomatic course is associated with the widespread use of antibacterial drugs without prior accurate diagnosis of the disease. Patients, believing that they are sick with another venereal pathology (chlamydia, gonorrhea, trichomoniasis), start the wrong therapy. It only suppresses the growth of the causative agent of syphilis - Pale treponema, contributing to the latent course of the infection.

The frequent detection of a latent course is due to mass preventive examinations for syphilis in healthcare.

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  The causative agent of the infection

  The cause of the infection is Treponema pallidum (Treponema pallidum). It is surrounded by a specific protective sheath that protects it from exposure to hazardous environmental factors: antibiotics, antibodies.

  Treponema exists in several forms:

  • typical spiral shape;
  • cyst;
  • L-shape.

  In the case of a typical spiral shape, the infection proceeds with vivid clinical manifestations. Diagnosing it is easy enough.

  Cysts and L-forms are special forms of treponema that the body cannot recognize and respond to; protected species of the pathogen do not cause the appearance characteristic symptoms, but form a latent course of syphilis, which can be detected only when laboratory research. Cysts, L-forms are simply found in human blood and are periodically activated when appropriate factors arise: reduced immunity, stress, etc.

  Features of the disease

  The main route of transmission of the infection is sexual - about 90% of cases. The household way is especially common in children, with kissing, breastfeeding. Sweat and urine from patients with syphilis are not contagious. Sperm, blood, vaginal secretion, saliva, breast milk- contain the pathogen in large numbers and are highly contagious. The source of infection is a person who is able to transmit the disease in the first years of the disease. Main routes of transmission:

  • sexual;
  • domestic;
  • transfusion (through the blood);
  • transplacental (from mother to child in utero).

  Classification of the disease from the duration of the infection in the body:

  The typical course of syphilis is characterized by a classic change of stages:

  • incubation period.
  • primary syphilis.
  • Tertiary syphilis.

  

  stages

  Incubation period(time from infection to the onset of clinical symptoms) lasts 3-9 weeks. 24-48 hours after infection, treponemas make their way to the regional lymph nodes and the systemic infection process starts. At this stage, the principle and timing of personal prevention after casual sexual intercourse is formed, which consists in the treatment of the genital organs with disinfectant solutions within 2 hours after intercourse.

  Primary Period begins from the moment of appearance (painless ulcer) at the site of introduction of treponema. In that place, the nearest lymphatic vessels and nodes increase. The end of the primary period is accompanied by fever and malaise, this is a consequence of the generalization of the infection: treponemas are released into the blood.

  

  Hard chancre on the genitals

  ATtoric period lasts 3 to 4 years. It is characterized by the appearance of rashes on the skin and mucous membranes. The rash may look like:

  • bubbles;
  • papules;
  • spots;
  • pustules.

  

  Rashes of secondary syphilis

  The rash disappears after a few weeks and does not leave a trace. Without appropriate treatment, the rash reappears. In addition, there may appear: skin pigmentation disorders, local hair loss on the head and eyebrows, seizures.

  Retarpen - the main tool for the treatment of syphilis

  The result is evaluated no earlier than 3 months after the end of treatment according to repeated serological tests: a decrease in the titer of specific antibodies is detected. When going faster, negative tests for infection are soon achieved. Late course is more difficult to cure, positive tests can remain forever, sometimes it is also characteristic of early syphilis.

  To deregister, you must:

  • full-fledged treatment taking into account all requirements;
  • optimal clinical examination data;
  • the results of a serological blood test (ELISA and RPHA may be positive with strictly negative MCI and CSR).