Differential diagnosis of secondary fresh and recurrent syphilis. Manifestations of secondary syphilis

On average 2-3 months after infection or 6-7 weeks after the onset of chancre as a result of hematogenous dissemination of pale treponema, on the skin and mucous membranes the first generalized rash appears.
Bones, muscles, joints are affected, internal organs, blood and lymphatic vessels, organs of hearing, vision, nervous and endocrine systems.
Secondary fresh syphilis (syphilis secundaria recens) sets in, which lasts an average of 2-2.5 months, after which the rash spontaneously regresses even without treatment and the disease passes into secondary latent syphilis (syphilis secundaria latens, lues II latens), which can last from several days to several months, followed by a second and subsequent outbreaks of new eruptions.
The reappearance of rashes (return of the disease) occurs after 3-6 months and occurs secondary recurrent syphilis(suphilis secundaria recidiva). In the future, relapses of secondary syphilis alternate with latent periods for 3-5 years, and sometimes more.
A wavy course is characteristic, that is, a change in the active clinical manifestations of the disease with latent (latent) periods (syphilis latens), which is due to a change in immunobiological reactions and the appearance of corresponding reactions of infectious allergies. Regardless of the nature of the elements, secondary syphilides have distinctive features that make it possible to recognize and differentiate them with various dermatoses similar in clinical picture. Benign course - spontaneous and traceless resolution of elements even in the absence of treatment after an average of 2-3 months. Less often, scars remain after ulceration of pustular elements.

When prescribing a specific treatment, syphilides quickly resolve and disappear, which is often used in practice as a diagnostic technique - "trial treatment" (therapia ex yuvantibus). The general condition is not violated. There are no subjective sensations (pain, itching, burning), which are often observed in skin diseases. Slightly pronounced itching sometimes occurs in the presence of rashes on the scalp and in the folds of the skin. Rashes appear paroxysmal, as a result of which the elements of the rash are at various stages of development (evolutionary or false polymorphism). However, the simultaneous occurrence of various morphological elements of the rash in the patient is possible.
For example, roseola and papules or papules and vesicles (true polymorphism). Rashes of the secondary period have a rounded shape, sharply delimited from healthy skin, located focally, not prone to peripheral growth and fusion. Rash without signs of acute inflammation, stagnant copper-red color with a brownish tinge, contains a large number of pale treponema. Then the color becomes more faded, in the words of the French syphilidologists "boring".
The presence of a dense infiltrate at the base of syphilides, excluding roseolous rashes, is characteristic. Serological blood tests are sharply positive with a high titer of reagins 1:160 and 1:320 in almost 100% of cases in patients with secondary fresh syphilis.
In 96-98% with a low titer of reagins 1:5-1:20 in patients with secondary recurrent syphilis.
RIF (immunofluorescence reaction) is sharply positive in almost 100% of cases.
RIBT (treponema pallidum immobilization reaction) positive in 60-80% patients with secondary fresh syphilis and in 80-100% of secondary recurrent.
In 50% of cases with secondary recurrent syphilis, pathological changes in the cerebrospinal fluid are observed in the absence of a clinical picture of meningitis (latent latent syphilitic meningitis).
Clinical features of secondary fresh syphilis:

• rashes are localized in the trunk area;
• they are small, small in size;
• elements are abundant, arranged randomly, scattered;
• there is no tendency to group and merge;
• symmetrically arranged;
• characteristic bright color;
• do not peel off;
• in 75-80% of patients, a hard chancre or its remains are detected;
• regional scleradenitis is observed in 22-30% of patients;
• pronounced polyscleradenitis - in 88-90%.

Features of secondary recurrent syphilis

The rash is localized on the extensor surfaces of the upper and lower extremities, contact areas of the skin that are irritated - skin folds (axillary, inguinal, perianal), mucous membranes of the genital organs, oral cavity (patients with carious teeth, people who abuse alcohol, smoke, hot and spicy food).
• The sizes are large.
• amount.
• asymmetrical arrangement.
• Rashes tend to group and merge with the formation of figures, garlands, arcs, circles, rings.
• They have a pale, slightly pronounced color.
• Slightly pronounced polyadenitis is revealed.

Spotted (macular) syphilide (syphilitic roseola)

Differential diagnosis of spotted (macular) syphilis (syphilitic roseola)

Papular syphilis

• Psoriasiform syphilis(syphilis psoriasiformis). On the surface of the papules are abundant, silvery-white, easily removable, lamellar scales. Around the papules, a copper-red corolla of the infiltrate is revealed.
• seborrheic papular syphilis(syphilis papulosa seborroica) - in persons with oily seborrhea on skin areas rich in sebaceous glands (scalp, nasolabial, chin, nasobuccal folds), on the border of the forehead and scalp (Venus crown, corona veneris). Papules with an uneven surface, covered with greasy scales and gray-yellow crusts.
• Ring-shaped, circinary or orbicular papular syphilides(syphilis papulosa annularis, circinata, orbicularis). On the back of the head, scrotum, penis - syphilitic papules arranged in an annular form in the form of a roller. In the center, the skin is of normal color or hyperpigmented. New papules may appear, gradually acquiring the shape of a ring.
• Miliary, small papular or lichenoid syphilides(syphilis papulosa miliaris seu lichen syphiliticus). A rare manifestation of secondary recurrent syphilis. It is observed mainly in elderly people with concomitant diseases (malaria, cirrhosis of the liver, tuberculosis), chronic intoxication (alcoholism, drug addiction). May arise both primary and secondary from previous roseola. Rashes are localized on the trunk, upper and lower extremities around the sebaceous hair follicles in the form of plaques, grouped arcs. Papules the size of a millet grain, round or cone-shaped, dense texture, copper-red color with a brownish tint. On the surface of individual papules, scales or horny spines are noted. Characteristic of small papular syphilis is resistance even after antisyphilitic therapy. Without treatment, they can last up to 2 months. After resorption, persistent atrophic scars remain. The presence of abundant miliary syphilis in patients indicates a severe course of syphilis. Often there may be weakness, malaise, fever, itching.
• Weeping papular syphilis(syphilis papulosa madidans). In places of skin with excessive sweating (genital organs, perineum, inguinal-femoral, inguinal-scrotal, axillary and other skin folds, anal area), maceration of the epidermis is noted, which becomes whitish in color. As a result of irritation, the stratum corneum of the epidermis is rejected and erosive papules (syphilis papulosa erosiva) are formed. If a secondary infection joins, ulcerative papules (syphilis papulosa ulcerosa) occur. Often worried about itching, soreness. In areas of the skin with friction and prolonged irritation (folds, perineum, anus, genitals), due to the growth of the papillary dermis, weeping papules increase, become red-bluish in color. They have a wide dense base, a bumpy surface, a grayish coating. Hypertrophic vegetative papules, wide condylomas (condilomata lata) are formed. Separate papules as a result of irritation increase in size, merge and turn into extensive plaques with scalloped outlines. A plaque-like papular sifidid (syphilis papulosa laminoideus) is formed. Subjectively itching.
• Coin-shaped (nummular) papular syphilis(syphilis papulosa nummularis). It is observed in patients with secondary recurrent syphilis. Papules appear in small numbers on any part of the skin. They are grouped, large, regular round shape with a pronounced infiltrate, color " raw ham"(bluish-red). There is a slight peeling on the surface. After the resolution of coin-like papules, a long-lasting brownish-dark (black) pigmentation remains. Often, they are combined with roseola, lenticular and pustular syphilis.
• Corymbiform syphilides(syphilis papulosa corymbiformis). A large, coin-shaped papule appears, surrounded by randomly scattered small papules. By appearance resembles a picture of an exploding bomb or shell ("bomb", "blasting" syphilis, "bomben syphilid").
• Cockade papular syphilis(syphilis papulosa en cocarde). One large papule is surrounded by a corolla of infiltrate, consisting of merged small papules. At the same time, a strip of normal skin resembling a cockade remains between the central papule and the corolla of the infiltrate.
• Papular syphilis of the palms and soles, palmoplantar syphilis(syphilis papulosa palmaris et plantaris). It is observed in secondary fresh syphilis, but is more common in secondary recurrent. Initially, red-violet-yellow papules appear on the palms and soles with dense infiltration at the base, which do not rise above the level of the skin. Dense scales appear on their surface. In the central part, the stratum corneum cracks and a collar-shaped peeling ("Biett's collar") is formed. Papules the size of lentils, flat, dense, yellowish-red or reddish-brown, clearly demarcated, without signs of inflammation.

• Lenticular type (syphilis papulosa lenticularis palmaris et plantaris) - papules the size of lentils, dense, red-yellow in color with horny scales on the surface.
• Ring-shaped type (syphilis papulosa orbicularis palmaris et plantaris) - nodules are arranged in the form of garlands, arcs, rings, sometimes have bizarre outlines. The presence of such rashes is a sign of recurrent syphilis.
• Horny type (comua syphilitica) - rounded papules with a stratum corneum on the surface and in appearance resemble an ordinary corn. At first they are stagnant red, soft consistency. In the future, the stratum corneum thickens in the form of a callus (clavus syphilitica) or a large wart (verruca syphilitica).
• Wide type (syphilis papulosa en nappe) - rounded or irregular plaques of various sizes up to 5-6 cm in diameter are formed with thick horny layers on the surface. This variety is extremely rare.
• Ragadiform papules (syphilis papulosa rhagadiformis) - papules are located in the natural folds of the skin (corners of the mouth, nasolabial, interdigital folds), where deep painful cracks form. A persistent flow (constant mechanical irritation) is characteristic.

Differential diagnosis of papular syphilis

Pustular (pustular) syphilide

• Acne (acneiform) syphilide
  Frequent manifestation of pustular syphilis in secondary fresh syphilis. Usually associated with roseola and papules. Differs in the distribution and abundance of rashes throughout the body (acne syphilitica disseminata). Sometimes accompanied by fever. It is characterized by a slow course, meager rashes, the temperature does not rise (acne syphilitica conferta). Localization of rashes is associated with the sebaceous glands and hair follicles (scalp, forehead, chest, interscapular region). The appearance of a rash may be preceded by fever, chills, arthralgia. Clinically, pinhead-sized follicular papules are demarcated from healthy skin. At the top of the papule, a conical or spherical pustule 0.2-0.3 cm in diameter is determined with purulent exudate, which shrinks into a yellowish-brown crust. After 1.5-2 weeks, the crusts fall off and barely noticeable, depressed, pigmented scars remain. Rashes exist up to 1-2 months.
  Differential Diagnosis acneiform (acneiform) syphilis
  Papulonecrotic tuberculosis. Mostly occurs in adolescence. A feature is a long chronic course. In patients with tuberculosis of the lymph nodes, lungs, flat, dense, superficial or deep, pale pink nodules with necrosis in the center appear on the extensor surfaces of the limbs, face, buttocks. After their resolution, "stamped" scars remain. Tuberculin tests are positive. Acne iodine and bromine. AT correct staging the diagnosis is helped by the data of the anamnesis (taking medications containing iodine, bromine). The rash is localized mainly on the face, neck, shoulders, buttocks. Large pustules appear with an acutely inflammatory corolla along the periphery, at the base of which there is no dense infiltrate, as well as erythematous, bullous, nodular, urticarial elements. There is a rapid regression of the manifestations of the disease after discontinuation of iodine or bromine preparations.
• Smallpox pustular syphilis
  Rashes are localized on the face, trunk, flexion surfaces of the limbs. In the amount of 10-20, pea-sized spherical or hemispherical pustules appear with an umbilical depression in the center and serous-purulent contents, along the periphery of which there is a copper-red delimited infiltrate. After 5-7 days, the content shrinks into a crust, which is located on an infiltrated base, and in this form the element exists for a long time. Scars do not remain, but sometimes a superficial scar is formed. The emergence of new elements occurs within 5-7 weeks. Often there is general weakness, moderate fever.
  Differential diagnosis of pox-like pustular syphilis
  Chicken pox. After prodromal phenomena (malaise, headache, loss of appetite, runny nose, cough), round or oval pink-red spots up to 2-4 mm in diameter appear on the scalp, trunk, inguinal and axillary areas, from single to several hundred. They transform into papules. Some turn into single-chamber vesicles with transparent contents. Vesicles dry up and yellow-brown crusts form.
• Impetiginous pustular syphilis
  It is detected in secondary fresh syphilis with spotty and papular rashes. Dense dark red papules up to 1 cm or more in diameter appear on the scalp, face, chest, back and flexor surface of the limbs. In the center, a superficial pustule with an infiltrate forms, which shrinks into yellowish-brown layered crusts surrounded by a dark red corolla. As a result of the constant flow of exudate from the depths of the pustule, the crust rises and reaches a significant size. After regression, a superficial pigmented scar remains. At the bottom of the pustule, the papillary layer can grow with the formation of warty, vegetative granulations (syphilis framboesiformis).
  Differential diagnosis of impetiginous pustular syphilis
  Vulgar impetigo. Children are sick. It is characterized by a rapid onset of the disease and the spread of rashes in open areas of the body (face, hands, shins, feet) in the form of flat conflicts with light, then cloudy contents and a rim of hyperemia along the periphery. The content shrinks with the formation of dirty gray crusts, which fall off leaving a depigmented spot. Conflicts tend to merge and form large foci with irregular outlines. With the appointment of therapy, the rashes regress after 1-2 weeks.
• Syphilitic ecthyma
  Severe malignant form of pustular syphilis. Occurs 5-8 months after infection, as well as at a later date of secondary recurrent syphilis. Often accompanied by general malaise, fever, bone and muscle pain, purulent iritis and other disorders. It can be observed with secondary fresh syphilis simultaneously with spotty and papular rashes. Rashes are localized on the lower extremities, especially on the shins, less often on the face, trunk, where a deep large pustule appears with regular or rounded outlines and a copper-red infiltrate along the periphery. The pustule dries into a dense, grayish-brown or black crust, which, as it were, is immersed to one or another depth - superficial and deep ecthymas (ecthyma syphiliticum superficiale et ecthyma syphiliticum profundum). After removing the crust, a deep ulcer with steep edges and surrounded by an infiltrated, dense, dark red roller is exposed. At the bottom of the ulcer, yellowish-gray necrotic masses and purulent discharge are noted. Elements appear in a small amount (no more than 6-8), asymmetrically arranged, prone to peripheral growth and decay. When healing, a pigmented scar remains.
  Differential diagnosis of syphilitic ecthyma
  Vulgar ecthyma. Persons of young age are ill. More often on the lower leg there is a bubble with purulent or purulent-hemorrhagic contents and the presence of an acute inflammatory reaction of the skin around. There is no dense infiltrate at the base of the pustule. After opening, a yellowish-dirty crust is formed, which, when rejected, reveals a rounded ulcer (ecthymatous ulcer) with steep edges and purulent masses at the bottom. With early and adequate treatment, the ulcer scars within 1-2 weeks, followed by the formation of a scar.
• Syphilitic rupee
  It is a type of ecthyma. Occurs in the late stages of secondary recurrent syphilis, not earlier than 2-3 years after infection. May be combined with other syphilides. Accompanied by significant violations of the general condition. It is located on the limbs, torso, less often on the face, head. A single, massive, layered, cone-shaped crust is formed up to 2 cm high and up to 5-6 cm in diameter, which is initially dirty brown in color, and then brown-black (reminiscent of an oyster shell). After removing the crust, a deep ulcer with sheer, infiltrated edges and a bloody-purulent bottom is revealed. There are 3 zones: in the center - a rupioid crust, along the periphery - a roller of papular purple-red infiltrate, and between them - an annular zone of ulceration. It is characterized by a slow course and a tendency to spread both in depth and along the periphery. After healing, a deep pigmented scar remains. The clinical picture of the rupee is typical and difficult to confuse with other dermatoses.

Vesicular (herpetiform) syphilis

Differential diagnosis of vesicular (herpetiform) syphilis

Syphilitic leukoderma (syphilis pigmentosa)

• spotted- large white spots are isolated from each other and surrounded by a wide halo of hyperpigmented skin, do not tend to merge.
• Mesh(lace) - a large number of white spots appear, prone to increase and merge. Narrow grayish stripes remain between the spots, which resemble a mesh or lace.
• Marble- against the background of slightly hyperpigmented skin, weakly expressed borders between depigmented spots and surrounding skin are revealed, which acquires a characteristic appearance of "dirty" skin.

Differential diagnosis of syphilitic leukoderma (syphilis pigmentosa)

Syphilitic alopecia (syphilitic alopecia)

• Small focal alopecia
  On the scalp in the occipital and temporal regions, less often - on the beard, eyebrows, eyelashes, a large number of small foci of baldness appear. They are irregularly rounded, not prone to fusion, up to 10-15 mm in diameter. In the foci of alopecia, there is a sharp thinning of the hair. Not all hair falls out. Therefore, the scalp resembles "moth-eaten fur." Hair loss in the area of ​​\u200b\u200bthe eyelashes is called "omnibus" or "tram" syphilis. As a result of partial loss of eyelashes and the successive growth of new ones, they are of different lengths - "stepped" eyelashes (Pinkus sign). Differential diagnosis of alopecia areata
  Alopecia areata. The centers of alopecia are large, correctly rounded with clear boundaries, in the amount of 1-3. Hair is completely absent. On the periphery are easily pulled out. The skin is smooth, shiny, reminiscent of a billiard ball. Superficial trichophytosis of the scalp. Children get sick school age. Foci of various sizes and irregular foma, indistinct. Mild inflammation and desquamation are noted. The hair is broken off at the level of the skin ("black dots") and at a distance of 2-3 mm from the surface of the skin, healthy. Trichophyton tonsurans is found. Superficial microsporia of the scalp. Children are sick. Foci of irregular shape, erythematous-scaly, with fuzzy edges. The hair is broken off at a distance of 5-8 mm above the skin level. They appear to be healthy. Fragments of hair are surrounded by a gray sheath (fungal spores). Microsporum ferrugineum is found.
• diffuse alopecia
  Acutely there is a continuous thinning of the hair without changing the skin in the temporal region and subsequent spread.
  Differential diagnosis of diffuse alopecia
  Favus of the scalp Erythematous spots appear on the scalp, which after 15 days turn into scooters. Skutula is a saucer-shaped, dry, bright yellow element, 2-4 mm in diameter, in the depressed center of which a hair sticks out. Hair dull, ash-gray. The outbreaks are spreading. After regression - atrophy, persistent hair loss. A "mouse" ("barn") smell emanates from patients. The fungus Trichophyton Schonleinii is found.
• Mixed syphilitic alopecia
  The combination of small-focal alopecia with diffuse.

Syphilitic lesions of the mucous membranes

They occur in the secondary period of syphilis and are more often observed in secondary recurrent syphilis. May be the only manifestation of the disease. Localized on the mucous membranes of the mouth, nose, genitals, anus - in areas exposed to irritating factors. In the oral cavity (carious teeth, deposits of stones around the teeth, smoking). In the area of ​​the external genitalia (discharge from the urethra, vagina, inflammatory processes); anus (feces). In half of patients with secondary syphilis, patchy, papular rashes and rarely pustular ones appear on the oral mucosa. They do not cause subjective sensations, they are detected late and cause direct and indirect infection of others.
• Spotted (macular, roseolous) syphilide of mucous membranes
  Rashes are localized on the arches, soft palate, tonsils, buccal mucosa in the form of separate, round, symmetrical, bluish-red spots with a smooth surface, 3-5 mm in diameter. May be associated with patchy, papular skin rashes. At the confluence, extensive continuous lesions (syphilitic erythematous angina, angyna erythematosa syphilitica) can form, which acquire a stagnant red color with a copper tint, have a smooth surface, clearly defined borders and slightly rise. Subjectively slight soreness and awkwardness when swallowing. If edema appears with erythematous angina, then a more persistent form of the lesion occurs with a protracted course, which is referred to as angyna syphilitica erythematosa infiltrata. With the formation of a superficial infiltrate, the lesions acquire a grayish color (plaques opalines), which is a transitional form of erythematous and papular syphilis. Due to desquamation of the epithelium, erosions occur on the surface of the rashes with localization on the lips, tongue, gums, mucous membranes of the external genital organs. They are round or oval in shape, 2-5 mm in size, with a red or grayish-white surface, a small serous discharge, clear boundaries.
  Differential diagnosis of spotted (macular, roseolous) syphilis of mucous membranes
  Banal catarrhal angina. Sudden start. Subfebrile temperature, general weakness, headache, malaise, pain when swallowing are noted. An objective examination of the tonsils hyperemic, edematous. Lymph nodes in the corner mandible and along the anterior edge of the sternocleidomastoid muscle enlarged, painful.
  Toxidermia fixed. Erythematous spots appear on the oral mucosa, oval in shape, 2-3 cm in diameter. Bubbles or blisters appear in the center of some, which then open with the formation of painful erosions. Rashes simultaneously appear on the skin, external genitalia, in the anus. In history, the relationship of the occurrence of a rash after taking medications (sulfonamides, penicillin, tetracycline), after the abolition of which the process regresses within 7-10 days. With widespread toxidermia, the general condition is disturbed - fever, chills, coma, dyspepsia. In the case of repeated administration of the same drugs, the process recurs in the same areas, but can also be localized in others.
• Papular syphilide of mucous membranes
  The most common manifestation of the secondary period of syphilis is on the oral mucosa. Papules occur on the tonsils, arches, soft palate and are located focally. They are rounded, up to 10 mm in diameter, with a smooth surface, dense texture, delimited. The color of the papules is dark red with a bluish tinge. Usually papules do not rise above the level of the mucous membrane ("opal plaques" - the term of the French authors), painless. After some time, the epithelium covering the papule is saturated with exudate and the papule becomes grayish-white with a red rim around the periphery. When plaque is removed from the surface of the papule with a spatula, red erosion is exposed, in the discharge of which a large number of pale treponemas are found. When the papules are irritated by spicy food, teeth, alcohol, they increase along the periphery, merge and form yellow-white plaques with scalloped outlines, which are eroded. Erosions can turn into painful dirty gray ulcers with an uneven surface and purulent plaque, which are often accompanied by bleeding. There are papulo-erosive (syphilis papulo-erosiva mucosae) and papulo-ulcerative (syphilis papulo-ulcerosa mucosae) syphilis of the mucous membranes. With prolonged trauma, the papules hypertrophy and the surface becomes uneven, granular, dirty yellow (white) in color. Sometimes red (white) vegetations appear on the surface of the papules, which, with prolonged irritation, take on a tumor-like appearance (syphilis papulosa mucosae vegetans). When localized on the back of the tongue, syphilitic papules differ in their appearance. In some cases, in the area of ​​the papule, the filiform papillae of the tongue are clearly expressed and the papule protrudes above the mucosa in the form of uneven gray foci. However, more often filiform papillae are absent, papules are pinkish-bluish, oval or irregular in shape, their surface is smooth ("polished"). They are located, as it were, below the level of the mucosa - plaques of a "sloping meadow", "glossy" papules, "alopecia of the tongue". With folded glossitis, papules are localized in the region of crests of folds - the furrows of the tongue deepen, the edges thicken, they become V-shaped, resembling deep cracks. Most often, with secondary recurrent syphilis, papules are located on the tonsils (syphilitic papular tonsillitis, angina papulosa syphilitica). In the mouths of lacunae, they look like a whitish coating, resembling nonspecific tonsillitis. In most cases, papules merge and cover the vast surfaces of the tonsils with a transition to the arches surrounding the mucous membrane (soft palate, lateral columns of the pharynx, retromalar space).
  Differential diagnosis of papular mucosal syphilis
  Diphtheria. Acute infectious disease. It is manifested by fibrous inflammation of the upper respiratory tract at the sites of infection and toxic damage to the cardiovascular, nervous and other systems. The incubation period is from 2-5 to 10 days. The throat, larynx, bronchi, nose, conjunctiva, oral and genital mucosa, and skin are often affected. An acute onset is characteristic - malaise, headaches, intoxication, decreased appetite, fever up to + 38 + 39 ° С. There is a bilateral increase in regional lymph nodes - dense, painful, not soldered to the underlying tissues, the size of a hazelnut. On the tonsils and pharynx, there is hyperemia, edema, a fibrous film tightly soldered to the underlying tissues, which is not removed, and when you try to remove it, bleeding occurs. Characterized by a progressive course. Fibrous plaques pass to the arches, tongue, back wall of the pharynx, nasal mucosa, larynx. Lymph nodes are enlarged. Intoxication increases and the disease turns into severe widespread diphtheria.
  Leukoplakia. On the buccal mucosa, mainly in the corners of the mouth, lower lip, less often on the tongue, due to prolonged chemical irritation, a rounded plaque of various sizes is formed without signs of inflammation with a grayish-white coating on the surface, which is not removed by scraping. Characterized by a chronic course. In the secondary period of syphilis, in particular with secondary recurrent syphilis, damage to the larynx (syphilitic laryngitis) is noted. Its main symptom is prolonged painless hoarseness, reaching up to aphonia in the absence of colds.
• Catarrhal syphilitic laryngitis
  Uniform congestive hyperemia of the mucosa with a brownish tint is determined. True and false folds are slightly thickened and do not close completely. During phonation, a gap remains. There is hoarseness and in some cases even aphonia (manifestation of spotted syphilis) in the absence of acute inflammatory phenomena. Antisyphilitic treatment leads to a rapid clinical effect. Catarrhal specific laryngitis may be the first symptom of secondary syphilis, for which patients are unsuccessfully treated by therapists, otolaryngologists.
• Papular syphilitic laryngitis
  In the area of ​​the free edge of the epiglottis, laryngeal surface and scoop-epiglottic folds, single, flat, oval, grayish-white papules 3-7 mm in diameter appear, elevated, not prone to erosion and ulceration. When papules occur against the background of laryngitis, hoarseness is noted. Papular laryngitis may be the only manifestation of recurrence. In the process of treatment, hoarseness decreases and the voice is restored after 1-1.5 months. In the diagnosis of syphilitic rashes on the oral mucosa, the presence of other clinical manifestations of secondary syphilis on the skin is important. In the malignant course of the secondary period of syphilis, pustular-ulcerative elements may appear on the soft palate, tonsils and other areas. They look like large edematous infiltrates. After disintegration, a rounded or irregular deep ulcer is formed with purulent discharge and necrotic masses on the surface. Part of the soft palate may be destroyed. There is fever, painful and difficult swallowing.
• Pustular-ulcerative syphilis
  There are painful solitary deep ulcers with a limited compacted base, undermined edges, 4-15 mm in diameter, with an uneven bottom, yellow-gray purulent decay. The ulcer increases along the periphery. After the regression, a sunken, irregularly shaped scar remains.

AT last years some features of the clinical course of the secondary period of syphilis are observed. Poor symptoms - single papules on the oral mucosa. Not a typical clinic - frequent localization of papules only on the genitals and in the perianal region. Peeling of papules by the type of "wafer". Cases of the appearance of only hypertrophic papules in the vulva. Frequent erythematous-papular tonsillitis. Early terms of the appearance of specific alopecia and leukoderma. Cases with characteristic clinic, but negative serological reactions, which often become positive only in the course of treatment.

The current course of secondary fresh syphilis: polymorphic (roseolous-papular, roseolous-pustular) rashes occur more often; there is abundant confluent roseola with subjective sensations (itching, burning, soreness); spotted rashes appear on the face, palms, soles; cases of papular rashes on the palms and soles (especially in women) have become more frequent, wide warts have become less common; increased cases of atypical lesions of the oral mucosa (lack of clear boundaries, infiltration, painful rashes); polyadenitis is mild or absent; often there are features of the dynamics of standard serological reactions - negative CSR and positive RIF, RIBT.

The current course of secondary recurrent syphilis: the clinical manifestations of early relapses are similar to both manifestations of secondary fresh and recurrent syphilis; a bright, profuse, small, monomorphic rash is more common; cases of papular and erosive-ulcerative rashes on the genitals, scrotum and in the anogenital region have become more frequent; pustular rashes in weakened people occur on unchanged skin, followed by the formation of a specific infiltrate.

The above features of the clinical picture of the secondary period of syphilis cause difficulties in the differential diagnosis of secondary fresh and secondary recurrent syphilis, are the cause of diagnostic errors and therefore, when making a diagnosis, serological reactions using RIF, RIBT are of great importance.

From the moment pale treponema enters the human body, the incubation period of syphilis begins to develop, and it ends when the first symptoms appear. Pathogenic microorganisms, getting into the lymphatic system, begin to multiply actively. The main reason for the development of the disease is sexual intercourse without the use of barrier protective equipment. It is also possible to become infected with pale treponemas by household means, but such cases are much less common.

The carriers of the infection are people, when interacting with which pathogenic pathogens can easily enter a healthy human body.

Pale treponemas are introduced through the skin and mucous membranes, blood during transfusion.

During the incubation period of syphilis, bacteria multiply rapidly, but despite their increasing number, it is difficult to detect the disease at this time even when using several research methods.

The duration of the asymptomatic course of syphilis takes from two weeks to six months and averages 21 days. Doctors conditionally divide the period into two parts:

1. Prehistological. In this phase, pale treponemas do not yet penetrate the tissues. It can last 9-10 days.
2. Histological. Pathogenic microorganisms spread throughout the body with lymph and blood.

All this time, the patient, not knowing about the infection with pale treponema, can infect others. Sexual partners are at high risk, especially if barrier contraception is not used during intimate contacts.

In the case when a person learns about his illness, he must inform all the people with whom he was in sexual relations. Sexual partners need to undergo an examination and a course of therapy if the analysis showed a positive result. Treatment of syphilis at the initial stage is not difficult. While taking medications prescribed by a venereologist, patients should avoid intimate life, use only personal belongings hygiene, dishes. It is forbidden to visit baths, saunas, swimming pools, because the patient is contagious.

Men are more dangerous in terms of possible infection, as they are more prone to promiscuity, especially if they do not use condoms as protection.

The primary stage of syphilis develops in a patient 2-3 weeks after the introduction of dangerous bacteria into the body. At the site of penetration of treponema in the mucous membranes or epidermis, a red spot 1-1.5 cm in size appears. On the third day, it begins to peel off, and then opens, forming a painless, rounded red ulcer with a smooth surface.

The first symptom of syphilis, manifested by ulcers, should be the reason for going to the doctor.

In addition to skin rashes, the patient has enlarged nearby lymph nodes. This symptom may come and go without treatment. medicines over time.

Ulcers (syphilomas) are usually localized on the genitals at the site of microtrauma that occurs during sexual contact. Sometimes they develop in hard-to-reach areas, and patients do not notice them. In such cases, some people go to the doctor for lymphadenitis, which is an inflammation of the lymph nodes. Such symptoms develop as a result of the work of immunity in response to the introduction of an infectious agent. In most patients, inflammation of the lymph nodes begins 26-36 days after infection.

The course of the incubation period in men and women does not have any special differences. Doctors do not note the difference in the manifestation of symptoms of the disease. With the same parameters of the strong and weak half of humanity, including age, the state of the immune system, general health, the initial stage of syphilis proceeds in the same way.

In both men and women, often the incubation period goes unnoticed even when laboratory tests during scheduled examinations and professional examinations. The first sign of infection is the appearance of one or more syphilomas on the body. If the route of infection is domestic, then sores are often localized on the mucous membranes of the oral cavity, skin. In the case when infection occurred during sexual contact, syphilomas form on the genitals.

Sometimes the disease proceeds in a latent form, without bright and characteristic symptoms: syphiloma and inflammation of the lymph nodes. This form of syphilis remains unnoticed for a long time, and periodization remains unmanifested. Men and women learn about the presence of infection by chance, during examinations conducted for other diseases. After the diagnosis, which showed positive results, patients must notify their sexual partners of a possible infection.

In some patients, the incubation period takes 10 days, but in most cases it stretches from a month to six months. The officially established average is 30 days. Often this period is typical for the male population in middle age with a well-functioning immune system. The maximum incubation period is 6 months.

A long course is typical for patients undergoing treatment with antibacterial drugs or having a strong immune system that can fight the effects of the pathogenic causative agent of syphilis.

Throughout the treatment of an infectious disease, patients should refrain from sexual intercourse, as well as get rid of harmful addictions.

The duration of treatment for syphilis in the incubation period is 14 days. In other stages, the disease is treated much longer. At the end of antibiotic therapy, the patient must undergo a follow-up examination and donate blood for tests.

For the treatment of syphilis, doctors prescribe drugs from the penicillin series. If there are signs of intolerance, they are replaced by macrolides or cephalosporins. When pale treponema is detected in pregnant women, therapy is carried out with the help of penicillins. This group of drugs does not cause pathologies in the fetus.

It is rarely possible to understand that the period of incubation of the disease has ended and the disease has passed into an active form. For this, it is necessary to undergo an examination by a urologist and a gynecologist. Specialists check the skin, mucous membranes and, at the first sign of infection, prescribe a complete examination, including blood tests for syphilis.

Patients rarely show symptoms on their own. Many patients, paying attention to rashes that later disappear, consider the manifestations to be allergic reactions or other ailments. At this time, infected people are dangerous to others, so the first signs should be the reason for going to the doctor.

When pale trepanoma is detected, the patient is prescribed complex therapy, including:

• antibacterial drugs, the type of which is selected depending on the general condition of the patient and the presence of chronic diseases;
• preparations containing useful bifido- and lactobacilli, which are necessary to restore the microflora of the digestive tract and the immune system;
• vitamin complexes containing also minerals;
• medicines, the action of which is aimed at increasing the body's defenses;
• antimycotic drugs necessary in the event of a fungal infection during treatment with antibacterial medicines.

During the examination of the patient, the doctor necessarily specifies what drugs were taken and when, what lifestyle the patient leads, whether he is fond of alcohol. Having collected the necessary data, the doctor can predict when the incubation period will end in case of infection. Based on the information received, the frequency of visits to the medical facility and testing is planned.

The duration of incubation may vary depending on the following factors:

1. The use of antibacterial drugs for the treatment of other inflammatory or infectious diseases, leading to a decrease in the symptoms of syphilis and inhibition of the development of pathogenic microorganisms.
2. Weakened state of immunity, which was caused by long-term chronic diseases.
3. Old age, at which protective forces are often weakened by a sedentary lifestyle, pathological changes in the body.
4. The presence of several foci of the introduction of harmful bacteria.
5. The development in the body of infectious processes associated with the transmission of pathogenic microorganisms during sexual intercourse.
6. Secondary syphilis that arose after the complete cure of the disease caused by pale treponomas.

In most cases, the incubation period of syphilis goes unnoticed. The danger lies in the high risk of infection of healthy people surrounding the patient.

To prevent infection, it is important to use only personal hygiene items, cutlery.

The choice of dental clinics and other medical institutions should be thorough. This is necessary to exclude infection with syphilis through the blood. When symptoms of the disease appear, it is important to consult a doctor in time. Self-medication can lead to serious consequences, life-threatening.

According to materials veneromed.ru

Syphilis is a specific venereal disease. It not only affects the genitals themselves, but slowly and surely destroys the entire body. Each stage of syphilis is the next step in the development of the disease. With each step, the disease changes, grows stronger and affects more and more organs.

At each stage, syphilis is characterized by its own, special manifestations. These manifestations divide the time of the disease into periods:

• incubation
• primary
• secondary
• and tertiary

At each stage, syphilis looks different. To understand when and how syphilis manifests itself, how it develops and proceeds, we make a brief overview of all periods of this disease.

The course of syphilis and how it manifests itself in different periods, have a certain pattern: the disease proceeds in waves - the phase of "well-being" is replaced by the phase of the manifestations of the disease, then the symptoms disappear, and everything repeats again.

Such a course is often confusing: a person has the illusion of recovery. That is why syphilis is often not detected in the early stages: at first, patients rarely go to the doctor for help. And this is the biggest mistake! Latent syphilis is just as dangerous for a person as manifested. During periods of external well-being, the disease continues to develop and affect more and more internal organs.

Conventionally, syphilis is divided into early, late, manifest and latent. Each of these "subspecies" is distinguished by its own characteristics of manifestations.

This is the time when the body is actively fighting the disease. On average, this period is 2 years. Treatment started at this time is usually very effective, and the disorders and complications that the disease leads to are quite reversible.

Early syphilis in venereology is divided into several periods:

• incubation period
• primary period
• secondary period

This is the time when, under the influence of the disease, the body's immune system is rebuilt. By this stage, most of the bacteria have already left the body, and those that remain cause a special allergic reaction of the "delayed" type in the patient's body.

This reaction is destructive for the body: trying to protect the body from the remaining bacteria, immune cells create large inflammatory infiltrates around them (seals from the particles of the immune cells themselves, blood and lymph). As a result, purulent processes gradually begin inside the infiltrates, they turn into ulcers and seriously damage the surrounding tissues.

Late syphilis includes one period - tertiary.

During syphilis, 2 forms of leakage are also distinguished, which do not depend very much on the temporary stages of the disease:

1. Hidden form flow (it happens in the primary and secondary periods).
2. Manifested form(it happens in the secondary or tertiary periods of syphilis).

Has no external symptoms It can only be detected by blood tests. It is considered early if less than two years have passed since the moment of infection, and late if more than two years have passed.

In addition to these classifications, there is another one - the classification of syphilis according to ICD-10 ( International classification diseases). This classification is used by doctors to indicate the diagnosis in the medical history and any other medical documentation. You can read more about the classifications of syphilis in a separate article.

Most often, those who are afraid of contracting syphilis are worried about how this disease begins. And most importantly - how long after infection it can be seen.

The time from the onset of infection to the first symptom of syphilis is called incubation period. It averages 3-4 weeks. At this time, the disease still does not manifest itself outwardly, it is impossible to guess about it - even by some indirect signs.

If at this time a person was treated for another disease and took antibiotics, then the incubation period of syphilis can increase to 2 months. If at that time the body, on the contrary, was weakened or a lot of treponema pallidum bacteria penetrated several damaged areas at once (for example, simultaneously through the mouth and genital tract), then the incubation period can be reduced to two weeks.

Photo: syphilis at the initial stage Photo: syphilis at the initial stage Photo: syphilis at the initial stage Photo: syphilis at the initial stage Photo: syphilis at the initial stage

Syphilis begins as a spot where the bacterium entered the body. In about a week, this spot thickens, grows, and then turns into an ulcer - into a hard chancre (primary syphiloma). A hard chancre is a sign of the onset of the primary period of syphilis.

In the photo, the beginning of syphilis looks like a common ulcer. Such an ulcer can also form if the skin is accidentally damaged (often by a zipper slider on pants). However, the main difference between a syphilitic ulcer is that it does not hurt. The syphilis bacteria in it secrete a special toxin that anesthetizes the affected area.

Also, a syphilitic ulcer has a dense base under it, which feels like cartilage. That is why it is called "hard chancre".

A hard chancre is not the only manifestation of primary syphilis, although it is the most noticeable in the photo. Also, at the initial stage of the disease, the lymph node closest to the hard chancre (most often the inguinal) and the adjacent lymphatic vessel increase.

These conditions are called lymphangitis and lymphadenitis, and reflect the body's first defensive response to invading bacteria. Lymphangitis and lymphadenitis begin 7-10 days after the appearance of a hard chancre. Around the same time, serological (determined by blood serum) tests for syphilis become positive.

Previously, in the first 3-4 weeks of the primary period, syphilis could not be determined by tests. Now, with the advent of more accurate tests of the mass survey of the population (RPR, TRUST), they learned to determine this disease already in the second week. Even more sensitive tests (ELISA-IgM, RIF-IgM) can detect syphilis at all. early dates.

Syphilis in the early stages (when there is already a hard chancre on the body, but blood tests do not yet show the disease) is called primary seronegative syphilis. When, according to the analyzes, it is already possible to establish the disease, doctors call it primary seropositive syphilis.

The initial period of the disease lasts 6-7 months. During this time, microbes have time to spread throughout the body. The reaction of the defense system to this “capture” becomes more pronounced: all lymph nodes increase, the temperature may rise, weakness and malaise may begin. The highest point of the defensive reaction is a rash (secondary syphilides), which appears throughout the body. The appearance of a rash signals the onset of a secondary period of syphilis.

In the photo, the beginning of the secondary period of syphilis is very easy to confuse with the manifestation of some infectious disease or allergy: rash, inflammation of the lymph nodes, weakness, sometimes fever. Patients often attribute this to poor nutrition and explain the appearance of the rash as "he ate something wrong, that's sprinkled." However, this syphilitic rash is different from the usual allergic one. An allergic rash manifests itself in the form of vesicles (as from nettles), and syphilitic - usually in the form of spots and nodules.

Most often, when a syphilitic rash occurs on the body, a hard chancre persists for another week. If a person has not noticed it before, then it is worth carefully examining the genitals, inguinal region, fingers and oral cavity.

Spots from syphilis (or roseola) range in color from pale pink to bright red. They usually occur on the lateral surfaces of the trunk, back, face. Often, at the same time, nodules (or papules) appear on the skin, less often these forms of rash occur separately.

A distinctive feature of nodules in syphilis is that they can be found on the palms and soles. They come in various sizes - from a couple of millimeters to 1.5-2 centimeters. The spots disappear on their own after 2-3 weeks, the nodules remain - from several weeks to 2-3 months.

Also, secondary syphilis can manifest itself in the form of baldness or a necklace of Venus (a rash on the neck of rounded light spots about 1 cm in diameter). These manifestations last longer than the rash, and the necklace of Venus is generally able to persist even for a long time after treatment.

In people with poor health (with HIV infection, diabetes, alcoholism), secondary syphilis can manifest itself in the form of pustules and ulcers. However, this is quite rare.

Secondary syphilis lasts from 2 to 4 years. Its stages (hidden and manifested) undulate into one another. Latent syphilis lasts from 3 to 6 months, manifested - from several weeks to 2-3 months.

After 2–4 years, syphilis enters its advanced stage - a late chronic form. Late (tertiary) syphilis is manifested by subcutaneous bumps ranging in size from a cherry seed to a walnut - the so-called tubercles and gums (nodes).

These formations last up to several months, and then turn into ulcers and destroy the surrounding tissue. The damaging effect of these nodes on the body is so great that ulcers from them can destroy even bones. Photos of the results of advanced syphilis are widely distributed throughout the world - a collapsed nose, a fistula of the hard palate, a mutilated body ...

However, at present, thanks to the effective modern treatment, rarely comes to such complications of syphilis. Much more common are internal complications hidden from view: neurosyphilis ( nervous system), visceral syphilis (internal organs), syphilis of the cardiovascular system, and so on. These complications are the main problem of chronic syphilis.

Read about internal complications in the articles "Neurosyphilis" and "Visceral syphilis".

Summing up, we recall how long all periods of syphilis last:

• The incubation period is 3–4 weeks (from 2 weeks to 2 months).
• The primary period is 6–7 weeks.
• The secondary period is 2–4 years.
• The tertiary period is from 10 to 40 years, depending on the damage to specific organs.

Maybe. Syphilis is an insidious disease that can occur with little or no symptoms at all.

• Incubation period never manifested by any external or internal signals. At this stage, infection can only be suspected. The probability of not noticing the symptoms of the disease is 100%.
• Primary Period marked by the appearance of a hard chancre. The main feature of a hard chancre is that it is not felt in any way: it does not hurt, does not itch, and does not cause any discomfort to the sick person. Often patients simply do not pay attention to it. In addition, the atypical (in unexpected places) location of a hard chancre - on the hands, lips, in the oral cavity - often confuses patients who are unaware of their disease.
  There are also cases when syphilis occurs completely without a hard chancre (the so-called decapitated syphilis). This occurs when treponema enters the bloodstream immediately (with injections, transfusions, cuts, etc.). The probability of not noticing the symptoms of the disease is 50%.
• Secondary period- usually the brightest of all periods of syphilis: a widespread rash, baldness, spots on the neck and face - all this rarely goes unnoticed. An accurate diagnosis is most often made in this period. However, it happens that patients write off the appearance of a rash and other symptoms of secondary syphilis to other diseases and do not take them seriously. In this case, syphilis passes into a late form. The probability of not noticing the disease is 15%.
• In the tertiary period lesions of the skin, nervous system and internal organs begin. If the patient has not yet turned to a dermatovenereologist about the nodes that have appeared on the body, then syphilis is detected by therapists and neurologists. The detection of syphilis in this period is only a matter of time. The probability of not noticing the disease (for the entire period of its course) is 5%.

Interestingly, in addition to the usual scenario for the development of syphilis (incubation period - primary - secondary - tertiary), there is also an atypical (non-standard) course of syphilis: the incubation period is immediately the tertiary period. In this case, syphilis goes unnoticed, because the primary and secondary periods do not manifest themselves in any way, and the disease is revealed immediately in a late, tertiary form. As a rule, from the moment of infection to the onset of symptoms in this course, 2 years pass. Atypical syphilis occurs in 5-10% of cases.

Based on materials from polovye-infekcii.ru

Syphilis (old name - lues) - systemic disease with a chronic course related to venereal infections. It is accompanied by damage to integumentary tissues and derivatives, nervous, musculoskeletal systems, as well as most internal organs. Depending on the characteristics of the course of syphilis and the stage of pathology, the clinical manifestations of the infection can be very diverse.

According to the generally accepted (in the scientific world it is also called traditional) classification of syphilis, all its types can be conditionally divided into: primary, secondary (early and late), tertiary.

A special place is occupied by congenital syphilis, characterized by a gross combined lesion of the nervous, cardiovascular, respiratory and musculoskeletal systems.

The symptomatology of syphilis at the initial stage is associated only with dermatovenereological syndromes (and often goes unnoticed by patients). The third stage of syphilis has much more dangerous and unpleasant health consequences. About the features of the syphilitic process at all stages of the development of the disease - in our review.

The specific causative agent of syphilis is Treponema palidum (pale treponema) - a type of gram-negative spirochetes that have an elongated shape and several curls.

Features of the transmission of infection are due to the microbiological characteristics of the pathogen, in particular, strict requirements for the level of humidity and temperature indicators of the environment, as well as anaerobicity.

Basically, the infection is transmitted sexually through unprotected sexual contact. However, blood and a number of other biological fluids are contagious, so cases of infection are not uncommon when:

• transfusion of drugs made on the basis of donor blood (plasma, erythrocyte mass);
• the use of common syringes and other medical instruments that come into contact with blood;
• using a common razor, toothbrush and other "bloody" household appliances;
• baby feeding breast milk.

The household way of spreading the infection is possible only with prolonged contact with a patient with syphilis of the last (3) stage. At this stage, the pathogen is actively isolated from syphilitic gums, and can get on damaged mucous membranes. healthy person when kissing, using common dishes and household items. Infection of medical personnel often occurs during work with biological material, as well as autopsy of the corpses of patients (especially children with congenital forms of syphilis).

Note! According to the latest data, the incidence of this venereal infection in Russia remains quite high - 52.6 people per 100,000 people. There is a significant (almost 7 times) increase in the number of infected compared to the statistics received from the USSR.

With the standard development of the pathological process, the following periods of syphilis are distinguished:

All these types of syphilis are characterized by a different mechanism of development and characteristic features of the course.

On average, 20 days pass from the first entry of the pathogen into the body until the appearance of clinical signs of syphilis. However, in medicine, there have been cases of shortening the incubation period to several days and lengthening to 5-6 weeks. The first is typical for infection from several sources at the same time or with the development of mixed infection (combined action of several pathogens). A prolonged course often develops while taking broad-spectrum antibiotics for the treatment of another disease.

At this stage of syphilis, the introduction of Treponema palidum into the body and its reproduction through division (every 28-32 hours, the number of microbial bodies increases exponentially) occurs. There are no clinical, morphological and serological manifestations of the disease yet: an analysis of the incubation period and the possible route of infection penetration into the body is carried out after the appearance of its first signs.

This stage of the disease ends with the appearance of a primary damage (affect) - a hard chancre, which indicates the development of a syphilis clinic.

The primary period of syphilis lasts about 6-7 weeks. For a long time it was divided into two subtypes - seronegative, lasting up to three to four weeks, and characterized by negative result classical serological tests (Wasserman, Sachs-Vitebsky, Kahn, Colmar reactions). When positive result on the part of at least one of the analyzes, the disease turned into a seropositive form. However, due to the development of modern highly specific and high-precision diagnostic methods (PCR, RIF, RIBT), this classification has lost its relevance. Today, specific avid antibodies to pathogen antigens are detected no later than in the diagnosis of other infections.

The main clinical manifestation of syphilis in early stage the appearance of a hard chancre (primary syphiloma) is considered. This formation is a dense painless ulceration in the area of ​​introduction of Treponema palidum. Inflammatory infiltrate, the integrity of the skin or mucous membrane on the surface of which is damaged, has a rounded shape. Erosion with clear, even edges and a scarlet shiny surface can be covered with a scanty transparent discharge, does not bleed. The size of a standard primary syphiloma is 10-20 mm, but there are small (2-5 mm) and giant (30-40 mm) chancres.

Among the typical localizations of education:

• glans penis, pubic skin, scrotum;
• mucous membrane of the urethra and the external opening of the urethra;
• vulva and vestibule;
• anorectal area;
• abdomen and thighs;
• hands and forearms;
• milk glands;
• chin, oral mucosa.

In appearance and other features, one can easily confuse primary syphiloma with mild chancre. Among the common features of these pathological formations, identical mechanisms for the development of affect are distinguished - the introduction of the pathogen through the skin or mucous membranes, the formation of a pustule and its transformation into an ulcer.

Typical differences are presented in the table below.

In addition, the syphilitic chancre does not contain dense adhesions with surrounding tissues, does not tend to grow and form additional ulcers. Its formation reflects the body's immune (protective) response to the introduction of a bacterial agent into the patient's body.

According to the studies of dermatovenereologists, atypical forms of the location of the primary affect have become widespread. Among them:

• multiple chancre;
• chancre on the skin of the fingers;
• indurative (dense) edema;
• chancre-amygdalite.

Multiple chancre is characterized by the formation of several dense infiltrates with ulceration close to each other. Its formation is associated with the introduction of a large number of pathogens into the body and an active immune response.

Chancre panaritium often develops in medical workers. In its clinical course, it practically does not differ from non-syphilitic purulent inflammation of the fingers, usually affecting the phalanges 1-3 of the fingers of the right hand. Unlike the classical primary affect, it can be accompanied by pain. Sometimes combined with syphiloma located on the skin of the genitals.

Indurative edema develops if the primary introduction of the pathogen occurred in the genital area. The scrotum in men or the area of ​​the labia in women increases in size, acquires a stagnant blue-violet color, intense in the center and less pronounced on the periphery of the lesion. On palpation of the skin, there is no fossa or other signs of "classic" edema. As a rule, patients do not complain of pain, however, swelling and induration can cause them slight discomfort associated with wearing underwear and clothing. This variant of the primary stage of syphilis lasts 1-4 weeks.

Amygdalitis develops in cases where the oropharynx has become the site of infection. Such a primary affect is accompanied by a unilateral increase in lymphoid tissue (tonsils), which acquires a denser texture, protrudes significantly into the throat, is accompanied by pain and discomfort when swallowing. The disease is differentiated with angina, which, as a rule, is characterized by a bilateral increase in the palatine tonsils.

Note! Chancre-amygdalite should be distinguished from the classic primary syphiloma located on the tonsil. Unlike it, it does not have an ulcerative defect and causes a uniform increase in the volume of the palatine tonsil.

In addition to primary syphiloma, both in the classical and atypical variant of the course, regional lymphadenitis attracts attention. In this case, the lymph nodes closest to the ulcer formation:

• increased in size;
• have a denser texture;
• do not have fusion with surrounding tissues;
• "cold" (there is no local increase in temperature).

In addition, some patients complain of weakness, fatigue, a feeling of weakness - common signs intoxication.

By the end of the initial period of pathology, all clinical manifestations, including primary syphiloma, disappear (even in the absence of antibacterial treatment). The second, bacteremic period of the disease begins.

The second stage of syphilis manifests with the generalization of the infectious process and the penetration of treponema into the systemic (general) bloodstream. It is characterized by pathological changes not only at the site of introduction of Treponema palidum, but also throughout the body.

The symptoms of syphilis in the second stage are varied. Meet:

• Dermatological lesions. Most often, a pale-spotted rash develops on the skin of the neck (“necklace of Venus”), chest, and abdomen. There may be many small subcutaneous hemorrhages.
• Dryness, brittleness and hair loss (up to baldness).
• Lymphadenitis. At stage 2, not only regional, but also main lymph nodes throughout the body are inflamed.
• Phenomena of intoxication - low-grade fever (often the temperature does not rise above 37-37.2 ° C), weakness, flu-like condition, accompanied by catarrh of the nasopharyngeal mucosa (runny nose, sore throat, cough), symptoms of conjunctivitis.

This period of the disease lasts no more than 6-7 days (usually 2-3 days). Upon their completion, the spotty rash turns pale, signs of inflammation of the respiratory tract disappear. Process chronization is observed.

After generalization of the infection, a latent (hidden) form of the disease occurs, which can last for years.

The third, last stage of syphilis actively develops in approximately 30% of patients. It is characterized by damage to all internal organs and systems:

• aorta and large arterial trunks;
• head and spinal cord;
• bone-articular apparatus and muscles;
• integumentary tissues - skin and mucous membranes.

At this stage of syphilis, due to the presence of many foci of inflammation on organs and tissues, soft tissue tumors are formed - syphilitic gummas, which then degenerate into fibrous nodes and cause functional insufficiency in the body.

With syphilitic aortitis, signs of hypoxic damage to all organs and tissues develop. Patients complain of dizziness, tinnitus, visual disturbances, fainting, angina pectoris pain in the heart, shortness of breath. Symptoms of endarteritis vary depending on the predominant localization of the inflammatory lesion.

The concept of "neurosyphilis" includes several forms of CNS pathologies, the main feature of which is the development in the third period of the disease in question. Most often develops:

• meningitis;
• meningomyelitis;
• acute violation of cerebral circulation;
• Bayle's disease;
• dorsal tabes;
• taboparalysis;
• atrophy of the second pair of cranial nerves;
• gummous lesions of the central nervous system.

Syphilitic changes in the central nervous system are manifested by progressive paralysis, or Bayle's disease. This pathology is characterized by gross changes in mental activity and cognitive impairment up to dementia. There are frequent cases of diagnosis of concomitant neurological symptoms.

AT classic version Bayle's disease consists of three stages: the initial stage, the stage of vivid clinical manifestations, dementia.

The initial stage is characterized by exhaustion, muscle hypotension, apathy, and fatigue. Over time, the first personality changes become noticeable: the patient loses the ability to comply with the norms of behavior, loses a sense of shame and tact. Sensitivity to relatives disappears, social contacts become unpleasant for both parties. Later, lethargy and an indifferent attitude to everything increase, memory and the ability to concentrate attention decrease. Criticism of his condition is completely absent.

Symptoms of a neurological deficit at this stage include:

• difference in pupil diameter;
• paresis and paralysis of the muscles of the eye;
• tremor;
• different intensity of tendon reflexes on the right and left limbs;
• uncertainty, unsteadiness of gait;
• impaired coordination of movements;
• monotony, slurred speech.

At the stage of vivid clinical manifestations, signs of dementia and cognitive impairment continue to grow. Perhaps the appearance of psychotic symptoms: delusional ideas, paranoid thoughts. Some patients develop a manic syndrome (high spirits, talkativeness, obsession) and gross sexual promiscuity. Others, on the contrary, face depression, depressed mood, suicidal thoughts and nihilistic delusions.

Note! Today, thanks to successful antibiotic therapy for syphilis, progressive paralysis occurs in medical practice rarely.

At the last stage of dementia, patients become profoundly disabled. They cannot serve even their simplest needs and need constant care.

Dryness is another neurological syndrome that occurs with syphilis. It is characterized by damage to parts of the spinal cord - the posterior columns and nerve roots.

At the first stage, the disease is manifested by pain in the projection of the affected roots, paresthesias (a pathological sensation of creeping, tingling). The second stage is accompanied by a sensitive ataxia: the patient loses his sense of support, walks carefully, as if on a rubber surface, "stamping" his every step. The third, paralytic stage is characterized by the loss of tendon reflexes, muscle-articular sensitivity. The patient loses the sense of body position in space and can no longer move independently.

The types discussed above reflect the classic course of syphilis. Unfortunately, there are many atypical and asymptomatic forms of infection that greatly complicate clinical diagnosis and require mandatory highly specific laboratory tests. Prevention of sexually transmitted diseases, contacting a doctor even with minor complaints, regular preventive examinations and timely treatment will help to avoid the development of serious complications of syphilis and maintain health.

Based on materials venerbol.ru

Syphilis has been known to mankind for centuries as a sexually transmitted disease. The peak incidence in Europe occurred in the 16th-18th century, and it was then that the signs of the disease were described in detail. For a long time, there was only one remedy for the treatment of syphilis - a toxic mercury preparation, which was negatively perceived by patients. Before the discovery of antibiotics, the infection affected entire families, settlements and was passed down from generation to generation.

At present, the current treatment regimens for syphilis have been developed, however, recently, the incidence of it has again crept up. In the vast majority of cases, clinicians diagnose the disease at the 3rd-4th stages, when the brain, spinal cord, internal organs, skin and mucous membranes are affected. Before the development of such phenomena, more than one year passes after infection, but the initial stages of syphilis proceed without discomfort and the person for a long time does not ask for help.

The secondary stage of syphilis is one of the longest. Its course takes from 2 to 15 years, during which exacerbations are replaced by asymptomatic periods. Often, patients stop the manifestations of secondary syphilis on their own, purchasing symptomatic drugs in a pharmacy. For a long time they are unaware of the presence of a pathogenic microorganism in the body, which in the meantime continues its destructive work.

The causative agent of syphilis is the mobile microscopic spirochete Treponema pallidum. It is not fully a bacterium, since it is arranged more perfectly, but it does not even reach the organization of the simplest, occupying an intermediate place between them. The source of infection is an infected person who is most contagious during the first two stages of syphilis. The transmission of infection occurs in the following ways:

• sexual - pale treponema is transmitted during any type of sex, if partners do not use a condom;
• contact-household - transmission is possible through common linen, wet towels, bath accessories, if fresh discharge of the patient has been preserved on them;
• vertical (from a sick mother to a child) - treponema penetrates the placenta, is excreted in large quantities with breast milk. Infection of an infant is possible both in the prenatal period and after it.

Pale treponema does not tolerate drying, exposure to alkaline soaps, disinfectants, heat. For a long time, it is stored in wet secretions from the genital tract, in blood plasma, when cooled and frozen.

Syphilis is an infection with a strict staging of the course. In its development, it goes through the following periods:

• Incubation - from the moment of infection to the appearance of a chancre, an average of 10-15 days pass, maximum duration period is 190 days.
• Primary - the appearance at the site of treponema introduction of a painless tubercle - a hard chancre, to which a local reaction of the lymph nodes (regional lymphadenitis) joins within one week. After 3-4 weeks, the described changes disappear on their own without treatment.
• The secondary period of syphilis - begins 2.5 months after infection, manifests itself as a rash on the torso and limbs of the patient. The appearance of loose elements is associated with hematogenous dissemination of treponema to various parts of the body and an inflammatory reaction in the capillaries of the skin to the presence of the pathogen. The course of the period largely depends on the immune reactivity of the person, but in most cases the resulting rash does not cause any discomfort. It passes without a trace without treatment, relapses last an average of 2-4 years.
• Tertiary - the formation on the skin, mucous membranes, in the internal organs of foci of specific inflammation - syphilitic gums. They disintegrate with the destruction of normal tissues and the formation of large defects (the nose collapses, the palate collapses). Also, tertiary syphilis occurs with severe damage to the cerebral cortex (neurosyphilis), leads to damage to the spinal cord with impaired muscle strength and limb mobility.

In the later stages, it is extremely difficult to help a person, since irreversible changes in tissues occur. Often the outcome of syphilis is severe disability or death from damage to internal organs. The easiest way to diagnose the disease is when symptoms of secondary syphilis appear, but for this you need to imagine them.

The clinical manifestations of this stage are very diverse and at first glance are not associated with a sexual infection. A significant duration of the secondary period of syphilis, the patient's normal state of health, periods of complete absence of symptoms - all these factors lead to late diagnosis of the disease. The patient may not associate episodes of rashes with each other, attributing them to manifestations of allergies and eliminating them with antihistamines.

During the secondary period, allocate:

• Secondary fresh syphilis - the initial appearance of dermatological symptoms, often in patients with hard chancre / hyperpigmentation at the site of its localization / regional lymphadenitis. Serological reactions at this stage are positive in all infected without exception.
• Recurrent - all subsequent episodes of the disease, which are repeated 1-2 times a year and completely disappear after 5 years of syphilis. With each new recurrence, the elements of the rash become more and more pale and few in number.

Skin manifestations of syphilis are only the visible part of the disease. Skin-like changes capture all the mucous membranes of a person: the gastrointestinal tract, respiratory and genital tracts, and visceral organs. In this regard, severe forms of secondary syphilis occur with a significant deterioration in the patient's condition.

The main signs of secondary syphilis are:

• rash on the skin and mucous membranes;
• inflammatory elements on the skin and mucous membranes - syphilides;
• baldness;
• change in skin pigmentation.

Occasionally, asymptomatic secondary syphilis occurs, it is associated with taking antibiotics after infection for some other reason. If their dose is not enough to destroy pale treponema, a latent infection develops, which can only be established by a blood test.

The rash in secondary syphilis is called spotted syphilis. It appears in the vast majority of patients in the form of elements from pale pink to deep red on the skin and mucous membranes. The typical localization of the rash is the lateral surfaces of the trunk, the upper half of the abdomen, in atypical cases it appears on any part of the body.

The element of the rash - roseola - is a spot with fuzzy boundaries with a diameter of 2-15 mm. Roseola lie on the skin separately without merging with each other. Their palpation is painless, their appearance is not accompanied by itching, fever or other infectious symptoms. The surface of roseola does not protrude above the skin; when pressed, it turns pale and acquires the color of normal skin. The elements of the rash do not peel off even during the healing period, unlike many other rash diseases.

Roseolas appear gradually, sprinkling lasts for several days. For the first time, they lie symmetrically, that is, the elements of the rash are on the same parts of the body on the right and left. Secondary recurrent syphilis is characterized by a large size of roseola, but their smaller number, asymmetric location. Often they are grouped into garlands, rings, platforms. The rash persists on the skin from 3 weeks to 2 months, after which it disappears without a trace without treatment.

Roseola in secondary syphilis

Usually papular syphilis is a manifestation of secondary recurrent syphilis, extremely rarely it appears simultaneously with the first episode of a roseous rash. Papules are inflammatory elements in the dermis of the skin that protrude above its surface and are rounded or oval seals to the touch. The period of their life is 1-2 months, then they dissolve, leaving behind areas of hyperpigmentation.

The secondary period of syphilis can proceed through:

• Lenticular papular syphilides are dense formations on the skin in the form of a truncated cone with a smooth surface. Their color varies from pink-red to cyanotic and yellow-red. Fresh papules, when pressed, are sharply painful - this is one of the characteristic symptoms of syphilis (Yadasson's symptom). When healing, syphilide is covered with small white scales, which are then rejected. Most often, papules are localized on the head along the hairline, forming the "crown of Venus" and on the back of the neck. However, they occur on any part of the body and may resemble psoriatic skin lesions along the course.
• Miliary papular syphilis is the formation of small (up to 2 mm in diameter) nodules in the mouths of the sebaceous glands. They have a rounded shape, a dense texture, a pale pink color and are covered with small scales. Papules are localized in areas with oily skin: on the upper 1/2 of the chest and back, sometimes on the stomach. Such a rash is typical for people with depressed immunity, patients with chronic pathology, and alcoholics. Miliary syphilide persists on the skin for a long time and is resistant to specific treatment.
• Numular papular syphilis is the appearance on the skin of single coin-shaped flat papules with a diameter of 2-2.5 cm. They are colored brown or bluish-red, often combined with other types of syphilides. Their resorption occurs within a few months, after which nummular papules leave scars, pigmentation, and skin atrophy.

Papular syphilis in the secondary period of syphilis

Lenticular papular syphilis

In people with immunodeficiency (HIV-infected, drug addicts, patients with severe chronic pathology), pustules join the papules. Such elements are called pustular syphilides, which manifest themselves as:

• Syphilitic impetigo - large (1-2 cm) papules on the skin, in the center of which, after 3-4 days from the appearance, a cavity filled with pus forms. After some time, it opens with the release of a sticky gray-yellow liquid. Allocations dry up on the papule in the form of a crust. At first, it is easily removed, then its thickness increases and sticks more and more tightly to the underlying tissues. The crust falls off when the discharge of pus from the papule stops, leaving hyperpigmentation or a scar in its place.
• Acne syphilis - papules are associated with the mouths of the sebaceous glands, so subsequently the pus is mixed with sebum. The resulting crusts are yellowish or brown-black in color and have a greasy texture. They exist for about 2 weeks, after which they fall off on their own, leaving small depressed scars instead.
• Syphilitic ecthyma is the most severe variant of the course of the disease. As a rule, it is formed after 1/2 year from the onset of the disease and is combined with a pronounced deterioration in the patient's condition. Clinically, ecthyma resembles a boil: a painful bright red knot appears in the thickness of the skin, on the surface of which, after a while, a cavity filled with pus matures. After opening it, a dense, dirty yellow crust is formed, pressed into the papule. Under the crust hides a painful ulcer filled with purulent discharge. Ecthyma exists on the skin for several months, after which it heals with the formation of a pigmented scar.

A rash in secondary syphilis in some cases is combined with diffuse or focal alopecia (alopecia). Hair loss is associated with the direct effect of pale treponema on the hair follicles, as a result of which an area of ​​​​inflammation forms around the follicle, which disrupts its nutrition. Foci of alopecia are formed of a rounded shape, located in most cases in the temporo-parietal and occipital regions of the head. The diameter of the bald spots is 1-1.5 cm, they have irregular shape, lie scattered and do not merge with each other.

Hair in the foci of baldness does not fall out completely, which is why the patient's hair becomes like "fur eaten by moths." The scalp, unlike fungal infections, does not peel off and has a normal color.

Diffuse alopecia is hair loss over the entire surface of the head evenly, leading to a sharp thinning of the patient's hair. It usually starts from the temples and gradually captures the rest of the area. The nature of the hair changes: it becomes dull and feels like a wig to the touch. Diffuse and focal alopecia in some cases are combined with each other. Hair loss in secondary syphilis usually occurs in the first year of illness and is associated with the appearance of a roseous rash. Their growth is fully restored after a couple of months from baldness.

Differential Diagnosis secondary syphilis includes a wide range of skin diseases and acute infections. It is easy to confuse a roseolous rash with rashes with measles, typhoid fever, rubella and typhus. However, unlike the listed diseases, the general condition of the patient is not disturbed and there are no symptoms of damage to internal organs.

Syphilides are differentiated from skin diseases, which are often accompanied by itching, soreness and pronounced signs of skin inflammation. Finally, microscopic and immunological examination of the discharge / scraping from papules allows them to be finally distinguished from each other. With syphilis, they contain a large number of mobile pale treponema.

Syphilitic alopecia is differentiated from androgenetic alopecia and fungal infections of the scalp. In the first case, there is a normal content of sex hormones in the blood and positive analysis for syphilis. Unlike fungal alopecia, the scalp with secondary syphilis does not peel off, there are no signs of inflammation and spores of the fungus.

Treatment of secondary syphilis is essentially simple, but requires strict adherence to the dose of antibiotic. Insufficient concentration of the drug becomes a distress signal for pale treponema, in response to which it turns into an invulnerable L-form. It allows the microorganism to survive adverse conditions and return to a viable state after their elimination.

All methods of treatment of secondary syphilis are based on the parenteral administration of penicillin antibiotics. Treatment of roseola rash is carried out on an outpatient basis with long-acting drugs. They are administered 1-2 times a week in a course of 6-10 injections. Severe forms of syphilis, alopecia, late relapses are treated with daily intramuscular or intravenous injections of penicillin antibiotics. Secondary latent syphilis lasting more than six months is cured by the introduction of penicillin 4 times / day. within 20 days.

Before treating secondary syphilis, the doctor will definitely find out from the patient about allergic reactions to penicillin antibiotics. If they took place, therapy is carried out with drugs of other groups.

Based on materials from gynekolog-i-ya.ru

Pale treponema, which is the causative agent, can cause quite a lot of inconvenience to an infected person. Not only does the disease lead to serious consequences, but also the social reaction is not very attractive - they tend to avoid such a patient, considering him one of the lumpen, that is, a representative of the lower strata of society. Moreover, like many other diseases, syphilis has several stages. Let's figure out what it is - a secondary form of an insidious disease (it is also called repeated syphilis).

Primary syphilis, that is, its initial stage, sometimes proceeds secretly, but most often the symptoms are clearly visible. The secondary stage is characterized by a deeper penetration of the infection into the body, which leads to somatic lesions of the internal organs, especially the nervous system and the musculoskeletal system. This happens about 2-3 months after the main infection.

Over time, pale treponema enters the patient's lymphatic system and spreads very quickly throughout the body. At the same time, the ability of the immune system to resist infectious diseases decreases. But before the body's defenses are defeated, the virus begins to form spores, which leads to the absence of symptoms characteristic of the primary form of syphilis. However, over time, the symptoms return, albeit in a slightly different form.

Periods

Depending on the behavior of treponema in the body and the timing of the development of the disease, doctors distinguish two main periods of development of the secondary form of syphilis:

• Latent (hidden) syphilis. It is impossible to identify the disease in this period by external signs - all clinical manifestations disappear for about 2-4 months. It is possible to detect an illness only through tests, but not all people go to hospitals: there are no symptoms - there is no disease. This is a big mistake.
• Recurrent syphilis. If we are talking about a fresh secondary form (the so-called fresh syphilis), that is, one that occurs immediately after the end of the primary stage, then the clinical symptoms persist - there are hard chancres, rashes, ulcers. But with the onset of the latent period, the signs disappear, appearing again only with recurrent exacerbations.

Note that the signs that occur during the recurrent period of syphilis are less abundant than during fresh syphilis and its primary form. All ulcers and spots are quite large, they form arcs, half rings, garlands and other shapes.

The reasons

Suppose that a certain patient was able to detect syphilis at an early stage, underwent an examination and a course of treatment. The symptoms are all gone, the person considers himself completely healthy. But somewhere in the depths of his body, undestroyed pale treponemas lurked. They have suffered greatly from antibiotics and restored immunity, but they do not want to leave the body. As soon as favorable conditions are created, the microorganisms will immediately begin to multiply again, which leads to re-infection and the second stage of syphilis.

These provoking factors include:

• penetration into the body of new treponemas;
• severe stress;
• oncological disease;
• any other infectious disease not properly treated.

This is if the patient was treated. If left untreated, syphilis begins to penetrate even deeper, affecting various organs and systems. At this stage, the bacteria change somewhat, the symptoms of the disease temporarily disappear, and the person feels well.

Thus, the causes of secondary syphilis include:

1. "weak" treatment in the early stages;
2. the development of infection in the complete absence of therapeutic measures.

Symptoms

At the stage of secondary syphilis, pale treponema reaches its peak of development. For some time after the transition of the disease to this form, the symptoms disappear, but soon return again (unless we are talking about a latent disease). Signs can be identified as follows:

• widespread rashes on the skin;
• the rash becomes burgundy;
• all formations are dense, have clear boundaries;
• over time, the rashes disappear on their own, without leaving scars and other “reminders” on the skin;
• muscle aches;
• weakness;
• insomnia;
• headache.

Also, some patients experience an increase in temperature, and both rise and fall, it suddenly and without outside intervention.

Diagnostics

Based on the history and analysis of skin rashes, the doctor can only draw preliminary conclusions; an accurate diagnosis cannot be made in this way. The fact is that such neoplasms, in combination with other signs (headaches, weakness, etc.), are inherent in some other diseases, including sexually transmitted diseases. Thus, the final diagnosis can only be made by conducting tests. All tests used by specialists are serological. Others will not be able to show the correct result.

Skin scrapings (in the area of ​​rashes) are used as a biomaterial. Conventionally, all studies of the obtained “product” can be divided into non-treponemal (microorganism substitutes are used) and treponemal, that is, using a real causative agent of syphilis. The first category includes:

The methods are quite simple, often giving false readings. Another group of studies include:

• RPGA;

These tests are expensive, but the result is more than accurate.

It is almost impossible to detect syphilis in a fetus in the womb.. One can only draw some conclusions in accordance with the state of health of a pregnant woman. But here you can diagnose syphilis in a newborn baby:

1. At the age of 3 months, the baby is examined by highly specialized specialists, and if signs of syphilis are found, then treatment begins.
2. Re-study of biomaterials in such a situation is carried out at the age of six months. If syphilis was not detected, then a second visit to the doctor will take place only at 9 months.

Treatment

Therapy of the disease is carried out only with antibacterial drugs. Pale treponema is most sensitive to penicillin and its derivatives. Usually, doctors prescribe injections of bicillin 5 (it costs no more than 100 rubles). But it happens that the patient has intolerance to penicillin derivatives. The situation is difficult, but not critical, there are substitutes:

• erythromycin (price about 150 rubles);
• doxycycline (costs around 20 rubles);
• tetracycline (the price usually does not exceed 100 rubles).

In addition to these antibiotics, doctors prescribe vitamin complexes and immunomodulators. This is necessary to maintain the body's defenses, which can be of great help in the fight against secondary syphilis.

Consequences and prevention

Syphilis refers to such diseases that do not go away for a person without a trace. People who are faced with its secondary form subsequently “get” the following complications:

• non-healing scars on the skin;
• baldness;
• infertility;
• chronic digestive disorders;
• kidney and liver problems.

In rare cases, pale treponema affects vision and hearing, as well as the heart muscle. In addition, some of those who have had syphilis suffer from dementia, because the disease affects the central nervous system.

You can avoid these consequences. But syphilis is easier to prevent than to completely cure. For prevention, you should:

1. exclude unprotected sexual contacts with casual partners;
2. observe the rules of personal hygiene;
3. monitor the state of your immunity;
4. diversify the diet with protein and plant foods;
5. regularly undergo preventive examinations.

Don't forget to tell your kids about these simple rules. Remember that you can get sick not only after casual sex, but at home. These measures will reduce the risk of disease and give you peace of mind and good mood!

You can watch this video, where the specialist will talk about secondary syphilis, what are the main signs of this disease, and you will also learn more about the consequences.

Syphilis is a rather dangerous disease that is sexually transmitted. The causative agent of this disease is a microorganism called pale treponema. It can exist for more than three minutes in the external environment and that is why it has time to penetrate into the body. This microbe is transmitted sexually from a sick person to a healthy one. Rarely enough, but still there are cases when syphilis is transmitted through the use of non-sterile medical instruments. A child can become infected through forced sexual contact with an infected adult. A newborn baby can become infected while in the womb of a sick mother. Usually, the causative agent of this disease enters the body through the skin, as well as through the mucous membranes of the mouth and genital organs. After entering the body, the virus enters the lymph nodes and soon spreads throughout the body.

In the classical course of syphilis, three clinical periods are distinguished:

primary,

secondary,

tertiary.

The time from the moment of infection to the appearance of primary manifestations at the site of the introduction of the pathogen is called the incubation period. On average, it is 4-6 weeks, but can be reduced to 8-15 days or even extended to 100-180 days.

The incubation period is lengthened if the patient after infection with syphilis took antibiotics for other diseases. In this case, it happens that the primary manifestation of syphilis may not be at all.

The incubation period is longer in elderly patients, in physically weakened people, in persons with reduced reactivity, with simultaneous illness with syphilis and mild chancre (venereal ulcer). Let us recall once again that, regardless of the duration of the incubation period, the patient at this time already infected, that is, it poses a real danger of infection for a sexual partner or members of their family.

The first manifestations and symptoms of syphilis

The first clinical sign of syphilis - "hard chancre" - appears at the place where pale treponema has entered the body. According to the figurative expression of the French: "with syphilis, the first place to be punished is the place with which they sinned." That is, a hard chancre can appear anywhere where there was contact with an infected person: on the genitals themselves, on the skin of the pubis, thighs, scrotum, abdomen, in the oral cavity or on the lips, in the anal region, on the skin of the hands. Therefore, such a universal remedy as a condom often does not save from infection with syphilis.

The formed hard chancre looks like round or oval superficial ulcers or erosions, often with a smooth, shiny bottom. Its dimensions can be different: from 1-3 mm (pygmy chancre) to 2 or more cm (giant chancre). From the moment a hard chancre appears, the primary period of syphilis begins, which continues until multiple syphilitic rashes appear on the patient's skin. 8-14 days after the onset of a hard chancre, the lymph nodes closest to it begin to increase. Sometimes in the primary period of syphilis, towards the end, before the appearance of rashes, patients often experience malaise, insomnia, headache, loss of appetite, irritability, pain in the bones and joints, fever up to 38 ° C. Possible indurative swelling of the genitals.

The primary period of syphilis is divided into

primary seronegative syphilis, when standard blood serological tests are still negative (the first 3-4 weeks from the onset of hard chancre)

primary seropositive syphilis, when blood tests become positive.

If the doctor has an assumption that the patient has contracted syphilis, and the serological reactions of the blood are still negative, then it is necessary to start treatment as soon as possible, since with seropositive syphilis, treatment is longer and more intensive.

Secondary syphilis. The secondary period of syphilis usually occurs 6-9 weeks after the appearance of the primary syphiloma (hard chancre) and continues without treatment for 3-5 years, and then the tertiary period begins. As a result of the penetration of the infection into the blood and its dispersion throughout the body, syphilitic rashes appear on the skin and mucous membranes of the patient, internal organs, bones and joints, the nervous and endocrine systems, and sensory organs are affected. In most patients with syphilis, the secondary period of the disease proceeds without disturbing the general condition. Sometimes there is a headache, fever, malaise, loss of appetite. Rashes of the secondary period of syphilis are very diverse, both in their morphology and in quantity and location. Usually they do not cause any subjective sensations, they can appear on any part of the skin or on the mucous membranes and are resolved, with rare exceptions, without leaving marks. One of the most frequent and early manifestations of secondary syphilis (symptoms of syphilis) is a spotted (roseolous) rash. A fresh eruption that occurs at the beginning of the secondary period is distinguished by symmetry, abundance, brightness and disorder of location. After 2-2.5 months, even if the patient with syphilis is not treated, the rash gradually disappears and secondary latent syphilis sets in. After some time, the disease recurs. At this stage, there are fewer rashes, they are more faded. The rash often occurs in areas where the skin is subjected to mechanical stress - on the extensor surfaces, in the inguinal folds, under the mammary glands, in the intergluteal fold, on the mucous membranes. Quite often, with secondary syphilis, a rash in the form of nodules (papular syphilitis) occurs, often combined with a spotty rash. A rash in the form of pustular eruptions occurs much less frequently and mainly in debilitated patients with syphilis. Syphilis alopecia is more common with recurrent syphilis. There are diffuse (solid) and small-focal alopecia. Any part of the skin can be affected by baldness, but the scalp is more often affected. With small-focal alopecia, the hair in the affected areas falls out partially, the lesions of irregularly rounded outlines up to 10-15 mm in size. The skin in the places of hair loss is not inflamed, does not peel off, there are no subjective sensations.

Tertiary syphilis. After 3-5 years or more from the moment of infection, the tertiary period of syphilis begins, the development of which is prevented by timely started full-fledged treatment. Cases of tertiary syphilis are fortunately now rare. With tertiary syphilis on the skin, patients usually develop rashes in the form of tubercles or nodes (syphilis gummas). The tubercle with syphilis is a dense spherical formation the size of a hazelnut. In the future, the tubercle either undergoes reverse development, or softens with the formation of a syphilis ulcer, which leads to significant destruction of tissues, including the bones of the skull

congenital syphilis. Congenital syphilis is called, which is transmitted to the unborn child transplacentally through the mother's blood. Congenital syphilis is early and late. Early congenital syphilis includes fetal syphilis, infancy syphilis and early childhood syphilis. Late congenital syphilis is usually detected after the age of 15-16, and until then it does not manifest itself in any way. However, sometimes the symptoms of late congenital syphilis appear starting from the third year of life. Fetal syphilis occurs around the 5th month of pregnancy, when pale treponemas penetrate the placenta and actively multiply inside the fetus. Fetal syphilis affects literally all the internal organs, brain and skeletal system of the fetus, so the chances of surviving the fetus are very low. Usually, fetal syphilis ends with his death on the 6--7th lunar month of pregnancy or premature birth of a dead child. According to the medical literature, 89% of pregnancies in women with secondary syphilis end in fetal death or stillbirth. Some children transplacentally infected with syphilis survive, but often such children, especially those born with active manifestations of syphilis, are not viable and die in the first days or months after birth. If the child remains alive, then, as a rule, he has very strong violations of all body systems.

Children with early congenital syphilis are weak, develop poorly, lag behind in height and body weight, and are underdeveloped both physically and mentally. In children with early congenital syphilis of infancy, the eyes are often affected, as well as internal organs: the liver, spleen, cardiovascular system. With early congenital syphilis, lesions of the skin, bones and cartilage, and teeth are often observed. Dropsy of the brain or syphilitic inflammation of the meninges may develop. Early congenital syphilis in children can occur both with symptoms of syphilis, that is, skin rashes, and in a latent form - asymptomatically. However, even with latent congenital syphilis, the disease is easy to determine by positive serological reactions in the blood and cerebrospinal fluid.

Children with early congenital syphilis between 1 and 2 years of age may present with: papular rashes around the anus, in the genital area, buttocks, less often on the mucous membrane of the mouth, larynx, nose. Papules can be localized on the palms and soles, on the skin of the face, mainly around the mouth and on the chin, less often in the forehead and superciliary arches. At the same time, radially located cracks form around the mouth, which, when healed, form a kind of radial scars. These scars are a very characteristic sign of congenital syphilis that remains for life.

syphilitic pemphigus. The most common type of syphilitic rash in early congenital syphilis. Syphilitic pemphigus is a blisters that are most often localized on the palms and soles of the child, less often on the flexor surfaces of the forearms and legs or on the trunk. Pemphigus is often observed already at the birth of a child or occurs in the first days and weeks of his life.

Syphilitic rhinitis.It is also a characteristic sign of congenital syphilis in infants. Rhinitis with syphilis occurs due to the inflammation that a papular rash causes on the nasal mucosa. With syphilitic rhinitis, nasal breathing is difficult, the child is forced to breathe through the mouth.

Osteochondritis. Another sign of early congenital syphilis in infants is syphilitic bone disease. Osteochondritis most often affects the limbs, causing local tension, swelling and pain in the affected area.

Periostitis and osteoperiostitis. Symptoms of bone system disorders in early congenital syphilis are observed in 70-80% of patients.

After the first year of illness, the symptoms of early congenital syphilis usually disappear. As with syphilis acquired in adulthood, recurrent rashes on the skin and mucous membranes in the form of roseola or papules are possible. In addition, damage to the larynx, bones, nervous system, liver, spleen and other organs is possible. As for late congenital syphilis, it can also occur in a latent form in the presence of positive serological reactions, and it can manifest itself with certain clinical symptoms. As a rule, late congenital syphilis is detected at the age of 15-16 years, sometimes later, but sometimes earlier.

The most dangerous symptoms of late congenital syphilis:

* damage to the eyes (sometimes up to complete blindness);

* damage to the inner ear (syphilitic labyrinth with irreversible deafness);

* gummas of internal organs and skin;

* change in the shape of the teeth (in which a semilunar notch appears along the free edge of the upper incisors)

Possible signs of late congenital syphilis include:

* "saber" shins;

* scars around the mouth;

* "buttock-shaped skull";

* saddle nose (in 15-20% of patients there is a characteristic symptom due to the destruction of the nasal bones and the bone part of the nasal septum);

* tubercles and gums can form on the skin of the patient;

* very often there is a lesion of the endocrine system

Congenital syphilis can be cured using modern medicine, and this should be done as soon as possible, until the changes caused by syphilis in the child's body become irreversible. Therefore, even before the onset of pregnancy, a woman with syphilis should certainly consult with a venereologist, and if the mother’s illness became known during pregnancy, the woman needs to undergo a course of syphilis treatment herself and carry out preventive treatment of the child immediately after birth.

Latent syphilis. Syphilis can also occur in a latent form. This variant of the course of the disease is called latent syphilis. Latent syphilis from the moment of infection takes a latent course, is asymptomatic, but blood tests for syphilis are positive. In venereological practice, it is customary to distinguish between early and late latent syphilis: if a patient has contracted syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late. If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis hidden unspecified syphilis, during the examination and treatment, the diagnosis can be clarified.

Early latent syphilis. As a rule, young people (under the age of 40) suffer from early latent syphilis, many of whom may have recently had contacts with patients with sexually transmitted diseases, including syphilis. Such patients are detected either when examining the sexual partners of a person with syphilis, or during medical preventive examinations (during pregnancy, upon receipt of various medical certificates, etc.). Unfortunately, those who independently turned to a doctor for examination for syphilis, for example, after sexual contact with an unfamiliar or unfamiliar person among such patients, are only 7%. Many of these patients had taken antibiotics shortly before going to the doctor to treat some infectious disease, which could provoke an asymptomatic course of the disease.

Late latent syphilis. Patients with late latent syphilis, as a rule, are over 40 years old, while most of them are married. Patients with late latent syphilis in 99% of cases are detected during mass preventive examinations of the population, and the remaining 1 percent - during examination of family contacts of patients with syphilis. As a rule, such patients do not know exactly when and under what circumstances they could become infected, and did not notice any manifestations similar to those of infectious syphilis. There is a possibility of error in diagnosing latent syphilis, since a positive serological reaction, on which the diagnosis is usually based, can also occur in some non-syphilis cases. Therefore, patients with suspected latent syphilis must be examined extremely carefully in order to either confidently make a diagnosis or refuse it. The introduction of pale treponema into the human body affects all body systems, including the central, peripheral and autonomic nervous system. All organic lesions of the nervous system by syphilis are united under the name syphilis of the nervous system or neurosyphilis.

Pathological changes in the nervous system begin from the first days of infection, although clinically this is expressed only by a change in the composition of the spinal cord fluid.

Syphilitic lesions of the nervous system are usually conventionally divided into:

early neurosyphilis (up to 5 years from the moment of infection);

late neurosyphilis.

According to the symptoms, they differ:

mesodermal neurosyphilis, which is characterized by damage to the meninges and blood vessels;

ectodermal neurosyphilis, proceeding in the form of dorsal tassel, progressive paralysis, amyotrophic syphilis.

Syphilis in men

Often a man may not even be aware of his infection. Usually men do not pay much attention to skin rashes and other symptoms of this disease. Moreover, the signs of syphilis disappear after some time. But this speaks of the progression of the disease, rather than its cure. Given this, you should pay attention to the obvious signs of syphilis. First of all, the foreskin thickens and swells in a man. In addition, a clear sign is the appearance of small ulcers in the genital area, urethra and anus. Ulcers can also appear on other parts of the body. Such ulcers are called hard chancre. They appear at the initial stage of the disease. Usually the chancre takes a round shape from one to four millimeters in diameter. It has dense edges, red color and is characterized by painlessness. However, such ulcers are very insidious, as they are contagious to another person. If an infection enters the ulcer, then tissue necrosis may begin. About a week after the ulcers appear, the lymph nodes swell and the temperature rises. However, the general well-being of a person remains more or less normal. At this moment, there are practically no sensations, and that is why a man does not always go to the doctor. With the onset of the second stage of syphilis, a rash appears on the skin. At the moment, this disease is already destroying the body. In case of failure to provide treatment to such a patient, after a few years, the systems and organs of the male body will slowly begin to fail. At such a time, a favorable outcome of treatment is impossible. That is why, for timely treatment, tests should be taken after accidental sexual contact or at the first manifestations of the disease.

Syphilis in women

In women, the first signs of syphilis are already noticeable a couple of weeks after infection. Ulcers appear in a woman in the labia and vaginal mucosa. However, they can also form on other parts of the body. There are cases when the disease proceeds absolutely invisible. The only thing you should pay attention to is general well-being and lymph nodes. In the first stage of the disease, only some lymph nodes increase. You should also consult a doctor if you feel weak and unwell.

The second stage of syphilis in women is characterized by an increase in lymph nodes throughout the body. In addition, there is a headache, aches, skin rash, a feeling of pain in the bones, as well as fever. The development of the disease can lead to loss of eyelashes and eyebrows. In the third stage of the development of syphilis, all internal organs suffer. Syphilis is especially dangerous during pregnancy. An infected woman can bear a child with special pathologies, which sometimes may not be compatible with life. She can also give birth to a dead baby. The incubation period of this disease can last from three to six weeks. As already mentioned, the first sign of the disease is an ulcer, which has a round shape and can be from half a centimeter to two centimeters in diameter. This ulcer has a smooth, shiny bottom and hard edges. Then the lymph nodes in the affected area gradually increase. After two or three months, a characteristic rash appears, which may be in the form of blisters or dark red spots. Sometimes the rash may be accompanied by itching. With syphilis, a woman usually feels a sore throat, malaise and fever.

Diagnosis of syphilis. Nowadays, there are a large number of blood tests that can diagnose a disease such as syphilis. Such analyzes are based on the detection of specific antibodies. When a mass examination is carried out, the Wasserman reaction is used. However, sometimes this analysis can give false readings. In addition, to diagnose this disease, a clinical examination of the anus, genitals and skin is carried out. Also, to detect syphilis, dark-field microscopy, direct immunofluorescence reaction and polymeric chain reaction are carried out.

Treatment of syphilis in men and women

The main method of treating this disease is considered to be the use of long-acting penicillins, since the causative agent of syphilis can die only from exposure to antibiotics. Moreover, all sexual partners of a sick person should be treated with this method. At all stages of the development of this disease, drugs such as erythromycin, penicillin, doxycycline and tetracycline are used. Treatment of syphilis should be prescribed by a dermatovenereologist and carried out under his constant supervision. Treatment is often done anonymously. After the end of treatment and complete recovery, the patient should be observed by a doctor for some time. To prevent syphilis, precautions must be taken when contacting other people, and educational work in your family. If signs of the disease are still detected, complex treatment should be started immediately.

TREATMENT OF PATIENTS WITH PRIMARY AND SECONDARY FRESH SYPHILIS

a) Methods for inpatient treatment: 1. METHOD №1. The treatment is carried out with water-soluble penicillin, administered intramuscularly at 400,000 units every 3 hours for 14 days, the total dose of the antibiotic is 44.8 million units. The technique is indicated for patients with primary seronegative syphilis. In case of primary seronegative and secondary fresh syphilis, treatment is 16 days, on the 16th day, 3 hours after the end of penicillin therapy, bicillin-3 is administered once at a dose of 4,800,000 units (2,400,000 units intramuscularly in two stages in each buttock) or bicillin-5 in a dose of 3,000,000 IU with an appointment 30 minutes before the injection of 1 tablet of an antihistamine. 2. METHOD №2. Novocaine salt of benzylpenicillin is administered intramuscularly at 600,000 IU 2 times a day for 16 days. The course dose of the antibiotic is 19,200,000 IU. b) Methodology for inpatient-outpatient treatment. The first 7 days of treatment of patients with primary and secondary fresh syphilis is carried out in a hospital with water-soluble penicillin at 500,000 IU 8 times a day, and then continues on an outpatient basis with bicillin-3 at 2,400,000 IU or bicillin-5 at 1,500,000 twice a week (first bicillins are injected in the hospital 3 hours after the last injection of penicillin). In total, patients with primary syphilis receive 4 injections of bicillin, primary seropositive - 6, secondary fresh - 8 injections. From the second day of inpatient treatment, patients with primary seropositive and secondary fresh syphilis receive daily injections of biogenic stimulants, for example, splenin (1 ml intramuscularly, per course - 15 injections) or immunostimulants, for example, thymogen (1 ml intramuscularly every other day, only 6 7 injections).

c) The method of outpatient treatment. The treatment is carried out by one of the durant preparations of penicillin - 1, -3, -5. A single dose of bicillin-1 is 1,200,000 IU, bicillin-3 - 2,400,000 IU, bicillin-5 - 1,500,000 IU. The first injection is made in an incomplete dose - 300,000 IU, the second injection is made on the second day of treatment in a full single dose, subsequent injections are made intramuscularly 2 times a week. The number of injections in the full dose: primary seronegative syphilis - 7, primary seropositive - 8, secondary secondary fresh syphilis - 10. It is preferable to start treatment in a day hospital with water-soluble penicillin at a dose of 100,000 units, after 3 hours 600,000 units of bicillin-3 are injected intramuscularly, for example, and from the second day of treatment, it is carried out with bicillin in a full dose with the number of injections indicated above.

24.06.2017

Syphilis is an infectious disease caused by a microscopic mobile spirochete called Treponema pallidum.

A spirochete is not a bacterium, but it is not an organization of protozoa either. This is something in between. The disease of syphilis passes from a carrier person whose syphilis is in the first or second stage of development.

The infection has three routes of transmission:

1. Sexual. When partners have sexual intercourse without protection, you can easily become infected with pale treponema.
2. Contact household. You can become infected when using shared underwear, wet towels, bath accessories, if they were previously used by an infected person.
3. Vertical. Pale treponema is transmitted by a sick mother to a child. This bacterium easily passes through the placental barrier and is excreted during breastfeeding. Therefore, the baby can become infected in utero and while breastfeeding.

Alkaline soaps, disinfectants, drying and heating negatively affect the development of the pathogen. For a long time, treponema lives in wet vaginal discharge, blood plasma.

Syphilis has a strict staging of the course. It develops in four stages:

1. Incubation - the infection begins to develop in the body two weeks after infection, and then you can notice signs of secondary syphilis. The maximum stay in the body is six months.
2. At the primary stage, treponema forms a hard chancre. Within five days, local reactions of the nodes of the lymphatic system join the chancre. After a month, these changes can go away on their own without appropriate treatment.
3. The secondary stage of syphilis begins to appear two to three months after infection. A rash appears on the body and limbs of the infected person. This is due to the fact that hematogenous dissemination of pathogenic microorganisms begins in various parts of the human body. An inflammatory reaction along the skin capillaries also begins. The immune reactivity of the patient influences the course of this stage in the development of syphilis. As a rule, a rash on the body does not cause any discomfort to the patient. After a few weeks, the rash goes away on its own, but after two or three years it may appear again.
4. The tertiary stage of development begins with specific inflammations, they are also called syphilitic gums. When they begin to disintegrate, the destruction of healthy tissues begins. After that, large defects are formed, in the form of a collapse of the nose and destruction of the palate. this stage of the development of an infectious disease can severely affect the cerebral cortex and ends with damage to the spinal cord, impaired muscle strength and immobility of the upper and lower extremities.

When the disease goes to the last stage, it is quite difficult to help the patient.Often, syphilis ends in severe disability, or complete dysfunction of vital organs.

It is easier for doctors to diagnose the disease when the symptoms of the secondary stage begin.

What is secondary syphilis

The secondary period of syphilis begins after the primary period, as a result of not timely treatment. Its first manifestation begins two, three months after pale treponema enters the body. There are frequent cases when the second stage of syphilis passes in a latent form and does not give even the slightest symptoms. Pale treponema can live in the body from two to five years. After this, the tertiary stage begins, which can also proceed in a latent form.

The secondary period differs from others in that it is easy to pass it on to someone, that is, to infect. In almost all cases, the period has a pronounced clinical picture, which allows the patient to see a doctor and diagnose an infectious disease. even if an infected person does not have intimacy, he is still able to infect another person. This occurs in everyday life, for example through dishes, towels, toothbrushes and other personal or hygiene items. Therefore, the treatment of secondary syphilis should be carried out in a hospital.

When the first skin rashes began in the patient, it means that secondary fresh syphilis began. This is due to the penetration of pale treponema into the circulatory and lymphatic system.

Thus, it spreads throughout the body. The rash on the body may not go away for up to three months, and after that they begin to turn pale and disappear. This is how immune resistance is manifested. After a while, the rash appears again.

A repeated outbreak of infection indicates secondary recurrent syphilis. Such processes can be observed up to two years.

Symptoms of the secondary period of syphilis

At the initial stage of development, secondary syphilis has general symptoms that are similar to the manifestation of an acute respiratory viral infection or influenza. The patient experiences rapid fatigue, headache and chills. Often, when the body temperature rises. Unlike other stages, the secondary may be accompanied by causeless joint and muscle pain, often aggravated during a night's sleep. After all these symptoms appear, rashes on the skin may begin.

The rashes that appear during this period are called secondary syphilides. Such rashes have their own characteristics:

• rashes proceed benignly, while there is no peripheral growth;
• do not destroy surrounding tissues;
• have a rounded shape with clear boundaries;
• no subjective symptoms. Rarely, the rash may itch;
• there are no acute inflammatory signs;
• heal without scarring.

Secondary syphilis consists of a large concentration of pathogenic microorganisms. This factor indicates the danger of secondary syphilis.

The most common forms of skin rashes are syphilitic roseola and spotted syphilides. They are pale pink in color and have a rounded shape with a diameter of no more than ten millimeters. As a rule, the localization of spots is on the skin of the body, upper and lower extremities. In rare cases, they can be seen on the skin of the face, feet and hands. Syphilitic roseolas during the secondary stage of the development of an infectious disease appear at 11-13 pieces per day. This lasts one week. To distinguish roseola from other forms of rash, you just need to click on it. When pressed, the roseolas disappear.

Much less often, a patient may notice a rash in the form of a scaly (lamellar scale with a sinking center) and voluminous (rises a few ml above the skin) roseol.

Another type of manifestation of the secondary period of syphilis is papular syphilides. They look like densely elastic papules with a diameter of not more than 6 mm. They are pink or copper red in color. After a certain period of time, the center of a densely elastic papule begins to peel off and spreads to the peripheral zones. Also, the papule can peel off only along the edge, but after the center has peeled off. When the papules begin to rapidly spread over the skin, long-term hyperpigmentation begins. They can be seborrheic, nummular, psoriasiform, weeping syphilis and papular forms.

The rarest form of rash appears in the form of pustular syphilis. It manifests itself in patients with weak immunity or other serious pathologies, such as drug addicts, alcoholics, or patients with tuberculosis. This is a sign of a severe course of the secondary period of syphilis. Such rashes have a purulent exudate, which, when dried, forms a yellowish crust. According to clinical signs, the rash is confused with pyoderma. Syphilis of a pustular type, is impetiginous, acne-like, ecthymatous, pox-like, and rupoid.

Recurrent secondary syphilis is characterized by pigmentary syphilis (syphilitic leukoderma). They appear on the side and back of the neck and are round in shape. The color of the rash is whitish.

Rashes on the skin cause a generalized increase in the nodes of the lymphatic system. The enlargement of the cervical, axillary, femoral, inguinal lymph nodes is painless and does not solder to the tissues that surround them.

Secondary syphilis can provoke hair loss, which often ends in the development of diffuse or focal alopecia. The patient notices that the mucous membrane of the oral cavity and larynx has become inflamed. If the mucous membrane of the larynx is affected, the patient may hoarse.

Somatic organs suffer from functional changes. If you start treatment in a timely manner, you can quickly get rid of these symptoms. The liver is affected and the liver test is disturbed. The patient often experiences pain in this case. On ultrasound, the doctor fixes its increase in size. It is not uncommon when patients with secondary syphilis are diagnosed with gastritis and dyskinesia of the gastrointestinal tract. Lipoid nephrosis and high protein concentrations in the blood may also occur.

The patient becomes irritable due to sleep disturbance and insomnia.

In rare cases, the symptoms of secondary syphilis are accompanied by syphilitic meningitis, but it is easily treatable. The skeletal system is affected, and osteoperiostitis and periostitis develop, which are accompanied by acute pain in the lower extremities at night.

Diagnosis of the secondary period of syphilis

The physician cannot make a diagnosis solely on the basis that the patient has skin rashes, associated signs, or infections as indicated by the medical history.

First of all, doctors take a scraping from the typhus on the skin for further study in the laboratory under a microscope.

These tests can detect the presence of pale treponema. During the entire diagnosis, doctors monitor the results of the Wasserman reaction. Her indicators are positive in the period of fresh secondary and recurrent syphilis. After the patient is finally diagnosed, secondary syphilis treatment begins immediately.

Treatment

During treatment, patients are strictly forbidden to have intimacy. You also need to be careful at home. The patient should use only his household items, personal hygiene products and make sure that no one from his relatives uses them.

When a patient undergoes treatment at home, he should eat only from his dishes, dry himself with his towel, use his washcloth and soap. If the patient has a permanent sexual partner, then during the treatment period you need to sleep on different beds and avoid close contact. Since all rashes on the skin have a high concentration of pale treponema.

Due to the fact that almost all patients cannot cope with these rules, patients diagnosed with secondary syphilis are treated in an inpatient setting.

In the treatment of secondary syphilis, antibiotics are used, which are administered intravenously. An antibiotic injection is given every four hours, which is also much more convenient to do in a hospital. This allows you to achieve a greater effect.

Penicillins are considered the most effective antibiotics today. Water-soluble penicillin is injected every three hours, and injections with benzylpenicillin salt are given in the morning and evening.

Outpatient therapy is carried out with prolonged preparations Bicillin. medicinal product injected once every 48 hours. If the patient has an allergic reaction to penicillin, then treatment is with Doxycycline, Tetracycline, Erythromycin, or Azithromycin.

In addition to injections with antibacterial drugs, doctors use immunostimulants, such as Pyrogenal, Methyluracil and others.

For internal use, doctors prescribe multivitamins.

Local therapy is aimed at treating the elements of skin rashes, using chlorhexidine and lubricating with heparin ointment. Ointment allows you to speed up the process of resorption.

If there is a patient in the family with a diagnosis of secondary syphilis, then all family members take the appropriate tests. Even if they have no signs and skin rashes. And the sexual partner of the infected person undergoes prophylactic treatment, the duration of which is several weeks.