History of syphilis. Primary (seronegative) syphilis: signs and symptoms, manifestations, treatment, complications

Primary syphilis is the first stage of syphilis (after the incubation period), which is characterized by the appearance of characteristic clinical symptoms on the skin. This stage begins 10-90 days (on average 3 weeks) after contact with a person who has infected this disease, and lasts about 4-8 weeks.

The primary period of syphilis is the easiest to diagnose and treat. Further, the disease enters the next, hidden stage. Therefore, the patient should seek help from a specialist immediately after identifying suspicious signs.

Localization and prevalence of primary syphilis

According to the World Health Organization (WHO), every year there are 12 million people with this diagnosis. Most infected patients live in developing countries.

The popularization of homosexuality has led to an 11.2% increase in syphilis cases since 2002. This problem is especially relevant in the southern states of the United States.

In our country, the situation is not so dramatic (incidence rates are falling), but no one is still protected from infection. Men are more likely to suffer from this disease.

Causes and ways of infection of primary syphilis

Syphilis is caused by a bacterium called Treponema pallidum (from the genus Spirochetes). Infection occurs mainly through sexual contact - during vaginal, anal or oral sex with an infected person. If the changes associated with this disease (ulcers) are present in the throat, the infection can also be transmitted through kissing.

Bacteria enter the human body through intact mucous membranes or minor skin lesions, after which they begin to multiply rapidly. The incubation period lasts 10-90 days, after which syphilis develops.

Another way of infection is through the placenta from mother to fetus, but in this case we are not talking about primary, but about congenital syphilis.

Symptoms of primary syphilis

The primary manifestation of syphilis is the so-called syphiloma, an ulcer (hard chancre). It appears at the site of penetration of spirochetes (vagina, anus, penis, mouth, throat). In men, erosion is most often localized on the inner side or edge of the foreskin, in the region of the frenulum, less often at the mouth of the urethra. In women, an ulcer is observed mainly on the labia, cervix, less often on the walls of the vagina. In addition, he (hard chancre) can appear in the pubic region, anus and rectum (with genital-anal relations), in the mouth, on the lips, tongue, tonsils and throat (after oral sex). Often, medical workers (dentists, gynecologists, dermatologists, laboratory assistants) become infected with a bacterium - in this case, the neoplasm is localized on the hands.

The ulcer takes on a round or oval shape with a moist, shiny coating. It has smooth edges and does not cause pain. A few days later, new signs appear - an increase in regional lymph nodes (lymphadenitis). In case of infection during vaginal or anal sex, the lymph nodes in the groin increase, with the oral method of infection, the cervical lymph nodes.

Currently, primary syphilomas often have an unusual appearance - this is due to the widespread use of antibiotics, as a result of which the pale spirochete mutates, taking on new forms. Such ulcers may look like a soft chancre or. Skin changes spontaneously disappear after 2-6 weeks, leaving an atrophic scar. However, the disappearance of symptoms does not mean that the disease has gone away on its own, in the absence of antibiotic treatment, it progresses further.

Atypical symptoms of primary syphilis

Only in 20% of cases, patients have the classic signs of the disease described above. In other cases, it takes the following clinical forms:

• multiple hard chancres;
• herperovirus form;
• syphilis inflammation of the glans penis (balanoposthitis);
• syphilis inflammation of the vulva and vagina (vaginitis, vulvovaginitis);
• abortive form of hard chancre (symptoms are almost invisible);
• giant chancre (change in diameter more than 2 cm);
• syphiloma of unusual localization (for example, on a finger or nipples);
• gangrenous form (with severe inflammation, suppuration and destruction of surrounding tissues);
• additional tissue infection (the skin around the ulcer becomes inflamed, swollen and painful).

Note that primary syphilis has two stages - seronegative and seropositive. Each of these stages lasts 3 weeks. During the seronegative stage, serological tests do not confirm the diagnosis.

Diagnosis of primary syphilis

Diagnosis is based on direct and indirect analyses. The direct method allows you to detect bacteria in the discharge from the primary focus (hard chancre) or by puncturing the lymph node adjacent to the ulcer.

The samples taken are sent for dark field microscopic examination, which is commonly used in the diagnosis of primary and congenital syphilis. This method is not recommended in cases where the lesions are located in the oral cavity or anal region (because of the difficulty in differentiating pallidum spirochetes from other, non-pathogenic spirochetes often found in these areas). In this case, a direct immunofluorescent reaction is performed.

The most common indirect method for diagnosing the disease is serological tests. These tests should detect antibodies produced by the blood upon contact with pathogenic bacteria. Serological tests are non-specific (screening) and specific. Usually the doctor prescribes several tests at once:

• precipitation microreactions;
• immunofluorescent reaction;
• enzyme immunoassay;
• analysis of passive indirect hemagglutination;
• Nelson-Meyer test (treponema pallidum immobilization reaction).

Why is it necessary to undergo multiple tests? The fact is that no test is 100% accurate, so the final diagnosis is made only after obtaining a complete picture from several studies.

Treatment of primary syphilis

The gold standard in the treatment of syphilis (both primary and its subsequent stages) is penicillin intravenously or intramuscularly. In the primary form, the duration of pharmacotherapy is 2 weeks.

The mechanism of the effect of penicillin should be clarified separately. This antibiotic has a different effect on the destruction of pale treponema and regression of clinical serological reactions. The disappearance of bacteria occurs on average 9-10 hours after the injection of penicillin. This process is accompanied by the occurrence of a temperature reaction and lasts several hours. The increase in body temperature is attributed to the active destruction of spirochetes under the influence of drugs, and the associated toxic effect that causes an allergic reaction. It does not pose a threat to the health and life of the patient.

Other antibiotics are prescribed only in case of allergy to penicillin. Most commonly used:

• erythromycin;
• tetracycline;
• oxytetracycline;
• chloromycetin;
• azithromycin.

These antibiotics have a weaker effect compared to penicillin. There are cases when such therapy did not give positive results (perhaps this was due to a violation of the medication regimen). The disadvantage of these antibiotics is their uneven absorption in the intestine, the destruction of the intestinal flora and frequent side effects from the digestive system.

In the case of syphilis, prophylactic treatment is also applied to all sexual partners of the patient, regardless of whether they have symptoms of the disease. Do not wait for the results of serological tests - treatment should be started as soon as possible. As a preventive therapy, a person is administered procaine penicillin in a single daily dose of 1,200,000 units intramuscularly or 5 injections of benzathine penicillin at four-day intervals (the first dose is 2,400,000 units, the rest are 1,200,000 units each).

Treatment with folk remedies

Patients are strictly forbidden to ignore traditional medicine in favor of folk remedies. Not a single herbal preparation fights the causative agent of syphilis, so you can only cure the disease with a doctor.

Herbal medicine can be used to support immunity and reduce the side effects of medications. To do this, take inside tea from chamomile, marigold, lime blossom and rose hips.

Prognosis and complications of primary syphilis

The curability of the disease reaches 100%. However, after recovery, the patient does not acquire immunity against this type of infection, so the risk of re-infection is not excluded.

Complications of primary syphilis can be:

• phimosis (narrowing of the foreskin, inability to expose the head of the penis);
• paraphimosis (inability to bring the foreskin back to the head of the penis);
• swelling of the genital organs;
• secondary infection.

During antibiotic treatment, there is a risk of the following complications:

1. The Yarisch-Herxheimer reaction is a rapid disintegration of the spirochete after the first injection of penicillin, which causes an increase in body temperature up to 40C, nausea, chills, tachycardia, and general weakness. It is recommended to take enough fluids before and during treatment to reduce the intensity of symptoms. Such an adverse reaction is not a contraindication to the use of penicillin. It is most often observed in the early stages of the disease, as well as in patients with AIDS.
2. Neurotoxic reactions (occur extremely rarely) - psychological anxiety, impaired consciousness and hallucinations that quickly pass without leaving any traces in the body.
3. Anaphylactic shock - each patient undergoes a sensitivity test before starting treatment with penicillin, which should ensure the safety of treatment with these drugs. Anaphylactic shock belongs to rare complications when using this antibiotic.

If the disease is not treated, the complications will be extremely severe. Syphilis in advanced stages leads to disorders of many organs and systems (musculoskeletal system, cardiovascular and nervous systems), disability and even death.

Prevention of primary syphilis

Prevention of syphilis is built, first of all, on the safety of sexual life. Sex should be with a permanent partner, in whose health you are sure. It is useful to use condoms during intercourse (this applies to vaginal, oral and anal sex), but remember that this method of contraception does not give a 100% guarantee against infection.

To exclude the possibility of non-sexual infection, it is recommended to carefully observe the rules of personal hygiene, especially in situations where the possibility of contact with objects touched by a sick person is not ruled out.

A photo

At the present stage, the diagnosis and treatment of syphilis is characterized by the use of new methods and highly effective drugs that prevent serious complications. The classification of the disease existing in Russia is based mainly on the epidemiological features and the specifics of the clinical manifestations of different periods of the course of the disease. Depending on this, primary syphilis, secondary and tertiary are distinguished. They, in turn, are subdivided into their respective subspecies.

The cause of the disease and its characteristics

The cause of syphilis, or the causative agent, is Treponema pallidum, belonging to the Spirochaetaecae family, which does not perceive staining. This property, as well as the presence of curls (on average 8-20 or more), which differ in width, uniformity and angle of bend, and characteristic movements (rotational, flexion, undulating and translational, like a whip in case of attachment to cells) are important for laboratory diagnostics.

The wall of pale treponema consists of biochemical components (protein, lipid and polysaccharide), which have a complex composition and have antigenic (allergenic) properties. The micro-organisms multiply within an average of 32 hours by dividing into many one-loop lengths capable of passing through the bacterial filter.

The causative agent under adverse conditions can be transformed into one of 2 forms of survival. One of them is cysts, which have a stable protective shell. They also have antigenic properties and are determined by serological (immune) reactions, which remain positive for many years after the transferred early form.

The second form of existence under adverse conditions is L-forms, which do not contain a cell wall, their metabolism is sharply reduced, they are not capable of cell division, but retain intensive DNA synthesis. Under appropriate conditions for life, they are quickly restored to their usual spiral shape.

The resistance of L-forms to antibiotics can increase by several tens and hundreds of thousands of times. In addition, they do not have antigenic properties or the latter are very reduced. In this regard, by means of classical serological reactions, the causative agent of the disease cannot be detected. In this case (in the later stages), it is necessary to carry out RIF (immune fluorescence reaction) or RIT (treponema immobilization reaction).

Pale treponema is characterized by low resistance to the influence of the external environment. The optimal conditions for its existence are high humidity and a temperature of 37˚C. Outside the human body at a temperature of about 42˚C, it dies after 3-6 hours, and at 55˚C - within 15 minutes.

In blood or serum at 4˚C, the duration of its survival is at least 1 day. For this reason, fresh donated blood and its preparations are currently not used, despite laboratory control. A significant absence of treponema in canned blood is noted after 5 days of storage.

The microorganism retains its activity on various objects only until they dry out, quickly dies under the influence of acids and alkalis and does not survive in products such as vinegar, sour wines, sour milk and kefir, kvass and sour carbonated drinks (lemonade).

Ways of infection and mechanisms of development of primary syphilis

The source of infection is only a sick person. The main conditions for infection are the presence of even imperceptible damage to the stratum corneum of the skin or the integumentary epithelial layer of the mucous membrane and the introduction of at least two pathogens through them into the body. According to some clinicians, mucosal damage is not necessary.

There are two ways of getting syphilis:

• direct - sexual contact (most often - 90-95% of cases), kissing, biting, breastfeeding, caring for a child or a sick person, professional (medical personnel when examining patients, operations and manipulations, attending childbirth, with musicians through common wind instruments, etc.), intrauterine infection of the fetus, transfusion infection (transfusion of blood and its preparations);
• indirect - infection through various wet common items, linen, etc. in everyday life, in kindergartens, military units, hairdressers and beauty salons, in medical institutions (mainly dental and gynecological rooms).

Men suffer from primary syphilis 2-6 times more often than women. In the latter, secondary and latent (latent) syphilis is more common, which are often discovered by chance only during examinations and mandatory serological tests in gynecological consultations and departments.

The first clinical symptoms of primary syphilis appear on average 3-4 weeks after the pathogen enters the damaged skin surface or mucous membranes (incubation period). This period can be reduced to 10-15 days or increased to 2.5-3 months, and sometimes up to six months, especially when taking low doses of antibiotics. The decrease in the duration of the incubation period is affected by:

• senile or early childhood;
• unfavorable living and working conditions;
• severe psycho-emotional stress, mental or physical overwork;
• malnutrition;
• concomitant chronic diseases, diabetes mellitus;
• acute and chronic infectious diseases;
• chronic intoxications (industrial, nicotine, alcoholic, narcotic);
• re-infection through repeated sexual contact with sick partners.

An increase in the duration of the incubation period of primary syphilis is observed in people with high protective properties of the body, when taking antibiotics or antibacterial agents for any inflammatory diseases, in the presence of genetic immunity to the causative agent of the disease (very rarely).

After pale treponema enters the body, their intensive division (reproduction) occurs at the site of introduction, where the first and main symptom of the primary period of syphilis, syphiloma, develops. Pathogenic microorganisms quickly spread by lymph and blood to all tissues and organs. A small number of them penetrate into the lymph of the perineural (around the nerve fibers) spaces and along them into the parts of the central nervous system.

This process is accompanied by a change in the reactivity of the whole organism, that is, an allergic reaction of tissues, and in parallel - an increase in immune defense against an infectious agent. Allergy and immune response are two phenomena of a single universal biological reaction of the body under the influence of an infectious agent, which subsequently manifests itself as clinical symptoms of primary syphilis.

Clinical picture of the disease

A specific sign of primary syphilis is a positive laboratory serological reaction. However, the entire incubation period and the first week, even up to the 10th day of the first period, it remains negative. Moreover, in some patients it is negative throughout the disease, which greatly affects the timely diagnosis and treatment of syphilis. In recent years, this has been observed in an increasing number of patients.

The results of the serological reaction are taken into account in the classification, in which primary syphilis is divided into:

• seronegative;
• seropositive;
• hidden.

Syphilis primary seronegative- this is only such a form of the disease, which throughout the entire period of the course of treatment is characterized by persistent negative results of standard serological tests carried out regularly and at least every 5 days. This does not take into account the results of immunofluorescence and Colmer reactions, which are a modification (cold mode) of the classical Wasserman serological test. If classical reactions gave at least one weakly positive result, primary syphilis is classified as seropositive.

After the end of the incubation period, two main signs of the disease develop:

• Primary syphiloma, or hard chancre, primary sclerosis, primary ulcer, primary erosion.
• Damage to the lymphatic vessels and nodes.

Roseolous rash in primary syphilis does not occur. Sometimes there are isolated cases of the so-called "headless" syphilis, when the latter manifests itself already in the secondary period (bypassing the primary) 3 months after infection. A symptom of secondary syphilis is a rash. This occurs mainly as a result of deep injections with infected needles, intravenous transfusion of infected blood and its preparations, after operations or manipulations with an infected instrument.

Primary syphiloma

Hard chancre occurs on average in 85% of infected people and is an erosive or ulcerative formation on the skin or mucous membranes at the site of inoculation (implementation) of pale treponema. This is not a true morphological element of the disease. It is preceded by "primary sclerosis", which in most cases goes unnoticed not only by the patient himself, but also by the dermatologist. This change begins with the appearance of a small speck of red color due to the expansion of capillaries, which within 2-3 days transforms into a painless papule in the form of a hemisphere (a dense formation without a cavity, slightly rising above the skin) with a diameter of several millimeters to 1.5 cm, covered with a small number of scales of the horny epithelium.

Over several days, peripheral growth of the papule, thickening and crusting occur. After spontaneous rejection or removal of the latter, the disturbed skin surface is exposed, that is, erosion or a superficially located ulcer with a seal at the base, which are the chancre.

Syphiloma is rarely painful. More often it does not cause any subjective sensations. After reaching a certain size, it is not prone to further peripheral growth. The average diameter of the chancre is 1-2 cm, but sometimes there are "dwarf" (up to 1-2 mm) or "giant" (up to 4-5 cm) formations. The first are formed in the case of penetration of treponema into the depth of the hair follicles and are localized in those areas of the skin in which the follicular apparatus is well developed. They are very dangerous because they are almost invisible and therefore are a source of infection. Large elements are usually located on the face, thighs (inner surface), on the forearm, in the lower parts of the skin of the abdomen, on the pubis.

Primary ulcer or erosion can be oval or round geometrically regular shape with even and well-defined borders. The bottom of the formation is located at the level of the surface of the surrounding healthy skin or somewhat deepened. In the latter version, the chancre acquires a "saucer-shaped" shape.

Its surface is smooth, bright red in color, sometimes covered with a dull grayish-yellow coating. Against this background, there may be petechial (pinpoint) hemorrhages in the center. Sometimes plaque is located only in the central sections of the ulcer and is separated from healthy areas of the skin by a red rim.

In open areas of the body, the ulcerative surface is covered with a dense brownish crust, and on the mucous membranes - with a transparent or whitish serous discharge, which gives it a kind of "lacquer" sheen. The amount of this discharge increases sharply when the surface of the chancre is irritated. It contains a large amount of the pathogen and is used for smears for microscopic examination.

Primary syphiloma is called a "hard" chancre due to the fact that it is delimited from the surrounding healthy tissues at the base by a soft elastic seal that extends beyond the ulcer or erosive surface by several millimeters. Depending on the shape, three types of this seal are distinguished:

• nodular, having the form of a hemispherical formation with clear boundaries and deeply penetrating into the tissues; such a seal is determined during a routine visual examination and is called the "visor" symptom; as a rule, it is localized in the region of the coronal sulcus and on the inner surface of the foreskin, which violates the displacement of the latter and leads to phimosis;
• lamellar - comparable to a coin at the base of a syphiloma, placed on the labia majora, the stem section of the penis or in the region of the outer surface of the foreskin;
• leaf-shaped - not a very solid base, similar to a thick paper sheet; occurs when localized on the glans penis.

Varieties and various options for hard chancre in primary syphilis

Special varieties of primary education are:

• Combustiform (burn) hard chancre, which is an erosion on a leaf-like base with a tendency to peripheral growth. As erosion increases, the correct outlines of its boundaries are lost, and the bottom acquires a granular red color.
• Folman's balanitis (symptom complex) is a rare clinical variety of chancre in the form of multiple small erosions without pronounced compaction. Its localization is the glans penis and labia majora. The development of this symptom complex in primary syphilis is facilitated by the use of antibiotics orally during the incubation period or the application of external agents with antibiotics to syphiloma at the initial stage of its development.
• Chancre herpetiformis, which has a significant resemblance to genital herpes. It is a grouped small erosion with a fuzzy compaction at the base.

Depending on the anatomical specifics of the location of the primary syphiloma, different options for its formation are possible. So, on the head of the penis, it is expressed by erosion with a slight lamellar base, in the region of the coronal sulcus - a large ulcer with a nodular seal, in the region of the frenulum of the penis, it looks like a strand with a dense base, bleeding during erection. When localized on the distal border of the foreskin, syphilomas are usually multiple and linear in nature, and on the inner sheet it looks like an infiltrate like a rolling plate (“hinged” chancre); removal of the head is difficult and is accompanied by tears.

Localization of syphilomas in primary syphilis

Primary syphilomas can be single or multiple. The latter are characterized by simultaneous or sequential development. The condition for their simultaneous development is the presence of multiple defects of the mucous membrane or skin, for example, with concomitant skin diseases accompanied by itching, injury or cracks. Successively occurring chancres vary in degree of density and size and are observed during repeated sexual intercourse with a sick partner.

Recently, bipolar formations have become more common, that is, on two parts of the body distant from each other (on the external genitalia and on the mammary gland or on the lips), and “kissing” ulcers - in the area of ​​\u200b\u200bcontacting surfaces of the labia minora, as well as chancre - "imprints" on the penis in the crown zone, which very often lead to the development of balanoposthitis. Such forms are accompanied by a shorter incubation period and an earlier appearance of seropositive reactions.

Localization of primary syphiloma depends on the method of infection. Most often it appears on the external genitalia. On the mucous membranes of the genital organs, the chancre can be located in men in the area of ​​​​the external opening of the urethra. In these cases, there is an increase in inguinal lymph nodes, painful urination, serous - spotting, which is often confused with gonorrhea. As a result of the healing of the ulcer, a stricture (narrowing) of the urethra may form.

With primary syphilis in women, erosion can form on the mucous membranes of the cervix - in the region of the upper lip (more often) of the vaginal part of the cervix, in the area of ​​​​the external pharynx of the cervical canal. It has the appearance of a round limited erosion with a bright red shiny surface or covered with a grayish-yellow coating and serous or serous-purulent discharge. Much less often, the primary formation occurs on the mucous membrane of the walls of the vagina.

With perverted sexual contacts on any part of the skin and mucous membranes, extragenital (extra-sexual) single and multiple syphilomas can develop, which occurs (according to various sources) in 1.5-10% of cases of infection. For example, it may occur:

• primary syphilis on the face (in the area of ​​the red border of the lips, more often on the lower, in the corners of the mouth, on the eyelids, chin);
• in the folds of the skin located around the anus (often resembles a normal crack);
• on the skin of the mammary glands (in the areola or nipples);
• in the armpit, on the navel, on the skin of the second (more often) phalanx of the fingers.

Extragenital hard chancre is characterized by more rapid formation of erosion or ulcers, soreness, prolonged course and a significant increase in peripheral lymph nodes.

During oral sex, primary syphilis of the oral cavity develops with localization in the region of the middle 1/3 of the tongue, on the tonsils, on the mucous membrane of the gums, at the neck of one or more teeth, on the back of the throat. In cases of anal sex in both men and women, primary syphiloma may occur not only on the skin in the anus, but also, in more rare cases, on the mucous membrane of the lower rectum. They are accompanied by pain during the act of defecation, bloody discharge mixed with mucus or pus. Such syphilomas often have to be differentiated from an ulcerated rectal polyp, hemorrhoids, and even a malignant neoplasm.

Damage to the lymph nodes and lymph vessels

The second main symptom of primary syphilis is lymphadenitis (enlargement) of regional lymph nodes, or the accompanying "bubo", scleradenitis. It is important in the differential diagnosis of primary syphilis and persists for 3 to 5 months even with adequate specific therapy and secondary syphilis.

The main symptom of syphilitic scleradenitis is the absence of acute inflammation and pain. As a rule, a symptom called the Rikor Pleiad is found. It is expressed in an increase in several lymph nodes up to 1-2 cm, however, the node closest to the syphiloma is large in comparison with those more distant from it. The lymph nodes show no signs of inflammation. They have a round or oval shape and a densely elastic consistency, they are not soldered to each other and to the surrounding tissues, that is, they are located in isolation.

Scleradenitis develops, as a rule, at the end of the first week after the formation of syphiloma. With an extension of the incubation period, which occurs in cases of concomitant intoxication of the body, taking antibacterial, antiviral or immune drugs, etc., lymphadenitis may appear before the formation of the chancre or simultaneously with it. Lymph nodes can increase from the location of the primary focus, from the opposite (cross) or from both sides.

If the primary chancre is located in the vulva, the inguinal nodes react, on the chin and lower lip - submandibular and cervical, in the areas of the upper lip and tonsils - submandibular, anterior and cervical, on the tongue - sublingual, in the region of the outer corners of the eyes or on the eyelids - anterior, in the region of the mammary glands - parasternal and axillary, on the fingers of the hands - elbows and axillaries, on the lower extremities - inguinal and popliteal. Regional lymphadenitis during external examination is not detected in the case of localization of syphiloma on the walls of the vagina, cervix or rectum, since in these cases the lymph nodes of the small pelvis react.

By the end of the primary stage of syphilis, syphilitic polyadenitis develops, that is, a widespread increase in the lymph nodes of the submandibular, cervical, axillary, inguinal, etc. Their magnitude is less than with regional lymphadenitis, and the farther from the primary focus, the smaller they are. Polyadenitis, like regional lymphadenitis, persists for a long time even with the use of specific therapy.

Syphilitic damage to the lymphatic vessels (lymphangitis) is not an obligatory symptom. In relatively rare cases, it manifests itself as a lesion of small lymphatic vessels mainly in the area of ​​​​the primary focus and is accompanied by painless swelling of the surrounding tissues, which persists for several weeks. Larger affected lymphatic vessels may be seen as firm, painless subcutaneous tourniquets.

Complications of primary syphilis

The main complication is the transition of the disease to the secondary stage in the absence of specific adequate therapy. Other complications are associated with primary syphiloma:

Ulcer formation

Erosion usually forms first. An ulcer in some cases is already considered a complication. Its development is facilitated by factors such as self-use of external irritating drugs, violation of hygiene rules, childhood or old age, concomitant chronic diseases, especially diabetes mellitus, anemia and chronic intoxication that weaken the body.

Balanitis (inflammatory process of the head) or balanoposthitis (inflammation in the region of the inner leaf of the foreskin, as well as the head)

They arise as a result of the addition of purulent or other opportunistic flora, including fungal, if personal hygiene is not observed, mechanical damage or irritation, weakened reactivity of the body. These complications are manifested in acute inflammatory processes around the chancre - redness, the appearance of additional small erosive areas, tissue swelling, soreness, purulent or purulent bloody discharge. All this may be similar to the usual banal balanoposthitis and makes it difficult to diagnose the underlying disease.

Phimosis (inability to move the foreskin to remove the head of the penis) and paraphimosis

Phimosis occurs as a result of swelling of the glans and foreskin or scarring of the foreskin after the ulcer has healed. These changes lead to a narrowing of its ring and prevent the removal of the head. With forcible removal, an infringement of the head (paraphimosis) occurs, which, if timely assistance is not provided, leads to its necrosis (necrosis).

Gangrenization

A rare complication of chancre that occurs on its own or as a result of activation of saprophytic spirochetes and bacilli (fusispirillosis infection) with weakened immunity. In addition, staphylococcal and streptococcal infections also join them. The complication is manifested by rapidly spreading necrosis along the surface and deep into the syphiloma. A scab of a dirty yellowish-gray or black color appears on the surface. When it is removed, an ulcerative surface with bright red granulations is exposed.

Gangrenization develops only within the syphilitic ulcer, and after healing, following the rejection of the scab, a scar is formed. Gangrenization is accompanied by a deterioration in the general condition, fever and chills, headache, the appearance of soreness in regional lymph nodes, and sometimes hyperemia (redness) of the skin above them.

Fagedinism

A rarer but more severe complication of primary syphilis caused by the same bacterial flora. It is characterized by the spread of tissue necrosis not only within the boundaries of the ulcerative surface, but also with the involvement of healthy tissues surrounding it. In addition, necrosis after rejection of the scab does not stop. Gangrene is increasingly spreading to healthy areas, resulting in severe bleeding, destruction of the wall of the urethra, followed by its cicatricial narrowing, complete destruction of the foreskin and even the head of the penis. Fagedinism is accompanied by the same general symptoms as with gangrenization, but more pronounced.

Diagnostics

As a rule, establishing a diagnosis with the appearance of a characteristic syphiloma does not cause any difficulties. Nevertheless, its laboratory confirmation is necessary by microscopic detection of pale treponema in a smear or scraping from an erosive (ulcerative) surface or in a punctate from a regional maximally large lymph node. Sometimes these studies have to be performed for several days before the onset of the epithelialization process. In addition, sometimes (relatively rarely) it becomes necessary to conduct a histological examination of tissues from a hard chancre.

Classical serological tests become positive only by the end of the 3rd week or by the beginning of the next month of illness, so their use for early diagnosis is less important.

Differential diagnosis of primary syphilis is carried out with:

• traumatic erosion of the genital organs;
• with banal, allergic or trichomonas balanitis and balanoposthitis that occurs in people who do not observe normal hygiene;
• with gangrenous balanoposthitis, which can develop independently or as a complication of the diseases listed above;
• with soft chancre, genital herpetic lichen, scabies ecthyma, complicated by staphylococcal, streptococcal or fungal infection;
• with ulcerative processes caused by or gonococcal infection;
• with acute ulcers of the labia in girls who are not sexually active;
• with malignant neoplasm and some other diseases.

How to treat primary syphilis

The disease is completely curable if timely adequate therapy is carried out in the early stages, that is, during the period of primary syphilis. Before and after the course of treatment, studies are carried out using CSR (a complex of serological reactions), including a microprecipitation reaction (MRP).

Treatment of primary syphilis is carried out with penicillin and its derivatives (according to the developed schemes), since this is the only antibiotic to which the causative agent of the disease develops resistance much more slowly and weakly compared to the others. In case of intolerance to antibiotics, penicillin derivatives, others are selected. The descending sequence of the effectiveness of the latter: Erythromycin or Carbomycin (macrolide group), Chlortetracycline (Aureomycin), Chloramphenicol, Streptomycin.

For outpatient treatment, long-acting penicillin preparations are used:

• foreign production - Retarpen and Extencillin;
• domestic preparations of bicillin - Bicillin 1 (one-component), which is a dibenzylethylenediamine penicillin salt, Bitsillin 3, including the previous one, as well as novocaine and sodium salts of penicillin, and Bitsillin 5, consisting of the first and novocaine salts.

In the conditions of inpatient treatment, penicillin sodium salt is mainly used, which is characterized by rapid excretion and provision of an initial high concentration of the antibiotic in the body. If it is impossible to use penicillin derivatives, alternative antibiotics (listed above) are used.

Ministry of Education and Science of Ukraine.

Odessa National University. I.I. Mechnekov.

Department of Microbiology.

Abstract topic:

"Syphilis"

3rd year student, group 5

Faculty of Biology

Department of Botany

Danylyshyn Andrey.

Teacher:

Ivanitsa V.A.

Odessa.

Introduction………………………………………………………………………….….…….3

Pathogen………………………………………………………………………….……3

Immunity………………………………………………………………………….……4

Symptoms……………………………………………………………………………………5

Primary stage…………………………………………………………………………5

Secondary stage………………………………………………………………………6

Tertiary stage…………………………………………………………………………9

Laboratory diagnostics………………………………………………………….…11

Diagnosis……………………………………………………………………………… 11

Research methods………………………………………………………………..…12

Treatment………………………………………………………………………………..…..14

Pregnant women with syphilis…………………………………….……17

Prevention……………………………………………………………………………….20

Dispensary observation of the sick person…………………………………………….21

History……………………………………………………………………………………..22

One of the main horrors of mankind for centuries - syphilis, called the "white plague", still remains among us: 50 thousand only registered cases per year, plus quite a lot of unreported ones. Decreasing in level among homosexuals, it is becoming more widespread among heterosexuals. Before the era of antibiotics, syphilis caused the same kind of panic among people that AIDS does today, and many then also claimed that victims of syphilis were paying for their immoral behavior - another parallel with modern times. So what happened to Caligula? Historians and doctors have at least one point in common - they both love to look for diseases in famous people. And here, in their opinion, syphilis shows its terrible face. Why were Beethoven and Goya deaf? Why did the poet Milton and the composer Bach go blind? Why did the composer Schumann, the Roman emperor Caligula and King George III of England go crazy? Of course, because of syphilis! Here, they say, it is impossible to make a mistake, because the last stages of it have many forms. But this is nonsense! Almost until the end of the 19th century, medicine was too primitive in its treatment of complex diseases. The old descriptions of patients with such ailments are very funny (every major library has medical journals of the 18th-19th centuries - read and see), but they are far from the truth.

There are congenital and acquired syphilis.
Definition - an anthroponotic chronic infectious disease that affects all organs and tissues of the human body, continuing in untreated patients for many years. It is characterized by primary affect, secondary rashes on the skin and mucous membranes, followed by damage to various organs and systems of the body. The causative agent is a mobile spiral microorganism Treponema pallidum (pallid treponema) from the family Spirochaetaceae of the genus Treponema. Pale treponema has a spiral shape, resembling a long thin corkscrew. The length of the spiral body of the cell ranges from 6 to 20 microns with a diameter of 0.13-0.15 microns. The protoplasmic cylinder is twisted into 8-12 equivalent curls. From the ends of the cells, 3 periplasmic flagella depart. Unlike other spirochetes, T. pallidum has a combination of four main types of movements: translational (forward and backward), rotational (around its own axis), flexion (pendulum-shaped) and contractile (wave-like). It is a facultative anaerobe. In this regard, the conditions of existence in the blood are not favorable for it, and a high concentration of the pathogen in the blood usually occurs with the most pronounced clinical manifestations (secondary syphilis).

T. pallidum does not accept aniline dyes well due to the small amount of nucleoproteins in the cell. Only with prolonged staining according to the Romanovsky-Giemsa method, it acquires a slightly pink color. There is no nucleus as such - there is no nuclear membrane, DNA is not divided into chromosomes. Reproduction occurs by transverse division every 30-33 hours. Under the influence of unfavorable factors, in particular medicinal preparations, treponemas can turn into an L-form, and also form cysts - spirochetes rolled into a ball, covered with an impermeable mucin membrane. Cysts can stay in the patient's body for a long time without showing pathogenicity. Under favorable conditions for them, spirochetal cysts become spiral, multiply and restore their pathogenicity. Penicillin used in the treatment of syphilis acts only on spiral forms of treponema, so the effectiveness of the funds is maximum in the first months of the disease. Pale treponema is called so because it is extremely poorly stained with dyes traditionally used in the diagnosis of STIs. The method of choice (i.e. the best method) is the study of the native drug in a dark field. At the same time, a flickering, smoothly curving syphilitic treponema is well distinguishable. A study for the detection of pale treponema is carried out mainly at the beginning of the disease - the material is taken from ulcers, erosions, papules, on the skin and mucous membranes of the genital organs, in the anus and oral cavity, the lymph nodes are punctured. At a later date, blood serum and cerebrospinal fluid are examined for the presence of specific antibodies (serological diagnostic methods). According to Romanovsky - Giemse is painted in a pale pink color. The most studied 3 antigens: cardiolipin, group and specific. It grows on media containing renal or brain tissue under strictly anaerobic conditions at a temperature of 35 ° C. Cultivation of treponems for a long time leads to loss of virulence and changes in other biological properties (biochemical, physiological). To preserve the original properties of treponemas in laboratories, they are passed on rabbits - in the testicular tissue of animals, where they multiply well. Spirochete finds optimal conditions for reproduction in the lymphatic tract, constantly present in the lymph nodes. In wet secretions it survives up to 4 days, in a corpse - up to 2 days, when heated to 60 ° C it dies within 10-20 minutes, at 100 ° C - instantly. Sensitive to the action of ethyl alcohol, 0.3-0.5% hydrochloric acid solution, 1-2% phenol solution.

Exciter transmission mechanismcontact; transmission route - sexual. Non-sexual infection is observed when using contaminated secretions of the patient (saliva, semen, blood, vaginal and other secretions) household items, medical instruments, etc. In the second half of pregnancy, vertical transmission of the pathogen (from mother to fetus) is possible.

Experimental infection of laboratory animals (rats, mice, guinea pigs) with treponema creates an asymptomatic infection. Infection of rabbits into the skin or testicles makes it possible to multiply and accumulate the required number of treponemas. This model made it possible, in addition to maintaining the initial biological properties of cultures isolated from sick people, to study their attitude to medicinal preparations and other issues of infectious pathology. The ability of treponems to resist the protective reaction of phagocytes, to actively penetrate into tissues under the damaging effect of endotoxin, ensures the development of the pathological process. Pale treponemas can be contained in the blood of people, even those who are in the vincubation period. If such blood is transfused to a healthy person for any reason, then infection will occur and so-called "transfusion" syphilis will occur. Therefore, donor blood must be examined for syphilis, subjected to canning, keeping for 4 days, which guarantees the death of bacteria. If by chance, in an emergency, blood is taken from a patient with syphilis by direct transfusion, then the person who received it is given preventive treatment. A 0.5% solution of caustic alkali, as well as acid solutions, is detrimental to pale treponema. Urine with a pronounced acid reaction, as well as some foods - sour milk, kvass, vinegar, and even lemonade can destroy the pathogen. He immediately dies in soapy foam, and therefore washing hands with soap reliably protects against infection.

Immunity

Human susceptibility to syphilis is high. Acquired immunity is characterized by protective cellular reactions that contribute to the fixation of treponema and the formation of granulomas, but not the elimination of the pathogen from the body. An infectious allergy also develops, which can be detected by intradermal injection of a dead suspension of tissue treponemas. At the height of the immune response, treponemas form cysts, which are usually localized in the wall of blood vessels - the disease goes into remission. The decrease in immunity is accompanied by the return of the pathogen to the vegetative stage, its reproduction, resulting in relapses of the disease. Antibodies formed against antigenic complexes of microbial cells do not have protective properties. The ability of some antibodies (reagins) to react with a cardiolipin antigen is used in the serodiagnosis of syphilis.

The transferred disease does not leave immunity. After treatment, a recurrence of the disease is possible with reinfection. The natural susceptibility of people is relatively low: about 30% of people who have had contact with the patient fall ill. HIV infection reduces a person's natural resistance to syphilis.

The territorial distribution of the disease is ubiquitous. The incidence prevails in cities, among persons of sexually active age (20-35 years). Men get sick more often than women. Prostitution, homosexuality, casual sex, poor socio-economic conditions contribute to the spread of syphilis.

Symptoms. After infection, most often (90-95%) there is a classic course of infection, less often (5-10%) - primary latent (the first clinical manifestations in the form of late forms of infection after years and decades). The possibility of self-healing is allowed. It is assumed that the course of infection depends on the form of the pathogen. The undulating course of syphilis with the change of active manifestations of the disease by periods of a latent state is a manifestation of changes in the reactivity of the patient's body to pale treponema. In the classical course of syphilis, four periods are distinguished: incubation, primary, secondary, tertiary. The periods differ from each other in a set of syphilides - various morphological elements of the rash that occur in response to penetration into the skin and mucous membranes of pale treponemas. Incubation period, i.e. the period from infection to the appearance of the first clinical signs of the disease averages 3-4 weeks.

Syphilis goes through a series of stages that are almost equally manifested in men and women. At the primary stage, a small lesion is formed, the so-called hard chancre; it may resemble a pimple or take the form of an open sore. It usually appears 3 weeks after infection, but sometimes occurs after 10 days or 3 months. The chancre is usually painless and can be ignored. Most often, chancres, which in 70% of cases are painless, are located on the genitals and in the anal area, however, they can form on the lips, in the mouth, on the finger, on the chest, or on any part of the body where the pathogen has penetrated the skin, sometimes it is multiple, but may go unnoticed. At the same time, regional lymph nodes are enlarged. They are dense, mobile, painless, do not suppurate. Initially, the chancre has the appearance of a soft red spot, which then turns into a papule (nodule). The papule ulcerates, forming a round or oval ulcer, usually surrounded by a red border. An ulcer, painless, with a clean bottom, compacted and raised edges - a chancre. The size of the chancre varies, averaging 10-15 mm. The discharged chancre is highly contagious. After 4-6 weeks without specific therapy, the chancre usually heals, giving the false impression that "everything worked out" leaving behind a thin atrophic scar.

Complications of hard chancre are balanitis and balanoposthitis, caused by the addition of a bacterial or trichomonas infection with the development of acute inflammatory phenomena around the syphiloma, which in turn can result in the development of phimosis and paraphimosis with an increase and soreness of regional lymph nodes. Gangrenization is less commonly observed - an ulcerative necrotic process in the area of ​​​​a hard chancre and phagedenism - a progressive ulcerative necrotic process that develops in the tissues surrounding the primary syphiloma and is accompanied by bleeding. Like gangrenization, it is observed in weakened individuals - chronic alcoholics, HIV-infected, etc. Regional lymphadenitis (regional scleradenitis) is the second obligatory clinical symptom of primary syphilis. It is expressed in a peculiar increase and compaction of the lymph nodes closest to the chancre. In rare cases, it may be mild or absent. With the localization of a hard chancre on the genitals, inguinal lymphadenitis occurs: the lymph nodes are enlarged, dense, not soldered to each other and the surrounding tissues, mobile, have an ovoid shape, painless, springy on palpation. The skin above them is not changed. Characterized by an increase in lymph nodes ("pleiades"), one of which is the largest. Lymphadenitis can be bilateral and unilateral. It never suppurates and does not open. Specific regional lymphangitis is the third, less constant sign of primary syphilis. A lymphatic vessel is affected from a hard chancre to nearby lymph nodes. Its cord in the form of a densely elastic painless cord, sometimes with thickenings along its course, is usually palpable on the dorsal surface of the penis. Approximately from the 3rd-4th week of the existence of a hard chancre, a specific polyadenitis occurs - an important concomitant symptom of massive hematogenous dissemination of pale treponemas. At the end of the primary period, approximately 5% of patients develop general symptoms (headaches, night pains in the bones and joints, insomnia, irritability, general weakness, fever, sometimes up to 39-40 ° C), as well as changes in the blood with mild hypochromic anemia, leukocytosis , an increase in ESR (up to 30-60 mm / h). In other cases, syphilitic septicemia proceeds without fever and general symptoms, and the transition from the primary stage of syphilis to the secondary occurs imperceptibly for the patient himself.

There may be deviations from the typical course of syphilis. In particular, when the pathogen enters the bloodstream (for example, with a deep cut, blood transfusion), the disease begins with secondary rashes. This is the so-called headless syphilis, syphilis without hard chancre, transfusion syphilis. In some patients with late forms (with a disease duration of more than 2 years), only internal organs or the nervous system (neurosyphilis) are affected.

The secondary stage usually begins 6 to 10 weeks after infection. The period of secondary syphilis lasts 2-4 years, characterized by remissions and relapses. Clinically, it can manifest as a flu-like syndrome with a slight increase in body temperature, headaches, weakness, anorexia, weight loss, myalgia, sore throat, arthralgia and generalized lymphadenitis. Symptoms: pale red or pinkish rashes (often on the palms and soles), sore throat, headache, joint pain, poor appetite, weight loss and hair loss. Wide warts (condyloma lata) can appear around the genitals and in the anal area, which are very contagious. Due to this variety of symptoms, syphilis is sometimes called the "great mimic". Symptoms of the secondary period of syphilis usually persist for 3-6 months, but they may periodically disappear and reappear. After the disappearance of all symptoms, the disease passes into a latent stage, when the patient is no longer contagious, but the pathogen is introduced into various tissues: the brain and spinal cord, blood vessels, bone tissue. In 50-70% of patients with untreated syphilis, this period continues until the end of their lives, but in the rest, the disease passes into the tertiary, or late, period of syphilis.

By this time, the chancre disappears, even without treatment, and treponema enters the bloodstream and spreads throughout the body. A rash appears all over the body or only on the arms or legs. Sometimes small sores develop in the mouth or around the vulva (external female genital organs). Like the primary chancre, secondary sores and rashes are highly contagious. Like the manifestations of the primary stage, these symptoms eventually disappear. Skin changes are expressed by an erythematous spotted rash that occurs first on the trunk and on the upper limbs. The rash progresses, acquires a generalized character, is not accompanied by itching, acquires a copper color, is especially noticeable on the palms and feet. Initially, the rash may acquire a maculopapular character (spotted and papular syphilides), affect hair follicles and cause localized hair loss. The formation of pustules (pustular syphilis) may also occur. Changes can occur on the mucous membranes (mucous plaques), forming oval, slightly raised erosions, covered with a gray coating and surrounded by a zone of redness. Skin changes in secondary syphilis always pose a great infectious danger. Papular syphilides are also the main manifestations of secondary syphilis. These are stripless formations, sharply delimited from the surrounding healthy skin, protruding above its level and containing a large number of pale treponemas. In most cases, they are located on the body. In general, syphilitic papules are not accompanied by subjective sensations, but pressing on them with a bellied probe causes acute pain - a symptom of Yadasson. The appearance of syphilitic papules depends on their localization, the duration of the infection, and the characteristics of the patient's skin. There are several forms of papular syphilides. Lenticular (lenticular) syphilis is more often observed in secondary fresh syphilis, it is represented by clearly delimited flat rounded papules the size of a lentil, bluish-red in color, densely elastic consistency, with a smooth shiny surface. Gradually, the papules acquire a yellowish-brown hue, flatten, and a meager collar peeling appears on their surface. Miliary syphilide is small in size (with a poppy seed) and has a semi-conical shape of papules; nummular (coin-like) - characterized by a significant size of papules (with a large coin and more), a tendency to grouping; annular, the elements of which are more often located on the face and neck; seborrheic, in which papules are localized on the face, along the edge of the forehead (“crown of Venus”) and are distinguished by greasy scales on the surface; erosive (weeping), in which the papules are distinguished by a whitish macerated, eroded or weeping surface, which is due to localization on the mucous membrane and in the corners of the mouth and skin folds, is one of the most contagious manifestations of syphilis. Wide condylomas (vegetative papules) are located in places of friction, physiological irritation (genital organs, anus, less often - axillary, inguinal folds and navel). They differ in large sizes, vegetation (growth up) and eroded surface. Horny papules (syphilitic calluses) are characterized by a powerful development of the stratum corneum on the surface, very similar to calluses, psoriasiform papules are characterized by pronounced peeling on the surface. Papular rashes, which often appear on the mucous membranes, especially the mouth, clinically correspond to erosive (weeping) papules. In the oral cavity, erosive papular syphilis most often occupies the soft palate and tonsils (syphilitic papular angina). Papular rashes on the mucous membrane of the larynx lead to hoarseness.

Pustular syphilis is a rare manifestation of secondary syphilis. They begin as a pustule and rapidly evolve to form a crust or scale and usually occur in individuals with reduced body resistance, suffering from tuberculosis, alcoholism, malaria, etc. Sometimes accompanied by fever and weight loss.

Depending on the location, size and degree of decay of the elements, five varieties of pustular syphilis are distinguished. Acne-like - small conical pustules on a dense papular base, quickly dry into crusts and slowly resolve. Impetiginous - superficial pustules that form in the center of papules and quickly shrink into a crust. Smallpox-like - differs in spherical pustules the size of a pea, the center of which quickly dries into a crust, located on a dense base. Syphilitic ecthyma - late syphilis (six months and later from the onset of the disease): deep rounded a pustule the size of a large coin, quickly dries into a thick crust encrusted in the skin, upon rejection of which an ulcer occurs with steeply cut edges and a peripheral roller of a specific purple-cyanotic infiltrate; Ecthymas are usually solitary and leave a scar. The syphilitic rupee is an ecthymous element under the layered conical (oyster) crust due to the growth and re-decay of a specific infiltrate. Usually single, heal with a scar.

Acne-like, impetiginous and pox-like syphilides are observed, as a rule, with secondary fresh syphilis, and deep varieties (ecthyma and rupee) - with recurrent. The combination of pustular, ulcerative and pustular rashes is a manifestation of the so-called malignant syphilis, which occurs in immunosuppressed patients (including HIV-infected people, alcoholics, etc.), with which the rashes are located mainly in the head and neck, and can also be accompanied by damage to the oral mucosa . When localized on the tonsil and soft palate, the process looks like a pustular-ulcerative sore throat. Patients with malignant syphilis have fever, chills, weight loss, but no lymphadenopathy. Seroreactions for syphilis become positive at later dates. In the absence of appropriate therapy, a fatal outcome is possible.

Syphilitic baldness is usually observed with secondary recurrent syphilis and manifests itself in three varieties. With diffuse baldness, any part of the skin can undergo baldness, but the scalp, including the temporal and parietal regions, is more often affected. Small-focal baldness is manifested by multiple small foci of baldness of irregularly rounded outlines, randomly scattered over the head (especially in the temples, nape, beard), and resembles fur eaten by moths. This form is characterized not by complete loss, but by partial thinning of hair; sometimes small focal alopecia affects the outer third of the eyebrows and eyelashes, which are of unequal length - "stepped" eyelashes, a symptom of Pinkus. With mixed baldness, there are signs of both varieties. Syphilitic baldness exists for several months, after which the hairline is completely restored. Syphilitic leucoderma (pigmented syphilide) is pathognomonic for secondary (usually recurrent) syphilis, is more common in women, is localized mainly on the lateral and posterior surfaces of the neck (“necklace of Venus”) and is characterized by hypopigmented rounded spots the size of a nail. There are spotted and lacy syphilitic leukoderma, when there are a lot of spots and they almost merge with each other, leaving only small stripes from a hyperpigmented background. Leukoderma exists for a long time (sometimes many months and even years), its development is associated with damage to the nervous system. In the presence of leukoderma in patients, as a rule, pathological changes in the cerebrospinal fluid are observed. Secondary syphilis is also accompanied by damage to many organs and systems. These are meningitis, hepatitis, glomerulonephritis, bursitis and (or) periostitis, etc. Naturally, a violation of laboratory parameters reflecting these lesions. The same patient may have spots, nodules, and pustules. The rashes last from several days to several weeks, and then disappear without treatment, so that after a more or less long time they are replaced by new ones, opening a period of secondary recurrent syphilis. New rashes, as a rule, do not cover the entire skin, but are located in separate areas; they are larger, paler (sometimes barely visible), and tend to cluster into rings, arcs, and other shapes. The rash may still be patchy, nodular, or pustular, but with each new appearance, the number of rashes decreases, and the size of each of them is larger. For the secondary recurrent period, nodules are typical on the external genital organs, in the perineal region, the anus, and under the armpits. They increase, their surface becomes wet, forming abrasions, weeping growths merge with each other, resembling cauliflower in appearance. Such growths, accompanied by a fetid odor, are not painful, but can interfere with walking. In patients with secondary syphilis, there is the so-called "syphilitic angina", which differs from the usual one in that when the tonsils are reddened or whitish spots appear on them, the throat does not hurt and the body temperature does not rise. On the mucous membrane of the neck and lips, whitish flat formations of oval or bizarre outlines appear. On the tongue, bright red areas of oval or scalloped outlines are distinguished, in which there are no papillae of the tongue. There may be cracks in the corners of the mouth - the so-called syphilitic seizures. Brownish-red nodules "crown of Venus" sometimes appear on the forehead encircling it. In the circumference of the mouth, purulent crusts may appear that mimic ordinary pyoderma. A very characteristic rash on the palms and soles. If any rashes appear in these areas, it is imperative to check with a venereologist, although skin changes here may also be of a different origin (for example, fungal). Sometimes on the back and sides of the neck, small (the size of a little finger nail) rounded light spots are formed, surrounded by darker areas of the skin. "Necklace of Venus" does not peel off and does not hurt. There is syphilitic alopecia (alopecia) in the form of either uniform hair thinning (up to pronounced), or small numerous foci. It resembles fur beaten by moths. Eyelashes often fall out as well. All these unpleasant phenomena occur after 6 or more months after infection. For an experienced venereologist, a quick glance at the patient is enough to make a diagnosis of syphilis based on these signs. Treatment quickly enough leads to the restoration of hair growth. In debilitated, as well as alcoholic patients, multiple ulcers scattered throughout the skin, covered with layered crusts (the so-called "malignant" syphilis), are not uncommon. The defeat of the nervous system in the secondary period of syphilis is usually called early neurosyphilis, characterized by damage to the meninges and blood vessels.

In the secondary period, almost all organs and systems may be involved in a specific process, although this does not happen often. Bones and joints, the central nervous system and some internal organs are mainly affected. Periostitis occurs in 5% of patients in the form of diffuse thickenings, manifesting as painful test-like swelling and nighttime pain in the bones. The bones of the skull and tibia are most commonly affected. Damage to the joints usually proceeds according to the type of polyarthritic synovitis with the formation of effusion in the joint cavity. The joint appears swollen, enlarged, painful pressure. The appearance of pain in the joint when trying to move and their disappearance during movement are very characteristic. The most common specific visceritis of the secondary period: syphilitic hepatitis (enlargement and soreness of the liver, fever, jaundice), gastritis, nephrosonephritis, myocarditis. Syphilitic visceritis quickly disappears after specific treatment. A neurological examination with an analysis of the cerebrospinal fluid reveals syphilitic meningitis (often asymptomatic), sometimes complicated by hydrocephalus, as well as syphilis of the cerebral vessels (meningovascular syphilis), less often - syphilitic neuritis, polyneuritis, neuralgia. A positive Wasserman reaction in secondary fresh syphilis is observed in 100% of cases, in secondary recurrent - in 98-100%.

If the patient has not been treated, then a few years after infection, he may have a tertiary period. In some patients, at the end of the secondary stage, any symptoms disappear forever. However, in others, they, remaining hidden for 1–20 years, are renewed. During the latent (latent) period, treponemas are carried by blood and enter various tissues of the body. The defeat of these tissues leads to severe consequences characteristic of the tertiary (late) stage of syphilis.

Tertiary syphilis, onset in 5-10 years, is a slowly progressive inflammatory process in adults that can develop in any organ. This stage of the disease is expressed by the formation of nodes (gum) and the development of cardiovascular disorders, diseases of the kidneys, liver, lungs, etc. The aorta and heart are most commonly affected. Already in the early stages of the disease, syphilitic meningitis, meningoencephalitis, a sharp increase in intracranial pressure, strokes with complete or partial paralysis, etc. can develop. III stage of syphilis. Single large nodes appear on the skin up to the size of a walnut or even a chicken egg (gum) and smaller ones (tubercles), usually located in groups. The gumma gradually grows, the skin becomes bluish-red, then a viscous liquid begins to stand out from its center and a long-term non-healing ulcer with a characteristic yellowish bottom of a “greasy” appearance is formed. Gummy ulcers are distinguished by their long existence, dragging on for many months and even years. Scars after their healing remain for life, and by their typical star-shaped appearance, it can be understood after a long time that this person had syphilis. Tubercles of igumma are most often located on the skin of the anterior surface of the legs, in the area of ​​​​the shoulder blades, forearms, etc. One of the frequent places of tertiary lesions is the mucous membrane of the soft and hard palate. Ulcerations here can reach the bone and destroy the bone tissue, the soft palate, wrinkle with scars, or form holes leading from the oral cavity to the nasal cavity, which makes the voice acquire a typical nasality. If the gummas are located on the face, then they can destroy the costinos, and it "falls through." At all stages of syphilis, internal organs and the nervous system can be affected. In the first years of the disease, syphilitic hepatitis (liver damage) and manifestations of “hidden” meningitis are found in some patients. With treatment, they pass quickly. Much less often, after 5 years or more, these organs sometimes form seals or gums, similar to those that appear on the skin.

The aorta and heart are most commonly affected. A syphilitic aortic aneurysm is formed; in some part of this most important vessel for life, its diameter expands sharply, a sac with strongly thinned walls (aneurysm) is formed. An aneurysm rupture leads to instant death. The pathological process can also “slide” from the aorta to the mouths of the coronary vessels that feed the heart muscle, and then angina pectoris attacks occur, which are not relieved by the means commonly used for this. In some cases, syphilis causes myocardial infarction. Already in the early stages of the disease, syphilitic meningitis, meningoencephalitis, a sharp increase in intracranial pressure, strokes with complete or partial paralysis, etc. can develop. These severe events are very rare and, fortunately, respond well to treatment. Late lesions (tasca dorsalis, progressive paralysis). They occur if a person has not been treated or has been treated poorly. With spinal dryness, pale treponema affects the spinal cord. Patients suffer from attacks of acute excruciating pain. Their skin becomes so desensitized that they may not feel the burn and only pay attention to skin damage. The gait changes, it becomes “duck”, difficulty urinating appears at first, and later urinary and fecal incontinence. Damage to the optic nerves is especially severe, leading to blindness in a short time. Gross deformities of large joints, especially the knees, may develop. Changes in the size and shape of the pupils and their response to light are detected, as well as a decrease or complete disappearance of tendon reflexes, which are caused by a hammer strike on the tendon below the knee (knee reflex) and above the heel (Achilles reflex). Progressive paralysis usually develops after 15-20 years. This is irreversible brain damage. Human behavior changes dramatically: working capacity decreases, mood fluctuates, the ability to self-criticism decreases, either irritability, explosiveness appear, or, conversely, unreasonable gaiety, carelessness. The patient does not sleep well, his head often hurts, his hands tremble, his facial muscles twitch. After a while, he becomes tactless, rude, lustful, reveals a tendency to cynical abuse, gluttony. His mental faculties fade, he loses his memory, especially for recent events, the ability to correctly count with simple arithmetic operations “vume”, when writing he skips or repeats letters, syllables, his handwriting becomes uneven, sloppy, his speech is slow, monotonous, as if “stumbling”. If treatment is not carried out, then he completely loses interest in the world around him, soon refuses to leave the bed, and with the phenomena of general paralysis, death occurs. Sometimes with progressive paralysis there is mania, sudden attacks of excitement, aggression, dangerous to others. Tertiary syphilis develops in about 40% of patients in the 3rd-4th year of the disease, continues indefinitely and is manifested by the development of a specific inflammation - infectious granuloma. The manifestations of the tertiary period are accompanied by the most pronounced, often indelible disfigurement of the patient's appearance, severe disorders in various organs.

2011-03-18 20:04:16

Yury Romanov asks:

Romanov Yu.S. born in 1962 II gr. blood(+)
I quit active sports (volleyball) in March 2008. I smoked for almost 30 years, I quit a year ago.
Case history September 2008 - pain in the shoulders, forearms (more muscular), in the chest, between the shoulder blades, accompanied by a slight dry cough. The pain is not constant, with attacks from half an hour to 1.5-2 hours. .- "twists" his hands. The therapist sent him for a consultation with a pulmonologist and a neuropathologist. Diagnosis by a pulmonologist: COPD type 1-2. Pass tests for uric acid, LE cells, coagulogram. From these tests, the excess of the norm for uric acid, the rest are normal. He prescribed allopurilic acid, meloxicam, fromilid uno (I don’t know why the antibiotic). Chest x-ray: no bone changes.
Assigned to: massage, vitamin B12, mucosat 20 amp, Olfen No. 10 in amp. After the use of these drugs, no improvement was observed. The pains either disappeared on their own for 2-3 weeks, then appeared for 1-2 weeks, but they were also paroxysmal. That is, the condition is excellent and suddenly, within 10-15 minutes, the condition is like at a temperature above 38-38.5 degrees. Over time, new ones were added symptoms are pain in the calf muscles, submandibular pain.
Passed tests for: helminths: toxocar. echinococcus, opisthorchis, ascaris, trichinosis-not found. Just in case, he drank 3 days of Vormil.
Tests for: Chlamydia, Giardia-negative, HIV, syphilis-negative, Toxoplasma-lgG-155.2 at a rate of less than 8 IU / ml. lgM-not detected.
Fibrobronchoscopy - diffuse endobronchitis with moderate mucosal atrophy.
Fibroesophagogastroduodenoscopy: d\z-peptic ulcer of the duodenal bulb 12. Hp-test-positive. Passed a course of treatment.
Analyzes for antibodies to native DNA: 1Y-29.0109Y.-0.48 POS.
2nd-27.05.09-0.32 positive
3rd-14.09.09-0.11-negative.
4th-23.02.2010-44IU/ml-posit.
5th-18.05.2010-20.04 IU/ml-neg.
6th-17.11.2010-33 IU/ml-position
Immunoglobulin class M: 2.67 at a rate of 0.4-2.3 (29.01.09)
SLE test - from 05/26/2009, and 11/17/2010 - negative. Analyzes for rheumatic tests were within the normal range.
There is a CT scan of the abdomen and an MRI of the lumbar spine. No pathologies.
During this time, neither the therapist nor the neuropathologist made an accurate diagnosis. Didn't go to other doctors. I passed almost 90% of the tests without referrals from doctors, by typing. Only once the variant sounded - SLE. I drank delagil for a month, 1 tablet each, with dolaren attacks.
Symptoms of aches in the muscles (90%) and joints (10%) of the arms and legs still appeared and disappeared for 10-15 days.
Since the autumn of 2010, muscle pains began with the shoulders and forearms, submandibular pains, pains in the chest and between the shoulder blades.
On November 16, 2010, he turned to a therapist at another hospital, because such pains were accompanied by depression. Constantly on painkillers, but you need to work, the impossibility of controlling the onset of seizures.
Direction for X-ray of the cervical, thoracic, right shoulders. joint. Based on the data, he was referred to a neuropathologist. The conclusion is osteochondrosis of the cervical and thoracic regions. Assigned - lidocaine in amp No. 10, vitamin B12, massage No. 10. The neuropathologist could not explain the above listed symptoms.
Consultation of a city rheumatologist-data in favor of SLE and rheumatoid arthritis – NO. Assigned: Olfen in amp. No. 10, Vitamins B1, B6, B12. Lyrica 1 ton 2 times a day. According to the consultations of a neuropathologist and a rheumatologist, the therapist prescribed:
Olfen No. 10, Lidocaine 2.0 No. 10, Prozerin 1.0 ml No. 10, Vitamin B12 No. 10, Gabalept 1 ton per month, massage.
Started treatment on 25.11.2010. From 1.12.2010, the symptoms began to change. The muscles below the elbows, hands, fingers began to hurt more strongly. Aches in the calf muscles, ankles, knees. Feeling of swelling of the arms and legs (below the knee joints). These symptoms appear from morning until bedtime + bouts of aches are added (as at a temperature of under 38 degrees) also from half an hour to 1.5 -2 hours.
From 10.12.10 symmetrical pains appeared in the small joints of the hands, in the wrist joints, and the ankles. After sleep, stiffness was felt both in the hands and in the legs. Under load, pain in the ankles increased with recoil under the heel, in the knees. There was a crunch in the joints of the arms and legs, which had never been observed before. These symptoms persisted until rest. Didn't bother at night.
At the same time, paroxysmal pain disappeared.
Since the appointment with the doctor at a certain time did not take place and was postponed, and the pain did not go away, but intensified, I started taking METIPRED 4 mg once a day. By December 20, 2010, the condition improved. The pain became weaker, but it still manifests itself in the fingers and hands, ankles and knees. The puffiness subsided, but sometimes it is felt in the hands. Pain appeared in the shoulders and hips. The crunch in the joints did not go away. Pain is especially strong in places of sports injuries of the ankle of the left, right knee joint, fracture of the wrist of the right hand. I did blood tests and everything was normal. A detailed blood test, taking into account the intake of Metipred (day 4), all indicators are normal.
The attending therapist directs to the neuropathologist and the traumatologist - reception 12/21/10. I am tired of the lack of a diagnosis. It can be very bad, but I don’t know which doctor to turn to, I don’t even know who to take a sick leave to lie down. Tell me what to do or who to contact for help!
Joint consultation of a neuropathologist and a traumatologist:
Neurologist - d\z: multiple sclerosis? An MRI of the head was recommended.
Traumatologist - there are no data for trauma and orthopedic pathologies in the acute stage.
In words, he said that you need to contact a rheumatologist about mixed collagenosis.
December 24, 2010 - underwent an MRI of the brain, the result is below.
After undergoing an MRI, the neurologist sent me to the regional clinic to see a neurologist with a diagnosis of:
- discirculatory encephalopathy, cephalgia, Sd?
To a rheumatologist:
myasthenic syndrome, SLE, rheumatoid arthritis.
From 12/23/10 I caught a cold (pain in the nasopharynx, temperature 37.8) - I started taking Arbidol, Amoxil. Three days later I felt the absence of pain in the joints of the fingers, hands, ankles, it became easier in the knees when walking.
There was a slight stiffness in the morning, disappearing after 5-10 minutes, there was a crunch in the joints. Significantly improved mood and general condition.
26.12.10 - interrupted the intake of METIPRED, taking it for 14 days from a dose of 4 mg-7 days and lowering it to 1 mg by the 14th day.
Approximately from 08.01.11. again there were pains in the small joints of the hands, ankles. Again he began to take Metipred 2 mg 1 r / d. The condition is average, the joints are crunchy. From 16.01. I take 1 mg metipred, sometimes reducing dolaren when the pain increases. Pain in the left ankle and right knee joint is especially reflected when moving up the stairs.
Consultation of the chief rheumatologist-d\z: RA.
For confirmation, he was sent to the regional clinic in the department of rheumatology. On the basis of x-rays, osteoarthritis of the small joints of the hands and feet was diagnosed.
The prescribed course of treatment by the rheumatologist of the region: arcoxia 60, 1 ton for 10 days, mydocalm 150 mg. 1r\10 days, artron complex 1t.2 r\d, calcium D-3, topical ointment.
At present, after taking these medications, the condition has worsened. The joints of 3-4 fingers of the hands are sore, swollen. In the morning there is a slight stiffness in the hands for 10-15 minutes. The joints are slightly swollen, also pain in the wrists. Pain in the hip joints in the region of the left greater trochanter and both ischial tuberosities progresses. Pain when walking under load. both ankles.
Again he turned to the glurematologist of his city. He prescribed Olfen at 100 mg 1r / d, movalis 2 mg i.m. h / d., continue artron complex.
10 day course of treatment gave nothing.
Today I was at the reception again, prescribed Metipred 2 mg r / d to the above described drugs.
I am at a loss! Unofficially, he diagnoses RA, but does not officially confirm it - if visual symptoms appear, he will confirm the diagnosis, and since the tests are clean, and pain cannot be “put to work”!
Time is running out for treatment. Tell me what should I do? Go to Kyiv? And there, too, without clinical manifestations, they kick back! And to whom - to a private clinic or to a public hospital?
Thank you for your attention! Sorry for the confusion.
Regards, Yuri.

2013-02-12 15:08:33

Vyacheslav asks:

Good afternoon!
Chronic HA VEB, as I think, for 5 years now has been a painful (more or less) daily test for me, causing lymphadenopathy in the ears, neck, submandibular nodes, which decreases in summer, increases in spring, causing chronic fatigue, more or less pronounced also seasonal.
Please help in prescribing treatment, because. to this day I have not treated anything, but, as I see it, the body is unlikely to cope on its own, and there will be a chronic process.
Briefly about myself: a man, born in 1980, Ukrainian, did not suffer from any chronic diseases, was not registered with any doctors for any diseases, I do not smoke, I almost do not drink alcohol, athletic build, 4th blood group Rh +
History of symptoms and illness.
In April 2007, my 4-year-old son, like his entire group in the kindergarten, fell ill with chickenpox. A lymph node inflamed behind his ear, fever, spots, then everything went away. At the same time, as it turned out, the persons in contact with me had infectious mononucleosis (not chickenpox), and after 14 days, expecting chickenpox (because I had not been sick in childhood), I felt an increase in the lymph node behind my ear, like in a son, but there were no red ulcers, there were pharyngitis, the submandibular nodes and / or salivary glands swelled, on the back, on the back of the head and a little on the parietal, there were unpleasant sensations, as if internal pressure, or inflammation, and, it is this sensation that is still , periodically increasing, then almost disappearing, but it has been annoying me for 5 years terribly.
At first I did not understand that the problem with the right ear was due to the lymph node, I went to the ENT, I was prescribed antibiotic injections for otitis, immediately after which a rash appeared in the neck and shoulders (although I had never been allergic to anything), and I refused to prick them.
Treatment of pharyngitis with all sorts of rinses, despite the fact that I had it very rarely before, and went away in 3 days, then it lasted for 3 weeks, but the throat went away, but lymphadenopathy on the head (in the sense of feeling pressure on the back of the head below and behind ears) did not pass, although it decreased. This problem periodically became barely noticeable, but sometimes, especially with any cold / flu disease, it increased many times over.
I couldn’t understand what was happening to me, and I didn’t think about herpes, because I never, and still don’t have any classic herpetic manifestations (sores on my lips, etc.) and don’t.
Today the situation does not change, but, at the insistence of my relatives, I had to start an examination and take tests.
VERY PLEASE HELP IN THE INTERPRETATION OF THE ANALYSIS AND THE PURPOSE OF TREATMENT! And give advice on where it is treated, specifically, professionally, because. there is no such clinic in my region, and I myself am already an amateur in this matter. my email address: [email protected]
ANALYSIS CARRIED OUT:
1. Blood from a vein for viruses:
a) HIV negative
b) RV/syphilis - negative
c) Hepatitis B - negative
d) Hepatitis C - negative
2. Blood from a vein liver tests:
- Alanine aminotransferase ALT U / l (F: up to 34 M: up to 45) - 35.8 - norm
- Aspartate aminotransferase ACT U / l (W: up to 31 M: up to 35) - 15.4 - norm
- Alkaline phosphatase ALP U / l (Adults up to 258) - 152 - normal
- Gammaglutamyltransferase U / l (Male up to 55) - 41.0 - norm
- Total protein g / l (Adults - 65-85) - 72.3 - norm
- Total bilirubin µmol / l (Adults - 1.7 - 21.0) - 15.5 - normal
- Direct bilirubin µmol/l (0-5.3) - 2.2 - norm
- Indirect bilirubin µmol / l (Up to 21) - 13.3 - norm
3. Blood from a vein hematological analysis:
Leukocytes WBC G/l (4.0 - 9.0) 6.0 – norm
Absolute number of lymphocytes Lymph# G/l 1.2 - 3.0 2.5 - norm
Absolute content cells avg. solution Mid# G/l 0.1 - 0.6 0.6 - norm
Absolute content granulocytes Gran# G/l 1.2 - 6.8 2.9 - norm
Hemoglobin HGB g/L Male (- 140 - 180) - 141 - norm
Erythrocytes RBC T / l (3.6 - 5.1) - 4.83 - norm
Hematocrit HCT % Male - 40 - 48 - 45.3 normal
Mean cell volume of erythrocyte MCV fl (75 - 95) 93.9 - norm
Hemoglobin concentration in one erythrocyte MCH pg (28 - 34) 29.1 - normal
The average corpuscular concentration of hemoglobin in erythrocytes MCHCg / L (300 - 380) 311 - the norm
Coef. variations in the width of the distribution of erythr-in RDW-CV% (11.5 - 14.5) 13.2 - norm
Width of distribution erythr-in - standard deviation RDW-SD fl (35.0 - 56.0) 45.1 - norm
Platelets PLT G/l (150 – 420) 328- norm
Average platelet volume MPV fl (7 - 11) 9.6 - normal
Platelet distribution width PDW% (14 -18) 14.5 - normal
Thrombocrit PCT ml/L 0.15 - 0.40 0.314 - norm
Basophils % (0 - 1) 0 - normal
Eosinophils % (1 - 6) 1 - norm
Myelocytes % 0 0 - normal
Metamyelocytes % 0 - normal 0
Band % (1 - 5) 4 - norm
Segmented % (over 12 years old - 47 - 72) 47 - norm
Lymphocytes % (over 12 years old - 19 - 37) 39 - not the norm!
Monocytes % - (3 - 10) 9 - norm
Plasma cells % (0 - 1) 0 - normal
Virocytes % 0 0 - norm
ESR mm / h (Male - 1 - 10, Women - 2 - 15) - 20 is not the norm!
4. Blood from a vein analysis for the Epstein-Barr virus:
- mononucleosis heterophile antibodies - negative - normal
- IgM to EBV capsid antigen Od/ml (norm less than 0.9) - 0.11– norm
- IgG to capsid antigen EBV S/CO (norm less than 0.9) - 23.8 - not the norm!
- IgG to the nuclear antigen EBV S / CO (norm less than 0.9) - 38.4 - not the norm!
- EBV DNA (Epstein-Barr virus), PCR - not detected - normal

Responsible Agababov Ernest Danielovich:

Good afternoon Vyacheslav, you don’t only have blood tests, do you? There should also be instrumental research methods - X-ray, ultrasound, etc. in order to objectively assess your situation, you need to familiarize yourself with all the examinations done, send it to me by mail - [email protected]

It is unlikely that anyone will call syphilis a little-studied disease, but scientists still do not have a consensus on the question of where exactly this disease came from and how it spread across our planet. For the dubious honor of being called the birthplace of syphilis, several places on the globe can argue at once - among them are Haiti and Africa, America and India.

There are several very convincing hypotheses of the origin of this disease at once, but the end of their discussion has not yet been set, and it is unlikely that world science will ever be able to completely give preference to any one of these theories.

Debut on the European stage
It must be said that the desire to blame foreigners for some kind of misfortune (for example, a dangerous illness) was characteristic of people already in ancient times. Therefore, in Europe until the 15th-16th centuries, syphilis was given different, but, in general, the same name. If in France it was called Neapolitan disease, then in Spain and Germany - French, and in Greece - Syrian; in other countries, syphilis was then called the Venetian, Italian, Portuguese, Castilian, Turkish, Polish and even Courland disease.
Around this time, European medicine finally singled out syphilis as an independent disease. This was due to an unprecedented epidemic of this disease that broke out at the end of the 15th century in southern Europe - the first historically recorded outbreak of syphilis. There are three main hypotheses for the emergence of this disease in Europe.

Where did the name "syphilis" come from?
The name "syphilis" was first heard, oddly enough, not at all in a dry scientific work, but in ... a poetic poem, which was published in Verona, in the homeland of Romeo and Juliet, in 1530 by an Italian poet, astronomer and doctor (then such a combination was commonplace). The author's name was Girolamo Fracastoro, and the poem was called Syphilis, or the French Disease. In it, a swineherd named Siphil bravely challenged the Olympian deities, and they punished him with an illness, the name of which the poet produced on behalf of his hero. It is to this poem that the disease, with its until then “international” name, owes its modern name. The poem soon gained wide popularity, it can be called the first popular science work on syphilis, since it was read not only by doctors, but by all more or less educated people.

"Souvenir" of Columbus
According to the first version, to which most historians are inclined, syphilis is of American origin and was brought to Europe by the sailors of Christopher Columbus. This version is confirmed by the fact that the first epidemic coincided with the return of the first expedition of Columbus from the West Indies (by the way, the cause of death of Columbus himself was aortitis, possibly of syphilitic etiology).
As you know, in America, spirochetosis is an endemic disease of some species of local ungulates, in particular llamas, from which microorganisms could get to the natives, and from them to the sailors of Columbus.
One of the Catholic missionaries who accompanied the Spanish fleet described in detail the disease, accompanied by rashes on the skin, which the Indians of Haiti suffered at the time when Columbus landed on the island. The symptoms of this disease fit perfectly into the clinical picture of syphilis.
It is worth mentioning a rather remarkable book, which was published in 1542 by the Spanish physician Rodrigo Diaz de Isla: "On the serpegic disease from the island of Hispaniola." According to de Isla, participating in the expedition of Columbus, he treated the sailors from one of the ships; their illness was accompanied by fever and a profuse rash. True, in addition to these facts, the book contains a sufficient number of unlikely stories, or even simply fantasies (perhaps this is due to the fact that de Isla wrote his book when he was already a very old man, or maybe he just wanted to make it more “interesting”. "). So, he writes that he examined tens of thousands of such patients, and claims that “throughout Europe there is not a single village where out of 100 inhabitants at least 10 people did not die of syphilis” - a clear exaggeration even taking into account the epidemic. In addition, describing the high contagiousness of the disease, the author says that it affects even plants if they are sprinkled with contaminated water, and describes in detail the pustules that developed on a head of cabbage.

Blame the war
The subsequent rapid spread of syphilis throughout Europe is associated with the military campaign of the French king Charles VIII, who in 1494 set off to conquer Naples with a huge army. Among his soldiers were sailors from the ships of Columbus, recently returned from America, and more than 800 canteens - it is not difficult to imagine how lightning the infection spread throughout the French army. In turn, the occupation of Italian territories by this army also greatly contributed, for obvious reasons, to the spread of the disease among the civilian population.
The historiographer of the Venetian Republic, Cardinal Pietro Bembo (by the way, a close friend of Girolamo Fracastoro) very expressively described the clinical picture of this disease: “Some patients were covered from head to toe with disgusting black buboes, large in size and so terrible that these people, abandoned by their brothers , there was nothing left but to wish for a speedy death in the forests and mountains where they were abandoned. In others, these buboes, which in hardness surpassed tree bark, appeared in various places, on the face and back of the head, on the forehead, on the neck, on the back, so that they pulled out their nails from suffering. Still others had deep ulcers all over their bodies, spreading such a nasty smell that those around them fled from them. These unfortunates paid dearly for their little pleasure: they were covered with scabs from head to knees, some lost their lips, others their eyes. The latter could no longer see how their "male pride" fell to the ground like a rotten fruit.
After the end of the Neapolitan campaign, the mercenaries of Charles VIII and the soldiers of the military coalition returned home, spreading the disease throughout Europe. According to the historical chronicles of that time, already a few years after the war, the "French disease" captured Italy, France, Switzerland and Germany, and then spread to Austria, Hungary and Poland, penetrating indiscriminately into all sectors of society. It is known that Pope Paul III specifically invited Fracastoro (who was apparently considered the most prominent specialist in syphilis) to treat high-ranking church dignitaries.
250 years after those events, the great philosopher Voltaire spoke very sarcastically about this war: “In their frivolous campaign against Italy, the French acquired Genoa, Naples and syphilis. Then they were driven back and lost Naples and Genoa, but not everything was lost - syphilis remained with them.
Soon, moving along the trade routes, the disease spread to North Africa, Egypt and Turkey; in addition, it penetrated into South and Southeast Asia, China, India and Japan (an outbreak of syphilis in 1512 in Kyoto is described).

Or maybe not…
However, the "American" hypothesis of the origin of syphilis today meets a number of very serious objections. First, the researchers provide compelling evidence that syphilis existed in Europe before the 1495 epidemic. For example, in Ireland, several centuries before, they knew the "disease of French pustules", whose clinical picture, according to the descriptions, is very similar to syphilis. In addition, it is known that long before the expeditions of Columbus, Popes Alexander VI, Julius II and Leo XI, as well as the famous French poet Francois Villon, suffered from syphilis.
Secondly, scientists question the role that Columbus's sailors may have played in the spread of the disease. When studying historical documents, it becomes clear that no more than ten sailors of Columbus could become mercenaries of Charles VIII. Considering the timing of the stages, the degree of contagiousness and the described clinical manifestations, we can conclude that the epidemic that engulfed most of the population of Naples could not theoretically or practically be caused by ten patients, even if they were at their maximum sexual activity. Another circumstance important from the standpoint of the general pathology of syphilis is that, even if the sailors were infected shortly before sailing from America, they were all already at a late, practically non-infectious stage of the disease.

The same age as medicine
The second hypothesis states that syphilis was well known in ancient times. The Ebers papyrus is cited as evidence, which refers to the disease of uhedu, which in its symptoms is very similar to syphilis. Assyrian cuneiform tablets found in the library of King Ashurbanipal describe the story of King Nimrod - the gods, angry with him, struck the king with a serious illness, from which a rash appeared all over his body and ulcers appeared.
Hippocrates and Celsus described the symptoms of syphilis quite accurately several centuries before our era, and a little later Plutarch and Horace wrote about scars and ulcers that appeared on the faces of depraved people. The biographer of the Roman Caesars, Gaius Suetonius Tranquill, mentioned similar skin diseases of the emperors Octavian and Tiberius, the Roman physician Claudius Galen also described some of the symptoms of syphilis in his writings. So, relying on the authority of the founders of ancient medical science, it can be argued that syphilis, including in Europe, has existed for at least as long as medicine itself.
However, there is one circumstance that prevents unconditionally accepting this hypothesis. Indeed, no matter how all the descriptions found coincide with the typical clinical picture of syphilis, this is not direct evidence of the unconditional presence of this disease. It is well known that similar symptoms on the skin and mucous membranes can also occur in other diseases - chancre, herpes, chancriform pyoderma, papillomatosis, psoriasis, lichen planus and many others; their differential diagnosis without serologic testing is often extremely difficult. Material proof of the presence of syphilis could be the discovery of typical syphilitic bone changes (osteitis, periostitis, ossified gums) in people who lived until the end of the 15th century. So, archaeologists find this evidence in Asia, and in Australia, and in Latin America, but never in Europe!

Gift from Africa
According to the third hypothesis, syphilis is the same age as humanity. At least both humanity and treponematosis appeared in one place - in Central Africa. Scientists, having studied the bone remains of people on all continents, came to the conclusion that treponematoses existed in prehistoric times and proceeded as asymptomatic infections in humans and animals.
And now in Central Africa you can find a lot of diseases generated by various treponemas.
In addition to the classic venereal syphilis pallidum spirochete, Treponema carateum has been found in Africa, causing a disease locally called pinta. Bejel disease is known among the Bushmen, its causative agent is Treponema bejol. In addition, Treponema pertenue, the causative agent of non-venereal syphilis, the so-called yaws, was found in African pygmies. Since pinta, bejel and yaws are characteristic only of those parts of Africa where they are found from time immemorial to the present, they can be called endemic African treponematoses.
Obviously, the causative agents of the most ancient types of human syphilis were bacteria that lived exclusively on the skin. Then they "moved" into wounds and skin lesions, being transmitted from person to person through household contacts (at this stage, the causative agents of non-venereal African syphilis - yaws remained). Then some treponemas managed to successfully overcome the immune barrier of the host organism and penetrate into its circulatory and lymphatic systems. Now a new route of infection was required; and since syringes did not yet exist, sexual contact became the most effective way to transfer microorganisms contained in the blood and interstitial fluid. It is precisely such a “brilliant career”, apparently, that one of the varieties of African treponemas did. The crown of this career was the emergence of a new human venereal disease - syphilis, and this happened in the early Neolithic period.
And already from Africa, the disease spread throughout the world - as a result of natural migrations, the development of trade relations, the Crusades, as well as the mass export of slaves and the pilgrimage of Christians to holy places in Jerusalem, and Muslims to Mecca.

Doctors' experiences
The history of syphilidology was entered by the young French doctor Lindemann, who in 1851, under the control of the commission of the Paris Academy, infected himself with syphilis by introducing a liquid taken from syphilitic papules into an incision on the skin of the forearm. There is also a story about the Russian student Mezenov, who inoculated himself with syphilis in order to then experience the therapeutic effect of the proposed I.I. Mechnikov calomel ointment.

Diagnosis…
The history of the development of the diagnosis of syphilis is replete with dramatic episodes. The first scientific description of the course of this disease was given by the English surgeon John Hunter, who considered syphilis and gonorrhea to be manifestations of the same disease. To prove this, in 1767 he injected pus into his urethra from a patient with gonorrhea. A few days later he developed a discharge, a few weeks later a chancre, and three months later a generalized red rash. John Hunter died 26 years later from a ruptured aorta as a result of mesaortitis (quite possibly of syphilitic etiology).
Today it is obvious that he took the material from a patient who, most likely, suffered from gonorrhea and syphilis at the same time. It must be said that the correct interpretation of Hunter's experience became possible thanks to the morally dubious studies conducted by the French doctor Rikor on prisoners sentenced to death. From 1831 to 1837 he infected 700 people with syphilis and 667 with gonorrhea; the data obtained by him made it possible to finally differentiate these diseases.

…and treatment
Since ancient times, the main method of treating syphilis has been the use of mercury preparations. They were recommended for the treatment of this disease both in ancient Indian treatises and in Chinese manuscripts.
In the Middle Ages, the treatment of syphilis was perceived rather as a punishment for debauchery, so it began with cruel scourging - to free the patient from his sin; then he was given a laxative for several days, and then they proceeded to the main part - mercury treatment. To begin with, the patient was placed in a special steam room (large barrels were used for this purpose), and then they were smeared with mercury ointment twice a day. I must say that most of the patients died very quickly from mercury poisoning; there is practically no convincing data on the recovery of the rest. Despite these results, the "mercury method" was not abandoned, although it seems that its main purpose was still intimidation and edification.

Stages of the modern history of the development of methods for the diagnosis and treatment of syphilis
1905 Shaudin and Hoffman isolated the causative agent of syphilis - treponema and call it a pale spirochete for poor staining with various dyes;
1906 Wasserman, together with Neisser and Brook, discovers a serological reaction for syphilis (later called the "Wasserman reaction"), which later made it possible to discover many other specific serological reactions;
1909 the German researcher and physician Ehrlich suggested using an arsenic derivative, salvarsan, for the treatment of syphilis, and then, in 1912, its improved version, neosalvarsan;
1921 Sazerac and Levatidi developed bismuth drugs for the treatment of syphilis;
1943 American scientists Magoneu, Arnold and Harris successfully used penicillin to treat syphilis (since then and until now, antibiotics have dominated the treatment of this disease);
1949 Nelson and Meyer proposed the treponema pallidum immobilization reaction (TPT); much more specific than the usual "classic" serological reactions, it is of great importance for the recognition of false positive, non-syphilitic serological reactions.