How syphilis manifests itself, the clinical course of the disease and symptoms. The first symptoms and signs of syphilis in men and women

The bacterial causative agent of syphilis - pale treponema - got its name due to the fact that when staining the material with special dyes, it is not visible when viewed with a light microscope. It looks like a thread twisted into a spiral. Outside the body, it quickly dies when dried. Also destructive to bacteria is heat and disinfectants, but she tolerates the cold perfectly.

Infection occurs in a large number of cases during unprotected intercourse, when there are open foci of infection in the area of ​​​​contact. Recently, there has been an increase in cases of infection by the oral route. Also, the microorganism can enter the bloodstream immediately (transfusion from an infected person, repeatedly used syringes from drug addicts). There are frequent cases of infection during pregnancy, when the disease passes from mother to child. household way infection is unlikely - pale treponema quickly dies outside the human body. However, the transmission of infection is possible with close prolonged contact with the patient, when pale treponemas from the affected areas fall on towels or dishes.

There are also forms of congenital syphilis.

What happens when you get infected?

After 3-4 weeks, a hard chancre appears at the site of the introduction of the pathogen - a painless ulcer of a bright red color with a dense base. It heals after a while, which does not mean the death of the infection. On the contrary, at the same time there is an active reproduction of pale treponema and its movement through the body through the lymphatic vessels. A sick person may feel a headache, fever, general malaise, but most often during this period there are almost no symptoms of the disease.

Later, syphilis manifests itself with small ulcers on the palms, a rash on the skin, mucous membranes and soles. If you let the disease take its course, it can flare up and fade for several years, and rashes can either appear or disappear without a trace. The person feels healthy. With the distance from the onset of the disease, the quiet intervals become longer. People who are not familiar with the features of syphilis even think that they recover completely. However, such well-being is imaginary, since pathogens are already present in all tissues and organs, and begin to affect them.

The reasons

The causative agent of the disease is a bacterial microorganism, Treponemapallidum (pale treponema). It enters the human body through microcracks, abrasions, wounds, ulcerations, from the lymph nodes enters the general bloodstream, affects the mucous surfaces, skin, internal organs, nervous system, skeleton. Bacteria multiply rapidly, division occurs every 33 hours, it is on this time period that the treatment of syphilis is based.

The likelihood of infection depends on the number of bacteria that have entered the body, that is, regular contact with the patient increases the risks.

Classification

The staging of syphilis is based on the method of first contact, i.e. this is the stage of the disease at which the patient first noticed the first symptoms of syphilis and sought medical attention.

Stages of syphilis:

• Primary gray-negative is characterized by the formation of a specific wound - a hard chancre, ulceration is not painful, rounded in shape with certain boundaries and a depression in the middle. It mainly affects the external genital organs, however, it can also be localized in other places on the skin, mucous surfaces, and in the internal organs. Appears after 3-6 weeks from the moment of infection and disappears after the same period of time after the onset.
• Primary sero-positive - positive sero-reactions are detected.
• Primary latent leaks without standard clinical picture.
• Secondary fresh appears 4-10 days after the appearance of ulceration, i.e. from the onset of the disease takes from 2 to 4 months. Symptoms of syphilis at this station are characteristic rashes on the skin and mucous membranes. The patient feels weakness, malaise, headaches, fever. Clinical tests reveal positive seroreactions, accelerated ESR, anemia, etc. in human blood. Lesions are noted internal organs: digestive tract, cardiovascular system, lungs.
• Secondary recurrent. Appears after a period of relative calm. The first symptoms of syphilis at this stage are the reappearance of a rash that merges into continuous foci, the formation of papules. Each relapse can last up to several months. In general, this form of the disease manifests itself for up to three years.
• The secondary latent form, in which the symptoms characteristic of syphilis are not observed, and it can only be determined using clinical tests. A patient with a latent form of the disease is highly contagious.
• The tertiary active stage is extremely rare today. Appears in untreated individuals, or in insufficient degree treated. It occurs in a time interval from 3 to 10 years after the onset of the disease (cases of fixation of up to 60 years after the alleged contact infection are described!) It is characterized by severe forms of diseases of the internal organs, the membranes of the brain and nervous system, skeletal bones and articular cartilage. The surface of the epidermis is affected by cicatricial atrophies, peculiar gummas are formed. This stage can be fatal for the patient.
• Tertiary hidden stage proceeds latently, without a clinic of typical manifestations.
• The latent form of the disease is asymptomatic, but tests for syphilis are positive. This group also includes patients whose treatment was started with an unidentified form of the disease.
• An early congenital form is transmitted to the fetus in utero, through the blood of a sick mother. Usually such children are not viable, but if the child survives, he has numerous violations of all functional systems. Such children lag behind in development, are weakened and often get sick.
• Late congenital stage practically does not manifest itself until the age of 15-16, followed by symptoms of tertiary syphilis.
• Hidden congenital, which includes all categories of children's ages.

What are the symptoms of syphilis?

The symptomatic picture of syphilis is polyvariant, depending on the nature of the course of the disease, its form. There are three phases of the disease that determine the symptoms and treatment of syphilis:

Primary:

The first symptom of the disease is the appearance of a hard chancre, localized to a greater extent on the genitals or having a different location. A hard chancre is a dense round ulcer with a diameter of up to 20 mm. It does not bleed, has no purulent discharge and is absolutely painless. A week after the appearance of the chancre near the affected area, the patient begins to enlarge the lymph nodes. The complexity of diagnosing syphilis at this stage lies in the absence of pronounced symptoms. In addition, there is a possibility of infection of the ulcer, when swelling and redness appear around the chancre, pus begins to be released. As a result, correct diagnosis can be difficult.

Spontaneous healing of ulceration (hard chancre) in the next 3-6 weeks.

What are the characteristics of the secondary form of the disease:

• Formation at 4-10 weeks after the primary hard chancre of a characteristic pale rash, located symmetrically over the body.
• Deterioration of the patient's well-being - headaches, general malaise, fever.
• Lymph nodes in the area and outside the affected area are enlarged.
• Characteristic hair loss with a ladder or focal alopecia, which involves the eyebrows, eyelashes, scalp.
• Wide condylomas of beige color appear on the skin and mucous membranes of the genital organs, in the anus.
• The repeatability of this picture of symptoms with intervals of bursts and absolute attenuation.

What are the symptoms of tertiary syphilis:

• The brain (both brain and spinal), nervous and cardiovascular systems are affected.
• Bones, joints and internal organs are affected.
• Changed skin with visible scarring.
• Characteristic granulomas, gummas, tubercles and bumps appear.

Diagnostics

Activities for the diagnosis of syphilis include the study of anamnesis, examination and assessment of the overall clinical picture, conducting clinical blood tests. The main goal is to identify what symptoms are observed in the patient and confirm the presence of pathology. All diagnostic measures are divided into two groups: treponemal and non-treponemal.

Non-treponemal tests are performed in mass studies, sometimes they can give false positive result in the absence of disease. Upon receipt of such an answer, treponemal tests are additionally prescribed. They are also used to assess the success of ongoing treatment in dynamics.

Treponemal tests for the detection of antibodies that remain in the body of a person who has recovered from syphilis forever cannot be used to evaluate the effectiveness of treatment, but with their help they reveal hidden forms of the disease.

Treatment of syphilis

After the procedures that revealed the first signs of syphilis and the diagnosis are established, an adequate treatment protocol is prescribed, which can be quite long - from 2-4 months, and in some cases of advanced disease - more than two years. Depending on general condition patient treatment is carried out in a hospital, rarely on an outpatient basis. For the whole time, until a complete cure, confirmed by clinical tests, sexual activity is prohibited. In addition, all members of the patient's family undergo examinations and preventive treatment.

Antibiotic therapy is the only effective method in the treatment of syphilis, since pale treponema is highly sensitive to penicillin drugs, which are most effective in combating the microorganism. Water-soluble penicillins are injected into the patient's body for 24 days every three hours in stationary conditions - this is the most effective method.

In the presence of an allergy to penicillin, the patient is prescribed antibiotics from a number of cephalosporins or macrolides - in tablets or intramuscularly. Active Forms diseases are treated in stationary conditions, latent - through outpatient therapy. The duration of treatment is determined by the stage of the disease and can reach several years.

It is necessary to treat syphilis with simultaneous support of the body's internal reserves, which is carried out with the help of immunostimulating complexes, vitamins, etc.

It is very important to inform all sexual partners about the presence of the disease and convince them to undergo the necessary studies, even in the absence of symptoms - this course of the pathology does not reduce the risk of complications. In the event that the patient is cured, but his sexual partner is not, re-infection is very likely.

Complications

On the different stages symptoms and treatment of syphilis can give a multiple picture of complications, due to the stage of the disease.

The primary period is characterized by:

• Examination of all pregnant women, passing tests for serological reactions three times to avoid cases of congenital syphilis.
• Mandatory preventive treatment for pregnant women who were previously registered, but were removed from it after the cure.
• Regular examinations for those at risk (drug addicts, prostitutes).
• It is imperative to examine everyone who had close contact with the sick person, necessarily for family members.
• Hospitalization of persons with a positive reaction, after treatment - dispensary observation.

Prevention and prognosis for recovery

It is impossible to reflect syphilis in advance. There is no vaccine or other active prevention against this disease. It is important to follow the rules of safe sex, to refuse casual relationships.

Public prophylaxis should be carried out in accordance with the general rules for combating venereal diseases. The components of such prevention are the mandatory registration of all patients, the examination of his family members and persons who were in close contact with him, the hospitalization of the infected and monitoring them over the next few months, constant dispensary control monitoring of the treatment of sick patients.

Forecast for clinical cure syphilis in the early stages is favorable. The earlier the disease is diagnosed and treated, the more favorable the prognosis.

On the late stages With the help of treatment, it is possible to significantly improve the patient's condition.

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Signs of syphilis in humans do not appear until a few weeks after infection, because the disease is characterized by a long incubation period. Without knowing about the disease, its carrier can continue to lead sexual life, introducing an infection into the body of random partners, and not even guess about it.

• Symptoms of secondary syphilis
• Diagnosis and treatment
• Exciter properties
• Syphilis infection
• Complications
• Classification
• Clinic of the primary period
• Epidemiology of syphilis
• The pathogenesis of syphilis
• Screening
• Reasons for development
• Treatment of syphilis

Symptoms of secondary syphilis

During the period of secondary syphilis, the disease, unlike the initial stage, spreads through the vessels of the whole organism with blood and lymph and manifests itself various symptoms. The first signs of syphilis of the secondary period occur in people 40-50 days after the formation of the chancre. It all starts with a painless enlargement of the lymph nodes, which are cold and hard to the touch, while the person feels unwell and weak. Runny nose and cough, elevated body temperature up to 37.5 ° C can also be attributed to syphilis as the first signs.

But characteristic symptoms diseases are specific formations: papillomas, nodules and spots (syphilides) on the mucous membranes of organs and skin. Most often in secondary fresh disease on the abdomen and sides of the human torso, roseolous syphilide occurs (round and smooth roseola spots of a pale pink color). A syphilitic symptom is often hair loss in different parts of the head - alopecia, or baldness. After the treatment of syphilis, the hairline is partially restored.

On the 60th day of the secondary period of syphilis, the signs of it (rashes) disappear, because. the body's immune system fights infection. But the disease continues to run its course. If a person catches a cold or experiences stress, a weak immune system will not be able to resist the disease, and a relapse will soon occur. It will manifest itself in one or more of the former syphilitic symptoms. They can be roseola on the body and mucous membranes of the sky or papular syphilis, the photo of which is below.

The last sign is hemispherical nodules (papules) with a smooth, and later with a scaly surface. They are localized not only on the genitals, but also on the palms and feet of the patient. In the clinic (clinical picture) of syphilis at this time, there may be a chancre of the genital organs (a sign more characteristic of its first period).

Other manifestations of secondary syphilis, which appear less frequently, include leukoderma (light oval-shaped spots localized in armpits, on the neck) and wide condylomas (warts) in the anus and genitals. All these symptoms can be in people for several years, if nothing is done against them, then tertiary syphilis develops in men and women.

Diagnosis and treatment

At early diagnosis diseases, doctors conduct an external examination of the human body and pay attention to the symptoms of 1 syphilis (photo). Often at this time, doctors make an erroneous diagnosis of patients, because. many skin diseases have manifestations similar to syphilis. Doctors take ulcers and rashes in the genital area as signs of a dangerous infection.

For example, with basal cell skin cancer, a dense roller of the tumor is formed with a gray-brown crust in the center, and with scabies ecthyma, the glans penis ulcerates. These phenomena resemble (syphiloma).

Sometimes you can take, for example, the primary syphiloma of the hard palate for manifestations of angina, and the sore of the chancre on the lip for herpes.

In the first and second periods of syphilis, if there are visible signs of the disease on the human body, doctors use a diagnostic method such as microscopy, i.e. smears are taken from the surface of ulcers, papules and erosions and pale treponema, the causative agent of the disease, is detected under a microscope on a dark background. In the latent period of syphilis, such a study is not carried out.

The most common method for diagnosing the disease in its early stages is serological tests of human blood serum for the presence of infection antibodies. The nonspecific Wasserman reaction is positive if, as a result of the study, white flakes fall out in the test tube. This method is not always reliable, therefore, laboratories additionally carry out a clarifying specific reaction of passive hemagglutination (RPHA). It occurs only in the presence of antibodies of pale treponema in the blood.

In the tertiary period of syphilis, it is possible to carry out the above diagnostic methods, but the presence of gum (purulent seals) on the human body indicates the presence of the disease in the body.

Exciter properties

The causative agent of syphilis is a pale spirochete (treponema), which easily enters the body through skin lesions (wounds, ulcers). It has the shape of a spiral and can move both rotationally and flexionally. Caught in lymphatic vessels, the spirochete actively reproduces by division. Pale treponema in the blood accumulates in large quantities only in the second period of the disease, therefore, only at this stage a rash appears on the body and mucous membranes of a person.

This microorganism with syphilis shows resistance to low temperatures for several days, and the best condition for its vital activity is a humid and warm environment (37 ° C). Spirochete dies under the influence of acidic and alkaline solutions, at a temperature of 55 ° C - after 15 minutes, and at 100 ° C - immediately.

Syphilis infection

The disease syphilis is an infection that in 97% is transmitted from a sick person to a healthy person through sexual contact through semen. This disease can be contracted by kissing (through saliva), using hygiene items shared with a sick person (straight razor, toothbrush) or one syringe, which is typical for drug addicts. AT medical institution during direct blood transfusion, infection with treponema is rare.

Syphilis can be transmitted to an unborn child by a sick pregnant woman or a nursing mother while breastfeeding. Sometimes domestic cases of infection are recorded, which can occur through shaking hands or sharing a wet towel.

Complications

With each subsequent week after the first symptoms of syphilis appear, the infection enters the body more and more. If a person does not pay attention to the appearance of a rash, ulcers in the area of ​​​​the glans penis, etc., an untreated disease causes a number of complications. It leads to damage to the central nervous system (CNS). Over time, there are disorders in the musculoskeletal system, the organs of hearing, vision, and breathing suffer. Ulcers and syphilides leave scars for life.

Classification

After treponema enters the body, syphilis goes through several stages in its development:

1. Primary seronegative (incubation) and seropositive.
2. Secondary (fresh, latent, recurrent).
3. Tertiary (active, latent, visceral, neurosyphilis).

The disease is congenital. All stages of syphilis pass from one to another.

The incubation period of the disease

The period lasts from the moment of infection to the first sign of the manifestation of the disease - a hard chancre (2-6 weeks). If a person is taking antibiotics at the same time, the incubation period increases to several months. Test results at this time will be negative.

Clinic of the primary period

The disease always manifests itself at the site of infection (in the mouth, on the genitals) with a round sore (chancre). Since the ulcer does not hurt, the person often does not notice it. After 5 weeks, the chancre heals, a scar remains in its place. The bacteria then invade the lymph nodes, which swell in response. This sign means that the second period of syphilis is coming.

Epidemiology of syphilis

In the 90s of the XX century in Russia there was a surge in the incidence of syphilis. Most high rate infection was recorded in 1997. It amounted to 277.3 cases per 100,000 people. In those years, the number of prostitutes and drug addicts increased in the country, and the sick self-medicated. Since 1998, the incidence began to decline sharply, 30% less cases were recorded in 2003-2004. From 2007 to 2013, this indicator either increased or decreased. Now there are 20.4 registered cases of syphilis per 100,000 population in Russia, which is 10.4% more than in 2013.

The pathogenesis of syphilis

Syphilis is a chronic infection caused by Treponema pallidum, which eventually affects all human tissues and organs. The disease develops in the body in stages. The symptoms of the first period are the same in all cases (with slight variations), at other stages the course of the infection is individual. A feature of syphilis is the successive change of active and latent stages.

Screening

Screening (examination of the population for infection) plays a positive role in detecting syphilis and reducing the incidence. It allows you to identify the disease at an early stage. Screening is carried out when applying for a job in children's institutions and institutions Catering. It is mandatory for pregnant women (prevention of congenital syphilis) and donors. Specialists examine people's blood by conducting serological tests in the laboratory.

Reasons for development

Syphilis can be contracted in different ways, but it develops in the body if a person does not treat the disease from the moment the first signs appear. This is because many people are embarrassed to see a doctor. They either self-medicate, which is not always correct, or they ignore the disease.

A severe complication of the infection is CNS damage (neurosyphilis), which can appear at any stage of the disease. The development of neurosyphilis occurs in the first few years from the moment of infection, later damage to the central nervous system is attributed to the 7-8th year of untreated syphilis. At this time, progressive paralysis and dorsal tabes occur.

Treatment of syphilis

In the early stages of the disease, hospitalization is not needed. The infection is treated with antibiotics - Penicillin, Erythromycin. If neurosyphilis has arisen, antibacterial drugs are administered intramuscularly to patients and the body temperature is artificially raised. In the third stage of syphilis, not only antibiotics are used, but also bismuth-based drugs, while treatment is carried out only in a hospital. Together with the sick person, his sexual partners should be treated. Early contact with doctors guarantees a quick recovery.

Infection with syphilis occurs as a result of the penetration of pale treponema into the human body through the skin or mucous membranes.

Even with treponema infection, syphilis may not occur in half of the cases.

However, if the infection did occur and the disease began to develop, what are the first signs of syphilis?

Currently, venereologists note changes in the course of primary syphilis. If years earlier syphilis manifested itself through a single hard chancre on the patient's body, now there are two or more such sores on the body. Also, if earlier it was possible to feel a clearly defined seal of a hard chancre, now this seal may not appear.

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The first signs of secondary syphilis

It should be noted that secondary syphilis can be of several varieties:

• Fresh- this type of syphilis is a consequence of the primary form. Symptoms - small polymorphic rash and hard chancre;
• Hidden- even the incubation period of syphilis does not manifest itself externally, but can be detected through serological studies;
• Recurrent- with this form of secondary syphilis, relapses alternate, during each relapse a rash appears on the body. But unlike fresh syphilis, the rash during relapses is less abundant, the spots are larger, and foci of rashes can be detected.

Signs of secondary syphilis:

• In men, the first signs of secondary syphilis are flu-like symptoms: weakness, fever, headaches. At night, arthralgia and myalgia are especially pronounced. Then secondary syphilides appear on the body, containing a significant amount of pale treponema, which creates a high risk for others to become infected with syphilis. Secondary syphilides do not form scars. Often, secondary syphilis is accompanied by alopecia, which can cover both large areas of the hairline, and be small focal.
• Syphilis of the secondary form in women manifests itself 2-8 weeks after infection with treponema. The signs of syphilis of this stage are especially pronounced in the genital area: a pink rash can be found on the mucosa, while the mucosa itself is moist and shiny. Along with the rash, papules can be found on the tongue and vocal cords, which often leads to hoarseness.
  In women, this stage of the disease may be accompanied by pigmentary syphilis, or, as it is also called the “necklace of Venus”. Pigmentary syphilis manifests itself through discoloration of the skin on the neck (back and sides). This discoloration of the neck usually develops 4-6 months after treponema enters the body. In addition to the neck, syphilitic leukoderma is diagnosed on the chest, lower back, arms, etc.
• In children, the first signs of secondary syphilis appear as a profuse papular or pustular rash. This rash indicates that pale treponema was not noticed at the first stage of the disease and is now in abundance in the child's blood. When the immune system strengthens, the rash will pass, but the recurrence of syphilis in a child is inevitable - tertiary syphilis will begin.

In men and women with secondary syphilis, syphilitic roseola can often be diagnosed - these are peculiar rounded pale pink spots that can reach 10 mm in diameter. Such spots can be on any part of the patient's body. A distinctive feature of syphilitic roseola is its gradual manifestation of 10-12 spots per day for seven days. If you press on the roseola, it disappears.

Also, with secondary syphilis, papular syphilis may appear.- These are papules, reaching a diameter of 5 mm. The color of the papules can be pink or copper-red. Over time, these papules begin to peel off from the center to the periphery.

An extremely rare first sign of secondary syphilis is pustular syphilis - purulent formations, which then dry up and form a yellow crust. The highest risk of developing pustular syphilis is observed in drug addicts, alcoholics and people suffering from tuberculosis.

Signs of syphilis in women, men and children in the tertiary form

If left untreated, tertiary syphilis develops in 30% of people with secondary syphilis. One fourth of those infected die from tertiary syphilis. It is extremely important to recognize the signs of syphilis in women and men at least at this stage.

Signs of tertiary syphilis:

• In men, tertiary syphilis is diagnosed through the appearance of tubercles and gums. The tubercles are quite small in size and quite a lot of them form on the body. Gummas are single, rather large and deep in the tissues. These formations do not contain such a large number of treponemas, so the risk of infecting another person is much lower than with secondary syphilis.
• In the tertiary form, the first signs of syphilis in women are bumps and gums like in men. Both tubercles and gummas eventually turn into ulcers, from which scars will remain after healing. These scars adversely affect the state of organs and tissues, severely deforming them. Gradually, the functions of organs are violated, which can eventually lead to death. If infection with syphilis occurred from a sexual partner, then the rash will primarily be in the genital area (on the vagina, etc.).
• In children, tertiary syphilis affects the skin, internal organs and nervous system with special tubercles - syphilides. Syphilides are formed due to the development of hypersensitivity of the child's body to treponemas, which are found in excess in the child's body.

Tertiary syphilis can last for decades. The patient may suffer from the development of mental insanity, deafness, loss of vision, paralysis of various internal organs. One of the most important signs of tertiary syphilis is a significant change in the patient's psyche.

If previously a person was quite calm, then as a result of prolonged exposure to syphilis on the body, a person begins to panic, suffers from paranoia, fits of rage and depression, which are replaced by periods of euphoria.

Often at this stage of the development of the disease, the patient experiences hallucinations - this occurs as a result of the destruction of brain tissue.

Signs of syphilis in men, women and children: how different types of syphilis manifest

Syphilis is quite diverse in its manifestations. It depends on a number of factors, ranging from the immune status of the person affected by treponema to the number of syphilis pathogens entering the body.

Can be distinguished the following types syphilis and their signs in men and women:

Atypical syphilis manifests itself in the form of an atypical hard chancre. These can be indurative edema, chancrapanaritsia, chancre on the tonsils and paraphimosis. Indurative edema is characterized by development in the area of ​​the labia and preputial sac, and such swelling is not accompanied by painful sensations. The chancre looks like a rather large ulcer, dense when palpated.

The skin takes on a purple hue. Another sign of syphilis in men and women in atypical form- chancre panaritium, which can be found near nail phalanx on the fingers.

At the same time, the ulcer has uneven edges, painful sensations are created on the affected phalanx. At the same time, the lymph nodes in the elbows increase, but do not hurt. With the manifestation of a hard chancre on the tonsils, erosion and ulcers occur, the tonsil increases in size.

Patients do not experience pain from sores on the tonsil. Paraphimosis in atypical syphilis is an inflammation of the preputial sac that develops when the head of the penis is exposed. Prolonged course of paraphimosis without proper treatment can lead to necrosis of the head.

Transplacental transmitted disease, that is, infection of the fetus with syphilis through the mother's blood. This disease is distinguished in two forms - early and late. early form congenital syphilis begins with fetal development and continues into early childhood. Late congenital syphilis manifests itself after the child has reached the age of 15, and before that it can be assumed that the child is healthy - the disease does not show itself in any way.

If syphilis affects the fetus (usually occurs in the fifth month of pregnancy), then treponema begins to destroy the internal organs of the child and the skeletal system. The chances of such a child surviving are negligible. According to official statistics, if a pregnant woman is sick with secondary syphilis, then in 90% of the pregnancy will end in the birth of a dead child or the death of the fetus.

Signs of congenital syphilis are diagnosed in the fetus: they can be an increased mass of the placenta (1:3 instead of the norm 1:6), and the placenta itself increases in size and is easily torn. The amount of amniotic fluid decreases. The organs and tissues of the fetus are affected.

If a child with syphilis was born and survived, then the newborn will have flabby and wrinkled skin (similar to senile), body disproportion (enlarged head), specific rhinitis and other diseases will develop. Children with congenital syphilis lag behind their peers in development.

Neurosyphilis- one of the varieties of syphilis, when the tissues of the brain, its membranes and blood vessels affect the gums. Neurosyphilis can be latent (diagnosed only through special studies, no outward signs are observed), early (develops against the background of primary or secondary syphilis, affects the vessels and membranes of the brain, accompanied by syphilitic meningitis and meningomyelitis), late (occurs seven years after infection with treponema and develops against the background of tertiary syphilis, accompanied by dorsal tabes, progressive paralysis and syphilitic gumma of the brain).

Neurosyphilis manifests itself through the following symptoms: syphilitic meningitis - syphilis is accompanied by meningeal symptoms (severe headaches, dislike of light, nausea and vomiting, high fever); syphilitic meningoencephalitis - in fact, it is syphilitic meningitis, which is accompanied by mental disorders (hallucinations may occur); dorsal tabes - with this manifestation, neurosyphilis affects the spinal cord, so the patient loses the sensitivity of the limbs, sees poorly, feels problems with urination and defecation; progressive paralysis - with neurosyphilis, a patient with paralysis loses reading and writing skills, dementia develops and complete disintegration of the personality.

Latent syphilis- a type of syphilis, when the disease is completely asymptomatic. Such syphilis can only be detected through laboratory tests. Diagnosis of latent syphilis is quite complicated - it is a set of procedures based on the body's specific reactions to syphilis.

Venereologists suggest that the development and spread of latent syphilis in the world is associated with the widespread use of antibiotics: patients take the symptoms of syphilis for signs of another sexually transmitted disease and try to cure it with an antibiotic. The drug drowns out the symptoms of syphilis, and the disease begins to be asymptomatic.

Latent syphilis can be early and late. Early latent syphilis- this is the period from primary to secondary syphilis, which usually corresponds to two years.

Despite the fact that latent syphilis does not manifest itself outwardly, an infected person is dangerous to others. Late latent syphilis is diagnosed more than two years after infection with treponema. Such patients are not dangerous to others. Most often in medical practice, latent syphilis is unspecified - the patient does not have any information about the expected date of infection with syphilis.

Household syphilis can be obtained non-sexually. This usually occurs as a result of inadequate or lack of personal hygiene. It is enough for a person to use someone else's towel or toothbrush, drink water from someone else's glass - and treponema enters the body. In general, treponema is quite tenacious only at low temperatures - its ability to infect can persist for several years. However, at temperatures above 45-50 degrees treponema dies.

Signs of household syphilis correspond to the signs of sexually acquired syphilis, the differences are only in the location of the hard chancre on the body infected person: with sexual infection, chancre most often manifests itself in the genital area, and with domestic infection can be found anywhere on the body.

Syphilis occupies a special place among diseases transmitted mainly through sexual contact. One of the main reasons this disease is the disorder of sexual relations, while the syphilitic rash, the symptoms of which are pronounced, becomes a kind of “gift” received not for too diligent behavior. The peculiarity of the disease also lies in the fact that complete disposal of it is possible only with initial stages its currents. The consequences become irreversible when the disease of the brain is affected, while treatment is already becoming almost impossible.

general description

The statement that syphilis is exclusively a sexually transmitted disease is not entirely true. The fact is that you can get infected with it in everyday life when the infection directly enters the bloodstream through scratches or wounds on the body, it is also possible when using toilet items (towel, washcloth) belonging to the patient. In addition, infection with syphilis can occur through blood transfusion, and syphilis can also be congenital. Basically, the rash is located in foci in the area of ​​\u200b\u200bthe hair and steps, as well as on the palms. In addition, in women, it is also localized under the mammary glands; for both sexes, its concentration can be located in the genital area.

After 3-4 weeks from the moment of infection, the place where the introduction of pale treponema, the causative agent of infection of this disease (which is mainly the genital organs), acquires signs indicating primary syphilis.

Symptoms of the primary stage

Signs of primary syphilis are the appearance of a red spot small sizes, which turns into a tubercle after a few days. The center of the tubercle is characterized by gradual tissue necrosis (its death), which eventually forms a painless ulcer, framed by hard edges, that is, a hard chancre. The duration of the primary period is about seven weeks, after the start of which, after about a week, all the lymph nodes undergo an increase.

Completion of the primary period is characterized by the formation of many pale treponema, causing treponemal sepsis. The latter is characterized by weakness, general malaise, joint pain, fever and, in fact, the formation of a characteristic rash, which indicates the onset of the secondary period.

Symptoms of the secondary stage

The secondary stage of syphilis is extremely diverse in its own symptoms, and it is for this reason that in the 19th century French syphilidologists called it the “great ape”, thereby pointing out the similarity of the disease at this stage with other types of skin diseases.

Signs of the general type of the secondary stage of syphilis are following features rashes:

• Lack of sensations of a subjective type (soreness, itching);
• Dark red color of rashes;
• Density;
• Clarity and regularity of roundness or roundness of outlines without their tendency to possible merging;
• Peeling of the surface is unexpressed (in most cases, its absence is noted);
• Spontaneous disappearance of formations without subsequent atrophy and scarring stage is possible.

Most often, rashes of the secondary stage of syphilis are characterized in the form of their manifestations (see photo of a syphilitic rash):

• This manifestation of this stage of syphilis is the most frequent. Indicates its occurrence to the fact that the spread of pale treponema has occurred throughout the body. A characteristic manifestation in this case, roseolas (spots) appear in a mild inflammatory form. Initially, the color is pale pink, the outlines of the rashes are blurred, the shape is oval or rounded. Their size is about 1-1.5 cm in diameter, the surface is smooth. Draining of roseola is not observed, nor do they rise above the skin surrounding them. There is no tendency to peripheral growth. Often, localization is concentrated in the region of the lateral surfaces of the trunk and abdomen.



• This type of rash is formed in the form of nodules (papules), their shape is round and hemispherical, the consistency is densely elastic. The value can reach the size of lentils, while reaching the size of peas. The first days of appearance are characterized by the smoothness and luster of the surface of the papules, after which it begins to peel until the formation of a scaly border along the periphery, by analogy with Biett's collar. As for the localization of papules, it does not have clear areas of concentration, respectively, they can form anywhere. Meanwhile, there are also “favorite” localization environments, which include the genitals, the anus, soles and palms.



• This form of formations is a frequent manifestation of papular syphilis. It is expressed in the formation of thickened nodules similar to calluses with a sharp limitation from the skin surrounding them. Their surface is smooth, the shade is erythematous-brown or lilac-red. The growth of papular elements leads to their cracking in the center, which leads to the formation of a scaly border along the circumference. Often, this form of syphilis is mistaken for ordinary calluses by patients, which does not lead to a timely visit to the doctor.



• This form of rash is also quite common in the secondary stage of syphilis. Broad condylomas are papules of a vegetative type, the formation of which occurs on the basis of weeping papules with a tendency to merge and hypertrophy. Often, their accompanying feature is the formation of a deep infiltrate, covered with a white coating of the horny swollen layer in the presence of a characteristic serous discharge. Quite often, wide warts are the only manifestation characteristic of the secondary period. Most often, rashes are localized in the anus, so it is often necessary to distinguish them from condylomas of genital warts (anal warts) and from hemorrhoids.



• Today it is extremely rare, but it is also impossible to exclude the possibility of this type of rash. Not so long ago, syphilitic leukoderma was such a specific manifestation of syphilis that it was given the no less striking name - “Venus's necklace”. Its manifestation is characterized in the formation of oval light rounded lesions against the background of a brownish-yellowish darkening of the skin. The most frequent sites of localization of syphilitic leukoderma are the lateral surfaces of the neck, in some cases - in the region of the anterior chest surface, as well as in the region upper limbs and armpits.



• This rash occurs in the form of roseolous spots that form along the mucous membrane of the mouth and throat, as well as in the region of the upper palate. The affected area is characterized by the acquisition of a stagnant red color of the surface, in some cases it may give off a copper tint. The surface is generally smooth, the outlines of the formations are clear. They are also characterized by the absence subjective feelings, however, some cases are marked by the occurrence of difficulties in swallowing. In the process of secondary syphilis, especially at the time of relapse of the disease, syphilides formed in the mucous membranes can act as almost the only clinical manifestation of the disease. In addition, their presence is extremely important from an epidemiological point of view, because they contain a huge number of pathogens of this infection.



• Syphilitic alopecia. The main manifestation is baldness, which provokes the formation of a large number of foci of a characteristic rash. At the same time, the hair falls out so that in appearance they can be compared with fur eaten by moths.

In general, considering the rash, it can be noted that with syphilis it can be completely various types character. Severe course syphilis provokes the appearance of pustular (or pustular) syphilis, which can manifest itself as a rash, and a rash characteristic of.

Secondary recurrent syphilis is characterized by fewer and fewer rashes, observed with each new form relapse. The rashes themselves in this case become larger and larger, characterized by a tendency to their own grouping into rings, ovals and arcs.

Secondary untreated syphilis is converted to tertiary.

Symptoms of the tertiary stage

This stage of the disease is characterized by a small amount of pale treponema in the body, but it is sensitized to their effects (that is, it is allergic). This circumstance leads to the fact that even with a small amount of treponema exposure, the body responds with a peculiar form of an anaphylactic reaction, which consists in the formation of tertiary syphilides (gums and tubercles). Their subsequent disintegration occurs in such a way that characteristic scars remain on the skin. The duration of this stage can be decades, which ends with a deep lesion received by the nervous system.

Stopping on the rash of this stage, we note that the tubercles are smaller when compared with the gums, moreover, both in their size and in the depth at which they occur. Tubercular syphilis is determined by probing the thickness of the skin with the identification of a dense formation in it. It has a hemispherical surface, the diameter is about 0.3-1 cm. Above the tubercle, the skin becomes bluish-reddish in color. Bumps appear in different times while grouping into rings.

Over time, necrotic decay is formed in the center of the tubercle, which forms an ulcer, which, as we have already noted, leaves a small scar after healing. Given the uneven maturation of the tubercles, the skin is characterized by the originality and variegation of the overall picture.

Syphilide gummy is a painless dense knot, which is located in the middle of the deep skin layers. The diameter of such a node is up to 1.5 cm, while the skin above it acquires a dark red hue. Over time, the gum softens, after which it opens, releasing a sticky mass. The ulcer, which was formed at the same time, can exist for a very long time without the necessary treatment, but at the same time it will increase in size. Most often, such a rash has a solitary character.

Treatment of syphilitic rash

The rash is treated in conjunction with the treatment of the underlying disease, that is, syphilis itself. by the most effective method treatment is the use of water-soluble penicillins in it, which makes it possible to provide support in the blood for a constant required concentration of the necessary antibiotic. Meanwhile, treatment is possible only in a hospital, where the drug is administered to patients for 24 days every three hours. Intolerance to penicillin provides an alternative in the form of a backup type of medication.

Additionally important point is also the exclusion of diseases that have arisen against the background of syphilis. For example, syphilis often contributes to an increase in risk, because in general it provokes a sharp decrease in the immune defense that the body has. Accordingly, the appropriate solution is to conduct a full course of treatment that helps to eliminate any type of infectious agents present.

If you suspect syphilitic rash you should immediately contact a dermatovenereologist or venereologist.

Experienced doctor talks about an infectious venereal disease - syphilis. From the interview you will learn everything about syphilis - the manifestations of the disease, how to diagnose in time, and what therapy is used for treatment.

- Viktor Ivanovich, today we will talk about syphilis - a disease inherited modern world from the depths of the Middle Ages, and which still has not lost its relevance. Although for last years and cases of infection have decreased, but the statistics of the Ministry of Health are still frightening, for a hundred thousand inhabitants of our country, 26 people are sick with syphilis. Tell me, is it the fault of the lack of awareness of our population or a simple disregard and confidence that this will not affect me?

- Yes, indeed, the statistics are frightening, but over the past ten years, cases of infection have decreased significantly, especially among the risk group - adolescents. This became possible thanks to special programs for informing with explanatory and preventive work. Lessons on reproductive health are regularly held in schools and universities. But cases of diseases have become more frequent in age category 40 years who, like you say, think it won't affect them. And this is a banal lack of awareness among the population, since explanatory events are not often held at the production facilities.

— Your smallest and most adult patient?

- You can say from zero and above. The disease is susceptible to both infants infected in the womb or during childbirth and elderly patients. But if we talk about those who came to the reception on their own, then the youngest is a teenager of 13 years old and the oldest is a man at the age of 80 years. So, all ages are submissive to syphilis).

- Is there any relationship between disease outbreaks and seasons?

- Yes, the most productive time is the end of summer, the beginning of autumn, when the vacation period ends and the realization comes, what have I done and whether I need to see a doctor)

- Who contacts you most often?

— There is no single answer to this question. Among patients there are both decent citizens and asocial elements, this ailment can affect everyone. But most often these are people with bad habits, I can’t say that they are all drunkards, but nevertheless, after the brain is damaged by alcohol, they begin to think with other parts of the body. This is where the danger lies.

Ways of infection

- From your hint about body parts, can we conclude that the most common route of infection is through sexual contact with an infected person?

- Yes, in 95% of cases, infection occurs in this way.

- Tell us in more detail, for our readers, about the ways of transmission of the infection and where the danger lies?

- As I said, the main route of infection is sexual. The fact is that the favorite place for the concentration of the pathogen in the body are all liquid media - sperm, vaginal discharge, blood and even saliva. During sexual intercourse, the greatest chance of infection is due to the exchange of sperm and vaginal fluid between partners.

- Before talking with you, I studied the comments on the Internet for syphilis infection, and many times I met advice in which it is recommended to interrupt sex before ejaculation. There is an opinion that this method protects against infection. Is it so?

- Definitely not. This is a deep delusion, just because of the very lack of awareness of the population. During sexual intercourse, contact occurs between the mucous membranes of the genital organs, which contain a lubricant that is released during arousal, and this, too, is a liquid gray in which a large concentration of the pathogen is observed. In the presence of minimal damage to the mucous membranes, instant infection will occur.

What is the probability of getting infected after the first sexual contact with the sick?

- Very high, 30-40% of infections occur after the first and only time. I should note that infection can also occur during oral sex and the risk of catching the disease is no less. With this method of sex, the same exchange of fluids and saliva contains no less pathogen than semen or vaginal fluid.

- What about anal sex?

- Statistics say that infection with anal sex occur less frequently than usual. It is homosexuals who are included in the risk group, they have the disease much more often. The fact is that the pathogen penetrates through the smallest damage to the mucous membranes and skin, and micro cracks in the rectum are a common thing.

- From all of the above, the question arises, is it possible to get infected with a kiss?

- The probability is very low, but it takes place, since the activity and ability of the pathogen to reproduce is preserved in humid environments, which is what saliva is. If there is damage oral cavity infection occurs.

- What other ways is the infection transmitted?

- Less likely to be infected:

1. Household way. In this case, the risk is minimal, since the pathogen is sensitive to environmental conditions, but nevertheless can remain active in a humid environment until completely dry. For example, the cutlery of an infected person will be a source of infection until saliva dries on it. Danger can lurk when using common household items and personal hygiene products, while taking a bath together with the patient or after it, when using a shared bed.
2. Infection of babies- a common problem and a painful topic for physicians, which requires a separate and detailed consideration, because it is always difficult to look at newborns with symptoms of syphilis. Infection in this case occurs during pregnancy from a sick mother to a child, through the placenta or during labor activity during the passage of the child through the birth canal.

What is syphilis

- Viktor Ivanovich, let's get straight to the point. What kind of terrible beast is hiding under the name of syphilis?

- This is an infectious lesion not only of the genitourinary system, as many believe due to the specific route of infection, the disease affects the entire body - bone and cartilage tissue, skin, all body systems, including the central nervous system, and internal organs. The causative agent of the disease is pale treponema, a pathogenic microorganism that, when entering the body, concentrates in the lymph flow, and then through the walls of small vessels penetrates into the bloodstream and spreads throughout the body.

How long does it take for syphilis to be detected after infection?

- The incubation of the disease or the asymptomatic period can last from 10 to 90 days, and after this time the first symptoms of the disease will appear. But on average, incubation lasts from 20 to 45 days.

- And why such ambiguous terms of manifestation of the disease?

- Yes, indeed, the time frame is very blurred and depends on many factors. The first symptomatology will appear when the pathogen reaches a certain concentration in the body, and how soon this happens depends on the state of immunity and on some other components. For example, comorbidities increase incubation with elevated temperature body and taking antibacterial agents, and reduce the time - weak immunity and the ingestion of a large amount of the pathogen.

What are the signs of syphilis?

- It is worth dwelling on this issue in more detail, since this is an extensive topic that requires detailed consideration. Syphilis is a very insidious disease with symptoms that may be present temporarily and then disappear completely and this does not mean that the disease has receded, on the contrary, it progresses more and more affecting the body. Depending on the degree of development, syphilis is divided into several stages.

Primary syphilis

The first stage of the disease manifests itself as a neoplasm in the area of ​​infection. This is the so-called "entrance gate" through which infection occurs. They can be located everywhere, from the genitals and oral cavity to any place on the skin. Neoplasm - hard chancre, primary sign syphilis.

- In what least expected place have you ever found a hard chancre?

– An interesting question, it all depends on the fantasies of the infected. In my many years of practice, the first sign of syphilis was found between the toes, in the area auricle, on the chest.

What does a hard chancre look like?

- This is a kind of ulcer or erosion with a diameter of up to 10 mm and a characteristic blue-red tint. Its distinctive feature is the sudden appearance and further disappearance without any treatment. Two weeks after the appearance of syphiloma (chancre), an inflammatory process begins in the lymph nodes of the area adjacent to it. For example, if syphiloma on the genitals is inflammation inguinal lymph nodes, when it is in the oral cavity - inflammation of the submandibular.

- What hurts with syphilis of the first stage?

- That's the insidiousness of the disease, that the first stage very rarely manifests itself as pain. In very rare cases, a hard chancre responds with pain during mechanical action and inflamed lymph nodes also do not cause discomfort. That's why, most of sick people do not seek help from doctors, attributing symptoms to allergies and other diseases, especially since syphiloma disappears on its own.

- How else is primary syphilis manifested?

- As for the symptoms, then at the first stage it is no longer there, only a hard chancre can have an atypical form:

• indurated edema- subcutaneous seal pink shade at the site of entry of treponema;
• felon- syphiloma on the nail plate, manifests itself as a tumor on the finger with a burgundy tint;
• amygdalitis- syphiloma affecting the tonsils with noticeable hardening and swelling (if it occurs, fever and weakness may occur)

At the end of the first stage, symptoms of diseases of the upper respiratory tract SARS.

- Does this mean that with syphilis there is a runny nose and cough?

- Yes, cough, as a rule, is observed in the later stages, and a runny nose with syphilis of the second stage is a common phenomenon, it is also called syphilitic rhinitis. It proceeds with the release of purulent and mucous secretions.

- Is there a temperature with syphilis?

- At the first stage of the disease, there is no hyperthermic reaction at all, or the temperature rises to imperceptible levels of 37 ° -37.2 ° C before the onset of secondary syphilis and the appearance of skin rashes. The symptom lasts for several days, until a rash appears on the skin, and then disappears.

- Does the body itch with syphilis?

- Definitely not.

Secondary syphilis

The second stage of syphilis is manifested by multiple skin rashes, which are characterized by a periodic course, that is, they appear and disappear after 30-60 days. With each new wave of the rash, it pales, losing its brightness and is less widespread throughout the body.

- What does the rash look like?

— Skin rashes or syphilides can manifest themselves in different ways.

Table number 1. Types of rash with syphilis of the second stage:

- Because of such a massive lesion of the skin, the question arises, is there itching with second-stage syphilis?

- Neither in primary nor in secondary syphilis, this symptom is absent. If a patient with syphilis has itching, this is a concomitant disease against the background of a weakened immune system with pale treponema, which requires separate diagnosis and appropriate treatment. Further, after skin manifestations, inflammation of the lymph nodes occurs throughout, since the lymph system is the first thing that affects pale treponema. An inflamed lymph node with syphilis is called a "syphilitic bubo". On examination, it is elastic and mobile, with a dense structure.

Do lymph nodes hurt with syphilis?

- Inflammation in the lymph nodes with syphilis does not cause pain and in most patients go unnoticed. Along with the defeat of the skin, syphilis also affects the mucous membranes, this manifests itself:

• erythematous angina, which affects the soft palate and tonsils;
• papular tonsillitis - a manifestation in the form of papules in the pharynx, which gradually transform into erosion;
• pustular tonsillitis - purulent lesions of the pharyngeal mucosa;
• pharyngitis - syphilides that affect vocal cords(may lead to loss of voice).

The second stage is characterized by baldness of all hairline. Pale treponema is to blame for this, which penetrates the skin and destroys the hair follicles. Hair loss with syphilis or syphilitic alopecia is divided into two types - small-focal and diffuse.

Table number 2. Hair loss types:

— hairline lost without recovery?

- No, with adequate therapy, the hair is completely restored.

- What are the other symptoms of secondary syphilis?

- This is where the clinical picture of the second period basically ends. Additional symptoms appear only in patients with a weakened immune system as a result of an unhealthy lifestyle or chronic diseases. In these cases, syphilis acquires a malignant course and is characterized by weight loss and symptoms of general intoxication of the body.

Tertiary syphilis

The third stage of the disease causes very serious health problems. During this period, pale treponema affects the entire body, from bone and cartilage tissue to all systems and internal organs, and pathological changes in the body are in most cases irreversible. Tertiary syphilis is no longer manifested by rashes on the skin, but has a completely different appearance.

- And what do the external manifestations of syphilis look like in the third stage?

- Skin rash is replaced by skin syphilides, which manifest themselves:

1. Tubercular formations- These are dense formations in the lower layers of the skin. They can have both group and single arrangement. In the region of the tubercle, there is a characteristic burgundy hue, and when pressed, painful sensations occur.
2. Nodular formations- a dense, immovable knot in the lower layers of the skin, has a size walnut and when it disappears, it leaves scar tissue.

The defeat of the mucous membranes in tertiary syphilis is called syphilitic gummas - these are dense nodular formations that develop in the subcutaneous fatty tissue, which deform soft tissues and lead to deformities. At the initial stage, gummy syphilis does not appear on the skin and mucous membranes, but in the process of development it forms a tumor protruding above the skin with a diameter of up to 4 cm.

Among the gums of the mucous membranes, there are:

• gummu tongue - thickening of the tissue, which leads to complete immobility and deformation:
• nasal gum deforms cartilaginous tissue, which leads to a complete collapse of the nose;
• gumma of the soft palate - formation in the deep layers of tissue, complication - complete immobility of the palate;
• Gumma of the pharynx, as in all previous cases, leads to complete immobility and makes swallowing difficult.

Syphilitic gummas affect not only the skin, but also internal organs, cartilage and bone tissues, blood vessels and muscles, leading to their complete destruction.

- Viktor Ivanovich, do the joints hurt with syphilis if the bones and joints are damaged?

- Oh sure. It should be mentioned that damage to the joints and bones is characteristic of all stages of syphilis, but in the first two periods, the inflammatory processes of the musculoskeletal system are asymptomatic. With syphilis, there are:

1. Damage to the bones and joints in the early stages is manifested in only 15% of patients and is manifested by body aches and minor pain in the bones.
2. Lesions in secondary syphilis are more common and may present with mild swelling in the affected areas (often the shoulder and knee joints), with no changes on the X-ray. In very rare cases, the patient may be pursued by severe pain and fever, while no pathologies are formed and the inflammation proceeds benignly, and with adequate treatment, the condition returns to normal.
3. The defeat of the bone-articular tissue in the tertiary period already has serious consequences. The patient is pursued by a strong pain syndrome and pathological changes. There is a lesion of the periosteum, brain and spongy substance.

- How does it manifest itself?

- This manifests itself:

1. Damage to the vertebrae - in a severe case, complete immobility and constant paroxysmal pain.
2. Damage to the bones of the skull and chest.
3. Damage to the nose and hard palate.

This is not the whole list of damage to the musculoskeletal system and bone tissue. All these pathological changes without proper treatment lead to disability. Along with bone tissue all internal organs and systems are affected.

In connection with these, there are:

1. CNS lesions or neurosyphilis can occur at any stage of the disease, but is most common in tertiary syphilis. After the penetration of treponema into nervous tissue damage to nerve cells and fibers begins, which is manifested by paralysis of the dorsal tabes, atrophy optic nerve and etc.
2. Syphilitic lesions of the digestive tract, which can be characterized by a fairly wide symptomatology, similar to other diseases of the digestive system - this is nausea, vomiting, loss of appetite. Oddly enough, but even diarrhea with syphilis is quite a possible symptom, as digestion is disturbed.
3. Liver damage can occur at all stages of the disease. In primary and secondary syphilis, it is not so critical and is manifested by jaundice, which is cured after two or three weeks of therapy, only in rare cases can it turn into atrophy, accompanied by symptoms of severe intoxication and coma. In the third stage, the liver is affected by gums and interstitial hepatitis is observed, as a result, adhesions of the liver occur, its work is disrupted and liver failure occurs, it is possible fatal outcome.
4. Pulmonary involvement is rare, but it does occur; this disease is called pulmonary syphilis. It is quite difficult to diagnose it, there may be minor manifestations on the radiograph in the form of minimal darkening and changes in the region of the lung root.

- Tell me, what are the symptoms of lung damage? Can coughing occur with syphilis?

- The clinical picture of lung damage has no distinctive features and is similar to the manifestation of other diseases, but the cough manifests itself in any case. A symptom of shortness of breath, hyperthermia and the release of a small amount of mucus may be added.

- What consequences last stage syphilis without proper treatment?

- It must be said right away that tertiary syphilis is very rare, since modern diagnostics allows you to recognize the disease in the early stages, but is still present in the risk group - these are the homeless, drug addicts and alcoholics. Without proper timely therapy, the patient develops mental insanity, loss of sight and hearing, paralysis of the brain and the fourth stage - death.

- Viktor Ivanovich, tell me if there is fundamental differences male and female syphilis?

- Differences between male and female syphilis can only be in the first stage of the disease with the appearance of a primary chancre and only with sexual infection. In men, erosion (hard chancre) is localized on the head of the penis or on the foreskin, in women on the labia, cervix or vaginal walls.

- Tell me, does the female body somehow especially react to infection with pale treponema? For example, how does menstruation proceed with syphilis?

- Not worth changing menstrual cycle taken as symptoms of the disease, and even more so, one should not hope that a normal cycle guarantees completely healthy body. Not all diseases, including sexually transmitted diseases, affect this physiological state. Menstruation with syphilis, especially in the first stages, pass without changes and in usual time and only later (tertiary) can cause pain and pass with a violation of the cycle. The tertiary stage of syphilis can last up to ten years and, as a rule, finds a woman at the age of forty, and changes in the cycle are attributed to menopause.

- Do you have divisions in women when infected?

- Yes, there are exceptions. They are distinguished from other STDs by their dense, pus-like structure. bad smell. Sometimes the discharge is accompanied by burning and discomfort in the genital area.

Syphilis and pregnancy

- Viktor Ivanovich, according to statistics, syphilis is not uncommon during pregnancy, and our readers are interested in this topic. How dangerous is the disease for future mother and the baby, what are the consequences of infection and what is congenital syphilis?

- Yes, to the deepest regret, such cases occur, although not often, due to the fact that during pregnancy the list of mandatory tests includes a reaction to syphilis, sometimes up to three times in nine months.

What to do if syphilis is discovered during pregnancy?

- A disease detected in time guarantees the unborn child health and birth without signs of syphilis. If the expectant mother does not receive timely treatment or therapy begins in the second and third trimester, the fetus is already affected by the pathogen and there is an almost 100% chance of congenital syphilis or even worse consequences - miscarriage and stillbirth. Congenital syphilis is distinguished early and late.

Symptoms of early congenital syphilis appear immediately after birth:

• damage to the skin;
• syphilitic runny nose;
• bone tissue damage;
• damage to internal organs and the central nervous system.

Symptoms of late congenital syphilis appear during the first two years of life or up to 14 years of age:

• damage to the optic nerve;
• deafness;
• damage to the teeth;
• damage to all organs.

- How realistic is the cure of the future mother from the disease?

— modern medicine is able to cope with the disease and minimize the risk to the child in almost one hundred percent of cases, but only with timely detected disease and timely therapy. An infected woman undergoes two courses of treatment - the main one immediately after the detection of the disease and prophylactic at later stages of pregnancy.

- Do they have an abortion for syphilis and in what cases?

- There are no prerequisites for abortion during pregnancy. If syphilis is detected early, adequate therapy will rule out all Negative consequences diseases. If the disease is detected at a later date, all the more so, abortion is out of the question. In this case, a treatment is prescribed that affects not only the mother, but also the child through the placenta. Modern medicine has drugs that are effective at any stage of the disease, so no qualified doctor will advise abortion.

- How to plan a pregnancy after treated syphilis?

- First of all, consult a doctor and pass necessary tests. If adequate therapy of the disease has been carried out and more than two years have passed, the risk of infection of the fetus is minimal. With treatment that has passed less than two years, at the discretion of the doctor, preventive therapy may be prescribed (after the 20th week of pregnancy), which will exclude infection.

Diagnosis of the disease

— Viktor Ivanovich, how is the disease diagnosed?

- First of all, this is an anamnesis, although in most cases this does not bring results, since most patients hide the details of their intimate life. The following is a series of laboratory measures to confirm the diagnosis:

1. Inspection, which reveals the external signs of the disease - hard chancres, inflammatory processes in lymph nodes and rash on the body.
2. Polymerase chain reaction or PCR is a sensitive diagnostic method that determines the presence of treponema pallidum DNA in the body with almost 100% result. For research, they take the liquid media of the body - amniotic fluid, cerebrospinal fluid. A puncture for syphilis for the study of cerebrospinal fluid is indicated only with a latent course of the disease.
3. Serological diagnosis identifies the presence of antibodies to the pathogen. Serum is used for research.
4. Wasserman's reaction - RV. The studied material is blood from a vein. In the presence of the disease, RV gives a positive result. When carrying out the analysis, different concentrations of serum are used for qualitative and quantitative formulation, and the titer of reagins is determined based on the maximum dilution. Titers for syphilis are indicated by a ratio from 1:2 to 1:800
5. Immunofluorescence reaction - RIF.
6. Treponema pallidum immobilization reaction -RIBT
7. RPHA - passive agglutination reaction.

What are titers for syphilis?

- Antibody titer - dilution of blood serum at which the activity of antibodies to the infectious agent is detected. With their low concentration, the disease is not confirmed, and with an increase in their number, we can talk about a possible disease. Also, the titer is used to control the dynamics of treatment, with its decrease.

What is a serological scar in syphilis?

- A serological scar or scar is the presence of antibodies to pathogens in the blood. This means that a person who has been ill has developed immunity to the disease in the form of antibodies. An experienced doctor on this indicator determines the duration of the infection.

- Say without specific analyzes Can the disease be diagnosed? At general analysis Whether blood leukocytes will be raised at a syphilis?

- Syphilis requires special diagnostics and the readings of leukocytes, both in the urine and in the blood, remain within the normal range.

- Very often there are statements false positive and false negative test results. Why can a syphilis test be false negative and false positive?

- Each of the laboratory diagnostics can give erroneous results. This happens when there is concomitant diseases(tuberculosis, lupus, etc.). Therefore, in order to avoid a false diagnosis, a combination of several laboratory tests is used and, on the basis of this, the disease is confirmed or refuted. If the results of the doctor are in doubt, they are prescribed additional research.

Table No. 3. The most common combinations of tests for syphilis and interpretation of the results:

- Viktor Ivanovich, very often in the comments, readers complain about doctors who confuse syphilis with other diseases. Is it possible?

Yes, in some cases it is possible. Syphilis in its symptoms is very similar to many other diseases and not necessarily venereal. I will give just a few examples:

• urologists confuse herpes, with syphilis of the first stage, when a hard chancre appears;
• on examination, the therapist may take the roseola of secondary syphilis for rubella or dermatitis;
• gynecologists with the appearance of erosion on the genitals diagnose thrush or trichomoniasis;
• ENT doctors stomatitis, with syphilis of the second stage, is confused with a syphilitic lesion of the oral cavity (ulcers, purulent rashes).

Separately, it should be said about the diagnosis of syphilitic gums, which are very often confused with:

• cancerous ulcers, their difference from gum metastases, which are not present with gums, as well as an irregular shape and a bumpy bottom;
• tuberculous ulcers, the differences are fistulas, at the bottom of the tuberculous ulcer there are bleeding granulations and the absence of a gummous core.

Therapy of the disease

- Viktor Ivanovich, let's move on to the treatment of the disease. What methods and drugs are used to treat syphilis and is it possible to completely get rid of the disease?

— Modern medicine has a wide range of methods and medicines against pale treponema, although treatment takes a long period of time. For example, primary syphilis is treated up to two months, and secondary up to two years. The success of therapy will depend on the stage of the disease and the timeliness of treatment. Therapy for each patient is prescribed individually, with the preparation of a specific scheme and under the constant supervision of a venereologist.

Where is syphilis treated?

- Depending on the stage of the disease and the drugs prescribed, therapy can be both outpatient and inpatient.

- Help me understand the medicines and tell me what drugs are used against syphilis?

- The main effect on pale treponema is the appointment of antibacterial agents, mainly from the group of penicillins, to which it is most sensitive. But with allergic reactions of the patient and the ineffectiveness of penicillin (in some cases), drugs from other groups are prescribed.

Table No. 4. Drugs of choice for the treatment of syphilis:

- What is the dosage of doxycycline for syphilis and the duration of treatment?

- The exact dosage of Doxycilin and other drugs is impossible to say. For each patient, an individual treatment regimen and an individual drug are selected, in some cases none, it all depends on:

• stage of the disease;
• the form in which the disease proceeds;
• the age of the patient;
• the presence of concomitant STDs;
• the presence of chronic diseases;
• individual response to drugs.

- If the disease occurs against the background of other chronic diseases and it is necessary surgical intervention, whether it is possible to do or make operation at a syphilis?

- During the period of syphilis therapy, any surgical intervention is contraindicated, until the moment of complete recovery. The exceptions are emergency operations without which death can occur.

- The first and most basic recommendation is not to delay the treatment of the disease and immediately seek help. The first two stages of the disease, with adequate and timely therapy, can be completely cured, but the third stage is already characterized by pathological irreversible consequences, and therapy can only maintain the patient's condition. It also follows:

• Do not stop receiving antibacterial drugs and do it according to the strict scheme prescribed by the doctor. This is necessary to maintain a constant therapeutic concentration of the drug in the body. Otherwise, the pathogen develops immunity to the drug and the disease is difficult to treat.
• Examine all sexual partners for syphilis. When diagnosing primary syphilis in a patient, all partners are checked for the last three months, if the disease is in the second stage - everyone who has been in contact with the patient over the past year.
• Refrain from sexual intercourse.
• Observe personal hygiene to avoid infecting others.

Video in this article - laboratory diagnostics diseases.