Is latent syphilis transmitted? Causes and treatment of latent syphilis

Latent syphilis - a disease that occurs without obvious symptoms (there is no external evidence in the form of a rash on skin no visible lesions internal organs and so on), it is possible to detect such a disease only with the help of laboratory diagnostics.

Unfortunately, latent syphilis cases are on the rise. In situations where the disease is not diagnosed, the patient self-medicates, and is treated for completely different diseases. As a result, the real disease is not cured, but acquires a latent form..

To detect latent syphilis, standard preventive examinations play a very important role, which help to identify positive antibodies to the pathogen bacteria. The presence of the latter must be confirmed in several cases of serological reactions:

Types of latent syphilis

Possible types of latent syphilis are presented below:

1. - characterized by the absence of symptoms in those who started treatment at the very beginning of the disease, but received inadequate treatment.
2. - occurs during the next period after the primary, flowing hidden.
3. - occurs with a latent course of the disease in those who have undergone an active third phase of the disease.
4. Early - occurs in cases where less than 2 years have passed since the onset of the disease.
5. Late - diagnosed in cases where more than 2 years have passed since the onset of the disease.
6. Unspecified - is determined in cases where neither the doctor nor the patient assumes how long the course of the disease lasts.
7. - occurs in cases where the disease is acquired from the mother, but there are no obvious symptoms.

Classification of latent syphilis

The main classification is early latent syphilis, late or unspecified, since the first three items on the list are a latent component of the active course of the disease after inadequate treatment.

The period corresponding to the first 2 years after infection corresponds to early latent syphilis. At this time, the infected may be a potential carrier of the disease. Since the disease can become active, a patient with latent syphilis should be isolated until complete recovery and sexual intercourse should be excluded. In the case of late latent syphilis, the patient is not a carrier of the infection, however, measures should be taken so that the damage is not critical.

The cause of latent syphilis is pale treponema

Treponema pallidum(pale treponema) is the main causative agent. If you look at it with multiple magnification, for example, using a powerful microscope, then we will see an organism that is a spiral in shape. The size of the curls varies from 8 to 14, the size of the microorganism is 7-14 microns in length, and the thickness is from 0.2 to 0.5 microns. Treponema is extremely mobile, and the variants of movements are diverse.

In structure, it is quite complex, a three-layer membrane covers the outside, followed by a cell wall, and inside a capsule-like substance. Fibrils located under the membrane are responsible for the number of movements (pendulum-like, movement around an axis, translational movement, etc.).

Under the influence of various factors (for example, during the treatment of a patient), biological properties pathogenic microorganism. Pale treponema is able to change the current form, and then return back to the spiral microorganism - it is in this case that the symptoms of the disease cease to be hidden and acquire an open form.

When pale treponema penetrates and settles in the cell, then the damaged cell prevents the spread of the disease, however, the balance is very unreliable, although it can last quite a long time - such cases are the latent course of syphilis.

Infection itself most often occurs when the mucous membrane or skin is damaged and directly comes into contact with the pathogen of the virus. Infection does not always occur (only about 50% of cases), but it is still better to avoid suspicious and unverified sexual contact. The state of the immune system is a very important factor in the occurrence of infection or its absence, thus, there is even the possibility of self-healing (purely theoretically, of course).

Symptoms of latent syphilis

The danger of latent syphilis is that there are no symptoms of the disease. Visually, there will be no defects in the skin and mucous membranes. But for any of the forms hidden disease existing in a pregnant woman, there is a danger of developing a congenital form of the disease in a future newborn.

There may be symptoms that are more common in the course of completely different diseases.

The main signs of latent syphilis

1. Regular unreasonable increase in body temperature, up to a maximum of 38 degrees Celsius.
2. Weakness, apathy, weight loss for no reason.
3. Change of lymph nodes in the direction of increase.

However, it is worth repeating that these signs can be symptoms of completely different diseases.

Diagnosis of latent syphilis

In order to diagnose latent syphilis, you must have a number of data:

1. Careful history over the past few years, such as whether self-treatment antibiotics for diseases not confirmed by a medical opinion.
2. The results of the examination of the current sexual partner of the patient to determine the presence (or absence) of the disease in the early stages.
3. A scar or induration at the site of the initial syphiloma, swollen lymph nodes (in most cases, these are inguinal lymph nodes).
4. In the case of the use of drugs containing penicillin - the reaction of the body with an increase in temperature.

The venereologist should establish the presence and type of the disease. The detection of a disease is very challenging task because a false-positive reaction is possible during the examination. Most often this happens in cases where the patient has previously suffered diseases such as:

• malaria;
• sinusitis (usually chronic);
• bronchitis;
• urinary tract infection, inflammation of the bladder;
• tonsillitis;
• chronic, possibly irreversible liver damage;
• rheumatism.

Therefore, studies to detect syphilis in a latent form are carried out many times, but at intervals.. If late latent syphilis is detected or if it is suspected, there is a need to take cerebrospinal fluid from the patient. A patient with a latent course of the disease needs to consult a general practitioner and a neurologist in order to identify and exclude concomitant progressive diseases that affect the entire nervous system and certain internal organs.

Treatment of latent syphilis

In the early stages, the goal drug treatment latent syphilis is to prevent the transition to an active form of the course of the disease, which can spread among others. In cases of a late stage, the main thing is to prevent irreversible damage to internal organs.

Treatment is with antibiotics containing penicillin.. If this is an early stage, then progress is observed by the end of 1-2 courses of therapy. If the disease is in the late stage, then progress is noticeable closer to the final part of the treatment, therefore, they usually begin with preparatory treatment.

Complications of latent syphilis

When timely treatment of latent syphilis does not occur, the infection moves further and further through the tissues and internal organs, having a weakening effect on the body as a whole. Sometimes there is a temporary improvement, but this is not a signal of recovery. Then comes the logical deterioration and progression of the disease.

In cases of early latent syphilis

• early onset: visual as well as auditory nerve(subsequently there is deafness and blindness);
• testicles are affected (in men);
• internal organs are affected, and their functions are impaired.

With a late course of latent syphilis the following complications are possible:

• insufficiency of the aortic valve;
• some part of the aorta undergoes expansion due to the pathology of its walls;
• sclerosis lung tissue, chronic suppurative process in the lungs.

There are also consequences that can lead to disability:

• changes in the palate that lead to the inability to eat;
• deformation of the shape of the nose, with subsequent difficulty in normal breathing;
• various inflammations and changes in bone tissue, leading to restriction of movement.

When neurosyphilis occurs a number of complications appear that lead to a neuropsychiatric disorder (all of them belong to the last stage of neurosyphilis):

• damage to the optic nerve leading to blindness;
• damage to the auditory nerve, leading to deafness;
• pathology of the spinal nerve, with subsequent spread to the ganglia.

Prevention of latent syphilis

Since syphilis is a sexually transmitted disease, you should be responsible in choosing a partner and use contraceptives. Those that directly protect against this kind diseases.

In cases where such contact was unavoidable, it is necessary to treat the contact areas with an antiseptic or antibiotic within a few hours after unprotected intercourse.

There are also general measures prevention, these include:

• risk group control (preventive examinations of persons suspected of having such viruses);
• control of pregnant women in order to exclude the occurrence of congenital disease syphilis.

The measures that everyone can take to avoid getting sick are very simple:

• you should be selective in choosing a sexual partner, jointly undergo regular examinations;
• use contraceptives that protect against sexually transmitted diseases (otherwise, use antiseptics and antibiotics);
• exclude the use of other people's personal items related to hygiene items.

The consequences of latent syphilis

The external consequences of the disease disappear quite quickly in case of timely treatment. In advanced cases, the disease and its effects only get worse. In the most neglected cases, it becomes absolutely impossible to restore the former health.

After an illness, one should approach the issue of pregnancy planning very responsibly. It should be noted that it will take more than one year for the normal restoration of the health of future parents. However, in some rather rare cases, damage after the disease leads to infertility. This should be remembered and accepted. preventive measures to avoid such a disease.

On the territory of our country, the spread of syphilis was first noted in the middle of the 15th century. This was due to insufficient medical care and illiteracy of the people.

Classification

Usually, latent syphilis is classified into several forms, depending on the severity of the symptoms:

• Primary.
• Secondary. Tertiary.
  • Secondary early hidden.
  • Secondary late latent syphilis.
• Congenital.

Primary syphilis has the most pronounced property to be transmitted from sick people to healthy people through direct contact. Severe forms have a lower degree of infection, but changes in human systems are already becoming clearly visible.

How is it transmitted

syphilis is venereal disease. As a rule, transmission is carried out from a sick person to a healthy person through sexual contact, but there are other ways. The main factors for the existence of a microorganism are humidity, anaerobicity and the required temperature. It is quite possible to get infected through the blood when it gets on the mucous membranes of another person or when it is transfused.

Important. Infection can also occur when using common dishes, towels and other household items, if a person has ulcers on the body. Bacteria are not detected in urine and sweat tests.

Stages of development

From the moment of infection to the onset of the first symptoms, a little less than a month passes. There are four stages in the development of the microbe and the immune response to it:

• Incubation.
• Primary.
• Secondary.
• Tertiary.

The period of reproduction of microorganisms does not betray itself in any way, the symptoms begin to manifest themselves clearly from primary stage development.

Note. This time is equal to four weeks, but it can decrease or increase depending on the amount of the source of infection. The bacterium divides once every 30 hours, which explains the rather long period before the manifestation of pathology. In addition, the use of antibiotics can increase this time.

Hard chancres (ulcers that do not cause discomfort) are a sign of the primary stage in the development of the disease. This period lasts 6-7 weeks. In addition to the appearance of chancres, rashes, patients have enlarged lymph nodes and vessels that conduct lymph in places close to the source of penetration.

The stage of reproduction of syphilis is usually divided into:

• gray-negative;
• gray positive.

They differ in the manifestations of the Wasserman reaction and enzyme immunoassay, respectively, negative or positive.

At the second stage of development, the disease affects the nervous system, and a rash on the skin and mucous membranes is also noted.

Here are distinguished:

• early;
• returnable;
• latent syphilis.

On the early stage the causative agent manifests itself as a rash. But at this time, other organs are also violated: the liver, kidneys, bones, central nervous system.

Spots on the skin indicate that the body is fighting the infection, but cannot be completely cured, which leads to a latent form of syphilis.

Important. This period is different in that the obvious symptoms disappear, patients with latent syphilis look healthy, but there are still bacteria inside them; the development of a relapse will occur as soon as the immune system fails even a little.

If proper treatment has not been carried out for one or two decades, the third and last form begins to develop. All organs and systems are affected here. Outwardly, it manifests itself in the form of syphilitic gums (nodules in tissues that irreversibly destroy them can form both on the skin and in internal organs, as well as bones). Manifestations are cyclical, it depends on immunity. As a rule, when the body is hypothermic, it decreases, at such moments the disease manifests itself. Often there is a localization of the microbe in one of the systems or organ.

Thanks to the use of antibiotic agents, the tertiary stage has become less and less common. It also happens that it did not come at all after normal passage first and second phases. Strong immunity may indicate this. Over time, the immune system is able to clear the infection from the body, so that conventional methods studies are unable to detect it due to the negligible amount of harmful microorganisms in the tissues. But with a slight deviation of immunity, the infection will begin to manifest itself again. Such a person becomes its carrier.

Symptoms of latent syphilis

The signs of the disease depend on the duration of the microbe inside the body and on the correctness of the treatment. Each phase is very different from each other.

Primary phase

It is characterized by the appearance of painless ulcers in the area closest to the source of penetration of the bacteria. As a rule, they are dense, regular rounded, solitary, do not increase either in volume or in diameter. This symptom is part of defense mechanism for an infection. There are other options for symptoms:

• Inductive edema. Occurs when sexually transmitted. Changes in size, skin color occurs in men - on the scrotum, in women - in the vagina. The epidermis in such areas becomes blue, pain does not occur when pressed. The phenomenon can persist for a month. It occurs much more frequently in women than in men. Edema can also form in other diseases, which makes it difficult to diagnose. This can be helped by a blood test, examining the patient for an increase in the number of lymphocytes.
• Chancre panaritium. It is an abscess on the fingers near the nails. Most often occurs in physicians operating on patients. This type of peculiar ulcer causes a lot of inconvenience, in addition to aesthetic, it hurts. The sick doctor can no longer work. In addition, there is a tendency to spread education on the organs responsible for reproduction.
• Chancre-amygdalite. Pathology is formed in the oral cavity - this is an increase in one of the accumulations of lymphoid tissue. In addition, the patient is tormented by fever and, of course, pain when swallowing. Unlike angina, only one side is affected and the mucosa remains smooth.

There are other types of surface formations. For example, when passing infection with another virus, chancres take on a different look. They can bleed, have an uneven frame and bottom. In such a situation, it is difficult to understand the origin of education. But there is always a sign of an increase in lymph nodes, which should be paid attention to when analyzing blood for the presence of a microorganism.

At the end of the stage external symptoms leave, a person may feel general malaise, fever, weakness.

Secondary

Characterized by skin rashes. Lymph nodes are cold, enlarged, dense. Here the patient feels the usual symptoms for an infectious disease. It also happens that there are no rashes, and even worse, if the stage does not manifest itself at all. In this case, outwardly, the patient will look like a cold, and the main virus will become chronic.

The latent period of syphilis lasts several days, rarely up to 7-14 days. After which the symptoms disappear.

Important. In the first two or three years, manifestation begins early syphilis with CNS damage. Pathological changes occur in the upper layers of the brain and blood vessels. The action of the immune system creates a barrier to meninges and thickening of the layers of blood vessels, by growing their inner walls. At the same time, nodular collapsing tissues are formed in them.

Often there is inflammation in the head and a violation of the reaction of the eyes to light. Less often - neuritis, polyneuritis, meningoencephalitis. With latent syphilis, there may be a violation of the reaction of the eyes to light.

Diagnosis of this stage is hampered by the similarity of symptoms with other infections.

Tertiary

Differs in the absence external signs. The person is a carrier of the infection, but he himself looks healthy.

Important. The stage of late syphilis can last more than two decades. But sooner or later, the disease makes itself felt: many destructive pathologies in different systems, which are gummas.

This period was classified in the middle of the twentieth century:

• Asymptomatic.
• Syphilitic meningitis.
• Meningovascular.
• Cerebral.
• Spinal.
• Parenchymal.
• progressive paralysis.
• Dorsal dryness.
• Taboparalysis.
• Atrophy of the optic nerve.
• Gummy.
• Gum of the brain.
• Gumma of the spinal cord.

The most common is the asymptomatic late form, which extends to the central nervous system. It accounts for more than 30 percent of cases. The second most common is spinal dryness.

All the species listed above develop after a long stay in the body of an infection that does not give itself away. Meningitis develops after two years, the rest - 15 years or more.

The clinical course is different, but there are similar points: a violation of the central nervous system, a decrease in memory and attention, the inability to think logically, paralysis, paresis.

Latent syphilis during pregnancy

If proper treatment of latent syphilis during pregnancy is not carried out, it can be transmitted to the child. In a newborn, changes are formed at the stage of formation of vital tissues, so the body is not restored. In this case, the following signs are noted:

• parenchymal keratitis;
• deafness;
• Hutchinson's teeth.

Important. In other cases, either early birth or death in utero.

Diagnostic methods

Pathology with obvious forms is perfectly noticeable, it is easy to identify it and suggest what kind of ailment the patient is tormented by. In their absence, serodiagnostic studies come to the rescue (recognition of the reaction when mixing the blood serum of the infected and the reagent).

Methods for diagnosing latent syphilis are usually distinguished into:

• Direct.
• Indirect.

The first ones include microscopy, infection with rabbit material, culture, and PCR diagnostics. The methods use several types per patient, each individually cannot give an accurate result. They have their drawbacks: long duration, impossibility of detection at certain stages, or they are expensive. Therefore, serological methods are used.

This includes various reactions human blood for the proposed reagents. Neither of indirect ways also cannot give an accurate answer to the presence of a microbe, and therefore the diagnosis is made only after two or more methods have been carried out.

Treatment

Important. The bacterium that causes this disorder remains one of the few organisms that cannot defend itself against penicillin. Therefore, therapy with this substance works great in our time. Taking the right dose of the drug for a long time helps to completely rid the body of the infection.

Erythromycin is another drug with the same effect, it is used for allergic reactions patient on penicillin drugs.

Treatment of late latent syphilis is carried out with penicillin in combination with antibacterial drugs that are injected into the muscles and orally.

Note. In the head section, as mentioned above, a barrier is formed that, as it were, protects the brain from the virus, but this same formation does not allow the healing substance to penetrate into the desired areas. This is facilitated by additional medications that are administered endolumbally. But there is a problem - the lack of specialized doctors.

How to treat latent syphilis if triponema is resistant to antibacterial drugs? It is allowed to use hard-to-reach mixtures with bismuth or arsenic.

Forecast

With the methods of treatment and prevention offered now, the disease is completely curable. But do not delay this, because after a certain period of time, the changes may be irreparable. The same prognosis applies to women during pregnancy with latent syphilis. After all, already in the womb, the baby receives pathological changes that remain with him forever.

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

What is latent syphilis

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

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

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

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

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

What is dangerous?

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

As the infection progresses, the pathogen spreads through the lymphatic system to the tissues of the liver, brain, and digestive tract, causing serious damage to organs. Pronounced signs violations develop during the transition of the latent phase to the active one. Serious changes occur in the absence of timely treatment against the background of a decrease in the body's defenses. With strong immunity, the patient becomes a carrier of infection.

Classification and forms of latent syphilis

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

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

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

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

Early period

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

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

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

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

Late period

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

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

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

Symptoms and signs of latent syphilis

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

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

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

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

Diagnostics

In diagnosing hidden form syphilis doctors are helped by the anamnestic method. Data collection takes into account:

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

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

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

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

Treatment and prevention

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

Examinations are assigned to the sexual partners of the patient.

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

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

Dosages of drugs:

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

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

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

How is the effectiveness of therapy monitored?

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

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

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

Latent syphilis - dangerous disease leading to disruption of many systems and organs. If you have any suspicious symptoms, you should consult a doctor.

Timely detection of infection helps prevent the development of complications.

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

Syphilis can also occur in a latent form.

This variant of the course of the disease is called latent syphilis. Latent syphilis from the moment of infection takes a latent course, is asymptomatic, but blood tests for syphilis are positive.

In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.

If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent, unspecified syphilis, and the diagnosis can be clarified during the examination and treatment.

The presence of treponemal syphilitic infection in a latent form is not observed in all patients, in 75% of cases after infection, at the end of the incubation period, the period of the first manifestations of the disease begins.

In some patients, after infection for years, the infection is present in the body, however, clinical symptoms there is no illness. Such a flow is called latent.

Currently, leading experts in the field of medicine and science believe that several factors influence the rate of development of the disease and the frequency of cases of transition to the latent course of the disease.

First of all, this is the state of the immune system, the frequency of taking medications, antibiotics during the period of infection and concomitant pathology.

It has been proven that taking any antibacterial drugs for syphilis prolongs the incubation period of the syphilitic system for different periods for each patient.

When the first signs of the disease appear, which can be very similar to a cold or flu-like condition, antibiotics can actually cause the disease to go into latent syphilis, which will not appear for months.

Ordinary syphilis develops when pale treponemas, the causative agents of this disease, enter the human body. During their activity, the patient develops symptoms of syphilis: rash, bumps, gummas, and so on.

At the same time, the patient's immunity does not stand aside: as with any infection, it secretes antibodies (protective proteins), and also sends cells of the immune system to the breeding sites of bacteria.

Thanks to these measures, the majority of pale treponemas die. However, the most tenacious bacteria remain, which change their shape so that the immune system no longer recognizes them.

In the cystic form, pale treponema cannot be active, but it can multiply

This kind of "disguised" pale treponema called cystic forms or L-forms. In this form, pale treponema cannot be active, but it can multiply.

As a result, when the immune system “loses its vigilance”, secretly breeding bacteria enter the bloodstream and harm the body again.

The same thing happens with improper treatment of syphilis. If the antibiotic is chosen incorrectly or in the wrong dose, not all pale treponemas die - the survivors are masked and remain invisible until better times.

Definition and causes

The diagnosis of latent syphilis in clinical practice is made if the patient has no specific symptoms on the mucous membranes and skin, there are no visible lesions of the internal organs, but according to the results of laboratory tests, antibodies to the pale spirochete are detected.

Diagnosis of this form of syphilis is considered the most difficult, since patients do not have the slightest suspicion of an infection. Usually, pathology is detected during examination for another disease.

In addition, strains of pale treponema are so insidious that they disguise themselves as chlamydia or gonorrhea, and with a special cunning of the pathogen, patients develop signs that indicate stomatitis, bronchial asthma, tonsillitis, but not syphilis.

The reason for the development of latent syphilis in patients, specialists in the vast majority of cases put attempts at self-treatment with a persistent unwillingness to consult doctors after casual sexual intercourse.

There are few people who, having felt a sore throat or a severe runny nose, decide that this is the result of casual sexual contact and immediately consult a doctor.

Most begin to be treated on their own, being completely confident in their actions and knowledge of medicine. And the most dangerous thing is to be treated with antibiotics.

Illiterate and uncontrolled intake of antibacterial drugs leads to the formation of new strains that are insensitive to drugs. And in the case of syphilis, the degeneration of pale treponema into a cyst state, which allows it to survive an unfavorable period without loss and harm to the colony.

As a result, the disease is not treated, but goes into a latent form, which is several times more dangerous.

One of the main reasons for the prevalence of latent syphilis among ordinary people is the illiteracy of people and their not entirely adequate attitude to their health.

The fact is that a person, having suspected a cold or the initial stage of the development of a sore throat, without prior consultation with a specialist, begins to take antibiotics uncontrollably.

But these medications hide the main symptoms of syphilis. In other words, syphilis is not cured, but healed and proceeds in a latent form.

Classification

The main classification of latent syphilis distinguishes such forms as:

• Early - diagnosed if 2 years have not passed since the moment of infection;
• Late - set if more than 10 years have passed since the infection;
• Unspecified (ignorant, unknown) - recorded if the time of infection cannot be determined;
• Congenital - diagnosed in children infected by sick mothers, but not having characteristic symptoms.

In addition, latent syphilis can have forms that are an active component of the latent course after inadequate therapy, these are:

• Primary, developing without any symptoms in patients who started treatment in a timely manner, but did not receive effective therapy;
• secondary, developing secondary syphilis, at total absence characteristic symptoms;
• Tertiary, placed in patients who have suffered an active third phase of syphilis.

Early latent syphilis

Early latent syphilis in clinical practice is considered the most dangerous form of the disease. The patient, unaware of his condition, infects the people around him. And what is most unpleasant is that not only sexual partners, but also relatives living nearby can be infected.

It is possible to establish the presence of a disease of this form only during a preventive examination or during an examination for another disease. A blood test for the Wasserman reaction is mandatory for any examination or hospitalization of patients with various pathologies.

This allows you to identify some forms of latent syphilis. But the analysis of the serological reaction does not always give accurate results therefore, patients should also undergo other tests.

When examining patients with suspected early latent syphilis, seals and swollen lymph nodes are often detected; short-term skin rashes are also possible, which did not cause concern, due to their transience.

Quite often, the nervous system suffers from an early latent form. In patients, there are violations of the walls of blood vessels and the lining of the brain.

late latent syphilis

Late latent syphilis is diagnosed if more than 2 years have passed since the infection. This form is distinguished by its safety for those around the patient.

Late latent syphilis does not skin rashes, but significantly destroys internal organs and negatively affects the functioning of the nervous system.

In the vast majority of cases, late latent syphilis is found in elderly people with symptoms of rheumatoid arthritis, myocarditis, or ischemic disease hearts.

Indicators of late latent syphilis consider such manifestations as:

It should be noted that the latent form of syphilis is divided into several subspecies:

• early latent syphilis;
• late;
• unspecified.

Usually, an early form of latent syphilis is detected within 2 years after infection. This form is considered the most dangerous, since an infected person poses a danger to other people.

After all, not only his sexual partners can become infected with this disease, but also people living with him under the same roof.

This disease is mainly found in medical examinations or during the examination of a patient who complains of a completely different disease. The Wasserman reaction is carried out, however, this study does not always give an accurate answer, therefore the patient is subjected to a number of other additional laboratory and clinical examinations.

During a clinical examination of a patient, enlarged and somewhat compacted lymph nodes are often found on the body. During the consultation, patients suddenly begin to remember that at a certain period of time rashes appeared on their body, which disappeared on their own.

All these symptoms indicate the presence in the patient's body of the causative agent of latent syphilis.

In some cases, early latent syphilis affects internal organs, such as:

• liver;
• stomach;
• thyroid;
• joints.

The central nervous system can also suffer from early latent syphilis. The nervous system, and in particular the membrane of the brain and the walls of blood vessels, is affected within 5 years after the moment of infection.

Syphilis is divided into several periods of the course of the disease:

• initial, or incubation;
• primary;
• secondary;
• tertiary.

Each period is divided into sub-periods. Latent syphilis refers to the secondary period of the course of the disease.

Secondary is divided into three types:

Early appears 10 days after the person has become infected. It is dangerous because a person, not knowing himself, infects the people around him.

Such syphilis often turns into active, in which it appears a large number of rashes, they have a lot of treponema, because of which a person becomes infected.

To find out about latent syphilis, you need to undergo the necessary research, so you can find out that you have a dangerous disease in a latent form, which is transmitted by contact and household.

The patient is immediately isolated from others until his body is completely rid of harmful bacteria.

A person learns about the late form of syphilis after 2 years. Such patients are not dangerous to others, they do not become infected.

But latent syphilis is dangerous because it is often diagnosed at a late stage, when it is in active phase, can affect internal organs, the nervous system, tubercles appear on the skin, low-contagious gummas.

Often a doctor cannot say exactly when a person became infected and how long latent syphilis lasts.

Symptoms and signs of latent syphilis

The latent form of syphilis does not have a visual visible symptoms and signs. This hidden syphilis is dangerous for sexual partners, for the immediate environment (the likelihood of infection in a domestic way), for an unborn child (if a pregnant woman has syphilis).

Symptoms of latent syphilis can occur in humans, according to the signs of some other diseases:

• rises to 38 degrees body temperature, without visible reasons and regularly;
• causeless weight loss;
• psychological disorders depression, apathy;
• a state of weakness throughout the body;
• enlargement and hardening of the lymph nodes.

Symptoms and Diagnosis

The course of latent syphilis practically does not affect the health status of patients. But, there are several signs by which patients may suspect the consequences of the life activity of pale treponema.

If a person for several years notices symptoms such as:

• regular increase in body temperature;
• enlargement and thickening of the lymph nodes;
• irresistible weakness;
• a feeling of apathy towards everything around;
• unexplained weight loss.

As well as obvious signs of a violation of the nervous system, which means that it is worth thinking about the causes of this condition. These may not be venereal diseases, but there may also be consequences of rash sexual intercourse, which resulted in infection with pale treponema, and the development of latent syphilis.

The diagnosis of latent syphilis is sufficient difficult process. The doctor may be disoriented by the patient's reticence, symptoms that point to other diseases and false positive results analyses.

Of great importance is a detailed history, the results of which can reveal not only the presence of suspicious sexual contacts, but also the appearance of erosion on the genitals or oral cavity in patients in the past, the use of antibiotics associated with a disease with suspicious symptoms, and much more.

Serological blood tests are mandatory. Indicators of ELISA, RIBT, RIF, and other specific tests help to identify the presence of pale treponema.

A consultation with a neuropathologist, gastroenterologist and proctologist is required to confirm or exclude damage to internal organs and disorders of the nervous system.

In practice, one has to deal with patients in whom the presence of syphilis is established only on the basis of positive serological reactions in the absence of any clinical data (on the skin, mucous membranes, from the internal organs, nervous system, musculoskeletal system) indicating the presence of in the patient's body specific infection. Many authors cite statistical data, according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis in 90% of patients is detected during preventive examinations, in women's consultations and somatic hospitals. This is explained both by a more thorough examination of the population (that is, improved diagnosis) and a true increase in the number of patients (including due to the widespread use of antibiotics by the population for intercurrent diseases and the manifestation of syphilis, which are interpreted by the patient himself not as symptoms venereal disease, but as, for example, the manifestation of allergies, colds, etc.).

Latent syphilis is divided into early, late and unspecified.

Latent late syphilis (syphilis lateus tarda) is epidemiologically less dangerous than early forms, since when the process is activated, it manifests itself either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of low-infectious tertiary syphilides (tubercles and gums).

Symptoms and Diagnosis

The following data can help in the diagnosis of a latent form of syphilis:

Before starting treatment for a latent form of syphilis, it is very important for a person with a suspicion of this disease to undergo a complete diagnosis. To do this, he needs to provide a venereologist full information about sexual partners.

The doctor also needs to determine the presence of single erosions in the genital area, mouth, or on the skin.

When diagnosing a disease, it is important to take into account the age of the patient and his lifestyle.

When diagnosing, it is very important to examine not only the patient himself, but also his sexual partner. Thus, early latent syphilis can be detected. The main confirmation of the presence of the disease are serological reactions.

Diagnosis of the latent form of syphilis is carried out using the following serological methods:

Treponema pallidum immobilization reaction (RIBT). For this analysis, the patient's blood serum and a suspension of pale treponema are used. They are mixed and see how the treponemas behave. Getting into the blood of a person with syphilis, treponemas are immobile. And when they get into the blood of a healthy person, they are active, swim for a long time, they are ready to infect. The accuracy of this test is 95%.

Diagnosis of latent syphilis is not an easy task for the doctor, as there is a possibility of a false positive reaction to syphilis.

1. The reaction of indirect hemagglutination (RPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
2. Enzyme immunoassay (ELISA). A special enzyme is added to the patient's prepared blood serum. If the serum replaces the color, then the patient is recognized as having syphilis.
3. RIF (immunofluorescence reaction). The presence of pale treponema is indicated by a specific glow.

It helps in determining the presence of the syphilis virus in the blood and the unusual type of pale treponema itself. Under a microscope, you can see that pale treponema has the appearance of a spiral.

The size of the curls decreases towards the end of the treponema, and the spaces between the curls increase. Movement in liquid media is slow and graceful.

A feature of pale treponema is its ability to maintain its spiral shape even under the pressure of its environment.

Elderly people are not treated for syphilis based on serological methods alone. They undergo additional examinations by a neuropathologist, an oculist and an otolaryngologist.

The definition of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times.

When a disease is detected, specific therapy is carried out, taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high chance of infection of the fetus, the formation of congenital malformations, miscarriage or premature birth.

A venereologist collects information about sexual partners who were earlier cases single erosions in the genitals, in the oral cavity, on the skin, whether the person took antibiotics for diseases similar to syphilis.

Age is taken into account sex life sick. After examining the patient, they notice scars, seals that remain after syphiloma. It is also often observed that the lymph nodes are enlarged, lymphadenitis develops.

It is important that not only you are examined, but also your partner, perhaps this is the whole problem, so early syphilis can be detected. The diagnosis is confirmed on the basis of a serological test.

The patient has elevated reagin titers. If a person has used antibiotics, the level of reagins may decrease.

Sexual partners who have an advanced form of syphilis often do not have different signs at all.

It is very difficult for a doctor to accurately diagnose latent syphilis; false positive reactions may occur due to the fact that a person has had bronchitis, malaria, chronic cystitis, tonsillitis, pyelonephritis, cirrhosis, hepatitis, pulmonary tuberculosis, rheumatism.

All tests for latent syphilis must be taken by the patient several times, they must be repeated after somatic disease in order to eliminate chronic infection in time.

Where to get tested for latent syphilis and who to contact?

It is not by chance that the latent course of syphilis is the cause of the epidemiologically dangerous and rapid spread of the disease. Prevention of infection consists not only in medical examinations, but also in timely access to doctors if syphilis infection is suspected.

Treatment

Treatment of latent syphilis is selected by a venereologist after a thorough examination and confirmation of the diagnosis. Early latent syphilis is cured quickly enough, after several courses antibiotic therapy. Late latent syphilis and other forms require a more complex treatment regimen.

Therapy of latent syphilis is accompanied by bouts of fever and severe internal discomfort. This is the result of the effective destruction of pale treponema.

After the detection of latent syphilis, treatment cannot be postponed for a day, since the insidious latent form can lead to serious consequences.

According to existing instructions and treatment regimens for syphilis, all patients with early latent syphilis are treated the same way. In those cases when it is possible to establish the prescription of the existence of an infection by means of anamnesis or according to confrontation data, the outcome of the disease can be predicted (naturally, the shorter the duration of the disease, the more favorable prognosis and treatment outcome).

Treatment of the latent form of syphilis should be started only after the diagnosis has been confirmed. It is carried out with the use of antibiotics of the penicillin group.

If treatment began at the initial stage of the development of the disease, then somewhere by the end of the second course of therapy, an improvement is noticeable. It is much more difficult to treat more advanced forms.

A significant increase in body temperature at the beginning of the course of treatment speaks only about the effectiveness of therapy. Fever is a sign that harmful microorganisms are rapidly being destroyed. Over time, this unpleasant symptom also disappears.

After completing the course of treatment, it is necessary to continue to take further complete examinations at the doctor's. It is very important to carry out serological control and this will last until the indicators of this analysis return to normal.

The treatment regimen for latent syphilis is to prevent the transition of the disease into a severe form.

When infected for less than two years, the treatment of early latent syphilis is aimed at eliminating the transition of syphilis to a secondary form and eliminating the epidemiological danger to others, family members and partners.

In cases where the patient has been infected for more than two years, and doctors determine late latent syphilis, treatment is aimed at eliminating all pathologies of internal organs and preventing the most serious complications - neurosyphilis, heart attacks and strokes.

The main treatment for syphilis is systemic antibiotic therapy with penicillins, or drugs of other groups for allergies and lack of sensitivity to treponema.

Depending on the severity of the organ damage, the manifestations of symptoms from the heart and nervous system, a treatment regimen is also formed. In addition, drugs are used to correct protective properties immune system.

Treatment of latent syphilis should take place according to the scheme, which should correspond to the type of disease and the timing of infection with it.

Syphilis is a disease that is treated for a long period. Latent syphilis is treated according to the same rules and schemes as other forms of syphilis. All family members should be examined and undergo a complex of treatment for prevention.

Treatment of latent syphilis is carried out with drugs of the penicillin group:

• the drug benzathine penicillin - 1 time per day for 3 days (for the early stage);
• benzylpenicillin sodium salt- 2 times a day, course of treatment 28 calendar days. After 2 weeks, a second course of treatment is carried out.

In case of allergy to penicillin, macrolides, fluoroquinolones and tetracyclines are administered to the patient. Also, in the treatment of the disease, in addition to antibiotics, vitamins and immunostimulants are attributed to the patient. If necessary, the patient is prescribed extracts medicinal herbs: echinacea, eleutherococcus, aralia.

Treatment of syphilis today practice 2 methods of treatment this disease, it is a continuous method and a course method.

Complex medical therapy consists of taking:

• antibiotics;
• fortifying the body preparations;
• symptomatic drugs;
• multivitamins;
• probiotics.

At the time of therapy, the patient is prescribed food, the diet of which is dominated by protein foods and a restriction in the consumption of fats and carbohydrates.

During this period, smoking and alcohol consumption are contraindicated, and it is also necessary to reduce physical activity on the body.

How to treat syphilis during childbearing? Women during the period of bearing a child are treated only with antibiotics of the penicillin group. Penicillins do not affect intrauterine development of the fetus.

How to treat syphilis while breastfeeding? At the time of treatment, it is necessary to refuse breastfeeding or in case of emergency, limit treatment to a minimum duration and doses.

Stress, depression and insomnia will have a negative effect on the treatment of the disease.

People who refuse treatment for latent syphilis, or who do not complete the full course of treatment medications, lose their health, which will already be restored.

The consequences of syphilis in female body can be:

• developing syphilitic gangrene;
• infectious syphilitic vaginitis;
• syphilitic infectious endocervicitis of the cervix.

The consequences of syphilis in the male body can be:

• syphilitic balanitis;
• syphilitic balanoposthitis of the glans penis;
• phimosis and paraphimosis of the foreskin;
• syphilitic infectious gangrenization of the head of the penis;
• phagedenism of the penis.

Therapy of latent early syphilis is carried out according to the same methods of treatment as regular forms of this disease. With a properly, adequately selected treatment regimen, the disease can be cured completely.

The therapy of late late syphilis is much more difficult, since both the internal organs and the brain, due to a long illness, have undergone structural changes that are difficult to treat.

Treatment for latent syphilis is the same as for other forms. Any syphilis is treated only with antibiotics, and the doses and terms depend on the prescription of the disease.

During treatment, patients undergo a course of injections (most often penicillin). With early latent syphilis, 1 course of injections is carried out, which lasts several weeks, with late - 2 courses are carried out lasting 2-3 weeks.

Early latent syphilis is most often treated at home (outpatient). Treatment of late latent syphilis is most often carried out in a hospital (in a hospital), because with an advanced disease, the risk of complications is much higher.

In addition, regardless of the stage of the disease, pregnant women with syphilis must be sent to the hospital. Syphilis is dangerous for an unborn child: the fetus can become infected and even die, in which case a missed pregnancy will develop. This will eventually lead to miscarriage or stillbirth.

For the duration of the treatment of latent syphilis (as well as its other forms!) The patient is prohibited from any sexual intercourse, kisses, use common subjects hygiene or utensils.

Latent syphilis is no better than the manifest and is very dangerous if left untreated! Therefore, it is important to be attentive to your health - if you suspect a sexually transmitted infection, immediately contact a specialized doctor. If the treatment of latent syphilis is started on time, it is completely curable.

Today, the treatment of syphilis is not difficult for doctors. But one thing should be understood.

When they talk about the treatment of latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformities, cardiovascular disorders, and nervous system disorders.

At the current stage of development of medicine, this is impossible to do.

In the treatment of latent syphilis, antibacterial drugs are used. The treatment regimen is selected individually, taking into account the stage of the disease and comorbidities.

Additionally, drugs are prescribed that raise immunity, since syphilis weakens it.

Approximate treatment regimens for latent syphilis are presented in the table:

Taking any medication is possible only after consulting a doctor. Self-medication is unacceptable! The frequency of taking medications and the duration of therapy are determined by the attending doctor.

It is important to prevent the disease in time before it worsens. During treatment, they prevent the development of neurosyphilis, protect somatic organs from various types of damage.

The latent form of syphilis is treated with antibiotics of the Penicillin group. At first, the patient rises sharply heat body, this indicates that the disease has worsened.

Whether treatment is effective or not, serological studies will help to find out whether the cerebrospinal fluid has returned to normal. A negative serological reaction should be observed, this indicates successful treatment. The late form is best treated with biyoquinol.

Complications of latent syphilis for the body

Latent syphilis is also dangerous for its possible serious complications. Untimely treatment of this disease can lead to an even greater spread of infection throughout the body and damage to internal organs.

If there is a temporary improvement, the disease continues to progress in its development.

Complications of the early form of syphilis are as follows:

• severe damage to the optic and auditory nerves occurs, which leads to blindness and deafness;
• the functionality of many internal organs is disrupted.

If the late form of syphilis is not treated, then:

• sclerosis of lung tissues;
• suppurative process in the lungs.

Prevention of syphilis is one of the effective ways avoid infection. Choose a partner carefully and very carefully. In any case, it is recommended to use protective equipment.

If, however, contact has occurred, after intercourse, the contact areas should be treated with an antiseptic or antibiotic. Also, don't use common funds hygiene.

Be healthy!

When people hide the infection with syphilis, try to treat themselves, or do not know about the latent syphilis in the body and do not undergo drug treatment, the infection spreads to the internal organs and tissues of the whole body and begins to destroy healthy state organs and systems.

As a result, the body weakens, and the person loses his ability to work. Periodically, there is an improvement in the general condition, but this improvement does not come for long.

Complications of the latent form of syphilis at an early stage:

• early development of neurosyphilis, which destroys optic nerve leading to blindness. As well as the auditory nerve, which produces deafness;
• in men, the testicles are affected, and their reproductive function is destroyed;
• internal organs are destroyed human body and systems.

Complications of the latent form of syphilis at a late stage:

• pathology of the aortic valve;
• pathology of the walls of the aorta, which causes the expansion of some of its sections;
• sclerosis of lung tissues, chronic stage suppuration of the lungs.

Complications that can turn a healthy person into a disabled person:

• palate deformity and inability to eat;
• destruction of the nose, which makes it impossible to breathe normally;
• destruction of bone tissue, which hinders movement.

Complications and prevention

Latent syphilis is a sexually transmitted disease that is more than 90 percent transmitted through sexual contact.

Preventive methods of syphilis are:

• permanent sexual partner;
• using a condom during sexual intercourse;
• douche with antiseptics after a sexual intercourse that was not protected by a condom;
• when planning pregnancy, a mandatory examination of both partners;
• refrain from sex at the time of drug treatment with antibiotics;
• healthy lifestyle;
• properly balanced diet;
• observance of intimate hygiene;
• regular examination by a gynecologist, urologist and venereologist;
• Maintain a healthy immune system at all times.

In order to avoid various infections, you must follow some rules.

1. Be selective in choosing sexual partners.
2. Use condoms during sex.
3. Use only your own personal hygiene items.
4. Do not rely on false positive results, but consult a doctor at the first sign of illness.

Remember that syphilis is not only a personal matter of a citizen. If a person is aware of his illness with syphilis, he hides it and infects another, then he may be held criminally liable.

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• What is Latent Syphilis
• Symptoms of Latent Syphilis
• Diagnosis of latent syphilis
• Treatment of Latent Syphilis
• Which Doctors Should You See If You Have Latent Syphilis?

What is Latent Syphilis

This variant of the course of the disease is called latent syphilis. Latent syphilis from the moment of infection, it takes a latent course, is asymptomatic, but blood tests for syphilis are positive.

In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.

If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent, unspecified syphilis, and the diagnosis can be clarified during the examination and treatment.

What causes latent syphilis

The causative agent of syphilis is pale treponema (Treponema pallidum) belonging to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically pale treponema (pallid spirochete) differs from saprophytic spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under the microscope, treponema pallidum is a spiral-shaped microorganism resembling a corkscrew. It has an average of 8-14 uniform curls of equal size. The total length of the treponema varies from 7 to 14 microns, the thickness is 0.2-0.5 microns. Pale treponema is characterized by pronounced mobility, in contrast to saprophytic forms. It is characterized by translational, rocking, pendulum-like, contractile and rotatory (around its axis) movements. Using electron microscopy, the complex structure of the morphological structure of pale treponema was revealed. It turned out that treponema is covered with a powerful cover of a three-layer membrane, cell wall and mucopolysaccharide capsule-like substance. Fibrils are located under the cytoplasmic membrane - thin threads that have a complex structure and cause diverse movement. Fibrils are attached to the terminal coils and individual sections of the cytoplasmic cylinder with the help of blepharoplasts. The cytoplasm is finely granular, containing the nuclear vacuole, nucleolus, and mesosomes. It has been established that various influences of exogenous and endogenous factors (in particular, previously used arsenic preparations, and currently antibiotics) had an effect on pale treponema, changing some of its biological properties. So, it turned out that pale treponemas can turn into cysts, spores, L-forms, grains, which, with a decrease in the activity of the patient's immune reserves, can reverse into spiral virulent varieties and cause active manifestations of the disease. Antigenic mosaicity of pale treponemas is proved by the presence in the blood serum of patients with syphilis of multiple antibodies: protein, complement-fixing, polysaccharide, reagins, immobilisins, agglutinins, lipoid, etc.

With the help of an electron microscope, it was found that pale treponema in the lesions is more often located in the intercellular gaps, periendothelial space, blood vessels, nerve fibers especially in early forms of syphilis. The presence of pale treponema in the periepineurium is not yet evidence of damage to the nervous system. More often, such an abundance of treponema occurs with symptoms of septicemia. In the process of phagocytosis, a state of endocytobiosis often occurs, in which treponemas in leukocytes are enclosed in a polymembrane phagosome. The fact that treponemas are contained in polymembrane phagosomes is a very unfavorable phenomenon, since, being in a state of endocytobiosis, pale treponemas persist for a long time, protected from the effects of antibodies and antibiotics. At the same time, the cell in which such a phagosome was formed, as it were, protects the body from the spread of infection and the progression of the disease. This unsteady balance can be maintained for a long time, characterizing the latent (hidden) course of a syphilitic infection.

Experimental observations of N.M. Ovchinnikov and V.V. Delektorsky are consistent with the works of the authors, who believe that when infected with syphilis, a long asymptomatic course is possible (in the presence of L-forms of pale treponema in the patient's body) and "accidental" detection of infection in the stage of latent syphilis (lues latens seropositiva, lues ignorata), t i.e. during the presence of treponema in the body, probably in the form of cysts, which have antigenic properties and, therefore, lead to the production of antibodies; this is confirmed by positive serological reactions for syphilis in the blood of patients without visible clinical manifestations of the disease. In addition, in some patients, the stages of neuro- and viscerosyphilis are found, that is, the disease develops, as it were, “bypassing” the active forms.

To obtain a culture of pale treponema, difficult conditions(special environments, anaerobic conditions, etc.). At the same time, cultural treponemas quickly lose their morphological and pathogenic properties. In addition to the above forms of treponema, the existence of granular and invisible filtering forms of pale treponema was assumed.

Outside the body, pale treponema is very sensitive to external influences, chemicals, drying, heating, influence sun rays. On household items, Treponema pallidum retains its virulence until it dries. The temperature of 40-42°C first increases the activity of treponemas, and then leads to their death; heating up to 60°C kills them within 15 minutes, and up to 100°C - instantly. Low temperatures do not have a detrimental effect on treponema pallidum, and storage of treponemas in an anoxic environment at -20 to -70°C or dried from a frozen state is currently the accepted method of preserving pathogenic strains.

Pathogenesis (what happens?) during latent syphilis

The reaction of the patient's body to the introduction of pale treponema is complex, diverse and insufficiently studied. Infection occurs as a result of the penetration of pale treponema through the skin or mucous membrane, the integrity of which is usually broken. However, a number of authors admit the possibility of introducing treponema through an intact mucosa. At the same time, it is known that in the blood serum of healthy individuals there are factors that have immobilizing activity in relation to pale treponema. Along with other factors, they make it possible to explain why contact with a sick person does not always cause infection. Domestic syphilidologist M.V. Milic, based on his own data and analysis of the literature, believes that infection may not occur in 49-57% of cases. The scatter is explained by the frequency of sexual contacts, the nature and localization of syphilides, the presence of an entrance gate in a partner, and the number of pale treponemas that have entered the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the intensity and activity of which varies depending on the degree of virulence of the infection. Therefore, not only the possibility of the absence of infection is discussed, but also the possibility of self-healing, which is considered theoretically acceptable.

Symptoms of Latent Syphilis

In practice, one has to deal with patients in whom the presence of syphilis is established only on the basis of positive serological reactions in the absence of any clinical data (on the skin, mucous membranes, from the internal organs, nervous system, musculoskeletal system) indicating the presence of in the body of a patient with a specific infection. Many authors cite statistical data, according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis in 90% of patients is detected during preventive examinations, in antenatal clinics and somatic hospitals. This is explained both by a more thorough examination of the population (i.e., improved diagnosis) and a true increase in the number of patients (including due to the widespread use of antibiotics by the population for intercurrent diseases and the manifestation of syphilis, which are interpreted by the patient himself not as symptoms of a sexually transmitted disease, but as, for example, the manifestation of allergies, colds, etc.).

Latent syphilis is divided into early, late and unspecified.

Latent late syphilis (syphilis lateus tarda) in epidemiological terms, it is less dangerous than early forms, since when the process is activated, it manifests itself either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of slightly infectious tertiary syphilides (tubercles and gums).

Early latent syphilis in time corresponds to the period from primary seropositive syphilis to secondary recurrent syphilis, inclusive, only without active clinical manifestations of the latter (on average, up to 2 years from the moment of infection). However, these patients may develop active, contagious manifestations of early syphilis at any time. This makes it necessary to classify patients with early latent syphilis as an epidemiologically dangerous group and to carry out vigorous anti-epidemic measures (isolation of patients, a thorough examination of not only sexual, but also household contacts, if necessary compulsory treatment and etc.). Like the treatment of patients with other early forms of syphilis, the treatment of patients with early latent syphilis is aimed at the rapid sanitation of the body from syphilitic infection.

Diagnosis of latent syphilis

The following data can help in the diagnosis of this form of syphilis:
1. anamnesis, which should be collected carefully, paying attention to the presence in the past (within 1-2 years) of erosive and ulcerative efflorescences on the genitals, in the oral cavity, various rashes on the skin, taking antibiotics (for "tonsillitis", "influenza condition"), treatment of gonorrhea (without examining the source of infection), if preventive treatment was not given, etc .;
2. the results of the confrontation (examination of a person who had sexual contact with the patient, and the identification of an early form of syphilis in him);
3. detection of a scar or induration at the site of primary syphiloma, enlarged (usually inguinal) lymph nodes, clinically consistent with regional scleradenitis;
4. high titer of reagins (1:120, 1:360) with sharply positive results of all serological reactions (in patients treated for gonorrhea or self-medicated, it may be low);
5. temperature reaction of exacerbation at the beginning of penicillin therapy;
6. rapid decline titer of reagins already during the first course of specific treatment; serological reactions are negative by the end of the 1st-2nd course of treatment;
7. a sharply positive result of RIF in these patients, although RIBT in a number of patients may still be negative;
8. the age of patients is more often up to 40 years;
9. possibility of normal cerebrospinal fluid; in the presence of latent syphilitic meningitis, rapid sanitation is noted in the process of antisyphilitic treatment.

Sick late latent syphilis practically considered harmless in epidemiological terms. However, in these cases, it is especially easy to mistake positive blood serological reactions for the manifestation of syphilis, while they can be false-positive, i.e., non-syphilitic, due to many causes (past malaria, rheumatism, chronic diseases liver, lungs, chronic purulent processes, age-related changes in metabolic processes organism, etc.). The establishment of this diagnosis in venereology is considered the most difficult and very responsible and should not be carried out without confirmation of REEF, RITT and RPHA (sometimes such studies are carried out repeatedly with an interval of several months, and also after the sanitation of the foci chronic infection or appropriate treatment for intercurrent diseases).

All patients are consulted by a neuropathologist, a general practitioner to rule out a specific lesion of the central nervous system and internal organs.

Diagnosis of late latent syphilis is facilitated by:
1. history data (if the patient indicates that he could have become infected from some source more than 2 years ago);
2. low titer of reagins (1:5, 1:10, 1:20) with sharply positive results for classical serological tests (CSR) or weakly positive results for CSR (with confirmation in both cases by RIF, RITT and RPHA);
3. negative serological reactions by the middle or end of specific treatment, as well as often the absence of negative CSR, RIF, RITT, despite vigorous antisyphilitic treatment using non-specific agents;
4. the absence of an exacerbation reaction at the beginning of penicillin therapy (it is preferable to start treatment of such patients with preparation - iodine preparations, biyoquinol);
5. pathology in the cerebrospinal fluid (latent syphilitic meningitis), observed in these patients more often than in early latent syphilis, and very slow sanitation of the cerebrospinal fluid.

In addition, late latent syphilis is also found in sexual partners or (much more often) they do not have any manifestations of a syphilitic infection (they are practically healthy, and preventive treatment of them as sexual contacts of patients with early latent syphilis should not be carried out). The main goal of specific treatment of patients with late latent syphilis is to prevent the development of late forms of visceral syphilis and syphilis of the nervous system in them.

Latent (unknown, unspecified) syphilis is diagnosed in cases where neither the doctor nor the patient knows when and under what circumstances the infection occurred. In connection with the division of latent syphilis into early and late in recent times this is seen less and less. The establishment of such a diagnosis in the absence of clinical and anamnestic data on syphilis confirms the possibility of asymptomatic undercurrent syphilis.