Manifestations of secondary syphilis. Causes of development, symptoms and treatment of secondary syphilis

Secondary syphilis begins some time after primary disease. Treponema pallidum affects 80% of the skin, spreads to mucous membranes and affects work internal organs. The infectious process seriously affects the patient's quality of life.

What is secondary syphilis

To make it easier to understand what secondary syphilis is, let’s look at the stages of the pathology. The violation occurs in 4 stages:

  1. Incubation. After infection, it may take 2-3 weeks before the patient notices discomfort and symptoms of syphilis.
  2. Primary. Treponema promotes the formation of chancre. In the coming week, reactions of the nodes of the lymphatic system will join it.
  3. Secondary. Begins several months after infection. Extensive rashes appear on the body due to the spread of treponemas throughout the body. The capillaries begin to undergo an inflammatory reaction.
  4. Tertiary. Severe inflammation or syphilitic gum occurs in the body. Healthy tissue is destroyed and serious defects are formed, such as the destruction of the palate or the collapse of the nose.

It is best to start treating syphilis at a latent stage, but at this stage only a doctor can detect it.


The tertiary form of inflammation ends with severe disability or failure of vital organs.

Secondary syphilis occurs due to untimely initiation of treatment. A few months after appearing in the body treponema pallidum symptoms of the disease appear. In rare cases, the secondary stage is asymptomatic. The infection can live in the body for up to 5 years.

Relapse is dangerous because it is easily transmitted from one person to another. Even in the absence sexual contact there is a risk of infecting loved ones. Treponema can be transmitted through personal hygiene products. For example, through underwear, toothbrush, washcloth and other things. Symptoms secondary syphilis will manifest itself acutely, so the patient should consult a doctor as soon as possible for help if discomfort is detected. Health care ends up in a hospital setting.

The secondary form is characterized by abundant skin rashes. At this time, treponema affects the blood and lymphatic system, spreading throughout the body.

Signs and symptoms of secondary syphilis

An exacerbation of the disease is easy to detect as the rash spreads throughout the body. However, one should not neglect skin damage, since the same changes occur with the internal organs of a person. First of all, the gastrointestinal tract suffers, then the functioning of the respiratory, reproductive system and visceral organs is disrupted.

The main symptoms of secondary syphilis are:

  • rash on mucous membranes and skin;
  • change in skin color;
  • syphilides (inflammatory elements) on the mucous membranes and skin;
  • hair loss.

An asymptomatic form of sexually transmitted disease is observed in patients who use strong antibiotics for the treatment of any disorder. The medications previously prescribed by the doctor are not able to completely eliminate treponemas, so the infection occurs in a latent form.

Rash

Most patients experience spotted syphilide, a red-pink rash on the skin and mucous membranes throughout the body. Most redness is observed on the sides and abdomen.

Each spot (roseola) has a diameter from 2 to 15 mm, the rashes do not merge with each other and have a clear edge. Pain is felt upon palpation, but there should be no itching or fever. The surface of the spot does not form a growth, so it practically does not protrude above the skin. When you press on roseola, it turns pale and becomes a normal skin color. Even during therapy, the skin does not peel off, this distinctive feature rashes due to syphilis.

Roseolas appear rather slowly, their spread takes 2-3 days. With secondary syphilis, the spots are located asymmetrically and are large in size. The rash may cluster in rings or other patterns. Roseola stays on the body from several weeks to 3 months.

Then they disappear even without drug treatment, but this does not mean that the disease has passed. After some time, a relapse will appear again, which will worsen the patient’s condition.

Papular syphilide

Papular syphilide is a papule that appears due to the accumulation of cellular infiltrate and is located in the upper dermis. Inflammations protrude above the surface of the skin and have a round or oval shape. They have a dense consistency and stay on the body for several months. Papules are located on the torso, face, palms, mucous membranes, scalp and genitals.

Syphilis occurs again through:

  1. Miliary papular syphilide. The patient develops small blisters near the sebaceous glands. They are covered with scales, have a pale color and a dense consistency. With syphilis, they are located mainly on the back, abdomen and chest. Miliary papular syphilide appears in people with weakened immune systems. This group includes people with chronic illnesses and those who abuse alcohol. This type of rash is resistant to medications, so it stays on the skin for a long time.
  2. Lenticular papular syphilide. The rash takes on the shape of a shortened cone and a smooth surface. Their color can be pink, yellow or blue. When you press on them, you feel a sharp pain. Papules are located on the head or neck and resemble psoriasis in appearance.
  3. Numular papular syphilide. The appearance of flat large rashes about 2 cm in size indicates numular syphilis. They will have a brown or blue tint and may be combined with other types of rash. After treatment, pigments or scars may appear at the site of the papules, and skin atrophy may also occur.

Pupular syphilides are contagious because they contain a lot of pathogenic microelements.

In this case, even shaking hands, kissing or hugging can cause syphilis infection.

Pustular syphilide

Doctors note that in their practice, patients with pastular syphilide were extremely rare. The rash is diagnosed in people with pathologically low immunity or malignant tumors. Treponemas depress general state body, so the patient suffers from headache, weakness and fever.

Pustular syphilide has its own classification, it can be acne-like, impetigious, smallpox-like, and also have the form of syphilistic ecthyma or rupee.


Acne syphilide is located on the head, neck and upper torso. Scanty rashes do not affect the general condition of the patient. The pustules are small in size and over time form a crust, which falls off on its own. Smallpox syphilide occurs in weakened patients. Pustules do not exceed the size of a pea; they can easily be confused with smallpox.

Impetiginous syphilide has a brown tint, the rash can fester and then shrink into a crust. The pustules are large and can merge with each other. Syphilide is located on the hairy areas of the body and takes a long time to heal. Pigment spots will remain at the site where the pustules formed; they will go away over time.

Sphilistic ecthyma is one of the most severe forms of the disease. It is observed in patients 5-6 months after infection. Large pustules reach a diameter of 3 or more centimeters. They become crusty and have a large compaction. The rashes rise above the skin and have a blue tint. This sign Syphilis occurs in pregnant women and immunocompromised men. The photo on the right shows what ecthyma looks like.

The rupee reaches a diameter of 5 cm. Blood or pus will periodically ooze from a deep ulcer. During the progression of syphilis, it occurs on the legs and is combined with other syphilides.

Alopecia

During syphilis, the rash can be combined with partial baldness. Hair begins to fall out due to the influence of treponema on the hair follicles. Pathogenic microorganisms provoke inflammation of the follicle, as a result of which the hair’s nutrition stops and it falls out.

Diffuse baldness with syphilis occurs rarely. During this, hair falls out evenly starting from the temples. In addition, the hair becomes dry and looks like a wig.

Hair growth will resume within a few months of starting treatment.

Diagnosis of the secondary period of syphilis

Prescribing medications is possible only after drawing up a complete clinical picture and conducting laboratory tests. Despite the fact that characteristic symptoms appear during syphilis, the doctor must make sure that venereal disease and confirm the diagnosis.

For this purpose, a scraping is taken from the affected cavity. Biological material examined under a microscope for the presence of treponemes. An immunological study is also carried out, which allows you to determine the exact form of the rash.

Features of the treatment of secondary syphilis


Patients with a confirmed diagnosis are prohibited from sex life during treatment. Also, people with syphilis are advised to be more careful to prevent infection of others. The person must use their own towel, cutlery, dishes and soap. If you have a sexual partner, it is recommended to sleep in separate beds and avoid physical contact.

Few people can follow such rules, so to prevent the illness from affecting other family members, patients are placed in a hospital.

Secondary syphilis is treated with antibacterial agents. For quick effect and maximum relief of health conditions, drugs are administered intravenously. The most effective drugs against treponemas are penicillin. Injections with this component are given every 3 hours.

For home treatment, binicillin is prescribed. It is consumed once every 2 days. If allergies or side effects are present, azithromycin, tetracycline or doxycycline are prescribed. Treatment of secondary syphilis must be comprehensive, since strong antibiotics can negatively affect the condition of some internal organs. Therefore, in addition to them, immunostimulants, multivitamins and probiotics are prescribed.

To improve performance immune system Doctors may recommend methyluracil or pyrogenal. Almost any multivitamin complex is suitable.

Excessive skin rashes that appear during syphilis must be treated periodically.

For this, heparin ointment or chlorhexidine is used. Local medications speed up the resorption and healing process.

Prevention methods

An advanced form of syphilis can lead to serious problems with health. Therefore, everyone should study in advance preventive measures to help prevent the disease:

  • the use of barrier contraceptives during sexual intercourse, they are needed regardless of whether vaginal, oral or anal sex is practiced;
  • the use of preventive medications that improve the functioning of the immune system;
  • regular completion of medical examination and passing the necessary tests;
  • use of personal hygiene products;
  • refusal to visit public bath, sauna or swimming pool during periods of unwellness.

There is also urgent prevention of syphilis, it is used immediately after unprotected sexual intercourse. In this case, you need to urinate and wash your genitals with disinfectant. Immediately after this, visit a skin and venereal disease clinic. Most of them operate around the clock, so examinations can be performed at any time.

Syphilis can seriously affect your health, so if you have any suspicions, seek help from a doctor.

The secondary period of syphilis often begins with prodromal phenomena, which usually occur 7-10 days before the appearance of secondary syphilides. More often they are observed in women or weakened patients and coincide in time with the massive spread of Treponema pallidum in the patient’s body through the hematogenous route. There is weakness, decreased performance, adynamia, headache, pain in muscles, bones, joints (increased in night time, which is typical for syphilis), increased temperature (up to average numbers, less often up to 39-40°C). Often this condition is regarded by patients and doctors as influenza, which delays timely diagnosis syphilis. During this period, leukocytosis and anemia may be observed in the blood. As a rule, with the appearance of clinical symptoms of the secondary period of syphilis, prodromal phenomena, which do not occur in all patients, disappear.

Secondary syphilis is characterized by a variety of morphological elements that are located on the skin and visible mucous membranes, as well as (to a lesser extent) changes in internal organs, nervous system, motor system, etc. Secondary syphilis develops after 2-2.5, less often 3 months. after infection. Without treatment, relapses can occur several times over several years or more. In the intervals between rashes, a diagnosis of secondary latent syphilis.

Syphilides in secondary syphilis have common symptoms:

    all elements are benign, they usually do not destroy tissue, do not leave scars, except for rare cases of malignant syphilis, accompanied by ulceration, disappear spontaneously after 2-3 months, are usually not accompanied by a violation of the general condition;

    rashes are not usually accompanied by subjective sensations. Only if there is a rash on the scalp and in large folds of the skin, some patients complain of slight itching;

    there are no signs in the elements acute inflammation, they have a copper-red, stagnant or brownish tint, and then their color becomes faded, “boring”, the latter reflects not only the tone of the color, but also the very course of the secondary syphilis rash;

    the rashes have a round shape, they are sharply demarcated from healthy skin, are not prone to peripheral growth and fusion, and therefore are focally located, remaining delimited from each other;

    expulsions are characterized by polymorphism, since secondary syphilis is often characterized by the simultaneous eruption of various syphilides, which causes true polymorphism, and the paroxysmal appearance of syphilides causes evolutionary or false polymorphism;

    syphilides quickly resolve under the influence of antisyphilitic treatment;

    serological blood reactions (RSC, RW) and sediment samples are sharply positive in almost 100% of cases with secondary fresh syphilis (with a high titer of reagins - 1:160, 1:320) and in 96-98% of patients with secondary recurrent syphilis (with a lower reagin titer). In almost 100% of cases, a sharply positive result is observed when examining the blood of patients using RIF. The immobilization reaction of Treponema pallidum (RIBT) gives a positive result in almost half of patients with secondary fresh syphilis (60-80% immobilization) and in 80-100% of patients with secondary recurrent syphilis (90-100% immobilization). Up to 50% of cases of secondary recurrent syphilis are accompanied by pathological changes in the cerebrospinal fluid in the absence of a clinical picture of meningitis (the so-called hidden, latent syphilitic meningitis).

Syphilides consist of vascular spots (roseola), nodules (papules) and, much less frequently, vesicles (vesicles), pustules (pustules). In addition, secondary syphilis includes pigmentary syphilide (syphilitic leucoderma) and syphilitic hair loss (alopecia).

With secondary fresh syphilis, the syphilides are smaller, more abundant, brighter in color, located symmetrically, mainly on the skin of the body, do not tend to group and merge, and, as a rule, do not peel off. In most patients, remains of hard chancre and pronounced regional lymphadenitis can be detected (in 22-30% of patients). In addition, polyscleradenitis is better expressed (enlarged, densely elastic consistency, mobile, painless lymph nodes in the axillary region, submandibular, cervical, cubital, etc.). Polyadenitis occurs in 88-90% of patients with secondary fresh syphilis.

With secondary recurrent syphilis, the elements of the rash are larger, less abundant, often asymmetrical, prone to grouping (formation of figures, garlands, arcs), paler in color, often localized in the perineum, inguinal folds, on the mucous membranes of the genitals, mouth, etc. e. in places subject to irritation. If with secondary fresh syphilis, 55-60% of patients have a monomorphic roseolous rash, then with secondary recurrent syphilis it is less common (about 25% of patients), and a monomorphic papular rash is more often observed (up to 22% of cases).

Spotted syphilide (syphilitic roseola) is the most common form of skin lesions in secondary fresh syphilis.

Roseola is first pink, and then pale pink, with blurred outlines, round, up to 1 cm in diameter, non-merging spots with a smooth surface that do not have peripheral growth and do not rise above the surrounding skin. Roseola appears gradually, 10-12 elements per day and reaches full development in 7-10 days, which explains the different intensity of its color. When pressure is applied to roseola, it temporarily disappears or turns pale, but after the pressure stops it appears again. Only when pressing on a long-existing roseola does a yellowish color remain in place of the pink one, due to the breakdown of red blood cells and the deposition of hemosiderin. Long-existing roseola becomes yellowish-brown in color. Roseola is located mainly on the trunk and limbs. The skin of the face, hands and feet is extremely rarely affected. Roseola is not accompanied by subjective sensations. After remaining on average for 3-4 weeks without treatment, roseola gradually disappears.

With secondary fresh syphilis, roseola is located randomly, but symmetrically and focally. Roseola in secondary recurrent syphilis occurs in smaller quantities than in secondary fresh syphilis, is usually localized only in certain areas of the skin, and is often grouped to form figures in the form of arcs, rings, semi-arcs, while retaining the focus of its location. At the same time, the size of recurrent roseola is slightly larger than the size of fresh roseola, and their color has a cyanotic tint. In patients with secondary fresh syphilis, after the first injections of penicillin, an exacerbation reaction usually occurs (Herxheimer-Yarish-Lukashevich reaction), accompanied by an increase in body temperature and increased inflammation in the area of ​​syphilitic rashes. In this regard, roseola, acquiring a more saturated pink-red color, is clearly visible. In addition, during an exacerbation reaction, roseola may appear in places where it was not there before treatment.

In addition to the typical roseola, there are the following varieties, which are extremely rare:

    flaking roseola - lamellar scales appear on the surface of the spotted elements, reminiscent of crumpled tissue paper, and the center of the element appears somewhat sunken;

    rising roseola (elevation roseola) - in the presence of perivascular edema, it rises slightly above the level of normal surrounding skin, resembling a blister, but is not accompanied by itching.

Differential diagnosis. Diagnosis of syphilitic roseola, especially with fresh secondary syphilis, usually does not present any difficulties. When making a differential diagnosis of macular syphilide, one should keep in mind the macular rashes that occur in some acute infections (rubella, measles, typhoid and typhus), toxicerma, pityriasis rosea, pityriasis versicolor, spots from flattened bites. However, rashes during acute infections are always accompanied by quite high temperature bodies and general phenomena. In patients with measles, a profuse, large, confluent, bright rash first appears on the face, neck, torso, extremities, including the back of the hands and feet; When the rashes regress, the rash peels off. Dotted whitish Filatov-Koplik spots appear on the mucous membrane of the cheeks, sometimes on the lips and gums. In patients with rubella, the rash first appears on the face, then the neck and spreads to the torso. The rashes are pale pink in color, up to the size of a lentil, have a round or oval shape, without a tendency to merge, often stand somewhat above the skin level, exist for 2-3 days and disappear without a trace; at the same time, similar rashes occur on the mucous membrane of the pharynx; Sometimes itching bothers me.

Rashes during typhoid and typhus are always accompanied by severe general symptoms; roseola during typhus is not so abundant and often takes on a petechial character; in addition, in these cases there is no primary sclerosis, scleradenitis, or polyadenitis.

In cases where the appearance of syphilitic roseola is preceded by prodromal phenomena with fever, the latter is not as high as with typhus and disappears in the very first days after the appearance of roseola rashes.

Spotty rashes due to toxicerma, which occur when taking medications or poor-quality food, are characterized by an acute onset and course, bright color, rapid addition of peeling, a tendency to peripheral growth and fusion, they are often accompanied by burning and itching.

In patients with pink lichen of Gibert, in contrast to syphilitic roseola, the so-called maternal plaque, which is an oval, pink-red spot measuring approximately 1.5x3 cm or more with a thin lamellar yellowish scale, wrinkled, like a crumpled cigarette, first appears more often in the area of ​​the lateral surface of the body paper. After 1-2 weeks. a large number of similar elements appear, but of smaller size, which are located with their long diameter along the metameres.

With pityriasis versicolor (multi-colored) in contrast to syphilitic roseola, non-inflammatory, café-au-lait-colored, scaly spots that tend to coalesce appear, most often in the area of ​​the upper torso. When such stains are lubricated with iodine tincture, they become more colored. dark color compared to the surrounding skin.

Spots from squash bites differ from syphilitic roseola in their grayish-violet color and the presence in the center of some spots of a barely noticeable hemorrhagic point from the bite pubic lice; these spots do not disappear with pressure.

When conducting differential diagnosis syphilitic roseola with the above diseases, the absence of other clinical symptoms of secondary syphilis, as well as the results of a serological examination of patients, are of great diagnostic importance.

Papular syphilide - the same frequent manifestation of secondary syphilis as roseola. But if roseola is the most common manifestation of secondary fresh syphilis, then papular syphilide is of secondary recurrent syphilis. Based on size, there are large-papular, or lenticular, and small-papular, or miliary, syphilides.

Lenticular papular syphilide is the most common type of syphilitic papules, which have a dense elastic consistency, round, sharply limited outline, hemispherical shape, size from a lentil to a pea (0.3-0.5 cm in diameter). They are not prone to peripheral growth and fusion. The color of the papules is initially pink, later becoming copper-red or bluish-red (ham). The surface of the papules is smooth and shiny in the first days, then begins to peel off. Peeling of papules begins in the center and ends earlier than at the periphery, which causes the appearance of marginal peeling of papules in the form of a “Biette collar”. Pressure on the center of the nodule with a blunt probe causes sharp pain (Jadassohn's symptom). Papular syphilides do not appear on the skin immediately, they appear in spurts, reaching full development after 10-14 days, after which they persist for 6-8 weeks, so in the same patient you can see papules at different stages of development. After the papules resolve, pigmentation remains in their place for a long time.

With secondary fresh syphilis, papules are symmetrically, randomly scattered on the skin of the trunk and limbs, often on the face and scalp. In patients with secondary recurrent syphilis, papules are few in number and tend to be grouped in the form of rings, garlands, arcs, semi-arches and localized in favorite places (genitals, anal area, oral mucosa, palms, soles, etc.).

The following clinical types of secondary papular syphilides are distinguished: psoriasiform, coin-shaped, seborrheic, palms and soles, weeping, condylomas lata, etc.

Seborrheic papular syphilide localized in areas of the skin rich in sebaceous glands, mainly in persons suffering from oily seborrhea on the face, especially in the forehead area at the border with the scalp (crown of Venus), in the nasolabial, nasobuccal and chin folds, on the scalp.

The papules are covered with yellowish or grayish-yellow greasy scales.

Psoriasiform papular syphilide characterized by the presence on the surface of the papules of a large number of silvery-white lamellar scales, due to which these elements become similar to psoriatic rashes.

Monetoid (nummular) papular syphilide represented by rounded papules with a diameter of a 2-ruble coin or more with a somewhat flattened spherical surface, brownish or red in color. Occurs mainly with recurrent syphilis. In this case, single rashes are noted, which are usually grouped.

Papular syphilide of the palms and soles has a unique appearance. At first, the papules almost do not rise above the level of the surrounding skin and look like sharply limited reddish-violet or yellowish spots with dense infiltration at the base. Subsequently, dense, difficult to remove scales form on the surface of such elements. The peripheral part of the element remains free from scales.

After some time, the stratum corneum in the central part of the papule cracks and the papule begins to peel off, gradually forming a Biette “collar”.

Such papules in the area of ​​the palms and soles can occur with fresh, but much more often with recurrent secondary syphilis. Moreover, the older the syphilis, the more pronounced is the asymmetry of the location of the rashes, including on the palms and soles, their grouping into rings, arcs and merging into large plaques with scalloped outlines, sometimes pronounced peeling, cracks, which is characteristic of late recurrent syphilis.

Sometimes keratinization of the surface of papules on the palms and soles reaches a significant degree, and callus-like thickenings form. However, they are always surrounded by a sharply limited, stagnant red, dim rim.

Weeping papular syphilide is formed when lenticular papules are localized in places with increased sweating and constantly exposed to friction (genital organs, anal area, inguinal-femoral, intergluteal, axillary folds, interdigital folds of the feet, under the mammary glands in women, etc.). In this case, maceration and rejection of the stratum corneum from the surface of the papule occur, resulting in a regularly rounded weeping erosion. The serous discharge of erosive papules contains a large number of pale treponema. Under the influence of prolonged irritation by friction, weeping papules can increase in size and merge into plaques with large scalloped edges. Under the influence of prolonged irritation and the addition of a secondary infection, the erosive papule can ulcerate. The sharp separation of each element from the surrounding healthy skin, the elevation of erosion above the surrounding surface and mild subjective sensations (itching, burning) allow us to establish a diagnosis. Condylomas lata (vegetative papules) arise from erosive papules located in the area of ​​the labia majora and on the adjacent skin, in the anal area, intergluteal and inguinal-femoral folds, armpits, interdigital folds of the feet, navel area, scrotum, inguinal-scrotal folds, at the root of the penis. These papules, under the influence of prolonged irritation, can vegetate, their surface becomes lumpy, uneven, covered with a serous or grayish sticky coating containing a large number of pale treponemes.

Vegetating papules, or condylomas lata, tend to increase and sometimes reach large sizes. Condylomas lata are characteristic mainly of secondary recurrent syphilis and at a certain stage may be the only manifestation of the late period of the disease.

Miliary papular syphilide is extremely rare. Grouped brownish-reddish or copper-red, conical, dense papules the size of poppy or millet grains appear mainly on the skin of the body. When grouped, the rashes form rings, arcs, plaques with jagged edges and a fine-grained surface. The nodules are located around the mouths of the pilosebaceous follicles. On the surface of individual papules there are scales or horny spines. Sometimes miliary papules are so pale and small that miliary syphilide may resemble so-called goose bumps.

Abundant miliary syphilide indicates severe course syphilis.

Differential diagnosis. Lenticular syphilide may be very similar to lichen planus, parapsoriasis and lichen planus. However, when red lichen planus In contrast to papular syphilide, flat, shiny, polygonal, liquid-colored papule appears, with an umbilical depression in the center of the papule. Due to uneven granulosis, a grayish-white mesh (Wickham mesh) is visible on the surface of the papules. Usually the process is accompanied by severe itching.

Clinically, the teardrop form of parapsoriasis can be very difficult to distinguish from syphilitic papules, however, with parapsoriasis there is a triad of symptoms characteristic only of this disease: hidden peeling, revealed by scraping the rash; symptom of “wafer” (L.N. Mashkilleyson), i.e. peeling revealed by scraping has the appearance of a colloidal film; and hemorrhages around the papule that occur when the latter is scraped. In addition, rashes with parapsoriasis are accompanied by a smaller infiltrate compared to syphilitic nodules and extremely rarely appear on the oral mucosa.

Lichen squamosus differs from psoriasiform papular syphilide by the presence of the phenomena of stearin stain, psoriatic film and pinpoint bleeding characteristic of psoriasis, peripheral growth and a tendency to merge with the formation of plaques, a chronic course with frequent relapses. In addition, psoriatic rashes are characterized by a pink color.

Condylomas lata may resemble genital warts, and when located in the anus, they may resemble hemorrhoids.

Genital condylomas differ from condylomas lata in their lobular structure, reminiscent cauliflower, the presence of a thin stem. Genital warts have a soft consistency, including in the area of ​​the base of their legs, vary in size, sometimes reaching the size of a cherry or more, the color of normal skin or pinkish-red, and they often bleed easily.

Due to the fact that genital warts are localized in the genital and anal areas, their surface can be macerated and eroded.

As for hemorrhoids, unlike condylomas lata, which are located with their entire base on the skin, a hemorrhoid has at least one surface covered with the mucous membrane of the rectum. In addition, the hemorrhoidal node has a soft consistency, often bleeds, and does not have a dense elastic infiltrate. The chronic nature of hemorrhoids should be taken into account, as well as the possibility of syphilitic rashes on hemorrhoids.

Miliary syphilide is similar to lichenoid tuberculosis of the skin, which, unlike syphilitic papules, is characterized by a soft consistency, yellowish-red color, a tendency to cluster, the formation of delicate scales on the surface of the rash, the onset of the process mainly in childhood, positive tuberculin reactions, and the absence of other signs syphilis and negative serological reactions to syphilis. All these signs allow you to make a correct diagnosis.

When carrying out differential diagnosis of papular syphilide vital importance has a serological examination of patients for syphilis.

Pustular (pustular) syphilide is a relatively rare manifestation of secondary syphilis. Its presence usually indicates a severe, malignant course of the disease. The appearance of pustular syphilide is often accompanied by fever and general symptoms. It occurs, as a rule, in weakened, exhausted patients suffering from alcoholism, tuberculosis, drug addiction, hypovitaminosis, etc.

The following clinical types of pustular syphilide are distinguished: acne-like, smallpox-like, impetiginous, ecthymatous (syphilitic ecthyma), rupioid (syphilitic rupee).

Superficial pustular syphilides, such as acne, smallpox and impetiginous, more often occur in patients with secondary fresh syphilis, and deep pustular syphilides (ectymatous and rupioid) - mainly during relapses of the disease. Pustular syphilides are ordinary syphilitic papules, the infiltrate of which is saturated with serous-polynuclear exudate, disintegrates, after which a yellowish-brown crust is formed, similar to pyoderma. At the same time, the varieties of pustular syphilides are determined by the location, size and degree of their decay.

Acne-like (acneiform) pustular syphilide are follicular papules sharply demarcated from healthy skin, at the top of which there is a cone-shaped pustule measuring 0.2-0.3 cm in diameter. The purulent exudate dries quite quickly into a yellowish-brownish crust, upon the fall of which barely noticeable depressed pigmented scars are revealed. Acneiform syphilide is usually combined with other manifestations of the secondary period of syphilis.

Differential diagnosis. Acne syphilide should be differentiated from acne vulgaris, papulonecrotic tuberculosis and iodine or bromide acne. Acne vulgaris differs from acne syphilide in the acute nature of inflammation, pain, the presence of severe seborrhea and comedones, the age of the patients, and a chronic course with frequent relapses of rashes. Papulonecrotic tuberculosis of the skin, localized on the extensor surfaces of the extremities, proceeds for a long time, the elements develop torpidly, and at the site of nodular rashes that undergo necrosis of the central part, “stamped” scars remain, which never occurs with syphilis. In the diagnosis of iodine and bromide acne, in contrast to syphilis, the presence of large pustules and an acute inflammatory corolla along the periphery of the acne-like elements is important; absence of dense infiltrate at the base, rapid resolution of rashes after stopping taking iodine or bromine preparations.

Smallpox pustular syphilide are hemispherical pustules the size of a lentil or pea, surrounded by a sharply demarcated copper-red infiltrate with an umbilical depression in the center. After 5-7 days, the contents of the pustule shrink into a crust located on the infiltrated base, and the element remains in this form for a long time. After the crust is rejected, brown pigmentation and often a scar remain. Smallpox syphilide can appear in any quantity, but more often up to 15-20 elements usually appear on the flexor surfaces of the limbs, torso, and face.

Differential diagnosis. Smallpox syphilide should be distinguished from natural and chickenpox. An acute onset with high body temperature, severe general condition of the patient, the absence of a dense infiltrate at the base of the pustules, the appearance of rashes initially on the face, negative serological reactions allow us to reject the diagnosis of smallpox syphilide.

Impetiginous pustular syphilide begins with the formation on the skin of the face, flexor surface of the upper extremities, chest, and back of dark red papules of dense consistency, usually up to 1 cm in diameter, less often - more. After a few days, thin-walled pustules form at the top of the papules, which quickly dry out, forming massive, raised, layered crusts of yellowish-brown color, surrounded by a dark red infiltrated corolla. When the crusts are forcibly removed, a dark red, easily bleeding ulcer is exposed.

Differential diagnosis. Vulgar impetigo differs from syphilitic impetigo by its acute onset, rapid spread, first formation of fliggen without compaction at the base, the presence of golden or dirty-gray crusts, when removed, a smooth, moist bright red erosive surface is exposed, “screenings” along the periphery and merging of rashes into large foci irregular shapes. Mostly children get sick.

Ecthymatous pustular syphilide is a severe malignant form of pustular syphilide and usually occurs after 5-6 months. after infection. Important feature ecthyma is the tendency of an element to decay both in depth and in breadth. A delimited dark red infiltrate appears, in the center of which a pustule quickly forms, which dries into a dense, as if depressed, grayish-brown, almost black crust, surrounded by a copper-red infiltrate. Ecthyma gradually increases due to peripheral growth, reaching the size of a 5-ruble coin or more. After removing the crust, a more or less deep ulcer with steep edges and a smooth bottom, covered with yellowish-gray necrotic masses with purulent discharge, is exposed. The ulcer is surrounded by a dense, sharply demarcated, dark red infiltrated ridge. After the ecthyma heals, a pigmented scar remains.

The period that fully corresponds to generalization infectious process, is called secondary. The bacterium, which is localized in the lymph nodes, begins to penetrate the bloodstream and spreads with the blood flow to other vital organs, as well as new areas of the skin.

Specific symptoms characteristic of the disease appear in all areas of human skin, most mucous membranes and certain internal organs.

Periods of pathology

Secondary syphilis develops in three periods: fresh, latent (latent) and recurrent.

Fresh period begins to develop immediately after. It manifests itself as an intensification of the rash and the preservation of remnants of chancre. Without adequate treatment, symptoms can persist for up to four months. At the end of this period, the disease progresses to. All signs of the disease disappear. But at the same time, the results of a serological blood test will be sharply positive.

After three months, the secondary one begins to develop recurrent syphilis. The rash on the skin does not appear as profusely as in the fresh period. Possible manifestation (hair loss). Characteristic sign this period - syphilitic leukoderma. Non-pigmented spots appear in the neck area. Gradually their number increases. If the pathology is not treated, it again goes into the latent period.

With the further development of secondary syphilis, a polymorphic protruding rash appears on the skin in the form of pustular, roseolous and papular elements.

Roseola elements are usually localized on the neck, which is why this symptom is called “ Venus necklace" Papules are located on the chest, sole, palms, perinatal area and genitals.

Symptoms of secondary syphilis

The main symptoms of the general type of secondary syphilis (features of pathological manifestations):

  • unexpressed peeling;
  • the contours are clear;
  • the structure is dense;
  • pathological elements have a dark red tint;
  • no subjective sensations are noted;
  • elements may disappear spontaneously.

General symptoms:

  • high infectiousness of secondary syphilides;
  • benign course;
  • sharply positive serological reaction;
  • at timely treatment pathological syphilides quickly disappear on their own.

With secondary syphilis, the following types of rash are distinguished:

Differential diagnosis of secondary syphilis

Diagnosis of secondary syphilis consists of a wide range of skin diseases and acute infections. Roseola rash is often confused with rashes associated with rash and,. But unlike the listed ailments, the patient’s general condition is not disturbed, and symptoms of damage to internal organs are completely absent.

Sphylids are differentiated from skin diseases, which are accompanied by pain and severe symptoms of skin inflammation. For that, to distinguish them from each other, immunological and microscopic examination of scrapings is used/ discharge from papules. With syphilis they contain a large number of pale treponema.

Syphilitic alopecia is differentiated from fungal infections of the scalp. In the latter case, the content of sex hormones in the blood is within normal limits. With secondary syphilis, the scalp does not peel off and there are no signs of inflammation.

Treatment of secondary syphilis

Complex therapy of pathology is aimed at eliminating the underlying disease and elements of the rash.

Administration of water-soluble penicillins allows maintaining optimal concentration antibiotic in the bloodstream.

Specific therapy is carried out 24 days from the moment the disease is detected. The drug is injected into the patient's body every three hours. Therefore, it is advisable to carry out treatment in a hospital, where doctors can monitor the patient’s condition. If the patient is allergic to penicillin, he is prescribed alternative drugs.

Along with the main therapy, diseases that have developed against the background of secondary syphilis are treated.

To boost immunity, it is prescribed.

In addition, specialists adjust the patient’s diet so that he receives all the necessary vitamins, minerals and other useful substances with food for half an hour.

Prevention

Basic measures aimed at preventing syphilis:

Compliance with these simple rules will help eliminate the possibility of infection.

  • What is Secondary syphilis
  • Symptoms of Secondary Syphilis
  • Treatment of Secondary Syphilis
  • Which doctors should you contact if you have secondary syphilis?

What is Secondary syphilis

Secondary syphilis- the stage of syphilis that occurs after the primary period of syphilis and is characterized by the generalized spread of the causative agent of syphilis (treponema pallidum) throughout the body.

With secondary syphilis, the infection spreads in the body through the lymphatic and blood vessels; accordingly, the secondary period of syphilis is characterized by a variety of clinical manifestations in the form of localized or diffuse lesions of the skin and mucous membranes (roseola, papules, pustules), generalized lymphadenopathy and damage to internal organs - i.e. . where the localization of spirochetes occurred. It begins 3-4 months after infection and can continue for several years, alternating with latent early syphilis - rashes are observed within several months, which spontaneously disappear and reappear after some time.

What causes secondary syphilis

The causative agent of syphilis is Treponema pallidum, belonging to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically, treponema pallidum (pale spirochete) differs from saprophytic spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under a microscope, Treponema pallidum is a spiral-shaped microorganism that resembles a corkscrew. It has on average 8-14 uniform curls of equal size. The total length of the treponema varies from 7 to 14 microns, thickness - 0.2-0.5 microns. Treponema pallidum 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 morphological structure of Treponema pallidum was revealed. It turned out that the treponema is covered with a thick cover of a three-layer membrane, a cell wall and a mucopolysaccharide capsule-like substance. Under the cytoplasmic membrane there are fibrils - thin filaments that have a complex structure and cause diverse movement. Fibrils are attached to the terminal turns and individual sections of the cytoplasmic cylinder using blepharoplasts. The cytoplasm is finely granular, containing a nuclear vacuole, nucleolus and mesosomes. It was established that various influences of exo- and endogenous factors (in particular, previously used arsenic preparations, and currently antibiotics) had an impact on Treponema pallidum, changing some of its biological properties. Thus, it turned out that pale treponema can turn into cysts, spores, L-forms, grains, which, when the activity of the patient’s immune reserves decreases, can reverse into spiral-shaped virulent varieties and cause active manifestations of the disease. The antigenic mosaic nature of Treponema pallidum has been proven by the presence of multiple antibodies in the blood serum of patients with syphilis: protein, complement-fixing, polysaccharide, reagin, immobilisin, agglutinin, lipoid, etc.

Using an electron microscope, it was established that treponema pallidum in lesions is most often located in intercellular spaces, periendothelial space, blood vessels, nerve fibers, especially when early forms syphilis. The presence of pale treponema in the periepineurium is not yet evidence of damage nervous system. More often, such an abundance of treponemes occurs during septicemia. During the process of phagocytosis, a state of endocytobiosis often occurs, in which treponemes in leukocytes are enclosed in a multimembrane phagosome. The fact that treponemes are enclosed in polymembrane phagosomes is a very unfavorable phenomenon, since, being in a state of endocytobiosis, treponema pallidums persist for a long time, protected from the effects of antibodies and antibiotics. At the same time, the cell in which such a phagosome has formed seems to protect the body from the spread of infection and progression of the disease. This precarious balance can persist for a long time, characterizing the latent (hidden) course of a syphilitic infection.

Experimental observations by N.M. Ovchinnikov and V.V. Delectorsky are consistent with the works of the authors who believe that when infected with syphilis, a long-term asymptomatic course is possible (if the patient has L-forms of Treponema pallidum in the body) and “accidental” detection of infection in the stage of latent syphilis (lues latens seropositiva, lues ignorata), i.e. i.e. during the period of presence of treponema in the body, probably in the form of cyst forms, which have antigenic properties and, therefore, lead to the production of antibodies; this is confirmed by positive serological reactions to syphilis in the blood of patients without visible clinical manifestations of the disease. In addition, in some patients, stages of neuro- and viscerosyphilis are detected, i.e., the disease develops as if “bypassing” the active forms.

To obtain a culture of Treponema pallidum, complex conditions are required (special media, anaerobic conditions, etc.). At the same time, cultural treponemes quickly lose their morphological and pathogenic properties. In addition to the above forms of treponema, the existence of granular and invisible filterable forms of pale treponema was assumed.

Outside the body, Treponema pallidum is very sensitive to external influences, chemicals, drying, heating, exposure to sunlight. On household items, Treponema pallidum retains its virulence until it dries. A temperature of 40-42°C first increases the activity of treponemes and then leads to their death; heating to 60°C kills them within 15 minutes, and to 100°C kills them instantly. Low temperatures do not have a detrimental effect on Treponema pallidum, and currently, storing Treponema in an oxygen-free environment at a temperature of -20 to -70 ° C or frozen dried is a generally accepted method for preserving pathogenic strains.

Pathogenesis (what happens?) during Secondary syphilis

The reaction of the patient's body to the introduction of Treponema pallidum is complex, diverse and insufficiently studied. Infection occurs as a result of penetration of Treponema pallidum through the skin or mucous membrane, the integrity of which is usually compromised. However, a number of authors admit the possibility of the introduction of treponema through an intact mucous membrane. At the same time, it is known that in the blood serum of healthy individuals there are factors that have immobilizing activity against Treponema pallidum. Along with other factors, they make it possible to explain why infection is not always observed upon contact with a sick person. Domestic syphilidologist M.V. Milich, based on his own data and analysis of the literature, believes that infection may not occur in 49-57% of cases. The variation is explained by the frequency of sexual intercourse, the nature and localization of syphilides, the presence of an entrance gate in the partner and the number of pale treponemas that have penetrated the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the tension and activity of which varies depending on the degree of virulence of the infection. Therefore, not only the possibility of no infection is being discussed, but also the possibility of self-healing, which is considered theoretically acceptable.

Symptoms of Secondary Syphilis

Symptoms of the secondary period of syphilis extremely varied. It was not for nothing that French syphilidologists of the 19th century called syphilis the “great ape” because of its similarity to many skin diseases.

General signs of rashes during the secondary period of syphilis:
- Lack of subjective sensations (itching, pain).
- Density of elements.
- Dark red color.
- Clear, regular rounded or circular outlines of elements without a tendency to merge.
- Invisible peeling of the surface (most often absent, and if it occurs, it is noted along the periphery of the lesion.
- Tendency to spontaneous disappearance without atrophy and scarring.

The most common manifestations of secondary syphilis are: roseolous syphilide, papular syphilide, including palmoplantar form, condylomas lata, syphilitic leukoderma, syphilitic tonsillitis, syphilitic alopecia.

Secondary syphilis begins 2-4 months after infection and can last from 2 to 5 years.

Secondary syphilis affects all organs and systems of the patient.

The main symptom of secondary syphilis is a rash that spreads throughout the body, including the palms and soles.

Rashes on the skin and mucous membranes may be accompanied by flu-like symptoms: headache, body aches, fever.

The rash with secondary syphilis can be:
-Roseola (pink or red spots).

It consists of syphilitic roseolas - individual pink or pinkish-red spots of a round shape and with a diameter of 3 to 10-12 mm, caused by disorders of the blood vessels. Roseolas have an irregular round shape, spots on the skin and mucous membranes are located randomly, mainly on the body, less often on the limbs, sometimes on the forehead and the back of the hands and feet. Roseolas do not rise above the skin level, do not peel, usually do not itch, and when pressed they turn pale or even disappear for a few seconds.

However, it should be noted that there are other varieties of syphilitic roseola: follicular or granular (rising above the skin level) roseola and scaly roseola.

Roseola rash in the secondary period of syphilis is characteristic symptom syphilis and is observed very often - in 75-80% of patients. Without treatment of syphilis, the roseola rash itself disappears without a trace after 2-3, sometimes 5-6 weeks. In the future, recurrent, that is, repeated rashes of roseola are possible. Unlike the rashes of the first wave, repeated roseolas are characterized by more sparse rashes, pale coloration of the spots, and their large size. Second-wave roseolas often cluster together, forming ring-shaped or arched lesions.

-Nodular rash (or papular).
In addition to roseola spots, the rash of the first wave of secondary syphilis can have the appearance of nodules, and sometimes these two types of rashes - spots and nodules - are combined. In venereology, a nodular rash is called papular. Why? Because the flat, rounded nodular formations that make it up, protruding above the skin level, are called papules or papular syphilides.

Papules in the practice of venereologists are divided into several main types, depending on their size: lenticular, millet-shaped, coin-shaped and plaque-shaped. They vary in size, appearance and location of the rash.
Papules are often located not only on the skin, but also on mucous membranes: the oral cavity, pharynx, larynx, tonsils, soft palate, lips, tongue, gums. Papular syphilides constantly grow and can merge with each other, forming large, sharply demarcated plaques with scalloped outlines.

Papules located in the inguinal-femoral and intergluteal folds, between the toes, under the mammary glands, that is, in places with increased sweating and constantly subject to friction, gradually turn into weeping erosion. The liquid separated from the erosion contains a huge amount of pale treponema. Therefore, patients with rashes in the mouth, genitals, and perineum are especially contagious. In this case, syphilis can be transmitted not only sexually, but also through any close contact - kissing, shaking hands, using common household objects (for example, dishes).

In general, it should be noted that skin rashes with syphilis can be extremely diverse, both in the nature of the rash and in its location, abundance, and duration.

One of the problems when setting correct diagnosis secondary syphilis is that syphilides (syphilitic skin rashes) can different cases be similar to manifestations of the most various diseases, also accompanied by a rash. Therefore, when examining a patient with skin rashes of any nature and location, dermatologists first take a blood test for the Wassermann reaction in order to confirm or exclude the syphilitic origin of the rashes. Rashes with syphilis usually occur in several “waves”, between which syphilis is asymptomatic.

Other symptoms of secondary syphilis include:
- Syphilitic alopecia. Hair loss occurs in 15-20% of patients with secondary syphilis. Baldness of a patient with syphilis can be diffuse (that is, spread over a fairly large area, most often on the scalp) or small focal.

Small focal baldness is said to occur when a patient develops many small foci of baldness with irregular rounded shapes, randomly scattered over the head, especially in the area of ​​the temples and the back of the head.

Diffuse syphilitic alopecia can be difficult to diagnose due to the fact that the pattern of hair loss is typical of alopecia in most cases. various reasons. On the contrary, fine-focal baldness with syphilis is a striking and indicative symptom, especially for fine-focal baldness of the eyebrows. With syphilitic alopecia, the patient's skin is not inflamed, does not itch or peel, and hair loss occurs painlessly. Hair loss can begin 3-6 months after infection, and not only hair on the head falls out, but also eyelashes, eyebrow hair, mustache, and beard. During the treatment of syphilis, hair grows back, and this indicates that the treatment is successful.

-Spotted leucoderma
A common feature of secondary syphilis in women can be the so-called “necklace of Venus” or (pigment syphilide). This is a discoloration of the skin on the back and sides of the neck, which appears 4-6 months after infection.

However, syphilitic leukoderma can appear not only on the neck, but also on the chest, back, abdomen, lumbar region, sometimes on the arms or in front of the armpits.

Discolored spots measuring 3-10 mm in diameter, surrounded by areas darker than the normal skin color, can exist without change even against the background of anti-syphilitic treatment for several months or even years.

Syphilitic leukoderma never flakes off, is not accompanied by inflammation and does not cause any pain.

Diagnosis of secondary syphilis

The diagnosis is made based on the clinical picture and laboratory confirmation by any of the following methods:
- Dark field research
- MR
- RIF, ELISA, RPGA
It must be taken into account that although in the modern classification there is no division primary syphilis for seronegative and seropositive, serological tests can be negative within 7-14 days.

Treatment of Secondary Syphilis

Regarding the treatment of syphilis, one cannot help but note several negative trends that we, as practicing doctors, often observe in Lately. Unfortunately, there are often cases when they try to treat primary and even secondary syphilis with “one or two” injections. And it’s not so much private doctors who are guilty of this, but rather state-run skin and venereal dispensaries, who simply don’t have time to deal with every patient while receiving a budget salary. In this case, neither immunostimulation of the patient nor even vitamin therapy is carried out. All this leads to the appearance in the patient’s body of forms of bacteria that are insensitive to antibiotics, or the emergence of seroresistance, that is, a condition when a high antibody titer remains in the patient’s blood tests for a long time (and even for life).
Of course, the most effective treatment for syphilis is with water-soluble penicillins, since this maintains a constant required concentration of the antibiotic in the blood. But such treatment can only be carried out in a hospital setting, since it requires administration of the drug every three (!) hours for at least 24 days.

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Secondary syphilis is the next stage of the disease. Activation of the presented stage occurs 2-5 months after infection. With the development of pathology, the bacteria Treponema pallidum, the main pathogen, spreads. With secondary syphilis, the symptoms are extremely varied, which complicates diagnostic measures.

The reasons that result in secondary damage are associated with the pathological activity of the bacterium Treponema pallidum. Such microorganisms can persist for a long time, while being protected from antibiotics and the patient’s antibodies. This is due to the confinement of bacteria in phagosomes, which has very unpleasant consequences. In addition to providing such protection, the phagosome keeps the treponema from spreading throughout the body. As a result, the disease proceeds in a latent phase.

The sensitivity of the bacterium increases if it is outside the body. As a result, treponema is sensitive to desiccation, direct sunlight, chemicals and heat treatment. The virulence of the bacterium also remains on household items, but until the said organism dries out completely. Low temperatures do not lead to the death of treponemes.

The secondary nature of the pathology indicates the further development of the disease, since the pathogen is already in the patient’s body. Pathogenic microorganisms spread throughout the patient’s body, penetrating the lymphatic and blood vessels. The result is lymphadenopathy, diffuse and localized lesions of the skin and internal organs.

Symptoms

Damage to the mucous membranes and skin has its own characteristics in each case. There are several types of the disease, which determine the nature of the symptoms. The first form on this list is secondary fresh syphilis. It begins to develop after primary type pathology. The disease can last for several months. As it develops, the patient develops a small rash on the skin.

In addition, secondary recurrent syphilis is isolated, in which relapses occur. At the presented stage, an alternation of hidden and open phases of the disease occurs, during which it fades away. After completion of the presented stage, manifestations arise again. The situation is complicated by the presence hidden form secondary syphilis. In most cases, patients mistake manifestations of this type for signs of the primary form, which has not been completely eliminated.

Symptoms of secondary syphilis have the following features:

  1. There is no peeling of the skin.
  2. There is no itching or pain in the affected areas.
  3. The symptoms may disappear on their own and without scarring.
  4. The elements are scattered, and the shape of the rashes is round.
  5. The rash has a red tint. In rare cases, a dark or purple color.
  6. The elements of the rash are dense.

Signs

Signs of secondary syphilis include rashes on the skin. These elements are characterized by great diversity. Skin rashes and other symptoms include the following:

  1. Erythematous sore throat.
  2. Syphilitic leukoderma.
  3. Anal condylomas.
  4. The palmar-plantar character of syphilide.
  5. Papular syphilide.
  6. Roseola syphilide.
  7. Baldness of a syphilitic nature.

The secondary period of syphilis is often represented by roseola syphilide. This sign indicates the active spread of the pale spirochete throughout the body of an infected person. Roseola is characterized by a small spot indicating the development of an inflammatory reaction. The spot is pale pink or pink tint, the shape is often oval or round, but the contours are unclear. The diameter of such a formation does not exceed 1.5 cm. The occurrence of roseola is observed due to a malfunction of the circulatory system.

Recurrence of the pathology is characterized by skin rashes in the form of papular syphilide. The neoplasm is represented by a nodule that has round shape. The papule is characterized by an elastic consistency combined with density. At the beginning of development, the formation has a smooth surface, but after some time roughness appears. Such peeling leads to the appearance of a Biette collar - appearing at the edges of the border.

A papule appears in any place, but more often it is found on the surface of the palms or on the skin of the genitals. The appearance of the presented type of syphilide occurs in waves, in which the formation disappears and appears again.

The rash with secondary syphilis is represented by a type of papular syphilide - the palmoplantar form. Callus-like nodules appear that have different shades: brown, purple or bright red. The surface can also be different - smooth or rough. At the initial stage, the formation is characterized by integrity, but in the process of development it cracks or begins to peel off. For this reason, the papule is often not noticed by patients, since such a manifestation makes it look like a callus.

Sometimes in the area anus A vegetative papule appears, which can combine with other neoplasms. Such papules are characterized by white coating and the stratum corneum. In most cases, it is the presented symptom that helps determine secondary syphilis.

With the development of the next stage, the necklace of Venus appears - syphilitic leukoderma. The appearance of the symptom occurs 4-6 months after infection. As a result, discolored spots appear on the neck. There is no pain or discomfort, but the rash may remain on the surface for several years.

Roseola can appear on the mucous membranes of the oral cavity, which indicates the development of syphilitic tonsillitis. The patient's throat takes on a red tint, and roseola has clear outlines. At the relapse stage, such manifestations may be the only signs indicating the development of syphilis in the patient. Sometimes patients experience hoarseness and damage to the vocal cords, which leads to a change in voice timbre.

Hair loss is also common. The nature of the loss is presented local changes or lesions affecting large areas. A striking manifestation of the pathology is fine focal baldness. Diagnosing such a symptom is quite easy. As for diffuse baldness, the analysis of this condition is extremely difficult, since the symptom is characteristic of many diseases.

Diagnostics

Secondary syphilis must be detected promptly. To identify pathology, they carry out laboratory research and use a variety of methods. During diagnosis, use following methods pathology detection:

  1. Passive hemagglutination reaction.
  2. Immunofluorescence reaction.
  3. Precipitation microreaction.
  4. Dark field research.
  5. Wasserman reaction.
  6. Linked immunosorbent assay.

Dark-field research uses a microscope, which allows doctors to observe living microorganisms. Using microprecipitation reactions, you can detect antibodies that are produced by the patient’s body to combat the development and penetration of treponema pallidum into other parts of the body.

To exclude false-positive diagnostic results aimed at detecting syphilis, an immunofluorescence reaction is used. Syphilis can be detected using a passive hemagglutination reaction. The analysis allows us to determine the stages of pathology.

Determination of sexually transmitted infections is possible using enzyme immunoassay. There are a large number of modifications of such a study, which allows you to obtain an accurate result. As for the Wasserman reaction, such research is gradually being replaced by newer techniques.

If secondary syphilis has external manifestations, then apply differential diagnosis. Similar tactics can be used in cases where the patient has the following diseases and manifestations:

  1. Lichen.
  2. Measles.
  3. Rubella.
  4. Spotted toxicoderma.
  5. Bite marks.
  6. Pityriasis rosea.
  7. Necklace of Venus.

Treatment

Treatment of secondary syphilis is a set of measures and techniques aimed at comprehensive effects. In addition, the patient needs to be observed by a specialist. During therapy use antibacterial agents, the purpose of which is the course. The duration of use of such medications can be up to 3 weeks.

Treatment is also carried out using antibiotic drugs penicillin series. This is due to the susceptibility of the pathogen to this category of drugs. It is possible to eliminate secondary syphilis, but this requires strictly following the doctor’s instructions and often being observed by a specialist.

During therapy, injections are used, which are administered intramuscularly every 3 hours. In some cases, home therapy may be prescribed, but most situations require treatment in a hospital setting.

In addition to the above-mentioned remedies, the doctor can prescribe treatment using ultraviolet irradiation, biogenic stimulants and immunostimulants. During the treatment period, a specialist may prescribe vitamins. Patients should note that self-treatment completely prohibited, as this will worsen the condition and further development diseases. Single-injection therapy is gaining popularity. The secondary type of pathology cannot be eliminated so quickly, since treatment is a long and labor-intensive process.

The pathology is especially dangerous for women who are in an interesting position. The disease can be transmitted to a child with a 100% probability, since studies have shown that the birth of a healthy baby in the presence of secondary syphilis in the mother is almost impossible. The disease will greatly affect the course of pregnancy, since there is a high probability of termination. Therefore, you need to see a specialist more often and follow his instructions.

Prevention of the secondary form consists of timely detection and treatment of the primary type of the disease. Need to pay a lot of attention own health and take care of the body's defense mechanisms. You can avoid the appearance and development of syphilis if you do not have casual sexual contact, use protection and eliminate any diseases that arise in a timely manner. It is easier to prevent the occurrence of pathology than to eliminate the disease later, since this will require a lot of time and effort.

Thus, the secondary nature of syphilis is the next stage in the development of pathology.

If signs of illness appear, you should immediately seek medical help.

Otherwise, the pathology will move to the next stage of development, which is more dangerous to the health and life of the patient. It is forbidden to treat syphilis on your own, as this leads to a worsening of the disease, the development of pathogenic bacteria to protect against antibiotics and a decrease in the chances of recovery.