Syphilis in a latent form. Latent syphilis (early, late): photo, causes and treatment

Syphilis can occur in 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, there are no clinical symptoms of the disease. 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 medicines, antibiotics during the period of infection and concomitant pathology.

It has been proven that the reception of any antibacterial drugs with syphilis, the incubation period of the syphilitic system is extended by 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 type of "masked" pale treponema is 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 after sexual intercourse, there are no visible lesions of the internal organs, but antibodies to spirochete pallidum are detected according to the results of laboratory tests.

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 indicating stomatitis, bronchial asthma, sore throat, 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 feel a sore throat or 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 reception 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 quite adequate attitude to their health.

The fact is that a person, suspecting a cold or First stage development of angina, 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 diseases. 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 enlargements are often detected. lymph nodes also possible short-term skin rashes, 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 give skin rashes, but significantly destroys internal organs and negatively affects work 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 detected during medical examinations or during examination of a patient who has complaints 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 clinical examination in 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 a large number of rashes appear, many treponemas are observed in them, due to which a person becomes infected.

To learn about latent syphilis, you need to go 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 has no visually 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 a rather complicated 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 in the past in patients of erosion on the genitals or oral cavity, antibiotic use 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 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 when preventive examinations, in women's consultations 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 widespread acceptance population of antibiotics 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, a 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 latent syphilis, it is very important for a person with suspected syphilis to undergo complete diagnostics. 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, sex life of the patient is taken into account. 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 can 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 more complex scheme treatment.

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 guidelines 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 done with antibiotics. 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 undergo full examinations with a doctor. 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 the protective properties of the 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 of 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.

Integrated 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 work on intrauterine development 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 period 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 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 different types 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. Delayed treatment 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 the optic nerve, leads 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 healthy person in a disabled person:

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

Complications and prevention

Latent syphilis is venereal disease, which is more than 90 percent transmitted by sexual contact.

Preventive methods of syphilis are:

• permanent sexual partner;
• using a condom during sexual intercourse;
• douche antiseptics after sexual intercourse that was not protected by a condom;
• when planning a pregnancy, compulsory examination both partners;
• abstain from sex at the moment drug treatment 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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A common sexually transmitted disease - syphilis - is caused by a microorganism - pale spirochete. It has several stages of development, as well as many clinical manifestations. In Russia, in the late 90s of the twentieth century, a real epidemic of this disease began, when out of 100,000 people fell ill per year, 277 people. Gradually, the incidence is decreasing, but the problem is still relevant.

In some cases, there is a latent form of syphilis, in which external manifestations diseases are absent.

Why does latent syphilis occur?

The causative agent of the disease - pale spirochete - under normal conditions has a typical spiral shape. However, under adverse environmental factors, it forms forms that promote survival - cysts and L-forms. These modified treponemas can persist for a long time in the lymph nodes of an infected person, his cerebrospinal fluid, without causing any signs of illness. Then they are activated, and there is a relapse of the disease. These forms are formed due to improper treatment with antibiotics, individual characteristics patient and other factors. Especially important role plays the self-treatment of patients for a disease that they consider to be, but in fact it is an early stage of syphilis.

The cyst form is the cause of latent syphilis. It also causes lengthening incubation period. This form is resistant to many drugs used to treat this disease.

How is latent syphilis transmitted? In nine cases out of ten, the route of transmission is sexual. Much less common is the household route (for example, when using one spoon), transfusion (with the transfusion of infected blood and its components), and transplacental (from mother to fetus). This disease is detected most often during a blood test for the so-called Wasserman reaction, which is determined for each admitted to the hospital, as well as when registering with a antenatal clinic for pregnancy.

The source of infection is only a sick person, especially during.

Latent period of syphilis

This is the time after infection of a person with treponema pallidum, when there are positive serological tests (blood tests are changed), but symptoms are not determined:

• rash on the skin and mucous membranes;
• changes in the heart, liver, thyroid gland and other organs;
• pathology of the nervous system and the musculoskeletal system, and others.

Usually changes in the blood appear two months after contact with the carrier. From this moment, the period of the disease is counted in a latent form.

Early latent syphilis occurs within two years of infection. It may not appear immediately, or it may be the result of regression. early symptoms disease, when there is an apparent recovery. There are no clinical symptoms of latent syphilis, it is characterized by a negative test of cerebrospinal fluid (cerebrospinal fluid). It is diagnosed using serological tests.

Latent late syphilis is characterized by a sudden activation of the process after a period of imaginary well-being. It can be accompanied by damage to organs and tissues, the nervous system. There are low-contagious elements of the skin rash.

What is latent unspecified syphilis?

In this case, neither the patient nor the doctor can determine when the infection occurred, since there were no clinical symptoms of the disease, and it was revealed, most likely, as a result of a blood test.

There is also the possibility of a false positive result of the Wasserman reaction. This happens when there is chronic infection(sinusitis, caries, tonsillitis, pyelonephritis and others), malaria, liver diseases (hepatitis, cirrhosis), pulmonary tuberculosis, rheumatism. An acute false-positive reaction occurs in women during menstruation, in the third trimester of pregnancy, in the first week after childbirth, myocardial infarction, acute diseases, injury and poisoning. These changes disappear on their own within 1-6 months.

When identifying positive reaction more specific tests are necessarily carried out, including polymerase chain reaction, which determines the antigen of pale treponema.

Early latent form

This form covers all forms from primary seropositive (hard chancre) to secondary recurrent (skin rashes, then their disappearance - secondary latency period, and relapses within two years), but there are no external signs of syphilis. Thus, the disease can be registered in the period between the disappearance of the hard chancre (end of the primary period) until the onset of the formation of rashes (the beginning of the secondary period) or be observed at the moments of remission in secondary syphilis.

At any time, the latent course can be replaced by a clinically pronounced one.

Since all of the listed forms are contagious, due to the coincidence in time with them, the early latent variant is also considered dangerous for others and all the prescribed anti-epidemic measures (identification, diagnosis, treatment of contact persons) are carried out.

How to detect the disease:

• the most reliable evidence is contact with a patient with syphilis in active form during the previous 2 years, while the probability of infection reaches 100%;
• find out the presence of unprotected sexual intercourse over the past two years, clarify whether the patient had subtle symptoms, such as sores on the body or mucous membranes, hair loss, eyelashes, a rash of unknown origin;
• to clarify whether the patient did not go to the doctor at that time for any reason that worried him, whether he took antibiotics, whether he received blood or its components;
• examine the genitals in search of a scar left after a hard chancre, assess the condition of the peripheral lymph nodes;
• serological tests in high titer, but not necessarily, immunofluorescent analysis (ELISA), direct hemagglutination test (DPHA), immunofluorescence test (RIF) are positive.

late latent form

The disease is detected most often by chance, for example, during hospitalization for another reason, when a blood test is taken (“unknown syphilis”). Usually these are people aged 50 years and older, their sexual partners do not have syphilis. Thus, the late latent period is considered non-contagious. In terms of timing, it corresponds to the end of the secondary period and the entire Tertiary.

Confirmation of the diagnosis in this group of patients is more difficult, because they have accompanying illnesses (rheumatoid arthritis and many others). These diseases are the cause of a false positive blood reaction.

To make a diagnosis, you should ask the patient all the same questions as with the early latent variant, only change the condition: all these events must have occurred more than two years ago. Serological tests help in the diagnosis: more often they are positive, the titer is low, and ELISA and RPHA are positive.

When confirming the diagnosis of latent syphilis, ELISA and RPHA are of decisive importance, because serological tests (rapid diagnostics) can be false positive.

Of these diagnostic methods, the confirmatory reaction is RPHA.

With latent syphilis, a puncture of the cerebrospinal fluid (CSF) is also indicated. As a result, latent syphilitic meningitis can be detected. Clinically, it does not manifest itself or is accompanied by minor headaches, hearing loss.

The study of cerebrospinal fluid is prescribed in the following cases:

• signs of changes in the nervous system or eyes;
• pathology of internal organs, the presence of gums;
• ineffectiveness of penicillin therapy;
• association with HIV infection.

What are the consequences of late latent syphilis?

Most often, syphilis has an undulating course with alternating remissions and exacerbations. However, it is sometimes observed long course without symptoms, ending several years after infection with syphilis of the brain, nerves, or internal tissues and organs. This option is associated with the presence in the blood of strong treponemostatic factors resembling antibodies.

How does the hidden late period manifest itself in this case:

• rash on the outer integument of the body in the form of tubercles and nodules, sometimes with the formation of ulcers;
• bone disease in the form of osteomyelitis (inflammation of the substance of the bone and bone marrow) or osteoperiostitis (inflammation of the periosteum and surrounding tissues);
• joint changes in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
• mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
• violation of the activity of the brain and peripheral nervous system.

Pain in the legs with latent late syphilis may result from damage to the bones, joints, or nerves.

Latent syphilis and pregnancy

If a woman has a positive serological reaction during pregnancy, but there are no clinical signs of the disease, she must definitely donate blood for ELISA and RPHA. If the diagnosis of "latent syphilis" is confirmed, she is prescribed treatment according to general schemes. Lack of therapy entails serious consequences for the child: congenital deformities, abortion and many others.

If the disease is cured before 20 weeks of pregnancy, childbirth proceeds as usual. If the treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many concomitant factors.

Treatment

Specific treatment is prescribed only after confirmation of the diagnosis by a laboratory method. The sexual partners of the patient are examined, if they have negative laboratory tests, then they are not prescribed treatment for the purpose of prevention.

Treatment of latent syphilis is carried out according to the same rules as its other forms.

Long-acting drugs are used - Benzathine penicillin, as well as Benzylpenicillin sodium salt.

Fever at the beginning of penicillin therapy - indirect evidence is correct established diagnosis. She accompanies mass death microorganisms and the release of their toxins into the blood. Then the state of health of patients is normalized. With a late form, such a reaction may be absent.

How to treat latent syphilis:

• in the early form, Benzathine penicillin G is injected at a dose of 2,400,000 units, two-stage, into the muscle once a day, only 3 injections;
• with a late form: Benzylpenicillin sodium salt is injected into the muscle at 600 thousand units. twice a day for 28 days, two weeks later, the same course is carried out for another 14 days.

In case of intolerance to these antibiotics, semi-synthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.

Latent syphilis during pregnancy is treated according to general rules, since the drugs of the penicillin group are not dangerous to the fetus.

Monitoring the effectiveness of treatment

After treatment of early latent syphilis, serological control (ELISA, RPHA) is carried out regularly until the indicators are completely normal, and then twice more with an interval of three months.

With late latent syphilis, if TPHA and ELISA remained positive, the term dispensary observation is 3 years. Tests are carried out every six months, the decision to deregister is made on the basis of a set of clinical and laboratory data. Usually, in the late period of the disease, recovery normal indicators blood and cerebrospinal fluid occurs very slowly.

At the end of the observation, a complete examination of the patient is carried out again, examination by a therapist, a neurologist, an otorhinolaryngologist and an oculist.

After the disappearance of all clinical and laboratory manifestations of the disease, patients can be allowed to work in children's institutions and public catering establishments. But once transferred and cured, the disease does not leave stable immunity, so re-infection is possible.

Latent syphilis- a disease that occurs without obvious symptoms (there are no external confirmations in the form of a rash on the skin, there are no visible lesions of internal organs, and so on), such a disease can be detected only with the help of laboratory diagnosis.

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 determine 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 the axis, forward movement And so on).

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 contacts. The state of the immune system is 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. Detection of the disease is a very difficult 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;
• infection urinary tract, cystitis;
• 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 initial stages, the goal of drug treatment of latent syphilis is to prevent the transition to an active form of the course of the disease, which can spread to 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 early stage, then progress is observed by the end of 1-2 courses of therapy. If a late stage course of the disease, 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: the visual and auditory nerves are affected (later deafness and blindness occur);
• 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 of 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 are related to last stage 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 of disease will do.

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

There are also general preventive measures, 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 for normal recovery the health of future parents will take more than one year. 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.

• 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, exposure to sunlight. 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 pale treponema, and at present, storage of treponema in an oxygen-free environment at a temperature of -20 to -70 ° C or dried from a frozen state is a common method for 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 reagin titer already during the first course 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 the metabolic processes of the body, 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 RIF, RITT and RPHA (sometimes such studies are carried out repeatedly with an interval of several months, and also after the rehabilitation of foci of chronic infection or appropriate treatment of 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.

With latent syphilis characteristics there are no pathologies, and the disease can be suspected when performing specific laboratory tests. Despite the fact that there are no obvious manifestations of infection, the disease progresses slowly and leads to irreversible consequences. Basically, the asymptomatic course is associated with the widespread use of antibacterial drugs without prior accurate diagnosis of the disease. Patients, believing that they are sick with another venereal pathology (chlamydia, gonorrhea, trichomoniasis), start the wrong therapy. It only suppresses the growth of the causative agent of syphilis - Pale treponema, contributing to the latent course of the infection.

The frequent detection of a latent course is due to mass preventive examinations for syphilis in healthcare.

• Show all

  The causative agent of the infection

  The cause of the infection is Treponema pallidum (Treponema pallidum). It is surrounded by a specific protective cover that protects it from impact. dangerous factors environment: antibiotics, antibodies.

  Treponema exists in several forms:

  • typical spiral shape;
  • cyst;
  • L-shape.

  In the case of a typical spiral shape, the infection proceeds with bright clinical manifestations. Diagnosing it is easy enough.

  Cysts and L-forms are special forms of treponema that the body cannot recognize and respond to; protected species of the pathogen do not cause the appearance of characteristic symptoms, but form a latent course of syphilis, which can only be detected in a laboratory study. Cysts, L-forms are simply found in human blood and are periodically activated when appropriate factors arise: reduced immunity, stress, etc.

  Features of the disease

  The main route of transmission of the infection is sexual - about 90% of cases. household way especially common in children, kissing, breastfeeding. Sweat and urine from patients with syphilis are not contagious. Sperm, blood, vaginal secretion, saliva, breast milk- contain the pathogen in large quantities and are highly contagious. The source of infection is a person with syphilis who is able to transmit the disease in the first years of the disease. Main routes of transmission:

  • sexual;
  • domestic;
  • transfusion (through the blood);
  • transplacental (from mother to child in utero).

  Classification of the disease from the duration of the infection in the body:

  The typical course of syphilis is characterized by a classic change of stages:

  • incubation period.
  • primary syphilis.
  • Secondary syphilis.
  • Tertiary syphilis.

  

  stages

  Incubation period(time from infection to the onset of clinical symptoms) lasts 3-9 weeks. 24-48 hours after infection, treponemas make their way to the regional lymph nodes and start system process infections. At this stage, the principle and timing of personal prevention after casual sexual intercourse is formed, which consists in the treatment of the genital organs with disinfectant solutions within 2 hours after intercourse.

  Primary Period begins with the appearance of a hard chancre (painless ulcer) at the site of introduction of treponema. At that place, the nearest lymphatic vessels and nodes. The end of the primary period is accompanied by fever and malaise, this is a consequence of the generalization of the infection: treponemas are released into the blood.

  

  Hard chancre on the genitals

  ATtoric period lasts 3 to 4 years. It is characterized by the appearance of rashes on the skin and mucous membranes. The rash may look like:

  • bubbles;
  • papules;
  • spots;
  • pustules.

  

  Rashes of secondary syphilis

  The rash disappears after a few weeks and does not leave a trace. Without appropriate treatment, the rash reappears. In addition, there may appear: skin pigmentation disorders, local hair loss on the head and eyebrows, seizures.

  Tertiary syphilis refers to late manifestations of the disease. It is accompanied by damage to the internal organs, brain and spinal cord. There are gummous (nodular) formations on the skin, bones, spine, internal organs, spinal cord and brain. These nodes lead to the destruction of the tissues surrounding them, followed by deformities, disability and death.

  

  Tertiary syphilis

  Some people, even when in contact with infected person remain resistant to treponema and do not get sick. Rarely, syphilis will clear up on its own without the use of specific antibiotics. This is due to the feature immune status person.

  

  Manifestations of latent syphilis

  With a latent (latent) course, all of the above symptoms are absent. But this does not negate the presence of treponema in the blood of a person. They are detected only when performing special serological tests.

  Latent syphilis is periodically activated, but it can accompany a person all his life until his death, without waking up. A person with latent syphilis is usually not contagious. The latent course, like the usual one, is divided into early and late syphilis.

  Clinic of the disease:

  If the latent form of syphilis manifested itself in the first 2 years, this is a favorable fact. During this time, treponema infections do not yet have time to affect the internal organs and brain, the bacteria are easily treatable.

  The negative side of the onset of symptoms in the first 2 years is the high contagiousness of the patient. It becomes very contagious during this period, since in the hard chancre, in the rashes on the skin there is a large number of active treponemas, which, upon contact with the skin or mucous membranes of a healthy person, begin to take root in them.

  The latter fact defines patients with early latent syphilis as an epidemiologically dangerous group. Large-scale anti-epidemic measures should be carried out:

  • isolation of patients;
  • examination of the patient's sexual and domestic partners;
  • forced treatment.

  If the latent course lasts more than 2-3 years, syphilis is called late. A person during this period is not contagious. When the process is activated, more serious life-threatening manifestations manifest: damage to the liver, heart, kidneys, bones, body skin. But its most serious consequence is damage to the brain and spinal cord: dorsal tabes, progressive paralysis. This is the danger of the latent course of the disease: without showing itself in the first 2-5 years, the infection manifests itself with deformities and disabling consequences.

  Therefore, it is best to identify latent syphilis at a preventive examination and start its treatment on time. Currently, a blood test for syphilis is performed everywhere, including on a budgetary basis.

  Diagnostics

  To determine the presence of latent syphilis in a person, you can use the following data:

  • features of the anamnesis (presence of a sore in the patient on the body, on the genitals, rash, enlarged lymph nodes, fever);
  • examination of contacts (identification of a patient with syphilis in sexual partners);
  • sharply positive results of all serological tests (MRP, ELISA, RIF, RPGA);
  • rise in body temperature after the start of specific treatment;
  • decrease in antibody titer to pale treponema after 1 course of therapy.

  During the diagnosis of latent syphilis, false positive results can be obtained. They are most often due to:

  • previous malaria;
  • the presence in the human body of a focus of chronic infection (tonsillitis, sinusitis, pyelonephritis);
  • chronic liver pathology (cirrhosis, hepatitis, alcoholic hepatosis of the liver);
  • sickness connective tissue(rheumatoid arthritis, scleroderma, systemic lupus erythematosus).

  In the examination for late syphilis, it is necessary to examine the cerebrospinal fluid to exclude damage to the nervous system by pale treponema. For this purpose, the patient is given lumbar puncture.

  Treatment

  Therapy of the early latent course of syphilis should stop its transition to an active state. Therapy of the late course is aimed primarily at preventing its progression and the development of neurosyphilis.

  Specific treatment of syphilis is based on the use of systemic antibiotics of the penicillin series. At the beginning, a temperature reaction occurs, which indicates in favor of the presence of treponema in the body. The introduction of drugs is carried out in stationary conditions.

  The following antibiotics are used for therapy: Benzylpenicellin, Retarpen, Bicillin, Erythromycin, Clarithromycin, Ceftriaxone, Oxacillin. Doses and time of treatment are selected by a specialist individually for each patient, depending on the form of the disease and its severity. The average time of therapy for latent syphilis is 1 month.

  Retarpen - the main tool for the treatment of syphilis

  The result is evaluated no earlier than 3 months after the end of treatment according to repeated serological tests: a decrease in the titer of specific antibodies is detected. With early syphilis, cure is faster, negative tests for infection are soon achieved. Late course is more difficult to cure, positive tests can remain forever, sometimes it is also characteristic of early syphilis.

  To deregister, you must:

  • full-fledged treatment taking into account all requirements;
  • optimal clinical examination data;
  • results serological study blood (ELISA and RPHA can be positive with strictly negative MCI and CSR).