Syphilis is a chronic disease and belongs to venereal diseases. The former name of syphilis is lues (“French”, Gallic disease).
Syphilis affects all organs and systems, starting with the skin and mucous membranes and ending with internal organs, joints, bones, nervous and cardiovascular systems (depending on the stage of the disease).
Despite the successful treatment of sexually transmitted diseases and the active education of the population in our time, the incidence of syphilis in World continues to grow in comparison with the XX century. Both men and women as well as a child can get it. Especially dangerous is considered to be a congenital form of the disease.
Among venereologists adopted the following classification:
- primary seronegative syphilis;
- primary seropositive syphilis;
- secondary fresh syphilis;
- secondary latent syphilis;
- secondary recurrent syphilis;
- tertiary active syphilis;
- tertiary latent syphilis;
- early congenital syphilis;
- late congenital syphilis;
- latent congenital syphilis;
- visceral syphilis;
- syphilis of the nervous system.
Syphilis is caused by treponema pallidum, which lives only 3 minutes in the external environment. Therefore, the main mode of transmission of the disease is sexual. Infection of the fetus is possible intrauterine (vertical path) or intranatally, when the child passes through the birth canal of the mother.
Domestic transmission is rare, infection is possible from people with the tertiary stage of syphilis, when the pale treponema falls on dishes, linens, towels, etc. from disintegrating gum. Transmission of syphilis by hematogenous by blood transfusion is not excluded.
It is not uncommon and cases of infection of medical professionals in contact with the blood of the patient. Infection is possible through “bloody” objects: a common toothbrush, a razor, a manicure set, and more.
Risk group for syphilis:
- promiscuous sex workers;
- drug addicts;
- hemophilia patients ;
- people who prefer group sex;
- antisocial elements of society;
- patients with gonorrhea .
The average incubation period for syphilis is 3-6 weeks. It can be shortened to 8–15 days (with one-stage infection from two sources, for example, sexually and through household) and can be extended to 108–190 days with antibiotic therapy after infection.
The primary signs of the disease manifest themselves in the form of a so-called hard chancre, which occurs in the damaged area of the skin or mucous membrane upon contact with the pathogen.
Hard chancre is a deep, painless (characteristic symptom) ulcer without bleeding, bordered by even, slightly elevated surfaces. The ulcer has a flat bottom and regular rounded shape. Its sizes are various, from 1 to 4 mm, it is not soldered to surrounding fabrics and dense to the touch.
In women, hard chancre can be localized:
- on the clitoris;
- on the posterior commissure of the labia;
- between the big and small sexual lips;
- on the walls of the vagina;
- on the crotch;
- near the anus;
- and even on the cervix.
In men, it is formed:
- on the penis, usually in the foreskin or near / inside the urethra;
- in the anal area;
- in the rectum (in homosexuals).
It is possible to place a hard chancre in the mouth region (tongue), on the lips and in the throat (with oral-genital contacts).
There is also an atypical course of primary syphilis:
- indurative (stagnant) edema, occurs on the genitals: the clitoris or scrotum, is accompanied by a bluish color, the holes remain after pressing;
- chancre-felon (arises on the nail phalanges of the hand and looks like the usual felon , the hallmark is soreness);
- chancre-amygdale (an increase in the tonsil on one side with characteristic pain when swallowing).
A primary period of 6–8 weeks continues until a rash appears. Approximately one week after the onset of hard chancre, regional lymph nodes (inguinal or submandibular) are enlarged.
Primary syphilis goes through 2 stages: seropositive and seronegative. Serological reactions (Wasserman reaction, ELISA) are negative in the seronegative period, they become positive 3-4 weeks after the appearance of a hard chancre.
Since the appearance of the characteristic rash on the skin and mucous membranes in the form of pale pink spots (Venus necklace) or multiple petechiae (hemorrhages), secondary syphilis begins.
The rash is localized mainly on the chest and back, but it is also possible to spread it throughout the body. The emergence of a rash is due to penetration of the pathogen from the affected regional lymph nodes in the blood vessels and its spread throughout the body.
Swollen lymph nodes is generalized, they are dense, painless and cold to the touch, not soldered to the surrounding tissues.
At this stage, patients note:
- temperature increase to subfebrile numbers (within 37-38 ° C);
- classic cold symptoms (cough, runny nose) and / or conjunctivitis.
Rashes in 1-2 weeks fade and disappear. A hidden secondary period begins. With the weakening of the body’s defenses, the rash returns again (recurrent secondary syphilis), and this happens repeatedly, with each subsequent relapse, its elements increase in size and merge.
The hematogenous treponema “journey” in the body involves the internal organs in the pathological process: syphilitic forms of diseases such as meningitis, gastritis, hepatitis, myocarditis and others develop.
This period is characterized by focal or diffuse alopecia (hair loss on the head, eyelashes, eyebrows).
Secondary syphilis is accompanied by:
- periodic temperature rises;
- bone pains;
- visual impairment.
Often there is syphilitic tonsillitis (sore throat, hoarseness).
Without treatment, secondary syphilis lasts 1-2 years.
In the absence of treatment of secondary syphilis, the disease passes into the tertiary stage, which lasts for years, up to 10-20 years.
In this case, the patient on the skin, mucous membranes, internal organs and bones form hillocks-gumma, which eventually disintegrate and disfigure a person (failed nose, hillocks on the skull, etc.).
The most dangerous manifestation of tertiary syphilis is the defeat of the spinal cord and brain with the development of dementia, spinal marrow (staggering gait), syphilitic meningitis.
Pathology concerns all internal organs and systems: syphilitic endarteritis and aortitis develops, optic nerve atrophy with a progressive decline in vision, syphilitic endocarditis occurs with valvular lesions, bones and so on are destroyed.
Serological reactions to the tertiary stage of syphilis are either negative or weakly positive.
This period is considered a late late syphilis, and patients become infectious to others only through household items.
Household syphilis is characterized by the fact that the disease is not transmitted sexually, but through household items, during surgical procedures, blood transfusion or breastfeeding by a woman, first a sick child, and then a healthy one.
Hard chancre occurs in everyday syphilis not on the genitals, but in the places of contact of the damaged skin and mucous membrane with an infected object (in the mouth, on the face, on the fingers, etc.).
Secondary household syphilis proceeds in the same way as normal.
Separately worth noting hidden syphilis. Allocate:
- early latent syphilis (from the period of primary syphilis to the recurrence of a rash with a secondary one), which lasts about 2 years;
- late latent syphilis (tertiary syphilis with damage to internal organs) with an infection duration of more than 2 years.
Hidden syphilis is either asymptomatic, or without obvious signs: hard chancre in the reach of the eye or slightly stained and almost imperceptible rash. The latent syphilis comes to light only at delivery of analyzes during physical examination.
Inspection of syphilis during pregnancy is carried out three times to all women (at the first appearance in the antenatal clinic, in the period of 28-30 and 38-40 weeks).
Infection can occur both before and during pregnancy. Regardless of the time and duration of the process, all pregnant women with syphilis are treated.
Therapy is no different from standard regimens: penicillin antibiotics are prescribed (they are safe during pregnancy). If syphilis is detected in the first 12 weeks, it is not necessary to terminate the pregnancy, especially if it is desired.
Untreated syphilis can lead to the following complications:
- spontaneous abortion in the first trimester;
- premature birth ;
- fetal death;
- death of the newborn in the first days or hours after birth;
- infection of the newborn when passing through the birth canal;
- congenital syphilis.
Congenital syphilis is characterized by the birth of a child with wrinkled yellowish-gray skin with a typical rash (syphilitic pemphigus ), with a lesion of the musculoskeletal system, an enlarged liver and spleen, anemia, and various malformations. Later, after reaching 2 and more years old, other signs develop:
- bone damage (saber tibia);
- dental problems (Getchinson’s teeth);
- impaired vision and hearing;
- mental retardation.
Primary syphilis must be distinguished from cervical erosion (in women), genital herpes , trichomonas ulcerations, and soft chancre. Secondary syphilis has similar symptoms with toxicoderma, a rash with other infectious diseases ( measles , scarlet fever , rubella ), genital warts , alopecia , psoriasis and fungal infections of the skin. Therefore, differential diagnosis is important.
From laboratory methods using serological reactions (blood from a vein):
- Wasserman reaction (RW);
- precipitation microreaction;
- immunofluorescence (REEF);
- the reaction of immobilization of pale treponem (RIBT);
- enzyme-linked immunosorbent assay (ELISA);
Microscopy of smears taken from a hard chancre or rash elements is also performed.
To confirm the diagnosis, it is necessary to conduct 2 different serological reactions.
Syphilis treatment is carried out only in the hospital by venereologist.
For this purpose, use antibiotics:
- penicillin (bicillin, benzylpenicillin, procaine):
- erythromycin series (sumamed);
The duration of treatment for primary syphilis is on average 10-15 days, secondary and latent tertiary syphilis – 20-28 days.
Prevention of congenital syphilis (if a woman has been ill and treated in the first trimester of pregnancy) is carried out from 16 weeks. Early congenital syphilis is treated with penicillins for two weeks, late congenital syphilis – for 28 days.
Preventive treatment (for persons who have been in contact with a patient, but who have not yet been infected) is treated with bicillin twice a week.
All patients with syphilis should be aware of criminal liability in case of intentional infection of a partner, and must also provide all information about persons with whom they have had sex. In case of refusal of treatment, the patient is forcibly (if necessary with the help of the police) hospitalized in a hospital.
Control tests after the treatment of primary, secondary, early latent and congenital syphilis pass after 1, 3, 6, 12, 24 months. After late latent and tertiary syphilis therapy, monitoring is needed after 12 and 24 months.
To the terrible complications of syphilis include damage to the central nervous system:
Development is also possible:
- IHD ( stenocardia and myocardial infarction );
- syphilitic pneumonia;
- hepatitis, up to hepatic coma and death.
In primary syphilis in men, the occurrence is not excluded:
- gangrene of the penis.
The prognosis depends on the stage of the process, the effectiveness of treatment and the presence or absence of damage to the internal organs, nervous system and bones.
In primary and early secondary syphilis, the prognosis is favorable. The following stages lead to the disability of the patient and the occurrence of his aesthetic defects.
With congenital syphilis, the prognosis is favorable, provided that there is adequate early treatment.