Syphilis

Kinds

The reasons

Symptoms of syphilis in men and women

Hidden syphilis

Syphilis during pregnancy

Diagnostics

Treatment of syphilis in men and women

Complications and prognosis

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.

Kinds

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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.

The reasons

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:

  • prostitutes;
  • promiscuous sex workers;
  • homosexuals;
  • drug addicts;
  • hemophilia patients ; 
  • people who prefer group sex;
  • antisocial elements of society;
  • patients with gonorrhea . 

Symptoms of syphilis in men and women

Incubation period

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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.

Primary syphilis

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.

Secondary syphilis

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:

  • malaise;
  • 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;
  • weakness;
  • bone pains;
  • headache;
  • visual impairment.

Often there is syphilitic tonsillitis (sore throat, hoarseness).  

Without treatment, secondary syphilis lasts 1-2 years.

Tertiary syphilis

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

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.

Hidden syphilis

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.

Syphilis during pregnancy

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.

Diagnostics

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.

Treatment of syphilis in men and women

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Syphilis treatment is carried out only in the hospital by venereologist.

For this purpose, use antibiotics:

  • penicillin (bicillin, benzylpenicillin, procaine):
  • erythromycin series (sumamed);
  • tetracycline;
  • oxacillin;
  • doxycycline;
  • ceftriaxone.

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.

Complications and prognosis

To the terrible complications of syphilis include damage to the central nervous system:

  • meningitis;
  • hydrocephalus;
  • neuritis;
  • deafness;
  • blindness;
  • stroke.

Development is also possible:

  • osteoarthritis;
  • IHD ( stenocardia and myocardial infarction );  
  • syphilitic pneumonia; 
  • gastritis;
  • hepatitis, up to hepatic coma and death.

In primary syphilis in men, the occurrence is not excluded:

  • balanitis;
  • balanoposthitis;
  • phimosis;
  • 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.

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With congenital syphilis, the prognosis is favorable, provided that there is adequate early treatment.

Gonorrhea

The reasons

Kinds

Symptoms of gonorrhea in women and men

Diagnostics

Gonorrhea treatment

Consequences and prognosis

Gonorrhea is an infectious and highly contagious disease in which the mucous membranes of the urogenital tract are affected, but infection of the oropharynx or rectum is also possible. Both men and women suffer from this disease.

The reasons

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It causes gonorrhea gonococcus (Neisseria gonorrhoeae), so named after the physician-researcher Albert Neisser. The disease is transmitted only from a sick person to a person.

The main route of transmission of gonorrhea is sexual (genital), but infection with anogenital and oral contact is possible.

In addition, the vertical pathway of infection is known – during childbirth the child is infected, passing through the birth canal of the sick mother.

The household transmission path is not excluded, but its reliability has not been established, since the pathogen is unstable in the external environment.

Kinds

There are genital and extragenital (not sexual) gonorrhea. Genital gonorrhea is characterized by lesions of the urinary organs.

The group of extragenital gonorrhea includes:

  • gonorrhea anorectal localization (inflammation of the rectum),
  • gonorrhea of ​​the bone and muscular systems (gonorrheal arthritis),
  • gonorrheal damage to the conjunctiva of the eye (gonoblina),
  • gonorrheal defeat of the pharynx (gonococcal pharyngitis).

The course of the disease is divided into fresh, chronic and latent gonorrhea.

Fresh gonorrhea is said when infection occurred less than 2 months ago. Fresh gonorrhea is divided into acute, subacute and torpid (there are no complaints, but there are insignificant secretions).

If the infection occurred more than 2 months ago, chronic gonorrhea is diagnosed.

Latent or latent gonorrhea has no clinical manifestations.

Symptoms of gonorrhea in women and men

The first signs of the disease appear 2–14 days after infection (incubation period). But in some circumstances (for example, treatment with antibiotics, the presence of good immunity) the first manifestations of the disease occur in 1-2 months.

Gonorrhea in men

The disease in men begins with the defeat of the urethra. Patients complain of discomfort (burning and itching) that occurs during urination. Also urination becomes painful.

If you press on the head of the penis there is a drop of pus. With the involvement of the posterior part of the urethra, urination becomes more frequent.

After intercourse, a bloody drop may occur.

On examination, hyperemia (redness) of the foreskin and penis head is noticeable.

The inguinal lymph nodes are often inflamed, they grow and become painful.

In the case of an ascending infection, gonorrhea spreads to the prostate gland, affects the seminal vesicles and testicles. At the same time, fever may occur, aching pain in the lower abdomen and erection problems occur.

Gonorrhea in women

More than half of the infected women have gonorrhea without marked clinical manifestations.

At the very beginning of the disease, the urethra, vagina and cervix are involved in the process. Inflammation of the urethra occurs with pronounced signs: there are pale yellow discharge from the urethra, a feeling of itching and burning in this area, urination becomes painful.

When gonorrheal vaginitis and cervicitis from the genital tract, purulent, greenish leucorrhoea with an unpleasant odor, sometimes a curd consistency , are secreted . There is also a burning sensation and itching, soreness during intercourse. 

In case of irritation with infected secretions of the vulva, it becomes inflamed, red and swollen, and an itchy perineum joins. 

When viewed in the mirrors marked hyperemia (redness) of the cervix and purulent discharge from the cervical canal.

If the infection rises higher, the uterus and its appendages are affected.

Diagnostics

Gonorrhea in women must be differentiated from other sexually transmitted infections ( trichomoniasis , candidiasis , bacterial vaginosis ).  

In men, with urethritis and prostatitis of another infectious or non-infectious etiology.    

The diagnosis of gonorrhea is established on the basis of the characteristic complaints of the patient and the typical clinical signs established during the examination.

But to confirm the disease it is necessary to conduct laboratory tests:

Smear microscopy

For taking smears, material is taken from the urethra, the cervical canal, the vagina and the anus. Before this, the doctor treats the listed anatomical structures with a swab dipped in saline. Before taking the test, it is necessary to refrain from urinating and stop taking antibacterial drugs for 4-5 days. All strokes are taken in duplicate. The first batch of smears is stained with methylene blue, and the second according to Gram.

Cultural method

The essence of the cultural (bacteriological) method consists in planting secretions from the urogenital tract organs on nutrient media. The conclusion is given after 7 days, but gives a 100% result. In addition, this method allows to determine the sensitivity of the planted gonococci to antibiotics.

Immune fluorescence response

The method consists in painting smears with special dyes, after which the gonococci glow under a microscope.

Linked immunosorbent assay

The essence of the method consists in identifying antibodies to the pathogen, and for the analysis are taken not swabs, but urine.

Polymerase Chain Reaction (PCR)

For PCR, you can use smears from the anatomical structures of the urinary tract and urine. The method is effective, but expensive.

If chronic gonorrhea is diagnosed (repeated and ineffective treatment, negative results of bacterioscopic and bacteriological analyzes), provocative tests are carried out, after which the pathogen is detected on the mucous membranes.

There are chemical, biological, thermal, nutritional and physiological provocations. For the most accurate result, a combined provocation is carried out (simultaneous carrying out of two or more samples). Smears after provocation are taken in a day, two and three.

Gonorrhea treatment

Gonorrhea is usually treated by a dermatovenereologist. But in some cases (for example, complicated gonorrhea), the gynecologist deals with the treatment of the disease in women and the urologist in men.

Uncomplicated gonorrhea is treated on an outpatient basis, all other cases are hospitalized. Treatment is indicated to both sexual partners, regardless of the results of the tests. For the period of therapy, it is necessary to observe sexual rest, the rules of personal hygiene (compulsory hand washing after using the toilet and taking a shower), and refusing spicy food and alcohol.

Acute gonorrhea

Etiotropic treatment (elimination of the cause of the disease) consists in getting rid of gonococci and consists in prescribing antibacterial drugs.

With fresh gonorrhea are appointed.

  • fluoroquinolone antibiotics (ciprofloxacin, abactal, ofloxacin),
  • cephalosporins (ceftriaxone, cefixime),
  • macrolides (azithromycin, josamycin),
  • tetracyclines (unidox).

The course of treatment lasts 7, maximum 10 days. It is advisable to combine the treatment with antibiotics that are active against chlamydia and ureaplasma (since gonorrhea often occurs on their background).    

Chronic form

Chronic gonorrhea is treated much longer.

At first, gonovaccine is administered by courses of 6-8-10 intramuscular injections and drugs that stimulate nonspecific immunity (pyrogenal, ribonuclease) and only after that antibiotic therapy is given.

Control tests are taken after the end of treatment and monthly for three months.

Consequences and prognosis

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Running gonorrhea is dangerous by the development of complications.

Among women:

  • endometritis , adnexitis ; 
  • obstruction of the fallopian tubes and infertility in women;
  • bartholinitis in women; 
  • pelvioperitonitis and tubo-ovarian abscess (in women);
  • ectopic pregnancy.

In men

  • prostatitis ;
  • inflammation of the testes and seminal vesicles;
  • violation of spermatogenesis;
  • impotence;
  • male infertility

The prognosis for the timely treatment of fresh gonorrhea is favorable, with chronic gonorrhea, both in men and women, is relatively favorable. 

Genital herpes

Kinds

The reasons

Symptoms of genital herpes

Genital herpes and pregnancy

Diagnostics

Treatment of genital herpes

Consequences and prognosis

Genital or genital herpes refers to viral diseases. This disease is one of the most common among sexually transmitted infections. Almost 99% of the world’s population is believed to be infected with the herpes simplex virus. This disease occurs equally in both women and men.

Kinds

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Depending on the clinical manifestations of genital herpes can be:

  • primary infection, that is, signs of herpes appeared for the first time;
  • recurrent infection, that is, the clinical picture of the disease is repeated more than once;
  • asymptomatic, that is, a person does not suffer from herpes, but is a virus carrier.

Genital herpes by the characteristics of the symptoms is divided into typical and atypical. 

The disease usually goes through 3 stages:

  • Stage 1 – external genital organs are affected;
  • Stage 2 – affected vagina, cervix, urethra in men and women;
  • Stage 3 – the internal organs are involved in the pathological process: in women, the uterus, appendages, bladder, in men, the prostate gland and bladder.

The reasons

The causative agent of the disease is herpes simplex virus (HSV), which is divided into type 1 HSV and type 2 HSV. As a rule, genital herpes causes a 2nd type of virus.

The disease is transmitted only sexually, household path is excluded. The spread of infection is promoted by all types of sexual contacts, both traditional sexual, anogenital and oral-genital. Therefore, infection with oral-genital contacts with a carrier partner of HSV type 1 is possible, especially if there are clinical manifestations of herpes in the lips and mouth cavity. 

Predisposing factors for infection with the herpes simplex virus include:

  • promiscuous sex life;
  • homosexual contact;
  • rejection of condoms;
  • reduced immunity;
  • hypovitaminosis;
  • the use of intrauterine devices;
  • artificial abortion with curettage of the uterus;
  • constant stress;
  • overwork;
  • hypothermia;
  • infection with other infections, both sexually and common;
  • climate change.

Symptoms of genital herpes

The period from infection with HSV to the onset of clinical signs can last from 3 to 26 days. Symptoms of genital herpes in men and women are generally similar.

As a rule, the external genital organs are involved in the pathological process: in men, the bubbles are located on the head of the penis, on the foreskin, along the entire length of the penis, in the groin and scrotum; in women, vesicles are localized on the pubis, labia, in the area of ​​the buttocks and thighs. During homosexual contacts in men, the buttocks and the anus are affected.

First, vesicles are formed against the background of reddish and edematous skin and mucous membrane at the site of infection. Their appearance is preceded by itching and burning. The size of the bubbles reaches 2-3 mm, sometimes they form a spot, the area of ​​which takes 0.5-2.5 cm. At this stage of the disease, vesicles do not last long, after 3 days they burst, and ulcers appear in their place. Sometimes they are covered with a bloom of yellow and then a crust. These wounds heal within 2, maximum 4 weeks, without scarring. 

Patients of both sexes may experience symptoms such as:

  • heaviness in the abdomen;
  • an increase in the inguinal lymph nodes;
  • malaise;
  • temperature rise;
  • headache.

If the urethra and the bladder are involved in the process, then signs of dysuria and the appearance of blood in the urine are expressed.

For atypical forms of genital herpes, the erased or abortive (short) course of the disease is characteristic. This affects not only the external genitalia, but also internal: the uterus, appendages, prostate, seminal vesicles. Most often, patients complain of persistent itching and burning, women have leucorrhoea, which is not amenable to treatment. At the same time, vesicles and edema may be absent on the genitals, only red (hyperemic) spots are visible.

Genital herpes and pregnancy

Especially dangerous is infection with genital herpes or relapse of the disease in the first and last trimesters of pregnancy. Infection can cause spontaneous miscarriage , missed abortion, premature birth or the birth of a child with developmental abnormalities. In addition, when passing through the birth canal of a woman with obvious clinical signs of infection, infection with the virus and the baby is possible, which can lead to his death.   

Therefore, pregnant women with an atypical form of infection during the last 6 months are examined (mucus from the cervical canal) for the presence of HSV antigen. If it is found, a planned cesarean section is performed.

Diagnostics

First and foremost, differential diagnosis aims to distinguish between genital herpes and primary syphilis. Also, the disease should be distinguished from pemphigus, recurrent thrush, lichen planus and staphylococcal impetigo.      

The diagnosis is established on the basis of anamnesis, characteristic complaints and clinical signs. In addition, additional laboratory research methods are used to detect HSV or its antibodies in the blood.

To identify the HSV DNA, material is collected from several sites: the cervix, urethra, etc. The analysis also includes a discharge of the prostate, urine, and so on. It is then sown on biological media to detect the virus, or the presence of the HSV antigen is determined using a polymerase chain reaction. Laboratory tests of blood are used to detect antibodies of class M and G: analysis of fluorescent antibodies and immunoperoxidase method.

Treatment of genital herpes

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The treatment of genital herpes is engaged in a dermatovenerologist.

In order to eliminate the virus (remove it from the blood), alleviate the clinical manifestations and reduce the frequency of relapses, antiviral drugs are used in tablets and injections (systemic therapy), as well as in ointments, creams and gels. 

  • The most commonly prescribed antiviral is zovirax (acyclovir). It is prescribed including during pregnancy.

No less effective are:

  •  foscarnet (pyrophosphate analogue);
  •  valacyclovir;
  •  alpizarin;
  •  panavir

The duration of treatment depends on the form of the disease and clinical manifestations and is usually 1 – 1.5 months. Six months later, a second course.

In addition, the first stage of therapy includes the appointment of immunomodulatory drugs:

  • interferon and its analogs: viferon, genferon;
  • interferon inducers, for example: lavomax, cycloferon, antiherpetic immunoglobulin, taktivin and others.

In the second stage of the disease, antiviral drugs are applied topically against the background of the administration of vitamins B1 and B6, autohemotherapy and the use of fortifying agents (tinctures of ginseng, eleutherococcus, echinacea).

The third stage of treatment is to conduct vaccine herpetic vaccine. And after the recurrence of the disease should take at least 2 months.

Consequences and prognosis

The most dangerous genital herpes during pregnancy, possible complications were considered by us above.

Genital herpes is also likely to:

  •  secondary infection of ulcers with the development of creeping phlegmon;
  •  acute urinary retention;
  •  synechiae in the region of the genital lips (their fusion of varying degrees);
  •  infertility in both men and women (with affection of the internal genital organs);
  • sexual problems are not excluded.

It is impossible to get rid of genital herpes, treatment is aimed at reducing the frequency of relapses and preventing complications, so the prognosis for the disease is relatively favorable.

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