is a sexually transmitted disease that has a long, wave-like course and affects all organs. The clinical picture of the disease begins with the appearance of hard chancre (primary syphiloma) at the site of infection, enlargement of regional and then distant lymph nodes. Characteristic is the appearance of syphilitic rashes on the skin and mucous membranes, which are painless, do not itch, and occur without fever. In the future, all internal organs and systems can be affected, which leads to irreversible changes and even death. Treatment of syphilis is carried out by a venereologist; it is based on systemic and rational antibiotic therapy.

General information

(Lues) is an infectious disease that has a long, wave-like course. In terms of the extent of damage to the body, syphilis is classified as a systemic disease, and in terms of the main route of transmission it is considered a sexually transmitted disease. Syphilis affects the entire body: the skin and mucous membranes, the cardiovascular, central nervous, digestive, and musculoskeletal systems. Untreated or poorly treated syphilis can last for years, alternating periods of exacerbations and latent periods. During the active period, syphilis manifests itself on the skin, mucous membranes and internal organs; during the latent period, it practically does not manifest itself in anything.

Syphilis ranks first among all infectious diseases (including STIs), in terms of incidence, infectiousness, degree of harm to health, and certain difficulties in diagnosis and treatment.

Features of the causative agent of syphilis

The causative agent of syphilis is the microorganism pale spirochete (treponema - Treponema pallidum). The pale spirochete has the appearance of a curved spiral, is capable of moving in different ways (translationally, rotationally, flexibly and wavy), reproduces by transverse division, and is painted with aniline dyes in a pale pink color.

The pale spirochete (treponema) finds optimal conditions in the human body in the lymphatic tract and lymph nodes, where it actively multiplies, and appears in the blood in high concentrations at the stage of secondary syphilis. The microbe persists for a long time in a warm and humid environment (optimum t = 37°C, in wet underwear for up to several days), and is also resistant to low temperatures (in the tissues of corpses - viable for 1-2 days). The pale spirochete dies when dried, heated (55°C - after 15 minutes, 100°C - instantly), when treated with disinfectants, solutions of acids, alkalis.

A patient with syphilis is contagious during any period of illness, especially during periods of primary and secondary syphilis, accompanied by manifestations on the skin and mucous membranes. Syphilis is transmitted through contact of a healthy person with a sick person through secretions (sperm during sexual intercourse, milk - in nursing women, saliva during a kiss) and blood (through direct blood transfusion, during operations - from medical staff, using a shared straight razor, a shared syringe - from drug addicts). The main route of transmission of syphilis is sexual (95-98% of cases). Less common is an indirect household route of infection - through wet household items and personal belongings (for example, from sick parents to children). There have been cases of intrauterine transmission of syphilis to a child from a sick mother. A necessary condition for infection is the presence in the patient’s secretions of a sufficient number of pathogenic forms of pale spirochetes and a violation of the integrity of the epithelium of the mucous membranes and skin of his partner (microtraumas: wounds, scratches, abrasions).

Periods of syphilis

The course of syphilis is long-term, wave-like, with alternating periods of active and latent manifestations of the disease. In the development of syphilis, periods are distinguished that differ in the set of syphilides - various forms of skin rashes and erosions that appear in response to the introduction of pale spirochetes into the body.

• Incubation period

It begins from the moment of infection and lasts on average 3-4 weeks. Pale spirochetes spread through the lymphatic and circulatory tract throughout the body, multiply, but clinical symptoms do not appear. A person with syphilis is unaware of his illness, although he is already contagious. The incubation period can be shortened (up to several days) and extended (up to several months). Extension occurs when taking medications that somewhat inactivate the causative agents of syphilis.

• Primary syphilis

Lasts 6-8 weeks, characterized by the appearance of pale spirochetes of primary syphiloma or chancre at the site of penetration and subsequent enlargement of nearby lymph nodes.

• Secondary syphilis

Can last from 2 to 5 years. Internal organs, tissues and systems of the body are damaged, generalized rashes appear on the mucous membranes and skin, and baldness occurs. This stage of syphilis occurs in waves, with periods of active manifestations followed by periods of absence of symptoms. There are secondary fresh, secondary recurrent and latent syphilis.

Latent (latent) syphilis does not have skin manifestations of the disease, signs of specific damage to internal organs and the nervous system, and is determined only by laboratory tests (positive serological reactions).

• Tertiary syphilis

It is now rare and occurs in the absence of treatment years after the lesion. Characterized by irreversible damage to internal organs and systems, especially the central nervous system. It is the most severe period of syphilis, leading to disability and death. It is detected by the appearance of tubercles and nodes (gummas) on the skin and mucous membranes, which, when disintegrating, disfigure the patient. They are divided into syphilis of the nervous system - neurosyphilis and visceral syphilis, in which internal organs are damaged (brain and spinal cord, heart, lungs, stomach, liver, kidneys).

Symptoms of syphilis

Primary syphilis

Primary syphilis begins from the moment when primary syphiloma, chancre, appears at the site of introduction of pale spirochetes. A chancre is a single, round-shaped erosion or ulcer, which has clear, smooth edges and a shiny bluish-red bottom, painless and non-inflamed. The chancre does not increase in size, has scanty serous contents or is covered with a film or crust; a dense, painless infiltrate is felt at its base. Hard chancre does not respond to local antiseptic therapy.

Chancre can be located on any part of the skin and mucous membranes (anal area, oral cavity - lips, corners of the mouth, tonsils; mammary gland, lower abdomen, fingers), but most often it is located on the genitals. Usually in men - on the head, foreskin and shaft of the penis, inside the urethra; in women - on the labia, perineum, vagina, cervix. The size of the chancre is about 1 cm, but can be dwarf - the size of a poppy seed and gigantic (d = 4-5 cm). Chancres can be multiple, in the case of numerous small lesions of the skin and mucous membranes at the time of infection, sometimes bipolar (on the penis and lips). When a chancre appears on the tonsils, a condition resembling a sore throat occurs, in which the temperature does not rise and the throat almost does not hurt. The painlessness of chancre allows patients not to notice it and not attach any importance. Soreness is distinguished by a slit-like chancre in the fold of the anus, and a chancre - felon on the nail phalanx of the fingers. During the period of primary syphilis, complications (balanitis, gangrenization, phimosis) may occur as a result of the addition of a secondary infection. Uncomplicated chancre, depending on the size, heals after 1.5 - 2 months, sometimes before signs of secondary syphilis appear.

5-7 days after the appearance of chancre, uneven enlargement and hardening of the lymph nodes closest to it (usually inguinal) develops. It can be unilateral or bilateral; the nodes are not inflamed, painless, have an ovoid shape and can reach the size of a chicken egg. Towards the end of the period of primary syphilis, specific polyadenitis develops - an enlargement of most subcutaneous lymph nodes. Patients may experience malaise, headache, insomnia, fever, arthralgia, muscle pain, neurotic and depressive disorders. This is associated with syphilitic septicemia - the spread of the causative agent of syphilis through the circulatory and lymphatic system from the lesion throughout the body. In some cases, this process occurs without fever or malaise, and the patient does not notice the transition from the primary stage of syphilis to the secondary stage.

Secondary syphilis

Secondary syphilis begins 2-4 months after infection and can last from 2 to 5 years. Characterized by generalization of infection. At this stage, all systems and organs of the patient are affected: joints, bones, nervous system, hematopoietic organs, digestion, vision, hearing. The clinical symptom of secondary syphilis is rashes on the skin and mucous membranes, which are widespread (secondary syphilides). The rash may be accompanied by body aches, headache, fever and may feel like a cold.

The rash appears in paroxysms: after lasting 1.5 - 2 months, it disappears without treatment (secondary latent syphilis), then appears again. The first rash is characterized by abundance and brightness of color (secondary fresh syphilis), subsequent repeated rashes are paler in color, less abundant, but larger in size and prone to merging (secondary recurrent syphilis). The frequency of relapses and the duration of latent periods of secondary syphilis vary and depend on the body’s immunological reactions in response to the proliferation of pale spirochetes.

Syphilides of the secondary period disappear without scars and have a variety of forms - roseola, papules, pustules.

Syphilitic roseolas are small round spots of pink (pale pink) color that do not rise above the surface of the skin and epithelium of the mucous membranes, which do not peel and do not cause itching; when pressed on, they turn pale and disappear for a short time. Roseola rash with secondary syphilis is observed in 75-80% of patients. The formation of roseola is caused by disturbances in the blood vessels; they are located throughout the body, mainly on the torso and limbs, in the face - most often on the forehead.

A papular rash is a rounded nodular formation protruding above the surface of the skin, bright pink in color with a bluish tint. Papules are located on the body and do not cause any subjective sensations. However, when pressing on them with a button probe, acute pain appears. With syphilis, a rash of papules with greasy scales along the edge of the forehead forms the so-called “crown of Venus.”

Syphilitic papules can grow, merge with each other and form plaques, becoming wet. Weeping erosive papules are especially contagious, and syphilis at this stage can easily be transmitted not only through sexual contact, but also through handshakes, kisses, and the use of common household items. Pustular (pustular) rashes with syphilis are similar to acne or chicken rash, covered with crust or scales. Usually occur in patients with reduced immunity.

The malignant course of syphilis can develop in weakened patients, as well as in drug addicts, alcoholics, and HIV-infected people. Malignant syphilis is characterized by ulceration of papulopustular syphilides, continuous relapses, impaired general condition, fever, intoxication, and weight loss.

Patients with secondary syphilis may experience syphilitic (erythematous) tonsillitis (severe redness of the tonsils, with whitish spots, not accompanied by malaise and fever), syphilitic seizures in the corners of the lips, and oral syphilis. There is a general mild malaise that may resemble the symptoms of a common cold. Characteristic of secondary syphilis is generalized lymphadenitis without signs of inflammation and pain.

During the period of secondary syphilis, disturbances in skin pigmentation (leukoderma) and hair loss (alopecia) occur. Syphilitic leukoderma manifests itself in the loss of pigmentation of various areas of the skin on the neck, chest, abdomen, back, lower back, and armpits. On the neck, more often in women, a “Venus necklace” may appear, consisting of small (3-10 mm) discolored spots surrounded by darker areas of skin. It can exist without change for a long time (several months or even years), despite antisyphilitic treatment. The development of leukoderma is associated with syphilitic damage to the nervous system; upon examination, pathological changes in the cerebrospinal fluid are observed.

Hair loss is not accompanied by itching or flaking; its nature is:

• diffuse - hair loss is typical of normal baldness, occurring on the scalp, in the temporal and parietal regions;
• small focal - a clear symptom of syphilis, hair loss or thinning in small patches located randomly on the head, eyelashes, eyebrows, mustache and beard;
• mixed - both diffuse and small-focal are found.

With timely treatment of syphilis, the hairline is completely restored.

Skin manifestations of secondary syphilis accompany lesions of the central nervous system, bones and joints, and internal organs.

Tertiary syphilis

If a patient with syphilis was not treated or the treatment was incomplete, then several years after infection he develops symptoms of tertiary syphilis. Serious violations of organs and systems occur, the patient’s appearance is disfigured, he becomes disabled, and in severe cases, death is likely. Recently, the incidence of tertiary syphilis has decreased due to its treatment with penicillin, and severe forms of disability have become rare.

There are tertiary active (if there are manifestations) and tertiary latent syphilis. Manifestations of tertiary syphilis are a few infiltrates (tubercles and gummas), prone to decay, and destructive changes in organs and tissues. Infiltrates on the skin and mucous membranes develop without changing the general condition of patients; they contain very few pale spirochetes and are practically not infectious.

Tubercles and gummas on the mucous membranes of the soft and hard palate, larynx, and nose ulcerate and lead to disorders of swallowing, speech, breathing (perforation of the hard palate, “failure” of the nose). Gummy syphilides, spreading to bones and joints, blood vessels, and internal organs, cause bleeding, perforations, scar deformities, and disrupt their functions, which can lead to death.

All stages of syphilis cause numerous progressive lesions of internal organs and the nervous system, the most severe form of which develops with tertiary (late) syphilis:

• neurosyphilis (meningitis, meningovasculitis, syphilitic neuritis, neuralgia, paresis, epileptic seizures, tabes dorsalis and progressive paralysis);
• syphilitic osteoperiostitis, osteoarthritis,

  Diagnosis of syphilis

  Diagnostic measures for syphilis include a thorough examination of the patient, taking an anamnesis and conducting clinical studies:

  1. Detection and identification of the causative agent of syphilis by microscopy of serous discharge from skin rashes. But in the absence of signs on the skin and mucous membranes and in the presence of a “dry” rash, the use of this method is impossible.
  2. Serological tests (nonspecific, specific) are performed with serum, blood plasma and cerebrospinal fluid - the most reliable method for diagnosing syphilis.

  Nonspecific serological reactions are: RPR - rapid plasma reagin reaction and RW - Wasserman reaction (compliment binding reaction). Allows the determination of antibodies to spirochete pallidum - reagins. Used for mass examinations (in clinics, hospitals). Sometimes they give a false-positive result (positive in the absence of syphilis), so this result is confirmed by performing specific tests.

  Specific serological reactions include: RIF - immunofluorescence reaction, RPHA - passive hemagglutination reaction, RIBT - immobilization reaction of treponemal pallidum, RW with treponemal antigen. Used to determine species-specific antibodies. RIF and RPGA are highly sensitive tests that become positive at the end of the incubation period. Used in the diagnosis of latent syphilis and to recognize false-positive reactions.

  Serological reactions become positive only at the end of the second week of the primary period, therefore the primary period of syphilis is divided into two stages: seronegative and seropositive.

  Nonspecific serological reactions are used to assess the effectiveness of treatment. Specific serological reactions in a patient who has had syphilis remain positive for life; they are not used to test the effectiveness of treatment.

  Treatment of syphilis

  Treatment for syphilis begins after a reliable diagnosis is made, which is confirmed by laboratory tests. Treatment of syphilis is selected individually, carried out comprehensively, recovery must be determined in a laboratory. Modern methods of treating syphilis, which venereology has today, allow us to talk about a favorable prognosis for treatment, subject to correct and timely therapy that corresponds to the stage and clinical manifestations of the disease. But only a venereologist can choose a therapy that is rational and sufficient in terms of volume and time. Self-medication of syphilis is unacceptable! Untreated syphilis becomes a latent, chronic form, and the patient remains epidemiologically dangerous.

  The treatment of syphilis is based on the use of penicillin antibiotics, to which the pale spirochete is highly sensitive. If the patient has allergic reactions to penicillin derivatives, erythromycin, tetracyclines, and cephalosporins are recommended as an alternative. In cases of late syphilis, iodine and bismuth preparations, immunotherapy, biogenic stimulants, and physiotherapy are additionally prescribed.

  It is important to establish sexual contacts of a patient with syphilis, and be sure to carry out preventive treatment of possibly infected sexual partners. At the end of treatment, all previously patients with syphilis remain under dispensary observation with a doctor until the result of a complex of serological reactions is completely negative.

  In order to prevent syphilis, examinations are carried out among donors, pregnant women, workers in children's, food and medical institutions, and patients in hospitals; representatives of risk groups (drug addicts, prostitutes, homeless people). Blood donated by donors must be tested for syphilis and canned.

Hidden syphilis. It is characterized by the fact that the presence of a syphilitic infection is proven only by positive serological reactions, while clinical signs of the disease, neither specific lesions of the skin and mucous membranes, nor pathological changes in the nervous system, internal organs, bones and joints can be identified. In such cases, when the patient knows nothing about the time of his infection with syphilis, and the doctor cannot determine the period and timing of the disease, it is customary to diagnose “latent unspecified syphilis.”

In addition, the group of latent syphilis includes patients with a temporarily or long-term asymptomatic course of the disease. Such patients already had active manifestations of syphilitic infection, but they disappeared spontaneously or after the use of antibiotics in doses insufficient to cure syphilis. If less than two years have passed since infection, then, despite the latent course of the disease, patients with such early latent syphilis are very dangerous in epidemiological terms, since they can expect another relapse of the secondary period with the appearance of infectious lesions on the skin and mucous membranes. Late latent syphilis, when more than two years have passed since the disease, is epidemiologically less dangerous, since the activation of infection will, as a rule, be expressed either in damage to internal organs and the nervous system, or in low-infectious tertiary syphilides of the skin and mucous membranes.

Syphilis without chancre (“decapitated syphilis”). When infected with syphilis through the skin or mucous membranes, primary syphiloma is formed at the site of introduction of pale treponema - chancre. If treponema pallidum enters the body bypassing the skin and mucous barrier, then a generalized infection may develop without previous primary syphiloma. This is observed if infection occurs, for example, from deep cuts, injections or during surgical operations, which is practically extremely rare, as well as during blood transfusion from a donor with syphilis ( transfusion syphilis). In such cases, syphilis is detected immediately in the form of generalized rashes characteristic of the secondary period. Rashes usually appear 2.5 months after infection and are often preceded by prodromal phenomena in the form of headache, pain in bones and joints, and fever. The further course of “decapitated syphilis” does not differ from the course of classical syphilis.

Malignant syphilis. This term refers to a rare form of syphilitic infection in the secondary period. It is characterized by severe disturbances in the general condition and destructive rashes on the skin and mucous membranes, occurring continuously over many months without hidden periods.

Primary syphiloma in malignant syphilis, as a rule, does not differ from that in the normal course of the disease. In some patients, it has a tendency to grow and disintegrate deeply. After the primary period, sometimes shortened to 2-3 weeks, in patients, in addition to the usual rashes for the secondary period (roseola, papule), special forms of pustular elements appear, followed by ulceration of the skin. This form of syphilis is accompanied by more or less severe general symptoms and high fever.

Along with skin lesions in malignant syphilis, deep ulcerations of the mucous membranes, damage to the bones, periosteum, and kidneys can be observed. Damage to internal organs and the nervous system is rare, but is severe.

In untreated patients, the process does not tend to go into a latent state and can occur in separate outbreaks, following one after another, for many months. Prolonged fever, severe intoxication, painful destructive rashes - all this exhausts patients and causes loss of body weight. Only then does the disease begin to gradually subside and enter a latent state. The subsequent relapses are usually of a normal nature.

61) Hidden form of syphilis.
Latent syphilis from the moment of infection takes a latent course and 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; during examination and treatment, the diagnosis can be clarified.

The reaction of the patient's body to the introduction of Treponema pallidum is complex, diverse and insufficiently studied. Infection occurs as a result of penetration of Treponema pallidum through the skin or mucous membrane, the integrity of which is usually compromised.

Many authors provide statistical data according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis is detected in 90% of patients during preventive examinations, in antenatal clinics and somatic hospitals. This is explained by both 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 manifestations 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 in epidemiological terms, it is less dangerous than earlier 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 gummas).
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 experience active, contagious manifestations of early syphilis at any time. This forces patients with early latent syphilis to be classified as an epidemiologically dangerous group and vigorous anti-epidemic measures to be carried out (isolation of patients, thorough examination of not only sexual but also household contacts, compulsory treatment if necessary, etc.). Like the treatment of patients with other early forms of syphilis, the treatment of patients with early latent syphilis is aimed at quickly sanitizing the body from a syphilitic infection.

62. The course of syphilis in the tertiary period . This period develops in patients who have not received any or insufficient treatment, usually 2–4 years after infection.

In the later stages of syphilis, cellular immune reactions begin to play a leading role in the pathogenesis of the disease. These processes occur without a sufficiently pronounced humoral background, since the intensity of the humoral response decreases as the number of treponemes in the body decreases. . Clinical manifestations

Tuberous syphilide platform. Individual tubercles are not visible; they merge into plaques 5–10 cm in size, of bizarre shape, sharply demarcated from the unaffected skin and rising above it.

The plaque has a dense consistency, brownish or dark purple color.

Dwarf tubercular syphilide. Rarely observed. It has a small size of 1–2 mm. The tubercles are located on the skin in separate groups and resemble lenticular papules.

Gummy syphilide, or subcutaneous gumma. This is a node that develops in the hypodermis. Typical localization sites for gummas are the legs, head, forearms, and sternum. The following clinical types of gummous syphilide are distinguished: isolated gummas, diffuse gummous infiltrates, fibrous gummas.

Isolated gumma. Appears in the form of a painless node measuring 5-10 mm, spherical in shape, densely elastic consistency, not fused to the skin.

Gummous infiltration. The gummous infiltrate disintegrates, the ulcerations merge, forming an extensive ulcerative surface with irregular large scalloped outlines, healing with a scar.

Fibrous gummas, or periarticular nodules, are formed as a result of fibrous degeneration of syphilitic gummas.

Late neurosyphilis. It is a predominantly ectodermal process involving the neural parenchyma of the brain and spinal cord. It usually develops 5 years or more from the moment of infection. In late forms of neurosyphilis, degenerative-dystrophic processes predominate.

Late visceral syphilis. In the tertiary period of syphilis, limited gummas or diffuse gummous infiltrations may occur in any internal organ.

Damage to the musculoskeletal system. In the tertiary period, the musculoskeletal system may be involved in the process.

The main forms of bone damage in syphilis.

1. Gummy osteoperiostitis:

2. Gummy osteomyelitis:

3. Non-gummous osteoperiostitis.

63. Tubercular syphilide of the skin. Tuberous syphilide. Typical places of its localization are the extensor surface of the upper limbs, torso, and face. The lesion occupies a small area of ​​skin and is located asymmetrically.

The main morphological element of tubercular syphilide is the tubercle (a dense, hemispherical, cavityless formation of a round shape, dense elastic consistency).

Grouped tubercular syphilide is the most common type. The number of tubercles usually does not exceed 30–40. The tubercles are at different stages of evolution.

Serpiginating tubercular syphilide. In this case, the individual elements merge with each other into a dark red horseshoe-shaped ridge, 2 mm to 1 cm wide, raised above the level of the surrounding skin, along the edge of which fresh tubercles appear.

What is syphilis? Chronic infectious pathology that develops when Treponema pallidum penetrates the body. The disease progresses rapidly, affects all systems and organs, and is accompanied by various complications.

Syphilis is transmitted when Treponema pallidum enters the body

Classification of syphilis

Syphilis (lues) is a sexually transmitted disease, the symptoms of which appear periodically, which often makes diagnosis difficult. To classify the disease, various criteria are used - the duration of infection, the degree of damage to internal organs.

How is syphilis classified:

1. By period of infection– incubation, primary, secondary, tertiary.
2. According to the duration of the disease. Early latent syphilis - infection occurred less than 2 years ago, the nervous system was not affected. Late latent syphilis - more than 2 years have passed since infection, pathogenic bacteria are present in the cerebrospinal fluid. Unspecified – the time of infection could not be determined.
3. Along the path of infection– early and late forms of congenital disease, sexual, domestic, transfusion, headless acquired syphilis.
4. Neurosyphilis– Treponema pallidum affects the vessels and membranes of the brain, then the tissues of the organ.
5. Visceral syphilis– divide the disease depending on which organs are destroyed.

The main feature of syphilis is its wavy course. In the active form, the clinical picture is clearly expressed. The latent type of the disease is the remission phase, there are no signs of infection, the pathogen can only be detected using laboratory tests.

Incubation syphilis

The incubation period lasts on average 3–4 weeks, with strong immunity it can extend to 3 months, in people with a weakened body it is reduced to 9–11 days.

After infection, there are no clinical manifestations; after the end of the initial period, characteristic ulcers and erosions appear at the site of penetration of pathogenic bacteria - chancre, most often in the genital area, what it looks like can be seen in the photo.

The appearance of hard chancres on the skin is the first sign of syphilis in the incubation period

Primary period

Duration – 6–7 weeks. The first signs are a red spot that gradually thickens. A distinctive feature is that the rashes have a regular shape in the form of a circle or oval, the color resembles raw meat, the surface is polished, since little serous fluid is secreted.

Hard chancre can occur anywhere, but most often they are found on the genitals, mouth, mammary glands, and in the rectal area. The size of the erosion can reach the size of a ten-kopeck coin; usually no more than 5 pieces appear. After 4–8 weeks they disappear on their own, even without drug therapy; a slight scar may remain - this does not mean that the disease has become latent; the bacteria continue to actively multiply.

Types of chancre:

1. Chancre felon– forms on the phalanx of the finger, is accompanied by swelling, redness, the ulcer has an uneven edge, a dirty gray coating accumulates in it, and in the advanced form, rejection of the nail is observed.
2. Chancroid-amygdalitis- forms on one of the tonsils, the affected tonsil swells, turns red, thickens, pain occurs when swallowing, and a headache in the back of the head.
3. Mixed chancre- the result of simultaneous infection with syphilis and chancroid, the disease can develop within 3-4 months.

At the secondary stage of the disease, pink syphilitic papules appear on the palms

After six months, the signs of the disease, spotted syphilide, disappear. In this form, the disease can persist until the end of life in 50–70% of patients; in other people it develops into tertiary syphilis. Secondary syphilis can be fresh and recurrent.

Tertiary syphilis

A slowly progressive inflammatory process that occurs after 5–10 years of illness. The pathology affects almost all internal organs, which causes death.

Signs:

• severe cardiovascular diseases, stroke, complete or partial paralysis;
• large single nodes (gummas) gradually turn into long-term non-healing ulcers, after which specific star-shaped scars remain;
• small group rashes on the lower legs, shoulder blades, and shoulders.

Specific scars that remain in place of large single nodes

In tertiary syphilis, the ulcers are deep, often destroy bone tissue, and form a hole between the nasal and oral cavities, which manifests itself in the form of a nasal voice.

Visceral syphilis

Syphilitic visceropathy– damage to internal organs by Treponema pallidum, develops in secondary and tertiary forms of syphilis, is diagnosed in every 5 patients.

A separate form of the disease is malignant syphilis, the disease develops quickly and is severe; it is diagnosed in people with weakened immune systems, HIV-infected people, diabetics, and in the presence of autoimmune pathologies.

Causes of the disease

The causative agent of syphilis is Treponema pallidum, a mobile spiral-shaped bacterium, anaerobic, absent nucleus, DNA without chromosomes. The pathogenic microorganism is poorly stained by dyes that are used in the diagnosis of sexually transmitted diseases.

Routes of infection:

1. Sexual– the main route of infection, the cause of the disease is sexual intercourse with a carrier of the infection, you can also become infected through a kiss, if there are wounds in the mouth, bacteria can also be present in saliva.
2. Intrauterine– congenital syphilis is considered the most dangerous form of the disease and causes the formation of various pathologies. The early type of the disease is diagnosed in a child under 2 years of age, the late type – in children over 3 years of age.
3. Vertical– transmitted through milk to the baby during lactation.
4. By everyday means- upon contact with a person on whose body there are open syphilitic rashes.
5. Transfusion– infection occurred due to accidental transfusion of contaminated blood.
6. Headless– bacteria enter the blood through cuts, syringe needles.

You can become infected with syphilis through an infected blood transfusion.

With transfusion and decapitated syphilis, pathogenic microorganisms penetrate directly into the blood, so chancroid does not occur, and signs of a secondary form of the disease immediately appear.

Which doctor should I contact?

If signs of syphilis appear, it is necessary to see a venereologist. After examination and identification of specific symptoms, it may be necessary. Some clinics have a syphilidologist - a specialist in syphilis.

It is possible to completely get rid of syphilis only in the early stages of the disease, when the pathological processes in the internal organs are still reversible; at the last stage, the disease cannot be treated and ends in death.

Diagnostics

Syphilis has a number of characteristic signs that allow a preliminary diagnosis to be made after an initial examination; the main criteria are the nature and location of the rash.

Types of skin manifestations and rashes with syphilis:

• roseola syphilide– round pink spots that appear on the legs, arms, in the area of ​​the ribs, on the mucous membranes, and when pressed they noticeably turn pale;
• papular syphilides– small nodules, dense, with a clear border;
• pigment syphilide– appears six months after infection, a dark rash;
• acne syphilide– conical small pustules, covered with crusts, do not disappear for a long time;
• impetiginous syphilide– dry out quickly;
• smallpox syphilide– spherical small dense rashes;
• syphilitic ecthyma– a sign of late syphilis, a deep and large pustule, covered with a thick crust, after which purplish-blue ulcers and a scar remain on the skin;
• syphilitic rupee– single rashes, prone to scarring;
• pustular syphilides– acne-like syphilitic rash with purulent contents;
• syphilitic alopecia– the appearance of small bald spots on the head;
• syphilitic leucoderma– white spots, located on the neck, chest, lower back.

Other external manifestations are enlarged lymph nodes, an increase in temperature, a decrease in blood pressure, muscle pain, headache, and heart rhythm disturbances.

Lab tests

After the examination, the doctor gives directions for tests that can confirm the diagnosis, show the extent of the disease, and the presence of damage to internal organs. For laboratory tests, samples are taken from rashes on the skin and mucous membranes of the genital organs, in the anus, in the mouth, puncture of the lymph nodes and cerebrospinal fluid is performed.

Diagnostics:

• clinical analysis of urine and blood;
• dark field microscopy– use a special microscope, against a dark background you can clearly see the treponemes;
• direct fluorescence reaction– after treating the biomaterial with a special serum, pathogenic bacteria begin to glow;
• PCR– allows you to detect the presence of Treponema DNA in the blood and cerebrospinal fluid;
• VDRL– shows the presence of antibodies, is highly reliable, only this reaction becomes negative after complete recovery, unlike other serological research methods;
• Wasserman reaction– can be positive, negative, doubtful, weakly positive, strongly positive;
• REEF– detects the presence of antibodies produced by the immune system after infection;
• RPGA– when plasma and specially prepared red blood cells are mixed, the blood becomes granular; even after complete recovery, the reaction remains positive for life.

Almost all methods for diagnosing syphilis are based on blood tests in various specific ways

ELISA is one of the main methods for identifying various infectious pathologies; it allows you to determine the number of bacteria and indicate the time period of infection. 14 days after infection, IgA antibodies are present in the blood; after 4 weeks, the body produces immunoglobulins such as IgA and IgM. If IgG joins the two previous groups of antibodies, the disease is at its peak of exacerbation.

Why do false positive test results occur?

In diagnosing syphilis, several types of tests are always used, since false positive results often occur.

Main reasons:

• exacerbation of chronic infectious diseases;
• serious injuries;
• heart attack;
• any vaccination a few days before testing;
• intoxication due to food poisoning;
• pathological processes in connective tissues;
• tuberculosis, HIV, hepatitis B, C;
• kidney diseases;
• autoimmune diseases.

False-positive reactions to syphilis often occur in pregnant women - this is due to changes in the body at the hormonal and immune levels.

Is there a cure for syphilis?

Syphilis can only be treated with antibacterial drugs; all other means and methods are useless. In therapy, medications are used mainly in the form of injections; the dosage and duration of the course depend on the severity of the disease.

How to treat:

• Bicillin-1 - injections are given every 24 hours;
• Bicillin-3 – administered intramuscularly in the morning and evening;
• Bicillin-5 - injections are indicated 2-3 times a week;
• Tetracycline – twice a day;
• Ceftriaxone – once a day;
• Doxycycline - morning and evening;
• drugs in tablets - Rovamycin, Sumamed, Cefotaxime, Amoxicillin, you need to take them every 8 hours.

When treating syphilis, Ceftriaxone injections are given daily.

If a woman has a history of even completely cured syphilis, she is recommended to undergo preventive treatment during pregnancy to avoid infecting the child.

Consequences and complications of syphilis

In representatives of both sexes, the disease progresses and is treated the same, but complications are sometimes different. Men sometimes develop phimosis, which develops against the background of the formation of a hard chancre in the area of ​​the foreskin. In women, chancroid can be in the vagina and cervix.

How dangerous the disease is - the consequences of the disease depending on the stage of the syphilitic process:

1. Primary syphilis- an atypical hard chancre located in a hard-to-reach, unusual place in the mouth, on the tonsils. Hard chancre can cause the development of balanitis, balanoposthitis, and ulcerative-necrotic processes.
2. Secondary syphilis– initial damage to the nervous system and internal organs, various types of rashes.
3. Tertiary syphilis. In advanced forms of the disease, many gummas form on the outside and on the internal organs - lumps that can destroy bone and muscle tissue.

Treponema pallidum is able to bypass the human immune system; when the body begins to fight pathogens on its own, the bacteria transform into an armored form, in which they can remain for several months.

Prevention

To avoid contracting syphilis, it is necessary to use condoms when engaging in any type of sex; people who are sexually active and often change partners must be tested for STIs every six months.

The constant presence of an infected person nearby increases the risk of household transmission of the disease, to prevent this, it is necessary to exclude any bodily contact, allocate individual dishes to the sick person, bedding, bathtub and toilet must be regularly treated with antiseptics and disinfectants.

After unprotected sexual intercourse with a possible carrier of the infection, you must visit a venereologist within 48 hours, the doctor will select antibiotics for preventive treatment.

A condom reduces the likelihood of contracting syphilis, but infection cannot be completely excluded - if there are erosions and ulcers on the body, they contain a lot of treponemes.

Syphilis is a dangerous disease from which you can die, mainly transmitted through sexual contact. Treatment is effective only in the early stages of the disease, then irreversible processes begin to occur in tissues and internal organs.

Despite successful laboratory experiments on infecting animals, under natural conditions animals are not susceptible to syphilis. Natural transmission of infection is possible only from person to person. As a source of infection, patients pose the greatest danger in the first 2 years of the disease. After 2 years of infection, the contagiousness of patients decreases, and infection of contact persons occurs less frequently. A necessary condition for infection is the presence of an entrance gate - damage (microtrauma) to the stratum corneum of the epidermis or the epithelium of the mucous membrane.

There are three ways of transmission of infection: contact, transfusion and transplacental. Most often, syphilis infection occurs through contact.

Contact path

Infection can occur through direct (immediate) contact with a sick person: sexual and non-sexual (household).

Most often, infection occurs through direct sexual contact. The direct non-sexual route of infection is rarely realized in practice (as a result of a kiss, a bite). In domestic conditions, young children are at particular risk of infection if their parents have active forms of syphilis. Preventive treatment of children who have been in close contact with patients with syphilis is mandatory. Cases of direct occupational infection of medical workers (dentists, surgeons, obstetricians-gynecologists, pathologists) during examination of patients with syphilis, carrying out medical procedures, contact with internal organs during operations, and autopsies are rare.

Infection can occur through indirect (mediated) contact - through any objects contaminated with biological material containing pathogenic treponemes. Most often, infection occurs through objects that come into contact with the oral mucosa - glasses, spoons, toothbrushes.

The risk of household infection with syphilis is real for people who are in close everyday contact with the patient: family members, members of closed groups. Indirect infection in medical institutions through reusable medical instruments is excluded if they are processed correctly.

A patient with syphilis is contagious during all periods of the disease, starting with incubation. The greatest danger is posed by patients with primary and especially secondary syphilis, who have weeping rashes on the skin and mucous membranes - erosive or ulcerative primary syphilomas, macerated, erosive, vegetative papules, especially when located on the mucous membrane of the mouth, genitals, and also in the folds of the skin.

Dry syphilides are less contagious. Treponemas are not found in the contents of papulopustular elements. Manifestations of tertiary syphilis are practically not contagious, since they contain only single treponemes located deep in the infiltrate.

The saliva of patients with syphilis is contagious in the presence of rashes on the oral mucosa. Breast milk, semen and vaginal secretions are contagious even in the absence of rashes in the breast and genital area. The secretion of the sweat glands, tear fluid and urine of patients do not contain treponemes.

In patients with early forms of syphilis, any nonspecific lesions that lead to disruption of the integrity of the skin and mucous membranes are contagious: herpetic rashes, cervical erosions.

Transfusion route

Transfusion syphilis develops during the transfusion of blood taken from a donor with syphilis, and in practice it occurs extremely rarely - only in the case of direct transfusion. Drug users expose themselves to a real risk of infection when sharing syringes and intravenous needles. When transmitted through transfusion, the pathogen immediately enters the bloodstream and internal organs, so syphilis manifests itself on average 2.5 months after infection with immediately generalized rashes on the skin and mucous membranes. However, there are no clinical manifestations of the primary period of syphilis.

Transplacental route

A pregnant woman with syphilis may experience intrauterine infection of the fetus with the development of congenital syphilis. In this case, treponemes penetrate through the placenta directly into the bloodstream and internal organs of the fetus. With congenital infection, chancre formation and other manifestations of the primary period are not observed. Transplacental infection usually occurs no earlier than the 16th week of pregnancy, after the formation of the placenta is complete.

The following variants of the course of syphilitic infection have been established: classic (staged) and asymptomatic.

Syphilis is characterized by a staged, wave-like course with alternating periods of manifestation and latent state. Another feature of the course of syphilis is progression, i.e. a gradual change in the clinical and pathomorphological picture towards increasingly more unfavorable manifestations.

Periods

During syphilis, there are four periods - incubation, primary, secondary and tertiary.

Incubation period. This period begins from the moment of infection and continues until the appearance of primary syphiloma - on average 30 - 32 days. The incubation period may be shortened or extended compared to the stated average duration. Incubation has been described to be shortened to 9 days and extended to 6 months.

When entering the body, already in the area of ​​the entrance gate, treponema meets the cells of the monocyte-macrophage system, however, the processes of recognition of a foreign agent by tissue macrophages, as well as the transfer of information by T-lymphocytes in syphilis, are disrupted for several reasons: glycopeptides of the cell wall of treponema are close in structure and composition to glycopeptides human lymphocytes; Treponemas secrete substances that slow down the recognition process; after introduction into the body, treponema quickly penetrates the lymphatic capillaries, vessels and nodes, thereby avoiding the macrophage reaction; even being phagocytosed, treponema in most cases does not die, but becomes inaccessible to the body’s defenses.

The early stages of syphilis are characterized by partial inhibition of cellular immunity, which promotes the reproduction and spread of pathogens throughout the body.

Already 2–4 hours after infection, the pathogen begins to move along the lymphatic tract and invades the lymph nodes. From the moment of infection, treponema begins to spread by hematogenous and neurogenic routes, and in the first day the infection becomes generalized. From this time on, bacteria are found in the blood, internal organs and nervous system, but in the tissues of the sick person during this period there is still no morphological response to the introduction of pathogens.

The humoral component of immunity is not able to ensure the complete destruction and elimination of Treponema pallidum. During the entire incubation period, pathogens actively multiply in the area of ​​the entrance gate, the lymphatic system and internal organs. At the end of incubation, the number of treponemas in the body increases significantly, so patients are infectious during this period.

Primary period. It begins with the onset of primary affect and ends with the appearance of generalized rashes on the skin and mucous membranes. The average duration of primary syphilis is 6–8 weeks, but it can be reduced to 4–5 weeks and increased to 9–12 weeks.

A few days after the onset of the primary affect, an increase and thickening of the lymph nodes closest to it is observed. Regional lymphadenitis is an almost constant symptom of primary syphilis. At the end of the primary period, approximately 7 to 10 days before its end, groups of lymph nodes remote from the area of ​​the entrance gate of infection increase and thicken.

During the primary period of syphilis, intensive production of antitreponemal antibodies occurs. First of all, their number in the bloodstream increases. Circulating antibodies immobilize treponemes, form membrane-attacking immune complexes, which leads to the destruction of pathogens and the release of lipopolysaccharide and protein products into the blood. Therefore, at the end of the primary – beginning of the secondary period, some patients experience a prodromal period: a complex of symptoms caused by intoxication of the body with substances released as a result of the massive death of treponemes in the bloodstream.

The level of antibodies in tissues gradually increases. When the amount of antibodies becomes sufficient to ensure the death of tissue treponemas, a local inflammatory reaction occurs, which is clinically manifested by widespread rashes on the skin and mucous membranes. From this time on, syphilis enters the second stage.

Secondary period. This period begins from the moment the first generalized rash appears (on average 2.5 months after infection) and lasts in most cases for 2 to 4 years.

The duration of the secondary period is individual and determined by the characteristics of the patient’s immune system. Recurrences of secondary rashes can be observed 10–15 years or more after infection, while at the same time in weakened patients the secondary period can be shortened.

In the secondary period, the undulation of the course of syphilis is most pronounced, that is, the alternation of manifest and latent periods of the disease. During the first wave of secondary rashes, the number of treponemas in the body is greatest - they multiplied in huge numbers during the incubation and primary periods of the disease.

The intensity of humoral immunity at this time is also maximum, which causes the formation of immune complexes, the development of inflammation and the massive death of tissue treponemas. The death of some pathogens under the influence of antibodies is accompanied by a gradual cure of secondary syphilides within 1.5 - 2 months. The disease enters a latent stage, the duration of which may vary, but on average is 2.5 - 3 months.

The first relapse occurs approximately 6 months after infection. The immune system again responds to the next proliferation of pathogens by increasing the synthesis of antibodies, which leads to the cure of syphilides and the transition of the disease to a latent stage. The undulating course of syphilis is due to the peculiarities of the relationship between Treponema pallidum and the patient’s immune system.

The further course of the syphilitic infection is characterized by a continuing increase in sensitization to treponema with a steady decrease in the number of pathogens in the body.

After an average of 2 - 4 years from the moment of infection, the tissue response to the pathogen begins to proceed according to the Arthus phenomenon, followed by the formation of a typical infectious granuloma - an infiltrate of lymphocytes, plasma, epithelioid and giant cells with necrosis in the center.

Tertiary period. This period develops in patients who have not received treatment at all or have not been treated sufficiently, usually 2 to 4 years after infection.

The balance that exists between the pathogen and the controlling immune system during the latent course of syphilis can be disrupted under the influence of unfavorable factors - injuries (bruises, fractures), weakening the body of the disease, intoxication. These factors contribute to the activation (reversion) of spirochetes in any part of a particular organ.

In the later stages of syphilis, cellular immune reactions begin to play a leading role in the pathogenesis of the disease. These processes occur without a sufficiently pronounced humoral background, since the intensity of the humoral response decreases as the number of treponemes in the body decreases.

Malignant course of syphilis

Severe concomitant diseases (such as tuberculosis, HIV infection), chronic intoxication (alcoholism, drug addiction), poor nutrition, heavy physical labor and other reasons that weaken the patient’s body affect the severity of syphilis, contributing to its malignant course. Malignant syphilis in each period has its own characteristics.

In the primary period, ulcerative chancre is observed, prone to necrosis (gangrenization) and peripheral growth (phagedenism), there is no reaction of the lymphatic system, the entire period can be shortened to 3–4 weeks.

In the secondary period, the rash tends to ulcerate, and papulopustular syphilides are observed. The general condition of the patients is disturbed, fever and symptoms of intoxication are expressed. Manifest lesions of the nervous system and internal organs are common. Sometimes there is a continuous recurrence, without latent periods. Treponemas are difficult to detect in the discharge of rashes.

Tertiary syphilides in malignant syphilis can appear early: a year after infection (galloping course of the disease). Serological reactions in patients with malignant syphilis are often negative, but can become positive after the start of treatment.

Re-infection with syphilis

True, or sterile, immunity does not develop with syphilis. This means that a person who has been ill can become infected again, just like a person who has never had this disease before. Repeated infection with syphilis in a person who previously had the disease and was completely cured is called reinfection. The latter is considered as convincing evidence that syphilis is completely curable.

With syphilis, the patient’s body develops so-called non-sterile, or infectious, immunity. Its essence is that a new infection is impossible as long as treponema pallidum remains in the body.

Primary period

The primary period of syphilis is characterized by the following set of clinical symptoms: primary syphiloma, regional lymphadenitis, specific lymphadenitis, specific polyadenitis, prodromal phenomena.

Primary syphiloma is the first clinical manifestation of the disease, occurring at the site of penetration of Treponema pallidum through the skin and mucous membranes (in the area of ​​the entrance gate).

The appearance of an erosive or ulcerative defect is preceded by the appearance of a small hyperemic inflammatory spot, which after 2–3 days turns into a papule. These changes are asymptomatic and are not noticed by either the patient or the doctor. Soon after the appearance of the papule, the epidermis (epithelium) covering it undergoes disintegration, and an erosion or ulcer is formed - the primary syphiloma itself. The depth of the defect depends on the severity and nature of the tissue reaction to the introduction of the pathogen.

Clinical signs of typical primary syphiloma.

1. Primary syphiloma is an erosion or superficial ulcer.

2. Primary syphilomas are single or single (2 - 3 elements).

3. Primary syphiloma has a round or oval shape.

4. Primary syphiloma usually has a size of 5 – 15 mm. There are also dwarf primary affects with a diameter of 1 – 3 mm. Giant chancre with a diameter of up to 4–5 cm or more are ulcerative, covered with serous-hemorrhagic or purulent-hemorrhagic crusts and have extragenital or perigenital localization.

5. Having reached a certain size, primary syphiloma does not tend to grow peripherally.

6. The boundaries of primary syphiloma are smooth and clear.

7. The surface of primary syphiloma has a bright red color (the color of fresh meat), sometimes covered with a dense coating of grayish-yellow color (the color of spoiled lard).

8. The edges and bottom of erosive syphiloma lie at the same level. The edges and bottom of the ulcerative chancre are separated from each other by the depth of the defect.

9. The bottom of primary syphiloma is smooth, covered with scanty transparent or opalescent discharge, giving it a peculiar mirror or varnish shine.

10. At the base of primary syphiloma there is a dense elastic infiltrate, clearly demarcated from the surrounding tissues and extending 2 - 3 mm beyond the syphiloma.

11. Primary syphiloma is not accompanied by subjective sensations. Soreness in the area of ​​primary affect appears when a secondary infection is attached.

12. There are no acute inflammatory changes in the skin around the primary syphiloma.

Localization of primary syphilomas: primary syphilomas can be located on any area of ​​the skin and mucous membranes where conditions have developed for the introduction of treponemes, i.e. in the area of ​​the entrance gate of infection. Based on localization, primary syphilomas are divided into genital, perigenital, extragenital and bipolar.

Atypical primary syphilomas. In addition to primary affects with a typical clinical picture and its many varieties, atypical chancre may be observed that does not have the characteristic features inherent in typical syphilomas. These include indurative edema, chancre-felon, chancre-amygdalitis. Atypical forms of syphiloma are rare, have a long course and often cause diagnostic errors.

Indurative edema is a persistent specific lymphangitis of small lymphatic vessels of the skin, accompanied by symptoms of lymphostasis.

It occurs in the genital area with a richly developed lymphatic network: in men the foreskin and scrotum are affected, in women - the labia majora and very rarely - the labia minora, clitoris, and cervical pharynx lips.

The chancre felon is localized on the distal phalanx of the finger and is very similar to the common felon. It is characterized by the formation of an ulcer on the dorsal surface of the terminal phalanx of the finger. A deep - down to the bone - ulcer with uneven, tortuous and undermined edges, crescent-shaped or horseshoe-shaped. The bottom of the ulcer is pitted, covered with purulent-necrotic masses, crusts, there is copious purulent or purulent-hemorrhagic discharge with an unpleasant odor.

Chancroid-amygdalitis is a specific unilateral enlargement and significant thickening of the tonsil without a defect on its surface. The tonsil has a stagnant red color, but is not accompanied by diffuse hyperemia.

The following complications of primary syphiloma are distinguished:

1) impetiginization. A hyperemic corolla appears along the periphery of syphiloma, the tissues acquire pronounced swelling, the brightness of the element increases, the discharge becomes abundant, serous-purulent or purulent, a burning sensation and pain appear in the area of ​​syphiloma and regional lymph nodes;

2) balanitis and balanoposthitis - in men, vulvitis and vulvovaginitis - in women. High humidity, constant temperature, and the presence of a nutrient medium in the form of smegma in the preputial sac contribute to the proliferation of microorganisms and the development of clinical manifestations of balanitis - inflammation of the skin of the glans penis. In women, secondary infection contributes to the occurrence of vulvovaginitis;

3) phimosis. In men who have not undergone circumcision, the inflammatory process of the skin of the preputial sac, due to the developed lymphatic network, often leads to phimosis - a narrowing of the ring of the foreskin. Inflammatory phimosis is characterized by bright diffuse hyperemia, mild swelling and an increase in the volume of the foreskin, as a result of which the penis takes on a flask shape and becomes painful;

4) paraphimosis, which is the infringement of the head of the penis by a narrowed ring of the foreskin, pulled towards the coronal sulcus. It occurs as a result of forced exposure of the head during phimosis. This leads to disruption of blood and lymph flow, worsening swelling of the preputial ring and severe pain in the penis;

5) gangrenization. Syphiloma undergoes necrotic decay, which is clinically expressed by the formation of a dirty gray, brown or black scab, tightly fused to the underlying tissues and painless;

6) phagedenism, which begins with the appearance of a necrosis area of ​​greater or lesser magnitude against the background of an ulcer. But the necrotic process is not limited to the chancre and extends not only into the depths, but also beyond the boundaries of syphiloma.

Regional lymphadenitis. It is an enlargement of the lymph nodes draining the site of primary syphiloma. This is the second clinical manifestation of primary syphilis.

Specific lymphangitis. It is an inflammation of the lymphatic vessel from the chancre to the regional lymph nodes. This is the third component of the clinical picture of primary syphilis.

Specific polyadenitis. At the end of the primary period of syphilis, patients experience specific polyadenitis - an increase in several groups of subcutaneous lymph nodes remote from the area of ​​the entrance gate of infection.

Prodromal syndrome. Approximately 7–10 days before the end of the primary period and during the first 5–7 days of the secondary period, general symptoms are observed due to intoxication as a result of the massive presence of treponemes in the bloodstream. It includes fatigue, weakness, insomnia, decreased appetite and performance, headache, dizziness, irregular fever, myalgia, leukocytosis and anemia.

Secondary period

The secondary period of syphilis is characterized by a complex of clinical manifestations such as spotted syphilide (syphilitic roseola), papular syphilide, papulopustular syphilide, syphilitic alopecia (baldness), syphilitic leucoderma (pigmented syphilide).

Spotted syphilide, or syphilitic roseola. This is the most common and earliest manifestation of the secondary period of the disease. The roseate rash appears gradually, in spurts, 10 to 12 elements per day. The rash reaches full development in 8 - 10 days, lasts on average 3 - 4 weeks without treatment, sometimes less or more (up to 1.5 - 2 months). The roseate rash resolves without leaving a trace.

Syphilitic roseola is a hyperemic inflammatory spot. The color of roseola varies from pale pink to deep pink, sometimes with a bluish tint. Most often it has a pale pink, faded color. Long-existing roseola acquires a yellowish-brown tint. The size of the spots ranges from 2 to 25 mm, with an average of 5 – 10 mm. The outlines of roseola are round or oval, the boundaries are unclear. The spots do not grow peripherally, do not merge, and are not accompanied by subjective sensations. There is no peeling.

The roseate rash is localized mainly on the lateral surfaces of the torso, chest, and upper abdomen. Rashes can also be observed on the skin of the upper thighs and the flexor surface of the forearms, and rarely on the face.

In addition to the typical roseola syphilide, its atypical varieties are distinguished: elevated, confluent, follicular and scaly roseola.

Elevating (rising) roseola, urticarial roseola, exudative roseola. With this form, the spots appear slightly raised above the skin level and become similar to the urticarial rash of urticaria.

Plum roseola. Occurs when there is a very abundant rash of spots, which, due to their abundance, merge with each other and form continuous erythematous areas.

Follicular roseola. This variety is a transitional element between roseola and papule. Against the background of the pink spot there are small follicular nodules in the form of dotted copper-red granules.

Flaky roseola. This atypical variety is characterized by the appearance on the surface of spotted elements of lamellar scales, reminiscent of crumpled tissue paper. The center of the element appears somewhat sunken.

Papular syphilide. Occurs in patients with secondary recurrent syphilis. Papular syphilide also occurs with secondary fresh syphilis; in this case, papules usually appear 1 to 2 weeks after the onset of roseola rash and are combined with it (maculopapular syphilide). Papular syphilides appear on the skin in spurts, reaching full development in 10–14 days, after which they exist for 4–8 weeks.

The primary morphological element of papular syphilide is a dermal papule, sharply delimited from the surrounding skin, regularly round or oval in outline. It can be hemispherical in shape with a truncated apex or pointed. The color of the element is initially pink-red, later becoming yellowish-red or bluish-red. The consistency of the papules is densely elastic. The elements are located in isolation; only when localized in folds and irritation is there a tendency towards their peripheral growth and fusion.

There are no subjective sensations, but when pressing on the center of a newly appeared papule with a blunt probe, pain is noted.

Depending on the size of the papules, four types of papular syphilide are distinguished.

Lenticular papular syphilide. This is the most common variety, which is characterized by a rash of papules with a diameter of 3–5 mm, observed both in secondary fresh and recurrent syphilis.

Miliary papular syphilide. This variety is extremely rare; its appearance is considered evidence of a severe course of the disease.

The morphological element is a cone-shaped papule of dense consistency with a diameter of 1–2 mm, located around the mouth of the hair follicle. The color of the elements is pale pink, as a result of which they stand out slightly against the surrounding background.

Nummular papular syphilide. This manifestation of the disease occurs mainly in patients with secondary recurrent syphilis. The rashes appear in small numbers and are usually grouped. The morphological element is a hemispherical papule with a flattened apex with a diameter of 2 - 2.5 cm. The color of the elements is brownish or bluish-red, rounded in outline. When nummular papules resolve, pronounced skin pigmentation remains for a long time.

Plaque papular syphilide. It occurs very rarely in patients with secondary recurrent syphilis. It is formed as a result of peripheral growth and fusion of nummular and lenticular papules exposed to external irritation. Most often, plaque-like syphilide forms in the area of ​​large folds - on the genitals, around the anus, in the inguinal-femoral fold, under the mammary glands, in the armpits.

Papulopustular syphilide. It is observed in weakened patients suffering from alcoholism, drug addiction, and severe concomitant diseases, and indicates a severe, malignant course of syphilis.

The following clinical types of papulopustular syphilide are distinguished: acne-like (or acneiform), smallpox-like (or varioliform), impetigo-like, syphilitic ecthyma, syphilitic rupee. Superficial forms of papulopustular syphilide - acne-like, smallpox-like and impetigo-like - are most often observed in patients with secondary fresh syphilis, and deep forms - syphilitic ecthyma and rupiah - are observed mainly in secondary recurrent syphilis and serve as a sign of the malignant course of the disease. All varieties of pustular syphilides have an important feature: at their base there is a specific infiltrate. Pustular syphilides arise as a result of the disintegration of papular infiltrates, so it is more correct to call them papulopustular.

Syphilitic alopecia. There are three clinical types of alopecia: diffuse, finely focal and mixed, which is a combination of finely focal and diffuse types of baldness.

Diffuse syphilitic alopecia is characterized by acute general hair thinning in the absence of any skin changes. Hair loss usually begins at the temples and spreads to the entire scalp. In some cases, other areas of the hairline also experience baldness - the area of ​​the beard and mustache, eyebrows, and eyelashes. The hair itself also changes: it becomes thin, dry, dull. The severity of diffuse alopecia varies from barely noticeable hair loss, slightly exceeding the size of the physiological change, to complete loss of all hair, including vellus hair.

Small focal syphilitic alopecia is characterized by the sudden, rapidly progressive appearance on the scalp, especially in the area of ​​the temples and the back of the head, of many randomly scattered small foci of hair thinning with a diameter of 0.5 - 1 cm. Bald spots have irregularly rounded outlines, do not grow along the periphery and do not merge with each other. The hair in the affected areas does not fall out completely, only a sharp thinning occurs.

Syphilitic leukoderma, or pigment syphilide. This is a kind of skin dyschromia of unknown origin that occurs in patients with secondary, mainly recurrent, syphilis. A typical localization of leukoderma is the skin of the back and sides of the neck, less often - the anterior wall of the armpits, the area of ​​the shoulder joints, the upper chest, and back. Diffuse yellowish-brown hyperpigmentation of the skin first appears on the affected areas. After 2 to 3 weeks, whitish hypopigmented spots with a diameter of 0.5 to 2 cm of round or oval shape appear on the hyperpigmented background. All spots are approximately the same size, located in isolation, and are not prone to peripheral growth and fusion.

There are three clinical varieties of pigment syphilide: spotted, reticulate (lace) and marbled. In macular leukoderma, hypopigmented spots are separated from each other by wide layers of hyperpigmented skin, and there is a pronounced difference in color between hyper- and hypopigmented areas. In the reticular form, hypopigmented spots are in close contact with each other, but do not merge, remaining separated by thin layers of hyperpigmented skin. In this case, narrow areas of hyperpigmentation form a network.

With marbled leukoderma, the contrast between hyper- and hypopigmented areas is insignificant, the boundaries between white spots are unclear, and the overall appearance of dirty skin is created.

Damage to the nervous system. Neurosyphilis is usually divided into early and late forms depending on the nature of the pathomorphological changes observed in the nervous tissue. Early neurosyphilis is a predominantly mesenchymal process affecting the meninges and vessels of the brain and spinal cord.

It usually develops in the first 5 years after infection. Early neurosyphilis is characterized by a predominance of exudative-inflammatory and proliferative processes.

Damage to internal organs. Syphilitic lesions of internal organs during early syphilis are inflammatory in nature and are similar in morphological picture to the changes occurring in the skin.

Damage to the musculoskeletal system. Lesions of the skeletal system, mainly in the form of ossalgia, less often - periostitis and osteoperiostitis, are localized mainly in the long tubular bones of the lower extremities, less often - in the bones of the skull and chest.

Tertiary period

Damage to the skin and mucous membranes in tertiary active syphilis is manifested by tuberculate and gummous rashes.

Tuberous syphilide. It can be located on any part of the skin and mucous membranes, but typical places for its localization are the extensor surface of the upper limbs, torso, and face. The lesion occupies a small area of ​​skin and is located asymmetrically.

The main morphological element of tubercular syphilide is a tubercle (a dense, hemispherical, cavityless formation of a round shape, dense elastic consistency). The tubercle is formed in the thickness of the dermis, sharply demarcated from apparently healthy skin, and has a size from 1 mm to 1.5 cm. The color of the tubercles is first dark red or yellowish-red, then becomes bluish-red or brownish. The surface of the elements is initially smooth and shiny, later fine-plate peeling appears on it, and in the case of ulceration, a crust appears. There are no subjective sensations. Fresh elements appear around the periphery of the hearth.

The following clinical types of tubercular syphilide are distinguished: grouped, serpiginating (creeping), tubercular syphilide with a platform, dwarf.

Grouped tubercular syphilide is the most common type. The number of tubercles usually does not exceed 30 - 40. The tubercles are at different stages of evolution, some of them have just appeared, others have ulcerated and become crusty, others have already healed, leaving scars or cicatricial atrophy.

Due to the unequal growth of the tubercles and the different depths of their occurrence in the dermis, individual small scars differ in color and relief.

Serpiginating tubercular syphilide. The lesion spreads over the surface of the skin either eccentrically or in one direction when fresh tubercles appear at one pole of the lesion.

In this case, the individual elements merge with each other into a dark red horseshoe-shaped ridge, 2 mm to 1 cm wide, raised above the level of the surrounding skin, along the edge of which fresh tubercles appear.

Tuberous syphilide platform. Individual tubercles are not visible; they merge into plaques 5–10 cm in size, of bizarre shape, sharply demarcated from the unaffected skin and rising above it.

The plaque has a dense consistency, brownish or dark purple color. Regression of tubercular syphilide by a platform occurs either by dry means with the subsequent formation of cicatricial atrophy, or through ulceration with the formation of characteristic scars.

Dwarf tubercular syphilide. Rarely observed. It has a small size of 1 – 2 mm. The tubercles are located on the skin in separate groups and resemble lenticular papules.

Gummy syphilide, or subcutaneous gumma. This is a node that develops in the hypodermis. Typical localization sites for gummas are the legs, head, forearms, and sternum. The following clinical types of gummous syphilide are distinguished: isolated gummas, diffuse gummous infiltrations, fibrous gummas.

Isolated gumma. Appears in the form of a painless node measuring 5–10 mm, spherical in shape, densely elastic consistency, not fused to the skin. Gradually increasing, the subcutaneous gum adheres to the surrounding tissue and skin and protrudes above it in the form of a hemisphere.

The skin over the gumma first becomes pale pink, then brownish-red, purple. Then a fluctuation appears in the center of the gumma, and the gumma opens. When opened, 1–2 drops of sticky, yellow liquid with crumbly inclusions are released from the gummosa node.

Gummous infiltration. They arise independently or as a result of the merger of several gummas. The gummous infiltrate disintegrates, the ulcerations merge, forming an extensive ulcerative surface with irregular large scalloped outlines, healing with a scar.

Fibrous gummas, or periarticular nodules, are formed as a result of fibrous degeneration of syphilitic gummas. Fibrous gummas are localized mainly in the area of ​​the extensor surface of large joints in the form of spherical formations, very dense consistency, ranging in size from 1 to 8 cm. They are painless, mobile, the skin over them is unchanged or slightly pinkish.

Late neurosyphilis. It is a predominantly ectodermal process involving the neural parenchyma of the brain and spinal cord. It usually develops 5 years or more from the moment of infection. In late forms of neurosyphilis, degenerative-dystrophic processes predominate. The actual late forms of neurosyphilis include: tabes dorsalis - the process of destruction of nervous tissue and replacement of its connective tissue, localized in the dorsal roots, dorsal columns and membranes of the spinal cord; progressive paralysis - degenerative-dystrophic changes in the cerebral cortex in the area of ​​the frontal lobes; Taboparalysis is a combination of symptoms of tabes dorsalis and progressive paralysis. In the tertiary period, lesions of the meninges and blood vessels may still be observed.

Late visceral syphilis. In the tertiary period of syphilis, limited gummas or diffuse gummous infiltrations may occur in any internal organ, as well as various degenerative processes may be observed. The morphological basis of lesions in late visceral syphilis is infectious granuloma.

Damage to the musculoskeletal system. In the tertiary period, the musculoskeletal system may be involved in the process.

The main forms of bone damage in syphilis.

1. Gummous osteoperiostitis (damage to spongy bone):

1) limited;

2) diffuse.

2. Gummy osteomyelitis (damage to spongy bone and bone marrow):

1) limited;

2) diffuse.

3. Non-gummous osteoperiostitis.

Most often the tibia bones are affected, less often - the bones of the forearm, collarbone, sternum, skull bones, and vertebrae. Damage to muscles in the form of gummous myositis and joints in the form of acute or chronic synovitis or osteoarthritis are rare in the tertiary period.

Latent syphilis is diagnosed on the basis of positive results of serological reactions in the absence of active manifestations of the disease on the skin and mucous membranes, signs of specific damage to the nervous system, internal organs, and musculoskeletal system.

Latent syphilis is divided into early (with a disease duration of up to 1 year), late (more than 1 year) and unspecified or unknown (it is not possible to determine the timing of infection). This time division is determined by the degree of epidemiological danger of patients.

Congenital syphilis occurs as a result of infection of the fetus during pregnancy through the transplacental route from a mother with syphilis. A pregnant woman with syphilis can transmit Treponema pallidum through the placenta, starting from the 10th week of pregnancy, but usually intrauterine infection of the fetus occurs in the 4th - 5th month of pregnancy.

Congenital syphilis is most often observed in children born to sick women who were not treated or received inadequate treatment. The likelihood of congenital syphilis depends on the duration of the infection in the pregnant woman: the fresher and more active the mother’s syphilis, the more likely the unfavorable end of pregnancy for the unborn child. The fate of a fetus infected with syphilis can be different. Pregnancy can end in stillbirth or the birth of a live child with manifestations of the disease occurring immediately after birth or somewhat later. It is possible to give birth to children without clinical symptoms, but with positive serological reactions, who subsequently develop late manifestations of congenital syphilis. Mothers who have had syphilis for more than 2 years can give birth to a healthy baby.

Syphilis of the placenta

With syphilis, the placenta is hypertrophied, the ratio of its weight to the weight of the fetus is 1: 4 - 1: 3 (normally 1: 6 - 1: 5), the consistency is dense, the surface is lumpy, the tissue is fragile, flabby, easily torn, the color is mottled. It is difficult to find treponema in placental tissue, so to detect the pathogen, material is taken from the umbilical cord, where treponema is always found in large quantities.

Fetal syphilis

The changes that have occurred in the placenta make it functionally defective, unable to ensure normal growth, nutrition and metabolism of the fetus, resulting in its intrauterine death in the 6th – 7th month of pregnancy. The dead fruit is expelled on the 3rd - 4th day, usually in a macerated state. A macerated fetus, compared to a normally developing fetus of the same age, is significantly smaller in size and weight. The skin of stillborns is bright red, folded, the epidermis is loosened and easily slides off in large layers.

Due to the massive penetration of Treponema pallidum, all internal organs and the skeletal system of the fetus are affected. A huge number of treponemas are found in the liver, spleen, pancreas, and adrenal glands.

Early congenital syphilis

If a fetus affected by a syphilitic infection does not die in utero, then the newborn may develop the next stage of congenital syphilis - early congenital syphilis. Its manifestations are detected either immediately after birth or during the first 3 to 4 months of life. In most cases, newborns with severe manifestations of early congenital syphilis are not viable and die in the first hours or days after birth due to functional inferiority of internal organs and general exhaustion.

Clinical signs of early congenital syphilis are detected from the skin, mucous membranes, internal organs, musculoskeletal system, nervous system and generally correspond to the period of acquired syphilis.

The appearance of a newborn with early congenital syphilis is almost pathognomonic. The child is poorly developed, has low body weight, the skin is flabby and folded due to the lack of subcutaneous tissue. The baby's face is wrinkled (senile), the skin has a pale sallow or yellowish color, especially on the cheeks. Due to hydrocephalus and due to premature ossification of the skull bones, the size of the head is sharply increased, the fontanelle is tense, and the cutaneous veins of the head are dilated. The child's behavior is restless, he often screams, and develops poorly.

Lesions of the skin and mucous membranes can be represented by all types of secondary syphilides and special symptoms characteristic only of early congenital syphilis: syphilistic pemphigoid, diffuse skin infiltrates, syphilitic rhinitis.

Massive bone deposits on the anterior surface of the tibia as a result of repeatedly recurrent osteoperiostitis ending in ossification leads to the formation of a crescent-shaped protrusion and the formation of false saber-shaped tibias. Periostitis and osteoperiostitis of the skull bones can lead to various changes in its shape. The most typical are the buttock-shaped skull and the Olympic forehead.

Patients with early congenital syphilis may experience various forms of damage to the nervous system: hydrocephalus, specific meningitis, specific meningoencephalitis, cerebral meningovascular syphilis.

The most typical form of damage to the organ of vision is damage to the retina and choroid - specific chorioretinitis. During ophthalmoscopy, small light or yellowish spots, alternating with pinpoint pigment inclusions, are found mainly along the periphery of the fundus. The child's visual acuity does not suffer.

Late congenital syphilis

This form occurs in patients who previously had signs of early congenital syphilis, or in children with a long asymptomatic course of congenital syphilis. Late congenital syphilis includes symptoms that appear 2 years or more after birth. Most often they develop between 7 and 14 years; after 30 years they rarely occur.

The clinical picture of active late congenital syphilis is generally similar to tertiary acquired: tubercular and gummous syphilis, damage to the nervous system, internal organs, and musculoskeletal system can be observed, as in tertiary syphilis. But along with this, with late congenital syphilis, there are special clinical signs that are divided into reliable, probable and dystrophies.

Reliable signs of late congenital syphilis, resulting from the direct impact of treponemes on the child’s organs and tissues, include parenchymal keratitis, specific labyrinthitis and Hutchinson’s teeth.

Possible signs of late congenital syphilis include radial perioral striae of Robinson - Fournier, true saber shins, saddle nose, buttock-shaped skull, syphilitic gonitis. Probable signs are taken into account in combination with reliable ones or in combination with data from a serological examination and anamnesis.

Dystrophies (stigmas) arise as a result of the indirect effect of infection on the child’s organs and tissues and are manifested by their abnormal development. They acquire diagnostic significance only when the patient simultaneously exhibits reliable signs of late congenital syphilis and positive serological reactions. The most characteristic dystrophies are the following: the Ausitidian sign - thickening of the thoracic end of the clavicle, usually the right one; axiphoidia (Keir's symptom) – absence of the xiphoid process of the sternum; Olympic forehead with very prominent frontal ridges; high (Gothic) hard palate; Dubois-Hissar symptom, or infantile little finger, is shortening and curvature of the little finger inward due to hypoplasia of the fifth metacarpal bone; hypertrichosis of the forehead and temples.

Main diagnostic criteria:

1) clinical examination of the patient;

2) detection of treponema pallidum in the serous discharge of weeping syphilides of the skin and mucous membranes by examining the native preparation, a crushed drop, using dark-field microscopy;

3) results of serological tests;

4) confrontation data (examination of sexual partners);

5) results of trial treatment. This diagnostic method is rarely used, only in late forms of syphilis, when other methods of confirming the diagnosis are impossible. In early forms of syphilis, trial treatment is unacceptable.

Early forms of syphilis are completely curable if the patient receives therapy that is adequate to the stage and clinical form of the disease. When treating late forms of the disease, in most cases clinical recovery or stabilization of the process is observed.

Specific treatment can be prescribed to a patient only if the diagnosis of syphilis is clinically justified and confirmed in accordance with the criteria listed above. There are the following exceptions to this general rule:

1) preventive treatment, which is carried out in order to prevent the development of the disease to persons who have had sexual or close household contact with patients with early forms of syphilis, if no more than 2 months have passed since the contact;

2) preventive treatment prescribed to pregnant women who are sick or have had syphilis, but have not been deregistered, in order to prevent congenital syphilis in a child, as well as children born to mothers who did not receive preventive treatment during pregnancy;

3) trial treatment. It can be prescribed for the purpose of additional diagnostics if late specific damage to internal organs, the nervous system, sensory organs, or the musculoskeletal system is suspected in cases where it is not possible to confirm the diagnosis with laboratory tests, and the clinical picture does not exclude the possibility of a syphilitic infection.

Antibiotics of the penicillin group currently remain the drugs of choice for the treatment of syphilis:

1) durant (long-lasting) penicillin preparations – the group name of benzathine benzylpenicillin (retarpen, extencillin, bicillin-1), ensuring that the antibiotic stays in the body for up to 18 – 23 days;

2) drugs of medium duration (procaine-benzylpenicillin, novocaine salt of benzylpenicillin), ensuring that the antibiotic remains in the body for up to 2 days;

3) preparations of water-soluble penicillin (benzylpenicillin sodium salt), ensuring that the antibiotic remains in the body for 3–6 hours;

4) combination preparations of penicillin (bicillin-3, bicillin-5), ensuring that the antibiotic remains in the body for 3–6 days.

The most effective are water-soluble penicillin preparations, which are treated in a hospital in the form of round-the-clock intramuscular injections or intravenous drips. The volume and duration of therapy depend on the duration of the syphilitic infection. The therapeutic concentration of penicillin in the blood is 0.03 U/ml or higher.

In case of intolerance to drugs of the penicillin group, patients with syphilis are treated with reserve antibiotics that have a wide spectrum of action - semisynthetic penicillins (ampicillin, oxacillin), doxycycline, tetracycline, ceftriaxone (rocephin), erythromycin.

Specific treatment for syphilis should be complete and vigorous. Medicines must be prescribed in strict accordance with the approved instructions for the treatment and prevention of syphilis - in sufficient single and course doses, observing the frequency of administration and course duration.

At the end of treatment, all patients are subject to clinical and serological monitoring. During observation, patients undergo a thorough clinical examination and serological examination every 3 to 6 months.

Name:

Treponema pallidum(Treponema pallidium) belongs to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically, treponema pallidum (pale spirochete) differs from saprophytic spirochetes.

The most common route of infection with syphilis is sexual, through various forms of sexual contact.

Syphilis infection occurs through minor genital or extragenital skin lesions, or through the epithelium of the mucous membrane upon contact with chancre, erosive papules on the skin and mucous membranes of the genital organs, oral cavity, condylomas lata containing a significant number of pale treponema.

Treponema pallidum can be found in saliva only when there are rashes on the oral mucosa.

Syphilis can be infected through the semen of a sick person if there are no visible changes on his genitals.

Rarely, infection with syphilis can occur through close household contact, and in exceptional cases - through household items. It is possible to become infected with syphilis through the milk of a nursing woman with syphilis. There have been no cases of syphilis infection through urine or sweat. Syphilis (the word “syphilis” is falsely used) from the moment of infection is a common infectious disease that lasts in untreated patients for many years and is characterized by an undulating course with alternating periods of exacerbation.

During an exacerbation of the disease, active manifestations of syphilis are observed on the mucous membranes, skin, and internal organs.

One of the main reasons for changes in the clinical picture, the duration of the incubation period, and the latent course of syphilis is the frequent use of antibiotics, changes in the body’s immune status and other factors. The classic course of syphilis is characterized by alternating active manifestations of the disease with a latent period. The classification of the course of syphilis is divided into incubation period, primary, secondary and tertiary periods.

Primary syphilis(syphilis I primaria) – stage of syphilis with the appearance of chancre and enlarged lymph nodes.

• Seronegative primary syphilis(syphilis I seronegativa) – syphilis with negative serological reactions during the course of therapy.
• Primary seropositive(syphilis I seropositiva) – syphilis with positive serological reactions.
• Primary latent syphilis(syphilis I latens) - syphilis with no clinical manifestations in patients who began treatment in the primary period of the disease and did not complete it.

Secondary syphilis(syphilis II secundaria) - stage of syphilis caused by hematogenous spread of pathogens (treponema) from the primary focus, manifested by polymorphic rashes (roseola, papules, pustules) on the skin and mucous membranes.

• Fresh secondary syphilis(syphilis II recens) – a period of syphilis with multiple polymorphic rashes on the skin and mucous membranes; Residual signs of chancroid are not often observed.
• Secondary recurrent syphilis(syphilis II recidiva) - a period of secondary syphilis, which is manifested by a few polymorphic grouped rashes and, sometimes, damage to the nervous system.
• Secondary latent syphilis(syphilis II latens) – the secondary period of syphilis, which occurs latently.

Tertiary syphilis(syphilis III tertiaria) – the stage following secondary syphilis with destructive lesions of internal organs and the nervous system with the appearance of syphilitic gummas in them.

• Active tertiary syphilis manifested by the active process of formation of tubercles, which resolve with the formation of ulcers, scars, and the appearance of pigmentation.
• Latent tertiary syphilis– syphilis in persons who have suffered active manifestations of tertiary syphilis.

Hidden syphilis(syphilis latens) - syphilis, in which serological reactions are positive, but there are no signs of damage to the skin, mucous membranes and internal organs.

• Early latent syphilis(syphilis latens praecox) – latent syphilis, less than 2 years have passed since infection.
• Late latent syphilis(syphilis latens tarda) – latent syphilis, more than 2 years have passed since infection.
• Unspecified latent syphilis(syphilis ignorata) is a disease of unknown duration.

Household syphilis– syphilis, infection of which occurs through household means.

Congenital syphilis– syphilis, in which infection occurred from a sick mother during fetal development.

Syphilis transfusion– when transfusion of donor blood from someone with syphilis, the recipient develops transfusion syphilis. Infection of medical personnel is possible when examining patients with syphilis, during surgery, during medical procedures, and during autopsies of corpses (especially newborns with early congenital syphilis).

Syphilis decapitated- infection occurs when treponema enters directly into the blood (through a wound, during a blood test). Characterized by the absence of chancre.

Syphilis of the nervous system– neurosyphilis (neurosyphilis): early (neurosyphilis praecox) – disease duration up to 5 years, late (neurosyphilis tarda) – more than 5 years.

The following are distinguished: forms of early neurosyphilis:

• hidden latent syphilitic meningitis;
• acute generalized syphilitic meningitis;
• syphilitic hydrocephalus;
• early meningovascular syphilis;
• syphilitic meningomyelitis.

Forms of late neurosyphilis:

• late latent syphilitic meningitis;
• late diffuse meningovascular syphilis;
• syphilis of cerebral vessels (vascular syphilis);
• gumma brain;
• progressive paralysis.

Syphilis visceral(syphilis visceralis) - syphilis, which affects internal organs (heart, brain, spinal cord, lungs, liver, stomach, kidneys).

Syphilis malignant– severe syphilis with massive damage to internal organs and the nervous system, characteristic of tertiary syphilis.

In the primary period, the first clinical sign of syphilis appears - chancre(in the place where Treponema pallidum entered the body). A hard chancre is a red spot that turns into a papule, then into an erosion or ulcer that occurs at the site of penetration of treponema pallidum into the body. Hard chancre is most often localized on the genitals (in women, often on the cervix), which indicates sexual infection; Extragenital chancres are observed much less frequently, which can be located on any part of the skin or mucous membranes: lips, tonsils, on the skin of the pubis, thighs, scrotum, abdomen. After 1–2 weeks, after the appearance of hard chancre, the lymph nodes closest to it begin to enlarge.

The disappearance of chancre indicates that syphilis has entered a latent stage, during which Treponema pallidum multiplies rapidly in the body. The secondary period of syphilis traditionally begins 5–9 weeks after the appearance of chancre (primary syphiloma) and continues without treatment for 3–5 years.

The course of secondary syphilis is wavy: the period of active manifestations is replaced by a latent form of syphilis.

The latent period is characterized by the absence of clinical signs of syphilis and only positive serological blood reactions indicate the course of the infectious process.

Clinical signs of tertiary syphilis may appear many years later as a result of a long asymptomatic course of the disease from the moment of infection with syphilis. The main reason influencing the formation of tertiary syphilis is the absence or inadequate treatment of patients with earlier forms of syphilis.

Tests for syphilis consist of clinical and laboratory data:

• study for Treponema pallidum;
• blood test for RV (Wassermann reaction);
• RIF (immune fluorescence reaction);
• RIBT (treponema pallidum immobilization reaction).

Diagnosis of syphilis the primary period is carried out by examining the discharged chancre, punctate regional lymph nodes.

In the diagnosis of syphilis of the secondary period, material from papular, pustular elements, erosive and hypertrophic papules of the skin and mucous membranes is used.

Tests for syphilis using the bacterioscopic method (microscopic) are carried out by detecting Treponema pallidum in a dark-field microscope.

Treponemal methods for diagnosing syphilis include:

• Wasserman reaction (RW);
• immunofluorescence reaction (RIF).
• RW (Wassermann reaction) is of great importance for confirming the diagnosis of syphilis in the presence of active manifestations of the disease, identifying latent (latent) syphilis, and the effectiveness of the treatment of syphilis. RW is also important for the prevention of congenital syphilis.

The Wasserman reaction is positive in 100% of patients with secondary syphilis, with early congenital syphilis, and in 70–80% of patients with tertiary syphilis.

The treponemal method of testing for syphilis is also the immunofluorescence reaction (RIF). RIF is the most highly sensitive method for diagnosing syphilis and becomes positive even with primary seronegative syphilis.

RIF is positive in secondary syphilis, congenital syphilis in 100%, in tertiary syphilis - in 95-100%, in late forms of syphilis (internal organs, syphilis of the nervous system) - in 97-100%.

Treatment of syphilis is built according to the relevant standards established in the world and is carried out only after the diagnosis has been established and confirmed by laboratory research methods.

Treatment of syphilis requires the venereologist to take into account various factors, various indicators, and complicating aspects. This largely determines the subsequent choice of treatment method for syphilis.

In the treatment of syphilis, specific antibacterial products of several groups and generations are used and they are the basis of therapy. When treating syphilis, the patient must also strictly adhere to the recommended regimen (sufficient sleep, balanced diet, vitamins, prohibition of alcohol), the duration of the intervals between courses of treatment, which significantly increases the effectiveness of treatment of syphilis. In addition to the therapy performed, the condition of the patient’s body and its reactivity are essential for the successful treatment of syphilis, therefore, during the treatment process it will be necessary to increase resistance to infection. For this purpose, products are prescribed that stimulate the body's defense reactions.

The venereologist determines in each case, depending on the stage of syphilis, complications, concomitant diseases from other organs and systems, allergic background, body weight, percentage of absorption and bioavailability of the drug, the required doses of medications, additional use of immunomodulators, enzyme, vitamin products, physiotherapy.

After completing treatment for syphilis, repeated clinical and serological blood monitoring is required over several months or years (depending on the stage of syphilis).

If, after treatment for syphilis for a year, the blood does not become negative, a state of seroresistance is determined and additional treatment for syphilis is prescribed.