Syphilis is a chronic disease and belongs to sexually transmitted diseases. The former name of syphilis is lues (French, Gallic disease).
With syphilis, all organs and systems are affected, from the skin and mucous membranes to the internal organs, joints, bones, the nervous and cardiovascular systems (depending on the stage of the disease).
Despite the successful treatment of sexually transmitted diseases and active education of the population in our time, the incidence of syphilis continues to grow compared to the 20th century. Both men and women and a child can get it. The congenital form of the disease is considered especially dangerous.
Types of syphilis
Among venereologists, the following classification is accepted:
- primary seronegative syphilis;
- primary seropositive syphilis;
- secondary fresh syphilis;
- secondary latent syphilis;
- secondary recurrent syphilis;
- tertiary active syphilis;
- tertiary latent syphilis;
- early congenital syphilis;
- late congenital syphilis;
- latent congenital syphilis;
- visceral syphilis;
- syphilis of the nervous system.
Causes of syphilis
Syphilis is caused by pale treponema, which lives in the external environment for only 3 minutes. Therefore, the main route of transmission of the disease is sexual. Infection of the fetus is possible intrauterinely (vertical pathway) or intrapartum, when the child passes through the birth canal of the mother.
The household route of transmission is infrequent, infection is possible from persons with the tertiary stage of syphilis, when pale treponema gets on dishes, linen, towels and other from decaying gum. The transmission of syphilis by the hematogenous route during blood transfusion is not excluded.
Cases of infection of medical workers by contact with the patient’s blood are not so rare. Infection is possible through “bloody” objects: a common toothbrush, razor, manicure set and more.
Syphilis risk group:
- people with promiscuous sex life;
- drug addicts;
- patients with hemophilia;
- people who prefer group sex;
- asocial elements of society;
- patients with gonorrhea.
The incubation period for syphilis is on average 3-6 weeks. It can be shortened up to 8-15 days (with simultaneous infection from two sources, for example, sexual and domestic) and lengthened to 108-190 days with antibiotic therapy after infection.
The primary signs of the disease appear in the form of the so-called hard chancre, which occurs in the damaged area of the skin or mucous membrane upon contact with the pathogen.
A chancre is a deep, painless (characteristic) ulcer without bloody discharge, bordered by even, slightly raised surfaces. The ulcer has a flat bottom and a regular rounded shape. Its sizes are different, from 1 to 4mm, it is not welded to the surrounding tissues and is dense to the touch.
In women, chancre may be localized:
- on the clitoris;
- along the posterior commissure of the labia;
- between the large and small labia;
- on the walls of the vagina;
- on the crotch;
- near the anus;
- and even on the cervix.
In men, it is formed:
- on the penis, usually on the foreskin or around / inside the urethra;
- in the anal area;
- in the rectum (in homosexuals).
The location of a hard chancre is possible in the mouth area (tongue), on the lips and in the pharynx (with oral-genital contacts).
The atypical course of primary syphilis is also distinguished:
indurative (congestive) edema, occurs on the genitals: the clitoris or scrotum, accompanied by a bluish color, after pressure pits remain;
chancre-panaritium (occurs on the nail phalanges of the hand and looks like an ordinary panaritium, a distinctive feature is soreness);
chancre-amygdalitis (enlargement of the amygdala on one side with characteristic pain when swallowing).
The initial period lasts 6-8 weeks until a rash appears. About a week after the onset of a hard chancre, regional lymph nodes (inguinal or submandibular) increase.
Primary syphilis goes through 2 stages: seropositive and seronegative. Serological reactions (Wasserman reaction, ELISA) are negative in the seronegative period, they become positive 3-4 weeks after the appearance of a hard chancre.
Since the appearance of a characteristic rash on the skin and mucous membranes in the form of pale pink spots (necklace of Venus) or multiple petechiae (hemorrhages), secondary syphilis begins.
The rash is localized mainly on the chest and back, but it can also spread throughout the body. The appearance of a rash is explained by the ingress of the pathogen from the affected regional lymph nodes into the blood vessels and spreading it throughout the body.
The enlargement of the lymph nodes is generalized, they are dense, painless and cold to the touch, not soldered to the surrounding tissues.
At this stage, patients note:
- an increase in temperature to subfebrile numbers (within 37-38 ° C);
- classic symptoms of a cold (cough, runny nose) and / or conjunctivitis.
The rash turns pale and disappears after 1-2 weeks. A latent secondary period begins. With the weakening of the body’s defenses, the rash returns again (recurrent secondary syphilis), and this happens repeatedly, with each subsequent relapse, its elements increase in size and merge.
The hematogenous “journey” of treponema through the body involves internal organs in the pathological process: syphilitic forms of diseases such as meningitis, gastritis, hepatitis, myocarditis and others develop.
This period is characterized by focal or diffuse alopecia (loss of hair on the head, eyelashes, eyebrows).
Secondary syphilis is accompanied by:
- periodic rises in temperature;
- bone pain;
- visual disorders.
Often there is syphilitic angina (sore throat, hoarseness).
Without treatment, secondary syphilis lasts 1-2 years.
In the absence of treatment for secondary syphilis, the disease passes into the tertiary stage, which lasts for years, up to 10-20 years.
At the same time, in the patient’s skin, mucous membranes, internal organs and bones, gum bumps are formed, which eventually disintegrate and disfigure a person (a sunken nose, bumps on the skull, etc.).
The most dangerous manifestation of tertiary syphilis is damage to the spinal cord and brain with the development of dementia, dorsal tabes (staggering gait), syphilitic meningitis.
Pathology concerns all internal organs and systems: syphilitic endarteritis and aortitis develops, optic nerve atrophy with a progressive decrease in vision, syphilitic endocarditis occurs with damage to the heart valves, bones are destroyed, etc.
Serological reactions in the tertiary stage of syphilis are either negative or weakly positive.
This period is considered late late syphilis, and patients become infectious to others only through household items.
Household syphilis is characterized by the fact that the disease is not transmitted sexually, but through household items, during surgical manipulations, during blood transfusion or breastfeeding by a woman, first a sick child, and then a healthy one.
Hard chancre occurs with common syphilis not on the genitals, but in the places of contact of damaged skin and mucous membranes with an infected object (in the mouth, on the face, on the fingers, and so on).
Secondary common syphilis proceeds in the same way as ordinary syphilis.
Latent syphilis should be noted separately. Allocate:
- early latent syphilis (from the period of primary syphilis to recurrence of the rash in the secondary), which lasts about 2 years;
- late latent syphilis (tertiary syphilis with damage to internal organs) with an infection of more than 2 years.
Latent syphilis is either asymptomatic or without pronounced signs: a hard chancre in places inaccessible to the eye or a weakly colored and almost invisible rash. Latent syphilis is revealed only when passing tests during a medical examination.
Testing for syphilis during pregnancy is carried out three times for all women (at the first visit to the antenatal clinic, at 28-30 and 38-40 weeks).
Infection can occur both before and during pregnancy. Regardless of the period and duration of the process, all pregnant women with syphilis are treated.
Therapy does not differ from standard regimens: penicillin antibiotics are prescribed (they are safe during pregnancy). If syphilis is detected in the first 12 weeks, it is not necessary to terminate the pregnancy, especially if it is desired.
Untreated syphilis can lead to the following complications:
- spontaneous abortion in the first trimester;
- premature birth;
- antenatal fetal death;
- death of a newborn in the first days or hours after birth;
- infection of a newborn when passing through the birth canal;
- congenital syphilis.
Congenital syphilis is characterized by the birth of a child with wrinkled yellowish-gray skin with a typical rash (syphilitic pemphigus), with damage to the musculoskeletal system, enlarged liver and spleen, anemia, and various malformations. Later, after reaching 2 or more years of age, other signs develop:
- damage to bones (saber shins);
- problems with teeth (Hutchinson’s teeth);
- impaired vision and hearing;
- mental retardation.
Primary syphilis must be distinguished from cervical erosion (in women), genital herpes, Trichomonas ulceration, soft chancre. Secondary syphilis has similar symptoms with toxicoderma, rash with other infectious diseases (measles, scarlet fever, rubella), genital warts, alopecia, psoriasis and fungal skin lesions. Therefore, differential diagnosis is important.
From laboratory methods, serological tests are used (blood from a vein):
- Wasserman reaction (RW);
- precipitation microreaction;
- reaction of immunofluorescence (RIF);
- the reaction of immobilization of pale treponemas (RIBT);
- enzyme immunoassay (ELISA);
Also, microscopy of smears taken from a hard chancre or from elements of a rash is performed.
To confirm the diagnosis, it is necessary to carry out 2 different serological reactions.
Treatment of syphilis is carried out only in a hospital by a venereologist.
For this purpose, antibiotics are used:
- penicillin series (bicillin, benzylpenicillin procaine):
- erythromycin series (sumamed);
The duration of treatment for primary syphilis is on average 10-15 days, secondary and latent tertiary syphilis – 20-28 days.
Prevention of congenital syphilis (if a woman has been ill and treated in the first trimester of pregnancy) is carried out from 16 weeks. Early congenital syphilis is treated with penicillins for two weeks, late congenital syphilis – within 28 days.
Preventive treatment (to persons who have been in contact with the patient, but not yet infected) are treated with bicillin twice a week.
All patients with syphilis should be aware of the criminal liability in case of intentional infection of a partner, and must also provide all information about the persons with whom they have had sex. In case of refusal of treatment, the patient is forcibly (if necessary with the help of the police) hospitalized in a hospital.
Control tests after therapy of primary, secondary, early latent and congenital syphilis are taken after 1, 3, 6, 12, 24 months. After the treatment of late latent and tertiary syphilis, control is necessary after 12 and 24 months.
The formidable complications of syphilis include lesions of the central nervous system:
Development is also possible:
- IHD (angina pectoris and myocardial infarction);
- syphilitic pneumonia;
- hepatitis, up to hepatic coma and death.
With primary syphilis in men, it is possible that:
- gangrene of the penis.
The prognosis depends on the stage of the process, the effectiveness of treatment and the presence or absence of damage to internal organs, nervous system and bones.
With primary and early secondary syphilis, the prognosis is favorable. The following stages lead to the patient’s disability and the appearance of aesthetic defects in him.
With congenital syphilis, the prognosis is favorable with early adequate treatment.