Syphilis is a venereal disease that has a long undulating course and affects all organs. The clinic of the disease begins with the occurrence of a hard chancre (primary syphiloma) at the site of infection, an increase in regional, and then distant lymph nodes. Characterized by the appearance on the skin and mucous syphilitic rashes, which are painless, do not itch, proceed without fever. In the future, all internal organs and systems can be affected, which leads to their irreversible changes and even death. Syphilis is treated by a venereologist; it is based on systemic and rational antibiotic therapy.
Syphilis (Lues) is an infectious disease with a long, undulating course. In terms of the volume of damage to the body, syphilis belongs to systemic diseases, and according to the main route of transmission, to sexually transmitted diseases. Syphilis affects the entire body: skin and mucous membranes, cardiovascular, central nervous, digestive, musculoskeletal systems.
Untreated or poorly treated syphilis can last for years, alternating periods of exacerbation and latent (latent) course. 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.
Syphilis ranks first among all infectious diseases (including STIs) in terms of morbidity, 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 a pale spirochete microorganism (treponema – Treponema pallidum). The pale spirochete has the appearance of a curved spiral, is able to move in different ways (translational, rotational, flexion and wave-like), multiplies by transverse division, is stained with aniline dyes in a pale pink color.
Pale spirochete (treponema) finds optimal conditions in the human body in the lymphatic tracts and lymph nodes, where it actively multiplies; in the blood, it appears in high concentration at the stage of secondary syphilis. The microbe persists for a long time in a warm and humid environment (optimal t = 37 ° C, in wet linen for up to several days), and is resistant to low temperatures (in the tissues of corpses it is 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 at any time of the disease, especially during periods of primary and secondary syphilis, accompanied by manifestations on the skin and mucous membranes. Syphilis is transmitted when a healthy person comes into contact with a sick person through secretions (semen during intercourse, milk – in nursing women, saliva during kissing) and blood (with direct blood transfusion, during operations – at the medical staff, using a common straight razor, a common syringe – at addicts).
The main route of transmission of syphilis is sexual (95-98% of cases). Less commonly, there 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.
The course of syphilis is long undulating, 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.
It starts from the moment of infection, lasts an average of 3-4 weeks. Pale spirochetes spread through the lymphatic and blood pathways throughout the body, multiply, but clinical symptoms do not appear. A patient with syphilis is unaware of his illness, although he is already contagious. The incubation period can be shortened (up to several days) and lengthened (up to several months). Elongation occurs when taking medications that somewhat inactivate the causative agents of syphilis.
Lasts 6-8 weeks, is characterized by the appearance of primary syphiloma or hard chancre at the site of penetration of pale spirochetes and subsequent enlargement of nearby lymph nodes.
It can last from 2 to 5 years. Damage to internal organs, tissues and body systems occurs, the appearance of generalized rashes on the mucous membranes and skin, baldness. This stage of syphilis proceeds in waves, periods of active manifestations are replaced by periods of absence of symptoms. Distinguish between 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, it is determined only by laboratory tests (positive serological reactions).
It is now rare, occurs in the absence of treatment years after the defeat. It is characterized by irreversible disorders of internal organs and systems, especially the central nervous system. It is the most difficult period of syphilis, leading to disability and death. It is detected by the appearance of tubercles and nodes (gum) on the skin and mucous membrane, which, decaying, 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).
Primary syphilis begins from the moment when a primary syphiloma appears at the site of the introduction of pale spirochetes – a hard chancre. A hard chancre is a single, rounded erosion or ulcer with clear, even edges and a shiny cyanotic-red bottom, painless and non-inflamed. The chancre does not increase in size, has a scanty serous content or is covered with a film, a crust, a dense painless infiltrate is felt at its base. Chancre is not amenable to local antiseptic therapy.
The 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 chancre is about 1 cm in size, but it can be dwarf – with a poppy seed and giant (d = 4-5 cm). Shankras 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 resembles a sore throat, in which the temperature does not rise, and the throat almost does not hurt. The painlessness of the chancre allows patients to ignore it, and do not attach any importance. Soreness is characterized by a slit-like chancre in the fold of the anus, and a chancre – panaritium on the nail phalanx of the fingers.balanitis , gangrene, phimosis ) as a result of the addition of a secondary infection. Uncomplicated chancre, depending on its size, heals in 1.5 – 2 months, sometimes before signs of secondary syphilis appear.
5-7 days after the onset of a hard chancre, an uneven increase and compaction of the lymph nodes nearest to it (usually inguinal) develops. It can be one-sided and two-sided, while the nodes are not inflamed, painless, have an ovoid shape and can reach the size of a hen’s egg. Towards the end of the period of primary syphilis, a specific polyadenitis develops – an increase in most of the 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 focus throughout the body. In some cases, this process proceeds without fever and malaise, and the patient does not notice the transition from the primary stage of syphilis to the secondary stage.
Secondary syphilis begins 2-4 months after infection and can last from 2 to 5 years. It is characterized by generalization of the infection. At this stage, all systems and organs of the patient are affected: joints, bones, nervous system, organs of hematopoiesis, digestion, vision, hearing. The clinical symptom of secondary syphilis is a rash on the skin and mucous membranes, which are widespread (secondary syphilis). The rash can be accompanied by body aches, headaches, fever, and colds.
Rashes appear paroxysmal: after 1.5 – 2 months, they disappear without treatment (secondary latent syphilis), then appear again. The first rash is characterized by an abundance and brightness of color (secondary fresh syphilis), subsequent repeated rashes are paler, less abundant, but larger in size and tend to merge (secondary recurrent syphilis). The frequency of relapses and the duration of the latent periods of secondary syphilis are different and depend on the immunological reactions of the body in response to the reproduction of pale spirochetes.
Syphilides of the secondary period disappear without scars and have a variety of forms – roseola, papules, pustules.
Syphilitic roseola are small rounded 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 off and do not cause itching, turn pale when pressed on and disappear for a short time. Roseolous 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 trunk and limbs, in the face area – most often on the forehead.
The papular rash is a bright pink with a bluish tinge, rounded nodular formations protruding above the surface of the skin. Papules are located on the body, do not cause any subjective sensations. However, when pressing on them with a bulbous probe, acute pain appears. In syphilis, a rash of papules with fatty 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, get wet. Weeping erosive papules are especially contagious, and syphilis at this stage can easily be transmitted not only through sexual intercourse, but also through handshakes, kissing, and the use of common household items. Pustular (pustular) rashes with syphilis are similar to acne or chickenpox, covered with crust or scales. Usually occurs in patients with reduced immunity.
The malignant course of syphilis can develop in debilitated patients, as well as in drug addicts, alcoholics, HIV-infected . Malignant syphilis is characterized by ulceration of papulopustular syphilides, continuous relapses, general disturbance, fever, intoxication, and weight loss.
Patients with secondary syphilis may experience syphilitic (erythematous) tonsillitis (pronounced redness of the tonsils, with whitish spots, not accompanied by malaise and fever), syphilitic seizures in the corners of the lips, syphilis of the oral cavity . There is a general mild malaise, which may resemble the symptoms of a common cold. Generalized lymphadenitis without signs of inflammation and pain is characteristic of secondary syphilis .
During the period of secondary syphilis, there are disorders in skin pigmentation (leukoderma) and hair loss ( alopecia ). Syphilitic leukoderma manifests itself in the loss of pigmentation of various areas of the skin on the neck, chest, abdomen, back, lower back, and in the armpits.
On the neck, more often in women, a “necklace of Venus” may appear, consisting of small (3-10 mm) discolored spots surrounded by darker areas of the skin. It can exist without change for a long time (several months or even years), despite the ongoing anti-syphilitic treatment. The development of leukoderma is associated with a syphilitic lesion of the nervous system; during examination, pathological changes in the cerebrospinal fluid are observed.
Hair loss is not accompanied by itching, peeling, by its nature it happens:
- diffuse – hair loss is typical for normal baldness, occurs on the scalp, in the temporal and parietal regions;
- small focal – a bright symptom of syphilis, hair loss or thinning in small foci located randomly on the head, eyelashes, eyebrows, mustache and beard;
- mixed – there are both diffuse and small focal.
With timely treatment of syphilis, the hairline is completely restored.
When the vocal cords are affected by syphilis, hoarseness of the voice appears.
Cutaneous manifestations of secondary syphilis accompany lesions of the central nervous system, bones and joints, and internal organs.
If a patient with syphilis was not treated or the treatment was inadequate, then a few 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, in severe cases, death is likely. Recently, the incidence of tertiary syphilis has decreased due to treatment with penicillin; severe forms of disability have become rare.
Allocate tertiary active (in the presence of manifestations) and tertiary latent syphilis. The 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.
Bumps and gummas on the mucous membranes of the soft and hard palate, larynx, nose ulcerate, 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, internal organs, cause bleeding, perforation, cicatricial deformities, disrupt their functions, which can lead to death.
All stages of syphilis cause numerous progressive lesions of the internal organs and the nervous system, their most severe form develops in tertiary (late) syphilis:
- neurosyphilis ( meningitis , meningo-vasculitis, syphilitic neuritis , neuralgia, paresis, epileptic seizures , tabes dorsum and progressive paralysis );
- syphilitic osteoperiostitis, osteoarthritis, synovitis ;
- syphilitic myocarditis , aortitis ;
- syphilitic hepatitis ;
- syphilitic gastritis ;
- syphilitic nephritis, nephronecrosis;
- syphilitic eye damage, blindness , etc.
Syphilis is dangerous in its complications. In the stage of tertiary syphilis, the disease is difficult to treat, and the defeat of all body systems leads a person to disability and even death. Intrauterine infection of a child with syphilis from a sick mother leads to a serious condition – congenital syphilis, which is manifested by a triad of symptoms: congenital deafness, parenchymal keratitis , Hutchinson’s teeth.
Diagnosis of syphilis
Diagnostic measures for syphilis include a thorough examination of the patient, taking anamnesis and conducting clinical studies:
- Detection and identification of the causative agent of syphilis by microscopy of serous discharge of 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.
- Serological reactions (nonspecific, specific) are performed with serum, blood plasma and cerebrospinal fluid – the most reliable method for diagnosing syphilis.
Nonspecific serological reactions are: RPR – reaction of rapid plasma reagins and RW – Wasserman reaction (reaction of binding a compliment). Allows to determine antibodies to pale spirochete – reagins. Used for mass examinations (in clinics, hospitals). Sometimes they give a false positive result (positive in the absence of syphilis), therefore, this result is confirmed by conducting specific reactions.
Specific serological reactions include: RIF – the reaction of immunofluorescence, RPHA – the reaction of passive hemagglutination, RIBT – the reaction of immobilization of pale treponemas, RW with treponemal antigen. Used to detect species-specific antibodies. RIF and RPGA are highly sensitive analyzes, which become positive already at the end of the incubation period. They are 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 tests are used to assess the effectiveness of the 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 is started after a reliable diagnosis has been made, which is confirmed by laboratory tests. Treatment of syphilis is selected individually, carried out in a comprehensive manner, recovery should be determined by laboratory. Modern methods of treating syphilis, which venereology owns today , allow us to talk about a favorable prognosis of treatment, provided that the therapy is correct and timely, which corresponds to the stage and clinical manifestations of the disease. But only a venereologist can choose a rational and sufficient therapy in terms of volume and time . Self-medication of syphilis is unacceptable! Untreated syphilis turns into 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. For allergic reactions of the patient to penicillin derivatives, erythromycin, tetracyclines, cephalosporins are recommended as alternatives. In cases of late syphilis, in addition, preparations of iodine, bismuth, immunotherapy, biogenic stimulants, physiotherapy are prescribed.
It is important to establish sexual contact with a patient with syphilis, it is imperative to carry out preventive treatment of possibly infected sexual partners. At the end of treatment, all previously patients with syphilis remain under medical supervision until a complete negative result of a complex of serological reactions.
In order to prevent syphilis, examinations of donors, pregnant women, workers in children’s, food and medical institutions, patients in hospitals are carried out; representatives of risk groups (drug addicts, prostitutes, homeless people). Donated blood must be tested for syphilis and preserve.