Case history of secondary syphilis. Case history in dermatovenereology: Secondary recurrent syphilis of the skin and mucous membranes The element of damage in primary syphilis is

Patient's name: ______________

Clinical diagnosis (in Russian and Latin):

Lues secundaria recidiva

Complications ________________________________________

Related:

floor male

age 47 years old

Home address:

Place of work: disabled group 2

Job title _____________________________________________________

Date of admission to the clinic: 12. 04. 2005

Clinical diagnosis (in Russian and Latin):

Secondary recurrent syphilis of the skin and mucous membranes

Lues secundaria recidiva

Accompanying illnesses: Neural amyotrophic Charcot–Marie syndrome in the form of tetraparesis with impaired mobility

complaints on the day of receipt: makes no complaints

on the day of supervision: makes no complaints

HISTORY OF THIS DISEASE

Who referred the patient to: Central District Hospital

Why: detection in blood test on RW 4+

When you felt sick: does not consider himself sick

What is the onset of the disease associated with? _____________________________

_______________________________________________________________

From what area of ​​the skin and mucous membranes did the disease begin? _____________________________

How the disease has developed so far: in mid-January 2005, swelling and thickening appeared in the penis area. He did not seek medical help regarding this. 21. 03. 05. contacted the Pochinkovskaya Central District Hospital regarding the inability to open the head of the penis, where he was operated on

The influence of past and currently existing diseases (neuropsychic injuries, functional state of the gastrointestinal tract, etc.): 03.21.05. - Circumcision

Influence of external factors on the course of this process (dependence on the season, nutrition, weather and meteorological conditions, production factors, etc.): no

Treatment before admission to the clinic: Before admission to the Regional Clinical Hospital, he received Penicillin 1 ml 6 times a day for 4 days

Self-medication (with what): not self-treated

Efficacy and tolerability of medications (which the patient took independently or as prescribed by a doctor for the present disease): no drug intolerance

EPIDEMIOLOGICAL HISTORY

Sexual activity from what age: from 16 years old

Sexual contacts: over the past two years, a regular sexual partner - ___________ - is being treated at the Regional Clinical Hospital for syphilis

Household contacts: does not indicate, lives alone

Donation: denies

LIFE HISTORY OF THE PATIENT

Physical and mental development: He began walking and talking in the second year of life. Did not lag behind peers in development

Education: graduated from 8th grade, vocational school

Past illnesses:“childhood” infections, suffers from ARVI every year

Injuries, operations: appendectomy 1970

Allergic diseases: none

Drug intolerance: doesn't note

Hereditary complications and the presence of a similar disease in relatives: heredity is not burdened

Habitual intoxications: smokes 10 cigarettes a day since age 18. Drinks alcohol in moderation

Working conditions: does not work

Living conditions: lives in a private house without amenities, observes personal hygiene rules

Family history: not married

OBJECTIVE RESEARCH

General state: satisfactory, clear consciousness

Position: active

Body type: normosthenic type

Height: 160 cm

Weight: 60 kg

SKIN

1. SKIN CHANGES

Color: ordinary

Turgor, elasticity: not changed

Characteristics of skin sweating: fine

Characteristics of sebum secretion: fine

Condition of hair and nails: nails are not changed. Alopecia of mixed nature

Condition of subcutaneous fat: subcutaneous fat is moderately developed and evenly distributed

Dermographism: pink, various, persistent

Description of all skin changes not related to the main pathological process (nevi, pigmentation, scars, etc.)

Ministry of Education and Science of Ukraine.

Odessa National University named after. I.I. Mechnekova.

Department of Microbiology.

Abstract on the topic:

"Syphilis"

3rd year student, 5th group

Faculty of Biology

Department of Botany

Andrey Danylyshina.

Teacher:

Ivanitsa V.A.

Odessa.

Introduction…………………………………………………………………………………….….…….3

Pathogen………………………………………………………………………………….……3

Immunity……………………………………………………………………………….……4

Symptoms………………………………………………………………………………5

Primary stage………………………………………………………………………………5

Secondary stage………………………………………………………………………………6

Tertiary stage………………………………………………………………………………9

Laboratory diagnostics……………………………………………………………………………….…11

Diagnosis………………………………………………………………………………11

Research methods……………………………………………………………..…12

Treatment………………………………………………………………………………..…..14

Pregnant women with syphilis…………………………………….……17

Prevention……………………………………………………………………………………….20

Dispensary observation of the ill person………………………………………….21

History…………………………………………………………………………………..22

One of the main horrors of humanity over the centuries, syphilis, called the “white plague,” still remains among us: 50 thousand only registered cases per year, plus quite a lot of unregistered ones. While decreasing in level among homosexuals, it is becoming more widespread among heterosexuals. Before the era of antibiotics, syphilis created the same panic among people that AIDS does today, and many then also claimed that syphilis victims paid for their immoral behavior - another parallel with modern times. So what happened to Caligula? Historians and doctors have at least one common ground - they both love to look for illnesses in famous people. And this is where, in their opinion, syphilis shows its terrible face. Why were Beethoven and Goya deaf? Why did the poet Milton and the composer Bach go blind? Why did the composer Schumann, the Roman Emperor Caligula and King George III of England go mad? Of course, because of syphilis! Here, they declare, it is impossible to make a mistake, because its last stages have many forms. But this is nonsense! Almost until the end of the 19th century, medicine treated complex diseases too primitively. Ancient descriptions of patients with such ailments are very funny (every major library has medical journals of the 18th-19th centuries - read and see), but they are far from the truth.

There are congenital and acquired syphilis.
Definition - an anthroponotic chronic infectious disease that affects all organs and tissues of the human body, lasting in untreated patients for many years. It is characterized by a primary affect, secondary rashes on the skin and mucous membranes with subsequent damage to various organs and systems of the body. The causative agent is a mobile spiral-shaped microorganism Treponema pallidum (pale treponema) from the Spirochaetaceae family of the genus Treponema. Treponema pallidum has a spiral shape, resembling a long thin corkscrew. The length of the spiral cell body ranges from 6 to 20 µm with a diameter of 0.13-0.15 µm. The protoplasmic cylinder is twisted into 8-12 equal curls. Three periplasmic flagella extend from the ends of the cells. Unlike other spirochetes, T. pallidum is characterized by a combination of four main types of movements: translational (forward and backward), rotational (around its own axis), flexion (pendulum-like) and contractile (wavy). It is a facultative anaerobe. In this regard, the conditions of existence in the blood are unfavorable for it, and a high concentration of the pathogen in the blood usually occurs with the most pronounced clinical manifestations (secondary syphilis).

T. pallidum does not accept aniline dyes well due to the small amount of nucleoproteins in the cell. Only with prolonged staining using the Romanovsky-Giemsa method does it acquire a faint pink color. There is no nucleus as such - there is no nuclear membrane, DNA is not divided into chromosomes. Reproduction occurs by transverse division every 30-33 hours. Under the influence of unfavorable factors, in particular medicinal drugs, treponemes can transform into the L-form and also form cysts - spirochetes rolled into a ball, covered with an impenetrable mucin membrane. Cysts can remain in the patient’s body for a long time without showing pathogenicity. Under favorable conditions, spirochete cysts become spiral-shaped, multiply and restore their pathogenicity. Penicillin, used in the treatment of syphilis, acts only on spiral-shaped forms of treponema, so the effectiveness of the drugs is maximum in the first months of the disease. Treponema pallidum is so called because it stains extremely poorly with the dyes traditionally used in the diagnosis of STIs. The method of choice (i.e., the best method) is the study of the native drug in a dark field. At the same time, the flickering, smoothly curving syphilitic treponema is clearly distinguishable. Research to detect treponema pallidum is carried out mainly at the beginning of the disease - material is taken from ulcers, erosions, papules, on the skin and mucous membranes of the genital organs, in the anus and oral cavity, and puncture of the lymph nodes is performed. At a later date, blood serum and cerebrospinal fluid are examined for the presence of specific antibodies (serological diagnostic methods). According to Romanovsky - Giemse is painted pale pink. The three most studied antigens are: cardiolipin, group and specific. It grows on media containing kidney or brain tissue under strictly anaerobic conditions at a temperature of 35°C. Cultivation of treponemes for a long time leads to loss of virulence and changes in other biological properties (biochemical, physiological). To preserve the original properties of treponemes in laboratories, they are passaged on rabbits - in the testicular tissue of animals, where they reproduce well. The spirochete finds optimal conditions for reproduction in the lymphatic tract, constantly present in the lymph nodes. It survives in wet secretions for up to 4 days, in a corpse for up to 2 days, when heated to 60° C it dies within 10-20 minutes, at 100° C it dies instantly. Sensitive to the action of ethyl alcohol, 0.3-0.5% hydrochloric acid solution, 1-2% phenol solution.

The mechanism of transmission of the pathogen is contact; The route of transmission is sexual. Extrasexual infection is observed through the use of household items, medical instruments, etc., contaminated with the patient’s secretions (saliva, semen, blood, vaginal and other secretions). In the second half of pregnancy, vertical transmission of the pathogen (from mother to fetus) is possible.

Experimental infection of laboratory animals (rats, mice, guinea pigs) with treponema creates an asymptomatic infection. Infecting rabbits into the skin or testicle allows them to multiply and accumulate the required amount of treponemes. This model made it possible, in addition to preserving the original biological properties of cultures isolated from sick people, to study their relationship to medications and other issues of infectious pathology. The ability of treponeme to resist the protective reaction of phagocytes and to actively penetrate into tissues under the damaging effects of endotoxin ensures the development of the pathological process. Treponema pallidum can be contained in the blood of people, even those in the incubation period. If for some reason such blood is transfused to a healthy person, then infection will occur and so-called “transfusion” syphilis will occur. Therefore, donor blood must be tested for syphilis and preserved for 4 days, which guarantees the death of bacteria. If by chance, in an emergency, direct transfusion is taken from a patient with syphilis, then the person who received it is given preventive treatment. A 0.5% solution of caustic alkali, as well as acid solutions, have a detrimental effect on Treponema pallidum. Urine with a pronounced acidic reaction, as well as some food products - sour milk, kvass, vinegar and even lemonade can destroy the pathogen. It immediately dies in soap suds, and therefore washing your hands with soap reliably prevents infection.

Immunity

Human susceptibility to syphilis is high. Acquired immunity is characterized by protective cellular reactions that promote the fixation of treponemas and the formation of granulomas, but not the elimination of the pathogen from the body. An infectious allergy also develops, which can be detected by intradermal injection of a killed suspension of tissue treponemes. At the height of the immune response, treponema form cysts, which are usually localized in the wall of blood vessels - the disease goes into remission. A decrease in immunity is accompanied by the return of the pathogen to the vegetative stage, its reproduction, which results in relapses of the disease. Antibodies formed against antigenic complexes of microbial cells do not have protective properties. The ability of some antibodies (reagins) to react with cardiolipin antigen is used in the serodiagnosis of syphilis.

The transferred disease does not leave immunity. After treatment, the disease may recur due to reinfection. The natural susceptibility of people is relatively low: about 30% of people who have had contact with the sick person become ill. HIV infection reduces a person's natural resistance to syphilis.

The territorial spread of the disease is widespread. The incidence prevails in cities, among people of sexually active ages (20-35 years). Men get sick more often than women. Prostitution, homosexuality, casual sex, and poor socio-economic living conditions contribute to the spread of syphilis.

Symptoms: After infection, most often (90-95%) a classic course of infection is observed, less often (5-10%) - a primary latent course (the first clinical manifestations in the form of late forms of infection after years and decades). The possibility of self-healing is allowed. It is assumed that the variants of the infection depend on the form of the pathogen. The undulating course of syphilis with the alternation of active manifestations of the disease with periods of a latent state is a manifestation of changes in the patient’s body’s reactivity to treponema pallidum. In the classical course of syphilis, there are four periods: incubation, primary, secondary, tertiary. The periods differ from each other in the set of syphilides - various morphological elements of the rash that arise in response to the penetration of pale treponema into the skin and mucous membranes. Incubation period, i.e. The period from infection to the appearance of the first clinical signs of the disease averages 3-4 weeks.

Syphilis goes through a number of stages, which manifest themselves almost equally in men and women. At the primary stage, a small lesion is formed, the so-called chancre; it may resemble a pimple or take the form of an open sore. It usually appears 3 weeks after infection, but sometimes occurs after 10 days or 3 months. Chancre is usually painless and can be ignored. Most often, chancre, which in 70% of cases are painless, are located on the genitals and in the anal area, but they can form on the lips, in the mouth, on a finger, on the chest or on any part of the body where the pathogen has penetrated the skin, sometimes it can be multiple, but may go unnoticed. At the same time, regional lymph nodes enlarge. They are dense, mobile, painless, and do not suppurate. At first, the chancre looks like a dim red spot, which then turns into a papule (nodule). The papule ulcerates, forming a round or oval ulcer, usually surrounded by a red border. An ulcer, painless, with a clean bottom, compacted and raised edges - chancre. The size of the chancre varies, averaging 10-15 mm. Chancre discharge is very contagious. After 4-6 weeks without specific therapy, the chancre usually heals, creating the false impression that “everything worked out”, leaving behind a thin atrophic scar.

Complications of chancroid are balanitis and balanoposthitis, caused by the addition of a bacterial or trichomonas infection with the development of acute inflammatory phenomena around syphiloma, which in turn can result in the development of phimosis and paraphimosis with enlargement and soreness of regional lymph nodes. Less commonly observed are gangrenization, an ulcerative-necrotic process in the area of ​​chancre, and phagedenism, a progressive ulcerative-necrotic process that develops in the tissues surrounding primary syphiloma and is accompanied by bleeding. Like gangrenization, it is observed in weakened individuals - chronic alcoholics, HIV-infected people, etc. Regional lymphadenitis (regional scleradenitis) is the second mandatory clinical symptom of primary syphilis. It is expressed in a peculiar increase and compaction of the lymph nodes closest to the chancre. In rare cases, it may be mild or absent. When chancre is localized on the genitals, inguinal lymphadenitis occurs: the lymph nodes are enlarged, dense, not fused to each other and the surrounding tissues, mobile, have an ovoid shape, are painless, and spring upon palpation. The skin over them is not changed. Characteristic is an enlargement of the lymph nodes (“pleiades”), one of which is the largest. Lymphadenitis can be bilateral or unilateral. It never festeres or breaks open. Specific regional lymphangitis is the third, less permanent sign of primary syphilis. The lymphatic vessel is affected from the chancre to the nearby lymph nodes. Its strand in the form of a densely elastic painless cord, sometimes with thickenings along its course, is usually palpable on the dorsal surface of the penis. From about the 3-4th week of the existence of chancroid, specific polyadenitis occurs - an important concomitant symptom of massive hematogenous dissemination of Treponema pallidum. At the end of the primary period, approximately 5% of patients develop general symptoms (headaches, night pain in the bones and joints, insomnia, irritability, general weakness, increased body temperature, sometimes up to 39-40 ° C), as well as changes in the blood with mild hypochromic anemia, leukocytosis , increased ESR (up to 30-60 mm/h). In other cases, syphilitic septicemia occurs without fever and general symptoms, and the transition from the primary stage of syphilis to the secondary occurs unnoticed by the patient.

There may be deviations from the typical course of syphilis. In particular, when the pathogen gets into the blood (for example, with a deep cut, blood transfusion), the disease begins with secondary rashes. This is the so-called headless syphilis, syphilis without chancre, transfusion syphilis. Some patients with late forms (with a disease duration of more than 2 years) exclusively affect internal organs or the nervous system (neurosyphilis).

The secondary stage usually begins 6–10 weeks after infection. The period of secondary syphilis lasts 2-4 years, characterized by remissions and relapses. Clinically, it can manifest as flu-like conditions (flu-like syndrome) with a slight increase in body temperature, headaches, fatigue, anorexia, weight loss, myalgia, sore throat, arthralgia and generalized lymphadenitis. Symptoms: pale red or pinkish rashes (often on the palms and soles), sore throat, headache, joint pain, poor appetite, weight loss and hair loss. Condylomas lata (condyloma lata), which are very contagious, may appear around the genitals and in the anal area. Due to such a variety of symptoms, syphilis is sometimes called the “great mimic.” Symptoms of the secondary period of syphilis usually persist for 3-6 months, but they may periodically disappear and reappear. After the disappearance of all symptoms, the disease enters the latent stage, when the patient is no longer contagious, but the pathogen invades various tissues: the brain and spinal cord, blood vessels, bone tissue. In 50-70% of patients with untreated syphilis, this period continues until the end of their lives, but in the rest, the disease passes into the tertiary, or late, period of syphilis.

By this time, the chancre disappears, even without treatment, and the treponema penetrates the blood and spreads throughout the body. A rash appears all over the body or just on the arms or legs. Sometimes small sores appear in the mouth or around the vulva (external female genitalia). Like primary chancroid, secondary sores and rashes are highly contagious. Like the manifestations of the primary stage, these symptoms eventually disappear. Skin changes are expressed by an erythematous macular rash that appears first on the trunk and upper extremities. The rash progresses, becomes generalized, is not accompanied by itching, acquires a copper coloring, and is especially noticeable on the palms and soles. Initially, the rashes may acquire a maculopapular character (macular and papular syphilides), affect the hair follicles and cause local hair loss. The formation of pustules (pustular syphilide) may also occur. Changes may occur on the mucous membranes (mucosal plaques), forming oval, slightly raised erosions, covered with a gray coating and surrounded by a zone of redness. Skin changes in secondary syphilis always pose a great infectious danger. Papular syphilides are also the main manifestations of secondary syphilis. These are bandless formations, sharply demarcated from the surrounding healthy skin, protruding above its level and containing a large number of pale treponemas. In most cases, they are located on the torso. In general, syphilitic papules are not accompanied by subjective sensations, but pressing on them with a button probe causes acute pain - Jadassohn's symptom. The appearance of syphilitic papules depends on their localization, the duration of the infection and the characteristics of the patient’s skin. There are several forms of papular syphilides. Lenticular (lenticular) syphilis is most often observed with secondary fresh syphilis, and is represented by clearly demarcated flat round papules the size of lentils, bluish-red in color, densely elastic consistency, with a smooth shiny surface. Gradually, the papules acquire a yellowish-brown tint, become flattened, and scanty collar-like peeling appears on their surface. Miliary syphilide is distinguished by its small size (about the size of a poppy seed) and the semi-conical shape of the papules; nummular (coin-shaped) - characterized by a significant size of papules (the size of a large coin or more), a tendency to cluster; ring-shaped, the elements of which are often located on the face and neck; seborrheic, in which papules are localized on the face, along the edge of the forehead (“crown of Venus”) and are distinguished by fatty scales on the surface; erosive (weeping), in which papules are distinguished by a whitish macerated, eroded or weeping surface, which is due to localization on the mucous membrane and in the corners of the mouth and folds of the skin, is one of the most contagious manifestations of syphilis. Condylomas lata (vegetative papules) are located in places of friction, physiological irritation (genital organs, anus, less commonly - axillary, inguinal folds and navel). They are distinguished by their large size, vegetation (growing upward) and eroded surface. Horny papules (syphilitic calluses) are distinguished by the powerful development of the stratum corneum on the surface, very similar to calluses; psoriasiform papules are characterized by pronounced peeling on the surface. Papular rashes, which often appear on the mucous membranes, especially the mouth, clinically correspond to erosive (weeping) papules. In the oral cavity, erosive papular syphilide most often occupies the area of ​​the soft palate and tonsils (syphilitic papular tonsillitis). Papular rashes on the mucous membrane of the larynx lead to hoarseness.

Pustular syphilides are a rare manifestation of secondary syphilis. They begin with a pustule and quickly evolve to form a crust or scale and usually occur in people with reduced body resistance, suffering from tuberculosis, alcoholism, malaria, etc. Sometimes accompanied by an increase in temperature and a decrease in body weight.

Depending on the location, size and degree of decay of the elements, five types of pustular syphilide are distinguished. Acne - small conical pustules on a dense papular base, quickly dry into crusts and slowly dissolve. Impetiginous - superficial pustules that form in the center of the papules and quickly dry into a crust. Smallpox-shaped - characterized by spherical pustules the size of a pea, the center of which quickly dries into a crust, located on a dense base. Syphilitic ecthyma - late syphilide (six months or later from the onset of the disease): deep round a pustule the size of a large coin, quickly dries into a thick crust encrusted into the skin, upon rejection of which an ulcer appears with sharply cut edges and a peripheral ridge of a specific infiltrate of a purple-bluish color; Ecthymas are usually single and leave a scar. Syphilitic rupee is an ecthyma-like element under a layered conical (oyster) crust due to the growth and repeated decay of a specific infiltrate. Usually single, heal with a scar.

Acne-like, impetiginous and smallpox-like syphilides are observed, as a rule, with secondary fresh syphilis, and deep varieties (ecthyma and rupiah) - with recurrent syphilis. The combination of pustular, ulcerative and pustular rashes is a manifestation of the so-called malignant syphilis, which occurs in immunosuppressed patients (including HIV-infected patients, alcoholics, etc.), in which the rashes are located mainly in the head and neck area, and may also be accompanied by damage to the oral mucosa . When localized on the tonsils and soft palate, the process has the appearance of pustular-ulcerative tonsillitis. Patients with malignant syphilis experience fever, chills, and weight loss, but no lymphadenopathy. Seroreactions to syphilis become positive at a later date. In the absence of appropriate therapy, death is possible.

Syphilitic baldness is usually observed with secondary recurrent syphilis and manifests itself in three varieties. With diffuse baldness, any part of the skin can become bald, but the scalp, including the temporal and parietal areas, is most often affected. Fine-focal baldness is manifested by multiple small patches of baldness with irregular round outlines, randomly scattered over the head (especially in the area of ​​the temples, back of the head, and beard), and resembles moth-eaten fur. This form is characterized not by complete loss, but by partial thinning of hair; Sometimes fine focal baldness affects the outer third of the eyebrows and eyelashes, which are of unequal length - “stepped” eyelashes, Pincus symptom. With mixed baldness, there are signs of both types. Syphilitic baldness lasts for several months, after which the hairline is completely restored. Syphilitic leukoderma (syphilide pigmentum) is pathognomonic for secondary (usually recurrent) syphilis, is more common in women, is localized mainly on the lateral and posterior surfaces of the neck (“necklace of Venus”) and is characterized by hypopigmented round spots the size of a fingernail. A distinction is made between spotted and lacy syphilitic leucoderma, when there are a lot of spots and they almost merge with each other, leaving only small stripes of the hyperpigmented background. Leucoderma exists for a long time (sometimes many months and even years), its development is associated with damage to the nervous system. In the presence of leukoderma, patients usually experience pathological changes in the cerebrospinal fluid. Secondary syphilis is also accompanied by damage to many organs and systems. These are meningitis, hepatitis, glomerulonephritis, bursitis and (or) periostitis, etc. It is natural that laboratory parameters are abnormal, reflecting these lesions. The same patient may have spots, nodules, and pustules. The rash lasts from several days to several weeks, and then disappears without treatment, only to be replaced by new ones after a more or less long period of time, opening the period of secondary recurrent syphilis. New rashes, as a rule, do not cover the entire skin, but are located in separate areas; they are larger, paler (sometimes barely noticeable) and tend to group together to form rings, arcs and other shapes. The rash may still be macular, nodular, or pustular, but with each new appearance the number of rashes becomes smaller and the size of each of them larger. For the secondary relapse period, nodules on the external genitalia, in the perineum, anus, and under the armpits are typical. They enlarge, their surface becomes wet, forming abrasions, and the weeping growths merge with each other, resembling cauliflower in appearance. Such growths, accompanied by a foul odor, are not painful, but can interfere with walking. Patients with secondary syphilis have the so-called “syphilitic sore throat,” which differs from the usual one in that when the tonsils become red or whitish spots appear on them, the throat does not hurt and the body temperature does not rise. Whitish flat formations of oval or bizarre outlines appear on the mucous membrane of the neck and lips. Bright red areas of oval or scalloped outlines appear on the tongue, in which there are no papillae of the tongue. There may be cracks in the corners of the mouth - so-called syphilitic seizures. Brownish-red nodules called the “crown of Venus” sometimes appear on the forehead. Purulent crusts may appear around the mouth, simulating ordinary pyoderma. A rash on the palms and soles is very common. If any rashes appear in these areas, you should definitely check with a venereologist, although skin changes here may also be of a different origin (for example, fungal). Sometimes small (the size of a little fingernail) rounded light spots, surrounded by darker areas of skin, form on the back and sides of the neck. “Necklace of Venus” does not peel and does not hurt. There is syphilitic baldness (alopecia) in the form of either uniform thinning of hair (up to pronounced) or small numerous patches. It resembles moth-eaten fur. Often eyebrows and eyelashes also fall out. All these unpleasant phenomena occur 6 or more months after infection. An experienced venereologist only needs a quick glance at the patient to diagnose him with syphilis based on these signs. Treatment quickly leads to restoration of hair growth. In weakened patients, as well as patients who abuse alcohol, there are often multiple ulcers scattered throughout the skin, covered with layered crusts (the so-called “malignant” syphilis). Damage to the nervous system in the secondary period of syphilis is usually called early neurosyphilis, characterized by damage to the meninges and blood vessels.

In the secondary period, almost all organs and systems may be involved in a specific process, although this does not happen often. Mainly bones and joints, the central nervous system and some internal organs are affected. Periostitis occurs in 5% of patients in the form of diffuse thickenings, manifesting itself as painful, doughy swelling and night pain in the bones. The most commonly affected bones are the skull and tibia. Joint damage usually occurs as polyarthritic synovitis with the formation of effusion in the joint cavity. The joint appears swollen, enlarged, and painful when pressed. The appearance of pain in the joint when trying to move and its disappearance during movement is very typical. The most common are specific visceritis of the secondary period: syphilitic hepatitis (enlarged and painful liver, increased body temperature, jaundice), gastritis, nephroso-nephritis, myocarditis. Syphilitic visceritis quickly disappears after specific treatment. A neurological examination with analysis of cerebrospinal fluid reveals syphilitic meningitis (often asymptomatic), sometimes complicated by hydrocephalus, as well as syphilis of the brain vessels (meningovascular syphilis), less often - syphilitic neuritis, polyneuritis, neuralgia. A positive Wasserman reaction in secondary fresh syphilis is observed in 100% of cases, in secondary recurrent syphilis - in 98-100%.

If the patient is not treated, then several years after infection he may enter the tertiary period. In some patients, upon completion of the secondary stage, any symptoms disappear forever. However, in others they recur after remaining hidden for 1–20 years. During the latent period, treponemas are carried by blood and enter various tissues of the body. Damage to these tissues leads to severe consequences characteristic of the tertiary (late) stage of syphilis.

Tertiary syphilis occurs after 5-10 years and is a slowly progressive inflammatory process in adults that can develop in any organ. This stage of the disease is expressed by the formation of nodes (gumms) and the development of cardiovascular disorders, kidney diseases, liver diseases, lungs, etc. The aorta and heart are most often affected. Already in the early stages of the disease, syphilitic meningitis, meningoencephalitis, a sharp increase in intracranial pressure, strokes with complete or partial paralysis, etc. can develop. Stage III of syphilis. Single large nodules up to the size of a walnut or even a chicken egg (gumma) and smaller ones (tubercles), located, as a rule, in groups, appear on the skin. The gumma gradually grows, the skin becomes bluish-red, then a viscous liquid begins to be released from its center and a long-term non-healing ulcer with a characteristic yellowish bottom of a “greasy” appearance is formed. Gummous ulcers are characterized by long-term existence, dragging on for many months and even years. Scars, once healed, remain for life, and by their typical star-shaped appearance, one can understand after a long time that this person had syphilis. Igumma tubercles are most often located on the skin of the anterior surface of the legs, in the area of ​​the shoulder blades, forearms, etc. One of the common sites of tertiary lesions is the mucous membrane of the soft and hard palate. Ulcerations here can reach the bone and destroy bone tissue, the soft palate, wrinkle with scars, or form holes leading from the oral cavity to the nasal cavity, causing the voice to acquire a typical nasal tone. If gummas are located on the face, then they can destroy the bone, and it “falls through.” At all stages of syphilis, internal organs and the nervous system can be affected. In the first years of the disease, some patients develop syphilitic hepatitis (liver damage) and manifestations of “latent” meningitis. With treatment they go away quickly. Much less often, after 5 or more years, compactions of lipoma, similar to those that occur on the skin, sometimes form in these organs.

The aorta and heart are most often affected. A syphilitic aortic aneurysm is formed; in some area of ​​this vital vessel, its diameter sharply expands, forming a sac with very thin walls (aneurysm). The rupture of an aneurysm leads to instant death. The pathological process can also “slide” from the aorta to the ostia of the coronary vessels that supply the heart muscle, and then attacks of angina occur, which are not relieved by the means usually used for this. In some cases, syphilis causes myocardial infarction. Already in the early stages of the disease, syphilitic meningitis, meningoencephalitis, a sharp increase in intracranial pressure, strokes with complete or partial paralysis, etc. can develop. These severe phenomena are very rare and, fortunately, respond quite well to treatment. Late lesions (tabes dorsalis, progressive paralysis). They occur if a person has not been treated or was treated poorly. With tabes dorsalis, treponema pallidum affects the spinal cord. Patients suffer from attacks of acute excruciating pain. Their skin loses sensitivity so much that they may not feel the burn and pay attention only to the damage to the skin. The gait changes, becomes “duck-like”, first there is difficulty urinating, and then urinary and fecal incontinence. Damage to the optic nerves is especially severe, leading to blindness in a short time. Severe deformities of large joints, especially the knees, may develop. Changes in the size and shape of the pupils and their reaction to light are detected, as well as a decrease or complete disappearance of tendon reflexes, which are caused by hitting the tendon with a hammer below the knee (patellar reflex) and above the heel (Achilles reflex). Progressive paralysis usually develops after 15-20 years. This is irreversible brain damage. A person’s behavior changes dramatically: ability to work decreases, mood fluctuates, the ability to self-criticize decreases, either irritability, explosiveness, or, conversely, unreasonable cheerfulness and carelessness appear. The patient sleeps poorly, often has a headache, his hands tremble, and his facial muscles twitch. After some time, he becomes tactless, rude, lustful, and displays a tendency to cynical abuse and gluttony. His mental abilities are fading, he loses memory, especially for recent events, the ability to count correctly in simple arithmetic operations “voume”, when writing he misses or repeats letters and syllables, his handwriting becomes uneven, sloppy, his speech is slow, monotonous, as if “stumbling”. If treatment is not carried out, he completely loses interest in the world around him, soon refuses to leave his bed, and with symptoms of general paralysis, death occurs. Sometimes, with progressive paralysis, delusions of grandeur, sudden attacks of excitement, and aggression that are dangerous to others occur. Tertiary syphilis develops in approximately 40% of patients in the 3-4th year of the disease, lasts indefinitely and is manifested by the development of specific inflammation - infectious granuloma. Manifestations of the tertiary period are accompanied by the most pronounced, often indelible disfigurement of the patient’s appearance, severe disorders in various organs

At the present stage, the diagnosis and treatment of syphilis is characterized by the use of new methods and highly effective drugs to prevent serious complications. The classification of the disease existing in Russia is based mainly on epidemiological features and the specificity of clinical manifestations of different periods of the disease. Depending on this, primary, secondary and tertiary syphilis is distinguished. They, in turn, are divided into corresponding subspecies.

Cause of the disease and its characteristics

The cause of syphilis, or causative agent, is Treponema pallidum, belonging to the Spirochaetaecae family, which does not perceive staining. This property, as well as the presence of curls (on average 8-20 or more), differing in width, uniformity and angle of bending, and characteristic movements (rotational, flexion, wavy and translational, whip-like in the case of attachment to cells) are important for laboratory diagnostics.

The wall of Treponema pallidum consists of biochemical components (protein, lipid and polysaccharide) that have a complex composition and have antigenic (allergenic) properties. Microorganisms multiply within an average of 32 hours by dividing into many parts of one curl, capable of passing through the bacterial filter.

Under unfavorable conditions, the pathogen can transform into one of 2 forms of survival. One of them is cysts, which have a stable protective shell. They also have antigenic properties and are determined by serological (immune) reactions, which remain positive for many years after the early form has been suffered.

The second form of existence in unfavorable conditions is L-forms, which do not contain a cell wall, their metabolism is sharply reduced, they are not capable of cell division, but retain intense DNA synthesis. Under conditions suitable for life, they quickly restore to their usual spiral shape.

The resistance of L-forms to antibiotics can increase by several tens and hundreds of thousands of times. In addition, they do not have antigenic properties or the latter are very reduced. In this regard, the causative agent of the disease cannot be detected using classical serological reactions. In this case (in the later stages), it is necessary to carry out RIF (immune fluorescence reaction) or RIT (treponema immobilization reaction).

Treponema pallidum is characterized by low resistance to environmental influences. The optimal conditions for its existence are high humidity and a temperature of 37˚C. Outside the human body at a temperature of about 42˚C it dies within 3-6 hours, and at 55˚C within 15 minutes.

In blood or serum at 4˚C, its survival time is at least 1 day. For this reason, fresh donor blood and its preparations are currently not used, despite laboratory control. A reliable absence of treponema in canned blood is noted after 5 days of storage.

The microorganism remains active on various objects only until they dry out, quickly dies under the influence of acids and alkalis and does not survive in products such as vinegar, sour wines, sour milk and kefir, kvass and sour carbonated drinks (lemonade).

Routes of infection and mechanisms of development of primary syphilis

The source of infection is only a sick person. The main conditions for infection are the presence of even imperceptible damage to the stratum corneum of the skin or the epithelial layer of the mucous membrane and the introduction of at least two pathogens into the body through them. According to some clinicians, damage to the mucous membrane is not necessary.

There are two ways of contracting syphilis:

• direct - sexual contact (most often - 90-95% of cases), kissing, biting, breastfeeding, caring for a child or a sick person, professional (medical personnel when examining patients, operations and manipulations, childbirth, among musicians through common wind instruments instruments, etc.), intrauterine infection of the fetus, transfusion infection (transfusion of blood and its preparations);
• indirect - infection through various wet common items, linen, etc. in everyday life, in kindergartens, military units, hairdressing and beauty salons, in medical institutions (mainly dental and gynecological offices).

Men suffer from primary syphilis 2-6 times more often than women. In the latter, secondary and latent (latent) syphilis is more common, which are often discovered by chance only during examinations and mandatory serological tests in gynecological consultations and departments.

The first clinical symptoms of primary syphilis appear on average 3-4 weeks after the pathogen enters the damaged skin surface or mucous membranes (incubation period). This period can be shortened to 10-15 days or increased to 2.5-3 months, and sometimes up to six months, especially when taking low doses of antibiotics at the same time. The reduction in the duration of the incubation period is influenced by:

• old age or early childhood;
• unfavorable living and working conditions;
• severe psycho-emotional stress, mental or physical fatigue;
• malnutrition;
• concomitant chronic diseases, diabetes mellitus;
• acute and chronic infectious diseases;
• chronic intoxication (industrial, nicotine, alcohol, drugs);
• re-infections through repeated sexual contact with sick partners.

An increase in the duration of the incubation period of primary syphilis is observed in people with high protective properties of the body, when taking antibiotics or antibacterial agents for any inflammatory diseases, in the presence of genetic immunity to the causative agent of the disease (very rarely).

After pale treponema enters the body, their intensive division (reproduction) occurs at the site of introduction, where the first and main sign of the primary period of syphilis develops - syphiloma. Pathogenic microorganisms quickly spread through lymph and blood throughout all tissues and organs. A small number of them penetrate into the lymph of the perineural (around the nerve fibers) spaces and along them into the parts of the central nervous system.

This process is accompanied by a change in the reactivity of the whole organism, that is, an allergic reaction of tissues, and in parallel - an increase in immune defense directed against the infectious pathogen. Allergy and immune response are two phenomena of a single universal biological reaction of the body under the influence of an infectious pathogen, which subsequently manifests itself as the clinical symptoms of primary syphilis.

Clinical picture of the disease

A specific sign of primary syphilis is a positive laboratory serological reaction. However, the entire incubation period and the first week, even until the 10th day of the first period, it remains negative. Moreover, in some patients it is negative throughout the entire disease, which significantly affects the timely diagnosis and treatment of syphilis. In recent years, this has been observed in an increasing number of patients.

The results of the serological reaction are taken into account in the classification, in which primary syphilis is divided into:

• seronegative;
• seropositive;
• hidden.

Primary syphilis seronegative- this is only a form of the disease that, throughout the entire period of treatment, is characterized by persistent persistence of negative results of standard serological tests carried out regularly and at least every 5 days. This does not take into account the results of immunofluorescence and Kolmer reactions, which are a modification (cold mode) of the classical serological Wasserman reaction. If classical reactions give at least one weakly positive result, primary syphilis is classified as seropositive.

After completion of the incubation period, two main signs of the disease develop:

• Primary syphiloma, or chancroid, primary sclerosis, primary ulcer, primary erosion.
• Damage to lymphatic vessels and nodes.

Roseola rash does not occur in primary syphilis. Sometimes there are isolated cases of so-called “decapitated” syphilis, when the latter manifests itself in the secondary period (bypassing the primary) 3 months after infection. A symptom of secondary syphilis is a rash. This occurs mainly as a result of deep injections with contaminated needles, intravenous transfusion of contaminated blood and its preparations, after operations or manipulation of an infected instrument.

Primary syphiloma

Chancre occurs on average in 85% of infected people and is an erosive or ulcerative formation on the skin or mucous membranes at the site of inoculation (implementation) of Treponema pallidum. This is not the true morphological element of the disease. It is preceded by “primary sclerosis,” which in most cases goes unnoticed not only by the patient himself, but also by the dermatologist. This change begins with the appearance of a small red spot due to the expansion of capillaries, which within 2-3 days transforms into a painless papule in the form of a hemisphere (a dense formation without a cavity, slightly rising above the skin) with a diameter of several millimeters to 1.5 cm, covered a small number of scales of the horny epithelium.

Over the course of several days, peripheral growth of the papule, thickening and crust formation occur. After spontaneous rejection or removal of the latter, a damaged skin surface is exposed, that is, erosion or a superficially located ulcer with compaction at the base, which is a chancre.

Syphiloma is rarely painful. More often it does not cause any subjective sensations. After reaching a certain size, it is not prone to further peripheral growth. The average diameter of chancre is 1-2 cm, but sometimes “dwarf” (up to 1-2 mm) or “giant” (up to 4-5 cm) formations are found. The first are formed when treponema penetrates into the depths of the hair follicles and are localized in those areas of the skin in which the follicular apparatus is well developed. They are very dangerous because they are almost invisible and therefore are a source of infection. Large elements are usually located on the face, thighs (inner surface), on the forearm, in the lower parts of the skin of the abdomen, and on the pubis.

The primary ulcer or erosion can be oval or round, geometrically regular in shape with smooth and clearly defined boundaries. The bottom of the formation is located at the level of the surface of the surrounding healthy skin or slightly deeper. In the latter version, the chancre takes on a “saucer-shaped” shape.

Its surface is smooth, bright red, sometimes covered with a dull grayish-yellow coating. Against this background, there may be petechial (point) hemorrhages in the center. Sometimes the plaque is located only in the central parts of the ulcer and is separated from healthy areas of the skin by a red rim.

On open areas of the body, the ulcerative surface is covered with a dense brownish crust, and on the mucous membranes - with a transparent or whitish serous discharge, which gives it a kind of “varnish” shine. The amount of this discharge increases sharply when the surface of the chancre is irritated. It contains a large amount of the pathogen and is used for smears for microscopic examination.

Primary syphiloma is called “hard” chancre due to the fact that it is delimited at the base from the surrounding healthy tissues by a soft elastic seal extending several millimeters beyond the ulcerative or erosive surface. Depending on the shape, there are three types of this seal:

• nodular, having the appearance of a hemispherical formation with clear boundaries and penetrating deeply into the tissue; such a compaction is determined during a routine visual examination and is called the “visor” symptom; as a rule, it is localized in the area of ​​the coronary sulcus and on the inner surface of the foreskin, which disrupts the displacement of the latter and leads to phimosis;
• lamellar - comparable to a coin at the base of the syphiloma, placed on the labia majora, the shaft of the penis or in the area of ​​the outer surface of the foreskin;
• leaf-shaped - not a very hard base, similar to a thick piece of paper; occurs when localized on the head of the penis.

Types and different variants of chancre with primary syphilis

Special types of primary education are:

• Combustiform (burn) chancre, which is an erosion on a leaf-shaped base with a tendency to grow peripherally. As erosion increases, the regular outlines of its boundaries are lost, and the bottom acquires a granular red color.
• Folman's balanitis (symptom complex) is a rare clinical type of chancre in the form of multiple small erosions without pronounced compaction. Its localization is the glans penis and labia majora. The development of this symptom complex in primary syphilis is facilitated by the use of oral antibiotics during the incubation period or the application of external antibiotics to syphiloma at the initial stage of its development.
• Chancroid herpetiformis, which has significant similarities with genital herpes. It consists of grouped small erosions with vague compaction at the base.

Depending on the anatomical specifics of the area where primary syphiloma is located, different options for its formation are possible. Thus, on the head of the penis it is expressed by erosion with a slight lamellar base, in the area of ​​the coronary sulcus - a large ulcer with a nodular compaction, in the area of ​​the frenulum of the penis it looks like a cord with a dense base that bleeds during erection. When localized on the distal border of the foreskin, syphilomas are usually multiple and have a linear character, and on the inner leaf they have the appearance of an infiltrate like a rolling plate (“hinged” chancre); removal of the head is difficult and is accompanied by tears.

Localization of syphilomas in primary syphilis

Primary syphilomas can be single or multiple. The latter are characterized by simultaneous or sequential development. The condition for their simultaneous development is the presence of multiple defects of the mucous membrane or skin, for example, with concomitant skin diseases accompanied by itching, injury or cracks. Consistently occurring chancre varies in degree of density and size and is observed with repeated sexual intercourse with a sick partner.

Recently, bipolar formations have become increasingly common, that is, on two parts of the body distant from each other (on the external genitalia and on the mammary gland or on the lips), and “kissing” ulcers - in the area of ​​​​the contacting surfaces of the labia minora, as well as chancre - “imprints” on the penis in the crown area, which very often lead to the development of balanoposthitis. Such forms are accompanied by a shorter incubation period and an earlier appearance of seropositive reactions.

The location of primary syphiloma depends on the method of infection. Most often it appears on the external genitalia. On the mucous membranes of the genital organs, a chancre can be located in men in the area of ​​the external opening of the urethra. In these cases, there is an increase in the inguinal lymph nodes, painful urination, and serous and bloody discharge, which is often confused with gonorrhea. As a result of the healing of the ulcer, a stricture (narrowing) of the urethra may form.

With primary syphilis in women, erosion can form on the mucous membranes of the cervix - in the area of ​​the upper lip (usually) of the vaginal part of the cervix, in the area of ​​the external os of the cervical canal. It has the appearance of a rounded limited erosion with a bright red shiny surface or covered with a grayish-yellow coating and serous or serous-purulent discharge. Much less often, primary formation occurs on the mucous membrane of the vaginal walls.

With perverted sexual contact, extragenital (extra-sexual) single and multiple syphilomas can develop on any part of the skin and mucous membranes, which occurs (according to various sources) in 1.5-10% of cases of infection. For example, this may occur:

• primary syphilis on the face (in the area of ​​the red border of the lips, often on the lower lip, in the corners of the mouth, on the eyelids, chin);
• in the folds of skin located around the anus (often similar to a regular fissure);
• on the skin of the mammary glands (in the area of ​​the areolas or nipples);
• in the axillary region, on the navel, on the skin of the second (usually) phalanx of the fingers.

Extragenital chancroid is characterized by more rapid formation of erosion or ulcers, pain, prolonged course and significant enlargement of peripheral lymph nodes.

During oral sex, primary syphilis of the oral cavity develops with localization in the middle 1/3 of the tongue, on the tonsils, on the mucous membrane of the gums, at the neck of one or more teeth, on the back wall of the pharynx. In cases of anal sex in both men and women, primary syphiloma may occur not only on the skin in the area of ​​the anus, but also, in more rare cases, on the mucous membrane of the lower parts of the rectum. They are accompanied by pain during defecation, bloody discharge mixed with mucus or pus. Such syphilomas often have to be differentiated from an ulcerated rectal polyp, hemorrhoids, and even a malignant neoplasm.

Damage to lymph nodes and lymph vessels

The second main symptom of primary syphilis is lymphadenitis (enlargement) of regional lymph nodes, or the accompanying “bubo”, scleradenitis. It is important in the differential diagnosis of primary syphilis and persists for 3 to 5 months even with adequate specific therapy for secondary syphilis.

The main symptom of syphilitic scleradenitis is the absence of acute inflammatory phenomena and pain. As a rule, a symptom called Ricor's galaxy is detected. It is expressed in the enlargement of several lymph nodes up to 1-2 cm, but the node closest to syphiloma is larger in size compared to those more distant from it. The lymph nodes show no signs of inflammation. They have a round or oval shape and a dense elastic consistency; they are not fused to each other or to the surrounding tissues, that is, they are located in isolation.

Scleradenitis usually develops at the end of the first week after the formation of syphiloma. When the incubation period is prolonged, which occurs in cases of concomitant intoxication of the body, taking antibacterial, antiviral or immune drugs, etc., lymphadenitis may appear before the formation of chancre or simultaneously with it. Lymph nodes may enlarge on the side of the primary lesion, on the opposite side (crosswise), or on both sides.

If the primary chancre is located in the area of ​​the external genital organs, the inguinal nodes react, on the chin and lower lip - submandibular and cervical, in the areas of the upper lip and tonsils - submandibular, preauricular and cervical, on the tongue - sublingual, in the area of ​​​​the outer corners of the eyes or on the eyelids - pre-auricular, in the area of ​​the mammary glands - peri-sternal and axillary, on the fingers - elbow and axillary, on the lower extremities - inguinal and popliteal. Regional lymphadenitis during external examination is not detected if syphiloma is localized on the walls of the vagina, cervix or rectum, since in these cases the pelvic lymph nodes react.

By the end of the primary stage of syphilis, syphilitic polyadenitis develops, that is, a widespread enlargement of the lymph nodes of the submandibular, cervical, axillary, inguinal, etc. Their size is less than with regional lymphadenitis, and the further from the primary focus, the smaller they are. Polyadenitis, like regional lymphadenitis, persists for a long time even with the use of specific therapy.

Syphilitic damage to the lymphatic vessels (lymphangitis) is not a necessary symptom. In relatively rare cases, it manifests itself as damage to small lymph vessels, mainly in the area of ​​the primary lesion, and is accompanied by painless swelling of the surrounding tissues, which persists for several weeks. Larger affected lymphatic vessels can be identified in the form of dense, painless subcutaneous “harnesses”.

Complications of primary syphilis

The main complication is the transition of the disease to the secondary stage in the absence of specific adequate therapy. Other complications are associated with primary syphiloma:

Ulcer formation

Erosion usually forms first. An ulcer in some cases is already considered a complication. Its development is facilitated by such factors as the independent use of external irritating drugs, violation of hygiene rules, childhood or old age, concomitant chronic diseases, especially diabetes, anemia and chronic intoxications that weaken the body.

Balanitis (inflammation of the head) or balanoposthitis (inflammation in the area of ​​the inner layer of the foreskin, as well as the head)

They arise as a result of the addition of purulent or other opportunistic flora, including fungal ones, due to poor personal hygiene, mechanical damage or irritation, and weakened reactivity of the body. These complications manifest themselves in acute inflammatory processes around the chancre - redness, the appearance of additional small erosive areas, tissue swelling, pain, purulent or purulent-bloody discharge. All this may be similar to ordinary banal balanoposthitis and makes it difficult to diagnose the underlying disease.

Phimosis (impossibility of moving the foreskin to remove the head of the penis) and paraphimosis

Phimosis occurs as a result of swelling of the glans and foreskin or the formation of scars on the foreskin after the healing of the ulcerative process. These changes lead to a narrowing of its ring and prevent the removal of the head. With forcible removal, strangulation of the head occurs (paraphimosis), which, if timely assistance is not provided, leads to its necrosis (death).

Gangrenization

A rare complication of chancre that occurs independently or as a result of activation of saprophytic spirochetes and bacilli in a weakened immune system (fusispirillosis infection). In addition, they are also associated with staphylococcal and streptococcal infections. The complication is manifested by rapidly spreading necrosis along the surface and deep into the syphiloma. A dirty yellowish-gray or black scab appears on the surface. When it is removed, an ulcerative surface with bright red granulations is exposed.

Gangrenization develops only within the syphilitic ulcer, and after healing, which follows the rejection of the scab, a scar is formed. Gangrenization is accompanied by a deterioration in the general condition, increased temperature and chills, headache, the appearance of pain in the regional lymph nodes, and sometimes hyperemia (redness) of the skin over them.

Phagedinism

A rarer, but also more severe complication of primary syphilis, caused by the same bacterial flora. It is characterized by the spread of tissue necrosis not only within the boundaries of the ulcerative surface, but also with the involvement of healthy tissues surrounding it. In addition, necrosis does not stop after the scab is rejected. Gangrene is increasingly spreading to healthy areas, which can result in severe bleeding, destruction of the wall of the urethra followed by cicatricial narrowing, complete destruction of the foreskin and even the head of the penis. Phagedinism is accompanied by the same general symptoms as with gangrenization, but more pronounced.

Diagnostics

As a rule, establishing a diagnosis when characteristic syphiloma appears does not cause any difficulties. However, its laboratory confirmation is necessary by microscopic detection of treponema pallidum in a smear or scraping from an erosive (ulcerative) surface or in punctate from a regional maximally large lymph node. Sometimes these studies have to be performed for several days before the onset of the epithelization process. In addition, sometimes (relatively rarely) there is a need to conduct a histological examination of tissue from chancre.

Classic serological tests become positive only at the end of the 3rd week or at the beginning of the next month of illness, so their use for early diagnosis is less important.

Differential diagnosis of primary syphilis is carried out with:

• traumatic erosion of the genital organs;
• with banal, allergic or trichomonas balanitis and balanoposthitis, occurring in people who do not maintain normal hygiene;
• with gangrenous balanoposthitis, which can develop independently or as a complication of the diseases listed above;
• with chancroid, genital herpetic lichen, scabies ecthyma, complicated by staphylococcal, streptococcal or fungal infection;
• with ulcerative processes caused by gonococcal infection;
• with acute ulcers of the labia in girls who are not sexually active;
• with malignant neoplasms and some other diseases.

How to treat primary syphilis

The disease is completely curable if timely and adequate therapy is carried out in the early stages, that is, during the period of primary syphilis. Before and after the course of treatment, studies are carried out using CSR (a set of serological reactions), including the microprecipitation reaction (MPR).

Treatment of primary syphilis is carried out with penicillin and its derivatives (according to developed regimens), since this is the only antibiotic to which the causative agent of the disease develops resistance much more slowly and weakly compared to others. If antibiotics derived from penicillin are intolerant, others are chosen. The order of decreasing degree of effectiveness of the latter is: Erythromycin or Carbomycin (macrolide group), Chlortetracycline (aureomycin), Chloramphenicol, Streptomycin.

For outpatient treatment, long-acting penicillin drugs are used:

• foreign production - Retarpen and Extensillin;
• domestic preparations of bicillin - Bicillin 1 (one-component), which is a dibenzylethylenediamine penicillin salt, Bicillin 3, including the previous, as well as novocaine and sodium salts of penicillin, and Bicillin 5, consisting of the first and novocaine salts.

In hospital treatment, the sodium salt of penicillin is used predominantly, which is characterized by rapid elimination and provision of an initial high concentration of the antibiotic in the body. If it is impossible to use penicillin derivatives, alternative antibiotics (listed above) are used.

Syphilis is considered a shameful disease, as if it can only be contracted by priestesses of love or those who use their services. Actually this is not true!

Firstly, there is also household syphilis, which can be infected by any person, even those leading a truly monastic lifestyle. Secondly, have you ever asked your partner for test results for HIV infection and syphilis? Unlikely! So, if condoms protect against HIV, then this problem does not always work with syphilis. So it turns out that the cause of the disease is not necessarily debauchery, although the main routes of infection are sexual and transplacental, that is, from mother to child.

"Gift" from Columbus?

History is silent about which stork brought syphilis to humanity. It is unclear where it came from, the unidentified infection instantly acquired the nature of a pandemic and plunged people into horror.

The debate about the origin of syphilis still does not subside, says Alexey Rodin, Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology of Volgograd State Medical University. - This venereal disease was first documented in Europe in 1493, immediately after Columbus returned from America. Supporters of the first version believe that the infection was brought by traveling sailors. But where from - from Haiti, from America, India or Africa? The disease was called “large smallpox”, since, unlike smallpox, it left large scars on the bodies of victims. Another hypothesis - that syphilis was already present in ancient times, but was not diagnosed - is unlikely. There is also a popular assumption among Americans that the “genital plague” came out of Africa and is nothing more than a mutation of local tropical diseases.

After 300 years of mercury - to penicillin

For a long time they did not know what and how to treat syphilis, the professor continues. - Thus, the famous Dutch philosopher Erasmus of Rotterdam “humanely” advised: “If a husband and wife are sick with syphilis, they should be burned.” In the XV-XVII centuries. doctors refused to treat the shameful disease, and therefore the fight against venereal diseases fell on the shoulders of barbers and fraudulent doctors, who used mercury as a medicine, since it was then used to treat many skin diseases, such as leprosy and scabies.

After applying the mercury ointment, the patient was wrapped in a sheet, placed in a barrel and steamed with dry steam. Before this they beat with a whip, driving out immorality. The vast majority of people died after such miraculous procedures, the few survivors became disabled, but syphilis did not go away.

The next stage is the introduction of bismuth preparations, which are also very toxic. However, for the first time they made it possible to achieve a biological cure, that is, to remove the pale spirochete from the body. And only in 1943-1945, with the invention of penicillin, effective treatment appeared. For a long time, until the 80s of the 20th century, magic mold was taken along with bismuth preparations. But it was finally proven that bismuth was absolutely unnecessary in this situation. Doctors switched to “naked” penicillin - a modern effective treatment for this venereal disease.

In pre-revolutionary Tsaritsyn, syphilis was not treated

It is believed that syphilis came to our country in the 15th century from Lithuania. From the middle of the 19th century, a wave of disease swept through Tsarist Russia. According to Professor Rodin, entire villages were sick. In the Kursk region there is still a village called Kurnosovka, which got its name from the “failed noses”.

The disease also flourished in pre-revolutionary Tsaritsyn. After 1917, one could read in the local press that Dr. de Wez’s drug “will cure your syphilis at any stage,” but serious scientific treatment and the establishment of the profession of dermatovenereologist, according to the scientist, can only be discussed since the creation of the Department of Dermatovenereology in 1938 year on the basis of the Stalingrad Medical Institute. Its first head was Professor Ioffe. Ezriy Izrailevich organized a society of dermatologists and venereologists; on his initiative, in 1940, the building of a dermatovenereal clinic was built at the regional hospital.

Special disease

“I would say that syphilis is a special disease,” says doctor Alexey Rodin. - For example, here is a fact: almost all viruses have become resistant to antibiotics, and only the pale spirochete, in the old fashioned way, retains its fear of penicillin! Another peculiarity is that the incidence of syphilis, if you look at it over the years, follows a sinusoid. Every 10-15 years there is a surge, then 10-15 years there is a fall. It is believed that this depends on the activity of the sun. Now we are in decline; in 2014, 235 cases of syphilis were registered in our region, in 2015 to date 188 cases. It is also unusual that a third of patients recover without any treatment, on their own. There was such an experiment carried out by the Americans. 400 blacks with primary signs of syphilis became “victims of science”; a contract was signed with them, according to which they were not to be treated for 10 years. After 10 years, it turned out that a third of them had tertiary syphilis and neurosyphilis, a third had no manifestations, but the blood was positive (this is considered latent syphilis in Russia) and 30% were completely healthy. By the way, Reagan and Clinton offered official apologies for this experience.

The cunning of the pale spirochete

Now there is an increase in the incidence of late forms of syphilis, the so-called neurosyphilis, and there is an accumulation of cases of congenital syphilis, states a dermatovenerologist. - A pale spirochete may not make itself known for years and suddenly suddenly affect blood vessels or the cerebral cortex. For example, a patient was treated with us, then worked as a driver for 10 years in crowded Moscow, and suddenly, according to him, one fine morning he did not know where to go. He was diagnosed with neurosyphilis. Late syphilis began to appear in patients who underwent treatment in the 90s. Apparently, it makes sense to talk about undertreatment in due time. It is no secret that the people who come to us are just the surface part of the syphilis iceberg, I urge you not to be afraid and contact specialists in a timely manner.

Do you know that:

Italian doctor "planted the pig"

Initially, syphilis was called lues, which means “pestilence”, “disease”. The modern name of the disease was given by the poem (and at the same time a medical treatise) by the Italian physician, astronomer, and writer Girolamo Fracastoro “Syphilis, or the Gallic Disease” (1530). It tells how once a mythical swineherd named Syphilus (ancient Greek συς - pig, φ?λος - lover) dared to compare the nobility and wealth of earthly rulers with the gods of Olympus and was punished with a serious incurable illness, the name of which came from the name of the hero.

A sick scientist has confused everyone for 100 years

No matter how old the disease is, the causative agent of syphilis, spirochete pallidum (treponema pallidum), was discovered only in 1905! The microbe is called a spirochete for its resemblance to a spiral, and pale because it can be seen under a microscope with weak staining.

Scottish surgeon John Hunter caused great confusion in the study of syphilis. He injected pus from the urethra of a patient with gonorrhea into his urethra and... fell ill with syphilis. The doctor was so happy that he didn’t even immediately realize that his “donor” was sick with two diseases at once. As a result of this oversight, for more than 100 (!) years, the scientific community mistakenly believed that syphilis and gonorrhea were caused by the same pathogen.

Our information

Famous syphilitics

Francisco Goya. The Spanish artist passionately loved not only art, but also women. It has not been proven that he had syphilis; at that time, sexually transmitted diseases were not very distinguished. But according to the description, that's exactly him.

Abraham Lincoln, President of America. By his own admission, in his youth he had the misfortune of meeting a pale spirochete. Moreover, he unwittingly infected his wife and three children.

Adolf Gitler. During the First World War, the Fuhrer was diagnosed with blindness and ended up in the infirmary. From the hospital documents it follows that the true Aryan was treated there for syphilis.

Guy de Maupassant. The writer in practice followed the conviction that loyalty and constancy are nonsense. Sexual debauchery in brothels brought him to syphilis. A true Frenchman, he was not upset even when the disease, despite treatment, began to progress. Maupassant self-ironically remarked: “Finally, I have real syphilis, and not a pathetic runny nose!”

Natalya Khairulina. Photos from open Internet sources

2011-03-18 20:04:16

Yuri Romanov asks:

Romanov Yu.S. Born 1962 II gr. blood(+)
I gave up active sports (volleyball) in March 2008. I smoked for almost 30 years, I quit a year ago. Height - 188. Weight - gained 11 kg - 103 kg in a year. Alcohol - I don’t abuse it.
Case history: September 2008 - pain in the shoulders, forearms (more muscular), in the chest, between the shoulder blades, accompanied by a slight dry cough. The pain is not constant, attacks last from half an hour to 1.5-2 hours. The pain resembles the condition as at a temperature above 38 degrees .-“twists” his arms. The therapist referred me for a consultation with a pulmonologist and a neurologist. Pulmanologist's diagnosis: COPD type 1-2. Test for uric acid, LE cells, coagulogram. Of these tests, uric acid was above the norm, the rest were normal. Prescribed allopurilic acid, meloxicam, fromilid uno (I don’t know why the antibiotic). Neurologist-chest X-ray: no bone changes.
Prescribed: massage, vitamin B12, mucosat 20 amp, Olfen No. 10 in amp. No improvement was observed after using these drugs. The pain either went away on its own for 2-3 weeks, or appeared for 1-2 weeks, but they were also paroxysmal. That is, the condition was excellent and suddenly within 10-15 minutes the condition was as if the temperature was above 38-38.5 degrees. Over time, new ones were added symptoms are pain in the calf muscles, submandibular pain.
I was tested for: helminths: toxocar. echinococcus, opisthorchis, roundworm, trichinel - not found. Just in case, I drank Vormil for 3 days.
Tests for: Chlamydia, Giardia - negative, HIV, syphilis - negative, Toxoplasma - lgG-155.2 with a norm of less than 8 IU / ml. lgM-not detected.
Fiberglass bronchoscopy reveals diffuse endobronchitis with moderate mucosal atrophy.
Fibroesophagogastroduodenoscopy: peptic ulcer of the duodenal bulb 12. Hp test - positive. Completed a course of treatment.
Tests for antibodies to native DNA: 1І-29.0109Г.-0.48 POSITIVE.
2nd - 05.27.09 - 0.32 position
3rd-14.09.09-0.11-negative.
4th - 02/23/2010 - 44 IU\ml-positive.
5th - 05/18/2010 - 20.04 IU\ml-negative.
6th-17.11.2010 -33IU\ml-positive.
Immunoglobulin class M: 2.67 with a norm of 0.4-2.3 (01/29/09)
SLE test - dated 05/26/2009, and 11/17/2010 - negative. Tests for rheumatic tests are within normal limits.
There is a CT scan of the abdomen and an MRI of the lumbar spine. No pathologies.
During this time, neither the therapist nor the neurologist made an accurate diagnosis. I was not referred to other doctors. I took almost 90% of the tests without a doctor’s referral, at random. Only once was the option mentioned – SLE. I took 1 tablet of Delagil for a month and took it during attacks.
Symptoms of aches in the muscles (90%) and joints (10%) of the arms and legs continued to appear and disappear for 10-15 days.
Since the fall of 2010, muscle pain began in the shoulders and forearms, submandibular pain, pain in the chest and between the shoulder blades.
On November 16, 2010, I turned to a therapist in another hospital because such pain was accompanied by depression. Constantly on painkillers, but I have to work, it’s impossible to control the occurrence of attacks. They don’t give sick leave, there are no pronounced symptoms!
Direction for x-ray of the cervical, thoracic, right shoulders. joint Based on the data, he was referred to a neurologist. Conclusion: osteochondrosis of the cervical and thoracic spine. Prescribed: lidocaine in amp No. 10, vitamin B12, massage No. 10. The neurologist could not explain the above symptoms.
Consultation with a city rheumatologist - data in favor of SLE and rheumatoid arthritis - NO. Prescribed: olfen in amp. No. 10, Vitamins B1, B6, B12. Lyrica 1 t 2 times a day. According to consultations with a neurologist and rheumatologist, the therapist prescribed:
Olfen No. 10, lidocaine 2.0 No. 10, proserin 1.0 ml No. 10, vitamin B12 No. 10, gabalept 1 t per month, massage.
Started treatment on November 25, 2010. From December 1, 2010, the symptoms began to change. The muscles below the elbows, hands, and fingers began to ache more intensely. Aches in the calf muscles, ankles, knees. A feeling of swelling in the arms and legs (below the knee joints). These symptoms appear from the morning until bedtime + attacks of aching are added (as at a temperature of 38 degrees) also from half an hour to 1.5-2 hours.
From 12/10/10 Symmetrical pain appeared in the small joints of the hands, wrist joints, and ankles. After sleep, I felt stiffness in both the arms and legs. With exertion, the pain in the ankles intensified, with a rebound under the heel and in the knees. A crunch appeared in the joints of the arms and legs, which had never been observed before. These symptoms persisted until the patient was at rest. Didn't bother me at night.
At the same time, the paroxysmal pain disappeared.
Since the appointment with the doctor did not take place at a certain time and was postponed, and the pain did not go away, but intensified, I started taking METIPRED 4 mg once a day. By December 20, 2010, the condition had improved. The pain became weaker, but still manifested itself in the fingers and hands, ankles and knees. The swelling has subsided, but is sometimes felt in the hands. Pain appeared in the shoulders and hip areas. The crunching in the joints did not go away. The pain is especially severe in areas of sports injuries to the ankle of the left, right knee joint, and fracture of the wrist of the right hand. I passed tests for rheumatic tests - everything is normal. A detailed blood test taking into account Metipred intake (4th day) - all indicators are normal.
The attending physician refers to a neurologist and traumatologist; appointment is December 21, 2010. I’m tired of the lack of a diagnosis. It can be very bad, but I don’t know which doctor to go to, I don’t even know who to take sick leave from so I can rest up. Tell me what to do or who to turn to for help!
Joint consultation of a neurologist and traumatologist:
Neuropathologist: multiple sclerosis? MRI of the head is recommended.
Traumatologist - there is no evidence of trauma and orthopedic pathology in the acute stage.
In words, he said that you need to contact a rheumatologist about mixed collagenosis.
12/24/10 - I underwent an MRI of the brain, the result is below.
After undergoing an MRI, the neurologist sent her to a regional clinic to see a neurologist with a diagnosis:
- dyscirculatory encephalopathy, cephalalgia, Sd?
To a rheumatologist:
-myasthenic syndrome, SLE, rheumatoid arthritis.
From 12/23/10 I caught a cold (pain in the nasopharynx, temperature 37.8) and started taking Arbidol and Amoxil. After three days, I felt no pain in the joints of my fingers, hands, and ankles, and my knees became easier when walking.
There remains a slight stiffness in the morning, which disappears after 5-10 minutes, and there is still a crunch in the joints. My mood and general condition have noticeably improved.
12/26/10 - I stopped taking METYPRED, taking it for 14 days at a dose of 4 mg-7 days and lowering it to 1 mg by the 14th day.
From about January 8, 2011 Pain in the small joints of the hands and ankles reappeared. I started taking Metypred again, 2 mg once a day. The condition is average, the joints are crunchy. Since 16.01. I take 1 mg of metypred, sometimes adding dolaren when the pain intensifies. The pain is especially reflected in the left ankle and right knee joint when moving up the stairs.
Consultation with the chief rheumatologist-d\z:RA.
For confirmation, he was sent to the regional clinic in the department of rheumatology. Based on x-rays, he was diagnosed with osteoarthritis of small joints of the hands and feet.
The prescribed course of treatment by the region’s rheumatologist: arcoxia 60, 1 ton for 10 days, mydocalm 150 mg. 1 r\10 days, arthrone complex 1 t. 2 r\d, calcium D-3, local ointment.
Currently, after taking this medication, the condition has worsened. The joints of the 3-4 fingers of the hands hurt and are swollen. In the morning there is a slight stiffness in the hands for 10-15 minutes. The joints are slightly swollen, there is also pain in the wrists. Pain in the hip joints progresses in the area of ​​the left greater trochanter and both ischial tuberosities. Pain when walking with a load. When sitting on a chair, after a couple of minutes pain appears in the ischial tuberosities in the form of a burning sensation. Pain in the heel tuberosities has intensified on both ankles.
Again I turned to the glurematologist in my city. He prescribed Olfen 100 mg once daily, Movalis 2 mg intravenously, and continued the artron complex.
The 10-day course of treatment did not give anything.
Today I had an appointment again and prescribed Metypred 2 mg daily in addition to the drugs described above.
I'm at a loss! Unofficially, he diagnoses RA, but does not officially confirm it - if visual symptoms appear, he will confirm the diagnosis, and since the tests are clear, and the pain “doesn’t help matters”!
Time is running out for treatment. Tell me, what should I do? Go to Kyiv? And there, too, without clinical manifestations, they will kick me off! And to whom - to a private clinic or a public hospital?
Thank you for your attention! Sorry for the confusion.
Regards, Yuri.

2013-02-12 15:08:33

Vyacheslav asks:

Good afternoon
Chronic CA EBV, as I think, has been a painful (more or less) daily test for me for 5 years now, causing lymphadenopathy in the ears, neck, submandibular nodes, which decreases in the summer, increases in the spring, causing chronic fatigue, more or less pronounced also seasonal.
Please help in prescribing treatment, because... To this day I have not treated anything, but, as I see, it is unlikely that the body will cope on its own, and it will become a chronic process.
Briefly about myself: male, born in 1980, Ukrainian, did not suffer from any chronic diseases, was not registered with any doctors for any diseases, do not smoke, hardly drink alcohol, athletic build, blood type 4 Rh+
History of symptoms and illness.
In April 2007, my 4-year-old son, like his entire group in kindergarten, fell ill with chickenpox. He had an inflamed lymph node behind his ear, fever, spots, then everything went away. At the same time, as it turned out, people in contact with me suffered from infectious mononucleosis (not chickenpox), and after 14 days, expecting chickenpox (since I didn’t get sick in childhood), I felt an enlargement of the lymph node behind the ear, like my son’s, but there were no red ulcers, there was pharyngitis, the submandibular nodes and/or salivary glands were swollen, at the back, on the occipital part of the head and a little on the parietal, unpleasant sensations appeared, as if internal pressure, or inflammation, and this is the feeling that is still , periodically increasing and then almost disappearing, but it has been annoying me terribly for 5 years.
At first I didn’t understand that the problem with my right ear was due to a lymph node, I went to an ENT specialist, I was prescribed antibiotic injections for otitis media, immediately after which a rash appeared in the neck and shoulders (although I had never been allergic to anything), and I refused to stab them.
Treatment of pharyngitis with all sorts of gargles, despite the fact that before I had it extremely rarely, and went away in 3 days, then it lasted for 3 weeks, but the throat went away, but lymphadenopathy on the head (in the sense of a feeling of pressure on the back of the head below and behind ears) did not go away, although it decreased. This problem periodically became barely noticeable, but sometimes, especially with any cold/flu disease, it increased many times over.
I couldn’t understand what was wrong with me, and I didn’t think about herpes, since I never, and still have, had any classic herpetic manifestations (ulcers on the lips, etc.) and never have.
Today the situation has not changed, but, at the insistence of my family, I was forced to start an examination and get tested.
I REQUEST YOUR HELP IN INTERPRETING THE TESTS AND PRESCRIBING TREATMENT! And give advice on where this is treated, specifically, professionally, because There is no such clinic in my region, and I myself am already an amateur in this matter. my email address: [email protected]
ANALYSIS HAS BEEN CARRIED OUT:
1. Blood from a vein for viruses:
a) HIV - negative
b) RV/syphilis - negative
c) Hepatitis B – negative
d) Hepatitis C - negative
2. Blood from vein liver tests:
- Alanine aminotransferase ALT U/l (W: up to 34 M: up to 45) - 35.8 – normal
- Aspartate aminotransferase AST U/l (W: up to 31 M: up to 35) - 15.4 – normal
- Alkaline phosphatase ALP U/l (Adults up to 258) – 152 – normal
- Gammaglutamyltransferase U/l (Male up to 55) - 41.0 – normal
- Total protein g/l (Adults - 65-85) - 72.3 – normal
- Total bilirubin µmol/l (Adults - 1.7 - 21.0) - 15.5 – normal
- Direct bilirubin µmol/l (0-5.3) - 2.2 - normal
- Indirect bilirubin µmol/l (Up to 21) - 13.3 – normal
3. Blood from a vein, hematological analysis:
Leukocytes WBC G/l (4.0 - 9.0) 6.0 – normal
Absolute number of lymphocytes Lymph# G/l 1.2 - 3.0 2.5 - normal
Absolute content cells avg. solution Mid# G/l 0.1 - 0.6 0.6 - normal
Absolute content granulocytes Gran# G/l 1.2 - 6.8 2.9 - normal
Hemoglobin HGB g/L Male (- 140 – 180) - 141 - normal
Red blood cells RBC T/l (3.6 - 5.1) - 4.83 - normal
Hematocrit HCT % Male - 40 - 48- 45.3 norm
Average cellular volume of erythrocyte MCV fl (75 – 95) 93.9 - normal
Hemoglobin concentration in one red blood cell MCH pg(28 – 34) 29.1 - normal
Average corpuscular concentration of hemoglobin in erythrocytes MCHCg/L(300 – 380)311 – normal
Coef. variations in the width of the erythrocyte distribution RDW-CV % (11.5 - 14.5) 13.2 - normal
Distribution width of erythrol - standard deviation RDW-SD fl (35.0 - 56.0) 45.1 - norm
Platelets PLT G/l (150 – 420) 328 - normal
Average platelet volume MPV fl (7 – 11) 9.6 - normal
Platelet distribution width PDW% (14 -18) 14.5 - normal
Thrombocrit PCT ml/L 0.15 - 0.40 0.314 - normal
Basophils % (0 – 1) 0 - normal
Eosinophils % (1 – 6) 1 - normal
Myelocytes % 0 0 - normal
Metamyelocytes % 0 - norm 0
Band % (1 – 5) 4 – normal
Segmented % (over 12 years - 47 - 72) 47 - normal
Lymphocytes % (over 12 years - 19 - 37) 39 – not the norm!
Monocytes% - (3 – 10) 9 - normal
Plasmocytes % (0 – 1) 0 - normal
Virocytes % 0 0 - normal
ESR mm/hour (Male - 1 – 10, Female - 2 – 15) - 20 is not the norm!
4. Blood from a vein test for Epstein-Barr virus:
- mononucleosis heterophilic antibodies – negative – normal
- IgM to EBV capsid antigen Od/ml (normal less than 0.9) - 0.11– normal
- IgG to capsid antigen EBV S/CO (normal less than 0.9) – 23.8 – not normal!
- IgG to nuclear antigen EBV S/CO (normal less than 0.9) – 38.4 – not normal!
- EBV DNA (Epstein-Barr virus), PLR - not detected - normal

Answers Agababov Ernest Danielovich:

Good afternoon Vyacheslav, you don’t just have blood tests, do you? There should also be instrumental research methods - x-rays, ultrasound, etc. In order to objectively assess your situation, you need to familiarize yourself with the entire examination performed, send it to me by email - [email protected].