Late forms of syphilis: current state of the problem

Syphilis is one of the most common sexually transmitted diseases. And at the same time one of the most dangerous. Due to the not very clear symptoms in most patients, syphilis is detected in late stages, so it takes a long time to treat. All the time from the moment of infection, a person remains infectious to others - he can transmit the disease to a sexual partner, and to others, even to children.

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The first stage of syphilis is easy to miss!

Syphilis is caused by a microbe that has a spiral shape and is called a pale spirochete. Getting even on a slightly damaged mucous membrane or skin, the pale spirochete penetrates into deeper tissues and then into the blood. At the place where the pale spirochete has penetrated the tissue, at the end of the third week after infection, an ulcer with dense edges and a bottom appears - a chancre.

This ulcer gradually increases over the course of 2-3 weeks, then its growth stops, it begins to shrink and heals, leaving behind a slight compaction. After the appearance of hard chancre, the nearest lymph nodes enlarge.

Many people do not even suspect that they have contracted syphilis, so they begin to treat the wound with antibiotics. As a result, it is delayed, but the infection remains in the body and undermines it from the inside.

If the symptoms are similar to a cold, how can you find out about the disease before your nose drops?

With the help of testing, of course!
To test for syphilis, you need to do two tests. The first is the RPR test (synonyms: nonspecific antiphospholipid test, cardiolipin test, modified Wasserman reaction (RW)). It is used to determine the presence in the patient’s blood of antibodies to cardiolipin, a special phospholipid, antibodies to which appear during infection with Treponema pallidum and some other diseases. The cardiolipin test is good for its simplicity, low cost and high speed - a positive result will be within 7-10 days after the appearance of the chancre, so it is used for primary screening for syphilis. The disadvantage of the method is that a positive result does not necessarily mean syphilis, because antibodies are determined to cardiolipin, and not to the treponema itself, and the result may be false positive. This test is also used to monitor the effectiveness of syphilis treatment. If the treatment was successful, the titer (concentration) of antibodies to cardiolipin will decrease by 4 or more times or they will disappear completely.

To confirm syphilis, in addition to the cardiolipin test, a test for total antibodies (IgM + IgG) to treponema pallidum antigens is done. This test has high specificity, since antibodies to the causative agent of the disease are determined. The problem is that IgG antibodies can remain in the blood even after successful treatment of syphilis. Therefore, only positive results of two tests - cardiolipin and total antibodies to Treponema pallidum - will indicate an active infection.

If the test for antibodies to Treponema pallidum is positive and the cardiolipin test is negative, this indicates that syphilis has been suffered and treated in the past. A positive cardiolipin test with a negative total antibody test may indicate either a very early stage of syphilis (in this case, the test for antibodies to Treponema pallidum is repeated after 10–14 days), or another disease that will also be characterized by the presence of antibodies to cardiolipin. Both negative tests will indicate the absence of the disease or its very early stage.

To determine the stage of syphilis, you can separately do an IgM test for Treponema pallidum. This class of antibodies predominates at the onset of the disease. Therefore, a positive result for IgM (with a positive cardiolipin test) will indicate a “fresh” infection that has not yet entered the asymptomatic latent phase. In later stages of infection, the IgM test will be negative with positive cardiolipin and positive IgG. The disappearance of IgM does not say anything about the effectiveness of treatment - these antibodies will disappear on their own over time, even if the disease is not treated at all. Effective treatment will be indicated only by a decrease in titer in the cardiolipin test.

Treponema pallidum can also be detected in smears under a microscope and using a PCR reaction. But these methods are used less frequently and only as an auxiliary one, since in the early stages of the disease (before the onset of secondary syphilis) there will not yet be a pathogen in the blood and it is also not always possible to detect it in a chancre smear.

Sexual infection with syphilis in women goes unnoticed

During sexual infection, chancre sometimes goes unnoticed by a woman. This happens in cases where the ulcer occurs on the inner surface of the labia, in the clitoris, external opening of the urethra, on the vaginal mucosa or on the cervix.

In all cases of ulceration, you should immediately consult a doctor. If a woman is not treated, she develops multiple enlargement of the lymph nodes, and then a rash on the skin and mucous membranes (secondary syphilis). This rash subsequently disappears, but then may appear again (recurrent syphilis).

Prevention

It is enough to see at least once what syphilis looks like to forever decide to give up promiscuous sexual intercourse. This is the most effective way to prevent this disease.

If a person has to live with a sick person, strict hygiene rules must be observed. Despite the fact that the risk of household transmission of infection is minimal, it still exists. Also, a person living with an infected person must periodically visit a doctor and undergo diagnostics to make sure that infection has not occurred.

If you have sexual contact with an infected person, it is recommended to immediately urinate, wash your genitals with laundry soap, and wipe your private parts with a disinfectant solution. This treatment is effective only in the first 48 hours after possible infection, since during this period of time the pathogen is still on the skin and mucous membrane. After more than 3 hours, such treatment is useless.

Syphilis is a dangerous disease that in the vast majority of cases is transmitted sexually. The disease is insidious in that even in the absence of symptoms, it can affect any organ of the human body and provoke various ailments. It is important to understand that cure for syphilis does not guarantee protection against re-infection. Immunity to Treponema pallidum is not developed. Therefore, you should always adhere to preventive measures, and at the first suspicion of a disease, immediately consult a doctor. With timely treatment, syphilis can be successfully treated. But untreated syphilis will destroy the body for years and can be fatal.

Syphilis in pregnant women is transmitted to children

In addition to the transmission of syphilis through sexual and non-sexual contact, infection of the fetus from a sick mother is possible. In this case, miscarriage often occurs, as well as premature birth, in which the born child soon dies.

In other cases, the sick mother gives birth on time, and signs of syphilis in the child may not appear immediately after birth. With congenital syphilis, a child has a rash, blisters, cracks on the face, etc. on the skin. In some cases, syphilis in children appears only after a few years in the form of gummas, eye diseases and other late signs of the disease. It is necessary to recall once again that most often syphilis infection occurs through casual sexual intercourse.

How is it transmitted?

The most common and typical route of transmission of the causative agent of syphilis is sexual. Infection can occur through vaginal, oral or anal sex. As already mentioned, infection is most likely with skin manifestations of syphilis; the most contagious are hard chancre - painless ulcers that form during primary syphilis. Erosive papules that appear with secondary syphilis also pose a great danger, but with nonspecific rashes it is possible to become infected. The sexual route of transmission of syphilis is the most common, since during intimate intimacy microtraumas are formed on the mucous membranes and skin, through which the pathogen actually penetrates.

Another route of transmission of infection is transplacental (from mother to fetus). It is known that in the first three years after the mother is infected, the likelihood of developing congenital syphilis increases. The pathogen penetrates the placenta at 4–5 months of pregnancy, but there are cases of infection as early as 10 weeks of gestation.

Blood transfusion is another way of contracting syphilis. The transfusion route is possible at any stage of infection, including the incubation period. Currently, all donor blood is thoroughly checked, so this route of transmission of infection is practically excluded.

It is almost impossible to become infected through household contact, but in medical practice this has still happened. The infection is not transmitted through shared utensils and household items, but in close contact with a patient this is still considered possible.

There is another way of infection - professional. We are talking about laboratory employees, as well as sex workers. There are known cases of syphilis infection among surgeons, dentists and obstetricians-gynecologists.

At risk for the disease:

• prostitutes;
• homosexuals;
• persons who are promiscuous;
• persons practicing group sex;
• asocial elements of society;
• drug addicts;
• patients with gonorrhea;
• patients with hemophilia.

Hard chancroid and soft chancroid are different diseases

In addition to gonorrhea and syphilis, venereal diseases include chancroid. This disease is transmitted from one person to another almost exclusively through sexual contact.

Chancroid is caused by a microbe that is shaped like rods, arranged one after the other in a chain. This microbe enters the body through cracks or abrasions in the skin and mucous membranes.

A few days (most often 3-4) after infection, an ulcer appears in the place where the microbe penetrated. This ulcer is covered with pus, has a round or oval shape with uneven edges and bottom; its size is 1-2 cm, sometimes more, it seems soft to the touch, in contrast to a dense syphilitic ulcer.

The ulcer is painful; More often there is not one, but several ulcers located on the mucous membrane of the vagina, the skin of the external genitalia, the perineum in the anus and on the thighs.

If a woman with chancroid is not treated, the ulcers heal very slowly (after 1-2 months, and sometimes after longer periods). In all cases, when a woman notices the appearance of an ulcer in the external genital area or increased vaginal discharge, she should consult a doctor to determine the nature of the disease and prescribe the necessary treatment.

In addition to the formation of ulcerations, with chancre, in some cases, inflammation of the inguinal lymph nodes is also observed. This complication can develop when the patient does not carry out the treatment prescribed to her or does not follow the correct regimen recommended by the doctor.

Classification of the disease

Syphilis is divided into forms and types, due to different timing, routes of spread and varied symptoms.

According to the degree of damage, syphilis is divided into:

• primary;
• secondary;
• tertiary.

In addition, it can be:

• hidden,
• congenital,
• late,
• chronic.

Primary syphilis - stage 1 of infection, a distinctive feature is the appearance of chancre. Chancres often appear on the genitals, since the sexual tract is the most common route of transmission of infection. Chancres can also appear on the face, mouth, mammary glands, and legs. Primary syphilis has no other manifestations.

Secondary syphilis - stage 2 of infection. It is characterized by the appearance of a papular rash. At this time, the patient experiences inflammation of the lymph nodes, damage to the nervous and musculoskeletal systems.

Tertiary syphilis develops in people who have not received treatment or have not completed treatment for the disease. Syphilitic granulomas appear on the mucous membrane, skin, bones, and internal organs, which destroy these structures. Currently, this stage is rare, since at stages 1 and 2 the disease can be successfully treated.

Latent syphilis is considered the most dangerous because the patient has no symptoms, but it poses a danger to others. Syphilis is classified as late if more than 2 years have passed since infection and symptoms have just appeared. Syphilis, which has developed over decades, is called chronic; it slowly destroys the body, and is not always accompanied by symptoms.

Syphilis is treated and not treated

Systematic treatment of syphilis currently gives good results, especially when it is started soon after the first signs of the disease appear. Timely and vigorous treatment of syphilis in the mother during pregnancy is the best way to prevent syphilis in the child. But advanced stages of the disease are incurable.

Treatment of syphilis, as well as gonorrhea, should only be carried out by a doctor. It must be remembered that a cure can be achieved only on the condition that the patient accurately follows every doctor’s prescription and carefully carries out the entire course of treatment.

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Treatment of syphilis

Syphilis is perhaps the most feared disease. It is caused by a bacterial pathogen - a spirochete. Syphilis is transmitted from person to person through sexual contact. The possibility of becoming infected through everyday life - through a handshake, contact with a towel, door handle, etc. – practically equal to zero.

• Story

It is believed that syphilis arrived in Europe from America. It was brought by the sailors of Christopher Columbus, and at the turn of the 15th – 16th centuries the first pandemic of this disease broke out in Europe; you can read more about it in this historical essay

. Today, when personal protective equipment is available to everyone, and everyone knows about the dangers of STDs, syphilis still affects 3-4 people out of 1000 people.

• First stage

Approximately 3-4 weeks after unprotected sexual intercourse, a man develops an ulcer on his penis. It's called chancre - if you touch it, it's hard at the base. Sometimes it looks like a pimple, sometimes like a sore with a crater. It is painless and does not bother you. Usually a person thinks that it is a rub, or a bite, or an allergy. Classically, sexual contact is considered vaginal. But besides it, there can be anal contact and oral. With oral infection, a chancre forms on the lip or palate. Patients often confuse chancre in the anus with an acute form of hemorrhoids and do not always realize to get tested. Following the appearance of chancre, the lymph nodes enlarge, but the person may not feel this. If the patient discovers a chancre and consults a doctor, syphilis can be cured at the first stage.

• Second stage

After some time, the chancre goes away on its own, and the lymph nodes become smaller. But after about six months - and given the widespread use of antibiotics, it can take a year or a year and a half - a person develops nonspecific skin rashes. Even doctors can sometimes mistake them for an allergic reaction, and by that time the patient had already forgotten about that ulcer (chancre), which did not bother him at all. Papules appear on the palms - red nodules. Leucoderma appears around the neck - what was previously called the “necklace of Venus”. Today, there are many erased forms of secondary syphilis; instead of the classic “necklace of Venus”, 2-3 incomprehensible spots appear, which even a doctor cannot always identify. If the diagnosis has not been made, syphilis develops further.

• Third stage

Tertiary syphilis is characterized by gummous changes in tissues. Gumma (syphilitic granuloma) is a tissue node in which spirochetes are concentrated. Most often, gummas occur in the liver, soft tissues, and in the wall of the aorta. The tissues are irreversibly destroyed and rough knots are formed. If the spirochete enters the trunks of the nervous system, an extremely dangerous condition develops - neurophysilis. However, tabes dorsalis (a form of late neurosyphilis characterized by damage to the central nervous system) now practically does not occur. The artist Mikhail Vrubel suffered from tabes dorsalis - this is where his demons came from. more about the tragedy of Vrubel and his doctors in this article.

• Condylomas lata

Lata condylomas should not be confused with genital warts, which occur with the human papillomavirus. Previously, broad-pointed condylomas occurred at stages 2 and 3 of syphilis. But now, either due to the widespread use of antibiotics, or for some other reasons, condylomas can occur in the first stage. Due to the difference in the anatomy of the genital organs, men find condylomas more easily than women. If you see or feel that a condyloma has appeared on the genitals, do not try to determine on the Internet whether it is wide-ended or not, go to the doctor immediately.

• Test for syphilis

3 weeks after casual unprotected sexual intercourse (including oral and anal intercourse), it is necessary to take a specific RW test (Wassermann reaction, or simply “syphilis test”). There is no point in getting tested earlier, since the body’s immune response has not yet developed, and the test may give a false negative answer. A test for syphilis can be taken in any private laboratory, but it is best to go to a dispensary at your place of residence.

It is important to understand that if syphilis infection has occurred, the RW test will always be positive. In only 1 out of 10 patients, the syphilis marker disappears after treatment. The presence of a marker (positive RW analysis) may raise unnecessary questions during hospitalization, obstetrics, and professional examinations at work. Therefore, a sick person needs to undergo only legal treatment in a government medical institution licensed to treat syphilis. Such an institution will issue the patient a certificate stating that there was syphilis, the patient completed a course of treatment, was registered and deregistered, and is healthy. No private clinic has the right to treat syphilis and issue such certificates! A private clinic can only make a diagnosis and refer the patient to a public medical institution.

• Treatment of syphilis

Today, all over the world, syphilis is easily treated with long-acting penicillin antibiotics, which until recently were available in Russia. Treatment of syphilis with long-acting antibiotics is only 4 injections of extencillin. But now this drug is not available in Russia, and bicillin or penicillin is used in the treatment of syphilis - 6 injections daily for 10 days, the treatment is complex. The task of the state is to make the patient not infectious to society. Everywhere in the world, when syphilis is detected, the patient is given the first injection of the long-acting antibiotic extencillin - after which he is no longer contagious. Treatment with bicillin or penicillin does not give such a quick effect and the person continues to pose a danger to sexual partners until the end of the course of treatment with bicillin. If you are allergic to penicillin, treatment with second-line drugs, such as tetracyclines, is possible.

• What to do if accidental unprotected sexual intercourse occurs

Specific antibodies to syphilis and HIV appear in the blood 3 to 4 weeks after infection. But you should consult a doctor 1 week after suspicious sexual contact. You should not take any medications before consulting a doctor. The doctor will prescribe a special laboratory test called immunoblot. This is a highly specific and highly sensitive method that allows you to detect traces of developing antibodies to the causative agent of syphilis.

For patients who have had syphilis in the past, it is important to understand the difference between a total test for immunoglobulins M and G and their determination in the blood separately. Their total analysis will always be positive, because immunoglobulin G remains in the blood of those who have previously had syphilis. Only immunoglobulin M indicates a new infection. This is a rather complex question; you should not solve it yourself using the Internet.

After suspicious unprotected sexual intercourse, a blood test is required for syphilis, an HIV test (this is also taken no earlier than 3-4 weeks after contact) and hepatitis C, which is easily transmitted through sexual contact. At the same time, a scraping is taken from the urethra or from the vagina and cervix for markers of diseases that are predominantly sexually transmitted. Their pathogens include gonococcus, trichomonas, ureaplasma, metaplasma, chlamydia, candida, gardnerella. The only correct approach to suspicious unprotected sexual intercourse is to take the entire set of tests.

• How to protect yourself from sexually transmitted diseases

A good condom guarantees protection against STDs, provided that it is put on correctly, that it does not burst, and that extragenital contacts - oral and anal - were also carried out in a condom. Today, there is no better protection against STDs than a condom. Treating the genitals with drugs like Miramistin is not effective!

Malignant syphilis

If a syphilitic infection returns after therapy, it may develop a malignant form.

The cause can be either relapse or reinfection (re-infection).

The resulting hard chancre is prone to necrosis and peripheral growth.

The initial period in case of infection lasts only 3-4 weeks, and then a rash appears on the body.

In addition to spots, rupee, ecthyma, and impetigo (pustular syphilide) appear.

The eruptions become ulcerated.

Serological tests may be negative.

But they become positive after the start of penicillin therapy.

General symptoms of relapse of syphilis appear if it occurs in a malignant form:

• fever
• weakness
• intoxication

The disease does not go into a latent state for months.

If this happens, remissions are very short.

Clinical relapses follow one after another.

Patient mistakes as a cause of relapse of syphilis

The patient's mistakes begin only after the doctor makes a mistake.

Namely, he will send a patient with syphilis home for treatment.

At home, a person can make many mistakes.

Basically they are the following:

• replacing an expensive drug with a cheap one because the pharmacy said it was “the same thing”
• refusal to use antibiotics due to personal belief that all diseases, including syphilis, can be treated with pickles, pine cones or propolis
• skipping injections due to lack of discipline
• use of incorrect doses (the name of the drug is the same as prescribed by the doctor, but the dose at the pharmacy was given differently)
• incorrect frequency of drug use (either I forgot how to inject, or did not consider it necessary to follow the doctor’s instructions in full)
• not all medications are purchased and used (the patient considers some medications important, but for some reason does not take others)

The most common mistake a patient makes is that he is not treated completely.

He tells the doctor that he continues to inject antibiotics.

But he refuses them because:

• symptoms have passed;
• the person considers himself healthy;
• fears the harm of antibiotics to health;
• the injections are painful, and there is no longer a living place on the “soft spot”;
• does not want to spend any more money on treatment.

All these factors combine.

Of course, if a person considers himself sick, he is ready to spend money on treatment and endure painful injections.

But if he believes that he has already been cured, and the doctor prescribes further injections just to be on the safe side, he can stop using the drugs.

Not in 100% of cases, but sometimes this results in relapses.

They can happen even several years after the end of therapy.

And all because the person was lazy or did not consider it necessary to complete the course, as a result of which a “handful” of bacteria remained in his body.