Symptoms of sexual syphilis infection in men: chancre and rash

Syphilis: symptoms and first signs, how to treat syphilis

Symptoms of syphilis depend on the stage of the disease, age and gender of the patient. The course of this venereal chronic disease may have its own characteristics in each specific case. It is even capable of being asymptomatic for the time being in a latent state.

A distinctive feature of treponema pallidum is its exceptional contagiousness, which is why it is so important to survey the population in order to avoid an epidemic of this disease.

The worst thing is when it has a hidden course and the person does not even realize that he is a carrier of syphilis and poses a danger to his family and others.

How is it transmitted?

Syphilis is caused by Treponema pallidum, which lives in the external environment for only 3 minutes. Therefore, the main route of transmission of the disease is sexual. Infection of the fetus is possible in utero (vertical route) or intrapartum, when the child passes through the mother’s birth canal.

The household route of transmission is uncommon; infection is possible from persons with the tertiary stage of syphilis, when treponema pallidum gets on dishes, linen, towels, etc. from decaying gums. Hematogenous transmission of syphilis through blood transfusion cannot be ruled out.

Cases of infection of medical workers through contact with the blood of a patient are not that rare. It is possible to become infected through “bloody” objects: a shared toothbrush, razor, manicure set, etc.

Syphilis - incubation period

The incubation period is a period of illness that lasts from the moment Treponema pallidum enters the body until the appearance of the first signs of syphilis (see photo), including chancre in combination with regional lymphadenitis. During this period, there is a gradual increase in the number of pathogen cells at the site of their introduction into the patient’s body. Treponema reproduces by division on average once every 30-32 hours.

This period of the disease is characterized by the absence of registered clinical and serological changes in the patient’s body; it lasts on average 3-4 weeks, it can be shortened to 8-15 days or lengthened to 108-190 days. A shortening of the incubation period occurs, as a rule, when the body is simultaneously infected from 2 sources; it is lengthened when taking antibiotics after the moment of infection, for example, for a sore throat, although it should be noted that an increase in the incubation period is not always due to the use of antibiotics.

Stability of pathogens in the external environment

• Treponema pallidum is resistant to low temperatures. Can withstand freezing for up to one year. Pathogenic strains of pathogens are stored in an oxygen-free environment at low temperatures (20 - 70 ° C) or dried from a frozen state.
• Treponemas retain their virulence on environmental objects until they dry out. At temperatures up to 42°C, the activity of bacteria first increases, and then they die. When heated to 60°C, treponemes remain active for 15 minutes. For more than 3 days, syphilis pathogens retain their pathogenic properties in cadaveric material.
• Outside the human body, bacteria quickly die. At a temperature of 100°C they die instantly. Treponema pallidum is sensitive to disinfectants and some antibiotics.

Rice. 2. To identify bacteria, an immunofluorescence reaction is used.

Primary syphilis

After the end of the incubation period, the characteristic first symptoms of syphilis appear. At the site of penetration of the treponemas, a hard chancre is formed, a specific round erosion or ulcer, with a hard, smooth bottom and “turned-up” edges. The size of the formations can vary from a couple of mm to several centimeters. Hard chancre can disappear without treatment. Erosions heal without a trace, ulcers leave flat scars.

The disappearance of chancre does not mean the end of the disease: primary syphilis only passes into a latent form, during which the patient is still infectious to sexual partners.

After the formation of hard chancre, local enlargement of the lymph nodes begins after 1-2 weeks. When palpated, they are dense, painless, and mobile; one is always larger than the others. After another 2 weeks, the serum (serological) reaction to syphilis becomes positive, from this moment primary syphilis passes from the seronegative stage to the seropositive stage. The end of the primary period: body temperature may rise to 37.8 - 380, sleep disturbances, muscle and headaches, and joint aches appear. Dense swelling of the labia (in women), the head of the penis and the scrotum in men is possible.

Secondary syphilis

The infection generalizes by 3 months from the moment of infection and lasts 3-5 years, this period is characterized by multiple different-looking rashes in various organs and tissues, and therefore absolutely any symptoms depending on which system/organ is affected more and how much it is affected was previously compromised, that is, was he healthy at the time of the defeat - if so, then the manifestations of syphilis will be minimal.

During this period, there are prodromal symptoms (as with colds - general malaise, pain in muscles, joints, the appearance of fever), they last 7-10 days until the appearance of syphilomas (roseolous-papular rashes) - often these are small red spots with clear boundaries , not merging with each other. When pressed, they disappear, and then appear, or may turn yellow due to the destruction of red blood cells. These rashes do not destroy tissue and, with antisyphilitic treatment, disappear instantly. These rashes are recurrent in nature, that is, they appear again, but are not as pronounced and in much smaller quantities.

Tertiary syphilis

Tertiary syphilis is characterized by a long latent course. It can appear after 3-4 years (with complete absence of treatment, or with insufficient treatment). Most often, this form of pathology can be found in patients suffering from chronic alcoholism, tuberculosis or other infections.

During this period, a small amount of dense infiltrates, localized in the subcutaneous tissue or in deeper tissues, is found on the patient’s skin and mucous membranes. After some time, they disintegrate, and in their place painless ulcers appear, which scar only after a few months or years. It should be noted that such syphilides are not accompanied by subjective disorders and do not disturb the general condition of the patient. They contain very little pathogen, and therefore are practically non-contagious.

Treponema pallidum under a microscope

The cytoplasm of syphilis pathogens contains a large number of hydrophobic components, which is why they are poorly stained with aniline dyes. According to the Romanovsky-Giemsa method, bacteria are stained pale pink, which is why they are called “pale treponema.”

• Treponemas are clearly visible using phase-contrast (dark-field) microscopy. In a freshly prepared smear with live pathogens, smoothly bending spiral-shaped bacteria are visible in a dark field. From saprophytic spirochetes, which are found in the oral cavity and on the mucous membranes of the genital organs, pale treponemas differ in the uniformity of curls, they are thinner, carry out smooth wave-like movements and are able to bend at an angle.
• Bacteria are clearly visible in smears prepared by silver impregnation (Levaditi technique). Treponemas are stained black and are clearly visible against the background of yellow-stained cells of the tissues under study. Silver is deposited on bacterial cells, increasing their diameter.
• An immunofluorescence reaction is used to identify bacteria. Bacteria in the smear, treated with luminescent serum, glow in the ultraviolet rays of a fluorescent microscope.

Rice. 10. The photo shows pale treponema under a microscope: silver impregnation (photo on the left), dark-field microscopy (photo in the middle), immunofluorescence reaction (photo on the right).

Congenital syphilis

It is transmitted from a sick mother when treponemes penetrate the placenta into the fetus. Syphilis infection can occur both during conception and much later. Regardless of the time of infection, pathological tissue changes are observed only in the VI-VII months of pregnancy, so active prevention of syphilis in the early stages will help give birth to a healthy child.

The possibility of transmitting pathogens through the father's sperm has not yet been proven, so all preventive measures usually concern the expectant mother. These include: identification of sick women in the early stages, full registration of pregnant women, monitoring the treatment of infected persons. In order to prevent the development of negative changes, mandatory regular examinations of pregnant women are carried out for the presence of treponemas and external signs of congenital syphilis.

Features of syphilis symptoms in men and women

The secondary and tertiary periods have almost the same symptoms. Differences in symptoms for men and women are present only in the primary period, when chancre appears on the genitals:

• gangrenous chancre on the penis - there is a possibility of self-amputation of the distal part of the penis;
• chancre on the cervix. Signs of syphilis, when hard chancre is located on the uterus in women, are practically absent and can only be detected during a gynecological examination;
• chancre in the urethra is the first sign of syphilis in males, which is manifested by discharge from the urethra, a dense penis and an inguinal bubo.

Diagnostics

Syphilis is diagnosed by examination, characteristic signs and laboratory tests:

1. Examination by a dermatovenerologist. He asks the patient in detail about the course of the disease, examines the skin, genitals, and lymph nodes.
2. Detection of treponema or its DNA in the contents of gummas, chancre, syphilides using dark-field microscopy, direct immunofluorescence reaction, and PCR.
3. Instrumental studies: search for gummas using ultrasound, MRI, CT, X-rays, etc.
4. Carrying out various serological tests: Non-treponemal - search for antibodies against treponema membrane lipids and phospholipids of tissues destroyed by the pathogen (Wassermann reaction, VDRL, rapid plasma reagin test). The result obtained may be false positive, i.e. show syphilis where there is none. Treponema - search for antibodies to Treponema pallidum (RIF, RPHA, ELISA, immunoblotting, RIBT).

Remember that for such a serious disease you cannot diagnose yourself “on the Internet” by reading about syphilis and its symptoms. The fact is that the rash and other changes can visually copy those of completely different diseases, so that even doctors are periodically misled.

Characteristics of the pathogen: external structure

Treponema pallidum resembles a corkscrew in appearance. It has 8 - 14 equal-sized curls, the height of which decreases at the ends. The spiral shape of the pathogen is preserved in all cases and under all conditions. The length of the microorganism is from 5 to 15 microns, the width is 0.2 microns.

Rice. 4. The photo shows the causative agent of syphilis Treponema pallidum (view under an electron microscope).

"End" formations

The ends of most treponemes are pointed. They contain disc-shaped outgrowths (blepharoplasts) with 10-11 fibrils attached to them.

The fibrils stretch along the body of the treponema and wrap around it, providing the bacteria with a spiral shape. From each end there are 2 independent bundles of fibrils. They are located under the outer wall, passing above the cytoplasmic membrane. Fibrils were also found under the cytoplasmic membrane. They are thinner and more numerous. The fibrils of the external bundle ensure movement of the treponema; they are twice as thick. They are long tubes consisting of flagellin protein, which is quite resistant to the action of a number of enzymes. The fibrils of the inner layer play the role of a framework.

At one end of the bacterium there are two round structures (corpus spongiosum). It ensures active penetration of bacteria into host cells.

Treponema pallidum can perform translational (back and forth), rotational, flexion, wave-like (convulsive) and helical movements.

Rice. 5. The photo shows treponema pallidum (cultured form).

Rice. 6. The photo shows pale treponema with a magnification of 3000 times (dark-field microscopy). This type of research allows you to record the shape and movement of living bacteria.

Consequences of syphilis

If left untreated, syphilis gradually spreads throughout the body and affects more and more healthy tissues and organs. Sometimes there is temporary relief, after which the patient’s condition sharply worsens. Complications of syphilis depend on its stage.

Primary syphilis can be complicated by the following conditions:

• tissue necrosis at the location of the chancre;
• balanitis;
• phimosis;
• paraphimosis

With secondary syphilis, the following complications are noted:

• damage to internal organs by syphilis;
• damage to the nervous system;
• bone damage.

Complications of tertiary syphilis are:

• damage to internal organs;
• brain damage;
• Treponema damage to the tissues of the neck and face;
• pathological fractures of bones when they are affected by syphilis;
• bleeding as a result of vascular rupture.

Internal structure of Treponema pallidum (ultrastructure)

Mucoprotein "case"

The body of the bacterium is surrounded by a mucus-like structureless substance (microcapsule). This mucopolysaccharide substance protects treponemes from phagocytes and antibodies. The capsular substance is produced by the treponema itself.

Cytoplasmic membrane

The cytoplasmic membrane of bacteria performs a number of vital functions: transport, protective, is the site of localization of antigens and enzymes, it takes an active part in cell division, L-transformation and sporulation. The cytoplasmic membrane has a three-layer structure. Its inner layer forms numerous outgrowths in the protoplasmic cylinder, due to which the active transfer of nutrients from the outside occurs. The vital activity of bacteria depends on the state of the cytoplasmic membrane.

Protoplasmic cylinder

The protoplasmic cylinder is located under the outer wall. The structure of the cytoplasm of Treponema pallidum is finely granular. Ribosome granules and many lamellar structures are immersed in the transparent hyaloplasm. Ribosomes provide protein synthesis in the bacterial cell. The cytoplasm also contains a nucleotide that does not have a limiting membrane. It stretches along the entire length of the protoplasmic cylinder.

Mesosomes

Mesosomes are derivatives of the cytoplasmic membrane. They occupy half or the entire axis of the diameter of the treponema. Mesosomes supply energy to the bacterial cell at points of increased growth during sporulation and division. Their function is similar to mitochondria. Mesosomes differ in the nature of their structure, but their number is always very large.

Rice. 7. Ultrastructure of Treponema pallidum. Mucoprotein cover on top, then a three-layer cell wall, inside there is a cytoplasmic membrane and a cylinder with nucleotide, mesosomes, ribosomes and other inclusions. The photo clearly shows the fibrils running along the body of the bacterium.

How to treat syphilis?

The treatment of syphilis is approached in a comprehensive manner, taking into account many individual factors (age, gender of the patient, stage of development of the disease, the presence of concomitant diseases, general condition of the body, etc.). In addition, all sexual partners of the suspected patient should also be examined for the presence of syphilis and, if necessary, undergo a course of therapy.

If a patient has primary syphilis, then everyone who has had sexual intercourse with him over the past three months must undergo examination and tests. In the case of secondary syphilis - everyone who had contact with the patient over the past year. The timeliness of the therapy itself, as well as the correct selection of modern medications, is important for achieving success in the treatment of this disease.

The most effective method of treating syphilis is the introduction of water-soluble penicillins into the body. This therapy is carried out in a hospital setting for 24 days with injections every 3 hours. The causative agent of syphilis is quite sensitive to penicillin antibiotics, but there is a possibility of an allergic reaction to these drugs or the ineffectiveness of such therapy. In this case, penicillin is replaced with drugs of the tetracycline, macrolide, and fluoroquinolone groups. In addition to antibiotics, natural immune stimulants, vitamins, and immunostimulants are also indicated for syphilis.

Cultural properties of syphilis pathogens

Treponema pallidums are obligate anaerobes - they live and grow in the absence of molecular oxygen. Bacteria practically do not grow on artificial nutrient media. For their cultivation, media containing horse and rabbit serum are used, on which pale treponema grows slowly and loses its virulent properties. Growth occurs at a temperature of 350C. Colonies of syphilis pathogens appear on 3–5 (on some media 7–9) days.

Rice. 11. The photo shows the growth of colonies of Treponema pallidum.

Prevention

Standard preventive measures include avoiding casual sex, using condoms, and to prevent occupational syphilis, wearing disposable latex gloves before examination, manipulation and surgery.

Condoms are not 100% protection - the chancre can be located extragenitally (pubis, perineum), and with secondary syphilis, a “necklace of Venus” is formed on the skin. In these cases, the infection from syphilis is transmitted by contact to the partner’s skin.

With syphilis, lifelong immunity is not formed. Having successfully recovered from this disease, you can become infected and get sick again. In this case, the disease will be just as severe. Therefore, there are no vaccinations against syphilis, and there cannot be.

Introduction to Basic Concepts

The literal translation from Latin - “infection” - very accurately positions this disease, because syphilis today is one of the three most common sexually transmitted diseases. The disease is extremely insidious and deadly, but the patient has every chance of a successful outcome if he does not neglect certain external signs. The theme of the new collection of photos from the website Obolezi.com is the features of the rash due to syphilis.

Forecast

It all depends on the stage of development of the disease and the treatment method. If therapy was started in the early stages of the disease (primary, secondary and early latent syphilis) and is carried out using treponemocidal antibiotics, then in almost all cases without exception, a complete clinical cure occurs, and relapses of early syphilis and the occurrence of late forms of syphilis are prevented.

Treatment of syphilis in pregnant women in the first half of pregnancy in most cases guarantees the birth of a healthy baby. In the case of congenital syphilis, the prognosis is favorable if treatment of the disease was started in a timely manner. Treatment of later forms of the disease is less successful, since it only slows down the progression of the disease, but in all cases it can restore the impaired function of the affected organs and lead to negative serological reactions.