Syphilis symptoms: a complete overview of possible manifestations. Symptoms and signs of syphilis in women and men. Causes and how to treat syphilis

Everyone needs to know how to recognize syphilis. Timely detection of this disease will help ensure a quicker cure.

The first observations of patients with syphilis in Europe date back to the 15th century; the symptoms of syphilis were described by the Italian physician Hieronymus Fracastoro. The pathology is named after the shepherd Syphilus, punished by the gods for his insolence, who was sent a disease that affected the genitals and turned him into a monster.

Europe experienced several disease pandemics during the Middle Ages; Depending on the countries from which the infection spread, it was called the French, Spanish or Italian disease. One of the common names for the disease is LUES.

Until the mid-fifties of the last century, the disease was actually a “delayed death sentence”, very quickly shortening a person’s life. The study of the disease and its treatment in medicine deals with a special field - syphilidology.

Syphilis - chronic venereal disease, spreading both sexually and by contact, systemically affecting the body. A distinctive feature of the disease is its cyclical course.

The widespread use of antibiotics (since 1943) has made it possible to completely cure the disease in the primary and secondary stages. The unjustified use of antibiotics in medicine has led to the erosion of the clinical symptoms of the pathology and made the course of syphilis hidden. According to medical statistics, 12-15 million people in the world are infected every year, so the question of how to identify syphilis remains relevant today.

The following cycles of the disease are distinguished:

Hidden;
Primary;
Secondary;
Tertiary.

Each of these cycles is divided into periods. Primary syphilis is classified depending on the blood test results:

Seronegative;
Seropositive.

The second cycle of disease development forms:

Hidden;
Fresh;
Recurrent syphilis.

In the last stage, or tertiary, both latent and active syphilis is observed.

The causative agent of the disease and routes of infection

The cause of the pathology is living exclusively in human body spiral-shaped bacterium Treponema pallidum (spirochete). It is not stable in the external environment, can withstand heating at a temperature of 50 degrees for no more than half an hour, does not survive contact with alcohol, soap, and dies when dried. It has the ability to penetrate the human body through the slightest lesions and microcracks in the mucous membranes and skin.

Direct infection occurs through sexual contact with an infected partner; the risk during unprotected sex with a new partner is 50%.

Treponema penetrates through microcracks in the intestine or oral cavity.

If you have close household contact with an infected person (without knowing it), you can become infected through the use of common utensils or hygiene items, household items (lipstick, cigarettes, cups, toothbrushes). Nowadays, this route of transmission of infection is quite rare.

Infection with the pallidum spirochete can occur when unprotected contact with the patient's blood:

When injecting infected, untested blood;
If one injection syringe is used by spill people;
Due to a violation of safety precautions by medical workers when treating an infected person (delivery, dental treatment). Cases of infection of doctors during the autopsy of a patient suffering from syphilis have been described.

The first signs of infection in classical syphilis can be detected precisely at the point of penetration of the pale spirochete. Women are more susceptible to infection due to the specific structure of the genital tract - wide, prone to the appearance of wounds and cracks.

Distinctive signs of the disease in the first stage

The onset of the disease begins from the moment the infectious agent enters the body and lasts up to 40 days. If the spirochete enters the body simultaneously in several places, the incubation period is reduced to 10-15 days. If treatment with antibiotics is carried out, the period of transition of the disease to the second cycle extends to three months. During the incubation period, the disease cannot be visually recognized.

The beginning of primary syphilis is the moment of appearance of the main sign of the disease - chancre. OK occurs at the site of penetration of the spirochete and makes it possible to diagnose the method of infection.

A chancre is a hard round formation, often single, with clear, sharply defined edges raised above the skin, usually the size of a small coin, with a red, dark pink, glossy surface. It often has the shape of a concave disc, is hard to the touch, and the color is bloody red - this indicates infection.

When healing, such a chancre (you can see in the photo) will leave a scar on the surface of the skin. It is not painful, does not cause itching or discomfort. But it is difficult to confuse such a skin formation with ordinary skin defects - chancre manifests itself on:

The head of the male penis;
Foreskin;
Labia in women;
Border of mucous membranes and skin in the anus area;
Lips, tongue, corners of eyes;
Between the fingers.

A characteristic symptom in men is the appearance of a characteristic thickening surrounding the root of the penis - syphilitic lymphadenitis. It is painless and does not cause any inconvenience.

The manifestation of these signs with sufficient attention and having sex with stranger allows you to recognize infection after self-examination. Additional feature there will be an enlargement of several lymph nodes in the area where the chancre appears - when palpated under the hands, lumps the size of beans will move painlessly.

But in some cases, chancre is not detected after infection:

Treponema enters the body through the skin with deep wounds or lesions, then rashes will immediately appear on the skin;
Chancre is formed in the internal genital organs of women, the inside of the anus of men and is not detected in a timely manner;
When affected in the nail area, felon forms, which is difficult to diagnose.

When a patient is diagnosed with chancre and enlarged lymph nodes, the doctor uses laboratory methods to determine the disease. Laboratory tests may be negative for up to a month, since the main marker of the disease, nonspecific antibodies, is critically low in the blood. After 28 days, the presence of specific proteins for treponema can be determined.

Latent syphilis in men in the first cycles of the disease can only be determined by testing. This most often occurs when mandatory examination partners for syphilis during pregnancy.

Quite often, the first symptoms of the disease remain undetected; after the chancre disappears, the disease enters the second cycle, in which the lesions are much easier to visually recognize.

How to identify secondary and tertiary syphilis

Syphilis can be distinguished from the secondary form of syphilis at the beginning of the disease by the appearance of a characteristic rash - bright, multicomponent, located symmetrically over the body. Most often it is detected on the sides of the body, arms and legs. The rash is characteristic, painless, without peeling.

When pressed, the rash turns pale and disappears. The appearance of a rash is often accompanied by symptoms similar to ARVI. After some time, the rash will disappear, the active phase of the disease will turn into secondary latent syphilis. Patients with latent syphilis do not have external symptoms, but remain highly contagious.

When contacting a doctor at this stage, direct methods for diagnosing syphilis are used. Several laboratory methods are used for accuracy.

Recognition by analytical diagnostic methods

The identified complex of symptoms of syphilis in a patient must be confirmed by methods laboratory diagnostics. The following methods are used for this:

Microscopic (bacteriological) examination involves studying the wet contents of chancre or ulcers. Disadvantage - can only be used for severe forms of the disease;
A blood serum test (serological), which analyzes the presence of specific proteins (globulins) in the blood that are produced as antibodies to Treponema pallidum, is effective after the 28th day of infection, but may give incorrect results;
Tissue examination (histology) is prescribed if previous methods have not yielded results; tissue from subcutaneous or lymph nodes is examined to determine treponema pallidum.

The following types of tests are most often prescribed:

Immunofluorescence reaction;
Passive hemagglutination (reaction);
An enzyme immunoassay will detect the disease a month after infection.
Treponema pallidum immobilization reaction;
The Wasserman reaction is an outdated, inaccurate analysis with many errors.

To prevent the disease, a mass examination of certain categories of people who may potentially become infected or transmit the disease is carried out - doctors, teachers, pregnant women, donors, persons in custody, military personnel.

Syphilis belongs to the group of sexually transmitted diseases. In the vast majority of cases, the infection is transmitted sexually. The signs and symptoms of syphilis are numerous and varied, which is why the disease is diagnosed by doctors of different specialties. The disease occurs in waves and in stages, affecting the skin, mucous membranes, internal organs, osteoarticular and nervous systems. The infection from a sick mother is transmitted through the placenta to her baby.

Syphilis has been known since ancient times. Its signs and symptoms in different periods diseases are described in the works of Hippocrates, Galen, Celsus, Plutarch, Avicenna and other great scientists. The causative agent of syphilis is the bacterium Treponema pallidum.

Rice. 1. In the photo, chancre is the main sign of primary syphilis.

The role of Treponema pallidum in the development of syphilis

Syphilis is caused by a bacterium (Treponema pallidum). Mucous membranes and damaged skin are entry points for infection. Treponema pallidum quickly penetrates the lymphatic vessels, where they multiply vigorously and spread through the bloodstream throughout the body, settling in the tissues of internal organs, bones, joints and the central nervous system. Damage to the skin and mucous membranes is specific to this disease. Bez goes through a number of stages in its development - the incubation period, the primary, secondary and tertiary periods.

In the early stages of the development of the disease in the patient’s tissues, Treponema pallidum has a great destructive ability. They are found extracellularly and actively reproduce. Patients during this period are active spreaders of infection. Over the years, in the case of untreated or insufficiently treated syphilis, bacteria acquire the ability to hide from the negative effects of environmental factors (antibodies and antibacterial drugs, depletion of the nutrient medium, exposure to a number of physical and chemical factors) and transform into L-forms and cysts. In such forms, treponema can exist for a long time in the patient’s body, without showing itself in any way, and then reverse (turn into an active form), causing relapses of syphilis and its chronic course. In the later stages of syphilis, a minimal number of pathogens are recorded in the affected tissues, and patients become less infectious.

Rice. 2. Type of Treponema pallidum in electron microscope.

Incubation period for syphilis

Mucous membranes and even the most minor damage to the skin are the entrance gates for Treponema pallidum. Bacteria quickly penetrate the lymphatic tract, where they multiply intensively and penetrate into regional The lymph nodes. After 5 days, Treponema pallidum enters the bloodstream and by the end of the incubation period they have spread throughout the body. The incubation period for syphilis lasts 3 - 4 weeks. Its duration extends to 2 - 3 months with uncontrolled antibiotic treatment of other diseases and with infection with cyst forms of the pathogen. A shortened incubation period is recorded in patients with the occurrence of several chancre.

The incubation period ends when primary signs syphilis - primary syphiloma (“hard” ulcer, chancre).

Rice. 3. Manifestations of syphilis in the primary period - chancre on the penis and tongue.

Stages of syphilis

The course of the disease is undulating and gradual. Specific signs of syphilis after the manifest course spontaneously disappear, and then reappear, changing their color.

Primary period of syphilis begins from the moment of appearance of primary syphiloma (hard chancre) and lasts until the moment of appearance - on average 6 - 7 weeks.

Secondary period characterized by the appearance of various rashes on the skin and mucous membranes, damage to internal organs, bones, joints and central nervous system. The active period lasts from several weeks to several months. Then the rashes disappear without a trace even without treatment. The latent phase of the disease begins. It lasts from several weeks to several years. The undulating course of the disease is the most important sign of early syphilis.

After 3 - 4 years from the moment of infection, it develops (late syphilis), which is characterized by the appearance of gummas - late syphilides (nodes), irreversibly destroying the organs and tissues in which they are located. The disease often ends in severe disability and even death of the patient.

After 10 - 20 years it develops fourth period of syphilis. The central nervous system is affected - tabes dorsalis, progressive paralysis, or a combination thereof develops.

Rice. 4. Signs of secondary syphilis - papular syphilide (photo on the left) and syphilitic roseola (photo on the right).

Signs and symptoms of syphilis in the primary period

The primary period of syphilis begins from the moment of the first manifestation of the disease - the appearance of a small erosion or ulcer at the site of introduction of pale treponema, which is called a “hard” ulcer, chancre, primary syphiloma. Its edges are raised, smooth, the bottom is smooth and shiny. The ulcer is dark pink in color, painless, with a dense cartilaginous infiltrate at the base.
The full picture of the disease is preceded by septicemia - the entry of pale treponema into the blood. During this period, the patient is often bothered by malaise, headache, and muscle and joint pain. There is a characteristic discrepancy between the completely satisfactory general condition patient and high temperature bodies.
A week after the appearance of chancre, regional lymph nodes enlarge. They are dense and mobile.
The duration of the primary period is from the moment the chancre appears until the appearance of the rash, which marks the beginning of the secondary period of syphilis (on average 6 - 7 weeks).
After 20 - 30 days, primary syphiloma heals. In some patients, it heals until rashes appear - the appearance of secondary syphilides; in other patients, healing is completed already in the second period of syphilis. When pale treponema enters directly into the blood, primary syphilomas are absent. Syphilis in this case is called “decapitated.”

Chancre, inflammation of the lymphatic vessels and enlargement of regional lymph nodes are the main signs and symptoms of syphilis in the primary period of the disease.

During traditional sex chancres are located in the genital area.

During oral sex chancrees appear on the mucous membrane of the lips, oral cavity, often on the tongue and the area of one of the tonsils, resembling or in the acute stage. Primary chancre on the tonsil can have an ulcerative, sore throat-like or mixed form. At the same time, the cervical and submandibular lymph nodes enlarge.

During anal sex chancres form in the anorectal area.

Chancre in women sometimes manifests itself in the form of inducing edema and resembles bartholinitis. The labia enlarges significantly and acquires a purplish-bluish color. The gynecologist’s doubts will be resolved by performing a simple and quick (within 20 minutes) test based on the microprecipitation reaction.

For medical workers sometimes registered atypical form primary syphilis - chancre-felon. The disease is associated in this case with professional activity.

Rice. 5. Chancre, inflammation of the lymphatic vessels and enlargement of regional lymph nodes are the main symptoms of primary syphilis.

Rice. 6. In the photo there are multiple hard chancres on the genitals of a woman and a man.

Rice. 7. Hard chancre in the anorectal area (photo on the left) and hard chancre in the form of indurative edema (photo on the right).

Rice. 8. Hard chancre on the lips and in the oral cavity on the tongue.

Rice. 9. Medical workers sometimes report an atypical form of primary syphilis - chancroid felon (an occupational disease).

Signs and symptoms of secondary syphilis

The secondary period of syphilis begins with the generalization of the infectious process. Various rashes (secondary syphilides) appear on the skin and mucous membranes; internal organs, the nervous system, joints and bones are less commonly affected.

The duration of secondary syphilis is 3 - 4 years. Periods of a pronounced clinical picture are replaced by a hidden, latent course. Each new relapse is characterized by fewer and fewer rashes, each of which is larger and less intensely colored. At the end of the second stage of syphilis, monorelapses occur, when the clinical picture is limited to a single element. The patients' well-being suffers little.

Patients in the second period of the disease are the most contagious.

Syphilis rash

First generalized rash in a patient previously untreated for syphilis, it lasts 1.5 - 2 months. It is abundant, symmetrical, small in size, brightly colored, located on skin chest, stomach, covers the back, side surfaces torso and rarely face. Lymph nodes always increased.

During the second wave of recurrent syphilis the rash is more limited, tends to group with the formation of arcs, garlands and rings. The number of elements is significantly less than during the initial rash and subsequently decreases even more with subsequent relapses.

The rash with syphilis has its own characteristics:

In the initial stage, the rash is bright, Pink colour, later she turns pale. Depending on the location, the rash of syphilis may have a cherry, copper-red, yellowish or bluish color.
There are no acute inflammatory phenomena.
The elements of the rash are not large, are not prone to radiance and peripheral growth, there is no peeling or itching.
Various other types of rashes are often reported simultaneously.
A benign course of secondary syphilides is noted.
After healing of secondary syphilides, no scars remain.
Elements of the rash with syphilis quickly disappear under the influence of specific treatment.

Secondary syphilides, especially in the form of erosions and ulcerations, are extremely contagious.

Syphilitic roseola or spotted syphilide

Syphilitic roseola occurs in 80% of patients with syphilis in the secondary period. The first “fresh” roseola appears 10 weeks from the moment of infection or 6 to 8 weeks after the appearance of chancre. It is most often pale pink in color. From 0.2 to 1.5 cm in diameter. In the same patient, roseola, due to evolutionary polymorphism, may have different shades of pink in saturation. The spots do not differ from the surrounding skin in either consistency or relief. There is no peeling.

Syphilitic roseola is hardly noticeable on the genitals. Roseola in the oral cavity are located in the area of the tonsils and soft palate, sometimes merging, forming continuous areas of hyperemia, sharply demarcated from the normal mucous membrane. Often, simultaneously with secondary syphilis, papular and erosive-ulcerative syphilides appear in the oral cavity. Elevated, papular, exudative, follicular and confluent roseola are relatively rare.

Such diseases as spotted toxicoderma, pityriasis rosea, “marbled” skin, rubella and measles have a similar picture of rashes.

Rice. 10. Rash with syphilis of the second period - spotted syphilide (photo on the left) and papular syphilide (photo on the right).

Rice. 11. Erythematous sore throat with syphilis. Roseola in the oral cavity merge to form continuous areas of hyperemia, sharply demarcated from the normal mucous membrane (photo on the left) and papular syphilide (photo on the right).

Papular syphilide

Papular syphilide is a collection of cells in upper sections dermis (cellular infiltrate). Papules are round in shape, clearly demarcated along the periphery from the surrounding tissues, dense in consistency, pointed or hemispherical, located in isolation. Fresh papules are shiny and smooth, soft pink in color, but can be copper or bluish-red in color. After 1 - 2 months, the papules resolve. When papules resolve, their surface is sometimes covered with scales. After resorption, brownish pigmentation remains in place of the papules.

Unfavorable conditions lead to damage to the top layer of papules ( erosive papules). When infected with secondary flora, they form ulcerative papules. Sometimes papular syphilides hypertrophy and grow ( condylomas lata).

When located in the folds of the skin in case of irritation (increased humidity and sweating), papules tend to grow peripherally and merge. They are often subject to erosion and ulceration ( weeping papular syphilide). The genitals, perineum, anorectal area, interdigital spaces, armpits, in the folds of the neck and under the breasts in women are their favorite localizations. Weeping papular syphilide is the most contagious form of papular syphilis.

Papules have different sizes, which is why they are divided into miliary, lenticular, nummular (coin-shaped) And plaque-like papular syphilides.

Rice. 12. Papular rash with secondary syphilis.

Rice. 13. The photo shows symptoms of secondary syphilis - syphilide of the face and papules on the scalp.

Rice. 14. The photo shows symptoms of secondary syphilis - papular syphilide of the face.

Rice. 15. When papular syphilides grow, condylomas lata are formed.

Rice. 16. A sign of syphilis of the secondary period is psoriasiform syphilide (photo on the left) and nummular (coin-shaped) syphilide (photo on the right).

Papular plantar and palmar syphilides

IN last years There has been an increase in cases of papular plantar and palmar syphilides. Syphilitic papules, due to the thick stratum corneum, are only visible through the skin. They have a red-brown color. On the feet they are most often located in the area of the arches, on the palms - in the center.

When the papules resolve, yellowish spots remain in their place, and scales of the epidermis appear along the periphery in the form of a corolla (Biette's collar) - a sign of syphilis. Sometimes papules on the soles and hands resemble calluses - formations sharply demarcated from healthy areas of the skin.

Rice. 17. Palmar syphilide.

Rice. 18. Plantar syphilide.

Papular syphilide of the mucous membranes

Papular syphilide of the mucous membrane of the cervix and vagina does not occur. Papules in patients with syphilis in the secondary period may appear on the oral mucosa. They are dense in consistency, round, whitish in color, with a smooth surface, painless.

Papular syphilides often appear on the lips along the line of closure of the teeth, soft and hard palate. Papules in the corners of the mouth often become crusty, crack, and resemble jams. Papules on the back of the tongue look like oval, devoid of papillae, bright red formations (“mown meadow symptom”). When papules are located on the vocal cords, syphilitic dysphonia develops, rarely turning into complete aphonia. All elements of the rash with syphilis in the oral cavity are extremely contagious. Papular syphilide of the oral cavity poses a great danger to dentists.

Rice. 19. In the photo there is syphilis in the mouth - papular syphilide of the tongue.

Rice. 20. In the photo there is syphilis in the mouth: papular syphilide hard palate and tongue (photo on the left) and syphilitic seizure (photo on the right).

Pustular syphilides

Pustular syphilides in secondary syphilis are rarely recorded and appear more often in weakened patients. Acne, impetiginous, smallpox-like, syphilitic ecthyma and rupee— the main types of pustular syphilides. In drug addicts and alcoholics, syphilides of the secondary period acquire a malignant course. Multiple ulcers appear on the skin of the face and torso, covered with purulent crusts, reminiscent of severe pyoderma.

An important criterion when carrying out differential diagnosis with other diseases is the presence of a clearly demarcated ridge of copper-red infiltrate along the periphery.

Rice. 21. Signs of syphilis of the secondary period - pustular syphilide - ecthyma.

Rice. 22. The photo shows impetiginous pustular syphilide of the face.

Rice. 23. In the photo, the symptoms of malignant syphilis of the secondary period are deep skin lesions - syphilitic ecthymas and rupees, multiple papules and acneiform syphilides.

Syphilide herpetiformis

Herpetiformis or vesicular syphilide is an extremely rare, severe manifestation of secondary syphilis. The disease is registered in weakened patients with chronic diseases and alcoholism.

Syphilitic alopecia

Hair loss due to syphilis can be diffuse, finely focal and mixed. Hair falls out quickly (overnight) or within 1 - 1.5 months. Eyelashes and eyebrows are often affected. For eyebrows with syphilis, small focal loss is typical. In place of the fallen eyelashes, they grow back, as a result of which they differ in different lengths (step-shaped eyelashes). The skin on the head does not become inflamed, there is no peeling or itching.

Similar signs are present with alopecia areata, superficial trichophytosis, microsporia, early baldness, lichen planus and lupus erythematosus.

Rice. 24. Alopecia is one of the signs of secondary syphilis.

Rice. 25. Alopecia in men.

Syphilitic leukoderma or pigment syphilide

One of the manifestations of secondary syphilis is leucoderma. Its appearance is associated with damage to the nervous system. Violation of pigment formation in the form of hypo- and hyperpigmentation is caused by trophic disorders. Leukoderma is most often localized on the posterolateral areas of the neck (“necklace of Venus”), less often on the back, torso, lower back and limbs. Against the background of pale yellow hyperpigmentation, round spots of depigmentation appear. They can be isolated or merge, taking on the appearance of “lace”. Leucoderma does not peel off or become inflamed and lasts for months and years. Cases of disappearance of leukoderma within a few days have been described. There are no Treponema pallidums in the affected areas. Under the influence of specific therapy, pigmentary syphilide does not disappear. Diseases such as pseudoleukoderma, vitiligo, plaque parapsoriasis and cicatricial atrophy have similar symptoms.

Rice. 26. A sign of secondary syphilis is leucoderma.

Visceral syphilis

Visceral syphilis (syphilitic damage to internal organs)

Internal organs with syphilis are affected already in the early stages of the disease, but are diagnosed much less frequently, since inflammation does not have specific signs. This circumstance leads to a large number of diagnostic errors.

Most often, syphilis affects the liver, stomach and kidneys. Damage to the gastrointestinal tract was observed in the form of syphilitic hyperplastic gastritis and enteritis, the lungs - in the form of specific pneumonia, the liver - in the form of syphilitic hepatitis, as well as the organs of vision.

Damage to bones and joints due to syphilis

Damage to bones and joints in syphilis begins at the end of the primary period, but obvious manifestations of the disease are recorded in the secondary period. Pain is the main symptom of syphilitic lesions of the osteoarticular system. The pain intensifies at night, more often appears in long periods of time. tubular bones on the legs, there is pain in large joints- knee and shoulder. Periostitis is rare.

Neurosyphilis of the secondary period

Neurosyphilis of the secondary period manifests itself mainly in the form of asymmetric meningitis, vascular lesions and autonomic dysfunction.

Patients with syphilis in the secondary period are identified by doctors of various specialties. The Wasserman reaction will help to identify and treat the patient in a timely manner.

Signs and symptoms of tertiary syphilis

After infection, tertiary syphilis develops 3 to 4 years later (without treatment). In a small proportion of patients (3 - 5%), the disease occurs immediately after secondary syphilis. In the majority of patients (95 - 97%), between the two periods there is latent period, the duration of which ranges from several to tens of years.

It is believed that the cause of the development of tertiary syphilis is the local activation of Treponema pallidum, as evidenced by the proliferation of tubercular syphilides along the periphery.

Tertiary syphilis is characterized by the development of destructive processes in the skin, mucous membranes, internal organs, osteoarticular and nervous systems. Gummas (late syphilides) are formed in the skin and internal organs, which irreversibly destroy tissues in their locations. Irreversible morphological and functional disorders occur.

After 10 - 20 years from the onset of the disease, damage to the central nervous system develops - tabes dorsalis, progressive paralysis, or a combination of both.

Patients develop tubercular syphilides. After some time, they either resolve or ulcerate.
In the subcutaneous fatty tissue they develop gumma. When the gumma is opened, a gummous ulcer is formed that heals over several months.
Healing ends with the formation of a retracted star-shaped scar. Gummas contain a small amount of pale treponema. Patients in the tertiary period of syphilis are less infectious.

The tertiary period of syphilis has its own characteristics:

the course and regression of the disease is slowed down,
periods of exacerbations are replaced by remissions (latent syphilis),
there are no subjective sensations or acute inflammatory phenomena,
rashes are monomorphic and asymmetrical,
Rice. 30. The disintegration of gummas located in the bones of the back of the nose leads to deformation of the organ. A saddle nose is a sign of the tertiary period of syphilis.

Articles in the "Syphilis" sectionMost popular

Today, many people are interested in questions about what the first symptoms of syphilis look like. After all, it’s no secret that with such a disease it is extremely important to start treatment on time - this is the only way avoid serious complications.

Unfortunately, not all people are aware of what signs accompany the primary stage of syphilis. That is why those infected simply do not seek help from a specialist, which is considered the main problem in modern medical practice. After all, the patient is a source of infection for others.

A little history...

In fact, the disease syphilis has accompanied humanity for hundreds of years. There is still debate among scientists and researchers about when such a disease appeared. And most of them are confident that syphilis is as old as humanity itself, although no mention of it has yet been found in the works of scientists from ancient civilizations.

Outbreaks of syphilis in Europe are associated with the campaigns of King Charles the Eighth in Italy. There is information that in those days the army was accompanied by a huge number of women of easy virtue, who “rewarded” the soldiers with this infection. When the army returned home, the disease quickly spread, first throughout France, and then throughout Europe.

Of course, in those days the disease had a different name - it was called “lues”. It was not until 1500 that the symptoms of syphilis began to be separated from those of leprosy. It was only in 1905 that scientists first managed to discover the causative agent of this disease. A year later, the famous scientist August von Wasserman developed a method for studying blood. This analysis (today known to science as the “Wassermann test”) still helps save lives.

At one time, many became victims of infection famous people, including monarchs, rulers and talented artists. It's no secret that such people suffered from syphilis famous personalities, like Beethoven, Vincent Van Gogh, Napoleon, Guy de Maupassant, Lucretia Borgia, Christopher Columbus, Leo Tolstoy, etc.

The causative agent of syphilis and its features

The causative agent of this disease is the pale spirochete, or treponema (Treponema pallidum), which belongs to the family of spirochetes. A bacterial cell is characterized by a very small size - it cannot be seen through a regular microscope, nor can it be detected when stained with traditional laboratory dyes.

This microorganism is a strict anaerobe, therefore it grows well and actively reproduces in an environment with a deficiency or absence of oxygen. However, bacteria can survive under normal conditions - they can remain on various household items for about three days. Spirochetes also tolerate cold well and low temperatures can retain the ability to reproduce throughout the year. But an increase in temperature has a detrimental effect on the microorganism - at 60 degrees Celsius, treponema dies. Bacteria are also sensitive to various disinfectants and antiseptics.

How is the infection transmitted?

Of course, the issue of transmission of this infection is extremely relevant today. The easiest way to spread bacteria is through unprotected sex. According to statistics, approximately 65 - 70% of patients become infected from a sexual partner. By the way, the data from sociological surveys are also extremely disappointing. Over the past few years, the number of patients with syphilis in Russia has increased almost 30 times. Outbreaks of the disease are also observed in many African countries, and even in more developed countries this disease can hardly be considered a rarity. Moreover, young people aged 15 to 20 years are most often affected, which is associated with the early onset of sexual activity.

By the way, using a condom cannot guarantee complete safety - you can catch an infection even with the appropriate level of protection. In addition, bacteria can enter the body during oral or anal intercourse. Transmission through saliva during kissing is also possible, although less likely.

IN modern medicine There is also such a thing as household syphilis. In this case, we are not talking about a specific type of disease, but rather about the route of transmission of the infection. If one of the partners (or simply people living in the same house) is infected, then there is always a chance of “picking up” the spirochete. After all, microorganisms can settle on household items. Sharing mugs, glasses, towels, toothbrushes, lipstick - all this can lead to infection. That is why household syphilis can hardly be considered a rarity.

In addition, infection with syphilis can occur through contact with the blood of a sick person (for example, during a transfusion, working in a laboratory, etc.). A child can pick up a spirochete from a sick mother during fetal development or childbirth.

Primary syphilis

Naturally, people are primarily interested in the question of what are the first signs of syphilis. This information is really important, because the sooner you notice changes in your own body, the sooner you will see a doctor and receive appropriate help.

In fact, there is a certain pattern according to which syphilis develops in most cases. The stages of the disease are as follows: primary, secondary and tertiary forms of the disease, which follow one after another. Moreover, each of these stages has a very characteristic clinical picture and comes with a unique set of symptoms.

First, treponema penetrates the body and migrates to the lymph nodes, where it begins to actively multiply. As a rule, the first manifestation of syphilis occurs four weeks after infection - this is the incubation period. At the site where microorganisms invade, a so-called chancre is formed, which opens as the disease progresses, forming a small ulcer. In this case, pain practically does not bother the sick person.

Most often, chancre appears in the area of the external genitalia. For example, in men it is often located on the head of the penis. However, the ulcer can be found on the skin of the thighs, abdomen, and sometimes near the anus. It is worth noting that sometimes chancre forms on the mucous membrane of the rectum, the cervix, or even on the tonsils - in such places it is almost impossible to detect it on your own, so infected people simply do not go to the doctor.

After some time, you can replace the enlarged lymph nodes next to the chancre - most often the infection invades the nodes located in groin area. In most cases, a person himself can detect an enlarged node, which is usually hard to the touch. In some cases, due to impaired lymphatic drainage, swelling of the labia, foreskin, scrotum, and tonsils appears (depending on the location of the infection).

This stage of the disease lasts about 2 - 3 months. If left untreated, chancre disappears. Of course, this does not indicate recovery - the disease moves to a new, more dangerous level.

Secondary form of the disease: main symptoms of syphilis

This stage of the disease lasts about 2 - 5 years. It is characterized by a wave-like course - the symptoms of syphilis appear and disappear. The main signs at this stage include the appearance of a rash. Rashes can form on various areas of the skin, including the torso, legs, arms and even the face.

By the way, the rash in this case can be different. Most often it looks like small spots of red or pink color with clear edges. The formation of papules or pustules is also possible. Sometimes syphilis is accompanied by another bacterial infection- in such cases, pustules may form on the skin. In any case, the rashes, as a rule, do not cause physical discomfort - there is no itching, no pain, no fever. Therefore, sick people rarely seek help from a specialist, which, naturally, allows the disease to progress further.

As for the other signs, when a rash appears on the scalp, partial alopecia develops - the hair in these areas falls out. In addition, the patient may notice an increase in certain lymph nodes.

By the way, in some patients, a rash on the body appears only when initial stage- during next years they do not have any visible signs syphilis. At the same time, other patients suffer from relapses constantly - the rash appears and then disappears. It is believed that a weakened immune system, frequent stress, hypothermia, exhaustion of the body, etc. can trigger a new outbreak of the disease.

Tertiary syphilis

The third stage of the disease, as a rule, begins 3 to 10 years after infection. It is accompanied by the appearance of so-called gummas. These are infiltrative tubercles with clear boundaries, formed on the tissues of internal organs. They are prone to decay and scarring.

In fact, gummas can affect almost any organ system, leading to dangerous complications. For example, if such tubercles “grow” on bone tissue, then a person develops arthritis, periostitis or another disease. Damage to the intra-abdominal lymph nodes leads to the development of mesadenitis, which is accompanied by severe pain. No less dangerous are gummas in the central nervous system, since their appearance often leads to damage to certain parts of the brain and gradual degeneration of the personality. If left untreated, syphilis is fatal.

Congenital form of the disease

As already mentioned, infection can also occur during pregnancy, since bacteria can easily penetrate fetal tissue through the placental circulatory system. As a rule, transmission of the pathogen occurs after the end of the first trimester. That is why pregnant women are strongly recommended to get tested for syphilis. The earlier the disease is detected, the easier it will be to eliminate the threat to the child’s health.

Of course, an infection can lead to disruption of the normal development of the fetus - in some cases, doctors even hold a consultation regarding termination of pregnancy. On the other hand, the child may be born quite viable. Congenital syphilis can be divided into several types:

The early form of the disease, as a rule, manifests itself already in the first two months of the baby’s life. The first signs of syphilis are the formation of a papular rash, as well as damage to the nasal mucosa. More serious complications include partial or complete destruction of the nasal septum, hydrocephalus, hepatosplenomegaly, and retardation in mental and physical development.
The late form of congenital syphilis is characterized by the so-called Hutchinson triad. Such children have corneal lesions, dental pathologies, and labyrinthine deafness.

In some cases, syphilis in children causes extreme severe complications up to fatal outcome. However, if the presence of infection is determined in time and adequate treatment is started, the prognosis for the child can be favorable. Therefore, you should never ignore symptoms or self-medicate.

Other types of syphilis

Today in medicine there are several forms of this disease. The classic type of the disease is easy to notice and, accordingly, cure. But there are more dangerous types of syphilis that you also need to know about.

Latent syphilis today is considered one of the main problems in venereology. Why? The fact is that in some people, treponema pallidum after penetration into the body does not cause any visible symptoms. In 90% of cases, this form of syphilis is discovered completely by accident, for example, during a routine examination or screening during pregnancy. At the same time, the infected person is not even aware of his problem, as a result of which he becomes a source of pathogenic microorganisms for everyone around.
There is another, no less dangerous type of the disease - sero-resistant syphilis. This form is spoken of in cases where, after a course of treatment, treponema is still present in the tests. Patients with a similar diagnosis require an additional course of antibacterial therapy. Unfortunately, it is not always possible to cure the resistant form of infection. And in some cases, the infected status remains with the person throughout his life.

Methods for diagnosing the disease

Today, there are many studies in which it is possible to determine the presence of treponema in the human body. When the first symptoms appear, you should go to the doctor. After a visual examination, the venereologist will decide which tests will be needed.

In case of primary syphilis, as a rule, bacterioscopic methods are informative, for which fluid from a chancre or a biopsy obtained from a lymph node is used as a test sample. A serological test for syphilis is considered no less accurate, during which it is possible to detect the presence of a specific substance in the body. immunoglobulin IgM. But it is worth considering that these tests are carried out only at the primary stage of the disease.

Secondary and tertiary syphilis require other studies. In particular, the most popular is the Wasserman test (RW analysis) - this is the test that is used in clinics for mass examination of patients. Such testing makes it possible to determine the presence of bacteria at any stage of the disease. However, the possibility of a false negative or false positive result cannot be excluded.

The most accurate method today is considered to be the immunofluorescence reaction (RIF). This method allows you to identify even hidden forms of the disease. Naturally, there are other methods laboratory research. For example, in some cases to obtain additional information the doctor refers the patient to a spinal cord puncture, after which the samples cerebrospinal fluid sent to the laboratory.

Modern methods of therapy

Treatment of syphilis is a long process. At one time, a single injection of large doses of penicillin was used to eliminate the infection. Now such a treatment regimen is considered incorrect.

Only the attending physician can select medications for the patient. Moreover, the sick person is obliged to follow all the specialist’s recommendations and strictly follow the intake schedule. In most cases, the presence of such an infection requires taking fairly large doses of antibiotics - most often substances of the penicillin series (penicillin, erythromycin, tetracycline) are used for this purpose. Patients who are allergic to these antibiotics receive other antibacterial drugs.

Since the doses of drugs in this case are really large, it is extremely important that treatment of syphilis takes place in a hospital setting under the constant supervision of medical personnel. In addition to antibiotics, immunomodulatory drugs are used. If there is a rash, the doctor may prescribe a special ointment that speeds up the healing process. To protect microflora, it is recommended to take products containing live strains of beneficial microorganisms.

If one of the sexual partners is diagnosed with syphilis, the other is also required to get tested and undergo a full course of treatment. Even if no signs of Treponema pallidum have been detected in the body, so-called preventive therapy is carried out. Compliance with this condition helps to avoid re-infection.

Primary and secondary syphilis is treated, as a rule, in 1.5 - 3 months. The tertiary stage of the disease requires longer therapy, which often lasts more than a year.

Disease prevention

Unfortunately, today there is no vaccine that can permanently protect against such a disease. People who have had syphilis can become infected again. Therefore the only effective measure prevention is the prevention of infection. This means that you should avoid promiscuous sexual intercourse, especially without using condoms. If unprotected sex still took place, it is worth treating the genitals antiseptic solution and make an appointment with a doctor.

It should be understood that not all carriers of the infection are aware of their own problem. Therefore, doctors recommend that people who are sexually active regularly get tested for STDs, as this helps to identify the disease in the early stages and, accordingly, eliminate the likelihood of the infection spreading. In addition, the disease is much easier to cure in the initial stages.

The first signs of syphilis appear 3-4 weeks after infection with the disease. The pathology has a wavy course. Treponemas actively multiply in the body and over time affect all internal organs and systems. The sooner the symptoms of syphilis are detected, the easier it will be for the doctor to eliminate the consequences of syphilis.

Incubation period

It is impossible to establish the exact period of incubation of treponemes. How long it will last depends on individual characteristics and the state of the immune system. If a person takes any medications during infection (for the treatment of another disease or for the purpose of prevention), then the incubation period increases significantly.

The first signs of syphilis may appear up to 190 days after infection.

If the infection gets into several places at once, the period of development of the disease will be reduced to 1-2 weeks. The incubation stage ends when the first symptoms of the disease appear. This may be a general malaise, inflammation of the lymph nodes, the appearance of a rash or chancre.

If treponema quickly enters the blood and spreads throughout the body, then the asymptomatic period of syphilis will move to the secondary stage of the disease, bypassing the first.

During the incubation period, microorganisms multiply. Once in the human body, treponemes begin to divide, this process occurs once every 30 hours. There are no symptoms at this stage of the disease. The primary stage of development of syphilis begins after the first signs of the disorder appear. If only a few weeks have passed from the moment of infection to the primary stage, then it will be easier for the doctor to detect microorganisms and prescribe effective treatment.

How does primary syphilis manifest?

If you know how syphilis progresses at different stages, you will be able to detect it in time and consult a doctor, this will minimize the risk negative consequences. Venereal disease has primary, secondary and tertiary forms. Signs of the disorder depend on the stage of development of the disease. Explicit characteristic features allow doctors to make a diagnosis based only on the patient’s condition and appearance.

Once in the body, treponemes move to the area of the lymph nodes and continue the division process there. In most patients, the incubation period ends at 4 weeks after infection. In the place where the penetration of organisms occurred, a hard chancre is formed. Over time, it will develop into an open sore that will ooze fluid or blood. The patient does not experience pain or discomfort.

Condensed areas appear in the genital area or oral cavity. Ulcers can also occur on the abdomen, thighs and near anus. In rare cases, ulcers form on the mucous membranes (rectal area, tonsils or cervix). It is impossible to independently detect a lump in such a place, since it does not cause discomfort and is isolated during primary syphilis.

In this regard, the infection continues to develop, and the person leads his usual lifestyle, comes into contact with other people and exposes them to serious danger.

With primary syphilis, the lymph nodes located near the chancre increase in size. The patient is able to detect this sign of the disease himself. When the lymph nodes in the groin area become enlarged and hardened, the outflow is disrupted, causing inflammation of the labia, scrotum or foreskin. Primary syphilis lasts no more than 3 months.

The first symptoms of secondary syphilis

In the absence of treatment for primary syphilis or violation of the rules for taking medications, a secondary form of infection appears. How it will be expressed depends on the discovered variety. There are 3 types of syphilis:

Fresh. It occurs as a result of primary syphilis. The symptoms are pronounced, so the disease can be detected early.
Hidden. Doesn't have external manifestations. It is usually detected as a result of tests.
Recurrent. Regular rashes and symptoms go away even without treatment. The signs of syphilis are not as pronounced as during the fresh form. Such relapses negatively affect the condition of the patient’s internal organs and systems.

The second stage of the disease lasts for several years (no more than 6). It will be expressed in the sudden appearance of symptoms of syphilis and their equally abrupt disappearance. The patient develops a rash on different parts of the skin. It can be found not only throughout the body, but also on the face and scalp.

The appearance of the rash and other signs depend on the type of symptom. During secondary syphilis, the following may be observed:

papules, spots have a rich pink or red color, have clear edges and do not cause discomfort;
pustules are diagnosed if present concomitant diseases, usually bacterial infections.

In the photo on the right you can see how the rash appears during secondary syphilis. At this stage, there is no acute pain, itching or peeling, so patients do not seek help from a doctor, but mistakenly believe that it is just food allergy or the body's reaction to new things.

After rashes, scars may remain on the skin.

Large lumps in the oral cavity (especially on the tongue) lead to speech defects. A rash during secondary syphilis that appears on the scalp leads to complete or partial baldness. Hair growth returns within a few weeks after completing a course of antibiotics.

Symptoms present in men with secondary syphilis colds. There is a temperature of up to 39 degrees, weakness and headache.

The first symptoms of tertiary syphilis

From the moment of infection to the appearance of the tertiary form of syphilis, it can take from 5 to 10 years. At this stage, gummas begin to form on the skin and internal organs. Infiltrate accumulates at the site of compaction, after which the process of decay and scarring begins.

Gummas can affect any system in the human body. For example, if they appear on bone tissue, then arthritis or periostitis will occur. At the third stage of development of syphilis, treponemes have a destructive effect on cartilage. The most common complication is a collapsed nose. Correct the consequences infectious disease It will only be possible through surgery.

The development of syphilis will continue due to the occurrence of mesodenitis. During this process, the lymph nodes located in the fold of the peritoneum become inflamed, general intoxication of the body begins and the patient feels acute pain in the abdominal area.

It is impossible to predict where exactly gummas will form, so diagnosis of syphilis must be carried out before the onset of the tertiary period. Damage to the nervous system or brain will cause the patient to degenerate. In this case, inappropriate behavior, aggression, hallucinations, etc. will be observed.

If left untreated, the patient may die.

How to recognize latent syphilis

If the disease is asymptomatic, doctors diagnose latent syphilis. It is determined through laboratory tests, which turn out to be positive. Latent syphilis can be late or early. In the first case, it is assumed that the infection occurred more than 2 years ago, and in the second, it is assumed that it was less than the specified period.

Typically, patients discover latent syphilis during preventive examinations. The late form of the disease is considered less dangerous, since when treponemas are activated, minor damage to internal organs is observed. IN small quantity Syphilides form on the body, face and lips; they are not contagious, so the patient can calmly communicate with other people.

Early latent syphilis has a more destructive effect on the body, especially if the patient continues to be sexually active. In this case, there is a high risk of serious complications. In addition, the person becomes contagious. Treatment involves his immediate isolation and testing of all people with whom he came into contact or came into contact. sexual relations sick.

Diagnostics

Complex diagnostic measures determined by the doctor. The method for detecting syphilis depends on the stage of its development. To confirm the primary form of infection, hard chancre is examined; usually there is a high concentration of treponemes. At the next stage, all affected areas and mucous membranes are diagnosed.

During the third period, several methods can be used at once. Usually, preference is given to the analysis of PRC, RIF, RPGA or Wasserman reaction. In the presence of concomitant diseases or under the influence of other factors, laboratory tests may be ambiguous. In this case, the patient is scheduled for another examination. In addition to the venereologist, the patient should be examined by other specialized specialists. This will eliminate complications and determine how much syphilis has progressed.

To diagnose an infectious disease at an early stage, it is necessary to undergo annual full examination your health. In case of unprotected sexual intercourse or suspected infection, a person should contact a dermatovenerology clinic for an urgent examination and preventive measures. After completion of treatment, the patient will be observed in the hospital for another 3-4 years. The absence of relapses means that the person is healthy.

The course of syphilis is wavy, with alternating periods of exacerbation and subsidence of the symptoms of the disease. In severe cases, the disease leads to damage to internal organs, osteoarticular and nervous systems.

Etiology and routes of infection

The causative agent of syphilis is Treponema pallidum, so called because it remains invisible through a light microscope when stained with conventional dyes.

In most cases, infection occurs sexually through contact with an open source of infection (chancroid, syphilitic gum). Transmission of the pathogen is also possible through household means (for example, when using shared utensils), through blood products, and also from mother to fetus (in this case we speak of congenital syphilis). Through the entrance gate of infection (microtraumas on the skin of the groin area, torso, mucous membrane of the oral cavity, genital organs), the pathogen enters the lymph nodes and then into the systemic bloodstream.

Symptoms

The incubation period averages about 3-6 weeks. The first sign of the disease is the formation at the site of contact of the chancre of a painless, dense, round ulcer with a diameter of 0.5-2 cm, with a smooth, shiny bottom. Such ulcers usually do not bleed and are not prone to fusion. During the first week after the appearance of hard chancre, the lymph nodes of the affected area enlarge (regional occurs). This period of the disease is called primary syphilis. Sometimes there may be no primary lesions at all, or they are located on the internal genital organs (for example, on the vaginal wall in women), which makes diagnosis much more difficult. A syphilitic ulcer can become secondarily infected. This process is accompanied by severe swelling and redness in the chancre area, and pus may separate from the surface of the ulcer. When analyzing discharge from the area of an ulcer, it is not always possible to isolate Treponema pallidum, which is why one can erroneously conclude that there is no syphilis.

Approximately 2-3 months from the moment of infection, when a generalized rash appears on the skin and mucous membranes, we can talk about the transition of the disease to the secondary period. By this time, the primary lesions, as a rule, disappear, leaving behind scar changes. Skin manifestations of secondary syphilis are caused by vascular changes in deep layers skin. The rash is localized on the trunk, limbs, face, as well as on the palms and soles. The rash may be macular, vesicular or pustular and has a dark red coloration that fades over time. Foci of the rash form against an unchanged background; individual elements are not prone to merging. Very rarely, the appearance of a rash is accompanied by itching. When analyzing scrapings from secondary syphilides, treponema pallidum is detected, which indicates their contagiousness. In 10% of cases, elements grow on the mucous membranes, under the mammary glands, in the area armpits, anus; then they start to get wet. These are so-called condylomas lata, which are characterized by a high degree of contagion.

The appearance of a rash is sometimes accompanied by mild malaise and a slight increase in temperature. The duration of the secondary period of illness is several days. Without treatment, the disease becomes latent (asymptomatic).

A patient with a latent form of syphilis remains contagious, and transmission of the infection from mother to fetus is also possible. During this period, which can last several years or even a lifetime, antibodies to the pathogen are detected in the blood. In approximately 30% of patients, the disease progresses to the tertiary period, which is characterized by severe destructive damage to internal organs and systems. Tertiary syphilides (gummas) on the skin are single, painless, dense tubercles that involve the deepest layers of the skin and the subcutaneous fat layer. In the center of the gumma it often forms an area of necrosis, followed by the formation of a rough, retracted scar. Exactly the same gummas can appear in any internal organ. Most often, the process involves osteochondral tissue and the nervous system. In the first case, holes are formed in the hard and soft palate, cartilage of the nose and larynx. Infection of the nervous system (neurosyphilis) leads to symptoms of damage meninges, development of paresis and paralysis, as well as mental disorders. Formation of gummas in cardiovascular system is fraught with the development of aneurysms, inflammation of the aortic wall, and narrowing of the blood vessels of the heart.

Diagnostics

There are many blood tests that can detect syphilis. All of them are based on the identification of specific antibodies and are divided into two groups: non-treponemal and treponemal. For mass examination, the so-called non-treponemal qualitative Wasserman reaction (RW) with cardiolipin antigen is used. Under certain conditions, the result of this test may be false positive. In this case, confirmation is required using treponemal studies (RW with treponemal antigen, RIBT), the results of which remain positive after the disease for life. Allergies to penicillin are prescribed antibiotics from a number of macrolides or cephalosporins. The drugs are prescribed intramuscularly or in tablets. Treatment of active forms of the disease takes place in an inpatient setting; patients with a latent form can receive outpatient therapy. The duration of treatment depends on the stage of the disease and can take from several weeks to several years.