Syphilis - Causes, symptoms and treatment. MF.

Syphilis is an infectious disease caused by pale spirochete( Treponema pallidum), manifested by a variety of clinical symptoms depending on the stage of the flow. The path of infection is predominantly sexual, but there is also the risk of infection through hygiene and everyday items that come into contact with the genitals.

The causative agent of syphilis

Spirochete is a strict anaerobic( it grows well and multiplies in anoxic conditions), but even so it can persist for 3 days on household items. To the effect of minus temperatures, they are stable and can be in a lifetime during the year. Much more destructive effect of high temperatures( about 60C) - perish within 20 minutes, boiling die instantly. With the action of antiseptic agents and disinfectants, rapid death also occurs.

Spirochete syphilis pathogen pallid( model)

Treponema( spirochaeta) under the microscope

The causes of infection are promiscuity and, with rare exceptions, neglect of personal hygiene.

Symptoms of syphilis

Clinical manifestations will depend on the stage of the infectious process, the compensatory reactions of the body and the state of the immune system both at the time of infection and at the time of the flow. Syphilis has 3 periods of flow.

The incubation period is the absence of symptoms from the moment of infection to the first manifestations. This period can last from 15 days to 2 months( duration will depend on the immune background and antibiotic intake).

Primary period( primary syphilis) - penetration of the pathogen into the internal medium with multiplication at the site of introduction and migration to regional lymph nodes. As the treponem multiplies at the site of implantation, a solid chancre is formed - a dense electrostatic infiltrate( ulcer or erosion) that occurs 4 weeks after the infection, the soreness is either insignificant or absent altogether. Therefore, if the chancre appears on the cervix or tonsils, the patient may not notice that he is sick.

Chancre on the cervix

Chakra on the lip

Hard chancre on the amygdala

Ulcer chancre on the penis

Once the pathogen spreads through the lymphatic vessels and reaches the lymph nodes, lymphangitis occurs( nearby lymphatic vessels from the solid chancre begin to be painful on palpation and,for infringement of outflow of a lymph, the infiltrative edema of tissues can still join - this is inherent in the scrotum, foreskin, labia, tonsils) and lymphadenitis( sclerogenesis) - an increase in nearbyfrom the solid chancre of the lymph nodes. Lymph nodes increase by 7-10 days from the appearance of a solid chancre, painless, dense, not soldered to themselves and surrounding tissues, the size of beans.

All these 4 symptoms consistently join each other for 1.5-2 months on average. After this, the next period appears -

secondary syphilis .There is a generalization of the infection by 3 months from the moment of infection and lasts 3-5 years, this period is characterized by multiple different kinds of rashes in various organs and tissues, and therefore absolutely any symptoms depending on which system / organ is affected more and how muchwas previously compromised, ie, whether he was healthy at the time of the defeat - if so, then the manifestations of syphilis will be minimal. In this period, there are prodromal symptoms( like common colds, common muscles, joints, and fever), they last 7-10 days before the appearance of syphilis( rose-papular rashes) - often small red spots, with clear boundaries, not merging with each other. When pressed, disappear, and then appear, or can turn yellow due to the destruction of red blood cells. The tissues do not destroy these rashes and, with antisyphilitic treatment, disappear instantaneously. These rashes are of a recurrent nature, ie, they arise repeatedly, but are not so pronounced and much less.

Rosaoleznaya rash with secondary fresh syphilis

Pustular syphilitic papules

Scaling syphilitic papules on the palms

Subjective sensations, these rashes do not appear, except on the scalp - a feeling of itching and the appearance of alopecia( hair loss areas).Eruptions can be different - from innocuous spots, to abscesses - which complicates the diagnosis, because secondary infection is attached. Also there is lymphadenitis. In the absence of treatment or immunopathology there is

tertiary syphilis - to 3-10 years from the time of infection. This period is characterized by the appearance of gumm( infiltrative limited tubercle, pseudo-elastic and prone to decay and scarring) in internal organs and bones. Visceral syphilis is a synonym for tertiary. Gummas are formed in internal organs and bones, and entail severe degenerative changes in internal organs and bones. Depending on the affected organ, there will be corresponding symptoms:

• CNS lesion - personality degeneration;
• damage to bones / joints - periostitis, arthritis;
• lesions of intra-abdominal lymph nodes - mesadenitis, with severe pain syndrome.

There are a lot of possible symptoms, depending on the localization of lesions. Untreated syphilis leads to the death of the patient.

Congenital syphilis in children occurs with transplacental infection of the fetus, after sufficient development of placental circulation( from 3 months of pregnancy), because through the placenta spirochetes do not penetrate. In the case of the birth of a viable child, congenital syphilis is divided into early and late.

• Early congenital syphilis is manifested by a papular rash on the buttocks, a lesion of the nasal mucosa, destruction of the nasal septum, hepatosplenomegaly, hydrocephalus, and also in the subsequent lag in mental and physical development.
• Late congenital syphilis is characterized by the Hutchinson triad: tooth pathology( barrel-shaped central upper incisors) + parenchymal keratitis( corneal damage) + labyrinthine deafness. There are also other manifestations that correspond to tertiary syphilis in adults.

Late congenital syphilis

During pregnancy, a mother who has syphilis or has a pain but has not been taken into account - a consultation is being held and the issue of abortion or preservation, but taking into account antibiotic therapy, is being decided.

Self-diagnosis and self-treatment are unacceptable, due to the variety of the clinical picture( variability of rashes, frequent latency periods), the possibility of erroneous diagnosis with subsequent infection of others and the risk of disabling complications is great.

This is especially true for rashes, they are so diverse that they have to distinguish them from such cutaneous manifestations as:

• herpes, shankriiform pyoderma, miliary tuberculosis( with these diseases differentiate in the first period);
• measles, rubella, typhus, pink and pityrious lichen, genital warts( with secondary syphilis).

Pay attention to the stage of the rash, accompanying manifestations, the morphology of the rashes, etc.- all these descriptions require clinical experience.

Analyzes for syphilis:

The main diagnostic methods are:

1. Bacterioscopic method( it is aimed at detection of the pathogen in a smear-imprint of a chancre or a lymph node biopsy) - this method is performed in the first 4 weeks from the moment of infection.

2. The serological method( the method for determining IgM - indicates the phase of an acute reaction, and is determined only with the help of RIF-abs and ELISA - only they determine immunoglobulins M, the use of other serological methods will give erroneous results of a seronegative reaction, since they are aimed atDetection of IgG - it speaks about the chronization of the process).

The first 2 methods are used for primary syphilis;In secondary and tertiary, serological methods are used to detect IgG( RW, RNGA, RIF).When diagnosing congenital syphilis, ELISA and RIF-abs are used( in the first 3 months), and afterwards - RW, RNGA, RIF.

That is, in the early stages of syphilis, there are immunoglobulins of class M( IgM) of treponemal origin - in laboratories and they write. And in the late stages write about the presence of IgG treponemal origin. And depending on what Ig( immunoglobulins) are determined, they say about an acute or already long-running process. But on what kind of serological test to send the patient, dermatovenereologist decides while determining the clinical stage.

3. Other laboratory diagnostic methods will be less informative and, except as a general picture of inflammation or immunopathology, no results will be given.

Treatment of syphilis

Treatment is not specific and is carried out by large doses of antibiotics sensitive to the causative agent of syphilis; these groups include: tetracyclines( doxycycline), erythromycin, azithromycin( sumamed), ceftriaxone.

The treatment is carried out under the control of biochemical parameters and OAK, OAM - for monitoring compensatory reactions on the part of organs and systems.

Treatment lasts an average of 2 months, and treatment during pregnancy does not differ in principle from the usual inpatient. Treatment partner is mandatory, this is called preventive therapy( treatment for individuals who are in close contact with the infected).For personal hygiene use a separate dish, towel and other personal items of use. Also, after sexual intercourse or other contact, 0.05% chlorogexedin bigluconate should be used, the solution of the albucid( it can and should be stored in a personal medicine chest) is used for any parts of the body with which contact has occurred.

Prevention of syphilis

Specific methods of rehabilitation, prevention and diet are not developed to date. You can, of course, try to treat the infected area with antiseptic solutions immediately after contact, but the risk of the disease will remain large enough, although it will decrease slightly.

Consultation of a doctor on syphilis:

Question: Is immunity developing after a disease?
Answer: There is no clear opinion on this score, for example, in the blood of some people who did not suffer from syphilis, treponemostatic, treponemicide antibodies that prevent infection were found. Also, at the time of illness, non-sterile immunity is formed, but at the time of latent flow it weakens and it is possible to re-infection in excess of what already exists - that is the formation of superinfection. But one can definitely say that there is no persistent immunity after the transferred disease.

Question: Why does the imaginary well-being come and there may not be any manifestations of the disease?
Answer: this occurs in the primary and secondary periods, this is due to the structure of the pale spirochaete, namely the presence of a capsule-like shell protecting it from phagocytosis, resulting in incomplete destruction by treponemus and their stay in the L-form( "sleeping" state) - protection from antibodies and antibiotics, but also protection against the development of the disease. The same effect answers the question about "Re-infection in the absence of contact with the patient" - that is, awakening the "sleeping" treponem.

Question: Are other transmission routes dangerous?
Answer: unlikely, but possible through household items.

Question: Do the scars remain after skin manifestations?
Answer: they can stay only if no timely treatment has been started and ulceration has occurred( ulcers formed) or the same mechanism but in places of frequent traumatization( anal area, tonsils area).

Question: Legal aspects of concealment of this disease?
Answer: for deliberate concealment of sexually transmitted diseases that entailed the infecting of others is considered an administrative violation of the Federal Penal Code No. 116 of Article 6.1.1-6.3 and is prosecuted by the Criminal Code of the Russian Federation in Article 121.

Doctor Shabanova IE