Is it possible to get infected with syphilis during menstruation. How does syphilis manifest, after how many days do the first symptoms appear? Modern Syphilis Treatment

Syphilis (Lues) is an infectious disease with a long, undulating course. In terms of the volume of damage to the body, syphilis belongs to systemic diseases, and according to the main route of transmission, to sexually transmitted diseases. It affects the entire body: skin and mucous membranes, cardiovascular, central nervous, digestive, musculoskeletal systems.

What kind of disease it is, the first signs and causes of development, as well as what the rash of syphilis looks like on the skin of an adult, and what is prescribed as a treatment - we will consider later in the article.

What is syphilis?

Syphilis is the most severe venereal disease, characterized by a long-term course and affecting all human organs.

In the environment, the causative agent of syphilis can live in the presence of moisture for several hours, but almost immediately dies when dried, exposed to high temperatures, and disinfectants. It retains its vitality when frozen for several days.

The disease is highly contagious even during the incubation period.

The symptoms of syphilis are so varied that it is quite difficult to understand them on the fly. As the disease progresses, the manifestations change fundamentally: from a painless ulcer at the first stage to severe mental disorders in a neglected form. The same symptom differs in different patients, depending on the immunity, the place of origin, or even the sex of the person.

Classification

The course of syphilis is long undulating, with alternating periods of active and latent manifestations of the disease. In the development of syphilis, periods are distinguished that differ in the set of syphilides - various forms of skin rashes and erosions that appear in response to the introduction of pale spirochetes into the body.

Depending on the length of time that has passed since the moment of infection, the following are distinguished:

early syphilis - up to 5 years,
more than 5 years - late.

According to the typical symptoms, syphilis is divided into:

primary (hard chancre, scleradenitis and),
secondary (papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis)
tertiary (gum, damage to internal organs, bone and articular systems, late neurosyphilis).

You can find out what syphilis looks like only after the incubation period. In total, the disease has four stages, each of which is characterized by its own symptoms. A long incubation period lasts 2-6 weeks, but sometimes the disease may not develop for years, especially if the patient took antibiotics, was treated for infectious colds. During this time, laboratory tests will not give a reliable result.

Primary syphilis

It lasts 6-8 weeks and is characterized by the appearance of primary syphiloma or hard chancre at the site of penetration of pale spirochetes and subsequent enlargement of nearby lymph nodes.

Secondary stage

This stage of the disease lasts about 2 to 5 years. It is characterized by an undulating 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 trunk, legs, arms, and even the face.

With secondary syphilis, it is often possible to diagnose syphilitic roseola - these are peculiar rounded pale pink spots that can reach 10 mm in diameter. Such spots can be on any part of the patient's body.

A distinctive feature of syphilitic roseola is its gradual manifestation of 10-12 spots per day for seven days. If you press on the roseola, it disappears.

It should be noted that secondary syphilis can be of several varieties:

Tertiary stage

Tertiary syphilis is manifested by focal destruction of mucous membranes and skin, any parenchymal or hollow organs, large joints, and the nervous system. The main signs are papular rashes and gum, degrading with rough scarring. It is rarely determined, develops within 5-15 years, if no treatment has been carried out.

Congenital form

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 a 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, mental and physical retardation.
For the late form of congenital syphilis, the so-called Hutchinson triad is characteristic. These children have corneal lesions, dental pathology, and labyrinthine deafness.

Incubation period

During the entire incubation period, no matter how long it was, a person is contagious. Therefore, after the patient is diagnosed, he must inform his sexual partners about it.

The length of the incubation period varies under the influence of many factors. It is shortened for a number of reasons:

Secondary infection after complete cure of syphilitic infection (superinfection).
Sexual infections (especially gonorrhea).
Severe concomitant diseases (cirrhosis, tuberculosis, malaria).
Substance and alcohol abuse.
The presence of more than two foci of penetration of pale treponema.

It lengthens due to the following factors:

Elderly age (55-60 years old). This is due to the withering of metabolic processes in the body.
Long-term diseases that are accompanied by a weakened immune system.
Individually reduced susceptibility to spirochete bacteria. The reason for this has not been established.
The use of antibiotics (for pneumonia, sore throat, flu, genital infections). This masks the disease and slows down the development of the pathogen.

How syphilis manifests itself: the first signs

The appearance of a syphilitic rash on the hands

The time between infection and the first signs of syphilis depends on the person's immunity and the way the bacteria were transmitted. As a rule, this happens after a month, but the manifestations may appear earlier or later, or be absent altogether.

The first signs to look out for are:

The very first visible symptom of syphilis is an ulcer, which manifests itself in the place where syphilitic bacteria have invaded.
Parallel to inflammation a lymph node located nearby, and behind it is a lymphatic vessel. In physicians, this stage is distinguished in the primary period.
After 6-7 weeks, the ulcer goes away, but the inflammation spreads to all the lymph nodes, and a rash appears. This is how the secondary period begins. It lasts from 2 to 4 years.

One of the signs, the appearance of a hard chancre on the face

In men, this is the appearance of a painless ulcer called chancre. Its location in almost all cases falls on the genitals. Chancre can appear on the head, on the foreskin, on the penis itself, or even on the scrotum.

The chancre itself is round and hard to the touch, covered with a white greasy bloom on top. By its consistency, it is cartilage-like. In almost all cases, it is one, only occasionally several small ulcers may appear close to each other.

In women, skin manifestations are characterized by the appearance of a hard chancre on the genitals. Cases of the first signs of infection in the form of a chancre on the lips or near the nipple on the chest have also been recorded. Sometimes there are several small ulcers, sometimes it is isolated.

Causes of occurrence

The causative agent of the disease is a bacterial microorganism, Treponemapallidum (pale treponema). It enters the human body through microcracks, abrasions, wounds, ulcerations, enters the general bloodstream from the lymph nodes, affects mucous surfaces, skin, internal organs, nervous system, skeleton.

The likelihood of infection depends from the number of bacteria that have entered the body, that is, regular contact with the patient increases the risks.

Having got from a sick person to the skin or mucous membranes of a healthy person, the pathogen is introduced through microscopic surface injuries and spreads throughout the body. In this case, complex immune processes occur. However, after a cure, persistent immunity is not formed, therefore, you can become infected with syphilis repeatedly.

External ulcers, erosions, papules are highly contagious. If a healthy person has microtraumas of the mucous membrane, then in contact with a patient, he risks becoming infected.

The blood of a person with syphilis is contagious from the first to the last day of the disease, therefore, transmission of infection can occur not only during transfusion, but also when mucous membranes and skin are injured.

How is syphilis spread?

Syphilis is transmitted in the following ways:

sexual (95%) after contact with a sick partner;
it is very rare to get sick with syphilis in a household way (this is due to the fact that the bacterium dies without the conditions it needs when it dries);
intrauterine - this is how babies become infected in the womb
through breast milk from a sick mother to a child;
during childbirth during the passage of the child through the birth canal;
through blood that is used for transfusion.

The most infectious patients- patients with primary and secondary periods of the disease. During the tertiary period, the concentration of pale treponemas in the patient's discharge decreases sharply.

Syphilis symptoms

Syphilis is quite diverse in its manifestations. It depends on a number of factors, ranging from the state of immunity of the person who is affected by treponema, and ending with the number of pathogens that enter the body.

The first symptoms of syphilis in most cases are characteristic enough to be seen and recognized. If you turn to a venereologist at the first suspicion, you can avoid a lot of trouble and really quickly get rid of this disease.

There are cutaneous manifestations of syphilis and internal lesions. Typical symptoms are:

the appearance of a hard chancre - a smooth, painless ulcer with rounded slightly raised edges up to a centimeter in diameter, bluish-red, sometimes it can hurt;
enlarged lymph nodes;
headaches, malaise, muscle and joint pain;
high temperature;
decreased hemoglobin, increase in blood;
inductive edema;
panaritium - inflammation of the nail bed, which does not heal for several weeks;
amygdalitis - hard, swollen, reddened tonsils, difficulty swallowing.

What syphilis looks like on human skin: photo

It looks like a rash on the palms

Signs of primary syphilis

The initial symptoms of the disease appear at the place through which the treponema entered the human body. There, a painless ulcer with dense edges forms - a hard chancre. Most often it occurs in the genital area - on the skin or mucous membrane.
A week after the formation of skin damage, first the inguinal, and then all groups of lymph nodes increase. The duration of this period is one and a half months.

5-6 weeks after the onset of the primary chancre spontaneously heals, even without treatment. This is one of the main dangers of syphilis - a person believes that everything is in order, but the main clinical symptoms appear later.

Secondary syphilis symptoms

The first rashes (papules or roseola) often occur with residual chancre and scleradenitis. After 1-2 months, they disappear without a trace, and a period of early latent syphilis sets in. After a few weeks (months), a wave of generalized rashes (secondary syphilis) comes, which lasts about 1-3 months.

Most often, a rash is:

roseolous - in the form of rounded pink spots;
papular - pink, and then bluish-red nodules, resembling lentils or peas in shape and size;
pustular - pustules located on a dense base, which can ulcerate and become covered with a dense crust, and often leaves a scar when healed.

At the same time, different elements of the rash may appear, for example, papules and pustules, but any type of rash contains a large number of spirochetes and is very contagious.

The first wave of rashes (secondary fresh syphilis) is usually the brightest, profuse, accompanied by generalized lymphadenitis.
Later rashes (secondary recurrent syphilis) are paler, often asymmetrical, arranged in the form of arcs, garlands in places subject to irritation (inguinal folds, mucous membranes of the mouth and genitals).

Despite the fact that during this period there is a purely skin symptomatology, pale treponema, which seeded all tissues and organs, can cause various forms:

meningitis,
liver pathology (icteric or anicteric),
lipoid nephrosis or other kidney disease,
syphilitic gastritis,
as well as various lesions of bones and joints.

Symptoms in the tertiary stage

If a patient with syphilis was not treated or the treatment was inadequate, then a few years after infection he develops symptoms of tertiary syphilis. Serious violations of organs and systems occur, the patient's appearance is disfigured, he becomes disabled, in severe cases, death is likely.

For the tertiary form, gummas are characteristic - rounded, large, painless syphilides. They can appear both on the surface of the skin and on internal organs. This disrupts the work of the heart, kidneys, and digestive system.

One of the typical symptoms of late syphilis- destruction of the saddle of the nose, due to which the profile takes on a characteristic shape.

After a while, the infection of the nervous system begins to affect. Neurosyphilis leads to gradual degeneration of the entire nervous system:

violation of sensitivity,
altered reflexes
errors of the senses,
paralysis,
change of character,
weakening of memory
dementia.

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 a hard chancre appears on the genitals:

chancre on the cervix. Signs of syphilis, when a hard chancre is located on the uterus in women, is practically absent and can only be detected during a gynecological examination;
gangrenous chancre on the penis - there is a possibility of self-amputation of the distal part of the penis;
a 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.

Complications

The most serious consequences of syphilis are:

first of all, damage to the central nervous system. It is fraught with manifestation, neuritis,.
Very often in patients with neurosyphilis, the functioning of the organs of hearing and vision is impaired.
Quite often, osteoarthritis manifests itself as a consequence of syphilis.
The cardiovascular system is also subject to complications: sometimes syphilitic myocarditis appears, later the functioning of the aortic valves is disrupted, and seizures periodically occur. Due to impaired blood circulation, the patient develops a myocardium.

Diagnostics

If a rash or sore develops on the skin, see a dermatologist. Often, patients get an appointment with a urologist or gynecologist. Doctors of all these specialties, after appropriate tests and detection of syphilis, refer the patient to a venereologist.

Laboratory diagnostic methods include:

Analysis for syphilis. In the biomaterial taken (blood, cerebrospinal fluid, discharge from skin elements), pale treponema is found under a microscope.
Wasserman reaction, testing for rapid plasma reagins. The patient donates blood for syphilis, where antibodies are found in the patient, which are produced against certain parts of the treponema and tissues that are destroyed by the pathogen.
PCR - polymerase chain reaction - a method of laboratory diagnostics, which also allows you to determine the treponema in the material taken from the patient.
Various kinds of serological reactions: RPHA, RIBT, RIF, ELISA.

Treatment

The main treatment for syphilis is antibiotic therapy. At the moment, as before, antibiotics of the penicillin series are used (short and prolonged penicillins or durant penicillin drugs).

In the event that this type of treatment is ineffective, or the patient has an individual intolerance to this group of drugs, he is prescribed drugs of the reserve group (macrolides, fluoroquinolones, azithromycins, tetracyclines, streptomycins, etc.)

It should be noted that early stage of syphilis antibacterial treatment is most effective and leads to a complete cure.

There are two main methods of treating syphilis: continuous (permanent) and intermittent (course). In the process, control analyzes of urine and blood are mandatory, the well-being of patients and the work of organ systems are monitored. Preference is given to complex therapy, which includes:

Antibiotics (specific treatment for syphilis);
General strengthening (immunomodulators, proteolytic enzymes, vitamin and mineral complexes);
Symptomatic agents (pain relievers, anti-inflammatory, hepatoprotectors).

The most commonly used tablets are:

Rovamycin. The dose is determined by the doctor. Cannot be used for liver complications and pregnancy. Overdose can manifest itself in the form of vomiting or nausea.
Sumamed. Negatively affects the liver and kidneys. Treatment is carried out at an early stage of syphilis, often used as an adjunct to stronger drugs.
Cefotaxime. The dosage will vary depending on the stage of the sexually transmitted disease and the patient's response to the medication. Forbidden in case of allergy to penicillin.
Amoxicillin. Poorly effective compared to penicillin and its derivatives. It is forbidden to take together with antibacterial drugs.

Prophylaxis

It is impossible to ward off syphilis in advance. There is no vaccine or other methods of active prevention against this ailment. It is important to follow the rules of safe sex, to refuse casual relationships.

Public prevention should be carried out in accordance with the general rules for the fight against sexually transmitted diseases. Components of such prevention:

mandatory registration of all patients,
examination of his family members and persons who were in close contact with him,
hospitalization of the infected and monitoring them over the next few months,
constant dispensary control observation of the treatment of sick patients.

If you are forced to have close contact with a person who has syphilis, then it is important to take all measures so that the disease does not spread. To do this, it is enough to strictly observe all the rules of hygiene, as well as to avoid close bodily contact with an infectious patient. If you follow all these rules, then the risk of infection is noticeably reduced.

Syphilis is a very dangerous infectious disease, both for the person himself and the people around him. When the first signs appear, it is important to consult a dermatologist or venereologist to make an accurate diagnosis, take tests and start correct treatment with drugs.

Syphilis is the most severe sexually transmitted disease, characterized by a long-term course and affecting all human organs. Scientists believe that syphilis arose almost simultaneously with the appearance of man. The first mass disease in Europe was reported in 1493, shortly after Columbus returned from America. Already in 1499, the disease appeared in Russia and even then caused great concern for the health of the country's population.

At first, syphilis was called "sexual plague", a French, Chinese disease. The modern name of the disease was given by the name of the shepherd Syphilus, who was punished by the gods for immorality with a lesion of the genitals. The poem was written in 1530 by the Italian physician Fracastoro.

Causes of the disease

The causative agent of syphilis, a microorganism called treponema pale, was discovered only in 1905. It got its name from the weak staining with aniline dyes used in microbiology. Treponema pallidum has the form of a thin thread twisted into a spiral. Its dimensions are small - up to 14 microns. Due to its structure, treponema quickly moves and penetrates into various organs of the human body.

How syphilis is transmitted

The main route of transmission of the disease is sexual, through contact between a healthy and a sick person. Infection occurs with different types of sexual contacts: oral-genital, anogenital, "traditional".

If a sick person has sores in the mouth, they can spread the infection through the household. Infection with syphilis is possible with a kiss, a bite of such a person, as well as through objects that have been in his mouth or are contaminated with saliva: a pipe mouthpiece, dishes, a toothbrush, a whistle, a cigarette, lipstick, and so on.

The most contagious patients are patients with primary and secondary periods of the disease. During the tertiary period, the concentration of pale treponemas in the patient's discharge decreases sharply.

There are two other ways of transmission of infection: through blood transfusion from an unexamined donor, as well as from mother to fetus during pregnancy. Syphilis during pregnancy contributes to spontaneous abortion, premature birth with a dead fetus at 5-6 months of gestation, or the birth of a sick child.

Stages of syphilis

In its course, the disease goes through regular stages. After infection, the sick person feels absolutely healthy. However, this time of supposed well-being lasts only 4-5 weeks. This is the so-called incubation period, during which microorganisms enter the body and multiply at the site of introduction.

How long does the disease manifest in an atypical course: in debilitated patients suffering from alcoholism, drug addiction, tuberculosis, acquired immunodeficiency syndrome, cancer, the period without clinical manifestations can be reduced to 2 weeks.

If a person during incubation was treated with antibacterial drugs for other diseases - concomitant gonorrhea (,), then the first signs of syphilis may appear in him only after a few months. All this time, the pathogen multiplies in the body, but the patient is unaware of it.

Symptoms of syphilis appear in waves, episodes of exacerbations alternate with stages of a latent (latent) course. With each new wave of exacerbation, the disease progresses more and more heavily, affecting an increasing number of organs.

How does syphilis manifest?

The symptoms of the disease differ depending on the period. There are secondary and tertiary types of syphilis, or its periods.

The initial symptoms of the disease appear at the place through which the treponema entered the human body. There, a painless ulcer with dense edges forms - a hard chancre. Most often it occurs in the genital area - on the skin or mucous membrane. A week after the formation of skin damage, first the inguinal, and then all groups of lymph nodes increase. The duration of this period is one and a half months.

During the first month after the development of the first symptoms, standard serological reactions are still negative, that is, they do not confirm the diagnosis, although the person is already a source of infection. It is during this period that the treatment of syphilis is most effective.

By the end of the primary period, weakness, poor health, pain in the limbs, and headache may appear.

Treatment

The answer to the question of how to treat syphilis depends on the goals of such treatment:

specific therapy is prescribed to patients in order to rid them of the pathogen;
preventive treatment is prescribed to the patient's sexual partners if no more than 2 months have passed since the moment of contact;
preventive medication is prescribed for sick pregnant women, and in case of non-compliance with these recommendations - for newborn children;
a trial appointment of therapy is used when syphilis is suspected, when the diagnosis cannot be confirmed laboratory.

Syphilis is most often treated on an outpatient basis. Patients with tertiary syphilis, sick pregnant women and children, persons with a complicated course of the disease, including those with an allergy to antibiotics, are hospitalized in a venereal hospital.

Drugs

The main medicine against syphilis is benzylpenicillin in extended-release forms (Bicillin-1, Bicillin-5 and others).

Semi-synthetic penicillins (Ampicillin, Oxacillin), macrolides (Erythromycin), tetracyclines (Doxycycline), cephalosporins (Ceftriaxone) are also effective.

With neurosyphilis, prednisolone tablets are prescribed, with damage to the heart and other internal organs, appropriate drugs.

Is syphilis treated? Of course, in modern conditions, this is a curable disease. In the early stages, just a few injections of penicillins are enough to destroy the pathogen in the body. For the preventive treatment of sexual partners, only one injection of long-acting benzylpenicillin is required.

Unwanted effects

After antibiotic treatment, so-called expected complications often develop. They are associated with the mass death of treponemes in the body and the release of their decay products into the blood. In addition, penicillin preparations themselves have a short-term toxic effect on the body.

In a third of patients with primary syphilis, an exacerbation reaction occurs soon after the administration of an antibiotic. It builds up within a few hours, but passes by the end of the first day. Patients complain of fever, chills, headache, weakness, sweating. Their heart rate increases, shortness of breath appears, and blood pressure decreases. With secondary syphilis, the skin rash becomes brighter, its elements merge, they can also occur on previously undamaged skin areas.

Such a reaction usually does not cause significant harm to the body and does not require special treatment. However, it should be avoided in pregnant women, children, persons with damage to the heart, eyes, nervous system. To reduce the likelihood of an exacerbation, prednisone is prescribed.

After the introduction of prolonged forms of penicillin, some patients develop the so-called Hine syndrome. It is accompanied by dizziness, pallor, fear of death, impaired vision and sensitivity, temporary mental disorders and increased blood pressure. The latter symptom allows you to distinguish Hine syndrome from vascular collapse, in which the pressure drops sharply. The duration of such an attack does not exceed 30 minutes.

Nicolau syndrome is a rare complication after intra-arterial penicillin administration in children. It is accompanied by the formation of painful spots on the skin with blistering. Sometimes limb paralysis occurs.

Other side effects may occur when using penicillins:

convulsions (more often in children);
increased edema in patients with concomitant chronic heart failure;
allergic reactions that occur in every 10 patients;
anaphylactic shock, accompanied by a sudden drop in blood pressure, decreased contractility of the heart, impaired consciousness.

Treatment of children and pregnant women

Abortion for syphilis is not necessary, since timely treatment of the expectant mother leads to the birth of a healthy child. The decision of whether to maintain or terminate the pregnancy remains with the parents of the unborn baby.

Timely treatment is considered to be started before 32 weeks of pregnancy. However, it is being held at a later date. Prolonged-release forms of penicillin are prescribed. After a course of specific therapy, after a while, preventive treatment is also carried out. Penicillin drugs are not contraindicated during pregnancy.

If a woman has received full-fledged therapy, her childbirth is taken in a regular maternity hospital, and the child is considered healthy and does not need any additional treatment.

Early and late congenital syphilis and acquired syphilis in children are treated with penicillin. Care is taken in the dosage so as not to cause severe complications or an allergic reaction.

If the expectant mother with syphilis during pregnancy did not receive timely full therapy, the newborn, even without signs of the disease, is prescribed preventive treatment.

Criteria for the effectiveness of treatment

Within a year after the end of treatment for primary or secondary syphilis, non-treponemal tests, in particular, a microprecipitation reaction, should become negative. If they remain positive, then there should be a decrease in the number of antibodies by at least 4 times.

RIT becomes negative 2-3 years after the completion of treatment.

Tests such as RIF, ELISA and RPGA can remain positive for many years. This is not a criterion for treatment failure.

If symptoms persist or positive serological reactions (bladder cancer) persist, treatment ineffective or delayed negativity of non-treponemal tests is indicated. In these cases, after an additional examination, the question of a second course of antibiotic therapy is decided.

Treatment of contact persons

If no more than 2 months have passed since sexual or close household contact, such people are given preventive antibiotic treatment. If from the moment of contact has passed from 2 to 4 months, they are limited to a two-time diagnostic study, and if more than 4 months, tests are done only once.

Disease prevention

Syphilis prevention is based on three principles.

Health education.
Screening examination of the population.
Timely treatment of patients and contact persons.

Prevention of congenital syphilis includes the following measures:

informing women about the need for early registration for pregnancy;
triple examination of pregnant women for syphilis;
if a disease is detected - timely full treatment;
if necessary, prophylactic treatment of newborns.

The basis for the personal safety of each person is the observance of the rules of intimate and household hygiene:

lack of casual sex;
using condoms with a new partner (read about the use of barrier contraception in ours);
with unprotected intercourse - the use of special means (miramistin and others).

Syphilis is a sexually transmitted disease. Most often, women 15-40 years old are infected. The peak incidence occurs at the age of 20-30 years. The pathological process proceeds in waves, with alternating periods of exacerbation and abatement. In advanced cases, there are lesions of internal organs, nervous and osteoarticular systems.

Causes

The causative agent of syphilis is the spirochete Treponema pallidum. After entering the body, it enters the lymphatic and circulatory systems, spreading throughout the body. From the time of infection until the first signs of syphilis appear in women, about 20-40 days pass. The duration of the incubation period is increased by conditions accompanied by high body temperature, old age, treatment with corticosteroids, antibiotics and other potent drugs. With massive infection with treponema, the incubation period is reduced.

The factors predisposing to the development of syphilis are unprotected sexual intercourse with a carrier of the bacterium, transfusion of contaminated blood, violation of the rules of sterility by medical personnel, and the use of common household items with the patient. There is also a risk of transmission of treponema to the baby from an infected mother. This happens during childbirth or breastfeeding.

First signs

One of the first signs of syphilis in women is the appearance of a hard chancre. It is a smooth erosion or cyanotic-red ulcer, up to 1 cm in diameter, with slightly raised rounded edges. Education can be either single or multiple, painful or not. On palpation, a dense infiltration is found at the base. It is localized at the site of infection - on the labia or cervix. It can also be located next to the anus or on the rectal mucosa, sometimes on the pubis, thighs, abdomen. The lips, tongue, fingers are most often affected in health care workers.

In some cases, the symptoms of syphilis in women are similar to lacunar sore throat or exacerbation of chronic tonsillitis. Also misleading is the anal chancre, which resembles a fissure of the anal fold with elongated outlines.

Even without treatment, after 4–6 weeks, the dense infiltrate resolves, and the hard chancre completely disappears. With its small size, no changes remain on the skin. Giant forms can produce black or dark brown spots. Ulcerative chancres leave circular scars surrounded by a pigment ring.

In addition to the classic chancre, there are other varieties of it, which makes it difficult to recognize syphilis. These include those presented below.

Felon. The chancre looks like a common inflammation of the nail bed: the finger is swollen, painful, purple-red in color. Rejection of the nail plate often occurs. Unlike real panaritium (purulent lesion of the tissues of the fingers), the wound does not heal for several weeks.
Amygdalitis. Swollen, hard, reddened tonsil, which makes swallowing difficult and painful. Like typical tonsillitis, amygdalitis is accompanied by malaise, general weakness, and fever. Headaches are also observed (mainly in the occiput).
Inductive edema. On the lower lip or labia majora, a large cyanotic red or pale pink seal appears. It spreads beyond the boundaries of erosion. Without proper treatment, such a chancre persists for several months.
Mixed chancre. A mixture of soft and hard chancre with parallel infection with these pathogens. Chancre ulcer forms first because it has a shorter incubation period. Then a picture of a typical hard chancre appears. A mixed chancre is characterized by a delay of laboratory tests (for example, Wasserman's reaction) by 3-4 months.

A week after the appearance of the chancre, the lymph nodes are enlarged. When the ulcer is localized in the rectum or on the cervix, the process remains unnoticed. If syphiloma has formed in the mouth, then the submandibular, chin, cervical or occipital lymph nodes increase. When a chancre is found on the fingers, the lymph nodes in the elbow bend are affected.

By the end of the primary period, the patient is worried about the following symptoms: pain in the bones and muscles, arthralgia, a decrease in hemoglobin, an increase in leukocytes in the blood.

Symptoms of secondary and tertiary syphilis in women

The period of secondary syphilis begins 6-9 weeks after the first signs of the disease appear. Its duration without therapy is 3 to 5 years. Typical manifestations are pale rashes all over the body, including on the soles and palms, bone aches, insomnia, headache, malaise, loss of appetite, and an increase in body temperature up to 38 ° C. At the same time, wide condylomas (bodily growths) appear in the anus and on the genitals. Eyebrows, eyelashes and scalp hair may fall out.

Also in the second stage of syphilis, papules form in the tongue, in the mouth and in the area of the vocal cords. As a result, there is a characteristic syphilitic hoarseness of the voice. After 2.5 months, the rash disappears without a trace, and secondary latent syphilis begins. Relapse of the disease soon sets in.

The symptoms of tertiary syphilis in women are more pronounced. All organs and systems are involved in the pathological process. The body becomes covered with nodes or bumps, which, when opened and then healed, form scars. Soft tissues melt, deform and degenerate into a kind of tumor - gum. If the mucous membranes of the pharynx and nose are affected, the bony part of the nasal septum and the palate may be affected. The nasal dorsum sinks with the subsequent throwing of food into the nasal cavity.

The gum of the soft palate makes it immobile, dense and dark red. Then it breaks through in several places at once, forming long-term non-healing ulcers. The gum of the tongue is manifested in two main forms: gummy and sclerosing glossitis. At the first, small ulcerations in the tongue are diagnosed. With the second, the tongue becomes dense and loses its mobility. Over time, it shrinks and atrophies, as a result of which speech, the ability to chew and swallow food suffers. For others, the tertiary stage of the development of the disease does not pose a danger.

Diagnostics

Depending on the stage of syphilis, the scope of diagnostic measures is determined. The first step is treponemal and screening tests, as well as microscopy in a heavy field.

Treponemal tests are designed to detect antitreponemal antibodies. They test positive 2–4 weeks after infection. These include RIF-ABS, RGA, RMGA-BT. These three reactions are more accurate than the rest of the tests.

Screening tests involve the use of lipoid antigens to detect syphilis reagins. They show a positive result no earlier than 4–5 weeks after infection. This group includes the VDRL tests and the rapid reagin test. VDRL test is a reaction that visualizes the interaction of antigen-cardiolipin with reagin antibodies from the patient's serum. The result can be weakly positive, positive, borderline, or negative. Positive and weakly positive indicate that a woman is infected with a pale spirochete. However, this must be confirmed by additional diagnostic methods.

Sometimes screening tests give a false positive result. It indicates diffuse pathologies of connective tissues, autoimmune diseases, the presence of a viral infection in the body. For maximum accuracy, they are performed at intervals of 2 weeks for 6 weeks.

Darkfield microscopy is a technique in which a beam of light is passed through a glass slide at an angle. It reflects off microorganisms on the glass surface. Treponema appears in the field of view as a light element on a dark background. So it is possible to study its morphological features and the nature of movement in exudative body fluids.

Treatment

They approach the treatment of the disease in a comprehensive manner, taking into account the individual characteristics of the patient - age, stage of development of syphilis, general condition, the presence of concomitant ailments, etc. In primary syphilis, everyone who has had sexual intercourse with the patient over the past 3 months should be examined. In the case of secondary syphilis, everyone who has had contact with an infected person in the last year.

In case of early latent forms of syphilis, hospitalization is required in a venereal hospital (within 24 hours after confirmation of the diagnosis). In the later stages, treatment is carried out in a psychiatric, neurological, venereal, therapeutic or cardiological hospital. This takes into account the nature of the prevailing lesions.

Syphilis is treated for 2-3 months using the drugs described below.

Probiotics - are taken from the first days of anti-syphilis therapy (Khilak, Latsidofil, Linex).
Immunomodulators (T-activin, thymalin).
Antibiotics are penicillin derivatives in sufficient doses (benzylpenicillin). With secondary and tertiary syphilis, Bismuth, iodine and Bismoverol are additionally prescribed. With progressive tertiary syphilis, resistance of the pathogen to antibiotics and a good general condition of the patient, arsenic derivatives (Novarsenol, Miarsenol) are added.
B vitamins and antioxidants.

While taking these drugs, alcohol and any sexual intercourse are strictly contraindicated. At the end of therapy, control serological tests are taken. Patients with primary seronegative syphilis should be observed by a venereologist for at least 6 months, with primary seropositive and secondary syphilis - up to a year.

Possible complications

In the absence of adequate treatment, a decrease in immunity and the addition of an infection, the following complications are possible:

meningitis with subsequent death;
partial or complete loss of vision;
inflammation of the vagina and vulva;
dementia, paralysis and paresis;
damage to the structure of joints and bones;
the appearance of gum in the internal organs with the development of their severe failure.

The development of phagedenization - gangrene, which spreads in breadth and depth of the hard chancre, is not excluded. It can cause complete rejection of the affected organ or part of it.

Syphilis during pregnancy

Syphilis is not an indication for abortion. The patient is prescribed drugs that increase the fetus's chances of avoiding serious complications. If untreated, the chance of having a healthy baby is 10%.

Often, especially severe forms of pathology are detected, in which newborns die in the first year of life. 25 out of 100 pregnancies end in miscarriage. If a woman has not treated syphilis either before or during pregnancy, there is a high likelihood of a stillborn baby.

Treatment of syphilis in pregnant women is performed with penicillin until the 32nd week. Then, as a preventive measure, after the birth of the baby.

Prevention and prognosis

As a preventive measure, it is recommended to observe precautions when living together with a patient. It is important to exclude the use of his toothbrushes, soap, shaving utensils, dishes, towels, bed linen, etc. In addition, sexual contact with an infected person is prohibited. Pallidum spirochete is transmitted both during vaginal and oral and anal sex. Even condoms are not 100% protective.

4.50 out of 5 (8 Votes)

According to statistics from the Ministry of Health, in the Russian Federation there are 30 syphilis patients per 100,000 inhabitants. These figures are not indicative, since a large number of infected people do not go to doctors for treatment. Thus, the risk of infection remains high.

A little about syphilis

Syphilis Is a sexually transmitted infection. The causative agent of this disease is treponema pale, which is a bacterium that is capable of movement.

How does syphilis appear on the skin?

Syphilitic manifestations are very diverse and cause difficulties in the differential diagnosis of syphilis with other skin diseases. The morphological elements that appear on the skin in syphilis vary depending on the stage of the process.

The incubation period of this disease is on average from 2 weeks to 2 months. Shortening of terms occurs in people with reduced immunity who have had infectious diseases, with a history of cancer, tuberculosis, HIV infection.

During these periods, the pathogen is in the human body, but its concentration is insufficient for the onset of symptoms of the disease. There are no manifestations on the skin.

After the specified time period, when the accumulation of pale treponema occurred, the stage of primary syphilis develops. It is characterized by a single but most contagious skin manifestation - chancre.

Formed, as a rule, in the place of penetration of pale treponema (with genital contact - in the genital area, with oral - genital contact - in the mouth, in the lips, etc.).

Chancre is formed in several stages:

the formation of a spot of small size, pink-red;
the formation of an erosive defect;
compaction of the bottom by erosion, color change to bright red. Erosion is covered with a transparent or brown film.

With timely treatment or, on the contrary, the transition to the next stage of syphilis, the chancre again goes into the stage of the spot, and then completely disappears. As a rule, such a neoplasm does not cause discomfort in an infected person. A slight itching may occur in the area of erosion.

A chronic venereal disease that is caused by treponema pallidum and is sexually transmitted in 90-99% of cases. It is manifested by specific skin rashes, enlarged lymph nodes, slow, progressive damage to various organs and systems. To diagnose syphilis, clinical data, the results of a physical examination, microscopic and serological diagnostics are used. Specific treatment involves the appointment of antitreponemal drugs, selected in accordance with the stage and characteristics of the course of the disease.

General information

Although the first documentary mentions of syphilis were recorded in the 15th-16th centuries, its causative agent was discovered only in 1905 by the Austrians Fritz Schaudin and Erich Hoffmann. In recent years, there has been a tendency towards a decrease in the incidence of syphilis. In 2013, 28.9 diseases were recorded annually in Russia per 100 thousand inhabitants with an increase in the number of latent and late forms. The high-risk group includes prostitutes, homosexuals and people with promiscuous sex lives. Syphilis is more commonly diagnosed in 20-39-year-old patients. Women get sick less often than men. An increase in the incidence is noted in the summer and autumn after unprotected sex with casual acquaintances on tours and summer vacations.

Causes of syphilis in women

Classical spirillary form. Possesses high pathogenicity. It is detected at the infectious stages of syphilis. It is highly sensitive to an increase in temperature of more than + 55 ° C, drying, treatment with alcohol and antiseptics, therefore it quickly dies in the external environment.
Long-term survival form (cystic with a protective membrane and filterable L-form). The pathogens are highly resistant to antibacterial drugs and are detected at latent and late stages.

A woman becomes infected with syphilis through damage to the skin or mucous membranes. Usually, infection occurs through sexual contact with unprotected vaginal, anal, oral sex with an infected partner. The pathogen can also be transmitted through the household (through kisses, cigarettes, underwear, personal belongings and items used by the sick person), through the placenta (from an infected pregnant fetus) and hematogenously through the transfusion of infected donor blood or the use of contaminated syringes, needles, droppers, etc. (in fresh blood, the microorganism lasts up to 3-4 days).

Pathogenesis

Syphilis is characterized by a staged course with alternating latent and clinically pronounced periods. The pathogen enters the lymphatic system and spreads in the lymphogenous, hematogenous, neurogenic way. A few hours after infection, treponemes are detected in the lymph nodes, blood, tissues, where they begin to actively multiply. With the accumulation of the pathogen and the action of its toxins, the disease manifests itself clinically. First, the lymph nodes enlarge and thicken, after which a hard chancre or an atypical variant of primary syphiloma is formed at the site of primary introduction. In the body, antibodies are intensively produced that attack treponema: microorganisms massively die in the blood, as a result of which intoxication develops. An increase in the concentration of antibodies in the tissues causes local inflammation, which is manifested by generalized rashes. Untreated syphilis flows in waves with periodic weakening of humoral immunity and relapses of the rash. Subsequently, granulomatous inflammation develops, causing gross organic changes in various organs and tissues.

Classification

The classification takes into account the stage of the disease, features of tissue and organ damage, and serological data. There are the following forms of syphilis in women:

Primary (with the appearance of a hard chancre):

Seronegative - with negative serological tests
Seropositive - with positive serological test results

Secondary (with generalized eruptions):

Fresh (early) - the first generalization of the rash
Hidden - the period between rashes
Recurrent (recurrent), previously treated or untreated - re-generalization of the rash

Hidden with positive serological tests, with traces of primary syphiloma, but without generalized rash and gross organ pathology:

Early - when the disease is up to 2 years old
Late - when syphilis is 2 years old or more

Tertiary(with tubercle syphilis, gum and organ lesions):

Active - period of exacerbation
Hidden - Carriage of L-forms

In visceral syphilis, the aorta, heart valves, bones, joints, etc. are affected.Syphilitic damage to the nervous system (neurosyphilis) is also distinguished separately, which is manifested by increasing dementia (progressive paralysis), decreased sensitivity, muscle hypotension, and other neurological symptoms (dorsal tabes), etc. There are several forms of the disease arising from transplacental infection - syphilis of the fetus, placenta, early, late and latent congenital syphilis.

Symptoms of syphilis in women

The asymptomatic incubation period lasts from 2 to 12 weeks (on average, 21-28 days). The disease manifests itself in the form of primary syphiloma (hard chancre) - a dense and painless to the touch of a dark red node up to 1.0 cm in diameter, located at the site of the initial penetration of the pathogen. On the surface of the nodule there is a rounded ulcer with a hard cartilage-like bottom and raised edges. In women, the chancre is most often located on the vulva, the walls of the vagina, the cervix, in the anal area, much less often in the oral cavity, on the lips, nipples. After 28-35 days, the chancre disappears on its own, leaving a small scar, atrophy, less often unchanged skin.

With an atypical course of primary syphilis, multiple painful ulcerations may appear, from which, with additional infection of the focus, pus may be separated. At this stage, a woman can identify enlarged painless lymph nodes (inguinal, cervical, axillary). With the domestic method of infection, the primary syphiloma is located on "atypical" areas of the skin or mucous membranes in the place of direct penetration of treponema, and with blood transfusion it is absent altogether.

21-42 days after the primary manifestation of syphilis, a generalized rash occurs in the form of spots, nodules, vesicles, pustules. They are most pronounced in the collar zone ("necklace of Venus"), on the palmar and plantar surfaces. Secondary syphilides contain a large number of microorganisms and are highly contagious. In addition to the characteristic rashes, a woman may find enlarged, indurated, painless lymph nodes. Weakness, malaise, conjunctivitis, runny nose, sore throat, cough are observed, the temperature rises to 37 ° C or slightly higher. The elements of the rash and catarrhal manifestations disappear on their own in a few weeks, and the asymptomatic phase of syphilis begins. Without etiotropic treatment, relapses of a rash on the skin and mucous membranes, focal hair loss, damage to the nervous system, kidney and liver parenchyma are possible. With a latent course, there are no symptoms pathognomonic for secondary syphilis.

After 3-6, and in some cases more years from the moment of infection, tertiary syphilis develops. Superficial tubercles of the size of a cherry stone or subcutaneous gummas with a diameter of 3-4 cm are formed. Usually they have a dense structure, clear boundaries, are not accompanied by pain, burning, itching. The ripening period of syphilis in tertiary cutaneous syphilis lasts from several weeks to several months. The tubercles are resolved by dry necrosis or in the form of ulceration with uncovered edges, a smooth clean bottom, tightly elastic tissue infiltration. In their place, a slightly sunken scar with a pigmented border appears. After spontaneous opening of the gum, ulcers with viscous discharge are formed, and then characteristic stellate scars. When granulomatous inflammation of the internal organs and the nervous system is affected, sensitivity is disturbed, a woman is worried about muscle weakness, joint pain, loss of vision, memory impairment, shortness of breath, chest pain, etc.

Complications

Primary and secondary syphilis in women can cause infection of other family members, lead to intrauterine infection or death of the child. Syphilitic meningitis is extremely dangerous, in which there is a high probability of death. In the absence of adequate treatment, the disease turns into tertiary syphilis in 1/3 of cases. Its most serious complications, in addition to gross cosmetic skin defects, are blindness, paresis and paralysis, pathological bone fractures, dementia, fatal bleeding due to rupture of large vessels.

Diagnostics

To diagnose syphilis in women in gynecology, anamnestic and epidemiological data, the results of a physical examination and tests are used. A comprehensive diagnostic plan includes:

Examination by a gynecologist... In primary syphilis, during a gynecological examination, a hard chancre is revealed on the mucous membrane of the external genital organs, vagina, cervix. In women with latent or secondary syphilis, the doctor may find a scar or tissue atrophy at the site of the primary syphiloma.
Physical examination... Syphilis is manifested by a specific skin rash corresponding to the stage of development of the disease. Lymphadenopathy is characteristic.
Laboratory diagnostics... Microscopy reveals treponema in the discharge of syphilis, punctate of the lymph nodes, cerebrospinal fluid. Positive results of the RPR test, Wasserman reaction (RW), RIBT, RPHA, RIF, ELISA are specific markers of the disease. The sensitivity of these methods ranges from 90 to 98%. PCR data are important in seronegative forms of syphilis and in monitoring the effectiveness of treatment.

The differential diagnosis of syphilis in women depends on the stage of the disease. Chancre may sometimes need to be distinguished from, etc. If the diagnosis of syphilis is confirmed, the woman is examined for other STIs.

Syphilis treatment in women

The main task of therapy is to destroy the pathogen. Patients are prescribed a course of benzylpenicillin, bicillin, or other antibiotics. The treponemicidal concentration of the drug should be maintained for 7-10 days or more, depending on the duration of the disease. The grounds for prescribing a course of anti-treponemal therapy are:

Clinical picture, which is confirmed by laboratory. In such situations, a scheme is used that corresponds to the specific stage of syphilis.
Close household or sexual contact with a patient who has one of the early forms of syphilis, or a transfusion of contaminated blood. The antibacterial course is carried out preventively in the absence of clinical and laboratory signs of the disease and the duration of contact or blood transfusion no later than 90 days.
Pregnancy. Therapy is prescribed for pregnant women with a newly diagnosed or treated for syphilis in the presence of positive serological tests.
Identification of lesions characteristic of syphilis in the internal organs. Trial treatment is carried out for diagnostic purposes.

In addition to specific therapy, women with tertiary syphilis are additionally prescribed symptomatic treatment (non-steroidal anti-inflammatory drugs, nootropics, etc.).

Forecast and prevention

With primary and secondary syphilis, the prognosis of the disease is favorable. After 24 hours from the appointment of etiotropic therapy, the patient becomes non-infectious. A woman develops non-sterile (infectious) immunity to syphilis with the possibility of re-infection (reinfection). Tertiary syphilis is accompanied by severe systemic and organ damage; mortality at this stage reaches 25%. After the completion of the course of treatment, control serological tests are carried out within the time frames established by the protocols. To prevent infection, it is recommended to avoid sexual intercourse with casual partners or to use condoms during such contacts. If there is a person with syphilis in the environment, it is necessary to provide him with a separate dish, to exclude the sharing of hygiene items, close physical contacts and kisses.