The latent syphilis — option of development of a syphilitic infection at which any clinical displays of a disease do not come to light, but positive results of laboratory researches on syphilis are observed. Diagnosis of the latent syphilis is difficult and based on data of the anamnesis, results of careful survey of the patient, positive specific reactions to syphilis (RIBT, RIF, RPR-the test), identification of pathological changes from tserebrospinalny liquid. For an exception of false positive reactions repeated carrying out researches, repeated diagnostics after treatment of the accompanying somatic pathology and sanitation of the infectious centers practices. Treatment of the latent syphilis is performed by penicillin medicines.
The modern venereology faces growth of cases of the latent syphilis worldwide. First of all it can be connected with broad application of antibiotics. Patients with not diagnosed initial displays of syphilis independently or on doctor's orders undergo antibiotic treatment including what are sick with other venereal disease (gonorrhea, trichomoniasis, clamidiosis), a SARS, cold, quinsy or stomatitis. As a result of such treatment syphilis does not recover, and gets the hidden current.
Many authors point that relative increase in incidence of the latent syphilis can be caused by its more frequent identification in connection with the mass inspection accepted recently in hospitals and antenatal clinics on syphilis. On statistical data about 90% of the latent syphilis are diagnosed during routine inspections.
Classification of the latent syphilis
The early latent syphilis corresponds to the period from primary syphilis to recurrent secondary syphilis (approximately within 2 years since infection). Though patients have no displays of syphilis, in the epidemiological relation they are potentially dangerous to people around. It is connected with the fact that at any time the early latent syphilis can pass into an active form of a disease with various skin rashes containing a large number pale trepony and being an infection source. Installation of the diagnosis of the early latent syphilis demands holding the anti-epidemic actions directed to identification of household and sexual contacts of the patient, his isolation and treatment before full sanitation of an organism.
The late latent syphilis is diagnosed at prescription of possible infection more than 2 years. Patients do not reckon dangerous in the infectious plan as upon transition of a disease to an active phase of its manifestation correspond to clinic of tertiary syphilis with damage of internals and nervous system (neurosyphilis), skin manifestations in the form of low-infectious gumm and hillocks (tertiary sifilid) with the late latent syphilis.
Not specified (unknown) latent syphilis includes cases when the patient has no information on prescription of the infection and the doctor cannot establish disease terms.
Diagnosis of the latent syphilis
With establishment of a type of the latent syphilis and prescription of a disease the venereologist is helped by carefully collected anamnestichesky data. They may contain the instruction not only on sexual contact, suspicious concerning syphilis, but also on the single erosion noted in the past at the patient in genitals or on a mucous mouth, rashes on skin, reception of antibiotics in connection with any disease similar to displays of syphilis. Also the age of the patient and his sexual behavior is taken into account. At survey of the patient with suspicion of the latent syphilis the hem or residual consolidation created later permissions of primary sifiloma (a firm shankr) quite often is found. Lymph nodes, increased and fibrozirovanny after the postponed lymphadenitis, can be revealed.
Confrontation — identification and inspection on syphilis of the persons which are in sexual contact with the patient can give big help in diagnosis of the latent syphilis. Identification at the sexual partner of an early form of a disease testifies in favor of the early latent syphilis. At sexual partners of patients with a late form of the latent syphilis no symptoms of this disease come to light more often, the late latent syphilis is less often observed.
The diagnosis of the latent syphilis has to be surely confirmed with results of serological reactions. As a rule, at such patients the high caption of reagin is noted. However the persons receiving antibacterial therapy can have it and low. Carrying out the RPR test has to be added with RIF, RIBT and PTsR-diagnostics. Usually at the early latent syphilis result the REEF sharply positive while some patients can have RIBT and negative.
Diagnosis of the latent syphilis represents a complex challenge as it is impossible to exclude the false positive nature of reactions to syphilis for the doctor. Such reaction can be caused by the malaria postponed earlier, presence at the patient of the infectious center (chronic sinusitis, tonsillitis, bronchitis, chronic cystitis or pyelonephritis, etc.), chronic damages of a liver (an alcoholic liver disease, chronic hepatitis or cirrhosis), rheumatism, tuberculosis of lungs. Therefore researches on syphilis are conducted several times with a break, repeat them after treatment of somatic diseases and elimination of the centers of a chronic infection.
In addition make a research on syphilis of the tserebrospinalny liquid taken from the patient by a lyumbalny puncture. Pathology in tserebrospinalny liquid testifies to the latent syphilitic meningitis and a thicket is observed at the late latent syphilis.
Patients without fail consult the therapist (gastroenterologist) and the neurologist for identification with the latent syphilis or an exception of interkurentny diseases, syphilitic defeats of somatic bodies and nervous system.
Treatment of the latent syphilis
Treatment of the early latent syphilis is directed to the prevention of its transition to the active form representing epidemiological danger to people around. A main objective of treatment of the late latent syphilis is prevention of neurosyphilis and defeats of somatic bodies.
Therapy of the latent syphilis, as well as other forms of a disease, is carried out by generally system penitsillinoterapiya. At the same time at patients with the early latent syphilis in an initiation of treatment temperature reaction of an aggravation can be observed that is additional confirmation of correctly established diagnosis.
Efficiency of treatment of the latent syphilis is estimated on decrease in credits in results of serological reactions and normalization of indicators of tserebrospinalny liquid. During treatment of the early latent syphilis by the end 1-2 courses of a penitsillinoterapiya are usually noted a negativation of serological reactions and bystry sanitation of a likvor. At the late latent syphilis the negativation of serological reactions occurs only by the end of treatment or does not occur at all, despite the carried-out therapy; changes in a likvor remain a long time and regress slowly. Therefore it is preferable to begin therapy of a late form of the latent syphilis with preparatory treatment with bismuth medicines.