Primary syphilis — the first stage of syphilis arising after infection pale treponemy and beginning with skin manifestations in the place of its introduction. It is characterized by emergence of a firm shankr (primary sifiloma) on skin or mucous with the subsequent development of a regionarny limfangit and lymphadenitis. At localization of elements of primary syphilis on skin of a penis development of a balanopostit, fimoz, gangrenization and other complications is possible. The diagnosis of primary syphilis is established on the basis of the anamnesis, detection of a firm shankr and identification in it separated pale trepony, positive results of serological researches, PTsR-diagnostics. Treatment is performed by penicillin medicines.
The modern venereology notes some differences in a clinical picture of primary syphilis in comparison with those its manifestations which were observed earlier. If earlier at 90% of the patients with primary syphilis firm had single character, then the number of cases of emergence of the 2nd and more shankr increased at once now. Essential increase in ulcer forms of a firm shankr and the forms of primary syphilis complicated by a piodermiya is noted. Specific weight of the firm shankr located on mucous a mouth and in the field of an anus grew.
Classification of primary syphilis
- Primary seropozitivny syphilis — is followed by positive serological reactions to syphilis.
- Primary seronegativny syphilis — at the patient serological researches yield negative result.
- The latent primary syphilis — proceeds with lack of clinical displays of a disease, can be seropozitivny and seronegativny. This form of syphilis is more often observed at patients who began treatment at early stages, but did not finish it.
Symptoms of primary syphilis
Clinical displays of primary syphilis arise 10-90 days later from the moment of infection of the patient. The place of emergence of primary sifiloma called by a firm shankr corresponds to the place of introduction of a pale treponema through integuments or a mucous membrane. As a rule, it is genitals: men have most often a head of a penis and extreme flesh, women have vulvar lips, mucous vaginas and necks of a uterus. Lately at primary syphilis the ekstragenitalny (extra sexual) arrangement of a shankr even more often meets: on skin and mucous an anus, a stomach, hips, a pubis, fingers of hands, mucous lips, language and a mouth.
Firm primary syphilis represents a roundish fleshy-red erosion with a diameter up to 1 cm. Raised edges of an erosion give it a saucer-shaped look, and poor serous separated does its surface as if varnished. Firm received the name thanks to the dense infiltrate lying in the erosion basis. However modern venereologists note in the practice cases of shankr without the expressed consolidation in the basis. Usually primary syphilis proceeds without subjective feelings, most of patients notes only insignificant morbidity in the field of a shankr. Permission of an erosive shankr occurs, without leaving on skin or mucous any traces. In too time at primary syphilis ulcer forms of a firm shankr meet more expressed edges and consolidation of the basis. Their healing happens about formation of a hem.
Primary syphilis can proceed with the advent of atypical forms of a firm shankr that meets rather seldom. Carry to atypical forms: indurative hypostasis, shankr-amigdalit also a shankr-felon. Indurative hypostasis meets in the field of a scrotum, extreme flesh and big vulvar lips. Its density is so big that pressing by a finger in the place of hypostasis does not leave behind deepening. Primary syphilis in the form of a shankra-amigdalit is shown by the unilateral painless increase and consolidation of an almond which is followed by its coloring in red and copper color. Lack of the expressed inflammatory changes, morbidity and temperature reaction allows to distinguish this form of primary syphilis from quinsy or an exacerbation of chronic tonsillitis. Shankr-panaritsy takes place most often at development of primary syphilis in health workers (gynecologists, urologists, stomatologists, laboratory assistants and so forth). It is characterized by sharp morbidity, consolidation and swelling of a trailer phalanx of one of hand fingers. Lack of the expressed reddening and existence of dense infiltration of the struck area helps to assume primary syphilis in such cases. It is possible to suspect primary syphilis at all atypical forms of a firm shankr on the typical for syphilis expressed increase in regionarny lymph nodes: inguinal at indurative hypostasis, cervical and submandibular at a shankre-amigdalita, elbow at a shankre-felon.
Complications of primary syphilis
The most often primary syphilis is complicated by a secondary bacterial or trikhomonadny infection with development of a balanit or balanopostit. The last can lead to narrowing of extreme flesh with emergence of a fimoz. If at the same time firm it is localized in a coronal furrow, then its inspection becomes impossible that complicates diagnosis of primary syphilis. Attempts of the patient to independently open a head can lead to its infringement and emergence of a parafimoz.
More rare of a complication of primary syphilis is the gangrenization caused by a fuzospirillezny infection. At the same time firm becomes covered by a black scab. Distribution of process out of limits of a shankr speaks about development of a fagedenizm.
Diagnosis of primary syphilis
Not only the venereologist, but also the andrologist, the urologist, the gynecologist, the dermatologist, the otolaryngologist, the proctologist, the stomatologist faces displays of primary syphilis in the practice. Identification of a firm shankr and existence in the anamnesis of the patient of data on sexual contact which could be the cause of infection is a main issue at the initial stage of diagnosis of primary syphilis. Then the research of the separated shankr for detection of a pale treponema is conducted. An auxiliary method is the research on pale treponema of the punktat taken during a biopsy of a lymph node. Serological reactions (RIF, RIBT, the RPR test) become positive only 3-4 weeks later from the beginning of displays of primary syphilis. Therefore during the early period of primary syphilis PTsR-diagnostics is applied.
Differential diagnosis of primary syphilis is carried out with genital herpes, trichomoniasis, gonorrhea, itch, psoriasis, balanopostity, Keyr's disease, a uterus neck erosion, cancer of a vulva and other diseases. At an arrangement of a firm shankr on lips primary syphilis needs to be differentiated from a heylit and simple herpes, at its localization on mucous a mouth — from stomatitis, a puzyrchatka, an ulcer form of miliarny tuberculosis, a cancer ulcer, defeats mucous at red flat herpes, system red a wolf cub, a leukoplakia.
Treatment of primary syphilis
Therapy of primary syphilis is carried out by medicines of a penicillinic row. Each 3 hours, novokainovy salt of benzylpenicillin twice a day or the combined benzylpenicillin medicines according to the scheme carry out intramuscular introduction of water-soluble penicillin. Doses and duration of treatment depend on a form of primary syphilis. Inspection and treatment of sexual partners of the patient is important.
At patients with an allergy to penicillin treatment of primary syphilis can be carried out by doxycycline or tetratsikliny. Some researches indicate efficiency of a tseftriakson in treatment of primary and secondary syphilis. However the small number of such observations gives insufficient amount of information for establishment of its optimum doses and the most expedient duration of treatment.
After the carried-out treatment patients with seronegativny primary syphilis within a year are on obligatory dispensary observation, and patients with seropozitivny primary syphilis — three years. Control of an izlechennost is exercised throughout the entire period of dispensary observation by carrying out the RPR test. Preservation of sharply positive test results within a year is the indication to additional treatment.