Secondary syphilis — the period of syphilis following for primary which is characterized by disseminirovanny rash with big polymorphism of elements (a rozeola, a papule, a vesicle, a pustula), defeat of somatic bodies, the musculoskeletal device, nervous system and generalized lymphadenitis. Diagnosis of secondary syphilis is carried out by identification of a pale treponema in separated skin elements, a punktata of lymph nodes and cerebrospinal fluid; statement of serological reactions. Treatment includes a penitsillinoterapiya and symptomatic therapy of damages of internals.
The period of secondary syphilis begins in 2-3 months after penetration into an organism pale trepony and is connected with their hit in blood and a lymph. On blood and lymphatic vessels causative agents of syphilis are carried in internals, lymph nodes and nervous system, causing their damage. Under the influence of the immune answer of an organism the pale treponema can form disputes and tsist in whom it remains in an avirulent look, causing development of the hidden period of secondary syphilis. At decrease of the activity of immune mechanisms the activator is capable to be transformed to the pathogenic mobile form causing a recurrence of secondary syphilis again.
Classification of secondary syphilis
Fresh secondary syphilis — develops after primary syphilis and is shown by plentiful disseminirovanny small polymorphic rash, existence of a firm shankr in a stage of permission and poliadenity. Duration is 2-4 months.
The latent secondary syphilis — is characterized by disappearance of clinical symptoms and comes to light only positive results of serological researches. Lasts up to 3 months and more.
Recurrent secondary syphilis — happens alternation of a recurrence of syphilis to the hidden periods. During the recurrence rash develops again. However, unlike fresh secondary syphilis, it less plentiful, larger also settles down groups, forming arches, rings, garlands and half rings.
Symptoms of secondary syphilis
Development of secondary syphilis often begins with the general a symptom, a SARS, similar to manifestations, or flu. This indisposition, temperature increase, fever, headache. Distinctive feature of secondary syphilis is the artralgiya and mialgiya amplifying at night. Only in a week after emergence of these prodromalny symptoms there are skin displays of secondary syphilis.
Rashes of secondary syphilis — secondary sifilida — differ in considerable polymorphism. At the same time they have a number of similar characteristics: a good-quality current without the peripheral growth and destruction of surrounding fabrics, rounded shape and an accurate otgranicheniye from the skin surrounding them, lack of subjective symptomatology (the small itch is occasionally noted) and ostrovospalitelny signs, healing without formation of hems. Secondary sifilida contain big concentration pale trepony and cause high infectious danger of the patient with secondary syphilis.
The most common form of rash at secondary syphilis is the syphilitic rozeola or spotty , shown roundish light pink spots with a diameter up to 10 mm. Usually they are localized on skin of extremities and trunks, but can be on a face, feet and brushes. Rozeola at secondary syphilis about 10-12 pieces a day within a week appear gradually. Disappearance of a rozeola when pressing on it is typical. The shelled and rising rozeola belong to more rare forms of rozeolezny rash at secondary syphilis. The first has a small zapadeniye in the center and is covered with lamellar scales, the second — towers over the general level of skin that makes it similar to a blister.
In the second place on prevalence at secondary syphilis is papular . Its most typical form lentikulyarny, having an appearance of plotnoelastichny papules with a diameter of 3-5 mm of pink or copper-colored color. Over time in the center of a papule of secondary syphilis the peeling which extends to the periphery begins. "Biyett's collar" - a peeling on edge of a papule is characteristic while in the center it already ended. Permission of papules comes to an end with education is long the existing hyperpegmentation. Carry to more rare forms of a papular sifilid seboreyny, monetovidny, psoriaziformny, becoming wet , papular palms and soles, and also wide condylomas.
Rare form of rashes of secondary syphilis is pustulous . Its emergence is usually observed at the weakened patients (TB patients, addicts, alcoholics) and testifies to heavier course of secondary syphilis. Pustulous it is characterized by availability of purulent exudate which dries with formation of a yellowish crust. The clinical picture reminds manifestations of a piodermiya. Pustulous secondary syphilis can have the following forms: impetiginous, eely, ektimatozny, ospennovidny, rupoidny.
At recurrent secondary syphilis it can be observed pigmentary (a syphilitic leykoderma), appearing on the side and back surface of a neck in the form of the roundish whitish spots which received the name "necklace of Venus".
Skin displays of secondary syphilis are followed by generalized increase in lymph nodes (lymphadenitis). The increased cervical, axillary, femoral, inguinal lymph nodes remain painless and are not soldered to the fabrics surrounding them. Violation of food of roots of hair at secondary syphilis leads to a hair loss with development of a diffusion or focal alopetion. Damages of mucous membranes of a mouth (oral cavity syphilis) and throats are often noted. The last cause a characteristic osiplost of a voice at patients with secondary syphilis.
From somatic bodies generally functional changes which quickly take place when performing treatment are observed and are absent during the periods of the latent secondary syphilis. Damage of a liver is shown by its morbidity and increase, violation of hepatic tests. Gastritis and dyskinesia of a GIT is often observed. From kidneys the proteinuria and emergence of a lipoidny nefroz is possible. Defeat of nervous system is shown by irritability and a sleep disorder. At some patients with secondary syphilis the syphilitic meningitis which is easily giving in to therapy is observed. Defeat of bone system with development of the osteoperiostit and periostit which are shown night pains mainly in bones of extremities and proceeding without bone deformations is possible. In some cases secondary syphilis otitis, dry pleurisy can be observed, retinit, neurosyphilis.
Diagnosis of secondary syphilis
The various clinical picture of secondary syphilis dictates need to conduct researches on syphilis at each patient with the diffusion rash which is combined with a poliadenopatiya. First of all this research separated skin elements on existence of a pale treponema and statement of the RPR test. It is possible to reveal a pale treponema and in the material taken at a punktsionny biopsy of a lymph node. The research of the tserebrospinalny liquid received by a lyumbalny puncture in the period of fresh secondary syphilis or a recurrence also often reveals existence of the activator.
At secondary syphilis at most of patients positive serological reactions (RIBT, RIF, RPGA) are noted. The exception is made by only 1-2% of cases of the false-negative reactions caused by too high caption of antibodies which can be lowered by serum cultivation.
Clinical manifestations from internals can demand additional consultation of the gastroenterologist, the urologist, the oculist, the neurologist, the otolaryngologist; performing ultrasonography of abdominal organs, gastroscopies, faringoskopiya, ultrasonography of kidneys, X-ray analysis of lungs and so forth.
Differential diagnosis of secondary syphilis
The expressed polymorphism of vysypny elements at secondary syphilis causes the big list of diseases with which it is necessary to carry out its differential diagnostics. These are the infectious diseases which are followed by rash (a rubella, measles, sypny typhus, a typhoid, chicken pox, etc.), dermatological diseases (a toksikodermiya, psoriasis, red flat deprive, skin tuberculosis, eels), fungal diseases (otrubevidny deprive, pink deprive of Zhiber, candidiasis), infectious damages of skin (a vulgar ektima, streptococcal impetigo). Wide condylomas of secondary syphilis need to be differentiated from the peaked condylomas caused by VPCh. Defeats of mucous differentiate with aftozny stomatitis, a leukoplakia, glossity, hard currency, quinsy, laryngitis, the milkwoman.
Treatment of secondary syphilis
In therapy of secondary syphilis the same medicines, as in treatment of primary syphilis are applied. At defeat of somatic bodies in addition use symptomatic means. The most effective treatment of secondary syphilis is considered water-soluble penicillin during which necessary concentration of penicillin in blood is constantly maintained. But similar therapy can be carried out only in stationary conditions as intramuscular introduction of medicine is required each 3 hours.
Not observance of the adequate scheme of treatment or sufficient duration of therapy leads to further development of a disease and its transition to the following stage — tertiary syphilis.