– the venereal disease having a long wavy current and affecting all bodies. The clinic of a disease begins with emergence in the place of introduction of an infection of a firm shankr (primary sifiloma), increase in the regionarny, and then and remote lymph nodes. Emergence on skin is characteristic and mucous syphilitic rashes which are painless do not scratch, proceed without fever. Further all internals and systems can be surprised that leads to their irreversible changes and even to a lethal outcome. Treatment of syphilis is carried out by the venereologist, system and rational antibiotic treatment is its cornerstone.
Lues – the infectious disease having a long, wavy current. On the volume of defeat of an organism syphilis belongs to system diseases, and on the main way of transfer - to venereal. Syphilis affects all organism: integuments and mucous membranes, cardiovascular, central nervous, digestive, musculoskeletal systems. The Nelechenny or badly treated syphilis can last for years, alternating the periods of aggravations and the hidden (latent) current. During the active period syphilis is shown on skin, mucous membranes and internals, during the hidden period is practically shown by nothing.
Syphilis is on the first place among all infectious diseases (including STD), on incidence, transmissibility, degree of harm to health, certain difficulties of diagnostics and treatment.
Features of the causative agent of syphilis
The causative agent of syphilis - a microorganism a pale spirokheta (a treponema - Treponema pallidum). The pale spirokheta has an appearance of a curved spiral, is capable to move in the different ways (progressively, vrashchatelno, sgibatelno and wavy), breeds cross division, is painted by aniline dyes in light pink color.
The pale spirokheta (treponema) finds optimum conditions in a human body in lymphatic ways and lymph nodes where actively breeds, to blood in high concentration appears in a stage of secondary syphilis. The microbe long remains in the warm and damp environment (opty. t = 37 °C, in damp linen up to several days), it is steady also against low temperatures (in fabrics of corpses – it is viable 1-2 days). The pale spirokheta perishes when drying, heating (55 °C – in 15 minutes, 100 °C – instantly), when processing by disinfectants, solutions of acids, alkalis.
The patient with syphilis is infectious during any periods of a disease, especially during the periods of primary and secondary syphilis which are followed by manifestations on skin and mucous. Syphilis at contact of the healthy person with the patient is transmitted through secrets (sperm at sexual intercourse, milk - at the feeding women, saliva at a kiss) and blood (at direct blood transfusion, during operations - at medical staff, use of the general open razor, the general syringe - at addicts). The main way of transfer of syphilis – sexual (95-98% of cases). The indirect household way of infection – through damp objects of use and personal belongings is less often observed (for example, from sick parents to children). Cases of pre-natal transfer of syphilis to the child from sick mother are noted. A necessary condition of infection is existence in secrets of sick enough pathogenic forms pale spirokht also violation of integrity of an epithelium of mucous membranes and integuments at his partner (microinjuries: wounds, scratches, grazes).
The course of syphilis – long wavy, with alternation of the periods of the active and hidden display of a disease. In development of syphilis allocate the periods differing with a set of sifilid - various forms of the skin rashes and erosion developing in response to introduction in an organism pale spirokht.
- Incubatory period
Begins with the infection moment, 3-4 weeks last on average. Pale spirokheta extend on lymphatic and blood ways on all organism, breed, but clinical symptoms are not shown. The patient with syphilis does not suspect about the disease though it is already infectious. The incubatory period can be shortened (up to several days) and to be extended (up to several months). Lengthening happens at reception of medicines which inactivate causative agents of syphilis a little.
- Primary syphilis
6-8 weeks last, it is characterized by emergence on the place of penetration of pale spirokht primary sifiloma or a firm shankr and the subsequent increase in nearby lymph nodes.
- Secondary syphilis
From 2 to 5 years can proceed. There is a damage of internals, fabrics and systems of an organism, emergence of generalized rashes on mucous membranes and skin, baldness. This stage of syphilis proceeds wavy, the periods of active manifestations are replaced by the periods of lack of symptoms. Distinguish the secondary fresh, secondary recurrent and latent syphilis.
The latent (latent) syphilis has no skin displays of a disease, signs of specific damage of internals and nervous system, is defined only by laboratory analyses (positive serological reactions).
- Tertiary syphilis
Meets now seldom, arises in the absence of treatment years later after defeat. It is characterized by irreversible violations of internals and systems, especially the central nervous system. Is the most difficult period of syphilis resulting in disability and by a lethal outcome. It is found emergence on skin and mucous hillocks and knots () which, breaking up, disfigure the patient. Subdivide into syphilis of nervous system – neurosyphilis and visceral syphilis at which internals are injured (a head and spinal cord, heart, lungs, a stomach, a liver, kidneys).
Symptoms of primary syphilis
Primary syphilis begins with that moment when in the place of introduction of pale spirokht primary sifiloma – firm appears. Firm is single, rounded shape the erosion or an ulcer having accurate, smooth edges and brilliant it is cyanotic – a red bottom, painless and not inflamed. Shankr does not increase in sizes, has poor serous contents or is covered with a film, a crust, in its basis dense painless infiltrate is felt. Firm does not give in to local antiseptic therapy.
Shankr can be on any site of skin and mucous (anal area, a mouth – lips, corners of a mouth, an almond; the mammary gland, a stomach bottom, fingers of hands), but most often settles down on genitals. Usually at men – on a head, extreme flesh and a trunk of a penis, in an urethra; at women - on vulvar lips, a crotch, a vagina, a uterus neck. The sizes of a shankr about 1 cm, but can be dwarfish - about poppy grain and huge (d of =4-5 cm). Shankra can be multiple, in case of numerous small injuries of skin and mucous at the time of infection, sometimes bipolar (on a penis and lips). At emergence of a shankr on almonds – there is a state reminding quinsy at which temperature does not increase and a throat almost does not hurt. Painlessness of a shankr allows patients not to notice it and not to attach any significance. Differ in morbidity slit-like in an anus fold, and – a felon on a nail phalanx of fingers of a hand. In the period of primary syphilis complications (balanit, a gangrenization, ) as a result of accession of a secondary infection can be observed. Uncomplicated depending on the size heals in 1,5 – 2 months, sometimes before emergence of symptoms of secondary syphilis.
In 5-7 days after emergence of a firm shankr uneven increase and consolidation of the next to it of lymph nodes develops (is more often than inguinal). Can be unilateral and bilateral, knots at the same time are not inflamed, painless, have the ovoidny form and can reach the egg size. Towards the end of the period of primary syphilis specific develops poliadenit – increase in the majority of hypodermic lymph nodes. At patients the indisposition, a headache, sleeplessness, temperature increase, artralgiya, muscular pains, neurotic and depressive frustration can be felt. It is connected with a syphilitic septitsemiya – distribution of the causative agent of syphilis on blood and lymphatic system from the defeat center on all organism. In some cases this process proceeds without fever and an indisposition, and transition from primary stage of syphilis to the secondary patient does not notice.
Symptoms of secondary syphilis
Secondary syphilis begins in 2 — 4 months after infection and can last from 2 to 5 years. It Hrakterizutsya by generalization of an infection. At this stage all systems and bodies of the patient are surprised: joints, bones, nervous system, bodies of blood formation, digestion, sight, hearing. A clinical symptom of secondary syphilis are – rashes on skin and mucous which have universal character (secondary sifilida). Rashes can be followed by an ache in a body, a headache, fever and to remind cold.
Rashes are shown pristupoobrazno: having lasted 1,5 – 2 months, without treatment disappear (secondary latent syphilis), then appear again. The first rash is characterized by a profuseness and brightness of coloring (secondary fresh syphilis), the subsequent repeated rashes - are more faintly painted, less plentiful, but is larger the sizes and are inclined to merge (secondary recurrent syphilis). Frequency of a recurrence and duration of the latent periods of secondary syphilis happen various and depend on immunological reactions of an organism in response to reproduction of pale spirokht.
Sifilida of the secondary period disappear without hems and have a variety of forms - rozeola, papules, pustula.
Syphilitic rozeola represent the small roundish spots of pink (light pink) color which are not rising over the surface of skin and an epithelium mucous which are not shelled and do not cause an itch, when pressing on them turn pale and for a while disappear. Rozeolezny rash at secondary syphilis is observed at 75-80% of patients. Education is caused by violations in blood vessels, they settle down on all body, generally on a trunk and extremities, in a face - most often on a forehead.
Papular rash represents the roundish nodular educations acting over the surface of skin, bright pink color with a cyanotic shade. Papules settle down on a trunk, do not cause any subjective feelings. However when pressing on them the pugovchaty probe, the acute pain develops. At syphilis the rash of papules with fat scales on edge of a forehead forms, so-called, "a crown of Venus".
Syphilitic papules can expand, merge with each other and form plaques, become wet. The becoming wet erosive papules are especially infectious, and syphilis can easily be transferred in this stage not only at sexual contacts, but also at handshakes, kisses, use of the general objects of use. Pustulous (pustulous) rashes at syphilis are similar to acne or wind rash, are covered with a crust or scales. Usually arise at patients with the lowered immunity.
The malignant course of syphilis can develop at the weakened patients, and also at addicts, alcoholics, HIV-positive people. The ulceration of papulo-pustulous sifilid, a continuous recurrence, violation of the general state, fever, intoxication, decrease in body weight is characteristic of malignant syphilis.
Patients with secondary syphilis can have syphilitic (eritematozny) quinsy (sharply expressed reddening of almonds, with whitish spots, not followed by an indisposition and fever), syphilitic zayeda in corners of lips, oral cavity syphilis. The general easy malaise which can remind symptoms of usual cold is observed. Generalized lymphadenitis without signs of an inflammation and morbidity is characteristic of secondary syphilis.
In the period of secondary syphilis there are violations in pigmentation of skin (leykoderm) and a hair loss (alopetion). The syphilitic leykoderma is shown in loss of pigmentation of various sites of skin on a neck, a breast, a stomach, a back, a waist, in armpits. On a neck, is more often at women, there can be "a necklace of Venus" consisting from small (3-10 mm) of the decoloured spots surrounded with more dark sites of skin. It can exist without change is long (several months and even years), despite the carried-out antisyphilitic treatment. Development of a leykoderma is connected with syphilitic defeat of nervous system, at inspection pathological changes in cerebrospinal fluid are observed.
The hair loss is not followed by an itch, a peeling, in character happens:
- diffusion - a hair loss is typical for usual baldness, occurs on a hairy part of the head, in temporal and parietal area;
- melkoochagovy - a bright symptom of syphilis, loss or a poredeniye of hair the small centers located randomly on the head, eyelashes, eyebrows, moustaches and a beard;
- mixed - meets both diffusion, and melkoochagovy.
At in due time carried out treatment of syphilis indumentum completely is restored.
At defeat by syphilis of vocal chords the voice osiplost appears.
Skin displays of secondary syphilis accompany defeats of TsNS, bones and joints, internals.
Symptoms of tertiary syphilis
If the patient with syphilis was not treated or treatment was defective, then in several years after infection it has symptoms of tertiary syphilis. There are serious violations of bodies and systems, appearance of the patient is disfigured, he becomes a disabled person, in hard cases the lethal outcome is probable. Recently the frequency of development of tertiary syphilis decreased in connection with treatment by its penicillin, severe forms of an invalidization became rare.
Allocate tertiary active (in the presence of manifestations) and tertiary latent syphilis. Displays of tertiary syphilis are not numerous infiltrates (hillocks and gumma) inclined to disintegration, and destructive changes in bodies and fabrics. Infiltrates on skin and mucous develop without change of the general condition of patients, they contain very few pale spirokht and are practically not infectious.
Hillocks and gumma on mucous a soft and hard palate, a throat, a nose , lead to disorder of swallowing, the speech, breath, (perforation of a hard palate, nose "failure"). Gummozny sifilida, extending to bones and joints, blood vessels, internals cause bleedings, perforation, cicatricial deformations, break their functions that can lead to death.
All stages of syphilis cause the numerous progressing damages of internals and nervous system, their most severe form develops at tertiary (late) syphilis:
- neurosyphilis (meningitis, meningovaskulit, syphilitic neuritis, neuralgia, paresis, epileptic seizures, a back sukhotka and progressive paralysis);
- syphilitic osteoperiostit, osteoarthritis, sinovit;
- syphilitic myocarditis, aortit;
- syphilitic hepatitis;
- syphilitic gastritis;
- syphilitic nephrite, ;
- syphilitic damage of eyes, blindness etc.
Syphilis the complications. In a stage of tertiary syphilis the disease will difficult respond to treatment, and defeat of all systems of an organism results the person in disability and even death. Pre-natal infection of the child with syphilis from sick mother leads to emergence of the most serious condition - congenital syphilis which is shown by a triad of symptoms: congenital deafness, parenchymatous keratit, getchinsonova teeth.
Diagnosis of syphilis
Diagnostic actions at syphilis include careful survey of the patient, collecting the anamnesis and performing clinical trials:
- Detection and identification of the causative agent of syphilis at microscopy serous separated skin rashes. But in the absence of signs on skin and mucous and in the presence of Sukhoi of rash application of this method is impossible.
- Serological reactions (nonspecific, specific) are put with serum, plasma of blood and a likvor – the most reliable method of diagnosis of syphilis.
Nonspecific serological reactions are: RPR – reaction of bystry plasma reagin and RW - Wasserman's reaction (reaction of binding of a compliment). Allow to define antibodies to a pale spirokheta – reagina. Apply to mass inspections (in policlinics, hospitals). Sometimes they yield false positive result (positive in absence of syphilis) therefore this result is confirmed with carrying out specific reactions.
Carry to specific serological reactions: The REEF - reaction of immunofluorescence, RPGA – reaction of passive hemagglutination, RIBT – reaction of an immobilization pale trepony, RW with a treponemny anti-gene. Are used for definition of species-specific antibodies. The REEF and RPGA highly sensitive analyses, become positive already at the end of the incubatory period. Are used in diagnosis of the latent syphilis and for recognition false positive reactions.
Positive indicators of serological reactions become only at the end of the second week of primary period therefore primary period of syphilis is divided into two stages: seronegativny and seropozitivny.
Nonspecific serological reactions apply to assessment of efficiency of the carried-out treatment. Specific serological reactions remain positive with the patient who had syphilis for the rest of life, for check of efficiency of treatment do not use them.
Treatment of syphilis
Begin treatment of syphilis after statement of the authentic diagnosis which is confirmed with laboratory analyses. Treatment of syphilis is selected individually, is carried out in a complex, recovery has to be defined laboratory. Modern methods of treatment of syphilis which are owned today by venereology allow to speak about the favorable forecast of treatment, on condition of the correct and timely therapy which corresponds to a stage and clinical displays of a disease. But to pick up therapy, rational and sufficient on volume and time, only the venereologist can. Self-treatment of syphilis is inadmissible! Undertreated syphilis passes into the latent, chronic form, and the patient remains epidemiologically dangerous.
At the heart of treatment of syphilis – application of antibiotics of a penicillinic row to which the pale spirokheta shows high sensitivity. At allergic reactions of the patient to derivatives of penicillin erythromycin, tetratsiklina, tsefalosporina are as an alternative recommended. In cases of late syphilis in addition appoint medicines of iodine, bismuth, an immunotherapy, biogenous stimulators, physiotreatment.
It is important to come into sexual contacts of the patient with syphilis, it is obligatory to carry out preventive treatment of perhaps infected sexual partners. Upon termination of treatment all earlier sick with syphilis remain on dispensary observation with the doctor to full negative result of a complex of serological reactions.
For prevention of syphilis examinations of donors, pregnant women, employees of child care, food and medical institutions, patients in hospitals are conducted; representatives of risk groups (addicts, prostitutes, bums). The blood test taken by donors surely is investigated on syphilis and is exposed to conservation.