Tertiary syphilis — the third period of syphilis developing at not enough treated patients or patients who were not undergoing treatment at all. It is shown by formation of syphilitic infiltrates (granulomas) in skin, mucous, bones and internals. Granulomas at tertiary syphilis squeeze and destroy fabrics in which are that can lead to a lethal outcome of a disease. Diagnosis of tertiary syphilis includes clinical inspection of the patient, statement of serological and immunological reactions, inspection of the struck systems and bodies. Therapy of tertiary syphilis is performed by courses of penitsillino-bismuth treatment with additional application of the symptomatic and all-strengthening means.
Now tertiary syphilis is seldom found syphilis form as in modern venereology identification and treatment of the majority of cases happens at a stage of primary or secondary syphilis. Tertiary syphilis can arise at the patients who completed an incomplete course of treatment or receiving medicines in an insufficient dosage. In the absence of treatment of syphilis (for example, in connection with not diagnosed latent syphilis) approximately at a third of the diseased tertiary syphilis develops. The factors contributing to developing of tertiary syphilis are the accompanying chronic intoxications and diseases, alcoholism, senile and children's age.
The patient with tertiary syphilis is almost not infectious as not numerous treponema which are in its organism settle down deeply in granulomas and perish at their disintegration.
Symptoms of tertiary syphilis
Earlier it was specified in literature that tertiary syphilis develops 4-5 years later from the moment of infection with pale treponema. However data of the last years demonstrate that this period increased up to 8-10 years. Tertiary syphilis is characterized by a long current with the big latent periods sometimes borrowing several years.
Skin defeats at tertiary syphilis — tertiary sifilida — develop within months and even years without signs of an inflammation and any subjective feelings. Unlike elements of secondary syphilis they settle down on the limited site of skin and slowly regress, leaving behind hems. Treat displays of tertiary syphilis bugorkovy and gummozny .
Bugorkovy — the infiltrative small knot which is formed in a term slightly acting over the surface of skin having the size of 5-7 mm, red-brown coloring and a dense consistence. Usually at tertiary syphilis of a rash of small knots happen wavy and asymmetrically on the local site of skin, at the same time separate elements are in different stages of the development and do not merge among themselves. Over time bugorkovy is exposed to a necrosis with formation of a roundish ulcer with smooth edges, the infiltrirovanny basis and a smooth pure bottom. Healing of an ulcer of tertiary syphilis proceeds weeks and months then on skin there is a site of an atrophy or a hem with a hyperpegmentation on edge. The hems appearing as a result of permission of several grouped bugorkovy sifilid form a picture of a uniform mosaic hem. Repeated rashes of tertiary syphilis never arise in the field of hems.
Gummozny (a syphilitic gumma) more often is single, education of several occurs at one patient less often. Gumma represents the painless knot located in hypodermic cellulose. The most frequent localization tertiary syphilis is a forehead, the forward surface of shins and forearms, area of knee and elbow joints. In the beginning the knot is mobile and is not soldered to nearby fabrics. Gradually it increases in sizes and loses mobility because of an union with the fabrics surrounding it. Then in the middle of knot there is an opening through which there is an office of jellylike liquid. Slow increase in an opening leads to formation of an ulcer with the crateriform breaking edges. At the bottom of an ulcer the necrotic core after which otkhozhdeniye the ulcer heals with formation of the star-shaped involved hem is visible. Sometimes at tertiary syphilis permission of a gumma without transition to an ulcer is observed. In such cases reduction of knot and its replacement with dense connecting fabric is noted.
At tertiary syphilis gummozny ulcers can take not only skin and hypodermic cellulose, but also the subject cartilaginous, bone, vascular, muscular tissue that leads to their destruction. Gummozny sifilida can settle down on mucous membranes. Most often it is mucous a nose, language, a soft palate and a throat. Defeat by tertiary syphilis mucous a nose leads to development of rhinitis with purulent separated and violation of nasal breath, then there is a destruction of nasal cartilages to formation of characteristic saddle deformation, nasal bleedings are possible. At defeat by tertiary syphilis mucous language develops glossit with difficulty of the speech and a chewing of food. Defeats of a soft palate and a throat result in twang of a voice and hit of food when chewing in a nose.
The violations from somatic bodies and systems caused by tertiary syphilis are observed on average in 10-12 years after infection. In 90% of cases tertiary syphilis proceeds with defeat of cardiovascular system in the form of myocarditis or an aortit. Defeats of bone system at tertiary syphilis can be shown by osteoporosis or osteomyelitis, damages of a liver — chronic hepatitis, a stomach — gastritis or stomach ulcer. Damages of kidneys, intestines, lungs, nervous system are in rare instances noted (neurosyphilis).
Complications of tertiary syphilis
The main and most terrible complications of tertiary syphilis are connected with defeat of cardiovascular system. So, syphilitic aortit can lead to aneurism of an aorta which can gradually squeeze the bodies surrounding it or suddenly become torn with development of massive bleeding. Syphilitic myocarditis can be complicated by heart failure, a spasm of coronary vessels with development of a myocardial infarction. Against the background of complications of tertiary syphilis death of the patient is possible that it is observed approximately in 25% of cases.
Diagnosis of tertiary syphilis
At tertiary syphilis diagnostics is based mainly on clinical and laboratory data. At 25-35% of patients with tertiary syphilis the RPR test yields negative result therefore major importance blood tests with the help have the REEF and RIBT which are positive in most cases tertiary syphilis (92-100%).
For identification of extent of defeat of somatic systems and bodies for indications carry out the ECG, by ultrasonography of heart, an aortografiya, a X-ray analysis of bones, a rinoskopiya and a faringoskopiya, gastroscopy and ultrasonography of a liver, a research of hepatic tests, a X-ray analysis of lungs, a lyumbalny puncture with a research of tserebrospinalny liquid and so forth. Additional consultation of the cardiologist, neurologist, otolaryngologist, gastroenterologist, oculist can be required by the patient.
Differential diagnosis of tertiary syphilis is carried out with skrofulodermy, indurative eritemy, ulcer displays of cancer of skin, miliarny tuberculosis, actinomycosis, a leprosy, the breaking-up lipomas.
Treatment of tertiary syphilis
Therapy of tertiary syphilis is begun with a preparatory stage in the form of a 2-week rate of erythromycin or a tetratsiklin. Then break to a penitsillinoterapiya two courses with an interval in 2 weeks. Duration of courses and a dosage select according to the chosen medicine, a condition of the patient and localization . Therapy by penicillin is supplemented with introduction of medicines of bismuth. At existence of contraindications to bismuth (damage of kidneys or a liver) in addition appoint a third year of a penitsillinoterapiya. During treatment of tertiary syphilis control of the main indicators of functioning of the struck bodies is surely carried out: clinical blood test and urine, biochemical tests of a liver, koagulogramm, ECG, etc. According to indications appoint the all-strengthening means and symptomatic treatment.