The possibility of damage to the nervous system in the earliest stages of syphilis has been fully proven: various researchers note its changes in 26-96% of patients with infectious forms of syphilis. Damage to the nervous system of a patient with syphilis contributes to insufficient treatment, chronic intoxication (alcoholism, etc.), traumatic brain injury, and the age of the patient. According to numerous data of domestic and foreign syphilidologists, in the last 10-15 years the number of patients with latent, recurrent and seroresistant forms of syphilis, which cause the formation of neurosyphilis, has increased.

The classification of syphilis of the nervous system is based on anatomical and clinical principles n. If the process affects the membranes and vessels of the brain or spinal cord, neurosyphilis is called mesenchymal; if the substance of the brain is involved in the process, they speak of parenchymal neurosyphilis.

Mesenchymal forms of neurosyphilis are defined as early (they develop in the first 5 years after infection), and parenchymal forms- as late (develop much later). Such a division of neurosyphilis is very conditional, because in patients with mesenchymal neurosyphilis, parenchymal elements also change, but secondarily, just like in patients with parenchymal forms, along with inflammatory-degenerative processes, a mesenchymal inflammatory reaction is noted. Thus, the symptoms of early and late neurosyphilis are often closely intertwined, forming the so-called transitional anatomical and clinical forms.

For modern neurosyphilis characterized by a lesser severity of subjective and objective symptoms, a milder course, less changes in the cerebrospinal fluid than before. Of the subjective symptoms, it is not a headache, shooting and tearing pains, paresthesias that come to the fore now, but complaints of lethargy, weakness, depression, insomnia, decreased performance, which add up to an astheno-neurotic syndrome. The degree and frequency of clinical manifestations and changes in the cerebrospinal fluid increase with the lengthening of the infectious process.

Syphilis of the nervous system early . The disease is based on damage to the vessels and membranes of the brain and spinal cord, as well as nerve trunks. It is expressed by various clinical variants of specific meningitis, vascular neurosyphilis and monopolyneuritis.

Latent syphilitic meningitis most often found in patients with infectious forms of syphilis and early latent syphilis. It occurs in 10-15% of patients with primary and in 20-50% of patients with secondary fresh, recurrent and early latent syphilis.

In most patients, clear clinical symptoms of meningitis can not be detected. Some patients complain of headache, dizziness, tinnitus. The diagnosis is made according to the results of studies of the cerebrospinal fluid (changes in the cerebrospinal fluid are insignificant or grade II according to G.V. Robustov), ​​as well as a change in the shape and size of the pupils when reacting to light, a weakening of pain and vibration skin sensitivity, and a decrease in bone conductivity of low sounds. Occasionally, you can detect hyperemia of the nipple of the optic nerve, signs of papillitis. Indicators of minimal pathology the following are considered: protein - 0.4%, cytosis - 8 cells per mm 3, globulin reactions (Nonne-Apelt) - ++, Lange reaction - more than two deuces and a positive Wasserman reaction. In some untreated or poorly treated patients, spontaneous sanitation of the cerebrospinal fluid may occur.

Asymptomatic meningitis also occurs in patients with mumps and meningitis caused by viruses of the Coxsackie group and ECHO.

If asymptomatic meningitis in patients with early forms of syphilis, some researchers (K. R. Astvatsaturov, M. V. Milich, etc.) do not attach much importance and consider it just one of the symptoms of acutely infectious syphilis (like chancre, roseola, papules, etc.) , then asymptomatic meningitis in patients with late forms of syphilis, all researchers tend to take for a manifestation of early neurosyphilis that requires active treatment.

Acute generalized syphilitic meningitis. It has been very rare lately. It is observed mainly during the period of recurrent syphilis. The disease develops within 1-1.5 weeks. All membranes of the brain are involved in the process. Patients complain of increasing headache, dizziness, vomiting that occurs suddenly without the urge to nausea and is not associated with eating, tinnitus, weakness, insomnia, loss of appetite and fever (up to 38 ° C and above), paresthesia. An objective examination shows stiffness of the muscles of the neck, positive symptoms of Kernig and Brudzinsky, positive pathological reflexes of Babinsky, Oppenheim, Rossolimo are recorded, deformation of the pupils with a sluggish reaction to light, a disorder of superficial sensitivity of the radicular type on the trunk and extremities, nasolabial folds are smoothed out, greatly reduced hearing.

There is a lesion of the basal part of the brain, accompanied by ptosis, deviation of the tongue to the side, descent of the soft palate. The appearance of pathological reflexes and tendon anisoreflexia indicates the involvement of not only the membranes, but also the substance of the brain in the process - we are talking about meningoencephalitis.

Some patients have hyperemia of the optic disc and papillitis. Sometimes vascular disorders join in the form of a stroke with epileptiform seizures, paresis. In the cerebrospinal fluid, the protein content is 1.2%, the number of cells (mainly lymphocytes) is from 200-400 to 1000 per 1 mm 3; Nonne-Apelt and Pandey reactions are sharply positive (+ + + +), Lange - in the form of a paralytic (6655432100) or meningitis (0012345420) curve, Wasserman, RIBT and RIF positive.

Acute generalized syphilitic meningitis should be differentiated from acute meningitis of another etiology (streptococcal, tuberculous, meningococcal).

Meningoneuritic form of syphilitic meningitis(basal meningitis). It occurs in 10-20% of cases of early neurosyphilis. It flows subtly. Its clinic consists of symptoms of meningitis, neuritis or neuritis of the nerves, originating in the region of the base of the brain. Patients complain of a mild headache that worsens at night, dizziness, sometimes nausea, and vomiting.

An objective examination in the case of involvement of the oculomotor, abducens, vestibulocochlear nerves in the pathological process reveals mild ptosis, facial asymmetry, smoothness of the nasolabial folds, deviation of the tongue, drooping of the soft palate, and decreased bone conduction. With damage to the optic nerve, central vision worsens and its field narrows. The optic disc is hyperemic, its borders are indistinct, the veins are dilated, the tissues of the disc swell slightly. From psychogenic reactions there are superficial depression, excitability, irritability and persistent deterioration in mood, accompanied by anxiety. In the cerebrospinal fluid, protein is usually found - 0.6-0.7%, cytosis - 20-40 cells per 1 mm 3, Nonne-Apelt and Pandey reactions, Wasserman positive or sharply positive, Lange - in the form of a meningeal curve (0123456543210), more often in the form of a syphilitic tooth (2244511000) or minimal pathology (00112221000).

Sometimes the membranes of the convex surface of the brain can be affected. In such cases, the clinical picture may resemble vascular syphilis (Jacksonian seizures, aphasia, apraxia, etc.) or progressive paralysis (impaired intelligence, behavioral abnormalities).

Syphilitic hydrocephalus. It is caused by local inflammation of the meninges, which leads to a violation of the circulation of cerebrospinal fluid from the ventricles to the external liquor spaces, as a result of which stagnation of cerebrospinal fluid develops in the ventricles of the brain. This disease accounts for 7-15% of all cases of early neurosyphilis. There are acute and latent hydrocephalus.

In the acute form, the communication between the ventricles of the brain and the subarachnoid spaces stops. The process develops acutely within 3-5 days and is manifested by a severe increasing headache, dizziness, indomitable vomiting, confusion, deafness, and sometimes a delirium syndrome. Speech disorders and the appearance of epileptiform seizures are possible. An ophthalmological examination revealed congestive nipples of the optic nerves. The patient's condition improves after spinal puncture. Liquor flows out under high pressure. It reveals protein-cell dissociation: a lot of protein (1.2%) with a small number of cells (10-15 in 1 mm 3). Nonne-Apelt and Pandey, Wasserman, RIF and RIBT reactions are positive, Lange - in the form of a syphilitic tooth (2244311000).

More common chronic syphilitic hydrocephalus. With this form of hydrocephalus, the communication between the ventricles and the subarachnoid space does not stop, but becomes difficult. Patients complain of persistent persistent headache, dizziness. Congestive discs of the optic nerves, detected ophthalmologically, and protein-cell dissociation in the cerebrospinal fluid develop. After the puncture, while other symptoms persist, the headache temporarily decreases or stops.

Syphilitic meningomyelitis. This is an inflammation of the meninges with a specific spinal endarteritis. It makes up 0.5% of early neurosyphilis. The disease develops 1-3 years after infection. The course can be acute and chronic, in terms of distribution - diffuse or limited. There are two clinical forms: meningoradiculitis and meningomyelitis. Meningoradiculitis is characterized by radicular pain, changes in superficial skin sensitivity according to the radicular type on the trunk and especially on the limbs, paralysis and atrophy of the corresponding muscle groups, deep trophic disorders, hypo- and areflexia. In patients with meningomyelitis, in addition to changes in skin sensitivity according to the radicular type, parasthesias, paraparesis, urinary incontinence and dysfunction of the sphincter, as well as bilateral pathological reflexes, are found. Syphilitic meningomyelitis is resistant to specific therapy. Positive reactions of RIBT, RIF and Wasserman with cerebrospinal fluid.

Early meningovascular syphilis. It is characterized by moderate involvement in the pathological process of the meninges and vascular lesions. The disease develops 3-5 years after infection; the ratio of early and late meningovascular syphilis is 1:30 and 1:40. Signs of meningitis in patients are expressed unsharply. The clinical picture is determined mainly by vascular lesions (patients complain of headache). Damage to the cranial nerves, impaired sensitivity, hemiparesis, alternating paresis, epileptiform seizures, apoplectic syndrome, memory impairment, aphasia, etc. are detected. The clinical picture of early meningovascular syphilis is no different from late meningovascular syphilis.

Damage to the optic nerves. With syphilis, optic neuritis occurs (usually bilateral), more often observed with basal meningitis. The patient has reduced central vision (from slight blurring to complete blindness), there is a change in the fields of fenia or a concentric narrowing of their boundaries, or a narrowing of the visual fields to red and green without significant disturbances to white. Ophthalmologically, hyperemia of the nipples of the optic nerve, blurred boundaries, swelling of the nipple tissue, expansion and tortuosity of the veins are detected, sometimes there is hemorrhage on the nipple and in its circumference, clouding of the retina around the nipple. The outcome of neuritis depends on timely vigorous treatment. In most cases, the process ends with a more or less significant decrease in vision, in rare cases, complete blindness.

Damage to the auditory nerves. Damage to the auditory nerve in early forms of syphilis, according to various authors, ranges from 60 to 76%. They are usually distinguished by special research methods, are functional in nature and are quickly eliminated under the influence of specific therapy. In the literature there are descriptions of isolated cases of deafness that occur in patients with early syphilis. Pathognomonic in case of damage to the auditory nerves is bone-air dissociation: a sharp decrease in bone conduction or even disappearance while maintaining air.

Neuritis and polyneuritis in patients with syphilis. Isolated mononeuritis in early syphilis is rare. The ulnar, sciatic, and peroneal nerves are most commonly affected. Mononeuritis is manifested by pain localized in the zone innervated by this nerve, sometimes zones of sensitivity disturbance can be determined, which are initially preceded by hyperesthesia, which is then replaced by a decrease in sensitivity up to its complete loss.

In the secondary period of syphilis, specific neuralgia of the trigeminal, sciatic or intercostal nerves and the brachial plexus may develop.

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This concept is quite rare, not many can explain its exact meaning. The infection penetrates the nerve tissues and seriously affects them. Manifestations depend on the individual characteristics of the patient's body. The basis of treatment is antibiotics on penicillin. In the past few years, neurosyphilis has been diagnosed much less frequently, as modern individuals have become more attentive to their health, and methods of diagnosis and treatment have improved.

What is neurosyphilis

What is neurosyphilis could only be accurately explained in the last century. The disease develops against the background of the presence in the body of a standard form of syphilis. The causative agent is called pale treponema. The disease can be contagious at any stage of development. It is considered the most dangerous at the first - up to 5 years of the presence of infection in the body. At the late stage of the lesion, syphilis is 90% not dangerous, because the treponema is located in the thickness of the soft tissues.

How is it transmitted

By itself, neurosyphilis is not transmitted, a sexually transmitted disease “passes” to a partner. In an infected person, pale treponema is found in semen, on the vaginal mucosa, blood, and saliva.

In most cases, a sick sexual partner infects a healthy one. This is the main route of infection with syphilis. Treponema is located in the microcracks of the mucous membranes. It can pass through any form of sexual contact: oral, vaginal, anal. The contraceptive may not always protect against the transmission of the disease.

The etiology of the disease allows the possibility of infection of a healthy person through the blood, through transfusion, the use of non-sterile medical instruments, the use of a used syringe.

Very rarely, but it happens that syphilis is transmitted by household means. The source can be a towel, dishes, hygiene items. Also, infection can occur during the passage of the child through the affected birth canal of the mother. High risk of infection in healthcare workers.

Any contact with an infected neurosyphis is potentially dangerous. The risk increases when it is accompanied by a primary and secondary stage of damage to the body. If the infection is in a late, tertiary form, the percentage of infection is minimized.

Classification

The early period of infection includes the following forms:

• Latent.
• Meningitis is syphilitic.
• Meningovascular syphilis.

The late form, in turn, is divided into:

• Meningovascular neurosyphilis.
• The paralysis is progressive.
• Neurosyphilis gummy.
• Atrophy of the optic nerve.

early form

The early period of infection is considered when the bacterium is present in the organs up to 5 years, it is active in the first 2 years. During this period, vessels, mucous surfaces, and in some cases nervous tissues are affected. Some experts call this period mesenchymal.

The latent form often comes to light incidentally. The patient does not know about his disease, there are no symptoms. It can be detected only by the presence of a failure of normal indicators in the composition of the cerebral fluid:

An elevated level of lymphocytes in the cerebral fluid is characteristic of an early form of neurosyphilis.

• Elevated level of lymphocytes.
• Positive serological reaction.
• Increasing the protein content.

Asymptomatic neurosyphilis in most cases is relevant for primary, secondary classical syphilis, it is especially active for a year and a half after the onset of infection. If treatment is not provided, complications are possible in the form of overt neurosyphilis, spontaneous sanitation of the cerebrospinal fluid.

Syphilitic meningitis is more relevant for young people. Its signs are quite obvious: headache, fever, jumps in blood pressure, vomiting. In advanced cases, the disease affects the cranial nerves, vision deteriorates, strabismus and sensorineural hearing loss form.

Meningovascular syphilis is divided into cerebral and spinal. Gradually, the blood circulation of the spinal cord is disturbed. When viewing the clinical picture, microfocal tissue lesions are detected. Main symptoms:

• Violation of the level of sensitivity.
• Decreased memory.
• Inability to concentrate on anything for a long time.

In difficult cases, ischemic, hemorrhagic stroke is possible. 25-30 days before the deterioration, the patient begins to constantly feel dizzy, aching headaches, insomnia, speech disturbance, bouts of weakness.

If the processes of blood circulation in the vessels of the spinal cord are disturbed, a spinal stroke is possible. The infected person gets tired quickly, the lower limbs become numb, weaken over time. If you do not fight the disease or the treatment is prescribed incorrectly, the infection rises, the pelvic organs are affected, problems with urination and defecation begin. If an individual is elderly, has additional diseases, moves little due to weakness, the skin is very flaky, pressure sores are formed.

late form

Pale treponema affects vital brain cells, gradually destroying them

Late neurosyphilis is diagnosed if the bacterium lives in human organs for more than 5 years. Here fiber, nerve cells are already affected.

Progressive paralysis can be considered meningoencephalitis, but only in a chronic form. It occurs in the human body within 6-15 years after infection with the bacterium syphilis. Pale treponema affects the vital cells of the brain, gradually destroying them. In the first few years, the negative impact of the disease is subtle, blurry: memory and concentration deteriorate, the individual quickly becomes irritated, often nervous because of trifles.

The disease progresses, negatively affecting the individual. A person is increasingly in a depressed state, outbreaks of inappropriate behavior are possible, hallucinations and delusions appear. Over time, the development of dementia, dementia, epilepsy is possible.

Optic nerve atrophy is considered a separate form of late period neurosyphilis. Initially, one eye is affected, and the other is gradually affected. Vision sharply "falls", a veil constantly appears before the eyes. If you do not start to fight the disease, the patient runs the risk of going blind.

Neurosyphilis is considered gummous if it occurs in the tertiary period. Gummas "look" like round-shaped formations, are the result of an inflammatory process. They can seriously damage the brain, constantly affecting the cranial nerve, resulting in increased intracranial pressure. The cervical and mid-thoracic regions are most commonly affected., the normal functioning of the pelvic organs and limbs is disrupted.

Symptoms

Syphilis can be in the human body for many years. Its incubation period is 20-40 days, it ends with the formation of a hard chancre. 6-8 weeks after infection, the individual develops a characteristic rash.

The next period of development of the disease lasts 3-5 years. Gradually become infected vessels and meninges. After that, infiltrates begin to form.

In the first 2-3 years of development of neurosyphilis, the following symptoms appear:

• Nausea.
• Headache.
• Rash in the form of spots.

Eye damage begins, intracranial pressure rises.

After the seventh year of the "life" of the bacteria in the body, a hemorrhagic stroke is possible. Insomnia, attacks of aggression, constant weakness are added to the above signs.

After 10 years of the development of the disease, brain cells are already affected. Mental abilities are at the lowest level, dementia, speech disorder, hallucinations, permanent depression, tremor, epilepsy are possible.

Congenital neurosyphilis

It manifests itself in the first 12 months of a baby's life, who was given pale treponema during the birth process. Congenital neurosyphilis is very rare, during the entire pregnancy of a woman, the doctor checks her several times for the presence of this infection. Clinically, it manifests itself as in an adult. If the child is properly treated, the infection can be stopped, but neurological damage can occur at any time.

Diagnostics

Neurosyphilis requires a comprehensive diagnosis, which will take place in several stages:

1. Examination by a neurologist, if necessary, an oculist.
2. The study of the composition of the blood.
3. Puncture sampling if necessary.
4. MRI, CT.

Competent diagnostics involves the use of two groups of tests, the results of which will be used in screening:

• Treponemal.
• Non-treponemal.

The examination can be carried out both with blood serum and with cerebrospinal fluid.

Only by examining the patient's analyzes in detail, the doctor can make an accurate diagnosis, based on 3 main criteria:

• Positive test for treponema.
• Disturbances in the composition of the cerebrospinal fluid.
• Explicit manifestation of symptoms of a neurological disorder.

Therapy

Treatment of neurosyphilis is mainly carried out with the antibiotic Penicillin.

Treatment of neurosyphilis is mainly carried out with the antibiotic Penicillin. The treatment regimen is compiled by the attending physician on an individual basis, the dosage of the drug directly depends on the degree of damage to the body. The most effective is therapy with the use of intravenous administration of the sodium salt of benzylpenicillin. Injections or droppers are given 6 times a day, the course of treatment is 14 days.

When the doctor recommends administering the drug intramuscularly, benzylpenicillin novocaine salt can be used plus probenecid orally 4 times a day, the course of treatment is 14 days. The drug Probenecid stimulates the full absorption of the antibiotic Penicillin by soft tissues.

After completing the course described above, therapy continues, the patient is given an injection with benzathine benzylpenicillin once a week, the course is 3 weeks. At the beginning of therapy, the infected person feels significantly worse: fever, headache and muscle pain, tachycardia attacks, and blood pressure jumps. In such cases, corticosteroids, non-steroidal anti-inflammatory drugs are additionally prescribed.

If the patient is found to be intolerant to penicillin, it is replaced with Ceftriaxone, Chloramphenicol. The effectiveness of this or that drug is evaluated by improving the health of the patient, the indicators of cerebrospinal fluid. A re-examination is carried out immediately after the initial course of penicillin administration, a puncture and cerebrospinal fluid are taken. Thereafter, every 6 months for two years. If the test results do not show improvement, the antibiotics are pierced again.

It is possible to cure an infected person, it can be considered harmless if the level of CSF indicators becomes standard. In the process of taking antibiotics, doctors recommend taking vitamin complexes, iron, nootropics.

Forecast

Almost all individuals know what Syphilis is, but they have no idea how serious this disease is. It is imperative to follow preventive measures. A healthy person is recommended to exclude casual sex, to observe the rules of hygiene in all public places. When contacting a medical institution, ask for a medical book.

After infection and successful treatment, the patient is not released from the diagnosis. He must periodically undergo examinations, consult with a neurologist, venereologist, mandatory prophylaxis is necessary. Once a year, an infected person must be forced to take cerebrospinal fluid for analysis. Only if all of the above is observed, the forecast will be positive.

Consequences of neurosyphilis

If the infection is detected and treated in an early form, there are no consequences of neurosyphilis. If the disease has developed to meningovascular syphilis, even after effective treatment, paresis, dysarthria, and pelvic dysfunction in various forms are possible. In difficult cases, the patient is given a disability.

Neurosyphilis is a venereal disease that disrupts the functioning of some internal organs, and if left untreated, spreads to the nervous system in a short time. May occur at any stage of the course. The development of the disease is accompanied by bouts of strong, weakness in the muscles,. Often there is dementia and paralysis of the limbs.

Infection occurs sexually, after which the infection spreads throughout the body with blood flow. With the development of the pathological process, the number of antibodies is reduced, after which the virus infects the nervous system.

The disease can be either acquired or congenital.

Etiology of the disease

The main factor in the occurrence of the disease is the bacterium pale treponema. This means that the infection comes from an infected person.

The main ways of spreading the infection:

Factors predisposing to disease progression:

• untimely treatment of syphilis;
• mental strain;
• frequent stress or a strong emotional outburst;
• brain injury;
• weakened;
• at risk are medical workers who are constantly in contact with various human biological secretions: blood, saliva or semen. Infection can occur during surgery or labor.

Patients who carry the disease in the early stages are considered the most contagious. People with a disease duration of five or more years are less of a threat.

Forms of neurosyphilis

In medicine, neurosyphilis is divided depending on the duration of infection. So allocate:

The disease is characterized depending on the severity of symptoms and there are several forms:

• latent- often diagnosed by chance during a routine examination. Symptoms of the disease are not observed, and the virus is detected by examining the cerebrospinal fluid;
• syphilitic meningitis- mostly seen in young people. Main symptoms: a, weakness, decreased visual acuity;
• dorsal tabes- damage to the cords and roots of the spinal cord occurs;
• meningovascular neurosyphilis- blood circulation in the brain is disturbed. It is observed, and there are problems with sleep;
• gummy neurosyphilis- characterized by progressive paralysis. This form occurs with late neurosyphilis.

If timely diagnosis is not carried out and treatment is not started, the disease can lead to disability, complete paralysis and death.

Symptoms of neurosyphilis

For each form of the disease, there are specific signs.

Symptoms of early neurosyphilis:

• seizures and;
• decreased sensitivity of the pelvic organs;
• strong and
• decreased visual acuity and hearing;
• against the background of night cramps, sleep disturbances occur;
• and concentration;
• muscle weakness.

Symptoms of late neurosyphilis:

• complete loss of vision at first in one eye, and then, as it progresses, blindness becomes bilateral;
• hallucinations;
• increased irritability;
• inappropriate behavior;
• change in gait and handwriting;
• tremor of the tongue;
• increase in body temperature.

Gradually, the disease leads to paralysis, seizures and disruption of the pelvic organs.

Symptoms of congenital neurosyphilis:

With timely diagnosis and proper treatment of the congenital form, the progression of the infection can be stopped, but the consequences of a violation of the nervous system will remain for life.

Diagnosis of the disease

Neurosyphilis is diagnosed on the basis of a clinical picture, a laboratory study of cerebrospinal fluid, and a positive test result. Also important is a neurological examination, laboratory blood tests (RIBT and RIF) and examination of the patient by an oculist. In some cases, blood tests are performed repeatedly.

In the latent stage of neurosyphilis, a study of cerebrospinal fluid is performed.

Examinations of either the spinal cord or brain can detect pathological changes in the membranes of these organs, as well as the location of the infection. An important part of the diagnosis is the differentiation of neurosyphilis from other diseases with similar symptoms. These include: malignant and spinal cord, sarcoidosis, of a different nature.

Treatment of neurosyphilis

Therapy of the disease is carried out only in a hospital. Special preparations with a high content of penicillin are injected into the patient's body.

The duration of the course of treatment is at least two weeks. For greater digestibility, probenecid is additionally prescribed, a substance that inhibits the excretion of penicillin by the kidneys. Patients who are allergic to this drug are given ceftriaxone. On the first day of therapy with this medicine, body temperature rises, heart rate increases and unbearable headaches occur.

In addition to penicillin, corticosteroids and anti-inflammatory drugs are prescribed.

The degree of expression of the symptoms of the disease and the improvement in the state of the cerebrospinal fluid are the criteria by which the effectiveness of therapy is evaluated. At the end of treatment, the patient's condition is monitored for two years. To do this, conduct a study of cerebrospinal fluid every six months. If new symptoms occur, or old ones worsen, a second course of drug therapy is prescribed.

At an early stage, the disease can be almost completely eliminated. With severe damage to the nerves and blood vessels, some signs may remain with the patient for life. The congenital form entails lifelong deafness, and sometimes disability.

To exclude the possibility of infection, it is enough to carefully follow personal hygiene procedures, exclude unprotected sexual intercourse, and also not use common things and devices with an infected person.

Today in our article we will talk about sexually transmitted diseases. More precisely, about one of the most famous diseases - about. We will pay closer attention to neurosyphilis, which occurs due to infection with syphilis.

This disease has been assigned the code A52.1 according to ICD-10 (International Classification of Diseases).

In general, syphilis is an ailment caused by such a microorganism called pale treponema.

Treponema

It has a spiral shape, like a corkscrew. When it enters the body, it moves through the lymphatic and bloodstream and reaches the organs.

In Russian history, many famous historical figures suffered from syphilis:

1. Ivan groznyj;
2. Peter I;
3. Nicholas II;
4. Vladimir Ilyich Lenin.

They say that Christopher Columbus brought syphilis to Europe after he discovered America and it is believed that this disease appeared as a result of bestiality. The indigenous people of America were very partial to llamas - who are carriers of this infection. Before antibiotics were invented, this was a fairly common ailment.

Treponema is sexually transmitted. The whole horror of this disease lies in the fact that it takes a chronic protracted form and the person in fact becomes a walking vessel of pale treponema and passes it on.

The incubation period after infection is approximately four to six weeks. That is, only after this time, some symptoms may begin to appear. Primary syphilis goes on for another two months, during this period hard chancres may appear on the human body.

Chancre

There is also a high probability of pigmentation on the neck with a very romantic name “Venus necklace”. These are white spots that are deployed on the chest and neck.

In addition to these symptoms, there is another one that can manifest itself only 4 years after the fact of infection - huma. Guma appears already during secondary syphilis. After that, internal organs, tissues, bones are affected, neurosyphilis develops, the central nervous system, spinal cord, etc. are affected.

Let's talk more about neurosyphilis (NS).

This is an anomaly of the central nervous system, provoked by infection with white treponema. Simply put, neurosyphilis is syphilis of the nervous system.

It manifests itself as dizziness, weakness in the muscles, convulsions, paralysis of the limbs and dementia can often be observed.

Causes and ways of infection

Infection occurs sexually, after which the virus moves further to the organs. Therefore, answering the question of whether neurosyphilis is contagious, we can say with confidence, yes, it is contagious. At first, the body is able to produce antibodies to fight treponema, but the more neglected the process becomes, the less antibodies are produced. This allows bacteria to enter the CNS.

Infection occurs from a carrier of bacteria. Below about the ways the disease appears:

• sexual intercourse- the main mode of transmission of infection. The virus enters the body through the mucous membrane and small lesions on the surface of the skin. To protect yourself, you must use condoms, but they do not guarantee 100% protection.
• Blood transfusion. Blood transfusion or dental treatment.

• Domestic. When a healthy person shares cutlery or a toothbrush with a person with syphilis, who has already begun to have gum in the oral cavity, there is a high probability of infection.
• intrauterine infection or transplacental route- transmission of the virus directly from mother to fetus.

In addition, the following list of factors contributes to the progression of the disease:

• reduced immunity caused by viral or inflammatory diseases;
• mental strain;
• incorrect or untimely treatment of syphilis;
• frequent stress or emotional outbursts;
• professional activity - the risk group includes honey. workers who have constant contact with various kinds of biological human secretions, such as saliva, semen and blood. Infection can occur during surgery, autopsy, or childbirth.

Carriers of the virus in the early stages of disease progression - the first two years - pose the greatest risk to others. A lesser threat is posed by patients with a protracted illness - more than five years.

Stages and symptoms

Depending on the time of infection, NS is divided into:

• Neurosyphilis early- it is realistic to diagnose it two or five years after infection. Pale treponema affects the vessels of the brain and its membrane. Because of what you can observe the development of various anomalies, such as:
  1. Latent NS is also called asymptomatic, so it can only be detected, so to speak, “accidentally”. It can be detected only by a change in the cerebrospinal fluid - the fluid surrounding the spinal cord and brain.
  2. Syphilitic meningitis. It is often found in young people. It is manifested by severe headaches, nausea, and sometimes vomiting. Rarely fever. Possible visual impairment and the development of hearing loss due to the involvement of the cranial nerves in the defective process.
  3. Meningovascular syphilis causes a malfunction in the blood circulation of the brain. Sensitivity is impaired, attention is reduced and memory deteriorates. Lack of therapy can lead to ischemic stroke, which is preceded by insomnia, severe headaches, and epileptic seizures are not uncommon.
• Neurosyphilis late. It can be detected more than five years after the virus enters the body. During this period, nerve cells begin to break down. There are also several ailments that manifest the virus:
  1. Progressive paralysis or chronic meningoencephalitis. Often, it is activated six to fifteen years after infection. The virus enters the brain cells and destroys them. At first, the patient can detect a decrease in attention, memory, vision. Later, mental disorders appear: hallucinations, depression, delusions. The disease develops quite quickly and the probability of death is high.
  2. Dorsal dryness.
  3. Hummous NS.
  4. Optic nerve atrophy is quite often an independent symptom of late-stage neurosyphilis, which greatly reduces the patient's quality of life. If left untreated, complete blindness occurs.
  5. Meningovascular syphilis (symptoms are similar to the early stage).
• Congenital NS rarely diagnosed. During pregnancy, the expectant mother takes a lot of tests to detect various infections. And if the infection nevertheless occurred inside the womb, then it will not be difficult to detect it. The symptoms are the same as in adults, but there is no dorsal tabes. Specific symptoms of congenital NS are deafness, deformity of the upper incisors, and keratitis. If you turn to the doctor in time, it is possible to stop the process. However, neurological symptoms remain for life.

Diagnostics

Above, we told what constitutes the National Assembly. But how to confirm this diagnosis? There are three criteria by which it is possible to do this:

1. test results for syphilis;
2. characteristic symptoms;
3. detection of changes in the composition of the cerebrospinal fluid.

A neurological examination of the patient is carried out, as well as an examination by an ophthalmologist. A serious role is played by blood tests, such as RIF (immunofluorescence reaction) and RIBT (treponema pallidum immobilization reaction). If the doctor deems it necessary, they will be performed many times.

If there are no pronounced symptoms, a lumbar puncture is prescribed. Thus, with NS, the virus itself and an increased level of protein will be found in the cerebral fluid.

Absolutely all patients with suspected neurosyphilis are prescribed MRI and CT of the spinal cord. This helps to detect atrophy of the medulla.

Treatment

Therapy is carried out exclusively stationary. The patient is injected with a drug with a high concentration of penicillin. The course lasts at least two weeks. Often, doctors prescribe complex therapy using several honey at once. funds. Standard scheme:

• penicillin;
• probenecid;
• ceftriaxone.

Medicines are administered intravenously, and penicillin is also injected into the spinal canal. Two weeks later, a check is made whether it was possible to get rid of the virus, if not, then the course is extended.

On the first day of treatment, headaches may increase, so the patient is also prescribed corticosteroid and anti-inflammatory honey. facilities.

At a later stage, bismuth and arsenic are used, which, as you understand, are very toxic.

Consequences

If the disease is detected and treated at an early stage, the probability of completely curing the patient is very high. If the vessels of the brain and nerves were severely damaged, then some symptoms may remain with the patient for life. A congenital ailment leads to lifelong deafness or disability.

NS carries a bunch of unpleasant consequences, so you can not ignore any initial symptoms. And try not to have promiscuity and always protect yourself. If, for example, you went on vacation, met someone like that and you had unprotected sex, then it’s better to immediately go get checked so as not to risk your health and life.

You can also watch this video, where a neurologist will tell you in detail about neurosyphilis, what are its main symptoms.

Many of us have heard about such a serious sexually transmitted disease as syphilis, however, few people represent the full severity and danger of this infection. Almost 30,000 new cases of infection are registered in Russia every year, and the total number of patients since the collapse of the Soviet Union has not ceased to grow. It is worth saying that the disease is not as dangerous as its secondary and tertiary manifestations. If in its initial stages syphilis of the brain affects only the skin, then over time, pathological processes develop in the internal organs.

The most dangerous moment during syphilis is the defeat of the central nervous system. Violation of the brain activity leads to behavioral disorders, cognitive decline, and can also cause death.

Stages and symptoms of the disease

Brain syphilis is a pathological condition in which damage to the brain and its structures occurs. The causative agent of infection (pale treponema), entering the body, multiplies for some time in the primary focus. Then comes the moment when the bacteria enter the general circulation. Spreading throughout the body, pale treponema releases its own endotoxin, which has an adverse effect on all organs and systems.

Violation of the activity of the brain is a kind of complication of syphilis and is mainly observed in patients who have not received antibiotic therapy. The early form of neurosyphilis, as a rule, develops 5 years after the initial entry of the pathogen into the body.

Symptoms

Depending on the stage of the course, the symptoms of cerebral syphilis also vary. If the course of the pathological process follows the sequence, then it is possible to distinguish three stages of brain damage:

• Syphilitic neurasthenia;
• Meningeal form of syphilis;
• Vascular and gummous lesions of the brain.

At the first stage, patients complain of constant fatigue, decreased exercise tolerance and increased fatigue. Such patients note episodic attacks of headache and general emotional depression.

In addition, infected patients are characterized by the appearance of such a symptom as senestopathy. This symptom of neurosyphilis is described by patients as a painful, aching feeling on the surface of the body or inside the organs. The absence of any objectivity and clarity in complaints is the main feature of the symptom. Senestopathy may indicate the initial manifestations of mental disorders.

Early neurosyphilis is manifested by damage to the vessels and membranes of the brain, so the symptoms will be appropriate. Syphilitic meningitis has a number of characteristic manifestations, upon detection of which it is necessary to consult a doctor:

• Neck stiffness;
• Episodes of intense headache that are diffuse or localized;
• Noise in ears;
• Violation of the stool;
• Nausea, vomiting;
• Dizziness.

Mental disorders that develop against the background of inflammation of the membranes of the brain can overlap during the acute phase of the process.

During the subacute phase, patients complain of severe headache and repeated vomiting that does not bring relief. In severe situations, stunning occurs, as well as paralysis and paresis of the cranial nerves. With the development of meningoencephalitis, delirious disorders can be added, manifested by a violation of consciousness, a decrease in cognitive abilities and the appearance of hallucinations.

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The duration of the meningeal stage takes from 2 weeks to several months. During this period of time, spontaneous remissions are often observed, which are characterized by the return of consciousness and the restoration of intellectual abilities.

With damage to the vessels of the brain, patients complain of insomnia, excessive emotional lability, and migraine pain. Symptoms at this stage directly depend on the localization of the pathological process (large or medium-sized arteries). With damage to large vessels, ischemia of the nervous tissue develops, and in advanced cases, a stroke occurs with various consequences.

The timeliness of therapeutic measures allows you to eliminate such complications of cerebral syphilis as paralysis and paresis. The dementia that develops in such patients after a stroke is manifested by a decrease in cognitive abilities and the general level of intelligence. Often there are epileptic seizures with a characteristic sequence of phases: aura, tonic, clonic convulsions and post-seizure sleep. Not so often there are hallucinations and psychotic disorders. With the development of epileptic seizures, their number will gradually increase.

Gumma is a kind of knot that forms in the tertiary period of syphilis. With the development of this formation, the clinical picture will be similar to the signs characteristic of a tumor lesion of the brain. The symptomatology of this condition directly depends on the localization of the gumma. During this period, patients are most characterized by a change in consciousness and focality of the clinic. The most common are paralysis, paresis, and aphasia. If several gums develop, then in such patients the symptoms characteristic of the psychosyndrome with concomitant euphoria and indifference prevail.

Diagnostics

At the moment, serological methods of research are considered the most reliable in the diagnostic plan. The Wasserman reaction - in the past was a priority method for determining the pathogen in the blood, however, now preference is given to enzyme immunoassay.

During the asthenic period, typical neurological and laboratory signs of brain syphilis inherent in this stage can be assessed. For asthenized patients, a sluggish reaction of the pupil to light is characteristic. During a lumbar puncture, there will be an increased content of lymphocytes, neutrophils and protein in the cerebrospinal fluid. In addition, when performing a serological analysis, a positive Wasserman reaction is observed.

At the stage of damage to the membranes of the brain, analyzes of the cerebrospinal fluid are variable. When conducting the Wassermann reaction, the result may be negative, and when analyzing blood plasma, it can be positive, or vice versa. The only clear criterion in this case is the increased content of cells in the spinal fluid.

The most reliable methods for detecting syphilis are the Wasserman reaction and enzyme immunoassay.

The vascular phase of the pathological process is characterized by positive or weakly positive serological reactions in the analysis of cerebrospinal fluid. The number of cells is slightly increased or is within the normal range. The increased concentration of protein is maintained.

Treatment

The good news is that Treponema pallidum is by far the only microorganism that has not developed resistance to penicillin. This bacterium does not synthesize enzymes that break down penicillin, and does not have internal defense mechanisms. Summing up all of the above, we can consider it lucky that after so many years, treponema has not developed resistance to this antibiotic. Even now, analogues and derivatives of penicillin are priority drugs in the fight against infection.