What is tertiary syphilis. Tertiary syphilis Tertiary period of syphilis

Tertiary syphilis develops in those patients who did not complete the course of medication or took inappropriate medications. This stage of infection development is dangerous for the health and life of the patient, since treponemes affect the internal organs and systems of the body.

The concept of tertiary syphilis

Symptoms and consequences of syphilis depend on its stage of development. An infectious disease goes through 3 stages:

Primary syphilis. It lasts no more than 3 months. This disorder is characterized by the appearance of hard chancre in the place where the infection has penetrated.
Secondary syphilis. This period lasts up to 4 years. The disease is quite easy to detect, since characteristic rashes appear on the patient’s body.
Tertiary syphilis. Treponemas actively multiply in the body, affecting vital organs. They affect cartilage, bones and the brain. Tertiary syphilis appears 7-10 years after infection.

The duration of each stage depends on the state of the immune system and whether the patient is taking any medications. For example, there are cases when a person is treated with antibiotics for another disorder. They are not able to eliminate the activity of treponemes, but they inhibit their reproduction. Therefore, the patient does not notice the manifestations of the infectious disease and each stage continues for a long period of time.

Patients with the tertiary form of syphilis should immediately seek help from a specialist, since in 60% of cases the disease is fatal.

Signs and symptoms

For a long time, tertiary syphilis occurs without any symptoms of the disorder. The patient does not experience discomfort, so he leads his usual lifestyle and does not stop sexual activity. This leads to infection of other people and aggravation of the carrier’s condition.

As treponemas multiply in the body, the following symptoms will become noticeable:

there is a disruption in the functioning of the nervous system, kidneys, intestines and lungs, this leads to the development of neurosyphilis;
tubercular syphilide forms on the skin;
destruction of bone tissue occurs, as a result osteomyelitis or osteoporosis is diagnosed;
syphilitic gummas appear;
chronic hepatitis develops due to liver problems;
problems are detected in the cardiovascular system.

In the photo in our article you can see what skin lesions with syphilis look like. Typically, patients seek help from a doctor due to the presence of skin rashes, so we want to tell you more about them.

Tuberous syphilide has a smooth surface and a blue tint. The tubercles do not merge with each other and after 2 weeks transform into purulent ulcers. This type of rash forms on any part of the body and head; after healing, a scar remains in its place.

Syphilitic gumma is a nodule that forms on muscles, bone tissue or fatty tissue. The compaction does not exceed 2 cm in size. At the site of the lesion, the skin becomes purple in color, and when pressure is applied, pain and discomfort are felt. Over time, the gumma increases as pus accumulates there. The lesion affects the nerve endings, so severe pain in the muscles or bones periodically occurs.

In the presence of concomitant diseases, the patient experiences late roseola. They grow up to 8 cm in diameter and have a rich pink color. During tertiary syphilis, lesions of the mucous membranes occur. They are diagnosed in the mouth, nose and near the genitals.

Is it possible to cure tertiary syphilis?

Treatment of tertiary syphilis is performed in a hospital setting. It is possible to recover from an infectious disease, but this will require several courses of antibiotics. Doctors will be able to eliminate treponemes in the body, but the consequences of their activities become irreversible.

Penicillin drugs suppress the activity of microbes, but do not contribute to the restoration of structures and internal organs that have suffered from this. Several doctors are brought in to help the patient. Therapy is selected by a dermatovenerologist, therapist and neurologist if necessary.

Along with taking basic medications, the patient is prescribed procedures or medications that help reduce the negative effects of syphilis. In addition to conservative treatment, patients with the tertiary form also need surgery to restore bone or cartilage tissue.

In dermatovenerology, treatment of tertiary syphilis takes from several months to 2-3 years. The duration of therapy depends on the presence of complications and how effective the medications are against treponemes.

Factors influencing the development of tertiary syphilis

People who seek medical help do not encounter the tertiary form of syphilis, since medications can promptly stop the disease and eliminate microorganisms.

One of the provoking factors of the tertiary stage of infection is age. Adolescents encounter problems when they begin to be sexually active. Against the background of hormonal changes, treponemas progress faster. Elderly people are also at risk.

The development of tertiary syphilis is promoted by:

If the patient does not detect clinical manifestations of secondary syphilis and does not seek help from a doctor, then this factor will become the main reason for the development of the third stage of syphilis. Some patients are recognized as non-contagious during treatment for an infection, but the ban on sexual activity remains, since sex will aggravate the patient’s condition.

Diagnostics

The doctor determines the diagnostic method depending on the patient’s condition and the presence of concomitant diseases.

The primary diagnosis is made during the examination, then laboratory tests are carried out to confirm the doctor’s assumption.

There are several options for diagnostic procedures:

RIF, allows you to detect treponemes in the body;
serological method, determines the presence of immunoglobulins, which are produced when an infection occurs in the body;
PRC, with its help doctors find the DNA of bacteria;
bacterioscopic examination is necessary to detect treponemes in liquids;
analysis of cerebrospinal fluid, with its help the content of lymphocytes, monocytes and protein is determined.

In case of serious damage to internal organs and systems, the patient needs a full diagnostic examination. It allows you to characterize the patient’s condition and select effective medications. Consultation with an otolaryngologist, neurologist, ophthalmologist, cardiologist and gastroenterologist is required. Extensive damage to internal organs is accompanied by ultrasound and ECG.

How and with what to treat tertiary syphilis

You should not refuse hospitalization when treating tertiary syphilis, since serious complications requiring immediate medical attention may arise at any time.

The patient is prescribed antibiotics of various groups and medications with a high iodine content. Therapy begins with a two-week course of tetracycline and erythromycin, and bicillin may be prescribed. Then doctors prescribe penicillin medications. The tertiary form of syphilis requires completion of at least 8 courses. At the final stages, doctors include mercury and bismuth preparations. The therapy is completed with bioquinol.

Along with taking antibiotics, medications are used that can increase the body's resistance to treponemes. Specialists select immunostimulating drugs, vitamin complexes and enzymes. These medications are also needed to minimize the negative effects of antibiotics on internal organs.

A set of measures is also carried out to speed up the healing of the skin and mucous membranes. For eye damage, use a penicillin solution. To relieve pain and normalize the condition of joints, analgesics and phenlepsin are prescribed. Throughout the treatment, doctors monitor the patient's condition. A person will have to undergo all laboratory tests several times so that a specialist can verify the effectiveness of the therapy.

After the end of drug therapy, doctors monitor the patient’s condition for another 5 years. During this period, complications or signs may appear that syphilis is not completely cured. Therefore, you should not neglect visiting a doctor.

If within 5 years the patient does not show characteristic symptoms of syphilis, then he is considered healthy.

Complications of the late form of the disease

During tertiary syphilis, destruction of internal organs and systems occurs. The presence of complications depends on exactly when the patient sought help from a doctor and how much the disease has progressed.

We list the most common types of complications encountered in patients:

Deformation of the skin. Syphilides and gummas trigger necrotic processes, after which the skin practically does not recover.
Damage to mucous membranes. New growths appear in the mouth, nose and genitals. It is dangerous when lumps appear on the tongue, as they leave behind a large scar that makes speech and chewing difficult.
Disorders of the musculoskeletal system. The bones and bone marrow are destroyed, which makes the patient disabled.
Damage to internal organs. Serious changes in the body lead to inflammation of the aorta, disruption of the outflow of bile, the appearance of myocarditis, and pathological changes in the lungs, kidneys and intestines.
Changes in the nervous system. With such disorders, the patient becomes disabled because they cannot be reversed. Miningitis, dropsy, neurosyphilis develops, or damage to the cranial nerves is observed.

Treatment of tertiary syphilis allows you to improve the functioning of internal systems and stop the progression of bacteria. But to achieve results, you must consult a doctor in a timely manner and follow all his instructions.

Tertiary syphilis is one of the forms of an infectious disease dangerous to human life and health, caused by the penetration of Treponema pallidum into the body. The pathological presence of the named bacterium in the body manifests itself in the form of damage to individual areas of the skin, mucous membrane, internal organs and nervous system.

The considered tertiary stage of the disease is the most dangerous for the body, which is associated with the absence of clearly expressed signs of the disease. In some cases, patients do not suspect its onset for a decade, while being chronic carriers of the bacterium.

With the use of modern treatment methods, the tertiary stage of syphilis develops extremely rarely. The factors that provoke primary syphilis most often are old age or infancy (secondary and tertiary are the most dangerous).

Lack of treatment, or incorrectly calculated doses of medications, if secondary syphilis was treated:

Failure to maintain personal hygiene, living in unacceptable social and living conditions;
Injuries, chronic diseases;
Immune system dysfunction, accompanied by immunodeficiency;
Physical, mental and mental stress accompanying secondary syphilis;
Poor nutrition, lack of the required amount of proteins, vitamins and microelements in food.

If secondary syphilis was not identified and treated in a timely manner, then it becomes the most common cause of the disease transitioning to the tertiary stage, the symptoms of which are described below. Predisposing factors to this are also alcohol addiction, smoking and promiscuity. However, patients in whom syphilis has reached the tertiary stage of development may not be infectious. Treponema pallidums are located inside the granuloma and die when they disintegrate.

Signs and types

The disease is characterized by long periods of latency. Tertiary syphilides (gummas, tubercles, roseola) develop over many years. The patient does not experience discomfort. Clinical signs are as follows:

Rashes appear on the skin - a specific type of tubercles (tubercular syphilide);
A gummous ulcer develops (gummy syphilide);
The cardiovascular system is affected (myocardial infarction, aortitis);
The structure of bone tissue changes (osteoporosis, osteomyelitis);
There are problems with the liver (chronic hepatitis);
Gastritis and stomach ulcers form;
There are difficulties in the functioning of the kidneys, intestines, lungs, and nervous system (neurosyphilis).

Ulcers (gummas) and tubercles disfigure the patient’s appearance. Such manifestations of tertiary syphilis are most unpleasant for women.

Most often they appear on the face, hands, and armpits. If the disease is not treated, it becomes irreversible and leads to the death of the patient. Both secondary and tertiary syphilis are successfully treated, the clinical picture of the disease is difficult, but modern drugs cope well with the disease at any stage.

Tertiary roseola

A rare type of tertiary syphilis, the photo of which is posted below. It is a pale pink spot with a diameter of 15 centimeters or more. Groups of spots are localized in the arms, legs and sacrum. Their appearance is associated with vascular disorders. The spots may merge, forming different patterns on the skin.

Patients have no subjective feelings about the appearance of spots (nothing bothers them). Roseola remains viable for 1 year, after which it disappears or recurs. A soft scar forms in their place.

Gunma

Gumma: deep nodular syphilide, appearing in half of people with the tertiary stage of syphilis. Gum is formed under the skin in the fiber and deep layer of the dermis. A gumma nodule is formed in the subcutaneous fatty tissue; it is mobile, changes in size and merges with the skin. In turn, the skin at the confluence becomes thinner and tighter, acquiring a red-violet hue. The diameter of the gumma often reaches 10 centimeters.

Having reached the largest possible volume, the nodule begins to disintegrate, which is accompanied by the opening of the granuloma and the formation of an oozing ulcer in its place. The liquid released from the wound is stretchy, has no specific color, and smells unpleasant. The depth of the ulcer reaches 1 centimeter, it has the shape of a circle with clear boundaries and steep edges. The bottom of the ulcer is dense, gray granulations are present.

Healing of the gummous nodule is slow, sometimes taking several months. After the process is completed, an unsightly pink star-shaped scar remains on the skin. Over time, the scar acquires a normal color, but does not disappear completely.

In some cases, the opening of the gumma does not occur, but an atrophic-looking scar still forms. Gummas can degenerate fibrously or become petrified. Several gummas can merge and form gummous infiltration, spreading to healthy areas of the skin and destroying tissue and bones.

Tuberous syphilide

Tubercular primary syphilide is a dense, spherical tubercle (rash) that forms on the skin and mucous membrane simultaneously with gummas. Syphilides of a tubercular nature are located asymmetrically, they are distinguished by a copper-red color with an admixture of cyanosis. The size of the tubercle does not exceed 1 centimeter in diameter, its consistency is dense, and its boundaries are clear.

At least 10 similar tubercles are formed on the human body. It may take several months from the moment they develop until they heal. The process of formation and healing is uneven; the presence of bumps on the skin at different stages of development is a standard phenomenon. Individual tubercles are located in groups, but fusion between them in most cases is not observed.

Healing of the tubercles occurs as dry necrosis, or with the formation of ulcers. The result of the disintegration of syphilide is the formation of atrophic scars. The following types of tubercular syphilide are distinguished:

Grouped tubercular primary syphilide. The resulting tubercles are homogeneous, never merge, painless, characterized by polymorphism, have a smooth, shiny surface and a red-brown tint. During healing, an atrophic scar or ulcer is formed, which results in the appearance of an unpleasant-looking scar with a pigment spot around it. The shape of the scars is round;
Creeping primary syphilide. A characteristic feature of this form of the disease is the fusion of tubercles, with their subsequent spread to healthy areas of the skin. At the same time, the nature of the rash at the edges may differ from the quality of the tubercles in the center. It is often possible to identify clear zones of growth, decay and scarring. The healed tissue has a bluish-red tint. Refusal to treat the disease leads to an increase in the affected area;
Dwarf primary syphilide. A rare type of tubercular syphilide, it mainly appears 10 years after infection. The rash is small, does not exceed 2-3 millimeters in diameter. The color of the pimples depends on the degree of damage; there is a rash of light yellow and dark red, almost brown tint. Pimples do not open, heal dry with subsequent formation of atrophic scars;
Syphilide platform. This type of syphilis is characterized by the fusion of tubercles and the resulting formation of a plaque-like infiltrate with a diameter of up to 20 centimeters. The color of the rash is brown-red. After the decay is complete, unpleasant-looking scars form on the skin.
Vegetating syphilide. A group of tubercles forms on the skin, and as a result of their opening, ulcers with lush granulations at the bottom appear.

Regardless of the type of tubercular syphilide, its localization area remains constant. Most often, the rash appears on the face, back, elbows and knees. The patient does not experience any unpleasant sensations.

Visceral syphilis

The most severe form of the disease (late tertiary syphilis), accompanied by significant complications. Pathological gummas and tubercular syphilides affect internal organs, primarily the liver, heart, blood vessels, intestines, stomach and lungs.

A consequence of the development of the visceral form of syphilis is the formation of syphilitic aortitis or myocarditis, which leads to deformation of the inner lining of the aorta, the development of aneurysms, the formation of blood clots, and damage to the heart muscle. When the liver is damaged, syphilitic hepatitis is formed.

Due to numerous lesions of internal organs, diagnosis of the disease is difficult, as evidenced by the presented presentation.

Neurosyphilis

Neurosyphilis is diagnosed when the nervous system is damaged and manifests itself in the form of:

Chronic meningitis;
Meningomyelitis;
Gummous lesions of the brain and spinal cord;
Vascular lesions;
Tabes dorsalis;
Progressive paralysis.

Neurosyphilis develops gradually, its obvious signs may appear after 10 or even 40 years.

Diagnosis and treatment

Diagnosis of tertiary syphilis is based on obtaining clinical and laboratory test results. To identify the stage of the disease, an RIF (immunofluorescence reaction) and a RIBT blood test are performed. In order to identify the extent of damage to individual internal organs, patients are referred for cardiac ultrasound, ECG examination, aortography, and bone x-ray.

Treatment of tertiary syphilis begins with taking erythromycin or tetracycline. Upon completion of a two-week course of antibiotics, the patient is prescribed penicillin therapy, combined with intravenous administration of Bismuth.

If there are contraindications to this drug, additional penicillin-containing medications are prescribed. The duration and treatment regimen depend on the form and degree of neglect of the disease. Simultaneously with treatment, blood counts are regularly measured, ECG and ultrasound data are studied,

The tertiary period of syphilis is extremely dangerous, characterized by multiple complications, but fortunately, it is rare; modern diagnostic tools make it possible to identify the first signs of the disease at an early stage.

The sexually transmitted disease syphilis is characterized by three stages, and the last (tertiary) is the most severe in terms of clinical manifestations and symptoms.

In each patient, the manifestations of syphilitic infection are very diverse; different manifestations of infection appear at different years of life. However, the last period of the disease is characterized by a state of pronounced dysfunction of all internal organs and systems of the body.

The last tertiary stage of the disease occurs when infection lasts from five to eight years.

Currently, tertiary syphilis occurs in 60% of patients who have not received specific treatment previously, and in 15% of patients who have not followed the entire treatment regimen throughout treatment.

It is also worth noting that most often the tertiary period of syphilitic infection occurs in patients who did not previously comply with the regularity of medical examinations. Advanced cases of the disease occur in patients who have not previously been seen by doctors and have not undergone appropriate screening tests over the past 5-10 years.

Nowadays, venereologists are extremely attentive to the examination of patients with a pronounced clinical picture of syphilis. This is explained by the fact that at a later stage, therapy is lengthy and expensive.

Every year, venereologists discover new methods that are effective even at later stages. In this article, we will answer all the most frequently asked questions to doctors about whether tertiary syphilis can be completely cured if detected late, how much it costs to treat this form of infection in modern clinics, and how exactly to treat tertiary syphilis is recommended by experienced venereologists.

Symptoms of tertiary syphilis include severe skin symptoms, severe complications from internal organs, and neurological pathologies. With a long course and inaction on the part of the patient, treponemal infection ends in death.

A typical sign of the last stage of the disease is tertiary syphilides - compactions and granulomas in any tissues and organs. These formations are noticeable only in the form of areas of compaction under the skin, which to the touch resemble tubercles or nodes, completely painless when touched or pressed.

Tuberous syphilides on the skin appear in the form of elevations up to a centimeter in size and are also distinguished by their color - a slight red or burgundy tint.

Such nodular granulomas may gradually appear under the skin one after another. However, they do not merge into a common conglomerate.

As compaction occurs, tissue necrosis in the center and transition to an ulcerative defect is observed. After healing of such ulcers, scar marks often remain on the patient's body, with or without a rim of pigmentation. With large areas of syphilis, areas of mosaic scars form on the skin, which are clearly visible when examined by a doctor.

Also, against the background of long-term reproduction of treponemal infection, such as tertiary gummous formations appear in the tissues of internal organs, bone or connective tissue structures. Such gummas initially resemble a compaction in the form of a knot under the skin or in the area of large or small joints. Most often, these formations are single, less often multiple, and can be localized both in the area of the upper or lower extremities, and on the face.

When palpating syphilitic gummas, patients do not experience pain or discomfort; in the first weeks, such nodular formations are mobile under the skin, but as the gumma increases in size, they fuse tightly with the surrounding tissues. Over time, the gummous areas become softer in the center, a hole appears through which the contents, similar to a jelly-like jelly, are separated. After all the contents are released, the ulcerative defect gradually heals, and a scar remains on the skin in the form of a scar.

Complications of tertiary syphilis

Against the background of rapidly progressing damage to all internal organs and tissues in the tertiary period, syphilitic gummies appear not only on the skin, but also under the skin in the tissue, in cartilage, bones, blood vessels, and muscles.

Against the background of damage to mucous tissues, a long-term complicated course of inflammatory diseases of the nasal and oral cavity, larynx and pharynx is observed. The symptoms resemble a runny nose and sore throat, with gradual destruction of the cartilage of the nasal cavity and acute inflammation of the tonsils and pharynx. When the bone and cartilaginous structures of the nasal cavity are damaged due to syphilitic infection, patients experience subsidence and deformation of the nose, constant bleeding and suppuration.

Today's cases of tertiary syphilis are observed after infection for more than ten years.

IMPORTANT TO KNOW!

Such patients are most often admitted to intensive care units of hospitals with severe pathology of the heart and blood vessels, heart attacks and inflammation of the aorta and heart muscle, with impaired cerebral blood flow, ischemia and stroke attacks, or with severe neurological symptoms.

When the digestive organs are affected, severe cases of gastritis with ruptured ulcers in the stomach are observed. When the bones and cartilages of the lower and upper extremities are affected, patients are admitted with osteomyelitis or osteoporosis, inflammation in the bones or fractures due to excessive fragility.

It is not surprising that due to the extensive symptoms of a disease such as tertiary syphilis, diagnosis consists of a complete, comprehensive examination of the patient.

How is tertiary syphilis diagnosed?

Treatment of tertiary syphilis is developed only after a thorough examination. First of all, laboratory tests are carried out to identify treponemal infection and interview the patient to determine the duration of infection.

For the study, blood is used and at least three tests are performed. The Wasserman screening reaction can be negative under certain conditions, but the RIF and RIBT tests for late-stage syphilis are positive in 94% of cases. Additionally, studies of cardiac function and the condition of blood vessels, liver and stomach are carried out.

If there are symptoms of damage to the nervous structures, a study of the cerebrospinal fluid and an encephalogram are performed. If the cartilaginous elements of the nose are damaged, the nasal cavities, nasal septum, pharynx, and larynx are examined with special instruments.

Treatment Basics

Quite often, you can hear questions from patients about how a venereologist treats tertiary syphilis and whether the disease can be treated when the course lasts for more than ten years.

Note that at present, all patients with confirmed treponemal infection are indicated for serious treatment, and in the case of a long course of the disease, therapy is longer. . Based on the results of sensitivity tests, at least 2 drugs are used to choose from.

Most often, erythromycin or tetracycline and derivatives are used for treatment, which are then replaced by large doses of penicillins.

As therapy progresses, mandatory monitoring of liver and kidney function indicators, monitoring of heart function and the general condition of the patient is carried out. Also, to strengthen the properties of the immune system, preparations of herbal complexes, vitamin compounds and minerals are indicated.

In case of complications from the functioning of internal organs, digestive and intestinal motility disorders, inflammatory processes in the respiratory organs, memory impairment and manifestations of brain damage, symptomatic therapy under the supervision of tests is indicated.

Relatives and loved ones of patients often ask whether tertiary syphilis can be treated at the stage of pronounced clinical manifestations of the disease. Let us answer that in our time, venereologists have the opportunity to provide treatment even at the stage of tertiary manifestations of the disease, but in this case long-term therapy is indicated, strictly within the walls of a medical institution and under the supervision of experienced specialists.

You should not take risks and do home treatment, because the risk of death with tertiary syphilis is extremely high. Currently, guarantees of effective treatment and qualified medical care can only be obtained by contacting real professionals.

If you don't know who to turn to, the Venereology Guide is ready to help you.

Our specialists help each patient with the choice of a modern clinic and an experienced venereologist for quality treatment and follow-up.

Contact the “Venereology Guide” and you are guaranteed to appreciate the European level of medical services.

MAKE AN APPOINTMENT:

Syphilis is an infectious disease that affects the mucous membranes, skin, as well as the bone, cardiovascular and nervous systems of the body. The disease is usually divided into three stages, the latest of which is tertiary syphilis. It develops in the 7th year of infection in the absence of proper treatment of the disease in the early stages or too late diagnosis.

Peculiarities

The tertiary stage of syphilis develops due to insufficiency or lack of treatment of the initial stages of the disease. It is accompanied by the formation of infiltrates or granulomas in the mucous membranes, skin and internal organs of a person. The resulting granulomas provoke tissue destruction. If treatment is not started in time, there is a high probability of severe complications, including death.

Today, this type of syphilis is extremely rare. Most cases of the disease are detected in the early stages. Tertiary syphilis can develop due to improper use of medications prescribed by a doctor or insufficient dosage.

Syphilis develops as a result of the activity of Treponema pallidum. These microorganisms settle in intercellular spaces, blood vessels or nerve fibers. Most often, the disease affects people suffering from alcoholism or chronic diseases. The risk group also includes young children and the elderly.

There are several factors that contribute to the development of the disease:

Unfavorable human living conditions.
Presence of injuries or chronic diseases.
Reduced immunity due to long-term illness.
Constant mental and physical overload.
Improper or insufficient nutrition.

The disease develops quite quickly. Therefore, it is important to take appropriate measures as soon as possible.

Pay attention! According to statistics, the disease most often affects people aged 20 to 30 years. The number of men and women is approximately equal.

Cutaneous syphilis and its symptoms

The most common form of the disease is cutaneous syphilis. It is characterized by the formation of syphilides, which lie under the skin. The following types of such formations are distinguished:

Tuberculate.
Gummous.
Erythema.

Each of these formations has its own characteristics and is localized in different parts of the body. Depending on this, the symptoms of tertiary syphilis will be determined.

Tuberous syphilides

They are small nodules that are located under the skin. Their diameter does not exceed 7 mm. The largest number of such formations is observed in the area of the limbs, lower back, face, head or back. Such syphilides have a red-brown tint. After some syphilides heal, new ones may form in their place.

At the very beginning of the disease, tiny nodules appear, the diameter of which does not exceed 3 mm. Gradually they begin to increase in size. Over time, ulcers will appear in their place. After healing, scars remain.

Experts distinguish several types of tubercular syphilides:

Grouped. The formations fit tightly to each other, but do not merge into a single whole. One group includes no more than 40 nodules. Often such groups form long chains that can close into a circle. Such syphilides are found in the area of the face, back and lower extremities.
Serpening. Nodules appear sequentially. Those that existed previously are scarred. Such formations occupy an impressive area of skin. A mosaic scar forms in the center of the lesion. Small scars gradually form around it.
Dwarf. Their formation is observed 15 years after the onset of the disease, when the late tertiary period of syphilis begins. Small round formations of a red hue form on the surface of the skin. They are grouped into figures resembling papules of secondary syphilis. Ulcers do not form at the site of syphilides. After healing, scars may form, which smooth out over time.
Diffuse. This is the rarest form of cutaneous syphilis. The resulting syphilides can be localized in any part of the body, but most often on the hands and soles. Several nodules gradually merge into one infiltrative area, which has a reddish tint and an oval shape. The diameter of such a section does not exceed 10 cm. They are never divided into separate tubercles. Deep cracks can form on the surface of such an area, which cause pain.

Pay attention! In some cases, tertiary syphilis can affect the human psyche. Often the patient experiences attacks of rage, depression and even paranoia. At such a moment, it is important not to leave the victim alone.

Gummous syphilides

Gummy formations are larger in size. They are painted dark red. They adhere tightly to the subcutaneous tissue. Such syphilides bring severe pain. Gummy syphilides often appear singly.

Syphilides are most often localized in the sternum, thighs, upper limbs, and genitals. The newly appeared formations are similar in size to a pine nut. They can be easily moved under the skin. The epithelium over the tubercle acquires a dark red tint. There is a noticeable lilac spot in the center. Later, an ulcer appears in its place. At its bottom there is a necrotic core, the withdrawal of which leads to the appearance of a scar.

Read also on the topic

What is the prevention of syphilis infection?

In some cases, gummas can resolve without the formation of ulcers. In such a situation, after the node is reduced, it is completely replaced by dense tissue.

Erythema

Erythema or tertiary roseola is considered the rarest manifestation of tertiary syphilis. It is a light pink spot. Such spots can be grouped. They fold into various geometric shapes with an area of 5 to 15 cm.

Most often, erythema can be observed on the buttocks, lower back, abdomen or back. As a rule, they always appear in the same place. Such areas may peel off over time.

Neurosyphilis

If the source of infection is in the brain tissue, then the entire nervous system is affected. With this form of tertiary syphilis, the symptoms will depend on the form of the disease:

Meningitis. This form develops five years after infection. Gummous formations begin to form around the vessels of the brain. The disease is accompanied by a significant increase in body temperature, severe headaches, dizziness, attacks of vomiting and nausea, and a person reacts painfully to bright light. If the auditory nerve is involved in the process, then a significant decrease in hearing occurs.
Meningoencephalitis. This form of the disease can develop even 30 years after infection. Most often it is observed in representatives of the stronger sex. In this case, the same symptoms appear as with the meningitis form of the disease. In addition to them, mental disorders appear. A person may be tormented by hallucinations and unmotivated attacks of aggression.
Tabes dorsalis. With this type of disease, the horns of the spinal cord are damaged. In this case, the limbs may lose sensitivity, muscle atrophy occurs, vision decreases, and the process of urination and defecation is disrupted. Often accompanied by vascular lesions. There are three stages of this form of the disease:
- Neuralgic. It is characterized by shooting pains in the lower extremities, which are paroxysmal in nature. Pain may be felt from the stomach and intestines.
- Ataxic. Manifests itself in an uncertain, shaky gait. The condition is aggravated if a person walks with his eyes closed.
- Paralytic. Tendon reflexes disappear, muscle tone decreases, and the pupils stop responding to light.
Paralysis. At the same time, all the signs of dementia appear; a person may lose the simplest everyday skills. Often this form of syphilis is combined with tabes dorsalis.
Vascular. An inflammatory process begins in the lining of small arteries. It leads to the formation of blood clots. As a result, the lumen of the blood vessels narrows to critical values, and certain areas of the brain begin to soften. This form of the disease often occurs in young men. The main signs of such a lesion are headaches, dizziness, and seizures that resemble epileptic seizures. If treatment of tertiary syphilis of this form is started in a timely manner, the prognosis is favorable.

Pay attention! In some cases, neurosyphilis can occur in a latent form. Signs of the disease are revealed only during a medical examination.

Damage to the osteoarticular apparatus

The manifestation of tertiary syphilis in the form of damage to joints and bones occurs rarely. Gummas appear in flat bones or the diaphysis of large tubular bones. Formations are often found in the bones of the skull, humerus and ulna, and tibia. Gummas can be concentrated in the periosteum, spongy or cortical substance. There are several types of the disease:

Periostitis. It is characterized by pain in the bones, which worsens at night. On palpation, swelling is detected. If proper treatment is not carried out, then tubercles or thickenings form at the site of the swelling, which are visible on x-rays.
Osteoperiostitis. The inflammatory process originates in the periosteum. Later it spreads to the entire bone tissue. In this case, the person is tormented by severe attacks of boring pain, which become especially unbearable at night. On palpation, a swelling is felt in the periosteum area, which subsequently develops into rough growths with boat-shaped depressions. There is a high probability of ulcer formation.
Osteomyelitis. This form of tertiary syphilis occurs due to the fact that gummas are concentrated in the bone substance. The inflammation soon spreads to the bone marrow. The process can also occur in reverse. The main symptoms are increased body temperature and pain.

Tertiary syphilis can also affect the joints. In this case, hydrarthrosis, osteoarthritis, and arthralgia develop. Severe pain appears that is not associated with movement.

Pay attention! Symptoms of joint damage may persist even after appropriate treatment. Relief comes from taking medications containing potassium iodide.

Visceral syphilis

This type of tertiary syphilis can have the most serious consequences. The appearance of gummous formations can be observed in any internal organs. In this case, severe disruptions occur in metabolism. Most often, the disease affects the cardiovascular system or liver.

One of the manifestations of this form of syphilis is aortitis. In this case, foci of infection appear in the lining of the aorta. Later they are replaced by connective tissue. The problem may be accompanied by significant narrowing of the heart vessels, aneurysm or aortic valve insufficiency.

Read also on the topic

Routes of infection with Treponema pallidum, symptoms of infection, treatment

In the early stages, the disease may be asymptomatic. Later, symptoms similar to those of coronary heart disease appear. Painful sensations in the chest area and heart murmurs appear.

Syphilis can also affect the liver. This form of the disease most often appears between the ages of 35 and 50 years. There are four forms of this problem:

Focal gummous hepatitis. The peripheral parts of the liver are primarily affected. Gummas are localized under the liver capsule, which leads to a change in the size of the organ.
Interstitial hepatitis. Pathological processes originate around the lobes of the liver.
Miliary hepatitis.
Chronic epithelial hepatitis.

Hepatitis with syphilis has similar symptoms. Painful sensations appear in the hypochondrium area, a person suffers from attacks of nausea, the sclera turns yellow, and normal bowel function is disrupted. Diagnosis is complicated by the fact that symptoms appear simultaneously in several organs.

Diagnostic techniques

The tertiary stage of syphilis can be determined after a thorough examination and interview of the patient, as well as appropriate diagnostic measures. When interviewing a person, the specialist must find out the symptoms of the problem and the measures that were taken previously. During the examination, the doctor determines the presence of manifestations of the disease. At this point, it is important to correctly distinguish them from tuberculosis, mycosis and other diseases.

Among the main diagnostic techniques, the following are used:

Laboratory tests of blood samples. First, a nontreponemal analysis is performed. After this, a treponemal study is carried out for control. This is the only way to make an accurate diagnosis.
Bacterioscopic examination. Samples taken from lymph nodes or from the bottom of ulcers are checked for the presence of traces of treponema.
Cerebrospinal fluid examination. Such an examination is carried out if neurosyphilis is suspected. An increased content of protein, monocytes and lymphocytes in the sample is detected.

Only after a complete diagnosis will a specialist be able to make a reliable diagnosis. Based on this, a competent treatment program will be developed in the future.

Treatment of the disease

It is necessary to start treatment as early as possible. Only in this case is a successful treatment possible. The main therapeutic method is the use of drugs containing benzalpenicillin. Thanks to this, the functioning of internal organs and systems occurs. If a patient exhibits an allergic reaction to penicillin antibiotics, they are replaced with Doxycycline, Ceftriaxone or Amoxicillin. In rare cases, there is an allergy to all antibiotics. In such a situation, medications from the macrolide group are used for treatment. Good results are obtained with the use of Summed, Josamycin, Clarithromycin.

If tertiary syphilis is not accompanied by damage to internal organs, then the following methods of using penicillin antibiotics can be used:

Novocaine salt of penicillin is used. It is administered in equal doses 4 times a day for 28 days. After the first two weeks, a break is taken for 14 days. After this, the drug is resumed.
The specialist prescribes water-soluble penicillin. It is also injected into the patient’s blood 4 times a day for 28 days. If necessary, the course of treatment is repeated, but procaine-penicillin is used. It is administered over 10 days.
Procaine-penicillin. The course of treatment with this drug is 20 days. After this, a ten-day break is taken, after which the use of the medication is resumed for another 10 days.

If the disease is accompanied by damage to internal organs, then comprehensive treatment of tertiary syphilis is carried out. The following techniques can be used:

The first two weeks a preparatory stage is carried out, during which the patient is prescribed Tetracycline or Erythromycin. After this, the patient is administered penicillin for 28 days.
After the preparatory stage using Tetracycline or Erythromycin, treatment is carried out using novocaine salt of penicillin.
At the end of the preparatory stage, treatment is carried out using procaine-penicillin.

Treatment of neurosyphilis is also carried out with the use of penicillin antibacterial drugs. Six months after the end of the main course of treatment, repeated laboratory tests are carried out. This is the only way to monitor the success of therapy.

Specific drugs and their dosage are determined by a specialist based on the form and severity of the disease. Sometimes it is necessary to use several courses of therapy to achieve results.

Pay attention! If gummy nodes are found in the brain or spinal cord, then Prednisolone is prescribed simultaneously with antibacterial therapy. This enhances the effectiveness of antibiotics and reduces the likelihood of symptoms reverting.

On average, treatment for tertiary syphilis takes from two months to several years. Everything will depend on the complications that arise and how sensitive the patient is to the drugs used. During treatment, the patient is advised to avoid sexual intercourse without using a condom. It is necessary to undergo periodic examinations for preventive purposes.

Syphilis, even in the last phase, can be cured. The sooner treatment is started, the greater the chance of successful treatment. Always be attentive to your health and consult a doctor at the first unpleasant symptoms.

What is Tertiary syphilis -

develops in a small number of patients who were insufficiently treated for syphilis or were not treated at all. The development of tertiary syphilis is facilitated by old age and childhood, trauma (physical, mental, medication), chronic diseases and intoxication, and alcoholism. Typically, tertiary syphilis begins after 4-5 years, but in recent decades it more often appears 8-10, and sometimes decades after infection. In Ukraine, patients with tertiary syphilis are currently rare.

Morphologically, tertiary syphilides are infectious granulomas.

Unlike secondary syphilis, clinical manifestations of tertiary syphilis are predominantly local in nature. They are accompanied by destruction of the organs and tissues in which they are localized, and leave scars after their resolution.

Morphologically, tertiary syphilides are infectious granulomas.

Pathogenesis (what happens?) during Tertiary syphilis:

The only causative agent of the disease is Treponema pallidum, which can be detected in the patient’s lymph nodes 10 hours after infection, and 5 days later in his blood.

This is a spiral-shaped infectious microorganism that is covered with a protective membrane that provides a reliable barrier against drugs. It can also exist in the form of a cyst and L-form, which determines the different types of syphilis.

Causes and development of the disease

The cause of syphilis is the introduction of Treponema pallidum into the body. This microorganism is transmitted from person to person mainly during sexual intercourse.

In addition, a large amount of the pathogen is contained in the blood of sick people, so syphilis can be transmitted through blood during a transfusion, among drug addicts when using a shared syringe.

There is a high risk of transmission of the pathogen from mother to child during breastfeeding, and there are also confirmed cases of infection with treponema through household means (through common hygiene items).

Article on the topic: Secondary syphilis: treatment, symptoms, signs

Tertiary syphilis develops after secondary syphilis with inadequate treatment or its absence. With prolonged circulation of Treponema pallidum, the immune system is sharply weakened, which predisposes to the development of syphilitic gummas on the skin and organs of the patient (neurosyphilis, syphilis of the heart, kidneys).

The disease occurs cyclically with phases of exacerbation and remission. An exacerbation of the process is observed with a decrease in immunity: injuries, infectious diseases, hypovitaminosis, malnutrition, stress.

The tertiary period of syphilis develops several years after infection. Human infection occurs in the following ways:

sexual;
artificial;
injection;
contact and household.

Treponema pallidums are highly pathogenic. Human infection occurs when just a few microbial cells enter the body. For a long time the disease is asymptomatic. Predisposing factors for the development of tertiary syphilis are:

chronic intoxication;
alcoholism;
addiction;
immunodeficiency;
exhaustion;
non-compliance with the dosage of the medication during treatment;
self-medication;
unprotected sex during therapy;
old age.

At the third stage of the disease, treponema spreads throughout the body, leading to the formation of granulomas in the internal organs and on the skin. Specific inflammation develops, which can lead to tissue destruction.

Signs and types

Different syphilides also have different characteristics: they look, are located and develop with some differences. Let us briefly consider each type of tertiary syphilitic formations.

Tuberous syphilide

This intradermal nodular inflammatory formation is the most common manifestation of tertiary syphilis.

Description: in the photo, tubercular syphilide looks like a smooth, shiny pea of dark red color with a yellowish or bluish tint.

single (solitary),
grouped,
in the form of a diffuse gummous infiltrate up to 6-8 cm in size, sometimes more.

Gummas located close to the extensor surfaces of large joints (knees, elbows, etc.) in rare cases may undergo fibrosis.

These fibrous gummas, or periarticular nodules, are painless, dense (the consistency of cartilage) nodes 1.5-2 cm in diameter, the color of the skin over them is not changed.

Lesions of the mucous membranes in the tertiary period of syphilis occur on the soft and hard palate, nasal mucosa, and less often on the back wall of the pharynx and tongue. Here gummas, gummous diffuse infiltration and tubercles can form.

Lesions are accompanied by tissue destruction, the formation of ulcers and scars. Gummous lesions of the mucous membrane of the hard palate usually develop secondary to the transition of the inflammatory process from the bone and periosteum to it.

Ultimately, separation of the bony sequestrum leads to perforation of the hard palate. A round-shaped perforation hole connects the oral cavity with the nasal cavity.

The nasal mucosa is usually affected secondarily when the pathological process spreads from the bone and, to a lesser extent, from the cartilaginous part of the nasal septum.

A perforation may form in the nasal septum. With significant destruction of the bone part of the septum and especially the upper part, the nose becomes deformed - it becomes saddle-shaped.

Each type has its own treatment, because the manifestations of the disease are different, and each type needs to treat a specific organ or system.

Active form: spreads throughout the body very quickly, you need to urgently consult a doctor, otherwise you may end up in intensive care with complications.
Latent syphilis: This type can appear in people who have had the active form.

These two types can only manifest themselves in degree 3.

How often does it reach the tertiary stage?

The tertiary period of syphilis is the last, 3rd stage of the disease, which always and inevitably develops if syphilis is not treated. However, the time for the development of the tertiary stage of syphilis is different for everyone.

In 10-20% of cases, the first signs of tertiary syphilis appear 3-5 years after infection;
in 65-85% - after 10 years or more;
and somewhere in 5-10% – already 2 years after infection.

If the symptoms of syphilis are ignored, the following complications are possible:

A serious complication of the 3rd period of the disease is late neurosyphilis. It occurs as tabes dorsalis, gumma cerebri or progressive paralysis. The following symptoms are observed with dryness:

back pain like radiculitis;
ulcers;
joint pain;
loss of sensation;
suppression of reflexes;
decreased potency;
constriction of the pupils;
impaired coordination of movements.

A dangerous complication is progressive paralysis. It is characterized by dementia, memory loss, decreased intelligence, dysarthria, epileptic seizures, delusional ideas and indifference to what is happening.

Signs of tertiary syphilis

As we already know, the third (or tertiary) stage of syphilis can manifest itself not only on the skin, but also inside the body. With this progression of the disease, bumps and bumps form unpredictably in a variety of areas.

For example, directly inside organs, in the space between them, in the tissues of the nervous system, on the walls of large vessels, and so on.
.

Let's look at the diseases that tertiary syphilis causes in more detail.

Tertiary neurosyphilis

This is a disease of the nervous system - the membranes, blood vessels and substance of the brain and spinal cord. Neurosyphilis develops in 30% of cases of the tertiary period. This is a very dangerous condition that can lead to dementia, insanity, paralysis and disability.

Initial neurosyphilis can manifest itself as headaches, increased fatigue, absent-mindedness, memory and sleep disturbances, numbness of the limbs, difficulty urinating, and so on. In each specific case, the set of symptoms will be different. More information about neurosyphilis can be found in the material “Syphilis of the nervous system.”

Syphilis of the nervous system can lead to paralysis, insanity and disability

Tertiary syphilis of the cardiovascular system.

This damage to the heart and blood vessels is less common than neurosyphilis. Most often, in the late stages of syphilis, the aorta is affected. In this case, aortic valve insufficiency, coronary artery stenosis and aortic aneurysm may develop.

Aortic aneurysm is the most dangerous complication of cardiovascular syphilis. It can lead to rupture of the aortic wall and instant death of the patient

Tertiary syphilis of bones and joints

If syphilis affects the bones and joints of a person, then they gradually become deformed - their shape and size change, cartilage and bone tissue are destroyed in those areas where the destruction of the gums occurred. As a result, the joints stop doing their job normally.

In addition, the cartilage of the facial area may be destroyed. Thus, the world-famous complications of syphilis are a saddle nose and a hole in the hard palate.

Tertiary syphilis of internal organs

In addition to the heart and blood vessels, syphilis in the tertiary period can affect almost any internal organ. This complication is called “late visceral syphilis” (late syphilis of the internal organs).

Visceral syphilis can affect the liver, kidneys, digestive system, internal genital organs, lungs, and so on.
.

In each of these cases, patients experience different symptoms. At the same time, the internal mechanism of the disorders is similar: inside the organ, one or more syphilides first form, and after a while they begin to resolve.

External signs of tertiary syphilis. Sometimes there is irradiation of gumma - the spread of gummous infiltrate to neighboring tissues (from the skin to the periosteum, bone, blood vessels), which can not only aggravate the disfigurement of the patient’s appearance, but also lead to death. Gummas of the mucous membranes are quite common. First of all, the mucous membrane of the nasal cavity is affected, then the pharynx. Gummy lesions of the tongue, hard and soft palate, nose, pharynx, larynx lead to severe and often irreparable disorders of speech, swallowing, breathing, and change the appearance of the patient (“saddle” nose, complete destruction of the nose, perforation of the hard palate).

Aching bones is one of the symptoms

As mentioned earlier, the tertiary period of syphilis is one of the stages of infection by the pathogen Treponema pallidum in the human body. It occurs as a result of the fact that treatment for this infection is either not carried out at all and the disease smoothly passes through all its clinical forms and manifestations on the skin, or due to the fact that the prescribed therapy was incomplete or was carried out incorrectly.

The main symptoms of tertiary syphilis:

On the skin and mucous membranes of the patient, tubercles, which are often grouped together, and gummas, which are large nodes, appear characteristic of this period of damage to the body.
Often gummas and tubercles with this disease appear in the area of skin injuries
The elements are located quite deep in the skin, often reaching bone tissue
Sometimes damage to the patient’s internal organs is also detected with the formation of these formations, for example, in the area of the liver, brain, lungs, heart
As a rule, gummas and tubercles with a diagnosis such as tertiary syphilis develop and proceed rather slowly and resolve with scars

It is important to note that tertiary diagnosed syphilis is characterized by non-infectious elements appearing on the skin. In addition, patients are not contagious through sexual contact during this form of the disease.

Symptoms of the disease are accompanied by the most pronounced, often indelible disfigurement of the patient’s appearance, severe disorders in various organs and systems, leading to disability and often death.

The third degree of syphilis affects internal organs and mucous membranes.

Vivid signs are severe malaise, headache, which may be accompanied by cough. These symptoms can be confused with a common cold. But the most important difference is that the temperature is normal, not high, but at the same time it can make you feel very hot.

Basically, the disease is detected, at most, at the second stage, and the third stage appears with poor quality treatment.

The tertiary form of syphilis can develop with excessive alcohol consumption. It can be inherited or through infection from another person. Older people usually have very weakened immune systems, so they have the highest percentage of cases of infection.

Symptoms

The disease develops in approximately 40% of patients in the 3rd–4th year of the disease and continues indefinitely. The transition of the disease to the tertiary period is facilitated by inadequate treatment or its absence in the previous stages of syphilis, severe concomitant diseases, poor living conditions, etc.

Symptoms of the disease include:

Infectious granulomas in tertiary syphilis. This is the name for formations in the form of large nodes or tubercles, which gradually turn into ulcers and then into scars. Typically, a patient can simultaneously observe granulomas in various stages of development.

Gummas. These are large nodules that appear under the skin. As the gumma develops, it opens and an ulcer appears. Gummas are observed on the mucous membrane and on the bones of the nose, hard and soft palate, etc.

Clinical manifestations of tertiary syphilis are localized, organ-based. They are characterized not by proliferative, but by destructive changes.

They leave behind scars or cicatricial atrophy. Tertiary syphilis lesions in the form of tubercles and gummas can develop in any organs and tissues, but most often the skin, mucous membranes, bones, vascular and nervous systems, and internal organs are affected.

At this stage, almost all organs and systems of the body suffer. These are the kidneys, stomach, liver, bones, spinal cord, heart, brain, nervous system.

The disease can last for decades. During this period, deafness and blindness may occur. Such patients are usually aggressive, prone to paranoia and depression.

Characteristic signs of tertiary syphilis:

All tertiary affects on the skin are divided into two large groups: the so-called tertiary syphilides and gummas (usually larger in size).