Latent syphilis is a condition when, in the absence of clinical manifestations of the disease, positive serological reactions are detected in the patient's blood. The treatment of such patients is aimed at serological negativity (obtaining negative serological reactions) and preventing the development of relapses of the disease.

Latent (latent) syphilis occurs in patients who have had active manifestations of the disease in the past, resolved on their own or under the influence of specific treatment.

In some cases, this condition is a special form of asymptomatic syphilis from the moment the patient is infected. Significant assistance in making a diagnosis is provided by a correctly collected anamnesis (history of the disease) and a number of other indirect signs.

Rice. 1. Manifestations of the disease in women in the primary period of the disease are multiple hard chancres (photo on the left) and hard chancre in the form of indurative edema (photo on the right).

The current state of the problem

According to some authors, the number of patients with latent forms of syphilis has increased 2-5 times in the last decade. Increasingly, it becomes difficult for a doctor to determine the timing of the disease, and the patient's sexual relations are often random. The only method for detecting syphilis in such cases is serological diagnosis.

In our country, the method of active detection of patients with syphilis is used during preventive examinations in clinics and hospitals, antenatal clinics and at blood transfusion points, for which a number of treponemal tests are also used. Thanks to this work, up to 90% of patients with latent forms of the disease are detected during preventive examinations.

Reasons for the increase in the number of patients:

• a true increase in the number of patients with latent syphilis;
• improvement of serological diagnostic methods;
• widespread uncontrolled use of antibiotics in the treatment of various diseases.

The possibility of asymptomatic syphilis is now recognized.

Serological reactions in latent forms of the disease are the only criterion for confirming the diagnosis.

Rice. 2. Manifestations of the disease in men in the primary period - a single hard chancre (photo on the left) and multiple hard chancres (photo on the right).

Forms of latent syphilis

If, from the moment of infection, syphilis takes a latent (latent) course (is asymptomatic), but with positive specific serological reactions, they speak of a latent form of the disease. The latent syphilis in most cases comes to light incidentally at statement of specific serological reactions. In some cases, the doctor manages to find out what period of the disease he belongs to:

• if the patient had previously recorded a hard chancre, but did not appear, then they talk about the latent period of primary syphilis;
• the latent period identified after the appearance of secondary syphilis and in the case of recurrent syphilis refers to the secondary period of the disease;
• there is also a latency period.

Such a division of the latent periods of the disease is not always possible, therefore, in venereological practice, it has been established to distinguish between early, late and unspecified latent periods.

1. Diagnosis early latent syphilis is established if more than 2 years have not passed since the moment of infection. In epidemiological terms, this category of patients is the most dangerous.
2. Diagnosis late latent syphilis established if more than 2 years have passed since the moment of infection.
3. Latent unspecified syphilis- this is a condition when, in the absence of anamnestic data and clinical manifestations of the disease, positive serological reactions are detected in the blood of a previously untreated patient.

Rice. 3. Manifestations of the disease in the secondary period - papular syphilis on the face and palms.

Early latent syphilis

Early latent syphilis includes the period from the moment of infection until the secondary recurrent period (on average up to two years). During this period, patients may experience manifestations of the disease of a high degree of contagiousness. A number of anti-epidemic measures are being taken against them. The main ones are:

• patient isolation,
• examination of sexual partners and domestic contacts,
• compulsory treatment (according to indications).

Who is sick

Early latent syphilis is recorded mainly in people under the age of 40 years. Most of them have no control over sexual desire. They are prone to numerous casual sexual relationships, which in an epidemic leads to the inevitable development of the disease. The absolute proof of a case of latent syphilis is the establishment of an active form of the disease in a sexual partner.

What you need to find out in the survey

Carefully collecting an anamnesis, it is necessary to pay attention to rashes of an erosive-ulcerative nature on the genitals, lips, oral cavity, skin, episodes of hair loss on the head, eyebrows and eyelashes, the appearance of age spots on the neck over the past 2 years. It is also necessary to find out whether or not the patient took antibiotics, was treated or not for gonorrhea.

Signs and symptoms of early latent syphilis

1. A scar or induration on the genitals revealed during a clinical examination and often the presence of enlarged regional lymph nodes, as well as residual effects of polyscleradenitis, may indicate a primary syphilis.
2. In 75% of patients in the latent early period of the disease, sharply positive serological reactions (1:160) are noted, a low titer (1:5:20) is observed in 20% of patients. In 100% of cases, a positive RIF is noted. In 30 - 40% of cases, positive RIBT is noted. In the treatment of antibiotics concomitant diseases titers of serological reactions are reduced.
3. In 1/3 of patients treated with penicillin, the Herxheimer-Yarish reaction is observed, which is characterized by a sudden increase in body temperature, headache and muscle pain, vomiting, tachycardia. This phenomenon is due to the mass death of pathogens. Symptoms are quickly relieved by aspirin.
4. In the case of the development of latent syphilitic meningitis, an increased amount of protein is noted in the cerebrospinal fluid, (+) reactions to globulin fractions and cytosis. With specific treatment, the cerebrospinal fluid is quickly sanitized.

Treatment of early latent syphilis

Treatment of early latent syphilis is carried out in accordance with approved instructions and is aimed at the fastest destruction of pathogens in the patient's body. With specific treatment, negative seroreactions occur quite quickly. The extinction and complete negativity of specific serological reactions in latent syphilis are the only criterion for confirming the effectiveness of the treatment.

Timely detection of patients in the period of early latent syphilis and adequate adequate treatment have a positive effect on the prognosis of the disease.

Rice. 4. Manifestations of the disease in the secondary period - syphilitic roseola.

late latent syphilis

The diagnosis of late latent syphilis is established in patients whose infection duration exceeds 2 years, there are no clinical manifestations of the disease, and positive serological reactions are recorded. Basically, such patients are detected during preventive examinations (up to 99%), including examinations for the identification of a patient with late forms of syphilis in the family (1%).

Who is sick

The disease is detected mainly in people older than 40 years (up to 70%). Of these, about 65% are married.

What you need to find out when interviewing a patient

When interviewing a patient, it is necessary to find out the timing of possible infection and the presence of signs indicating manifestations of infectious syphilis in the past. Often the anamnesis remains uninformative.

Signs and symptoms of late latent syphilis

1. During the examination, it is not possible to determine the traces of previously resolved syphilides. During the examination, there are no signs of a specific lesion of internal organs and the nervous system.
2. In the diagnosis of late latent syphilis, serological tests such as RIF, ELISA, TPHA and RITT are used. The reagin titer is usually low and is 1:5 - 1:20 (in 90% of cases). In rare cases, high titers are noted - 1:160:480 (in 10% of cases). RIF and RIBT are always positive.

Sometimes serological studies have to be repeated after a few months.

In patients with late latent syphilis, whose age ranges from 50 to 60 years, there are a number of comorbidities that cause the appearance of false positive serological reactions.

1. There is no Herxheimer-Yarish reaction to the administration of antibiotics.
2. Late latent meningitis is rare in these patients. In the cerebrospinal fluid, when specific meningitis is detected, a mild inflammatory component is noted - low cytosis and protein levels, signs of a degenerative component predominate - a positive Wassermann reaction and a Lange reaction. During the period of specific treatment, the sanitation of cerebrospinal fluid occurs slowly.

Treatment of late latent syphilis

Treatment of late latent syphilis is carried out in accordance with approved instructions and is aimed at preventing the development of a specific lesion of internal organs and the nervous system. Patients should be consulted by a neurologist and therapist. During the period of specific treatment, negative seroreactions occur extremely slowly. In some cases, after a full-fledged specific treatment, serological reactions remain positive.

The extinction and complete disappearance of specific serological reactions in latent syphilis are the only criterion for confirming the effectiveness of the treatment.

Rice. 5. Manifestations of the disease in the tertiary period - gumma of the face and gummous infiltration of the hand.

Latent unspecified syphilis

In the absence of information about the circumstances and timing of infection and the presence of positive results of serological studies, a diagnosis of latent, unspecified syphilis is established. Such patients are subject to careful clinical and serological examination, often repeated. Setting RIF, RIF-abs and RIBT, ELISA and RPHA are mandatory.

You should be aware that in patients with late and unspecified syphilis, false positive nonspecific serological reactions are often detected. Reagin antibodies produced against the cardiolipin antigen appear in the blood of patients with collagenosis, hepatitis, kidney disease, thyrotoxicosis, oncological diseases and infectious diseases such as leprosy, tuberculosis, brucellosis, malaria, typhus and scarlet fever, during pregnancy and monthly cycles, when taking fatty foods and alcohol, in patients with diabetes mellitus, myocardial infarction and concussion. It is noted that with age the number of false positive reactions increases.

Rice. 6. Hummous infiltration of the buttocks and peripapillary zone in the tertiary period of the disease.

On the territory of our country, the spread of syphilis was first noted in the middle of the 15th century. This was due to insufficient medical care and illiteracy of people.

Classification

Usually, latent syphilis is classified into several forms, depending on the severity of the symptoms:

• Primary.
• Secondary. Tertiary.
  • Secondary early hidden.
  • Secondary late latent syphilis.
• Congenital.

Primary syphilis has the most pronounced property to be transmitted from sick people to healthy people through direct contact. Severe forms have a lower degree of infection, but changes in human systems are already becoming clearly visible.

How is it transmitted

Syphilis is a venereal disease. As a rule, transmission is carried out from a sick person to a healthy person through sexual contact, but there are other ways. The main factors for the existence of a microorganism are humidity, anaerobicity and the required temperature. It is quite possible to get infected through the blood when it gets on the mucous membranes of another person or when it is transfused.

Important. Infection can also occur when using common dishes, towels and other household items, if a person has ulcers on the body. Bacteria are not detected in urine and sweat tests.

Stages of development

From the moment of infection to the onset of the first symptoms, a little less than a month passes. There are four stages in the development of the microbe and the immune response to it:

• Incubation.
• Primary.
• Secondary.
• Tertiary.

The period of reproduction of microorganisms does not betray itself in any way, the symptoms begin to manifest themselves clearly from the primary stage of development.

Note. This time is equal to four weeks, but it can decrease or increase depending on the amount of the source of infection. The bacterium divides once every 30 hours, which explains the rather long period before the manifestation of pathology. In addition, the use of antibiotics can increase this time.

Hard chancres (ulcers that do not cause discomfort) are a sign of the primary stage in the development of the disease. This period lasts 6-7 weeks. In addition to the appearance of chancres, rashes, patients have enlarged lymph nodes and vessels that conduct lymph in places close to the source of penetration.

Hard chancres - the primary stage in the development of syphilis

The stage of reproduction of syphilis is usually divided into:

• gray-negative;
• gray positive.

They differ in the manifestations of the Wasserman reaction and enzyme immunoassay, respectively, negative or positive.

At the second stage of development, the disease affects the nervous system, and a rash on the skin and mucous membranes is also noted.

Here are distinguished:

• early;
• returnable;
• latent syphilis.

At an early stage, the pathogen manifests itself as a rash. But at this time, other organs are also violated: the liver, kidneys, bones, central nervous system.

Spots on the skin indicate that the body is fighting the infection, but cannot be completely cured, which leads to a latent form of syphilis.

Important. This period is different in that the obvious symptoms disappear, patients with latent syphilis look healthy, but there are still bacteria inside them; the development of a relapse will occur as soon as the immune system fails even a little.

If proper treatment has not been carried out for one or two decades, the third and last form begins to develop. All organs and systems are affected here. Outwardly, it manifests itself in the form of syphilitic gums (nodules in tissues that irreversibly destroy them can form both on the skin and in internal organs, as well as bones). Manifestations are cyclical, it depends on immunity. As a rule, when the body is hypothermic, it decreases, at such moments the disease manifests itself. Often there is a localization of the microbe in one of the systems or organ.

In the late stage of latent syphilis, all organs and systems of the patient are affected.

Thanks to the use of antibiotic agents, the tertiary stage has become less and less common. It also happens that it did not come at all after the usual passage of the first and second phases. Strong immunity may indicate this. For a certain time, the immune system is able to remove the infection from the body, so that conventional research methods are not able to detect it due to the negligible amount of harmful microorganisms in the tissues. But with a slight deviation of immunity, the infection will begin to manifest itself again. Such a person becomes its carrier.

Symptoms of latent syphilis

The signs of the disease depend on the period the microbe has been inside the body and on the correctness of the treatment. Each phase is very different from each other.

Primary phase

It is characterized by the appearance of painless ulcers in the area closest to the source of penetration of the bacteria. As a rule, they are dense, regular rounded, solitary, do not increase either in volume or in diameter. This symptom is part of the defense mechanism for infection. There are other options for symptoms:

• Inductive edema. Occurs when sexually transmitted. Changes in size, skin color occurs in men - on the scrotum, in women - in the vagina. The epidermis in such areas becomes blue, pain does not occur when pressed. The phenomenon can persist for a month. It occurs much more frequently in women than in men. Edema can also form in other diseases, which makes it difficult to diagnose. This can be helped by a blood test, examining the patient for an increase in the number of lymphocytes.
• Chancre panaritium. It is an abscess on the fingers near the nails. Most often occurs in physicians operating on patients. This type of peculiar ulcer causes a lot of inconvenience, in addition to aesthetic, it hurts. The sick doctor can no longer work. In addition, there is a tendency to spread education on the organs responsible for reproduction.
• Chancre-amygdalite. Pathology is formed in the oral cavity - this is an increase in one of the accumulations of lymphoid tissue. In addition, the patient is tormented by fever and, of course, pain when swallowing. Unlike angina, only one side is affected and the mucosa remains smooth.

There are other types of surface formations. For example, when passing infection with another virus, chancres take on a different look. They can bleed, have an uneven frame and bottom. In such a situation, it is difficult to understand the origin of education. But there is always a sign of enlargement of the lymph nodes, which should be paid attention to when analyzing blood for the presence of a microorganism.

Enlarged lymph nodes may be a sign of latent syphilis.

At the end of the stage, external symptoms disappear, a person may feel general malaise, fever, weakness.

Secondary

Characterized by skin rashes. Lymph nodes are cold, enlarged, dense. Here the patient feels the usual symptoms for an infectious disease. It also happens that there are no rashes, and even worse, if the stage does not manifest itself at all. In this case, outwardly, the patient will look like a cold, and the main virus will become chronic.

The latent period of syphilis lasts several days, rarely up to 7-14 days. After which the symptoms disappear.

Important. In the first two or three years, the manifestation of early syphilis begins with damage to the central nervous system. Pathological changes occur in the upper layers of the brain and blood vessels. Under the action of the immune system, a barrier is created in the meninges and thickening of the layers of blood vessels, by growing their inner wall. At the same time, nodular collapsing tissues are formed in them.

Often there is inflammation in the head and a violation of the reaction of the eyes to light. Less often - neuritis, polyneuritis, meningoencephalitis. With latent syphilis, there may be a violation of the reaction of the eyes to light.

Diagnosis of this stage is hampered by the similarity of symptoms with other infections.

Tertiary

Differs in the absence of external signs. The person is a carrier of the infection, but he himself looks healthy.

Important. The stage of late syphilis can last more than two decades. But sooner or later, the disease makes itself felt: a lot of destructive pathologies in different systems, which are gummas.

This period was classified in the middle of the twentieth century:

• Asymptomatic.
• Syphilitic meningitis.
• Meningovascular.
• Cerebral.
• Spinal.
• Parenchymal.
• progressive paralysis.
• Dorsal dryness.
• Taboparalysis.
• Atrophy of the optic nerve.
• Gummy.
• Gum of the brain.
• Gumma of the spinal cord.

The most common is the asymptomatic late form, which extends to the central nervous system. It accounts for more than 30 percent of cases. The second most common is spinal dryness.

All the species listed above develop after a long stay in the body of an infection that does not give itself away. Meningitis develops after two years, the rest - 15 years or more.

The clinical course is different, but there are similar points: a violation of the central nervous system, a decrease in memory and attention, the inability to think logically, paralysis, paresis.

Latent syphilis during pregnancy

If proper treatment of latent syphilis during pregnancy is not carried out, it can be transmitted to the child. In a newborn, changes are formed at the stage of formation of vital tissues, so the body is not restored. In this case, the following signs are noted:

• parenchymal keratitis;
• deafness;
• Hutchinson's teeth.

Important. In other cases, either early birth or death occurs in utero.

Diagnostic methods

Pathology with obvious forms is perfectly noticeable, it is easy to identify it and suggest what kind of ailment the patient is tormented by. In their absence, serodiagnostic studies come to the rescue (recognition of the reaction when mixing the blood serum of the infected and the reagent).

Methods for diagnosing latent syphilis are usually distinguished into:

• Direct.
• Indirect.

The first ones include microscopy, infection with rabbit material, culture, and PCR diagnostics. The methods use several types per patient, each individually cannot give an accurate result. They have their drawbacks: long duration, impossibility of detection at certain stages, or they are expensive. Therefore, serological methods are used.

This includes various reactions of human blood to the proposed reagents. None of the indirect methods can also give an accurate answer to the presence of a microbe, and therefore the diagnosis is made only after two or more methods have been carried out.

Treatment

Important. The bacterium that causes this disorder remains one of the few organisms that cannot defend itself against penicillin. Therefore, therapy with this substance works great in our time. Taking the right dose of the drug for a long time helps to completely rid the body of the infection.

Erythromycin is another drug with the same effect, it is used for allergic reactions of the patient to penicillin drugs.

Penicillin is the most effective treatment for syphilis.

Treatment of late latent syphilis is carried out with penicillin in combination with antibacterial drugs that are injected into the muscles and orally.

Note. In the head section, as mentioned above, a barrier is formed that, as it were, protects the brain from the virus, but this same formation does not allow the healing substance to penetrate into the desired areas. This is facilitated by additional medications that are administered endolumbally. But there is a problem - the lack of specialized doctors.

How to treat latent syphilis if triponema is resistant to antibacterial drugs? It is allowed to use hard-to-reach mixtures with bismuth or arsenic.

Forecast

With the methods of treatment and prevention offered now, the disease is completely curable. But do not delay this, because after a certain period of time, the changes may be irreparable. The same prognosis applies to women during pregnancy with latent syphilis. After all, already in the womb, the baby receives pathological changes that remain with him forever.

Many sexually transmitted infections do not cause symptoms for a long time. Among these is latent syphilis, a sexually transmitted disease that patients learn about during a random examination. However, the disease can be diagnosed by certain signs.

Syphilis is the causative agent

The causative agent of the disease is pale treponema. The microorganism belongs to spirochetes, under a microscope it looks like a spiral-shaped bacterium. On average, there are 8–14 turns in the structure, and the total length does not exceed 14 µm. With a latent course of a disease such as syphilis, the causative agent of infection is in an inactivated state for a long time, forming cysts, L-forms.

Such modifications of treponema are able to stay for a long time in the regional lymph nodes, cerebrospinal fluid of an infected person. Under favorable conditions for the pathogen (decreased immunity, chronic diseases), treponemas are activated and an active stage develops with a characteristic clinical picture and symptoms.

Syphilis - ways of transmission

To prevent infection, each person must imagine how pale treponema is transmitted. The main route is sexual, with unprotected intercourse. However, it is impossible to completely exclude the possibility of transmission of the pathogen by household means, when using hygiene items and cutlery alone with the patient. The penetration of the pathogen occurs through the mucous membranes, on the surface of which there are microabrasions, cracks. Among the rare ways of infection, venereologists call:

• transfusion (transfusion of infected blood and components to a patient);
• transplacental (during pregnancy and childbirth, from mother to child).

What is latent syphilis?

Hearing a similar term, patients are often interested in doctors if there is latent syphilis and what kind of disease it is. The definition of "latent syphilis" is used to denote a form of the disease in which there are no clinical manifestations, symptoms and signs of the disease, but the results of laboratory tests indicate the presence of the pathogen in the body. More often, changes in the blood are noticeable already 2 months after infection. Immediately from this time, the countdown of the duration of the latent period of syphilis begins.

In most cases, the detection of pathology occurs by chance, during the delivery of tests, which are mandatory during a preventive examination (blood on RW). In women, a gynecologist can suspect the disease during the next examination. However, in practice, a latent form of syphilis is detected when diagnosing changes in internal organs (heart, liver, thyroid gland, musculoskeletal system).

Is latent syphilis contagious?

Many mistakenly assume that the absence of signs of disease is the main criterion for absolute health. For this reason, a common question arises: is latent syphilis transmitted? Venereologists say that infection with this type of syphilis is possible. However, the transmission of the pathogen occurs only in two ways:

• with infected blood
• during sexual contact.

It should be noted that the risk of infection is maximum during the first two years after the onset of the disease. When diagnosing a disease in a sexual partner at this time, doctors advise to refrain from sexual intercourse and also undergo a comprehensive examination. Early diagnosis and timely initiation of therapy lead to a favorable outcome.

Hidden early syphilis

The term "early syphilis" is used to denote the period of the disease, which corresponds to the time from primary infection to recurrent secondary syphilis. Doctors talk about early syphilis, when two years have not passed since the infection. Patients at this stage have no manifestations of the disease, but they represent a potential danger in an epidemic sense.

At any time, the early latent form of syphilis can go into the active phase, which appears with skin rashes and general symptoms of intoxication. The elements of the rash contain a large number of pale treponema, the release of which can cause infection in contact with infected persons. It should be noted that early latent syphilis is more common in patients under 40 years of age who are promiscuous.

late latent syphilis

Late latent syphilis is registered 24 months or more after infection. When the disease passes into the active phase, symptoms and clinic of tertiary syphilis are observed. With this form, there is always damage to the internal organs and nervous system (neurosyphilis). At the same time, low-infectious tertiary syphilides, tubercles, and gummas can be observed on the skin. If their integrity is violated, it is possible to isolate pale treponema, infection of others in contact with the patient.

Latent congenital syphilis

Rarely diagnosed in children. Infection comes from an infected mother. In this case, the woman herself can get sick before pregnancy or during the process of bearing a child. The pathogen enters the fetus through the umbilical vein or through the lymphatic slits. Pathological changes in the organs and tissues of the unborn baby can be recorded at 5-6 months of gestation, during an ultrasound scan.

However, more often the latent form makes itself felt in early childhood. Prior to this, the detection of pathology is possible through serological studies, analysis of biological material (cerebrospinal fluid). Often, the indication for a comprehensive examination of the child is the detection of a positive mother in the postpartum period or during pregnancy.

Latent unspecified syphilis

The diagnosis of "unspecified syphilis" is made if the patient has no information regarding the possible time of infection. At the same time, doctors also find it difficult to determine the duration of the disease. Patients are assigned a set of serological studies, during which, according to the morphological forms of treponema, assumptions are made regarding the type of disease. Unspecified latent syphilis can give false-positive non-specific serological reactions, so they are repeated before the final diagnosis.

Latent syphilis - signs

Symptoms of latent syphilis do not make themselves felt for a long time. On the mucous membranes and skin of ulcers, rashes are not observed, however, changes can be recorded in the internal organs, the nervous system, and the musculoskeletal system. Among the indirect signs of an early form of latent syphilis, doctors call:

1. The presence in the anamnesis of rashes, the nature of which could not be diagnosed earlier.
2. Treatment of STIs, previously.
3. The presence of an active form of syphilis in a sexual partner.
4. Inflammatory reactions in the analysis of cerebrospinal fluid.

It is customary to single out indirect signs indicating a late stage:

• degenerative changes in the spinal underlying fluid;
• positive result of serological tests.

In addition, the following phenomena may indicate syphilis:

• prolonged increase in body temperature up to 38 degrees of unknown origin;
• an increase in peripheral lymph nodes (no pain);
• weight loss;
• general weakness, depressed mood.

Diagnosis of latent syphilis

How to identify latent syphilis in a particular situation - doctors determine depending on the nature of suspicions, indirect signs. The final diagnosis is made on the basis of a comprehensive assessment of the results of the studies. Among the main diagnostic methods:

1. The reaction of indirect hemagglutination (IPHA)- prepared red blood cells are mixed with the patient's serum. With a positive result, the cells stick together.
2. (IFA)- a special enzyme is added to the patient's serum sample, which changes color with a positive result.
3. RIF (immunofluorescence reaction)– a characteristic glow is present in the sample of the patient's biomaterial.

How to treat latent syphilis?

In the treatment of latent syphilis, the main goal is to eliminate the cause of the disease. It takes more time to eliminate the consequences (bone deformities, disorders of the nervous system, heart), and some of them can no longer be corrected. Treatment of late latent syphilis is based on the use of antibiotics, which are selected taking into account the stage of the pathology. Above is a table that shows the treatment regimen for latent late syphilis, with drug names and dosages. However, it should be borne in mind that all appointments are made only by a doctor.

With latent syphilis, there are no characteristic signs of pathology, and the disease can be suspected when performing specific laboratory tests. Despite the fact that there are no obvious manifestations of infection, the disease progresses slowly and leads to irreversible consequences. Basically, the asymptomatic course is associated with the widespread use of antibacterial drugs without prior accurate diagnosis of the disease. Patients, believing that they are sick with another venereal pathology (chlamydia, gonorrhea, trichomoniasis), start the wrong therapy. It only suppresses the growth of the causative agent of syphilis - Pale treponema, contributing to the latent course of the infection.

The frequent detection of a latent course is due to mass preventive examinations for syphilis in healthcare.

• Show all

  The causative agent of the infection

  The cause of the infection is Treponema pallidum (Treponema pallidum). It is surrounded by a specific protective sheath that protects it from exposure to hazardous environmental factors: antibiotics, antibodies.

  Treponema exists in several forms:

  • typical spiral shape;
  • cyst;
  • L-shape.

  In the case of a typical spiral shape, the infection proceeds with vivid clinical manifestations. Diagnosing it is easy enough.

  Cysts and L-forms are special forms of treponema that the body cannot recognize and respond to; protected species of the pathogen do not cause the appearance of characteristic symptoms, but form a latent course of syphilis, which can only be detected in a laboratory study. Cysts, L-forms are simply found in human blood and are periodically activated when appropriate factors arise: reduced immunity, stress, etc.

  Features of the disease

  The main route of transmission of the infection is sexual - about 90% of cases. The household way is especially common in children, with kissing, breastfeeding. Sweat and urine from patients with syphilis are not contagious. Semen, blood, vaginal secretions, saliva, breast milk - contain the pathogen in large quantities and are very contagious. The source of infection is a person with syphilis who is able to transmit the disease in the first years of the disease. Main routes of transmission:

  • sexual;
  • domestic;
  • transfusion (through the blood);
  • transplacental (from mother to child in utero).

  Classification of the disease from the duration of the infection in the body:

  The typical course of syphilis is characterized by a classic change of stages:

  • incubation period.
  • primary syphilis.
  • Secondary syphilis.
  • Tertiary syphilis.

  

  stages

  Incubation period(time from infection to the onset of clinical symptoms) lasts 3-9 weeks. 24-48 hours after infection, treponemas make their way to the regional lymph nodes and the systemic infection process starts. At this stage, the principle and timing of personal prevention after casual sexual intercourse is formed, which consists in the treatment of the genital organs with disinfectant solutions within 2 hours after intercourse.

  Primary Period begins with the appearance of a hard chancre (painless ulcer) at the site of introduction of treponema. In that place, the nearest lymphatic vessels and nodes increase. The end of the primary period is accompanied by fever and malaise, this is a consequence of the generalization of the infection: treponemas are released into the blood.

  

  Hard chancre on the genitals

  ATtoric period lasts 3 to 4 years. It is characterized by the appearance of rashes on the skin and mucous membranes. The rash may look like:

  • bubbles;
  • papules;
  • spots;
  • pustules.

  

  Rashes of secondary syphilis

  The rash disappears after a few weeks and does not leave a trace. Without appropriate treatment, the rash reappears. In addition, there may appear: skin pigmentation disorders, local hair loss on the head and eyebrows, seizures.

  Tertiary syphilis refers to late manifestations of the disease. It is accompanied by damage to the internal organs, the brain and spinal cord. There are gummous (nodular) formations on the skin, bones, spine, internal organs, spinal cord and brain. These nodes lead to the destruction of the tissues surrounding them, followed by deformities, disability and death.

  

  Tertiary syphilis

  Some people, even when in contact with an infected person, remain resistant to treponema and do not get sick. Rarely, syphilis will clear up on its own without the use of specific antibiotics. This is due to the peculiarity of the human immune status.

  

  Manifestations of latent syphilis

  With a latent (latent) course, all of the above symptoms are absent. But this does not negate the presence of treponema in the blood of a person. They are detected only when performing special serological tests.

  Latent syphilis is periodically activated, but it can accompany a person all his life until his death, without waking up. A person with latent syphilis is usually not contagious. The latent course, like the usual one, is divided into early and late syphilis.

  Clinic of the disease:

  If the latent form of syphilis manifested itself in the first 2 years, this is a favorable fact. During this time, treponema infections do not yet have time to affect the internal organs and brain, the bacteria are easily treatable.

  The negative side of the onset of symptoms in the first 2 years is the high contagiousness of the patient. It becomes very contagious during this period, since in the hard chancre, in the rashes on the skin, there is a large number of active treponemas, which, upon contact with the skin or mucous membranes of a healthy person, begin to intrude into them.

  The latter fact defines patients with early latent syphilis as an epidemiologically dangerous group. Large-scale anti-epidemic measures should be carried out:

  • isolation of patients;
  • examination of the patient's sexual and household partners;
  • forced treatment.

  If the latent course lasts more than 2-3 years, syphilis is called late. A person during this period is not contagious. When the process is activated, more serious life-threatening manifestations manifest: damage to the liver, heart, kidneys, bones, body skin. But its most serious consequence is damage to the brain and spinal cord: dorsal tabes, progressive paralysis. This is the danger of the latent course of the disease: without showing itself in the first 2-5 years, the infection already manifests itself with deformities and disabling consequences.

  Therefore, it is best to identify latent syphilis at a preventive examination and start its treatment on time. Currently, a blood test for syphilis is performed everywhere, including on a budgetary basis.

  Diagnostics

  To determine the presence of latent syphilis in a person, you can use the following data:

  • features of the anamnesis (presence of a sore in the patient on the body, on the genitals, rash, enlarged lymph nodes, fever);
  • examination of contacts (identification of a patient with syphilis in sexual partners);
  • sharply positive results of all serological tests (MRP, ELISA, RIF, RPGA);
  • rise in body temperature after the start of specific treatment;
  • decrease in antibody titer to pale treponema after 1 course of therapy.

  During the diagnosis of latent syphilis, false positive results can be obtained. They are most often due to:

  • previous malaria;
  • the presence in the human body of a focus of chronic infection (tonsillitis, sinusitis, pyelonephritis);
  • chronic liver pathology (cirrhosis, hepatitis, alcoholic hepatosis of the liver);
  • connective tissue disease (rheumatoid arthritis, scleroderma, systemic lupus erythematosus).

  In the examination for late syphilis, it is necessary to examine the cerebrospinal fluid to exclude damage to the nervous system by pale treponema. For this purpose, a lumbar puncture is taken from the patient.

  Treatment

  Therapy of the early latent course of syphilis should stop its transition to an active state. Therapy of the late course is aimed primarily at preventing its progression and the development of neurosyphilis.

  Specific treatment of syphilis is based on the use of systemic antibiotics of the penicillin series. At the beginning, a temperature reaction occurs, which indicates in favor of the presence of treponema in the body. The introduction of drugs is carried out in stationary conditions.

  The following antibiotics are used for therapy: Benzylpenicellin, Retarpen, Bicillin, Erythromycin, Clarithromycin, Ceftriaxone, Oxacillin. Doses and time of treatment are selected by a specialist individually for each patient, depending on the form of the disease and its severity. The average time of therapy for latent syphilis is 1 month.

  Retarpen - the main tool for the treatment of syphilis

  The result is evaluated no earlier than 3 months after the end of treatment according to repeated serological tests: a decrease in the titer of specific antibodies is detected. With early syphilis, cure is faster, negative tests for infection are soon achieved. Late course is more difficult to cure, positive tests can remain forever, sometimes this is also true for early syphilis.

  To deregister, you must:

  • full-fledged treatment taking into account all requirements;
  • optimal clinical examination data;
  • the results of a serological blood test (ELISA and RPHA may be positive with strictly negative MCI and CSR).

Syphilis is a sexually transmitted disease that is included in the category of the most famous sexually transmitted infections. The causative agent of syphilis is Treponema pallidum, translated from Latin as pale treponema. The disease is characterized by a rather slow, but progressive course, up to serious damage to the body and the central nervous system in the late stages. Most often, infection occurs during vaginal, anal and oral sex. According to medical statistics, people suffering from primary syphilis pose the greatest danger. In such patients, ulcers have already appeared in the mouth, on the genitals, or inside the anal canal. If a single sexual intercourse with a sick person was without a condom, the probability of infection is approximately 30%. A pregnant woman can infect her child with syphilis, and there is also a risk of infection at the time of blood transfusion. Least of all, infection occurs in domestic conditions, since once outside the human body, the causative agent of syphilis quickly dies. In situations where infection is still associated with marketing, it most likely occurred during sexual intercourse. In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they say early latent syphilis, and if more than 2 years ago, then late.

For 12 months of 2014 in Novopolotsk, 6 cases of syphilis were detected, of which 4 cases (67%) - late latent syphilis, 2 cases - early latent syphilis. For 3 months of the current year, 1 case of early latent syphilis was detected. More women get sick (more than 80% of all cases).

Patients with late latent syphilis, as a rule, are older than 40 years, while most of them are married. Patients with late latent syphilis in 99% of cases are detected during mass preventive examinations of the population, and the remaining one percent - when examining family contacts of patients with syphilis. As a rule, such patients do not know exactly when and under what circumstances they could become infected, and did not notice any clinical manifestations of the disease.

Latent syphilis at the time of infection takes a latent course, is asymptomatic, but blood tests for syphilis turn out to be positive. Patients with late latent syphilis are not considered dangerous in terms of infection, since when the disease passes into the active phase, its manifestations correspond to the clinic of tertiary syphilis with damage to internal organs and nervous system (neurosyphilis), skin manifestations in the form of low-infectious gums and tubercles (tertiary syphilides). All patients are consulted by a neuropathologist, therapist to exclude specific lesions of the central nervous system and internal organs. Additionally, a study is made on syphilis of cerebrospinal fluid taken from a patient by lumbar puncture. Pathology in the cerebrospinal fluid indicates latent syphilitic meningitis and is more often observed with late latent syphilis.

Syphilitic lesions of the nervous system are usually conventionally divided into early neurosyphilis (up to 5 years from the moment of infection) and late neurosyphilis. According to the symptoms, mesodermal neurosyphilis, which is characterized by damage to the meninges and blood vessels, and ectodermal neurosyphilis, which occurs in the form of dorsal tabes, progressive paralysis, and amyotrophic syphilis, are distinguished.

Among the late visceral lesions, the leading place belongs to the cardiovascular system (90-94% of cases); in 4-6% of patients the liver is affected. In all cases of late visceral pathology, limited gummy nodes are formed in the internal organs. Of the lesions of the cardiovascular system, there are specific myocarditis, aortitis, and changes in the coronary vessels. The most common pathology is syphilitic aortitis, and in the future it is accompanied by complications - aortic aneurysm, aortic valve insufficiency and (or) stenosis of the mouths of the coronary arteries, which determine the clinical picture of the disease. The outcome of an aortic aneurysm may be its rupture and

instant death of the patient.

Syphilitic hepatitis and hepatosplenitis are often accompanied by jaundice. Gastric lesions may present with symptoms such as chronic gastritis, gastric ulcers, or cancer.

Lung lesions may present as interstitial pneumonia or a focal process that must be differentiated from cancer and tuberculosis.

Syphilitic changes in the kidneys appear as amyloidosis, nephrosclerosis, or isolated gums.

Damage to other organs is extremely rare.

Late manifestations of the pathology of the musculoskeletal system include arthropathy and gummy lesions of bones and joints (knee, shoulder, elbow, ankle, as well as the vertebral body). Deformities of the joints and significant destruction of bone tissue are characteristic, with the patient feeling well and maintaining the function of the joints.

The establishment of this diagnosis in venereology is considered the most difficult and very responsible and should not be carried out without confirmation of RIF and RPHA (sometimes such studies are repeated with an interval of several months, and also after the rehabilitation of foci of chronic infection or the appropriate treatment of intercurrent diseases).

If there is a suspicion of syphilis, there can be only one - an immediate appeal to a venereologist. Self-diagnosis and self-treatment are absolutely unacceptable options! It is known that syphilis is the most serious sexually transmitted disease, with improper treatment of which the most unpleasant consequences are inevitable. The treatment of syphilis is antibiotic therapy, and it is absolutely necessary to complete the full course of treatment. After the end of the course of treatment, it is necessary to undergo clinical and serological observation by a venereologist before deregistration for this disease.

Public prevention of syphilis is carried out according to the general rules for the fight against sexually transmitted diseases. The important components of this prevention are: mandatory registration of all patients with syphilis, examination of family members and persons who were in close contact with the patient, hospitalization of patients and subsequent monitoring of them for several months, constant control dispensary monitoring of the treatment of patients with syphilis. In addition to public prevention of syphilis, there is also personal prevention, which includes quite understandable points: abstinence from casual sex and the use of condoms. More competent and reliable protection against syphilis has not yet been invented.

Therefore, the best prevention of syphilis can be called a close relationship with a permanent healthy partner, and if an accidental relationship did take place, an early examination by a venereologist as possible.

You can make an appointment with a venereologist by calling the reception of the Novopolotsk Dermatovenerologic Dispensary: ​​37 15 32, daily (except weekends) from 7.45 to 19.45. Information is also posted on the website.

The helpline is open at 37 14 97, daily (except weekends) from 13.00. until 14.00. Your questions will be answered by highly qualified specialists.

Elena Krasnova

dermatovenereologist

UZ "NTsGB" KVD