Syphilis is one of the few sexually transmitted diseases that can lead to criminal liability if others and a sexual partner are infected. In most cases, signs of the disease in women and men do not appear immediately, but some time after the direct fact of infection. This feature makes syphilis even more dangerous.
Syphilis also stands out from other socially significant diseases (which can harm not only health, but also lead to death) in that today in Russia the syphilis epidemic is acquiring a progressive trend. The disease's growth rate has increased fivefold over the past decade. If left untreated, this pathology can lead to male or female infertility, and during the pregnancy of an infected woman, infection of the fetus is observed in 70% of cases. After infection, the fetus either dies or is born with congenital syphilis.
Syphilis is distinguished:
according to the timing of occurrence - late and early;
according to the stage of the disease - tertiary, secondary, primary;
by origin - acquired and congenital.
Diagnosis of the disease
Under no circumstances can such a serious disease as syphilis be diagnosed “on the Internet,” simply by reading about the symptoms and treatment of the disease. You need to know that rashes and other visual changes can be copied from completely different diseases to such an extent that sometimes even doctors can make mistakes. That is why the diagnosis of the disease must take place according to all the norms of the clinic, starting with an examination by a doctor for characteristic signs and ending with laboratory tests:
examination by a dermatovenerologist. The doctor examines the lymph nodes, genitals, skin in detail and conducts a survey regarding the course of the disease;
detection of treponema itself or its DNA in the composition of syphilides, chancre, gum by PCR, direct immunofluorescence reaction, dark-field microscopy;
carrying out serological tests: treponemal - search for Treponema pallidum antibodies (RIBT, immunoblotting, ELISA, RPGA, RIF); non-treponemal - search for antibodies against tissue phospholipids, treponema membrane lipids that are destroyed by the pathogen (fast plasma reagin test, VDRL, Wasserman reaction). It is worth noting that the result may be false positive, that is, show the presence of syphilis when it is actually absent;
instrumental studies: search for gummas using x-rays, CT, MRI, ultrasound.
Properties of the pathogen
The causative agent of syphilis is the spirochete Treponema pallidum. In the human body, treponema is capable of multiplying very quickly, which causes damage to internal organs. Among other things, there are a lot of these microorganisms on the mucous membranes. It is this property that causes a high risk of transmission through sexual or household contact, for example, through personal hygiene items, shared utensils and other items that are in common use. Treponema pallidum is not an infection for which the body gains lasting immunity, so if a sexual partner has had syphilis, he or she runs the risk of contracting it again through unprotected sexual intercourse with a sick partner.
Treponema is not resistant to external environment and dies almost instantly when boiled. When exposed to a temperature of 55 degrees, it destroys treponema within 15 minutes. Also, the microorganism does not tolerate drying out, but in a humid environment and low temperatures the spirochete exhibits significant “survivability”:
viability remains throughout the year, subject to freezing to -78 degrees;
survives on dishes in residual moisture for several hours;
Even if a syphilitic patient dies, his corpse is capable of infecting others for another 4 days.
Methods of transmission of syphilis
Syphilis is transmitted through:
through saliva - this route of transmission is quite rare, mainly among dentists who work without protective gloves;
through household objects, provided that the patient has open ulcers or decaying gums;
intrauterine transmission (congenital syphilis in a child);
through mother's milk (acquired syphilis in a child);
through blood (sharing shaving utensils, toothbrushes, shared syringes among drug addicts, during blood transfusions);
sexual contact (anal, oral, vaginal).
In case of unprotected, casual sexual contact of any kind, for emergency prevention of the disease, it is necessary to carry out the following procedure (it is advisable to perform it no later than 2 hours after sexual intercourse): first, you must thoroughly wash the inner thighs and external genitals with soap and water with the antiseptic solution “Miramistina” or "Chlorhexidine". In this case, women should syringe the vagina with this solution, and men should inject an antiseptic into the urethra.
But it is worth noting that this method is an exclusively emergency measure, which does not provide a 100% guarantee (only 70%) and cannot be used constantly. The condom is for today the best remedy protection against STIs, however, even when using a condom with an unreliable sexual partner, emergency preventive measures should be taken. Also, after casual sexual contact, you should be examined by a venereologist for the presence of other infections, but it is worth remembering that in order to establish a diagnosis of syphilis, it is worth examining a few weeks later, since, as mentioned above, the incubation period of the disease takes just that long.
External ulcers, erosions, papules are very contagious. If a healthy person has microtraumas of the mucous membrane, then if he comes into contact with a sick person, he runs the risk of becoming infected. The blood of a person with syphilis is contagious from the first to the last day of the disease, so transmission of the infection can occur not only through transfusion, but also when the mucous membranes and skin are injured by manicure and pedicure instruments in beauty or medical salons that contain the blood of a sick person.
Incubation period of the disease
After entering the human body, Treponema pallidum is sent to the lymphatic and circulatory systems, through which it quickly spreads throughout the body. However, a person who has just become infected continues to feel well and does not observe any manifestations of the disease. From the moment of infection to the appearance of the first symptoms of syphilis, it may take from 8 to 107 days, but on average the incubation period takes 20-40 days.
Thus, for 3 weeks to 1.5 months after direct infection, syphilis may not manifest itself in any way, and not only are there no external signs and symptoms, but even a blood test does not detect the disease.
The incubation period can be extended by:
taking medications: corticosteroids, antibiotics and others;
condition of the body, which is accompanied for a long time high temperature bodies;
old age.
A reduction in the incubation period occurs in the presence of massive infection, when a large number of treponemas penetrate the body at one time.
It is worth remembering that a person is contagious even at the stage of the incubation period, but at this time infection of another person can only occur through blood.
Syphilis statistics
Syphilis in the early stages is perfectly treatable, however, even despite this fact, the disease confidently ranks 3rd among STDs, second only to trichomoniasis and chlamydia.
According to international official statistics, about 12 million new patients are registered on the planet every year, but it is worth considering that the numbers do not reflect the full scale of the disease, since a large number of people self-medicate.
Most often, people between the ages of 15 and 40 become infected with syphilis, with the peak incidence occurring between 20 and 30 years of age. Women are more susceptible to infection (due to the appearance of microcracks in the vagina during sexual intercourse) than men, but recently it has been men who have taken first place in the number of infected people. This trend is explained by the increase in the number of homosexuals in the EU countries and the USA.
Ministry of Health Russian Federation does not have a unified record of syphilis patients in the country. In 2008, there were 60 cases of the disease per 100,000 people. At the same time, the bulk of the infected are people without permanent residence, service sector workers, representatives of small businesses, people who have low-paid jobs or do not have a regular income.
Most cases of syphilis are recorded in the Volga, Far Eastern and Siberian districts. Recently, in some regions there has been an increase in the number of cases of neurosyphilis, which is not treatable. The number of registrations of such cases increased accordingly from 0.12% to 1.1%.
The first signs of the disease are the stage of primary syphilis
If syphilis proceeds according to the classic scenario, then the main symptoms are enlarged lymph nodes and chancre. At the end of the primary period, patients are concerned about the following symptoms:
an increase in the number of leukocytes in the blood;
decreased hemoglobin levels;
high body temperature;
arthralgia, pain in bones, muscles;
general malaise;
headache.
A chancre, or typical chancre, is a smooth erosion or ulcer that has rounded, slightly raised edges and reaches a diameter of 1 cm. The ulcer may be painful or not painful at all, and it has a bluish-red color. At the moment of palpation of the chancre, a hard infiltrate is felt at its base, which gave rise to the name of this type of chancre. In men, hard chancre is found in the foreskin or glans, and in women, mainly on the labia or cervix. Also, chancre may be present on the mucous membrane of the rectum or on the skin near the anus; in some cases, erosions are located on the thighs, abdomen, and pubis. U medical workers The chancre can be located on the fingers, lips, or tongue.
Erosion on the mucous membrane or skin can be either single or multiple, and most often manifests itself at the site of infection. In most cases, a week after the chancre appears, the lymph nodes begin to enlarge, but sometimes patients notice an enlargement of the lymph nodes before the chancre itself appears. After oral sex, enlarged lymph nodes and chancre may resemble symptoms of lacunar tonsillitis or an exacerbation of chronic tonsillitis. This feature may cause inadequate treatment of the disease. Also, anal chancre can lead “the wrong way,” since its symptoms resemble a fissure of the anal fold without infiltration and with elongated outlines.
Even in the absence of therapy, chancre disappears on its own after 4-6 weeks, and the dense infiltrate gradually resolves. Most often, after the chancre disappears, no traces remain on the skin, however, with gigantic erosion, pigment spots of black or dark brown color may remain. Ulcerative chancre leaves behind rounded scars that are surrounded by a pigment ring.
Usually, when such an ulcer appears, a patient with syphilis experiences a feeling of anxiety and concern about his health, so the disease is diagnosed in a timely manner and treatment is carried out in a timely manner. But in cases where the chancre remains invisible (for example, on the cervix), when the ulcer is deliberately ignored or through self-medication (treatment with brilliant green or potassium permanganate), it disappears after a month. The person calms down and forgets about the problem, but the danger from the disease remains, and it passes into the secondary stage.
Atypical chancre. In addition to classic chancre, there are other varieties of it, so recognizing syphilis is a difficult task:
indurative edema. A large, bluish-red or pale pink lump on the labia majora, foreskin, or lower lip that extends beyond the ulcer or erosion. Without adequate therapy, such a chancre can persist for several months;
felon. Chancre, which manifests itself in the form of ordinary inflammation of the nail bed, which is accompanied by almost identical symptoms of panaritium, namely: the finger is swollen, painful, purplish-red. Nail rejection occurs quite often. The only difference is that such a chancre does not heal for several weeks;
amygdalitis. This is not just a hard ulceration on the tonsil, but a hard, red, swollen tonsil that makes swallowing difficult and painful. Usually, by analogy with ordinary sore throat, amygdalitis causes increased body temperature, malaise, and general weakness. In addition, headaches may appear, mainly in the occipital region. A sign of syphilis may be unilateral damage to the tonsil and low effectiveness of treatment;
mixed chancre. A mixture of soft and hard chancre, which appears during parallel infection with these pathogens. In this case, an ulcer of soft chancroid initially appears, since its incubation period is much shorter, after which thickening and symptoms characteristic of hard chancroid appear. Mixed chancroid is characterized by a delay in laboratory tests by 3-4 weeks and, accordingly, the appearance of signs of secondary syphilis.
Lymph nodes. Primary syphilis accompanied by enlarged lymph nodes, mainly in the groin area. If the chancre is localized in the rectum or on the cervix, the enlargement of the lymph nodes may go unnoticed, since they are located in the pelvis, but if syphiloma appears in the mouth, then the enlargement of the submandibular and mental lymph nodes is difficult to miss. If a chancre appears on the skin of the fingers, then an enlargement of the ulnar lymph nodes occurs. One of the main signs of male syphilis is a painless cord with periodic thickenings that forms at the root of the penis. This condition is called syphilitic lymphadenitis.
Regional lymphadenitis (bubo). This is a mobile, painless, dense lymph node, which is close to the chancroid:
chancre on the nipple - lymph node under the arm;
chancre on the tonsils - on the neck;
chancre on the genitals - in the groin.
Regional lymphangitis. This is a mobile, painless, dense cord that is located under the skin between the enlarged lymph node and the chancre. On average, the thickness of such a formation is 1-5mm.
Polyadenitis. Appears at the end of the primary period of syphilis. This is compaction and enlargement of all lymph nodes. In general, from this moment the disease passes into the secondary stage.
Complications of primary syphilis
In most cases, complication of the disease in the primary period occurs due to a decrease in the body's defenses or when a secondary infection attaches to the area of chancre. This may lead to:
phagedenization (a type of gangrene that penetrates wide and deep into the chancre. Such gangrene can cause rejection of part or even the entire organ);
gangrene;
paraphimosis;
narrowing of the foreskin;
inflammation of the vulva and vagina;
balanoposthitis.
Symptoms of secondary syphilis
Secondary syphilis appears 3 months after infection and on average the duration of this period of the disease ranges from 2 to 5 years. It is characterized by the presence of wave-like rashes that go away on their own after 1-2 months, leaving no marks on the skin. In addition, the patient is not bothered by either an increase in body temperature or itchy skin. Initially, the symptoms of secondary syphilis are:
Cutaneous syphilides. Secondary syphilides are various options skin rashes, but they are all similar:
the rash does not hurt or itch;
different elements appear at different times;
the rash does not lead to fever and lasts several weeks;
With appropriate treatment, syphilis is characterized by a benign course and rapid disappearance.
Syphilide options:
pigmented (Venus necklace) – leucoderma (white spots) on the neck;
pustular - multiple ulcers, which subsequently ulcerate and scar;
seborrheic - formations covered with greasy crusts or scales that form in areas with increased activity of the sebaceous glands (nasolabial folds, forehead skin); if such papules appear along the edge of hair growth, they are usually called the “crown of Venus”;
miliary – cone-shaped, dense, pale pink. It disappears later than other elements of the rash, leaving behind characteristic spotty pigmentation;
papular - multiple dry and wet papules, quite often combined with syphilitic roseola;
syphilitic roseola is an irregular or round-shaped spot of pale pink color, which is often present on the sides of the body.
Syphilides of the mucous membranes. First of all, these are pharyngitis and tonsillitis. Syphilides can spread to the oral mucosa, tongue, tonsils, pharynx, vocal cords. Most often found:
pharyngitis. If syphilide develops in the area of the vocal cords, hoarseness may appear until the voice completely disappears;
pustular tonsillitis. It manifests itself as pustular lesions of the mucous membrane in the pharynx area;
papular tonsillitis. A large number of papules appear in the pharynx area, which begin to merge, and then ulcerate and become covered with erosions;
erythematous sore throat. Syphilides are present on the tonsils and soft palate in the form of bluish-red erythema.
Baldness. There may be two types. Focal - represents small rounded areas without hair on the eyebrows, mustache, beard, head. Diffuse alopecia is profuse hair loss on the scalp. Hair grows back 2-3 months after the start of treatment for the disease.
Complications of secondary syphilis. The most severe complication of the secondary period of syphilis is the transition of the disease to the tertiary period, in which neurosyphilis and its attendant complications develop.
Tertiary syphilis
Over the years or decades, after the end of the secondary period of syphilis, treponemes begin to transform into L-forms and cysts, gradually beginning to destroy internal systems and organs.
Skin syphilides of the tertiary period
Gummous is a sedentary node that is the size of a pigeon egg or walnut and is located deep under the skin. As the gumma grows, it begins to ulcerate, and after it heals completely, a scar appears on the skin. In the absence of adequate treatment, such gumma may be present for several years.
Tubercle is a dense, painless lump burgundy color, which lies in the skin. In some cases, such tubercles can be grouped, forming garlands that resemble scattered shot. After the disappearance of syphilides, scars remain.
Syphilides of the mucous membranes of the tertiary period
First of all, they are represented by a variety of gums, which ulcerate and destroy soft tissues, cartilage and bones, leading to permanent deformities of the body (deformities).
Gumma of the pharynx - accompanied by disorders and painful sensations that make swallowing difficult.
Gumma of the tongue - there are 2 main forms of tongue pathologies in tertiary syphilis: sclerosing glossitis - the tongue loses its mobility, becomes dense, then wrinkles and completely atrophies (the ability to swallow and chew food is impaired, speech suffers); gummous glossitis - small ulcerations on the mucous membrane of the tongue.
Gumma of the soft palate. Gumma appears in the thickness of the palate, causing it to become motionless, dense and dark red in color. Subsequently, a breakthrough of the gum occurs in several places simultaneously, and long-term non-healing ulcers appear.
Gumma of the nose. Destruction of the bridge of the nose or hard palate, causing deformation of the nose (sagging), leading to food entering the nasal cavity.
Complications of the tertiary period of syphilis:
Formation of gumma on internal organs(stomach, aorta, liver), which, when developed, cause severe failure or sudden death.
Neurosyphilis - accompanied by paresis, dementia, paralysis.
Features of syphilis symptoms in men and women
The secondary and tertiary periods have almost the same symptoms. Differences in symptoms for men and women are present only in the primary period, when chancre appears on the genitals:
chancre on the cervix. Signs of syphilis, when hard chancre is located on the uterus in women, are practically absent and can only be detected during a gynecological examination;
gangrenous chancre on the penis - there is a possibility of self-amputation of the distal part of the penis;
chancre in the urethra is the first sign of syphilis in males, which is manifested by discharge from the urethra, a dense penis and an inguinal bubo.
Atypical syphilis
This is latent syphilis. This form of the disease is characterized by an invisible course for the patient and can only be diagnosed through tests, while the carrier can infect others.
Today in the world, venereologists are increasingly faced with cases of latent syphilis, which is due to the widespread use of antibiotics in cases where the first signs of syphilis were not diagnosed and the patient began to independently treat the disease. In most cases, antibiotics are used to treat stomatitis, ARVI, and sore throat. Also, during diagnosis, secondary infections (chlamydia, gonorrhea, trichomoniasis) may be detected; in such cases, the doctor prescribes antibiotics to treat these STDs. As a result, syphilis is not treated and becomes latent.
Transfusion. It is distinguished by the absence of a primary period and chancre and begins with secondary syphilis, from the moment of transfusion of infected blood (2-2.5 months).
Erased. There are no symptoms of the secondary period of syphilis, or they are present, but almost invisible. After this, the disease turns into asymptomatic meningitis and neurosyphilis.
Malignant. The rapid course of the disease, which is accompanied by severe exhaustion, decreased hemoglobin and gangrene of chancre.
Congenital syphilis
A woman who is infected with syphilis can pass it on hereditarily, right down to her grandchildren and great-grandchildren.
Early syphilis – sallow skin color, severe exhaustion, continuous crying, deformation of the baby’s skull.
Late syphilis is manifested by the so-called Hutchinson triad: keratitis, labyrinthine symptoms (dizziness, deafness), semilunar edges of the teeth.
Treatment of syphilis
Which doctor should I contact for treatment of syphilis?
People with syphilis are treated by a dermatovenerologist, and they need to go to a dermatovenereal dispensary.
How long does it take to treat syphilis?
Syphilis requires long-term treatment. If the disease was detected at the primary stage, then treatment will take about 2-3 months, and it should be noted that treatment should be continuous. If syphilis was diagnosed at the secondary stage, its treatment may take over 2 years. During the treatment period, active sexual activity is prohibited, and the entire family and close circle of the patient must undergo preventive treatment.
What folk remedies exist for treating syphilis?
If you have syphilis, it is strictly contraindicated to self-medicate or treat folk remedies. Such “treatment” is not only dangerous and ineffective, but also complicates the diagnosis of the disease, blurring the clinical picture of the pathology. In addition, the effectiveness of therapy and cure of the disease is determined not by the absence of symptoms, but by laboratory data. Also in many cases it is required inpatient treatment, not homemade.
What drugs are used to treat syphilis?
Most effective method treatment is the introduction of water-soluble penicillins into the body. This therapy is carried out in a hospital setting for 24 days with injections every 3 hours. The causative agent of syphilis is quite sensitive to penicillin antibiotics, but there is a possibility of an allergic reaction to these drugs or the ineffectiveness of such therapy. In this case, penicillin is replaced with drugs of the tetracycline, macrolide, and fluoroquinolone groups. In addition to antibiotics, natural immune stimulants, vitamins, and immunostimulants are also indicated for syphilis.
How is preventive treatment carried out for the family of a patient with syphilis?
Syphilis is a highly contagious infection that has a high probability of sexual transmission, however, in the presence of skin manifestations of syphilis, the risk of infection increases significantly. Therefore, if there is a person with syphilis in the house, it is necessary to minimize the risk of transmission of the disease through household means. To do this, the patient must have individual dishes, linen and toiletries. It is also necessary to exclude physical contact between the patient and family members if the patient is at the infectious stage.
How to plan a pregnancy if a woman has had syphilis?
To avoid congenital syphilis in a child, a pregnant woman should be examined by a doctor several times. If a woman planning a pregnancy has been successfully treated and has had syphilis and is no longer registered with a dermatovenerological clinic, she still needs to consult a doctor and undergo preventive therapy.
Treatment of the disease is carried out with penicillin drugs, which are administered intramuscularly every three hours, twice a day - novocaine salt and benzylpenicillin, or combination drugs according to the regimen. The duration of treatment and dosage depend on the form of primary syphilis.
Patients who are on penicillin are prescribed dixycycline and tetracycline.
It is imperative to examine and treat all the patient’s sexual partners.
Complications of primary syphilis
The disease is often accompanied by trichomonas or secondary bacterial infection, which leads to the development of or. The localization of chancre in the eternal sulcus significantly complicates diagnosis, since its examination is impossible. An attempt by the patient to open the head on his own can lead to its pinching and development.
Much less frequently, a complication occurs in the form of gangrenization caused by fusospirillosis infection. In this case, the chancre is covered with a black scab.
At the end of treatment, patients with seronegative primary syphilis must undergo clinical observation for another year, and those with seropositive primary syphilis for three years. During this period, constant monitoring is carried out by conducting an RPR test.
Beginning of the primary period of syphilis characterized by the formation of primary syphiloma or chancre, which appears within 10 to 90 days (usually 3-5 weeks) from the moment of infection: The incubation period may be shortened with bipolar chancre (distanced far from each other; for example, the genitals and red border of lips). And lengthen if the patient, after infection with syphilis, uses antibiotics for intercurrent diseases.
Hard chancre (primary syphiloma) occurs at the site of the primary penetration of pale treponema through the skin and mucous membranes. The development of primary syphiloma begins with a reddish inflammatory spot, which within a few days infiltrates and takes on the appearance of a papule, followed by the appearance of erosion or ulcers. A typical chancre looks like a saucer-shaped erosion or superficial ulcer of a round or oval shape, with clear, even borders. The size of chancre can vary - from 1-3 mm to 1.5-2 or more cm (diameter on average 5-10 mm). The bottom of the chancre is smooth, shiny, “varnished” flesh-red or yellowish-pink in color. After a few days, the surface of the chancre may acquire a grayish color and a greasy appearance, depending on the coagulation of proteins and superficial tissue necrosis. Typically there is an absence of acute inflammatory elements around the chancre and very scanty serous discharge. The edges of the chancre are at the level of unaffected tissues or rise slightly above them due to pronounced infiltration at the base.
Most characteristic feature hard chancre - an infiltrate of dense elastic cartilaginous consistency, palpable at the base and which determined the name of the primary syphilitic affect - “hard chancre”. The infiltrate at the base of the chancre may not be so pronounced, thin, in the form of a rounded plate, but the density of the element is preserved (leaf-shaped, lamellar infiltrate).
A feature of chancre is the absence of subjective sensations or very slight pain. When a secondary infection occurs, pronounced swelling develops around the chancre, the brightness of the element increases, the discharge becomes abundant, serous-purulent or purulent, and pain appears in the area of the chancre and regional lymph nodes.
Clinical features chancre depends largely on its location. The following types of chancre are distinguished:
Burn (combustiform) chancre - the edges of the erosion lose their correct outlines, its bottom becomes bluish-red, granular, the compaction at the base becomes leaf-shaped.
Cockade chancre- the central zone of erosion acquires gray, and the peripheral remains meat-red.
Chancroid herpetiformis- grouped multiple hard chancre in a small area.
Most often, solitary hard chancre occurs in patients.
However, cases of the disease with two or more chancre are now increasingly being observed. Based on localization, primary syphilomas are distinguished between genital and extragenital. There are also so-called bipolar chancres with the simultaneous occurrence of primary syphilomas on the genitals and outside them.
Atypical chancre:
Indurative edema located in places rich in lymphatic vessels (labia majora, scrotum, foreskin). There is swelling of these areas and a pronounced compaction of the tissues, when pressure is applied to which no depression is formed. Indurative edema can be mistaken for inflammatory phimosis in men and bartholinitis in women. The absence of acute inflammatory phenomena during indurative edema and specific lymphadenitis make it possible to establish a true diagnosis. On the fingers, hard chancre can occur in the usual clinical form (erosive or ulcerative) or occur atypically. This localization of chancre is often observed in medical personnel(gynecologists, dentists, laboratory assistants, etc.). Chancre felon the clinical picture resembles a banal panaritium (club-shaped thickening of the nail phalanx of the finger, pain), however, the presence of a dense infiltrate and characteristic regional scleradenitis facilitate recognition. However, despite this, diagnosing chancre-felon can be very difficult.
Primary syphilis of the mucous membranes of the oral cavity. Damage to the oral mucosa in the primary period is quite common. Hard chancroid can occur on any part of the red border of the lips or the oral mucosa, but is most often localized on the lips, tongue, and tonsils. A feature of hard chancre of the oral cavity is its small size and similarity to traumatic defects, which creates significant difficulties for diagnosis. Chancre upper and, more often, lower lips appears as an ulcer or erosion, the bottom of which can often be covered with a raised brownish crust. In the corners of the mouth, usually in small folds of the skin, it can be localized slit-like chancre, resembling a crack in shape, but when the fold in which the chancre is located is stretched, its oval outline is determined. When hard chancre is located in the corners of the mouth, it can clinically resemble jams, which are distinguished by the absence of compaction at the base. Lip chancre often imitates impetiginous, traumatic, herpetic erosion, and with severe infiltration - epithelioma. Significant difficulties in diagnosis arise in cases where the chancre is covered with a massive brownish crust (crusted chancroid). Extremely rare on the red border of the lips hypertrophic chancroid. This is a hemispherical, densely elastic formation, sometimes in the shape of a mushroom cap, rising sharply above the skin level with a diameter of up to 2-3 cm. The surface of the hypertrophic chancre is usually shiny, smooth, with scanty discharge, subjective sensations are little expressed. Regional (submandibular) lymph nodes are sharply enlarged, usually on one side, and are often painless. Diagnosis poses great difficulties gum chancre, located in the form of a crescent at the neck of one or several (usually two) teeth. The ulcerative form of chancre of the gums is very similar to banal ulceration and has almost no signs characteristic of primary syphiloma. Diagnosis is facilitated by the presence of regional lymphadenitis in the submandibular region.
On the tongue The chancre is usually single, more often found in the middle third. When a hard chancre is located on the back of the tongue, due to significant infiltration at the base, the chancre sharply protrudes above the surrounding tissue, and there is flesh-red erosion on its surface. In addition to the erosive or ulcerative forms, chancre of the tongue is often presented in the form of fissure-like erosion or an ulcer with a shiny bottom. A less common sclerotic hard chancre may have the appearance of a sclerotic tip of the tongue, in which redness without sharp boundaries passes into the normal mucous membrane (chancre “without edges”). Noteworthy is the absence of inflammation around the chancre and its painlessness. Very rare and difficult to diagnose are chancre of the tonsils, which can have one of three forms: erosive, ulcerative and sore throat-like (chancre-amygdalitis). Erosive tonsil chancre occurs in the form of erosion of a red or opal color, round in shape, ranging in size from 2 to 10 mm, with compaction at the base, a smooth bottom and scanty discharge. Soreness, as a rule, is not noted. The tonsil around the erosion is of normal color and dense. In the ulcerative form, the tonsil is enlarged and dense. Ulcerative chancre of the tonsil It is distinguished by its larger size, significant depth, its bottom is covered with a grayish coating, and there is often pain when swallowing and palpation. Both types of chancre are characterized by one-sided lesions and specific scleradenitis of the cervical and submandibular lymph nodes. An atypical manifestation of chancre on the mucous membranes of the oral cavity is chancre-amygdalitis, which is characterized by enlargement and hardening of one tonsil in the absence of erosion or ulcers. When palpating the tonsil with a spatula, its elasticity is felt. An enlarged, hyperemic tonsil obscures the lumen of the pharynx and can cause a change in voice. In some cases, pain when swallowing, general malaise, and increased temperature are possible, as with a common sore throat, which makes it difficult to diagnose syphilis. Chancre-amygdalitis is characterized by specific submandibular and cervical lymphadenitis, also unilateral.
Complications of chancre. Complications of chancroid include erosive balanoposthitis, vulvovaginitis, phimosis, paraphimosis, gangrenization and phagedenism, which usually develop with the addition of a secondary infection, irrational treatment or self-medication.
Damage to the lymph nodes and blood vessels is the second most important symptom of primary syphilis. Regional scleradenitis appears 7-10 days after the onset of chancre. The lymph nodes closest to the chancroid enlarge to the size of a pea, bean or hazelnut or more,... while remaining painless. On palpation, the lymph nodes have a dense elastic consistency, are not fused to each other and the surrounding tissues, are mobile, the skin over them is not changed.
When chancre is localized on the face and mucous membranes of the oral cavity, the submandibular, anterior and posterior cervical, occipital, and preauricular lymph nodes enlarge. Recently, according to various authors, 4.4-8% of patients with primary syphilis did not have regional scleradenitis.
The third symptom of the primary period of syphilis - syphilitic lymphangitis - is not permanent and is now rare.
Throughout our lives, we repeatedly hear about the dangers of sexually transmitted diseases, about the harm caused to the body of women and men when infected with syphilis. We also know that you can get a syphilitic infection through unprotected sex or through a blood transfusion. However, not everyone knows that with treponemal infection at different stages of progression different symptoms are observed.
Primary syphilis is the period of the first clinical manifestations of the disease, knowing which it is possible to prevent the progression of the disease and deterioration of health in the early stages.
That is why in modern medicine, leading urologists, gynecologists and dermatovenerologists are introducing many new programs to inform the population about the main risks of contracting sexually transmitted diseases.
Also, every year many programs are introduced in which the population is told about methods of independent primary diagnosis. The measures taken by WHO help each patient to consult a specialist for therapy at an early stage, thereby reducing the risks of a latent course of the disease.
In this article we will answer all the questions most frequently asked to venereologists. We will talk about exactly what primary symptoms of syphilis can be noticed at home, how the primary period of the sexually transmitted disease proceeds, and also what needs to be done if alarming symptoms are confirmed.
Infection with syphilitic, treponemal infection can occur both through unprotected sex and through any direct contact with the pathogen. After the pathogen penetrates into the internal environment of a person and spreads throughout all organs, the incubation period is replaced by the primary stage of syphilis - the period when initial clinical signs begin to appear.
If we evaluate the time intervals after infection and the onset of the first manifestations of the disease, we can say that the primary stage typically begins 20-50 days after infection. At the same time, while taking antibiotics and disinfectant medications, the period for the first clinical symptoms to appear may occur in 50-90 days.
What is the first sign of the onset of the primary stage of syphilis?
In all patients, the primary stage of syphilis begins with the appearance - it is the primary syphiloma and an indicator of the area in which the treponemal infection has occurred.
In 68% of cases, infection and penetration of treponemes occurs in the anogenital area, less often in the mucous membranes of the mouth and pharynx, where a characteristic syphilitic formation appears.
Most often, chancre on tissues and mucous membranes is single, but in 12% of patients two or more hard chancres are observed simultaneously. Symptoms when primary syphilomas appear vary depending on the area of penetration of pathogenic microorganisms.
When formations are localized in the oral cavity, patients can contact dentists or therapists, assuming the appearance of sore throat or stomatitis, and this lengthens the period of making a correct diagnosis: in contrast to the situation when, when chancre appears on the genitals, patients immediately turn to gynecologists and urologists, who Together with venereologists, they are actively involved in the diagnosis and treatment of such diseases.
Other manifestations of primary syphilis
Quite often, at the stage of primary manifestations, the first diagnosis is erroneous. This is due to the variety of symptoms and masking of symptoms. When syphiloma appears in areas that are visually invisible in everyday life, the first signs of the disease may only be weakness, slight fatigue, mild soreness in the throat or perineal area. Diagnosis is even more difficult when chancre appears in the rectum or pharynx, since in addition to subjective complaints of discomfort or pain, even doctors are not always able to visualize these syphilomas.
As the primary stage of syphilis progresses, the condition of patients worsens. This is due to the reactive response of the immune system to pathogenic bacteria and the onset of inflammatory processes in the lymph nodes near the foci of treponemal syphiloma.
The symptoms of primary manifestations of syphilis also differ in men and women. Therefore, only an experienced venereologist can not miss important ones and prescribe a competent treatment regimen.
IMPORTANT TO KNOW!
Specifics of the course of the primary stage of the disease in men and women
The primary symptoms of syphilis when chancre appears are similar in both men and women. In the area in which the treponema infection occurred, a formation appears that looks like an ulcer or erosion.
All primary syphilomas have a round or somewhat oval shape, however, depending on the area of manifestation, narrow defects that look like cracks may also be observed.
The size of such an ulcer does not exceed a centimeter, and syphilomas are characterized by a dense infiltrated middle and smooth saucer-shaped edges. The typical place for the appearance of hard chancre is the anogenital area, but nowadays extragenital chancre is being observed more and more often.
In men, syphilitic ulcers appear most often on the tissues of the penis or in the area near the anus. Women are characterized by hard chancre on the tissues and mucous membranes of the labia majora, less commonly the labia minora, near the anus or in the lumen of the rectum.
In addition to ulcerative formation, the primary stage of syphilis manifests itself in the form of swelling of the tissues around the syphilomas and an increase in nearby lymph nodes.
In men and women in the primary stage of syphilis, there is an increase, pain and swelling of the lymph nodes of the perineum and inner thigh if primary syphiloma appears on the genitals. When a chancre forms in the oral cavity, inflammatory swelling and discomfort of the cervical, sublingual and parotid lymph nodes are possible. When palpated, the inflamed lymphatic ducts are elastic and not fused with the surrounding tissues, but are extremely painful. There may also be pustular formations on the skin near the chancre, which are chancre felons.
Diagnostic Basics
The main diagnosis of primary syphilis is to examine the skin and mucous membranes to identify primary syphiloma - chancre, and assess the degree of involvement of the lymph nodes and adjacent tissues in the inflammatory process. A full survey is also conducted to clarify whether there have been unprotected sexual contacts or contacts with infected people. This is followed by laboratory serological diagnostics, which is carried out to identify the pathogen - Treponema pallidum in human blood and in ulcerative formations.
Based on these tests, primary seronegative syphilis can be detected when the results of serological tests are negative, and seropositive syphilis when the results are positive. A latent course may also be observed, in which, despite the complete absence of symptoms, test results may be positive.
In the case of primary syphilis, during the first 5-10 days, patients receive negative serological tests when taking tests for lipid reactions, which include the most widely used Wassermann test. However, when conducting a treponemal test, which is highly sensitive to the pathogen after 10-14 days (at the primary stage of the disease), such reactions are positive, and the result for syphilis is seropositive. Also, with positive treponemal reactions for seropositive syphilis, the Wasserman reaction will also be positive.
Treatment plan
After receiving tests confirming primary syphilis, the patient is prescribed antibacterial injection treatment. Traditionally, antibiotics from the penicillin group are used in large dosages.
If the patient has a persistent allergic reaction to the main drugs, the treatment plan is adjusted in favor of tetracycline or doxycycline. Additionally, restorative therapy can be used.
Further tasks of the doctor and the patient are reduced to monitoring the recovery process according to the following principle: for seronegative syphilis - at least a year, for seropositive syphilis in the stage of primary manifestations - three-month clinical observation.
Where to get tested and who to contact?
With early diagnosis of treponemal infection at the stage of primary syphilis, complete recovery is possible without harm to the body. And only with timely contact with a specialist is it possible to make a correct diagnosis.
In the “Venereology Guide” you are guaranteed to receive full consultation and assistance in choosing the best venereologist in your city. Do not miss the opportunity to cure syphilis forever and maintain your health.
Contact the “Venereology Guide”, because we guarantee true European quality of all medical services provided.
MAKE AN APPOINTMENT:
Primary syphilis is the initial stage, the start of a long chronic disease. Often a person misses the primary signs of syphilis simply because they have no idea what they look like.
However, it is important to know your enemy by sight, because the main thing in the fight against syphilis is to detect the disease in time and begin to act!
We offer a detailed dossier on primary syphilis - photographs, description of symptoms and diagnosis of the disease.
The onset of syphilis - basic information
Syphilis first makes itself felt three to four weeks after sexual contact or domestic infection. A spot appears at the site where the microbe enters, which turns into an ulcer in about a week. This is how hard chancre appears - primary syphiloma.
Seven days after the formation of a hard chancre, the lymph nodes closest to the chancre become inflamed and enlarged - lymphadenitis develops. The lymphatic vessels through which bacteria pass to the lymph nodes also become enlarged - scientifically this is called “lymphangitis”.
Hard chancre, lymphadenitis and lymphangitis are the main “documents” of primary syphilis. This triad is considered the standard “set of symptoms” for primary syphilis.
Duration
The primary period of syphilis lasts 6-8 weeks. During this time, the syphilitic chancre gradually changes: from a spot it turns into an ulcer, then the ulcer gradually heals, and the chancre again turns into a light or dark spot. After some time it disappears completely.
In rare cases, after a chancre, a scar remains on the skin (usually with complicated syphilis).
Changes in chancre can be represented by the following diagram:
Other symptoms of primary syphilis
While chancre remains on the body (the first 1-1.5 months), syphilis bacteria manage to spread through the lymphatic vessels to all areas of the body. Therefore, by the end of the primary period, almost all lymph nodes on the human body enlarge, and polylymphadenopathy develops (multiple inflammation of the lymph nodes). Later, a lot of pale treponema “breaks through” from the lymph into the blood. Then the patient’s temperature rises and a rash appears on the body. Typically, when the rash occurs, the chancre is still on the skin and lasts for about a week. The rash is considered the beginning of the second stage of syphilis.
Contagiousness of primary syphilis
A patient with syphilis is contagious, from the appearance of hard chancre on his body until recovery from the disease. Depending on the stage of the disease, the risk of infection gradually decreases. In the primary and secondary periods of syphilis, the risk of becoming infected from a patient is extremely high, but in the tertiary period it becomes lower.
You can become infected with syphilis through a long, deep kiss Primary syphilis is very contagious because there are many active bacteria (treponema pallidum) in the discharge from the chancre and in the patient’s fluids. Through contact with an ulcer, as well as with semen, saliva or blood, treponema can be easily transmitted to another person. Moist contact with a sick person especially “helps” infection - sex, kissing, sitting on your knees in a sauna, etc.
Oddly enough, the most common route of transmission of syphilis is not vaginal, but oral contact. This includes long, deep kisses, cunnilingus and blowjobs. Unfortunately, many people forget about the dangers of unprotected oral contact.
The most noticeable manifestations of the initial stage
As we have already found out, the main manifestations of primary syphilis are chancroid, lymphangitis and lymphadenitis. How to distinguish them from other phenomena not related to syphilis? Let's look at these symptoms in more detail.
Chancroid - features
In the photo, the chancre looks like a regular ulcer: it is round or oval in shape, bluish-red in color with a sore in the center. If the ulcer is not deep, it is called erosion. To the touch, a chancre is a hard formation; it feels like cartilage. The surface of the chancre is usually moist.
The location of the chancre can be:
- genital(labia, cervix, head of penis, scrotum, etc.);
- extragenital(oral cavity, lips, anus, fingers, breasts, etc.).
The ulcer does not cause any discomfort to the infected person: it does not hurt, does not itch, and does not manifest itself in any way. This kind of “anesthesia” develops due to special toxins released by Treponema pallidum.
Usually a patient has one chancre. Less commonly, if at the time of infection there were several microtraumas in one area of the skin, several chancre appear (on average from two to six). Also, chancre can form in different places - for example, on the genitals, in the mouth, on the fingers, on the chest, and so on. This happens if treponema pallidum has entered the body simultaneously through several “entrances.”
Most often, chancre occurs on the genitals and in the oral cavity. According to statistics, patients with genital chancre often come to the doctor, because ulcers in other places usually do not cause much suspicion. For example, a chancre in the oral cavity is usually confused with an injury of another origin (biting the cheek or tongue), and a chancre inside the genital organs (on the cervix or in the anus) may simply not be noticed.
Syphilitic lymphangitis
From the chancre, syphilitic bacteria tend to spread throughout the body - for this they begin to move through the vessels of the lymphatic system. The first is the lymphatic vessel, which is closest to the chancre. For example, if the chancre is in the mouth, lymphangitis will affect one of the lymphatic vessels in the neck, and if on the genitals, then the vessel in the groin area will be affected.
If there is a hard chancre in the mouth, then lymphangitis will appear on the neck. If chancre occurs on the genitals, lymphangitis will develop in the groin area
When treponema enters a vessel, it becomes inflamed due to the poisons that these bacteria secrete. This is how syphilitic lymphangitis begins. Inflammation is manifested by swelling and thickening of the vessel (it becomes like a wire), and sometimes by redness of the skin over it. There may also be pain in the area where the inflammatory process began. However, sometimes the inflammation of the lymphatic vessel is almost not noticeable, and in some patients it may not begin at all.
Syphilitic lymphadenitis
Lymphadenitis with syphilis occurs because pallid treponema moves further from the chancre - through the lymphatic vessels to the nearest lymph nodes. When treponemes penetrate the lymph node, an inflammatory reaction begins there: immune cells attack the bacteria and try to neutralize them and prevent them from spreading throughout the body.
Enlargement of the lymph nodes also begins near the area where the chancre appeared. If it is located genitally, then the inguinal lymph nodes enlarge; if in the mouth, then the superficial or deep cervical nodes.
As a rule, lymph nodes take on the size of a large bean to chicken egg. They do not hurt, are not glued together, and the skin over them remains unchanged in texture, but can sometimes change color to red or burgundy.
If treatment is not started, syphilis will spread throughout the body through the lymphatic vessels.
Unfortunately, in the case of syphilis, the human immune system is not strong enough: it cannot stop or at least delay treponema for a long time. If treatment does not begin, then after some time the bacteria unstoppably spread further throughout the body: from the lymph nodes - through the lymphatic vessels - to a variety of organs.
Unusual course of primary syphilis
Primary syphilis cannot always be recognized from a photo. Indeed, in addition to the classic primary period, there are such “scenarios” in which syphilis is very difficult to suspect. For example, chancroid may look different from its standard description or may not appear at all. The same applies to lymphangitis and lymphadenitis.
A hard chancre can also be painful if it is located near the urethral canal, anus, or if another infection is attached to it.
Varieties of atypical chancre
- Dwarf chancre
- Huge chancre
- Slit-like chancre
- Indurative edema
- Chancre felon
- Chancroid-amygdalitis
Typically, the size of chancre is 1-2 centimeters. However, due to the peculiarities of the location, as well as the condition of the body, dwarf hard chancre may appear on the body. They are up to 2 mm in size and appear most often on the foreskin or on the coronal groove of the penis.
Also, a patient with syphilis may, on the contrary, develop huge chancre - the size of a child’s palm. They usually occur on the abdomen.
It also occurs unusual shape chancre - slit-like. It can be found in the corners of the lips and between the fingers.
This is swelling of any part of the genital organs - the labia, scrotum or foreskin. The affected area increases in size two to three times and becomes reddish-purple
and “wooden” to the touch. During swelling, erosion or ulceration may sometimes occur in the affected area. This atypical chancre lasts a long time (up to several months) and takes a long time to heal after treatment.
This type of chancre occurs on the finger and is characterized by swelling of its terminal phalanx - most often the index finger. The nail phalanx acquires a bluish-red color, swells, becomes dense, “wooden.” The patient complains of shooting or throbbing pain.
This is a unilateral enlargement of the tonsil in the throat. Externally, this atypical “chancre” is very similar to a sore throat: the tonsil enlarges, the throat turns red, and the person may experience pain when swallowing. However, unlike tonsillitis, with syphilis the tonsil is unusually hard and usually enlarges only on one side.
Primary syphilis and complications
Often microbes from the external environment can enter a wound (syphilitic erosion or ulcer). This leads to the development of an “additional” disease against the background of syphilis. Doctors call such cases “secondary infection” - this expression should not be confused with “secondary syphilis.”
If other microbes get into the chancre, the surrounding tissue swells, turns red, heats up and causes sharply painful sensations.
If such inflammation occurs on the genitals, then outwardly it manifests itself as a gynecological or urological disease: balanitis, balanoposthitis, vulvitis, and so on. Often, due to inflammation of the glans penis, foreskin or labia, the chancre itself goes unnoticed.
After treatment, the surrounding tissue returns to normal: the skin turns pale, pain and swelling disappear. Then the chancre appears more clearly.
Let us consider the most interesting manifestations of secondary inflammation during initial syphilis.
- Phimosis
- Paraphimosis
- Gangrenization and phagedenism
If a hard chancre appears on a man's foreskin, inflammation and phimosis may begin: complete closure of the head of the penis by the foreskin. In the photo, phimosis looks like a bell: dome-shaped, with a smooth and shiny surface, “tense” skin. A yellow-green purulent liquid is released from the internal space.
This condition is dangerous because not only the head of the penis is compressed, but also the opening of the urethra, which can lead to impaired urination.
This is a more dangerous complication, which also begins if the chancre causes swelling of the foreskin and compression of the head of the penis. Paraphimosis is dangerous because with strong compression of the head, the vessels in it are compressed, blood does not flow to the organ and necrosis develops - tissue death.
The only way out of this situation is surgical intervention: either repositioning the head or excision of the ring that compresses the head.
If the immune system is weakened, then the complications described above can develop into their most dangerous form - gangrenization and phagedenism. In this case, necrosis (gangrene) begins in the center of the chancre. In the photo it looks like a black or dirty gray, shrunken fragment of flesh or skin.
If the patient is “lucky,” the scab separates and in its place remains an ulcer, which is gradually covered by a scar. But if the course is unsuccessful, necrosis goes deep into the tissue and destroys a significant part of the organ where the complication began. Thus, complete destruction of the head of the penis, its foreskin, labia, and the like is possible.
Severe primary syphilis occurs in elderly people, debilitated patients, people with chronic diseases– diabetes mellitus, immune system defects, HIV-infection
Headless syphilis
Can syphilis occur without chancre? Of course it can. Such cases are not uncommon. If treponema enters directly into the blood (for example, during a blood transfusion, non-sterile injections, cuts), then syphilis does not appear at all in the first stage. In this case, it begins immediately with the second, widespread rash. Typically, such infection is accompanied by high fever. The patient's condition is similar to the flu.
Differential diagnosis: what can chancroid be confused with?
It happens that other injuries or infections resemble the manifestations of primary syphilis. We list the most common diseases that can be confused with the onset of a syphilitic infection.
For any skin lesions of the genital organs, the first thing you should think about is syphilis. If you suspect this, you should definitely consult a doctor and get tested. Under no circumstances should treatment be started before the diagnosis is confirmed - this can blur the course of the disease and drive the infection into a passive state, which is why it will certainly recur in the future.
How is the diagnosis made?
Stage 1 syphilis is suspected primarily on the basis of visible manifestations: chancroid, lymphadenitis and lymphangitis. If a patient comes with such symptoms, then the first thing he is tested for is syphilis.
In addition to symptoms, an important part of the diagnosis of primary syphilis is the patient’s anamnesis (medical history). Have you had sexual contacts in the last six months (depending on the situation), how many sexual contacts and sexual partners have you had, and so on. Any situation in which infection could occur is important.
In the first two weeks after the appearance of chancre, blood tests cannot yet show the presence of syphilis. To make a diagnosis at this stage, you need to take a scraping from the chancre and examine it either under a microscope (this analysis is called TPM- dark-field microscopy), or using modern high-tech equipment (analysis PCR- polymerase chain reaction).
In scrapings, using these methods, you can detect the treponema bacteria themselves or their particles - DNA. PCR-method is more accurate, but also more expensive. Positive result These tests confirm the diagnosis of syphilis with 100% probability. However, a negative result also does not exclude the disease.
Primary seropositive syphilis
If the chancre has existed for two to three weeks, then to confirm syphilis they resort to other methods - blood serum tests. Most often, the patient is prescribed a non-treponemal RPR test. It is the most accurate non-treponemal test, and according to recent studies, it can detect syphilis within 7-10 days after the appearance of chancre.
If the test gives a negative result, but the patient’s body has signs similar to syphilis, then the test RPR It is recommended to repeat after 2 weeks. If the test result is positive, then to be completely sure, a treponemal test is performed - usually ELISA— for the determination of class G antibodies to syphilis.
The sooner a person is able to suspect syphilis, the easier it will be to treat it and the less harm this disease will cause to health. This is why it is so important to know the first signs of syphilis.
Even one ulcer should alert you, especially in the genital area or mouth. If after some time a vessel or lymph node enlarges next to the ulcer, it is even more likely to be primary syphilis.
If you suspect a sexually transmitted infection, there is no need to be shy or let everything take its course. Urgently contact a venereologist and take all prescribed tests.