Syphilis

Syphilis (syphilis) - a chronic venereal disease caused by Treponema pallidum, having relapsing course with characteristic periodization of clinical symptoms that can affect all organs and systems, is transmitted mainly through sexual contact.

Etiology. Pathogen - pale treponema. The source of infection - syphilis people, especially those with active symptoms of syphilis fresh on the skin and mucous membranes. The most contagious rash with eroded (wet, weeping) surface in the discharge of which contains a large amount of the pathogen. The main route of infection - direct (usually sexual) contact with a patient. It is also possible the so-called consumer syphilis (infection through household items and so on. N.). In congenital syphilis infection occurs in utero-placental vessels.

Pathogenesis. Treponema pallidum spread in the body through the lymphatic system, actively proliferate and periodically entered the bloodstream to various organs and tissues, causing those or other manifestations of the disease. Over time, the number of pale treponemes in the patient's body decreases, however, tissue reaction to the pathogen becomes more turbulent (sensitization), which causes a change of clinical symptoms for the disease. Usually after infection occurs during classical syphilitic infection with characteristic periodization symptoms. It is also possible long-term (multi-year) asymptomatic with the development of the subsequent late nerve and visceral forms of the disease.

The clinical picture of a. In untreated patients distinguish 4 periods of acquired syphilis: incubation, primary, secondary and tertiary.

The incubation period (from infection to onset of clinical symptoms - chancre) lasts an average of 20-40 days. It is possible both shortening (15.7 days), and elongation (3-5 months).

Primary period (from the appearance of the chancre before the first generalized rashes) lasts 6-8 weeks. Typical three symptoms: chancre, regional and regional lymphadenitis lymphangitis. Solid chancre is the erosion or ulcer that occurs at the site of introduction of pale treponemes. When sexual infection chancre located on the genitals (in men more often on the penis or foreskin, women - on the labia, cervix). For the chancre is characterized by the following features: small size (up to a small coin), regular round or oval shape, flat (saucer-shaped) edge, smooth bluish-red bottom soskuyanym detachable, plotnoelasticheskoy (is flexible) infiltration in the ground. Uncomplicated painless chancre, is not accompanied by acute inflammation phenomena.

Frequent deviations from the described clinic. Solid chancre may be very small or very large (a dwarf and a giant chancre), the bottom of it can be covered with foil or necrotic crust (cortical and diphtheritic chancre). There are multiple (up to several dozen) and painful (anal and urethral) chancres. There are also atypical solid chancres: indurativnyy edema (swelling painless tight foreskin or the labia), chancre-amygdala (dense swelling of the tonsils) and chancroid-felon (simulates purulent felon). Solid chancre may be complicated by a secondary infection with the development of the phenomena of acute inflammation in his circle. When introducing fuzospirilleznogo symbiosis occurs necrosis and bottom edges (gangrenizatsiya chancre). Re gangrenizatsiya (fagedenizm), is usually observed in alcoholics, results in significant tissue destruction.

The regional lymphadenitis appears specific changes to the next chancre lymph nodes (usually inguinal). It occurs a week after the appearance of the chancre, and can be both single and double-sided. Lymph nodes are enlarged unevenly, mobile, painless, have plotnoelasticheskuyu consistency, never suppurate not burst, the skin over them is not changed.

The regional lymphangitis not always detected. It is commonly found in men (at the location of the chancre on the penis) in the form of rolling plotnoelastichnogo painless subcutaneous cord at the back and at the root of the penis. At the end of the initial period of developing specific polyadenylation (moderate increase in all groups of lymph nodes), sometimes have blurred common phenomenon (low-grade fever, general weakness).

Second period (from the first generalized rash until tertiary syphilides - bumps or gummas) lasts 3-4 years, is characterized by undulating course, the abundance and variety of clinical symptoms. Can affect all organs and systems, however, the main manifestations are presented rash on the skin and mucous membranes (syphilides second period). The emergence syphilides due to penetration into the skin and mucous membranes pale treponemes. The first generalized rash, running to replace the healing chancre, is the most abundant (secondary fresh syphilis), it is accompanied by a pronounced polyadenylation. The rash lasts for several weeks (at least 2-3 months), then disappears for an indefinite period. Repeated episodes of rash (secondary recurrent syphilis) alternate with periods of complete absence of manifestations (secondary latent syphilis). Rash in secondary recurrent syphilis less abundant, tends to group. In the first half it gradually allowed to accompany polyadenylation. Syphilides second period is usually not accompanied by subjective sensations.

In the secondary period distinguish 5 groups syphilides:

1. syphilitic roseola: pale pink rounded neshelushaschiesya spots of various sizes, usually located on the trunk;
2. syphilitic papules: bluish-red smooth rounded nodules of various sizes, often changing their surface, depending on the location - erosive mucous, callus on the palms and soles, vegetating in the folds of the anus and the genitals - the so-called broad warts;
3. syphilitic pustules: various sizes and depths of pustules on the basis of a particular dense, turning into ulcers or purulent crusts;
4. syphilitic baldness: booming diffuse or microfocal thinning hair on his head without inflammatory changes in the skin;
5. syphilitic leukoderma: spotted or lace hypopigmentation of the skin of the neck. Often the affected mucosa of the throat, where there are syphilitic sore throat (erythematous, papular and pustular-ulcer), which differ from banal angina sharp boundaries, lack ostrovospalitelnyh phenomena, fever and pain. When eruptions on the vocal cords marked hoarseness.

In rare cases, there is involvement of other organs and systems: diffuse periostitis and osteoperiostity with nocturnal bone pain (usually legs), with hydrarthrosis poliartriticheskie synovitis, diffuse or focal hepatitis, nephritis, gastritis with nonspecific symptoms, polyneuritis and a syphilis.

In the secondary period of syphilis is marked the largest number of diagnostic errors. Syphilitic roseola unlike roseolous rash and flu at tifah more abundant, not shelled, when it lacks common phenomenon and the characteristic lesion of other organs, there is no petechiae, there are attendant syphilides. When medication toxicoderma unlike syphilitic roseola has a clear connection with the drug intake, there is a tendency to merge rash and desquamation, are expressed in the form of subjective sensations of burning and itching, rash quickly disappears with the abolition of the drug caused her. Extensive warts in the anal region are different from hemorrhoids sharp density, opalescent color, the absence of pain and bleeding, short-lived existence. The diagnosis is confirmed syphilis sharply positive serological reactions (PB. RIF, RIBT).

Tertiary period of syphilis begins most often in the 3-4 th year of the disease and, if untreated, lasts until the end of life of the patient. Its manifestations differ most weight, lead to a lasting disfigurement of appearance, disability and often death. Due to advances in the diagnosis and treatment of tertiary syphilis is now rare.

The main features of tertiary syphilis: an undulating course with infrequent relapses and perennial latencies, multiplicity delineated powerful prone to disintegration of granulomas with the duration of their existence (months, years), the predominant localization of lesions at the site of injury, a small number of pale treponemes in tissue and in connection this tiny contagiousness tertiary syphilides, a high level of infectious allergy in low tension immunity, often negative classical serological tests for syphilis.

In the Tertiary period may be a loss of any organ, but most often occurs skin lesions, mucous membranes and bones.

Syphilides Tertiary represented by two elements - tubercles and nodes (Gunma), bumps are usually located in large quantities in the skin and have the form hemispherical dense formations bluish-red color, smooth, clearly delineated, the size of a cherry stone. They do not give a subjective sensation, usually located in groups on any part of the skin, never merge, quickly ulcerate and then heal, leaving a kind of pigmented on the periphery ( "Mosaic") scars. new bumps never formed in relapsed on scars.

Syphiloma is a painless node in the depth of subcutaneous tissue. As he reaches the growth of walnut, it becomes bluish-red color, hemispherical shape, plotnoelasticheskuyu consistency and then ulcerate in the center with the Department of scarce liquid adhesive and form a necrotic core. Gummy painless ulcer, a dense valikoobraznye edge and the right shape, it leaves on the wound on the periphery of pigmented smooth or strapped to the center ( "stellate") scar. Gunma sporadic, localized usually in the legs or arms (along the tibial and radial bone), at least on the head. Their appearance is usually triggered by mechanical trauma. Gum may be complicated by secondary infection, sometimes amazed subject bone.

The defeat of the mucous membranes presented with gummy changes over a similar manner. Most often gummas localized in the mucosa of the nose and pharynx, sometimes on the tongue. They often radiating to the underlying tissues, leading to a breach of phonation, swallowing, breathing, bone fracture of the nasal septum with the subsequent formation of saddle nose.

Lesions of other organs and systems in the Tertiary period of syphilis are described in the relevant sections.

In congenital syphilis infection occurs in utero from sick mother. Pale treponema penetrate into the body of the fetus from the placenta through the umbilical diseased vein or lymph slit cord.

Fetus syphilis usually occurs in the first three years of his mother's illness, it may interfere with the course of pregnancy and cause late miscarriages, stillbirths and premature births.

There are early (4 years) and late (after 4 years) congenital syphilis. Early congenital syphilis, are further divided into fetal syphilis, congenital syphilis, thoracic (up to 1 year) and early childhood (from 1 to 4 years). Each of the periods and sub-periods has its own clinical features.

Syphilis fetus usually develops from the 5th month of pregnancy, it is characterized by a primary lesion of the internal organs and the skeletal system in the form of a diffuse inflammatory small cell infiltration, followed by growth of connective tissue, which can seriously disturb the function of the organs and lead to death of the fetus. Most often affects the liver, spleen and tubular bones.

Congenital syphilis infants along with common degenerative and feverish symptoms, visceral and bone lesions (hepatitis, nephritis, pneumonia, osteochondritis, and others.) Gives a very rich and varied rash on skin and mucous membranes, in many respects similar to syphilides second period (different species syphilitic roseola, papules and pustules). Separate syphilides infants have their own characteristics. Even papules on the skin often have erosive, weeping surface. Papules in the circumference of the mouth merge into solid pleural plaques, covered with deep radial cracks (diffuse infiltration Gohzingera) that leave later radiant characteristic scars on the skin of the lips, neck and chin (radial scars Robinson - Fournier). Erosive papules on the nasal mucous membrane leads to the formation of crusts, preventing nasal breathing, due to which the baby can not breastfeed ( "syphilitic runny nose"). Large pustular rash on the palms, soles and other parts of the extremities characterize syphilitic pemphigus.

In the metaphyseal areas of long bones often occur osteochondritis, often ending with pathological fractures (psevdoparalich Parrot).

Congenital syphilis early childhood is characterized by a primary lesion of the skin, mucous membranes and bones. Eruptions less abundant, localized, similar to those with secondary recurrent syphilis (often found extensive warts, syphilitic alopecia).

Late congenital syphilis usually manifests itself between the ages of 5-17 years. Its main symptoms are similar to symptoms of tertiary syphilis. The skin and mucous membranes occur Bugorkova and gummy changes. However, unlike the case of late tertiary syphilis congenital syphilis has a persistent set of characteristics that result from syphilis attacks during infancy or later appearing as a result of the influence of syphilitic infection developing skeletal system and some other organs. Distinguish unconditional and probable signs of late congenital syphilis.

By unconditional (pathognomonic) featured the late congenital syphilis refers only to "Hutchinson triad": getchinsonovy teeth (barrel-shaped upper central incisors with a groove at the free edge), parenchymatous keratitis and labyrinthine deafness. They often occur simultaneously.

Possible signs although typical for late congenital syphilis, but can also occur in other diseases, so they have meaning only in the aggregate of diagnostic symptoms. Key among them: "saber shin", "gothic sky" thickening sternal end of the clavicle (Avsitidiyskogo symptom), radial scars Robinson - Fournier, various dental dystrophy (diastema, macro or mikrodentiya, hypoplasia of the canines, and others.).

syphilis diagnosis is based on clinical manifestations, results of confrontation (the alleged source of the survey), mandatory laboratory study (detection pale treponem positive serological tests). The substrate for studies on the pale treponema are detachable chancre, erosive and weeping papules and pustular contents syphilides. Wasserman (PB) is positive in all the patients in the second half of the first period and throughout the secondary. In the Tertiary period is negative about a third of patients. A more accurate and specific immunofluorescence (RIF), which is positive in all three periods, and the reaction of immobilization pale treponem (RIBT), positive in the secondary and tertiary periods. Repeated positive serological reaction in the absence of clinical manifestations allow the diagnosis of latent syphilis. If you suspect a tertiary or congenital syphilis patients are subject to a thorough examination.

Syphilis Treatment is carried out in accordance with the guidance approved by the USSR Ministry of Health. Apply antibiotics (penicillin, bicillin 3 bicillin 5, erythromycin), sometimes in combination with bismuth preparations (biyohinol, bismoverol). The drug is used continuously (permanently) or individual courses. The number and duration of treatment, single and course doses depend on the stage of syphilis, patient weight, presence of concomitant diseases. They may also be non-specific therapy (pyrogenic substances, vitamins, biogenic stimulators, immunomodulators), especially at the secondary recurrent and latent syphilis. Treatment is initiated in the hospital.

After treatment, all patients are subject to long-term observation (from 1 year to 5 years), after which they undergo a thorough examination and then removed from the register.

Syphilis Prevention provides a set of public and private events. Среди мер общественной профилактики основное значение имеют госпитализация всех больных с активными проявлениями болезни, строгий контроль за больными до снятия с учета, активное выявление источников заражения, обследование контактов, профилактические осмотры, исследование крови беременных и всех стационарных больных на реакцию Вассермана, санитарно-просветительная работа, организация пунктов индивидуальной профилактики при вендиспансерах. Меры индивидуальной профилактики: половое воздержание до вступления в брак, недопустимость беспорядочной половой жизни и внебрачных половых связей, при случайных половых связях пользование мужским презервативом и последующее обмывание половых органов теплой водой с мылом, посещение пункта индивидуальной профилактики в первые часы после подозрительного полового контакта.