Donetsk State Medical University

Department of skin and venereal diseases

Head department prof. Romanenko V.N.

Lecturer Assoc. Kovalkova N.A.

Medical history

sick x

Curator: 4th year student of the 8th group of the II Faculty of Medicine Seleznev A.A.

Co-curators: 4th year students of the 8th group II of the Faculty of Medicine Dokolin E.N. Shcherban E.V.

Donetsk, 1995

PASSPORT DATA

FULL NAME. x

Age 21 years old floor F

Education the average

Home address Donetsk-41

Place of work seamstress

Receipt date: 10.XI.95

Diagnosis at admission: fresh secondary syphilis

COMPLAINTS

The patient complains of a rash on the large and small labia, pain, fever in the evenings up to 37.5-38.0 C, general weakness.

HISTORY OF DISEASE

For the first time the patient discovered a rash on the large and small labia on October 10, 1995, she tried to be treated at home, using baths with chamomile and potassium permanganate. Then there was pain in the groin. She assumes that she got infected from her husband, after the onset of symptoms of the disease, she had no sexual contacts. The last sexual contact had with the husband about two months ago.

ANAMNESIS OF LIFE

Patient x, 21 years old, was born as the second child in the family (sister is 2 years older). Parents died when the patient was 12 years old, after that she lived with her older sister. Material and living conditions are currently satisfactory, she is married and has no children. Colds are more rare, diseases of Botkin's disease, malaria, typhoid fever, dysentery, tuberculosis, and other sexually transmitted diseases are denied. Smokes up to 1/2 pack a day, does not abuse alcoholic beverages. Heredity is not burdened. She has had sexual intercourse since the age of nineteen, and has never been promiscuous.

Objective research

The general condition of the patient is satisfactory, the position in bed is active. Build normosthenic, moderate nutrition. Skin covers are clean, pale pink. There is a postoperative scar (appendectomy) in the right iliac region. Dermographism pink. The growth of nails and hair is not changed. The mucous membrane of the oral cavity is pink, the tongue is of normal size, slightly lined with a yellow coating.

Respiratory rate 16 per minute, percussion sound over the lungs - clear pulmonary. Breathing is vesicular, there are no pathological sounds. The pulse is rhythmic, 78 beats per minute, satisfactory filling, blood pressure 130/80. The boundaries of the heart are not expanded, the tones are clear, pure.

The abdomen is soft, slightly painful in the iliac regions. The liver and spleen are not enlarged. Symptoms of peritoneal irritation, Georgivsky-Mussi, Ortner, Mayo-Robson, Shchetkin-Blumberg and Pasternatsky are negative.

Description of the lesion

On the large and small labia symmetrically there is a monomorphic rash in the form of papules with a diameter of up to 5 mm in diameter, brownish-red, painless, peripheral growth is absent. Some papules ulcerate with the formation of small ulcers with purulent discharge, painful. Inguinal lymph nodes are enlarged on both sides, up to 3 cm in diameter, painless on palpation, mobile, not soldered to surrounding tissues.

Lues secundaria recidiva

Complications ________________________________________

___________________________________________________

Related:

floor male

age 47 years old

Home address: ______________________________

Place of work: disabled group 2

Position _____________________________________________________

Date of admission to the clinic: 12. 04. 2005

Clinical diagnosis (in Russian and Latin):

Secondary recurrent syphilis of the skin and mucous membranes

Luessecundariarecidiva

Accompanying illnesses: Neural amyotrophic Charcot-Marie syndrome in the form of tetraparesis with impaired locomotion function

complaints on the day of receipt: makes no complaints

on the day of curation: makes no complaints

HISTORY OF THE DEVELOPMENT OF THIS DISEASE

Who referred the patient: CRH Pochinok

Why: detection in a blood test for RW 4+

When I felt sick: does not consider himself sick

What is the onset of the disease associated with? _____________________________

_______________________________________________________________

_______________________________________________________________

From what part of the skin and mucous membranes did the disease begin? _____________________________

How the disease has evolved to date: in mid-January 2005, swelling and induration appeared in the penis. He did not seek medical attention for this. 21. 03. 05. applied to the Pochinkovskaya Central District Hospital about the inability to open the head of the penis, where he was operated on

Influence of past and currently existing diseases (neuro-psychic injuries, functional state of the gastrointestinal tract, etc.): 21. 03. 05. - circumcision

The influence of external factors on the course of this process (dependence on the time of year, on nutrition, weather and weather conditions, on production factors, etc.): no

Treatment before admission to the clinic: before admission to the SOKVD received Penicillin 1 ml 6 times a day for 4 days

Self-medication (than): not self-treated

Efficacy and tolerability of drugs (which the patient took on his own or as prescribed by a doctor for this disease): no intolerance to drugs

EPIDEMIOLOGICAL HISTORY

Sex life from what age: from 16 years old

Sex contacts: over the past two years, a regular sexual partner - _____________________ - has been treated at the SOKVD for syphilis

Household contacts: does not indicate, lives alone

Donation: denies

LIFE HISTORY OF THE PATIENT

Physical and mental development: Walking and talking began in the second year of life. Did not lag behind peers in development

Education: graduated from 8 classes, vocational school

Past illnesses:"Children's" infections, ARVI is sick every year

Injuries, operations: appendectomy 1970

Allergic diseases: missing

Drug intolerance: does not note

Hereditary burdens and the presence of a similar disease in relatives: heredity is not burdened

Habitual intoxications: has been smoking 10 cigarettes a day since the age of 18. Moderately consumes alcohol

Working conditions: does not work

Living conditions: lives in a private house without amenities, observes the rules of personal hygiene

Family history: not married

OBJECTIVE STUDY

General state: satisfactory, clear consciousness

Position: active

Body type: normosthenic type

Growth: 160 cm

The weight: 60 kg

SKIN

1. SKIN CHANGES

Colour: normal

Turgor, elasticity: not changed

Characteristic of sweating skin: fine

Characteristics of sebum secretion: fine

Condition of hair, nails: nails are not changed. Mixed alopecia

Condition of subcutaneous fat: subcutaneous fat is moderately developed, evenly distributed

Dermographism: pink, various, resistant

Description of all skin changes that are not related to the main pathological process (nevi, pigmentation, scars, etc.)

2. DESCRIPTION OF THE PATHOLOGICAL PROCESS

Prevalence (common, limited, generalized, universal) polymorphism, rash monomorphism, symmetry, severity of inflammatory phenomena: common. In the pharynx, hyperemia with a bluish tinge, with clear boundaries (erythematous tonsillitis). On the body, a roseolous rash of a pale pink color is predominantly localized on the lateral surfaces, asymmetrically. The foreskin is missing due to circumcision. Mixed alopecia on the head.

Characteristics of each of the primary morphological and its description (describe in turn all morphological elements). Specify in the characteristic: localization, shape, color, size, character of borders, tendency to merge or to group. Characteristics of the infiltrate (dense, soft, doughy). Characteristics of the exudate (serous, hemorrhagic, purulent), specific signs or symptoms (s-m Nikolsky, the triad of symptoms in psoriasis).

Spot - localized throughout the body with a predominant location on the back and side surfaces. The size of the spots is about 0.7 cm. The elements appear gradually. Fresh elements disappear during vitroscopy, the old ones do not completely disappear, in their place there is a brown stain - a consequence of the formation of segments from disintegrated erythrocytes. There is no tendency to merge and group. The color of the spots is pale pink. The arrangement is not symmetrical. They are allowed without a trace. Positive Biedermann's sign.

Characteristics of secondary morphological elements: peeling, pityriasis, small-, large-lamellar detachment, crack, deep, superficial, erosion, color, size, discharge, boundary characteristics, etc., characteristics of vegetation, lichinification, characteristics of secondary pigmentation, crusts - serous, hemorrhagic, purulent, color, density, etc. No.

Musculoskeletal system

Posture is correct. The physique is correct. Shoulders are on the same level. The supraclavicular and subclavian fossae are equally pronounced. There are no chest deformities. Movements in the joints are preserved with the exception of active movements of the joints of the lower extremities. On palpation, they are painless, there are no visible deformations. There is a slight atrophy of the muscles of the lower extremities, mainly of the left leg, which is the reason for the difficulty of active movements of the lower extremities, muscle strength is reduced.

Respiratory system

Breathing through both halves of the nose is free. NPV - 16 per minute. Both halves of the chest are equally involved in the act of breathing. Abdominal breathing. Breathing is vesicular, except for the places where physiological bronchial breathing is auscultated. There are no wheezes.

The cardiovascular system

There are no deformities in the region of the heart. Apex beat in the 5th intercostal space medially from the mid-clavicular line. The limits of relative dullness are normal. The heart sounds are clear, the rhythm is correct: 78 per minute. BP: 120/80 mm Hg. The pulse is symmetrical, regular, of normal filling and tension. There is no pulse deficit.

Digestive system

Tongue wet, lined with white coating. The oral cavity requires sonation. In the pharynx, there is hyperemia of the palatine arches, the posterior pharyngeal wall with clear boundaries, a bluish tinge. Abdomen of normal shape, symmetrical. In the right iliac region, there is a postoperative scar from an openectomy. The liver protrudes 1 cm from under the costal arch. Its percussion dimensions are 9/10/11 cm. The spleen is not palpable, percussion its dimensions are 6/8 cm. The stool is normal.

genitourinary system

There are no visible edema in the lumbar region. Pasternatsky's symptom is negative. There are no dysuric disorders. Urination is free.

sense organs

The sense organs are not changed.

Neuropsychic status

Consciousness is clear. The mood is normal. Sleep is normal. The patient is oriented in person, space and time.

Laboratory data

Survey plan

1. complete blood count

2. urinalysis

5. ELISA for IgM, G

7. HIV, Hbs Ag

Received results with date

1. UAC 13.04.05

Erythrocytes - 5.0 * 10 12 / l

Hb — 124 g/l

Leukocytes - 5.2 * 10 9 / l

Eozonophils - 1%

Neutrophils - 67%

Monocytes - 5%

Lymphocytes - 27%

ESR - 22 mm/h

Conclusion: the norm

2. OAM 13.04.05

Color - homogeneous - yellow

Specific gravity - 1010

transparent

Epithelial cells - 1 - 4 in p / s

Protein - absent

Leukocytes - 2 - 3 in p / s

Conclusion: the norm

3. RMP 22.04.05.

1. RW 12.04.05

Caption 1:20

5. Hbs Ag, HIV not detected

Basis for diagnosis

The diagnosis was made on the basis of:

1. Data from laboratory research methods: 12.04.05 Wassermann reaction revealed a sharply positive reaction (++++), microprecipitation reaction ++++

2. Clinical examination data: in the pharynx, hyperemia of the palatine arches, posterior pharyngeal wall with clear boundaries, cyanotic tint (erythematous tonsillitis). On the body, a roseolous rash of a pale pink color, mainly localized on the lateral surfaces and back, is symmetrical. Mixed alopecia on the head.

Differential Diagnosis

Roseolous (spotted) syphilis should be differentiated from:

1. Pink deprive. With pink lichen, the elements are located along the lines of tension of the Langer skin. Size 10 - 15 mm, with characteristic peeling in the center. Usually, a “maternal plaque” is detected - a larger spot that occurs 7 to 10 days before the onset of a disseminated rash. There may be complaints about a feeling of tightness of the skin, slight itching, tingling.

2. Roseola with toxicoderma. It has a more pronounced bluish tint, a tendency to merge, peel, develop itching. In the anamnesis there are indications of taking medications, foodstuffs, often causing allergic reactions.

Mixed alopecia should be differentiated from:

1. Alopecia after an infectious disease. In this case, hair loss occurs quickly. In the anamnesis there is data on the transferred infectious diseases.

2. Seborrheic alopecia. The condition of seborrhea is characteristic, hair loss develops slowly (over the course of years).

3. Alopecia areata. It is characterized by the presence of a small number of foci of baldness up to 8 - 10 mm in diameter. Hair is completely absent.

Principles, methods and individual treatment of the patient

Antibiotic therapy:

Penicillin sodium salt 1,000,000 units 4 times a day

Vitamin therapy:

Thiamine chloride 2.5% 1 ml / m 1 time per day for 14 days.

Ascorbic acid 0.1 g 1 tablet 3 times a day

Forecast

Favorable for health, life and work

Literature

1. Skrinkin Yu. K. "Skin and venereal diseases" M: 2001

2. Adaskevich "Sexually transmitted diseases" 2001

3. Radionov A. N. "Syphilis" 2002

Syphilis (syphilis) refers to infectious diseases, transmitted in most cases sexually. The causative agent of syphilis is a spiral-shaped microorganism Treponema pallidum(pale treponema), is very vulnerable in the external environment, multiplies rapidly in the human body. Incubation period, i.e time from infection to first symptoms, approximately 4-6 weeks. It can be shortened to 8 days or lengthened to 180 with concomitant sexually transmitted diseases (,), if the patient is weakened by an immunodeficiency state () or took antibiotics. In the latter case, the primary manifestations of syphilis may be absent altogether.

Regardless of the length of the incubation period, the patient at this time is already infected with syphilis and is dangerous to others as a source of infection.

How can you get syphilis?

Syphilis is transmitted mainly through sexual contact - up to 98% of all cases of infection. The pathogen enters the body through defects in the skin or mucous membranes of the genitals, anorectal loci, mouth. However, approximately 20% of sexual partners who have been in contact with patients with syphilis remain in good health. Risk of infection significantly reduced if there are no conditions necessary for the penetration of infection - microtrauma and a sufficient amount of infectious material; if sexual intercourse with a patient with syphilis was single; if syphilides (morphological manifestations of the disease) have a small contagiousness(the ability to infect). Some people are genetically immune to syphilis because their body produces specific protein substances that can immobilize pale treponema and dissolve their protective membranes.

It is possible to infect the fetus in utero or in childbirth: then congenital syphilis is diagnosed.

The everyday way - through any objects contaminated with infectious material, handshakes or formal kisses - is realized very rarely. The reason is the sensitivity of treponemas: as they dry, the level of their contagiousness drops sharply. Get syphilis through a kiss it is quite possible if one person has syphilitic elements on the lips, mucous membrane of the mouth or throat, on the tongue, containing a sufficient amount of virulent (that is, live and active) pathogens, and another person has scratches on the skin, for example, after shaving.

The causative agent of syphilis is Treponema pallidum from the Spirochete family.

Very rare routes of transmission of infectious material through medical instruments. Treponemas are unstable even under normal conditions, and when sterilized or treated with conventional disinfectant solutions, they die almost instantly. So all the stories about syphilis infection in gynecological and dental offices most likely belong to the category of oral folk art.

Transmission of syphilis with blood transfusions(blood transfusions) almost never occurs. The fact is that all donors must be tested for syphilis, and those who have not passed the test simply will not be able to donate blood. Even if we assume that there was an incident and there are treponemas in the donor blood, they will die during the preservation of the material in a couple of days. The very presence of a pathogen in the blood is also rare, because Treponema pallidum appears in the bloodstream only during treponemal sepsis» with secondary fresh syphilis. Infection is possible if enough virulent pathogen is transmitted with direct blood transfusion from an infected donor, literally from vein to vein. Given that the indications for the procedure are extremely narrowed, the risk of contracting syphilis through the blood is unlikely.

What increases the risk of contracting syphilis?

• Liquid secretions. Since treponemas prefer a humid environment, mother's milk, weeping syphilitic erosions and ulcers, sperm discharged from the vagina contain a huge number of pathogens and are therefore the most infectious. Transmission of infection through saliva is possible if there is syphilides(rash, chancre).
• Elements of dry rash(spots, papules) are less contagious, in abscesses ( pustules) treponema can be found only along the edges of the formations, and in pus they are not at all.
• Disease period. With active syphilis, nonspecific erosions on the cervix and head of the penis, herpetic rash vesicles and any inflammatory manifestations leading to defects in the skin or mucous membranes are contagious. In the period of tertiary syphilis, the possibility of infection through sexual contact is minimal, and papules and gummas specific for this stage are actually not contagious.

With regard to the spread of infection, latent syphilis is the most dangerous: people are unaware of their illness and do not take any measures to protect their partners.

• Accompanying illnesses. Patients with gonorrhea and other STDs are more easily infected with syphilis, since the mucous membranes of the genitals are already damaged by previous inflammations. Treponemas multiply rapidly, but the primary lues is "masked" by the symptoms of other venereal diseases, and the patient becomes epidemically dangerous.
• The state of the immune system. People who are debilitated by chronic diseases are more likely to contract syphilis; AIDS patients; in alcoholics and drug addicts.

Classification

Syphilis can affect any organs and systems, but the manifestations of syphilis depend on the clinical period, symptoms, duration of illness, age of the patient, and other variables. Therefore, the classification seems a little confusing, but in reality it is built very logically.

1. depending from time span, which has passed since the moment of infection, early syphilis is distinguished - up to 5 years, more than 5 years - late syphilis.
2. By typical symptoms syphilis is divided into primary(hard chancre, scleradenitis and lymphadenitis), secondary(papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis) and tertiary(gummas, damage to internal organs, bone and joint systems, late neurosyphilis).

chancre - an ulcer that develops at the site of introduction of the causative agent of syphilis

1. primary syphilis, according to blood test results, may be seronegative and seropositive. Secondary according to the main symptoms are divided into stages of syphilis - fresh and latent (recurrent), tertiary are differentiated as active and latent syphilis, when treponemas are in the form of cysts.
2. By preference damage to systems and organs: neurosyphilis and visceral (organ) syphilis.
3. Separately - fetal syphilis and congenital late syphilis.

Primary syphilis

After the end of the incubation period, the characteristic first signs appear. At the site of penetration of treponema, a specific rounded erosion or ulcer is formed, with a hard, smooth bottom, “tucked” edges. The sizes of formations can vary from a couple of mm to several centimeters. Hard chancres can disappear without treatment. Erosions heal without a trace, ulcers leave flat scars.

Disappeared chancres do not mean the end of the disease: primary syphilis only passes into a latent form, during which the patient is still contagious to sexual partners.

in the figure: chancres of genital localization in men and women

After the formation of a hard chancre, after 1-2 weeks begins local enlargement of lymph nodes. When palpated, they are dense, painless, mobile; one is always larger than the others. After another 2 weeks it becomes positive serum (serological) reaction to syphilis, from this point on, primary syphilis passes from the seronegative stage to the seropositive stage. The end of the primary period: the body temperature may rise to 37.8 - 380, there are sleep disturbances, muscle and headaches, aching joints. Available dense swelling of the labia (in women), head of the penis and scrotum in men.

Secondary syphilis

The secondary period begins about 5-9 weeks after the formation of a hard chancre, and lasts 3-5 years. Main symptoms syphilis at this stage - skin manifestations (rash), which appears with syphilitic bacteremia; wide warts, leukoderma and alopecia, nail damage, syphilitic tonsillitis. Present generalized lymphadenitis: the nodes are dense, painless, the skin above them is of normal temperature ("cold" syphilitic lymphadenitis). Most patients do not notice any special deviations in well-being, but the temperature may rise to 37-37.50, runny nose and sore throat. Because of these manifestations, the onset of secondary syphilis can be confused with a common cold, but at this time, lues affects all body systems.

syphilitic rash

The main signs of a rash (secondary fresh syphilis):

• The formations are dense, the edges are clear;
• The shape is correct, rounded;
• Not prone to merging;
• Do not peel off in the center;
• Located on visible mucous membranes and over the entire surface of the body, even on the palms and feet;
• No itching and soreness;
• Disappear without treatment, do not leave scars on the skin or mucous membranes.

accepted in dermatology special names for morphological elements of the rash that can remain unchanged or transform in a certain order. First on the list - spot(macula), may progress to stage tubercle(papula) bubble(vesicula), which opens with the formation erosion or turns into abscess(pustula), and when the process spreads deep into ulcer. All of the listed elements disappear without a trace, unlike erosions (after healing, a stain first forms) and ulcers (the outcome is scarring). Thus, it is possible to find out from trace marks on the skin what the primary morphological element was, or to predict the development and outcome of already existing skin manifestations.

For secondary fresh syphilis, the first signs are numerous pinpoint hemorrhages in the skin and mucous membranes; profuse rashes in the form of rounded pink spots(roseolaе), symmetrical and bright, randomly located - roseolous rash. After 8-10 weeks, the spots turn pale and disappear without treatment, and fresh syphilis becomes secondary. hidden syphilis flowing with exacerbations and remissions.

For the acute stage ( recurrent syphilis) is characterized by a preferential localization of the elements of the rash on the skin of the extensor surfaces of the arms and legs, in the folds (groin, under the mammary glands, between the buttocks) and on the mucous membranes. The spots are much smaller, their color is more faded. The spots are combined with a papular and pustular rash, which is more often observed in debilitated patients. At the time of remission, all skin manifestations disappear. In the recurrent period, patients are especially contagious, even through household contacts.

Rash with secondary acute syphilis polymorphic: consists simultaneously of spots, papules and pustules. Elements group and merge, forming rings, garlands and semi-arcs, which are called lenticular syphilides. After their disappearance, pigmentation remains. At this stage, the diagnosis of syphilis by external symptoms is difficult for a non-professional, since secondary recurrent syphilis can be similar to almost any skin disease.

Lenticular rash in secondary recurrent syphilis

Pustular (pustular) rash with secondary syphilis

Pustular syphilis is a sign of a malignant ongoing disease. More often observed during the period of secondary fresh syphilis, but one of the varieties - ecthymatous- characteristic of secondary exacerbated syphilis. Ecthymes appear in debilitated patients approximately 5-6 months from the time of infection. They are located asymmetrically, usually on the shins in front, less often on the skin of the trunk and face. Syphilides number 5 - 10, rounded, about 3 cm in diameter, with a deep abscess in the center. A gray-black crust forms above the pustule, below it there is an ulcer with necrotic masses and dense, steep edges: the shape of the ecthyma resembles funnels. After that, deep dark scars remain, which eventually lose their pigmentation and become white with a pearly tint.

Necrotic ulcers from pustular syphilides, secondary-tertiary stages of syphilis

Ecthymes can go into rupioid syphilides, with the spread of ulceration and disintegration of tissues outward and deep. Centered rupees multilayer "oyster" crusts are formed, surrounded by an annular ulcer; outside - a dense roller of a reddish-violet color. Ecthymas and rupees are not contagious, during this period all serological tests for syphilis are negative.

Acne syphilides - abscesses 1-2 mm in size, localized in the hair follicles or inside the sebaceous glands. Rashes are localized on the back, chest, limbs; heal with the formation of small pigmented scars. Smallpox syphilides are not associated with hair follicles, they are lentil-shaped. Dense at the base, copper-red color. syphilis similar to impetigo- purulent inflammation of the skin. It occurs on the face and scalp, pustules are 5-7 mm in size.

Other manifestations of secondary syphilis

Syphilitic warts similar to warts with a wide base, often formed in the fold between the buttocks and in the anus, under the armpits and between the toes, near the navel. In women - under the breast, in men - near the root of the penis and on the scrotum.

Pigmentary syphilide(spotted leukoderma literally translated from Latin - "white skin"). White spots up to 1 cm in size appear on the pigmented surface, which are located on the neck, for which they received the romantic name "Venus' necklace". Leukoderma is determined after 5-6 months. after infection with syphilis. Possible localization on the back and lower back, abdomen, arms, on the front edge of the armpits. The spots are not painful, do not peel off and do not become inflamed; remain unchanged for a long time, even after specific treatment for syphilis.

Syphilitic alopecia(alopecia). Hair loss can be localized or cover large areas of the scalp and body. Small foci of incomplete alopecia are often observed on the head, with rounded irregular outlines, mainly located on the back of the head and temples. On the face, first of all, attention is paid to the eyebrows: with syphilis, the hairs first fall out from their inner part, located closer to the nose. These signs marked the beginning of visual diagnostics and became known as " omnibus syndrome". In the later stages of syphilis, a person loses absolutely all hair, even vellus.

Syphilitic angina- the result of damage to the mucous membrane of the throat. Small (0.5 cm) spotty syphilides appear on the tonsils and soft palate, they are visible as bluish-red foci of sharp outlines; grow up to 2 cm, merge and form plaques. The color in the center quickly changes, acquiring a grayish-white opal shade; the edges become scalloped, but retain the density and original color. Syphilides can cause pain during swallowing, a feeling of dryness and constant tickling in the throat. Occur along with a papular rash during the period of fresh secondary syphilis, or as an independent sign of secondary exacerbated syphilis.

manifestations of syphilis on the lips (chancre) and tongue

Syphilides on the tongue, in the corners of the mouth due to constant irritation, they grow and rise above the mucous membranes and healthy skin, dense, the surface is grayish in color. May become covered with erosions or ulcerate, causing pain. papular syphilis on the vocal cords initially manifested by hoarseness of voice, later a complete loss of voice is possible - aphonia.

syphilitic nail damage(onychia and paronychia): papules are localized under the bed and at the base of the nail, visible as reddish-brown spots. Then the nail plate above them becomes whitish and brittle, begins to crumble. With purulent syphilis, severe pain is felt, the nail moves away from the bed. Subsequently, depressions in the form of craters form at the base, the nail thickens three or four times compared to the norm.

Tertiary period of syphilis

Tertiary syphilis is manifested by focal destruction of the mucous membranes and skin, any parenchymal or hollow organs, large joints, and the nervous system. Main features - papular rashes and gummas degrading with rough scarring. Tertiary syphilis is rarely defined, develops within 5-15 years if no treatment has been carried out. Asymptomatic period ( latent syphilis) can last for more than two decades, is only diagnosed by serological tests between secondary and tertiary syphilis.

what can affect advanced syphilis

Papular elements dense and rounded, up to 1 cm in size. They are located in the depths of the skin, which becomes bluish-red above the papules. Papules appear at different times, grouped into arcs, rings, elongated garlands. Typical for tertiary syphilis focus rashes: each element is determined separately and in its stage of development. The disintegration of papular syphilomas begins from the center of the tubercle: rounded ulcers appear, the edges are sheer, there is necrosis at the bottom, and a dense roller along the periphery. After healing, small dense scars with a pigmented border remain.

Serpinginous syphilides are grouped papules that are in different stages of development and spread to large areas of the skin. New formations appear along the periphery, merge with the old ones, which at this time already ulcerate and scar. The sickle-shaped process seems to crawl to healthy areas of the skin, leaving a trail of mosaic scars and pigmentation foci. Numerous tubercular seals create a colorful picture true polymorphic rash, which is visible in the late periods of syphilis: different sizes, different morphological stages of the same elements - papules.

syphilitic gumma on the face

syphilitic gumma. At first it is a dense knot, which is located in the depth of the skin or under it, mobile, up to 1.5 cm in size, painless. After 2-4 weeks, the gumma is fixed relative to the skin and rises above it as a rounded dark red tumor. A softening appears in the center, then a hole forms and a sticky mass comes out. In place of the gumma, a deep ulcer is formed, which can grow along the periphery and spread along the arc ( serping gummy syphilis), and in the "old" areas there is healing with the appearance of retracted scars, and in the new ones - ulceration.

More often syphilitic gummas are located alone and are localized on the face, near the joints, on the legs in front. Closely located syphilides can merge to form gum pad and turn into impressive ulcers with compacted, uneven edges. In debilitated patients, with a combination of syphilis with HIV, gonorrhea, viral hepatitis, gum may grow in depth - mutilating or irradiating gumma. They disfigure the appearance, can even lead to the loss of an eye, testicle, perforation and death of the nose.

gummas in the mouth and inside the nose disintegrate with destruction of the palate, tongue and nasal septum. Defects appear: fistulas between the cavities of the nose and mouth (nasal voice, food can get into the nose), narrowing of the orifice(difficulty swallowing), cosmetic problems - failed saddle nose. Language first increases and becomes bumpy, after scarring it wrinkles, it becomes difficult for the patient to talk.

Visceral and neurosyphilis

At visceral tertiary syphilis, organ damage is observed, with the development neurosyphilis- symptoms from the central nervous system (CNS). During the secondary period, early syphilis of the central nervous system appears; it affects the brain, its vessels and membranes ( meningitis and meningoencephalitis). In the tertiary period, manifestations of late neurosyphilis are observed, these include atrophy of the optic nerve, dorsal tabes and progressive paralysis.

Dorsal tabes– Manifestation of syphilis of the spinal cord: the patient literally does not feel the ground under his feet and cannot walk with his eyes closed.

progressive paralysis It manifests itself as much as one and a half to two decades after the onset of the disease. The main symptoms are mental disorders, from irritability and memory impairment to delusional states and dementia.

optic nerve atrophy: with syphilis, one side is first affected, a little later vision deteriorates in the other eye.

Gummas affecting the head brain are rarely observed. According to clinical signs, they are similar to tumors and are expressed by symptoms of brain compression - increased intracranial pressure, rare pulse, nausea and vomiting, prolonged headaches.

bone destruction in syphilis

Among the visceral forms predominates syphilis of the heart and blood vessels(up to 94% of cases). Syphilitic mesaortitis- inflammation of the muscular wall of the ascending and thoracic aorta. It often occurs in men, accompanied by an expansion of the artery and phenomena of cerebral ischemia (dizziness and fainting after exercise).

Syphilis liver(6%) leads to the development of hepatitis and liver failure. The total proportion of syphilis of the stomach and intestines, kidneys, endocrine glands and lungs does not exceed 2%. Bones and joints: arthritis, osteomyelitis and osteoporosis, the consequences of syphilis - irreversible deformities and blockade of joint mobility.

congenital syphilis

Syphilis can be transmitted during pregnancy, from an infected mother to her baby at 10-16 weeks. Frequent complications are spontaneous abortions and fetal death before delivery. Congenital syphilis according to time criteria and symptoms is divided into early and late.

early congenital syphilis

Children with a clear lack of weight, with wrinkled and flabby skin, resemble little old people. Deformation skull and its facial part ("Olympic forehead") is often combined with dropsy of the brain, meningitis. Present keratitis- inflammation of the cornea of ​​​​the eyes, loss of eyelashes and eyebrows is visible. Children aged 1-2 years develop syphilitic rash, localized around the genitals, anus, on the face and mucous membranes of the throat, mouth, nose. A healing rash forms scarring: scars that look like white rays around the mouth are a sign of congenital lues.

syphilitic pemphigus- a rash of vesicles, observed in a newborn a few hours or days after birth. It is localized on the palms, the skin of the feet, on the folds of the forearms - from the hands to the elbows, on the trunk.

Rhinitis, the causes of its occurrence are syphilides of the nasal mucosa. Small purulent discharge appears, forming crusts around the nostrils. Breathing through the nose becomes problematic, the child is forced to breathe only through the mouth.

Osteochondritis, periostitis- inflammation and destruction of bones, periosteum, cartilage. It is most often found on the legs and arms. There is local swelling, pain and muscle tension; then paralysis develops. During early congenital syphilis, destruction of the skeletal system is diagnosed in 80% of cases.

late congenital syphilis

late form manifests itself in the age period of 10-16 years. The main symptoms are visual impairment with the possible development of complete blindness, inflammation of the inner ear (labyrinthitis), followed by deafness. Skin and visceral gummas are complicated by functional disorders of organs and scars that disfigure the appearance. Deformation of teeth, bones: the edges of the upper incisors have semilunar notches, the legs are bent, due to the destruction of the septum, the nose is deformed (saddle-shaped). Frequent problems with the endocrine system. The main manifestations of neurosyphilis are tabes dorsalis, epilepsy, speech disorders, progressive paralysis.

Congenital syphilis is characterized by a triad of signs Getchinson:

• teeth with an arched edge;
• cloudy cornea and photophobia;
• labyrinthitis - tinnitus, loss of orientation in space, hearing loss.

How is syphilis diagnosed?

Diagnosis of syphilis is based on clinical manifestations characteristic of different forms and stages of the disease, and laboratory tests. Blood take to conduct a serological (serum) test for syphilis. To neutralize teponems in the human body, specific proteins are produced - which are determined in the blood serum of an infected or sick person with syphilis.

RW analysis blood test (Wassermann reaction) is considered obsolete. It can often be false positive in tuberculosis, tumors, malaria, systemic diseases and viral infections. Among women- after childbirth, during pregnancy, menstruation. The use of alcohol, fatty foods, and certain drugs before donating blood for RW can also be the cause of an unreliable interpretation of the analysis for syphilis.

It is based on the ability of antibodies (immunoglobulins IgM and IgG) present in the blood of those infected with syphilis to interact with antigen proteins. If the reaction has passed - analysis positive, that is, the causative agents of syphilis are found in the body of this person. Negative ELISA - no antibodies to treponema, no disease or infection.

The method is highly sensitive, applicable for the diagnosis of latent - hidden forms - syphilis and checking people who have been in contact with the patient. positive even before the first signs of syphilis appear (according to IgM - from the end of the incubation period), and can be determined after the complete disappearance of treponema from the body (according to IgG). ELISA for the VRDL antigen, which appears during alteration (“damage”) of cells due to syphilis, is used to monitor the effectiveness of treatment regimens.

RPHA (passive hemagglutination reaction)- bonding of erythrocytes that have antigens on their surface Treponema pallidum with specific antibody proteins. RPHA is positive in case of illness or infection with syphilis. Remains positive throughout the patient's life even after complete recovery. To exclude a false positive response, RPHA is supplemented with ELISA and PCR tests.

Direct Methods laboratory tests help to identify the causative microorganism, and not antibodies to it. With the help, you can determine the DNA of treponema in the biomaterial. Microscopy a smear from a serous discharge of a syphilitic rash - a technique for visual detection of treponema.

Treatment and prevention

Treatment of syphilis is carried out taking into account the clinical stages of the disease and the susceptibility of patients to drugs. Seronegative early syphilis is treated more easily, with late variants of the disease, even the most modern therapy is not able to eliminate consequences of syphilis- scars, organ dysfunction, bone deformities and disorders of the nervous system.

There are two main methods of treatment for syphilis: continuous(permanent) and intermittent(course). In the process, control tests of urine and blood are required, the well-being of patients and the work of organ systems are monitored. Preference is given to complex therapy, which includes:

• Antibiotics(specific treatment of syphilis);
• Restorative(immunomodulators, proteolytic enzymes, vitamin-mineral complexes);
• Symptomatic drugs (painkillers, anti-inflammatory, hepatoprotectors).

Assign nutrition with an increase in the proportion of complete proteins and a limited amount of fat, reduce physical activity. Prohibit sex, smoking and alcohol.

Psychotrauma, stress and insomnia adversely affect the treatment of syphilis.

Patients with early latent and contagious syphilis undergo the first course of 14-25 days in the clinic, then they are treated on an outpatient basis. Treat syphilis with penicillin antibiotics- intramuscularly injected sodium or potassium salt of benzylpenicillin, bicillins 1-5, phenoxymethylpenicillin. A single dose is calculated according to the weight of the patient; if there are inflammatory signs in the cerebrospinal fluid (spinal fluid), then the dosage is increased by 20%. The duration of the entire course is determined according to the stage and severity of the disease.

permanent method: the starting course for seronegative primary syphilis will take 40-68 days; seropositive 76-125; secondary fresh syphilis 100-157.

course treatment: tetracyclines are added to penicillins ( doxycycline) or macrolides ( azithromycin), preparations based on bismuth - bismovrol, biyoquinol, and iodine - potassium or sodium iodide, calcium iodine. Cyanocobalamin (vit. B-12) and solution coamide enhance the action of penicillin, increase the concentration of the antibiotic in the blood. Injections of pyrogenal or prodigiosan, autohemotherapy, aloe are used as means of non-specific therapy for syphilis, which increase resistance to infection.

During pregnancy, syphilis is treated only with penicillin antibiotics, without drugs with bismuth salts.

Proactive(preventive) treatment: carried out as in the case of seronegative primary syphilis, if sexual contact with the infected was 2-16 weeks ago. One course of penicillin is used for medical prophylaxis of syphilis if the contact was no more than 2 weeks ago.

Prevention of syphilis- Identification of the infected and the range of their sexual partners, preventive treatment and personal hygiene after sexual intercourse. Surveys for syphilis of people belonging to risk groups - physicians, teachers, staff of kindergartens and catering establishments.

Video: syphilis in the program “Live healthy!”

Video: syphilis in the encyclopedia of STDs

Primary syphilis is the first stage of syphilis (after the incubation period), which is characterized by the appearance of characteristic clinical symptoms on the skin. This stage begins 10-90 days (on average 3 weeks) after contact with a person who has infected this disease, and lasts about 4-8 weeks.

The primary period of syphilis is the easiest to diagnose and treat. Further, the disease enters the next, hidden stage. Therefore, the patient should seek help from a specialist immediately after identifying suspicious signs.

Localization and prevalence of primary syphilis

According to the World Health Organization (WHO), every year there are 12 million people with this diagnosis. Most infected patients live in developing countries.

The popularization of homosexuality has led to an 11.2% increase in syphilis cases since 2002. This problem is especially relevant in the southern states of the United States.

In our country, the situation is not so dramatic (incidence rates are falling), but no one is still protected from infection. Men are more likely to suffer from this disease.

Causes and ways of infection of primary syphilis

Syphilis is caused by a bacterium called Treponema pallidum (from the genus Spirochetes). Infection occurs mainly through sexual contact - during vaginal, anal or oral sex with an infected person. If the changes associated with this disease (ulcers) are present in the throat, the infection can also be transmitted through kissing.

Bacteria enter the human body through intact mucous membranes or minor skin lesions, after which they begin to multiply rapidly. The incubation period lasts 10-90 days, after which syphilis develops.

Another way of infection is through the placenta from mother to fetus, but in this case we are not talking about primary, but about congenital syphilis.

Symptoms of primary syphilis

The primary manifestation of syphilis is the so-called syphiloma, an ulcer (hard chancre). It appears at the site of penetration of spirochetes (vagina, anus, penis, mouth, throat). In men, erosion is most often localized on the inner side or edge of the foreskin, in the region of the frenulum, less often at the mouth of the urethra. In women, an ulcer is observed mainly on the labia, cervix, less often on the walls of the vagina. In addition, he (hard chancre) can appear in the pubic region, anus and rectum (with genital-anal relations), in the mouth, on the lips, tongue, tonsils and throat (after oral sex). Often, medical workers (dentists, gynecologists, dermatologists, laboratory assistants) become infected with a bacterium - in this case, the neoplasm is localized on the hands.

The ulcer takes on a round or oval shape with a moist, shiny coating. It has smooth edges and does not cause pain. A few days later, new signs appear - an increase in regional lymph nodes (lymphadenitis). In case of infection during vaginal or anal sex, the lymph nodes in the groin increase, with the oral method of infection, the cervical lymph nodes.

Currently, primary syphilomas often have an unusual appearance - this is due to the widespread use of antibiotics, as a result of which the pale spirochete mutates, taking on new forms. Such ulcers may look like a soft chancre or. Skin changes spontaneously disappear after 2-6 weeks, leaving an atrophic scar. However, the disappearance of symptoms does not mean that the disease has gone away on its own, in the absence of antibiotic treatment, it progresses further.

Atypical symptoms of primary syphilis

Only in 20% of cases, patients have the classic signs of the disease described above. In other cases, it takes the following clinical forms:

• multiple hard chancres;
• herperovirus form;
• syphilis inflammation of the glans penis (balanoposthitis);
• syphilis inflammation of the vulva and vagina (vaginitis, vulvovaginitis);
• abortive form of hard chancre (symptoms are almost invisible);
• giant chancre (change in diameter more than 2 cm);
• syphiloma of unusual localization (for example, on a finger or nipples);
• gangrenous form (with severe inflammation, suppuration and destruction of surrounding tissues);
• additional tissue infection (the skin around the ulcer becomes inflamed, swollen and painful).

Note that primary syphilis has two stages - seronegative and seropositive. Each of these stages lasts 3 weeks. During the seronegative stage, serological tests do not confirm the diagnosis.

Diagnosis of primary syphilis

Diagnosis is based on direct and indirect analyses. The direct method allows you to detect bacteria in the discharge from the primary focus (hard chancre) or by puncturing the lymph node adjacent to the ulcer.

The samples taken are sent for dark field microscopic examination, which is commonly used in the diagnosis of primary and congenital syphilis. This method is not recommended in cases where the lesions are located in the oral cavity or anal region (because of the difficulty in differentiating pallidum spirochetes from other, non-pathogenic spirochetes often found in these areas). In this case, a direct immunofluorescent reaction is performed.

The most common indirect method for diagnosing the disease is serological tests. These tests should detect antibodies produced by the blood upon contact with pathogenic bacteria. Serological tests are non-specific (screening) and specific. Usually the doctor prescribes several tests at once:

• precipitation microreactions;
• immunofluorescent reaction;
• enzyme immunoassay;
• analysis of passive indirect hemagglutination;
• Nelson-Meyer test (treponema pallidum immobilization reaction).

Why is it necessary to undergo multiple tests? The fact is that no test is 100% accurate, so the final diagnosis is made only after obtaining a complete picture from several studies.

Treatment of primary syphilis

The gold standard in the treatment of syphilis (both primary and its subsequent stages) is penicillin intravenously or intramuscularly. In the primary form, the duration of pharmacotherapy is 2 weeks.

The mechanism of the effect of penicillin should be clarified separately. This antibiotic has a different effect on the destruction of pale treponema and regression of clinical serological reactions. The disappearance of bacteria occurs on average 9-10 hours after the injection of penicillin. This process is accompanied by the occurrence of a temperature reaction and lasts several hours. The increase in body temperature is attributed to the active destruction of spirochetes under the influence of drugs, and the associated toxic effect that causes an allergic reaction. It does not pose a threat to the health and life of the patient.

Other antibiotics are prescribed only in case of allergy to penicillin. Most commonly used:

• erythromycin;
• tetracycline;
• oxytetracycline;
• chloromycetin;
• azithromycin.

These antibiotics have a weaker effect compared to penicillin. There are cases when such therapy did not give positive results (perhaps this was due to a violation of the medication regimen). The disadvantage of these antibiotics is their uneven absorption in the intestine, the destruction of the intestinal flora and frequent side effects from the digestive system.

In the case of syphilis, prophylactic treatment is also applied to all sexual partners of the patient, regardless of whether they have symptoms of the disease. Do not wait for the results of serological tests - treatment should be started as soon as possible. As a preventive therapy, a person is administered procaine penicillin in a single daily dose of 1,200,000 units intramuscularly or 5 injections of benzathine penicillin at four-day intervals (the first dose is 2,400,000 units, the rest are 1,200,000 units each).

Treatment with folk remedies

Patients are strictly forbidden to ignore traditional medicine in favor of folk remedies. Not a single herbal preparation fights the causative agent of syphilis, so you can only cure the disease with a doctor.

Herbal medicine can be used to support immunity and reduce the side effects of medications. To do this, take inside tea from chamomile, marigold, lime blossom and rose hips.

Prognosis and complications of primary syphilis

The curability of the disease reaches 100%. However, after recovery, the patient does not acquire immunity against this type of infection, so the risk of re-infection is not excluded.

Complications of primary syphilis can be:

• phimosis (narrowing of the foreskin, inability to expose the head of the penis);
• paraphimosis (inability to bring the foreskin back to the head of the penis);
• swelling of the genital organs;
• secondary infection.

During antibiotic treatment, there is a risk of the following complications:

1. The Yarisch-Herxheimer reaction is a rapid disintegration of the spirochete after the first injection of penicillin, which causes an increase in body temperature up to 40C, nausea, chills, tachycardia, and general weakness. It is recommended to take enough fluids before and during treatment to reduce the intensity of symptoms. Such an adverse reaction is not a contraindication to the use of penicillin. It is most often observed in the early stages of the disease, as well as in patients with AIDS.
2. Neurotoxic reactions (occur extremely rarely) - psychological anxiety, impaired consciousness and hallucinations that quickly pass without leaving any traces in the body.
3. Anaphylactic shock - each patient undergoes a sensitivity test before starting treatment with penicillin, which should ensure the safety of treatment with these drugs. Anaphylactic shock belongs to rare complications when using this antibiotic.

If the disease is not treated, the complications will be extremely severe. Syphilis in advanced stages leads to disorders of many organs and systems (musculoskeletal system, cardiovascular and nervous systems), disability and even death.

Prevention of primary syphilis

Prevention of syphilis is built, first of all, on the safety of sexual life. Sex should be with a permanent partner, in whose health you are sure. It is useful to use condoms during sexual intercourse (this applies to vaginal, oral and anal sex), but remember that this method of contraception does not give a 100% guarantee against infection.

To exclude the possibility of non-sexual infection, it is recommended to carefully observe the rules of personal hygiene, especially in situations where the possibility of contact with objects touched by a sick person is not ruled out.

A photo

If the course of a sexually transmitted disease is not aggravated by anything, approximately four to five weeks after treponema enters the body, the incubation period ends and the primary signs of syphilis appear. Unfortunately, this stage is not rare, since it is quite difficult to determine the initial period without specific analyzes (only by signs or symptoms), so all photos showing the primary symptoms of syphilis could only be taken after the end of the incubation period.

Signs, manifestations and symptoms of the primary stage of the disease

It will not be news to anyone that the treatment of any disease will be the more successful the sooner it is started. That is why those diseases, the symptoms and signs of which are manifested in such a way that it is impossible not to notice them, cause doctors less concern. As for the primary manifestations of syphilis, they often go unnoticed by the patient. This is facilitated by many factors, the main of which is the location of the primary signs of syphilis, the photo of which is not even always possible to take, as well as the absolute painlessness of the manifestations.

A symptom indicating that primary syphilis is developing in the body is a hard chancre. This is an absolutely painless sign, more often 1 than a group that does not itch, does not become inflamed and will not cause other unpleasant sensations. Photos showing such a manifestation show that it can be easily confused with a sign of more harmless formations, the symptoms of which occur on the human body. As a rule, the chancre first appears where there was contact with pale treponema - most often it is the genitals. If a person who suspects that one of his sexual partners could be infected with syphilis finds signs or symptoms in himself that he could see in the photo of patients with syphilis, then most often treatment begins in a timely manner. Otherwise, primary syphilis, a photo of which, like pictures of signs and symptoms, can be easily found on specialized sites, becomes secondary.

There is another manifestation, the presence of which should tell a person that a venereal disease is developing in his body. Such a sign is lymphadenitis, i.e. inflammation of the lymph nodes. By itself, this symptom is by no means a specific manifestation of a sexually transmitted disease, although, of course, it requires some control and treatment. But if the inflammation of the lymph nodes, especially the inguinal ones, coincided with the appearance of a painless neoplasm on the genitals or the inner thigh, most likely, this symptom indicates precisely the primary period of syphilis.

In addition to these signs, as well as symptoms, others are also possible, for example, general weakness, fever, fatigue. As a rule, the manifestations are similar to the symptoms and signs of colds, and a person can even start taking antiviral drugs on their own, unaware of their ineffectiveness.

Another sign indicating the presence of treponema in the body and which cannot be seen in a photo or picture is a positive serological reaction. It should be noted that this is a specific symptom of exactly the 1st period, since from the moment of infection the indicators are seronegative, moreover, they remain seronegative throughout the entire incubation period and the first 7-10 days of stage 1. Also, the case histories of some patients indicate that seronegative reactions, as a symptom, are possible during the entire period of the disease. In addition, in recent years, the period of seronegative reactions has been steadily increasing, which prevents timely detection and treatment of the disease.

As can be seen from the listed signs of the primary stage of the disease, it is quite difficult to detect it. This leads to the fact that the disease progresses, gradually moving into the secondary stage. By the way, the disappearance of the manifestations characteristic of 1 syphilis does not mean that the body managed to cope with the disease on its own and treatment is not required - it only indicates an aggravation of the condition and the transition of the disease to the secondary period.

Treatment of primary syphilis

Both primary and secondary syphilis are treated in the same way - with antibiotics. True, the 1st stage is treated much faster, since the photos show that there are no serious changes (at least those that are noticeable) with the human body, while the secondary invariably suffers from internal organs and during treatment one should pay attention not only to general stabilization work of the body, but also for the treatment of individual organs and systems. The most important thing that ensures the success of treatment of both the first and any other stages of a sexually transmitted disease is absolute adherence to the recommended prescriptions.

Remember that the course of treatment should last as long as it is written in the medical history, and not until the manifestations of the disease disappear. In addition, it is desirable to prescribe prophylactic treatment for all sexual partners with whom the patient had contact for six months before the discovery of the disease, or within 4-5 weeks before the appearance of a hard chancre (the date is set according to the medical history). As a rule, the history of primary syphilis does not contain any surprises, and generally accepted antibiotic therapy soon brings positive results.

Complications of primary syphilis

As a rule, primary syphilis, pictures of which can be easily found on specialized sites, is easily treatable, and after a few weeks only entries in the medical history remind of the disease. Primary seronegative syphilis is the easiest to treat, since this is the very initial period of the disease, but specific tests are required to detect it, which are extremely rare. Stage 1 does not carry specific complications in the form of damage to organs or body systems.