- History reference
- Causative agent
- Ways of infection
- Stages of development of the disease
- Incubation period
- Primary syphilis
- Secondary syphilis
- Tertiary syphilis
Syphilis is a dangerous infectious disease that gradually affects almost all organs and the central nervous system of a person. Without adequate treatment, it develops to the last stage, the symptoms of which can lead to irreversible deformities and death.
Syphilis accompanies mankind since ancient times. Mention of this disease occurred in the works of Avicenna, and images of people with characteristic symptoms in the form of ulcers and deformities can be seen in old paintings.
As for the name, some sources refer to the essay by the scientist Frakastoro, who in 1530 described a similar disease in a swineherd named Sifil. And some believe that the name of the disease is taken from the mythological character Cifilus, who sent the disease as a punishment to people.
For the first time the epidemic was officially recorded at the end of the 15th century in Europe and Asia. In Russia, syphilis appeared in 1499. At first, due to religious prejudices and medical illiteracy, the disease was not treated, but when the infection became rampant, patients were isolated, attempts were made to stop the process. The first systematic measures against syphilis began to take place under Peter I. At that time, the illness was called “Franz-Venus,” which means “French disease.” It is because of the uncontrolled spread of syphilis that the first special venereal clinical complexes were created.
The pathogen bacterium was only detected in 1905. The cause of the disease was pale treponema (pallidum) from the spirochetic family. The word “treponema” in Greek means “rotating thread.” This definition accurately describes the bacterium – a thin flexible spiral that is constantly moving, looks like a corkscrew. Treponema produces a special mucus-like substance that forms around it a capsule that protects against phagocytes (immune cells of the body), as well as some antibiotics.
It is a relatively resistant to the environment microorganism. Once on any item with the discharge from the sick person, the bacterium will live until they are completely dry. Treponema during the year can remain viable in a frozen state. The bacterium dies within 10-15 minutes at a temperature of 60 ° C, and when heated to 100 ° C dies instantly. Treponema continues its vital activity even in a human corpse, and more than 3 days. Outside the body in the open air is not able to maintain vitality.
With the onset of adverse conditions (taking antibiotics, the production of antibodies, lowering the temperature) the bacterium is twisted into a tangle – a cyst. Thus, the pathogen tries to survive. The disease at the same time goes into a sluggish or hidden form, but the number of cysts is constantly growing. Transformation into an L-form is also an option to protect against adverse effects. In this case, the cell wall becomes thin, a large volume of DNA strands is formed.
The greatest effect is the treatment in the early stages, since at this time only the easily resilient antibacterial preparations of the spiral-shaped treponema are present in the body. In the later period, cysts and L-forms appear, which acquire immunity against a number of antibiotics.
Ways of infection
A man in 99% of cases is infected with syphilis during traditional sexual intercourse with an infected partner or with other types of intimate contact (including kisses), when secretions fall on the mucous membranes and into the body.
Treponema is also transmitted through fresh blood: donation, using someone else’s razor, toothbrush, needle. In such cases, transfusion syphilis is diagnosed.
Domestic way to bring the pathogen into the body can only be if the damaged skin or mucous membranes were released from the ulcers of the patient or other biological fluids. The transmission of domestic syphilis can occur, for example, when using someone else’s wind instrument, a pipe, cigarettes, or mugs. Medical workers are at risk of contracting household syphilis by contact with the patient’s blood (dentists, obstetricians, surgeons, pathologists).
Stages of development of the disease
Syphilis is characterized by the passage of 4 stages of development, including the incubation period. The disease proceeds in waves: relapses are replaced by hidden forms. As the duration of the presence of treponema in the body increases, the symptoms become more dangerous.
Treponema at the earliest opportunity quickly penetrates the damaged skin or mucous membrane. The bacterium multiplies in the lymph, and from there it is sent to the systemic circulation. The more pathogen in the blood, the faster the incubation period will end. The term ranges from 9 to 90 days, on average, the disease begins to manifest itself after 20 days. No signs appear during the incubation phase.
The incubation period is completed by the appearance of a solid ulcerative formation, a chancre,at the site of the introduction of the bacterium into the body . It is also called primary syphiloma. In men, the chancre is usually localized on the genitals, in the scrotum, on the inner thighs, on the pubis. But if the infection has occurred as a result of practicing non-traditional forms of sexual activity, then syphiloma can occur in the anus region, as well as in the mouth, on the lips and on any other parts of the body (extragenital chancre).
Primary syphiloma is a painless dimple in the skin, resembling a crater, with clearly defined dense edges-rollers. The diameter of the formation of approximately 10-20 mm, but in the pubis and on the scrotum can be much more. The bottom of the chancre is either flat and solid, or erosive – a recess with pus and inflammatory fluid.
Erosive ulcers usually occur on the head of the penis. The bridle is characterized by the formation of elongated chancres. If the primary sifiloma was formed in the urethra, then painful urination, bleeding is noted. When there are several points of invasion of pale treponema into the organism, multiple chancre are possible, separate or merging into foci.
In men, the following types of primary syphiloma are distinguished:
- diphtheric , covered with a gray crust;
- herpetiformis , resembling herpes sores;
- cortical for it is characterized by a quickly drying top layer;
- Folman balanitis – a scattering of small erosions on the head of the penis;
- painful , localized on the frenulum of the penis, in the folds of the anus.
An additional infection may be attached to an open ulcer on the penis, which is fraught with the development of the following consequences:
- phimosis (sticking of the foreskin to the head of the penis);
- gangrene (tissue death);
- head rejection , destruction of the urethra;
- balanoposthitis – inflammation of the head and foreskin.
Chancres may not appear if the infection has occurred through household or medical means, that is, the treponemes have invaded the body without overcoming the epithelial barrier: through a cut, with a needle, during a blood transfusion. Such syphilis is called decapitated . In homosexuals, the disease in the primary phase is often not diagnosed, since the anorectal form is often asymptomatic.
At the initial stage of the development of primary syphilis, there are signs of infection of the lymphatic system: 5–8 days after the formation of chancre, the lymph nodes are thickened (bilateral lymphadenopathy), and there is no pain. In genital and anal infections, the inguinal lymph nodes are the first to react, since it is they who drain both the sex organs and the rectum.
One of the most important symptoms of syphilis infection is lymphangitis, which is an inflammation of the lymphatic vessels. If the chancre is localized in the area of the penis, the inflamed lymphatic vessels look like a tortuous cord under the skin. Inflammation can develop into pronounced edema, while the sexual organ significantly increases in size, loses sensitivity.
From the point of view of diagnosis, primary syphilis is divided into seronegative and seropositive. In the first case, blood tests for antibodies are negative, in the second – positive. Seropositive phase occurs 3-4 weeks after the onset of chancre.
After 1-3 months in 40% of patients, the chancre heals, leaving an inconspicuous round scar with a rim. But for many, primary syphiloma remains on the background of secondary signs.
After 6-8 weeks after the appearance of chancre begins a massive release of treponema into the bloodstream (syphilitic septicemia). The bacterium spreads throughout the body, causing intoxication: headaches, aching joints, general weakness, fever. These manifestations indicate that the internal organs, the musculoskeletal, and the nervous system are already involved in the pathological process.
7-10 days after the onset of malaise on the mucous membranes, skin manifold various rashes appear – secondary syphilides. The period of secondary syphilis proceeds in waves: the acute state becomes hidden (defined as “secondary latent syphilis”). During each recurrence, the rash becomes larger.
Secondary syphilis is the most contagious stage, because the rash contains a huge concentration of treponema.
This stage lasts from 2 to 5 years, is divided into two phases:
- fresh secondary syphilis . During this period, there is the first appearance of a rash. Education on the skin abundant, small, bright, may vary in shape and color. A rash can occur on any part of the skin, as well as on mucous membranes;
- recurrent secondary syphilis – repeated manifestations of rash. Formations are no longer so abundant and chaotic, often grouped into arcs, circles, curved lines.
In secondary syphilis, several types of rash (syphilides) may appear simultaneously: vesicular (vesicles), nodular (papular), pustular (pustular), and spots (roseola). All of the above morphological elements are benign:
- disappear in 2-3 months, without leaving significant changes on the skin (except for severe ulcers);
- do not worsen the general condition of the patient;
- Do not bother with itching and inflammations.
In some cases, small scars or peeling remain.
Often the symptom that accompanies secondary syphilis is syphilitic leucoderma – discolored spots on the neck and collarbone. This phenomenon is called the necklace of Venus . The reason for their formation is a violation of skin pigmentation. In half of the patients, the pathology of the cerebrospinal fluid is recorded. The symptom does not respond to therapy, it exists from two months to several years.
In case of primary fresh syphilis, there is an increase in the liver and spleen, signs of gastritis, symptoms of kidney damage are recorded. These manifestations are associated with general intoxication and after some time subside. Often there is pain in the bones (especially in the lower limbs), which are aggravated at night. On the part of the nervous system, sleep disturbance, nervousness, signs of latent meningitis are possible.
In 20% of cases, secondary to syphilis, hair loss occurs – syphilitic alopecia. In men, this symptom is more common than in women. Hairline on the face (beard, mustache) disappears, focal baldness is possible on the head, eyelashes and eyebrows fall out. The cause is a malnutrition of the roots due to intoxication. However, the bulb is not damaged, so after a month of competent therapy, the hair grows back.
Nail damage is an infrequent symptom. It is expressed in the appearance of nodules or pustules on the periungual ridge. Gradually, the inflammation increases, passes to the nail, which becomes dirty-brown, crumbles, often completely rejected.
In secondary syphilis (mainly when it is decapitated), the mucous membrane of the mouth, the larynx, and also the nasal passages can be isolated in isolation. Nodular formations (papules) often take the form of jars at the corners of the lips, and bright red plaques appear on the mucous membranes. At their distribution on a throat loss of a voice is possible. A complicated version of the lesion of the oral mucosa is syphilitic tonsillitis. The papules begin to ulcerate, which causes pain when swallowing, often the temperature rises and the general condition worsens.
An exacerbation usually does not linger longer than 2–3 weeks. Rashes gradually turn pale and disappear, the general condition is normalized, the disease enters a latent phase.
Secondary syphilis does not necessarily manifest itself rashes. Of all the symptoms, there may be a common ailment, like a cold. Signs of the disease may be absent altogether, then it immediately goes into the chronic phase.
Without treatment or with inadequate therapy, syphilis from the secondary stage goes to the tertiary (approximately 3-4 years after infection). At this stage, the amount of antibodies in the blood is reduced. Pale treponema manifests itself by periodic local activation, which leads to the growth of phagocytes – cells capable of absorbing foreign microorganisms. As a result, deep solitary ulcers form – gumma, at the edges of which the connective tissue is located, and in the center – a center of disintegration (necrosis).
The process of formation of gum begins with the appearance in the fatty tissue under the skin of a rolling nodule. Gradually, it is soldered to the surrounding tissues, expands, and is filled with inflammatory fluid. As the knot increases, the skin over the gummous formation becomes thinner and becomes purple. Gunma can grow to the size of a fist or more, capturing new tissues. In case of a mild outcome, the abscess opens and a little fetid liquid flows out. The purulent rod comes out later, after which a round fossa with a solid gray bottom remains and its scarring begins.
The gumma may consist of several foci, expanding in breadth and taking irregular outlines – gummy infiltration. If it is located near vital organs, there is a high probability of their damage due to the spread of a purulent focus, for example: destruction of the esophagus wall, bones, periosteum, and skull. Such gummas are called mutilating.
In addition to gummas, there are also hillocks in tertiary syphilis – bluish formations the size of a pea, arranged in groups. Subsequently, they either ulcerate and scar, or dry up.
The disease can be hidden for a long period. Some men may be carriers of pale treponema throughout life. But in most cases, the asymptomatic period ends with signs of a more formidable phase of the disease – tertiary syphilis, which leads to the following complications:
- late neurosyphilis . This definition includes a whole series of symptoms of central nervous system damage, for example: cerebral stroke, meningitis, progressive paralysis, as well as blindness atrophy of the optic nerve;
- late visceral neurosyphilis – serious pathologies of the liver and kidneys. The cardiovascular system suffers most;
- late syphilis of the joints and bones . The excessive mineralization of bone tissue and the formation of gum destroying it is characteristic.
In some cases, the disease reaches the last stage, since it is quite difficult to determine the presence of pale treponema in the blood due to the transition of the bacteria to various forms.
Video about the symptoms and manifestations of syphilis:
Despite the seriousness of the disease, timely diagnosis, proper treatment can completely cure syphilis.