Pale treponema (Treponema pallidum) - the causative agent of syphilis: microbiology, antigenic properties, immunity, general information on the diagnosis of syphilis. The causative agent of syphilis - pale treponema: description of the type of bacteria, causes and symptoms of venereal disease

The content of the article

Pale treponema

Morphology and physiology

Pathogenicity and pathogenesis

Immunity

Ecology and epidemiology

Syphilis and other treponematoses

Bacterioscopic research

Serological diagnosis of syphilis

Precipitation microreaction

Immunofluorescence reaction (RIF)

Treponema pallidum immobilization test (PIT)

Enzyme immunoassay (ELISA)

Pale treponema (Treponema pallidum) - a type of gram-negative pathogenic bacteria that are the causative agents of a widespread sexually transmitted disease -. Their discovery took place in 1905 and belongs to two German scientists - Fritz Schaudin and Erich Hoffmann. Bacteria have a spiral shape and belong to spirochetes. The number of curls, as a rule, varies from 8 to 14. The spiral tapers at the ends, its length is from 4 to 20 microns, its width is 0.2 - 0.5 microns, and the depth usually does not exceed 1 micron. The nucleus is absent, the genetic material is presented in the form of DNA molecules organized into chromosomes. The cell wall is formed by polysaccharides, which gives it strength and protects its contents from the adverse effects of external factors, including cell attacks. immune system person.

The nature of the movement of microbes resembles that of a corkscrew - they rotate around their axis and thus are introduced into the surrounding space. Their penetration into the tissue is facilitated by the presence of microtraumas - cracks, cuts, sores. Pale spirochete is characterized by high mobility, it owes its name to the fact that it stains rather poorly with special dyes used in the laboratory diagnosis of sexually transmitted diseases. This is due to the presence in its cytoplasm of a large number of hydrophobic elements. Dark-field microscopy or fluorescence is used to detect its unstained cells, which cannot be seen with a conventional microscope.

For the primary detection of the causative agent of syphilis, the material collected from ulcers and papules that form on the mucous membranes of the genital organs, oral cavity, and rectum is examined. Sometimes the lymph nodes are punctured. The blood serum is then analyzed and cerebrospinal fluid in which specific antibodies can be detected by serological methods. Infection in most cases occurs sexually. In addition, it is possible in domestic conditions (shared towel, dishes), with blood transfusion, during intrauterine development of the fetus or the passage of a child through the birth canal of a sick woman.

In the external environment, the causative agent of syphilis quickly dies, especially when exposed to disinfectants and antiseptics. It lasts a little longer at high humidity and low temperature. After penetration into the human body, pale treponema begins to multiply intensively and spread throughout the body. She causes heavy defeat skin And internal organs. A very unpleasant feature of Treponema pallidum is that the human body is not able to develop immunity to this infection, so even after successful treatment syphilis, there is a possibility of re-infection.

Pale treponema can provoke the development of severe autoimmune diseases that affect organs and various body systems. She possesses a high degree resistance to adverse conditions and is able to penetrate the body in different ways.

For effective treatment of pale treponema, it is necessary to conduct laboratory tests that will help determine the severity and form of the disease. There are several methods for diagnosing and treating spirochetes, depending on the stage of the disease.

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What is pale treponema?

Treponema pallidum is a bacterium that causes syphilis. It was discovered in 1905 by German microbiologists Eric Hoffmann and Fritz Schaudin. A pathogenic microorganism can enter the body through damaged skin or injured areas of the mucous membrane.

Treponema became known to microbiology only at the beginning of the 20th century, because it is difficult to see it even with a microscope. The microorganism has special properties in the refraction of light. Because of this, it is called the pale spirochete. Outwardly, it resembles a corkscrew, because it has a spiral shape and has a transparent structure.

Morphology provides the following structure of pale treponema:

• nucleoid with DNA;
• various semi-liquid components that control metabolism and protein synthesis;
• cytoplasmic membrane;
• the outer wall of the cell, which protects the bacterium from the effects of antibodies and drugs;
• organs of movement that help bacteria move through the body of an infected person.

Treponema is the classic form of syphilis. However, there are other subspecies of bacteria that are characteristic of certain geographical areas:

• in Africa and Southeast Asia - yaws;
• V Latin America- pint;
• in the Middle East - bejel.

Pale treponema is resistant to many antibiotics, including macrolides.



Blood test for syphilis - Wasserman reaction

Spirochete and the environment

Treponema reproduces in a humid warm environment at a temperature of 37 degrees by division. These favorable conditions are provided by the human body.



But when infected with a bacterium, the immune system begins to produce antibodies. Before the threat of destruction, the spirochete changes its shape, in which it is better preserved. It can take one of the following states:

1. 1. Cyst. To do this, the bacterium curls into a sphere and begins to produce protective mucus. The characteristic of the state resembles a kind of dream, because during this period the pathogen does not manifest itself in any way. Spirochete goes into a latent form. If the impact of antibodies decreases, then the bacterium "comes to life" again.
2. 2. L-shape. Its bacterium acquires when its protective wall becomes weak with incomplete division, which led to an increase.

If a pathogenic microorganism is in an external dry environment, then it dies. In case of contact with water or wet clothes, he is able to live for several more days. The life time of a bacterium under adverse conditions is also determined by temperature:

• she dies when exposed to heat of more than 60 degrees for 15 minutes;
• instant destruction of the structure occurs when the temperature reaches 100 degrees;
• at zero temperature, the bacterium can live for 2 days.

Alkaline and acidic environments are detrimental to spirochetes. She dies when exposed to her laundry soap or weak acid solution.



Ways of infection

Pale treponema is distinguished by its survivability due to its elastic structure and the ability to adapt to various adverse conditions. For its existence, oxygen is not needed, but only a moist, warm environment and blood plasma without fibrinogen.

The spirochete enters the human body by screwing into the tissue like a drill. The risk of infection is highest through sexual contact with an infected partner. But there are other ways of penetration of a pathogenic microbe:

• through hygiene items used by several people;
• through the blood;
• from mother to fetus - transplacental method;
• in case of violation of the conditions for the operation and dental procedures (careless disinfection of instruments).

Pale treponema at low temperatures change their shape, and does not die.



Symptoms and manifestations of diseases

Pale treponema causes syphilis in an infected person. The disease in the human body can develop and pass in 3 stages. Each stage of the course of the disease has its own signs and symptoms:

1. 1. Primary. At the site of penetration of the bacterium, a hard chancre is found - a painless, dense formation with a characteristic red tint. The patient has malaise, aches in all the bones and joints of the body, a slight increase in temperature and inflammation of the lymph nodes.
2. 2. Secondary. At this stage, treponema affects the internal organs and various systems. The patient may present with pancreatitis, arthritis, nephrosis, or hepatitis. A characteristic difference in the second stage of syphilis is a rash on the skin and mucous membrane, as well as an increase in the size of the lymph nodes.
3. 3. Tertiary. The last stage proceeds with the formation of accumulations of blood and lymph. Vivid symptoms begin to appear, but the latent course of the disease prevails more.



The most dangerous is primary syphilis, which poses a threat to others. At this stage, the infected person develops ulcerative formations on the skin and mucous membranes. Even a single sexual contact with a patient gives a 30% chance of infection, and if the proximity is constant (more than 2-3 times), then infection occurs with a 100% probability.

Methods for detecting the causative agent of syphilis

Treatment and getting rid of pale treponema depends on how timely syphilis was diagnosed in the patient. To date, there are several effective testing methods:

1. 1. Microscopic analysis of blood or urine of an infected person against a dark background. This is one of the most effective ways to study a spirochete because the bacteria will be in a familiar environment. To detect them and determine the stage of the disease, contrast staining is carried out with a special solution. This method can identify other pathogenic microorganisms that differ from pale treponema and do not affect the development of syphilis in the body.
2. 2. Burri staining of bacteria. To detect a spirochete, the urine or blood of the subject is mixed with a special ink and allowed to dry. If gray spirals are observed under a microscope, then syphilis is diagnosed.
3. 3. A smear from the mucous membrane of the penis. This method research allows to determine the presence / absence of pale treponema and treatment strategy. In order for the natural microflora not to interfere with the analysis and increase the accuracy of the result, the place where the smear is taken from is treated with special indifferent substances.
4. 4. Test for the total number of antibodies. After infection IgM antibodies formed in a week, IgG - a month later. Their concentrations in healthy person practically equal to zero. Therefore, if they have increased, then the initial form of syphilis is diagnosed. Analysis of the amount of total antibodies allows you to determine the stage of the disease and the tactics of drug therapy. Treatment is aimed at lowering the level of IgM and achieving a consistently high concentration of IgG. Studies have shown that this ratio allows you to develop a strong immunity to treponema.



Testing for antibodies can be complicated if the patient has thyroid diseases or oncological processes. The effectiveness of the study is low in pregnant women.

Treatment

To get rid of syphilis, only specialists should prescribe drug therapy, since self-treatment will not destroy bacteria, but will only change their shape.

If syphilis is detected in a timely manner at the first stage, then a successful cure is possible within 2 months. The main therapy is aimed at eliminating treponema with antibacterial drugs. They are prescribed and given to the patient under the supervision of doctors in a hospital setting. At the same time, immunomodulatory treatment is carried out.

Secondary or tertiary syphilis is treated with antibiotics given orally or by injection. All treatment lasts at least 3 weeks.

In some cases, syphilis occurs in conjunction with other sexually transmitted diseases. Then carry out treatment and concomitant diseases. With latent syphilis, the patient is prescribed intramuscularly Bioquinol. It is recommended to examine the partners of the infected person.



If pale treponema was found in pregnant women, then therapy is started from the 32nd week of the child's gestation to reduce the possibility of infection of the fetus. For this, penicillin injections are prescribed. If at birth the baby is still infected from the mother, then he is given intravenous and intramuscular injections. Apply preparations Sovarsen and Miarsenol.

It is necessary to try to minimize contact with infected people and not share the same things with them. Even after effective treatment, it is necessary to disinfect all objects that the infected person has touched. It is worth remembering that pale treponema is very tenacious.

Unfortunately, a huge number of people around the world become infected with venereal diseases every day, and some diseases can pose a real threat to human life. In particular, we are talking about syphilis, the causative agent of which is pale treponema. It should be noted that the above disease belongs to the category of infectious, and it proceeds systemically, affecting not only the skin, but also the tissues of the internal organs.

Dangerous bacterium

Pale treponema is a very thin, long and spiral microorganism that is highly mobile. Previously, it had a different name: lues.

It belongs to the class of anaerobes - it does not need oxygen for life. This bacterium may be in nerve fibers, lymphatic and blood vessels, in interstitial crevices and cells of internal organs.

The virus “destroyed” by macrophages and leukocytes in most cases remains viable and is finally “killed” only with the help of antibiotics. In some cells of the immune system, treponema pallidum is enclosed in a polymembrane phagosome, and after the leukocyte is destroyed, such membranes can become extracellular.

The bacterium reproduces by transverse division, and this happens every 30-32 hours.

Outside the body, a dangerous microbe is unstable and dies during heat treatment (60-100 degrees Celsius).

Antibodies to the virus

It should be noted that, as a rule, the causative agent of syphilis can be detected on the mucous membranes. Moreover, the disease can be transmitted to others not only sexually. You can also become infected through household items: towels, dishes, objects. We should not forget that the milk of an infected mother is also an environment in which the pathogen is present, that is, a child can also become infected with a sexually transmitted disease. The situation is aggravated by the fact that if there is a pale treponema in the blood, then the body is not able to develop immunity to syphilis, which means that anyone can become infected with it again after treatment.

At the same time, it should be noted that many people who became victims of the above ailment produced antibodies to the syphilis virus: in the primary and secondary episodes, in 88% and 76% of patients, respectively. The rest of the patients had no "protective" cells at all. In particular, there are no lgM antibodies at all in those who have been treated for syphilis before. However, it is a mistake to think that the absence of "protective" cells is a sign of "unskilled" treatment. Please note that only in 20% of cases it is possible to detect antibodies to treponema at the latent stage of the development of the disease.

stages

Of course, pale treponema is a serious health hazard. The symptoms of infection can vary. Let's consider the issue in more detail.

First stage

In the initial phase of the disease, a person develops a chancre that is hard in structure on the mucous membrane of the mouth, rectum or genital organ.

Also, the patient has an increase in local lymph nodes. 4-6 weeks after the appearance of the first signs of ulcers heal.

Second stage

In the central phase of the course of the disease, a syphilitic symmetrical form appears in a person. The patient suffers from headaches, his body temperature rises, he feels unwell. In addition, all lymph nodes increase, in some cases hair loss is observed, and wide condylomas form on the genitals.

Already at the first stage, it is necessary to take measures to treat such a dangerous disease as syphilis. Pale treponema, if not detected in time, can cause irreparable harm to health. As a rule, this happens in the third stage of the disease.

Third stage

The neglected form of syphilis is characterized by the following: in a person, the nervous system, head and internal organs are affected.

Treatment Methods

What is dangerous syphilis - complications of syphilis

Early complications (primary and secondary syphilis)

Gangrene and self-amputation of the penis
Early neurosyphilis: syphilitic meningoneuritis with auditory and optic nerves(with their subsequent atrophy - blindness and deafness)
Testicular involvement (syphilitic orchiepididymitis)
Liver and kidney damage
Cosmetic complications - rash, hair loss, scarring at the site of chancres

Late complications (late latent syphilis, tertiary syphilis)

Complications that can lead to death of the patient
Syphilitic aortitis
Syphilitic aortic aneurysm
Syphilitic pneumosclerosis and bronchiectasis

Complications leading to disability of the patient
Perforation of the hard palate (inability to eat)
Saddle nose (difficulty breathing)
Gummy periostitis, osteitis and osteomyelitis (limitation of movement)

Complications leading to persistent neuropsychiatric disorders
(Late neurosyphilis)
Late meningovascular syphilis with damage to the optic and auditory nerves
Tabes
progressive paralysis

Cosmetic Complications
The formation of large, disfiguring scars in place of tuberculous and gummous syphilides
saddle nose

Complications during pregnancy

Premature termination of pregnancy
Fetal death
Early congenital syphilis and neonatal death
Late congenital syphilis leading to disability and early death

What is the Tuskegee Experiment (outcomes of untreated syphilis)

The Tuskegee Experiment is an illegal and immoral experiment conducted by the US Health Service for the purpose of documentation natural flow syphilis in blacks and identifying racial differences in its clinical manifestations. The experiment began in 1932 in Macon County, Alabama under the name "Tuskegee Study of Untreated Syphilis in the Negro Male" - Tuskegee Study of Untreated Syphilis in the Negro Male negroid race- and continued for 40 years.
399 patients with syphilis and 201 healthy people were involved in the experiment. Patients were not informed that they were ill with syphilis, were not advised on how to avoid the spread of this disease, and were not treated throughout the entire observation period. This study was the longest (1932 -1972) in the history of medicine is not a therapeutic experiment on humans and an example that testifies to the possibility of exploitation of persons not only of the black race, but also of any other population potentially vulnerable in terms of race, ethnicity and gender, disability, age or social status.
As a result of the experiment, 28 men died of syphilis, 100 died due to complications associated with syphilis, more than 40 women were infected with syphilis and more than 40 women fell ill, 19 children were born with congenital syphilis. Photo. Congenital syphilis

Treponema pallidum is a bacterium that causes the sexually transmitted disease syphilis. It is a microorganism in the form of a spiral. Due to this form, it is referred to as spirochetes - spiral-shaped bacteria.

Spirochetes are a group of bacteria that are very similar to each other. Among them there are pathogenic bacteria, and harmless. In addition to the causative agent of syphilis, they also include pathogens of leptospirosis, relapsing fever, borreliosis, as well as conditionally pathogenic (harmless) bacteria that live on human skin, in the genital tract and on the oral mucosa.

What does a pale spirochete look like?

Treponema pallidum has a small size (a quarter of a micrometer), a filamentous spirally twisted shape and pointed ends. In general, it is very similar to other spirochetes. It can be distinguished by the number of curls (on average, from 7 to 14), as well as by characteristic movements: it spins around its axis, bends, and makes translational and undulating movements. The length varies from 6 to 10 micrometers, the diameter of the curls is about a quarter of a millimeter.

In the photo and under the microscope it looks like a delicate filamentous formation, almost transparent in color. The bacterium does not stain with any dye, so in microbiology it is called "pale". In microbiology, this type of bacteria is called gram-negative. To see it, it is viewed against a dark background, directing light at the bacterium. The rays refracted by it reflect light and allow you to see the bacterium. This is quite difficult, because, in addition to being transparent, the bacterium moves quickly and is difficult to catch.

It is extremely difficult to cultivate the causative agent of syphilis on artificial nutrient media.

If conditions are favorable, then the reproduction of pale spirochetes occurs every 33 hours: the bacterium is divided transversely into several curls, each of which contains all the structures of a full-fledged bacterium.

Spirochetes are made up of parts that are standard for bacteria:

1. kernel with included DNA- stretches along the entire length of pale treponema
2. cytoplasm (protoplasmic cylinder), which includes the main functional elements microbe. First of all, it provides protein synthesis (in ribosomes) and energy is produced (in mesosomes)
3. cytoplasmic membrane - carries nutrients from the outside, participates in cell division and in the transformation of adverse conditions (more on this later), plus it serves as a warehouse for enzymes and antigens
4. microcapsule - the outer cell wall that protects the spirochete from external environment, primarily from phagocytes and antibodies.

At the ends of the bacterium, outgrowths, flagella, are located, with the help of which it moves. Thanks to them, treponema pallidum is very mobile. How mobile she is can be understood from this video:

"Sweet life", or ideal conditions of existence

Treponema pallidum loves warmth, moisture and lack of oxygen. Once in the body (usually sexually), the bacterium is screwed like a corkscrew through the mucous membrane or damaged skin inside, and gets to the nearest lymphatic vessels and lymph nodes. The lymphatic system is heaven for her. The optimum temperature (37⁰) and the lack of oxygen make this system her favorite habitat. Over time, it spreads throughout the lymphatic system, and during periods of greatest activity, it even goes into the blood. This is usually accompanied by symptoms of secondary syphilis - the appearance of a rash spread over the entire surface of the body. During the primary and secondary periods, treponema can also be found in semen, cervical secretions, saliva, and skin rashes.

Surprisingly, treponema is difficult to tolerate vaginal secretion and rarely settles on the walls of the vagina. This is due to the bacteria's love for a neutral environment (pH 7.4). The acidic environment of the vagina immobilizes the bacteria and partially neutralizes it. Unfortunately, this is not enough to prevent infection, and the bacterium can safely settle on the cervix or at the entrance to the vagina.

While in the body, the causative agents of syphilis can survive, even if the bacterium has captured and is trying to digest a leukocyte or macrophage - the body's main defense cells. This property allows pale treponema to resist nonspecific immunity (that is, it does not specialize in a specific pathogen, but is aimed at enemies in general).

Treponema in severe conditions. survival tactics

If unfavorable conditions are created in the body for the life of a bacterium (for example, if a person starts taking antibiotics), then it can change its form to another one that is more adapted to survival. There are two such forms: cystic and -form.

Even in these protective forms treponema is quite realistic to enter the body and infect a person with syphilis. At the same time, in the -form, it becomes even easier for the microbe to do this, in this form it penetrates better through barriers - skin and mucous membranes, including those treated with antiseptics. If the infection occurred in the cyst form, then the lengthening of the incubation period, latent syphilis, and the development of drug resistance are more likely.

As syphilis progresses, the ratio between different forms pale treponema present in the body is changing.

1. In the early stages, standard spiral shapes predominate. They have not yet penetrated into the cells of the body, are actively dividing and are more vulnerable to antibiotics.
2. In secondary recurrent syphilis already observed a large number of cyst forms. Microbes caught by phagocytes have penetrated into them. Treatment is less effective.
3. With late syphilis, there are noticeably fewer standard forms, protective ones predominate. The total number of treponemas is reduced.

In order to avoid a recurrent (persistent, periodically manifested) course of syphilis, it is important to start treatment as early as possible and only (!) Under the supervision of a physician

Treponema outside the body. How long will he live?

Treponema pallidum does not like the external environment. On a dry surface and when dried, the bacterium dies almost instantly. In a humid environment and water, it remains much longer: in wet wipes, handkerchiefs, underwear - it can survive for several days. During washing of things (at a temperature of 60⁰), pale treponema is neutralized within five to twenty minutes, and when boiled, within a few seconds. Cold treponema tolerates somewhat easier. In the refrigerator, at 0⁰, it can live up to two days. In medicine, there were even cases of infection with syphilis from corpses that had lain for some time in refrigerators.

Also, the bacterium does not like acidic and alkaline environments. She instantly dies when using laundry soap and 0.5% solutions of alkalis and acids.

What can kill treponema?

The bacterium is sensitive to the action of many antiseptic solutions. She instantly dies when treated with a 0.05% chlorhexidine solution, 0.001% sublimate solution, 1-2% phenol solution and already 70% alcohol.

Vodka (40% alcohol) kills the causative agent of syphilis less effectively: for complete death, they must be kept in it for up to 20 minutes. Also, in relation to pale treponema, potassium permanganate is ineffective: it is not used at all to neutralize pale spirotech.

To neutralize treponemas that have already penetrated the body, antibiotics are used: penicillins, cephalosporins, tetracyclines and macrolides. Penicillins are the main drugs used to treat syphilis in the first place. The remaining antibiotics are reserve drugs: they are less effective and are used only when penicillins are intolerant or ineffective.

How pale treponema is found in the body

The first analysis to clearly identify the pathogen and diagnose syphilis was invented by August Wasserman in 1906. Prior to this, people were guided solely by the symptoms.

Treponema pallidum or pale treponema is a microorganism in the form of a spiral with 8-12 curls, which has a cellular membrane, due to which a certain period of time may not lose its pathogenicity under the influence of factors environment. The bacterium belongs to spirochetes and is the causative agent of a disease such as syphilis.

Characterizing features of the pathogen

Once in the environment with saliva, semen or secretions from erosions and ulcers of the patient, pale treponema is able to maintain its activity until the substance in which the treponema resides dries out.

The causative agent is resistant high temperatures, 54 degrees above zero destroy the pathogen only after 15 minutes, higher numbers become detrimental to treponema pallidum faster. Even during boiling, the pathogen does not lose its activity for several seconds. An interesting fact is that at a temperature of 42 degrees treponema becomes more active and only dies over time. The causative agent of syphilis is considered pathogenic for three days, even if it is in cadaveric material.

The pale spirochete has a high level of resistance to the effects of low temperatures, even when frozen, it retains its pathogenicity for 12 months. The best living conditions for the pathogen are an oxygen-free environment and low temperature.

Pale treponema dies under the influence of disinfectants and some types of antibacterial agents.

Unfavorable for the pale spirochete (lead to its death) are:

• arsenic and bismuth;
• penicillin;
• mercury;
• influence of acids and alkalis;
• exposure of the microorganism to light and ultraviolet radiation;
• antiseptic solutions.

However, the findings of studies on the resistance of the causative agent of syphilis to adverse environmental factors indicate that treponema in some cases can still retain its activity and cause disease even when oxygen penetrates to it, when dried and exposed to light rays.

Transmission routes

The entrance gate through which the pathogen enters our body is the injured tissue surface of the mucous membranes of the oral cavity or genital organs.

Transmission of pale treponema occurs:

• Sexually - with unprotected sexual relations with the patient.
• Household - as a result of the use of contaminated towels, linen, cosmetics.
• Transplacental - from a sick mother to a child.
• Vertical - when a child passes through infected birth canal mother.
• Hematogenous - during the transfusion of blood and its components, during surgical interventions, the use of a common syringe with a sick person (especially characteristic of drug addicts).

It should be noted that there is a rather high risk of infection among employees of medical and cosmetic establishments, especially if they carry out procedures associated with a violation of the integrity of the skin.

The greatest number of cases of infection is diagnosed in people who have a promiscuous sex life and do not use contraceptives.

Clinical manifestations of the disease

Please note that a high level of contagiousness is observed in patients with primary and secondary syphilis, which is manifested by the formation of the first manifestations of the disease on the skin and mucous genital organs. It is during this period of time that intensive reproduction and release of pale treponema into the surrounding space takes place.

In our time, a growing number of patients in whom syphilis is manifested by extragenital chancres, which are localized on the mucous membrane of the mouth, pharynx, anus. Elements of the rash can be observed on the face, and syphilis on the palmar surface of the hands and soles.

• The duration of the incubation period can vary, and range from 3 weeks to 3 months, while the spread of microorganisms with the flow of lymph and blood, as well as their intensive reproduction in the lymph nodes, will be observed.
• In the area of ​​​​introduction of pale treponema, a hyperemic nodule of a dense consistency soon appears, which later forms an ulcer, it is called a hard chancre. In most cases, this pathological symptom is localized on the penis, labia, vagina, chest, fingers, lower abdomen and oral cavity. As for the size of the ulcerative process, they can range from microscopic to very large, there may be several of them. In parallel with this, there is an increase in the size of the lymph nodes in the area of ​​localization of the infection zone.
• After 10 days from the moment of the appearance of a hard chancre, secondary syphilis is formed, characterized by the spread of infection throughout the body by the hematogenous route. Clinically manifested by the appearance of elements of a pink rash, they are called secondary syphilides. A characteristic feature is their independent disappearance and reappearance after a while. There is an addition of signs of intoxication, namely: a feeling of heat, general weakness, pain in the joints, sudden loss body weight. secondary form pathological process accompanied by the formation of tonsillitis, stomatitis, genital warts, which are localized on the genitals and an increase in lymph nodes. Please note that in the absence of adequate and timely therapy, the disease passes into the third stage, which is characterized by damage to nerve fibers.
• The tertiary form of syphilis can manifest itself 3-15 years after infection with pale treponema. Its course is characterized by the appearance of gums and foci of destructive changes. There is a violation of the functioning of internal organs and systems of an irreversible nature. The patient begins to be disturbed by respiratory and speech disorders, the process of swallowing becomes more complicated. Proceeding in this form, the disease leads to disability or even death.

Syphilis of congenital origin, as already noted, is formed as a result of infection of a child from a sick mother while still in her womb. It is characterized by the presence of such pathological symptoms as:

• congenital deafness;
• keratitis;
• Hutchison teeth.

Diagnostics

Before starting to treat the patient, the doctor, in order to make the correct diagnosis and prescribe effective therapy, examines the patient and collects anamnestic data, and also prescribes the following:

• Microscopic and bacterioscopic examination of a smear taken from the surface of the chancre (the material is tissue exudate) or biopsy material of the lymph node (but only in the first month of the disease). For better information content of the smear, the surface of ulcers and erosions is pre-lubricated with saline, the material is taken and the preparation is prepared for microscopic examination. The material is stained according to Romanovsky-Giemsa, while pale treponema acquires a pink tint. It is necessary to focus on the fact that live pale treponemas in an unstained smear are not detected under a light microscope. In this case, the use of dark-field or phase-contrast microscopy is considered justified. Treponema has the ability to lead to the refraction of light rays and looks like a spiral strip of white.
• Serological tests, the purpose of which is to diagnose antibodies to the causative agent of syphilis in blood plasma. Most often, the Wassermann reaction and the reaction of fast plasma reagents are carried out. These studies are considered mandatory and are used even when performing a medical examination with preventive purpose in polyclinic medical institutions.
• Reactions of immunofluorescence, hemagglutination, immobilization of treponemas. These studies have an extremely high level of sensitivity and accuracy. Allow to detect antibodies in human blood. For example, IgM indicate the presence of an acute inflammatory process, IgG indicate chronic course illness.
• enzyme immunoassay. This examination method, like the previous ones, helps to diagnose the presence of antibodies to pale treponema. After 14 days have passed, IgM and IgA begin to appear in the blood plasma, and after a month - IgG (a feature is that it is during this period that their number is at its peak, over time it decreases).
• PCR diagnostics.

Treatment

When pathological symptoms appear, you should consult a dermatologist. The attending physician will conduct a thorough examination of the patient and prescribe an individual treatment regimen, which will depend on the severity of the clinical manifestations of syphilis and physiological features sick. It should be noted that the correct, full-fledged treatment leads to a complete recovery.

The main direction of therapeutic therapy is the destruction of pale treponema. For this purpose, patients are prescribed antibacterial drugs in large doses. In most cases, drugs from the group are used:

• penicillins - benzylpenicillin;
• tetracyclines - Doxacycline;
• macrolides - Clarithromycin or Sumamed;
• cephalosporins - Cefazolin;
• fluoroquinolones - Ciprofloxacin.

Important! The duration of the medication should be at least two months.

In parallel with antibiotic therapy, the following is prescribed:

• immunostimulants;
• vitamin and mineral complexes;
• probiotics;
• physiotherapy procedures.

The sexual partner of the patient must also be treated without fail, this will prevent the risk of re-infection.

An important nuance that requires special attention is that for the period of treatment it is strictly forbidden to conduct sexual life.

Determining the effectiveness of syphilis treatment is considered quite difficult. This is explained by the fact that almost all clinical manifestations of the disease disappear already during part of the treatment, but this is not yet a confirmation that the pale spirochete has died. To find out if the patient is cured, it is necessary to prescribe the passage of serological tests.

The treatment of the disease must be treated with full responsibility, because it is considered asocial and can cause severe complications and even death.

Prevention measures

In order to prevent the entry of pale treponema into the body, it is necessary:

• Pay special attention to personal hygiene.
• Use only your underwear.
• Use individual cosmetics.
• Avoid casual sex. If an unprotected relationship nevertheless occurred, it is necessary to treat the genital organs as soon as possible with a solution of Albucid or Chlorhexidine, from which the pale spirochete dies.
• Use barrier contraception.

Mandatory preventive examination for the presence of syphilis is carried out:

• donors;
• women during the period of bearing a child;
• persons whose profession is related to the food industry;
• teachers and kindergarten teachers;
• medical workers;
• persons admitted to the hospital for treatment.

Summing up, it should be noted that due to the development of the pharmaceutical industry and the use of antibiotic therapy, the prognosis of syphilis is considered favorable. All it takes is to pass proper treatment and follow all doctor's recommendations. In no case do not self-medicate, because this can lead to very disastrous consequences.

Here is practically all the information about what pale treponema and syphilis are and how this pathological condition should be treated. We hope it will be useful for you and will help you deal with exciting issues.

Syphilis is an infectious disease caused by a pale spirochete (Treponema pallidum), which manifests itself in a variety of clinical symptoms depending on the stage of the course. The route of infection is predominantly sexual, but there is also a risk of infection through hygiene and household items that come into contact with the genitals.

The causative agent of syphilis

Spirochete is a strict anaerobe (it grows and reproduces well in anoxic conditions), but even so, it can persist for 3 days on household items. They are resistant to the action of sub-zero temperatures and can be in a vital state throughout the year. The effect of high temperatures (about 60C) is much more detrimental - they die within 20 minutes, and when boiled, they die instantly. Under the action of antiseptics and disinfectants, rapid death also occurs.

The causative agent of syphilis is spirochete pale (model)

The causes of infection are promiscuity and, with rare exceptions, neglect of personal hygiene.

Symptoms of syphilis

Clinical manifestations will depend on the stage of the infectious process, compensatory reactions of the body and the state of the immune system both at the time of infection and at the time of the course. Syphilis has 3 periods of flow.

The incubation period is the absence of symptoms from the moment of infection to the first manifestations. This period can last from 15 days to 2 months (the duration will depend on the immune background and antibiotics).

Primary period (primary syphilis)- penetration of the pathogen into the internal environment with reproduction at the site of introduction and migration to regional lymph nodes. As treponemas multiply at the site of introduction, a hard chancre is formed - a densely elastic infiltrate (ulcer or erosion) that occurs 4 weeks from the moment of infection, pain is either insignificant or absent at all. Therefore, if a chancre appears on the cervix or tonsils, the patient may not notice that he is sick.

As soon as the pathogen spreads through the lymphatic vessels and reaches the lymph nodes, lymphangitis occurs (reaching nearby lymphatic vessels from hard chancre they begin to be painful on palpation and due to a violation of the outflow of lymph, infiltrative tissue edema can also join - this is inherent in the area of ​​​​the scrotum, foreskin, labia, tonsils) and lymphadenitis (sclerodenitis) - an increase in lymph nodes nearby from a hard chancre. Lymph nodes increase by 7-10 days from the appearance of a hard chancre, are painless, densely elastic, not soldered to themselves and surrounding tissues, the size of a bean.

All these 4 symptoms consistently join each other for 1.5-2 months on average. After that, the next period occurs -

secondary syphilis. There is a generalization of the infection by 3 months from the moment of infection and lasts 3-5 years, this period is characterized by multiple different-looking rashes in various organs and tissues, and therefore absolutely any symptoms, depending on which system / organ is affected more and how much it was previously compromised, that is, was he healthy at the time of the defeat - if so, then the manifestations of syphilis will be minimal. There are prodromal symptoms in this period (as in colds- general malaise, pain in the muscles, joints, the appearance of temperature), they last 7-10 days before the appearance of syphilomas (roseolous-papular rashes) - often these are small red spots, with clear boundaries, not merging with each other. When pressed, they disappear, and then appear, or may turn yellow due to the destruction of red blood cells. These rashes do not destroy tissues and, with antisyphilitic treatment, disappear instantly. These rashes are recurrent in nature, that is, they reappear, but are no longer so pronounced and in much smaller quantities.

These rashes do not appear subjectively, except on the scalp - a feeling of itching and the occurrence of alopecia (hair loss in patches). Rashes can be different - from harmless spots to pustules - which complicates the diagnosis, because a secondary infection joins. There is also lymphadenitis. In the absence of treatment or immunopathology, there is

tertiary syphilis- by 3-10 years from the moment of infection. This period is characterized by the appearance of gums (infiltrative limited tubercle, plonoelastic and prone to decay and scarring) in the internal organs and bones. Visceral syphilis is a synonym for tertiary. Gummas are formed in the internal organs and bones, and entail severe degenerative changes in the internal organs and bones. Depending on the affected organ, there will be corresponding symptoms:

• damage to the central nervous system - personality degeneration;
• bone / joint damage - periostitis, arthritis;
• defeat of intra-abdominal lymph nodes - mesadenitis, with severe pain syndrome.

And there are many more possible symptoms, depending on the location of the lesions. Untreated syphilis leads to the death of the patient.

congenital syphilis in children occurs with transplacental infection of the fetus, after sufficient development of placental circulation (from the 3rd month of pregnancy), because spirochetes do not penetrate the placenta. If a viable child is born, congenital syphilis subdivided into early and late.

• Early congenital syphilis is manifested by a papular rash on the buttocks, lesions of the nasal mucosa, destruction of the nasal septum, hepatosplenomegaly, hydrocephalus, and subsequent retardation in mental and physical development.
• Late congenital syphilis is characterized by the Hutchinson triad: dental pathology (barrel-shaped upper central incisors) + parenchymal keratitis (corneal damage) + labyrinthine deafness. Other manifestations corresponding to tertiary syphilis in adults are also possible.

During pregnancy, a mother who is ill with syphilis or has been ill, but not taken off the register, gathers a council and decides whether to terminate the pregnancy or save it, but taking into account antibiotic therapy.

Self-diagnosis and self-treatment are unacceptable, because due to the diversity of the clinical picture (variability of rashes, frequent latent periods), there is a high possibility of erroneous diagnosis with subsequent infection of others and the risk of disabling complications.

This is especially true of rashes, they are so diverse that they have to be distinguished from such skin manifestations as:

• herpes, chancrioform pyoderma, miliary tuberculosis (with such diseases they are differentiated in the first period);
• measles, rubella, typhus, pink and pityriasis versicolor, genital warts(with secondary syphilis).

Pay attention to the stages of rashes, concomitant manifestations, morphology of rashes, etc. All of these descriptions require clinical experience.

Tests for syphilis:

The main diagnostic methods include:

1. Bacterioscopic method (it is aimed at detecting the pathogen in a smear-imprint of a chancre or a biopsy of a lymph node) - this method is carried out in the first 4 weeks from the moment of infection.

2. Serological method (method for determining IgM - indicates the phase acute reaction, and is determined only with the help of RIF-abs and ELISA - only they determine immunoglobulins M, the use of other serological methods will give erroneous results of a seronegative reaction, because they are aimed at detecting IgG - it indicates a chronic process).

The first 2 methods are used for primary syphilis; In secondary and tertiary - use serological methods for the detection of IgG (RW, RNGA, RIF). In the diagnosis of congenital syphilis, ELISA and RIF-abs are used (in the first 3 months), and after that - RW, RNHA, RIF.

That is, in the early stages of syphilis, class M immunoglobulins (IgM) of treponemal origin appear - this is what they write in laboratories. And in the later stages they write about the presence of IgG of treponemal origin. And depending on which Ig (immunoglobulins) are determined, they speak of an acute or already long-term process. But what kind of serological test to send the patient to, the dermatovenereologist decides, while determining the clinical stage.

3. Others laboratory methods diagnostics will be less informative and, except for the general picture of inflammation or immunopathology, they will not give any results.

Treatment of syphilis

Treatment is not specific and is carried out with large doses of antibiotics that are sensitive to the causative agent of syphilis, these groups include: tetracyclines (doxycycline), erythromycin, azithromycin (Sumamed), ceftriaxone.

Treatment is carried out under the control of biochemical parameters and KLA, OAM - to monitor compensatory reactions from organs and systems.

Treatment lasts an average of 2 months, and treatment during pregnancy does not differ fundamentally from conventional inpatient treatment. Treatment of the partner is mandatory, this is called preventive therapy (treatment for persons who are in close contact with the infected). For personal hygiene use separate dishes, towels and other personal items. Also, after intercourse or other contact, you need to use 0.05% chlorhexidine bigluconate, albucide solution (you can and should have it in your personal first-aid kit) - use for any parts of the body with which contact has occurred.

Prevention of syphilis

Specific methods of rehabilitation, prevention and diet have not been developed to date. You can, of course, try to treat the infected area with antiseptic solutions immediately after contact, but the risk of the disease will remain quite high, although it will decrease slightly.

Consultation of a doctor on the topic of syphilis:

Question: Does immunity develop after an illness?
Answer: there is no unequivocal opinion on this matter, because in the blood of some people who did not have syphilis, treponemostatic, treponemocidal antibodies were found that prevent infection. Also, at the time of illness, non-sterile immunity is formed, but at the time of the latent course, it weakens and re-infection is possible in excess of what is already there - that is, the formation of superinfection. But we can definitely say that there is no stable immunity after the disease.

Question: Why does an imaginary well-being come and there may not be any manifestations of the disease?
Answer: this occurs in the primary and secondary periods, this is due to the structure of the pale spirochete, namely, the presence of a capsule-like membrane in it that protects it from phagocytosis, resulting in incomplete destruction of treponemas and their stay in the L-form (“sleeping” state) - protection against antibodies and antibiotics, but also protection against the development of the disease. The same effect answers the question about "Re-infection in the absence of contact with the patient" - that is, the awakening of "sleeping" treponemas occurs.

Question: Are other routes of transmission dangerous?
Answer: unlikely, but possible through household items.

Question: Do scars remain after skin manifestations?
Answer: can remain only if it has not been started timely treatment and ulceration occurred (ulcers formed) or the same mechanism but in places of frequent trauma (anal region, tonsil region).

Question: Legal aspects of hiding this disease?
Answer: for deliberate concealment of sexually transmitted diseases, which entailed the infection of other persons, is considered as an administrative offense of the Federal Law of the Russian Federation No. 116, Article 6.1-6.3, and is prosecuted by the Criminal Code of the Russian Federation in Article 121.

Doctor Shabanova I.E

- This is a venereal disease that has a long undulating course and affects all organs. The clinic of the disease begins with the appearance of a hard chancre (primary syphiloma) at the site of infection, an increase in regional, and then distant lymph nodes. Characterized by the appearance of syphilitic rashes on the skin and mucous membranes, which are painless, do not itch, proceed without fever. In the future, all internal organs and systems can be affected, which leads to their irreversible changes and even death. Treatment of syphilis is carried out by a venereologist, it is based on systemic and rational antibiotic therapy.

(Lues) - an infectious disease that has a long, undulating course. According to the volume of damage to the body, syphilis refers to systemic diseases, and along the main route of transmission - to venereal. Syphilis affects the entire body: skin and mucous membranes, cardiovascular, central nervous, digestive, musculoskeletal systems. Untreated or poorly treated syphilis can last for years, alternating periods of exacerbations and latent (latent) course. During the active period, syphilis manifests itself on the skin, mucous membranes and internal organs, in the latent period it practically does not manifest itself.

Syphilis is in the first place among all infectious diseases(including STIs), according to the level of morbidity, contagiousness, degree of harm to health, certain difficulties in diagnosis and treatment.

Features of the causative agent of syphilis

The causative agent of syphilis is the microorganism pallidum spirochete (treponema - Treponema pallidum). Pale spirochete has the appearance of a curved spiral, is able to move different ways(translationally, rotationally, bending and wavy), multiplies by transverse division, stained with aniline dyes in a pale pink color.

Pale spirochete (treponema) finds optimal conditions in the human body in the lymphatic tracts and lymph nodes, where it actively multiplies, in the blood in high concentration appears in the stage of secondary syphilis. The microbe persists for a long time in a warm and humid environment (optimum t = 37°C, in wet linen up to several days), and is resistant to low temperatures (in the tissues of corpses it is viable for 1-2 days). Pale spirochete dies when dried, heated (55 ° C - after 15 minutes, 100 ° C - instantly), when treated with disinfectants, solutions of acids, alkalis.

A patient with syphilis is contagious during any period of illness, especially during periods of primary and secondary syphilis, accompanied by manifestations on the skin and mucous membranes. Syphilis is transmitted by contact of a healthy person with a patient through secrets (sperm during intercourse, milk - in lactating women, saliva during a kiss) and blood (during direct blood transfusion, during operations - with medical staff, using a common straight razor, a common syringe - in drug addicts). The main route of transmission of syphilis is sexual (95-98% of cases). An indirect household route of infection is less commonly observed - through wet household items and personal items (for example, from sick parents to children). There are cases of intrauterine transmission of syphilis to a child from a sick mother. Necessary condition infection is the presence in the patient's secrets of a sufficient number of pathogenic forms of pale spirochetes and a violation of the integrity of the epithelium of the mucous membranes and skin of his partner (microtrauma: wounds, scratches, abrasions).

Periods of syphilis

The course of syphilis is long undulating, with alternating periods of active and latent manifestations of the disease. In the development of syphilis, periods are distinguished that differ in the set of syphilides - various forms skin rashes and erosions that appear in response to the introduction of pale spirochetes into the body.

• Incubation period

It starts from the moment of infection, lasts an average of 3-4 weeks. Pale spirochetes spread through the lymphatic and circulatory pathways throughout the body, multiply, but clinical symptoms do not appear. A patient with syphilis is unaware of his illness, although he is already contagious. The incubation period can be shortened (up to several days) and lengthened (up to several months). Lengthening occurs when taking medications that somewhat inactivate the causative agents of syphilis.

• Primary syphilis

Lasts 6-8 weeks, characterized by the appearance at the site of penetration of pale spirochetes of primary syphiloma or hard chancre and subsequent enlargement of nearby lymph nodes.

• Secondary syphilis

It can last from 2 to 5 years. There is a defeat of the internal organs, tissues and systems of the body, the appearance of generalized rashes on the mucous membranes and skin, baldness. This stage of syphilis proceeds in waves, periods of active manifestations are replaced by periods of no symptoms. There are secondary fresh, secondary recurrent and latent syphilis.

Latent (latent) syphilis does not have skin manifestations of the disease, signs of a specific lesion of internal organs and the nervous system, it is determined only laboratory tests(positive serological reactions).

• Tertiary syphilis

It is now rare, occurs in the absence of treatment years after the lesion. It is characterized by irreversible disorders of internal organs and systems, especially the central nervous system. It is the most severe period of syphilis, leading to disability and death. It is detected by the appearance of tubercles and nodes (gum) on the skin and mucous membranes, which, disintegrating, disfigure the patient. They are divided into syphilis of the nervous system - neurosyphilis and visceral syphilis, in which the internal organs (head and spinal cord heart, lungs, stomach, liver, kidneys).

Symptoms of syphilis

Primary syphilis

Primary syphilis begins from the moment when primary syphiloma appears at the site of the introduction of pale spirochetes - a hard chancre. A hard chancre is a solitary, rounded erosion or ulcer that has clear, even edges and a shiny bluish-red bottom, painless and non-inflamed. The chancre does not increase in size, has scanty serous contents or is covered with a film, a crust, at the base of which there is a dense, painless infiltrate. Hard chancre does not respond to local antiseptic therapy.

The chancre can be located on any part of the skin and mucous membranes (anal area, oral cavity- lips, corners of the mouth, tonsils; mammary gland, lower abdomen, fingers), but most often located on the genitals. Usually in men - on the head, foreskin and shaft of the penis, inside the urethra; in women - on the labia, perineum, vagina, cervix. The size of the chancre is about 1 cm, but can be dwarf - with poppy seeds and giant (d = 4-5 cm). Chancres can be multiple, in case of numerous small lesions of the skin and mucous membranes at the time of infection, sometimes bipolar (on the penis and lips). When a chancre appears on the tonsils, a condition occurs that resembles a sore throat, in which the temperature does not rise, and the throat almost does not hurt. The painlessness of the chancre allows patients not to notice it, and not attach any importance. Soreness is distinguished by a slit-like chancre in the fold of the anus, and a chancre - panaritium on the nail phalanx of the fingers. During primary syphilis complications may occur (balanitis, gangrenization, phimosis) as a result of the addition of a secondary infection. Uncomplicated chancre, depending on the size, heals in 1.5 - 2 months, sometimes before the appearance of signs of secondary syphilis.

5-7 days after the appearance of a hard chancre, an uneven increase and compaction of the lymph nodes closest to it (usually inguinal) develops. It can be unilateral or bilateral, but the nodes are not inflamed, painless, ovoid in shape and can reach the size chicken egg. Toward the end of the period of primary syphilis, specific polyadenitis develops - an increase in the majority of subcutaneous lymph nodes. Patients may experience malaise, headache, insomnia, fever, arthralgia, muscle pain, neurotic and depressive disorders. This is associated with syphilitic septicemia - the spread of the causative agent of syphilis through the circulatory and lymphatic systems from the lesion throughout the body. In some cases, this process proceeds without fever and malaise, and the transition from the primary stage of syphilis to the secondary patient does not notice.

Secondary syphilis

Secondary syphilis begins 2 to 4 months after infection and can last 2 to 5 years. Characterized by generalization of infection. At this stage, all systems and organs of the patient are affected: joints, bones, nervous system, organs of hematopoiesis, digestion, vision, hearing. Clinical symptom secondary syphilis are - rashes on the skin and mucous membranes, which are ubiquitous (secondary syphilides). The rash may be accompanied by body aches, headache, fever, and resemble a cold.

Rashes appear paroxysmal: lasting 1.5 - 2 months, they disappear without treatment (secondary latent syphilis), then reappear. The first rash is characterized by profusion and brightness of color (secondary fresh syphilis), subsequent repeated rashes are paler colored, less abundant, but larger in size and tend to merge (secondary recurrent syphilis). The frequency of relapses and the duration of latent periods of secondary syphilis are different and depend on the immunological reactions of the body in response to the reproduction of pale spirochetes.

Syphilis of the secondary period disappear without scars and have a variety of forms - roseola, papules, pustules.

Syphilitic roseolas are small rounded spots of pink (pale pink) color, which do not rise above the surface of the skin and mucous epithelium, which do not flake off and do not cause itching, when pressed on them turn pale and disappear for a short time. Roseolous rash with secondary syphilis is observed in 75-80% of patients. The formation of roseola is caused by disorders in the blood vessels, they are located throughout the body, mainly on the trunk and limbs, in the face area - most often on the forehead.

A papular rash is a rounded nodular formation protruding above the surface of the skin, bright pink in color with a bluish tint. Papules are located on the trunk, do not cause any subjective sensations. However, when pressing on them with a bellied probe, a sharp pain. With syphilis, a rash of papules with greasy scales along the edge of the forehead forms the so-called "crown of Venus".

Syphilitic papules can grow, merge with each other and form plaques, get wet. Weeping erosive papules are especially contagious, and syphilis at this stage can easily be transmitted not only through sexual contact, but also through handshakes, kisses, and the use of common household items. Pustular (pustular) rashes with syphilis are similar to acne or chicken rash, covered with a crust or scales. Usually occurs in immunosuppressed patients.

The malignant course of syphilis can develop in debilitated patients, as well as in drug addicts, alcoholics, and HIV-infected people. Malignant syphilis is characterized by ulceration of papulo-pustular syphilides, continuous relapses, impaired general condition, fever, intoxication, weight loss.

In patients with secondary syphilis, syphilitic (erythematous) tonsillitis (sharply pronounced reddening of the tonsils, with whitish spots, not accompanied by malaise and fever), syphilitic seizures in the corners of the lips, oral cavity syphilis may occur. Observed common lung malaise, which may resemble the symptoms of a common cold. Characteristic of secondary syphilis is generalized lymphadenitis without signs of inflammation and pain.

During the period of secondary syphilis, skin pigmentation disorders (leukoderma) and hair loss (alopecia) occur. Syphilitic leukoderma is manifested in the loss of pigmentation of various skin areas on the neck, chest, abdomen, back, lower back, and armpits. On the neck, more often in women, a "necklace of Venus" may appear, consisting of small (3-10 mm) discolored spots surrounded by darker areas of the skin. It can exist without change for a long time (several months or even years), despite ongoing antisyphilitic treatment. The development of leukoderma is associated with a syphilitic lesion of the nervous system; during examination, pathological changes in the cerebrospinal fluid are observed.

Hair loss is not accompanied by itching, peeling, by its nature it happens:

• diffuse - hair loss is typical for normal baldness, occurs on the scalp, in the temporal and parietal region;
• small-focal - a vivid symptom of syphilis, hair loss or thinning in small foci located randomly on the head, eyelashes, eyebrows, mustache and beard;
• mixed - both diffuse and small focal are found.

With timely treatment of syphilis hairline is fully restored.

Skin manifestations of secondary syphilis accompany lesions of the central nervous system, bones and joints, and internal organs.

Tertiary syphilis

If a patient with syphilis was not treated or the treatment was inadequate, then a few years after infection, he develops symptoms of tertiary syphilis. happening serious violations organs and systems, the appearance of the patient is disfigured, he becomes disabled, in severe cases likely to be fatal. Recently, the incidence of tertiary syphilis has decreased due to its treatment with penicillin; severe forms disability.

Allocate tertiary active (in the presence of manifestations) and tertiary latent syphilis. The manifestations of tertiary syphilis are a few infiltrates (tubercles and gums), prone to decay, and destructive changes in organs and tissues. Infiltrates on the skin and mucous membranes develop without changing the general condition of patients, they contain very few pale spirochetes and are practically not contagious.

Tubercles and gummas on the mucous membranes of the soft and hard palate, larynx, nose, ulcerating, lead to a disorder of swallowing, speech, breathing (perforation of the hard palate, "failure" of the nose). Hummous syphilides, spreading to bones and joints, blood vessels, internal organs cause bleeding, perforation, cicatricial deformities, disrupt their functions, which can lead to death.

All stages of syphilis cause numerous progressive lesions of internal organs and the nervous system, their most severe form develops with tertiary (late) syphilis:

• neurosyphilis (meningitis, meningovasculitis, syphilitic neuritis, neuralgia, paresis, epileptic seizures, tabes dorsalis and parenchymal keratitis, Hutchinson's teeth.

  Diagnosis of syphilis

  Diagnostic measures for syphilis include a thorough examination of the patient, taking an anamnesis and conducting clinical studies:

  1. Detection and identification of the causative agent of syphilis by microscopy of serous discharge of skin rashes. But in the absence of signs on the skin and mucous membranes and in the presence of a "dry" rash, the use of this method is impossible.
  2. Serological reactions (non-specific, specific) are made with serum, blood plasma and cerebrospinal fluid - the most reliable method for diagnosing syphilis.

  Non-specific serological reactions are: RPR - rapid plasma reagin reaction and RW - Wasserman reaction (compliment binding reaction). Allow to determine antibodies to pale spirochete - reagins. Used for mass examinations (in clinics, hospitals). Sometimes they give a false positive result (positive in the absence of syphilis), so this result is confirmed by carrying out specific reactions.

  Specific serological reactions include: RIF - immunofluorescence reaction, RPGA - reaction passive hemagglutination, RIBT - pale treponema immobilization reaction, RW with treponemal antigen. Used to determine species-specific antibodies. RIF and RPGA are highly sensitive tests, they become positive already at the end of the incubation period. They are used in the diagnosis of latent syphilis and for the recognition of false positive reactions.

  Positive indicators of serological reactions become only at the end of the second week of the primary period, so the primary period of syphilis is divided into two stages: seronegative and seropositive.

  Nonspecific serological reactions are used to evaluate the effectiveness of the treatment. Specific serological reactions in a patient who has had syphilis remain positive for life; they are not used to test the effectiveness of treatment.

  Treatment of syphilis

  Treatment of syphilis begins after a reliable diagnosis is made, which is confirmed by laboratory tests. Treatment of syphilis is selected individually, carried out in a complex manner, recovery should be determined by laboratory. Modern methods treatment of syphilis, which venereology owns today, allow us to talk about a favorable prognosis for treatment, provided that the therapy is correct and timely, which corresponds to the stage and clinical manifestations of the disease. But only a venereologist can choose a rational and sufficient therapy in terms of volume and time. Self-treatment of syphilis is unacceptable! Untreated syphilis becomes latent, chronic form, and the patient remains epidemiologically dangerous.

  The basis of the treatment of syphilis is the use of antibiotics penicillin series, to which the pale spirochete is highly sensitive. In case of allergic reactions of the patient to penicillin derivatives, erythromycin, tetracyclines, cephalosporins are recommended as an alternative. In cases of late syphilis, in addition, iodine, bismuth, immunotherapy, biogenic stimulants, and physiotherapy are prescribed.

  It is important to establish sexual contact with a patient with syphilis, it is imperative to carry out preventive treatment of possibly infected sexual partners. At the end of treatment, all previously syphilis patients remain under dispensary observation by a doctor until the complete negative result of the complex of serological reactions.

  In order to prevent syphilis, examinations of donors, pregnant women, employees of children's, food and medical institutions, patients in hospitals are carried out; representatives of risk groups (drug addicts, prostitutes, homeless people). The blood donated by donors is necessarily examined for syphilis and canned.