Name of the patient: ______________

Lues secundaria recidiva

Complications

Related:

floor male

age 47 years old

Home address:

Place of work: disabled group 2

Job title

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

Secondary recurrent syphilis of the skin and mucous membranes

Lues secundaria recidiva

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

Who referred the patient: CRH

Why:

Doesn't consider himself sick

_____________________________

Self-medication (than): not self-treated

EPIDEMIOLOGICAL HISTORY

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

Education: graduated from 8 classes, vocational school

Past illnesses:

Injuries, operations: appendectomy 1970

Allergic diseases: missing

Doesn't mark

Habitual intoxications:

Working conditions: does not work

Living conditions:

Family history: not married

OBJECTIVE STUDY

General state:

Position: active

Body type: normosthenic type

Height: 160 cm

Weight: 60 kg

SKIN

1. SKIN CHANGES

Color: ordinary

Turgor, elasticity: not changed

Fine

Characteristics of sebum secretion: fine

Condition of hair, nails:

Dermographism: pink, various, resistant

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Secondary recurrent syphilis of the skin and mucous membranes

Clinical diagnosis (in Russian and Latin):

Secondary recurrent syphilis of the skin and mucous membranes

Lues secundaria recidiva

Complications ________________________________________

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

floor male

age 47 years old

Home address: ______________________________

Place of work: disabled group 2

Job title _____________________________________________________

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

Clinical diagnosis (in Russian and Latin):

Secondary recurrent syphilis of the skin and mucous membranes

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

Height: 160 cm

Weight: 60 kg

SKIN

1. SKIN CHANGES

Color: ordinary

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

Received results with date

Erythrocytes - 5.0 * 10 12 / l

Leukocytes - 5.2 * 10 9 / l

Color - homogeneous - yellow

Specific gravity - 1010

Epithelial cells - 1 - 4 in p / s

Leukocytes - 2 - 3 in p / s

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

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

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

For health, life and work - favorable

Literature

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

2. Adaskevich "Sexually transmitted diseases" 2001

3. Radionov A. N. "Syphilis" 2002

istorii-bolezni.ru

Case history of secondary syphilis

FULL NAME. x
Age 21 Gender F
Secondary education
Home address Donetsk-41
Seamstress job
Date of receipt: 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 STUDY
The general condition of the patient is satisfactory, the position in bed is active. Build normosthenic, moderate nutrition. Integuments are clean, pale pink in color. 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.

LOCATION DESCRIPTION
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.

POSITIVE DIAGNOSIS
Given the localization of the eruptions on the genitals, its nature (monomorphism, lack of peripheral growth, painlessness), the presence of enlarged inguinal lymph nodes, it can be assumed that the patient has a fresh secondary syphilis. This disease must be differentiated from lichen planus, psoriasis, parapsoriasis, folliculitis, genital warts, pseudo-syphilitic Lipshutz papules.

LABORATORY DATA
Blood and urine tests without features
RW from 10.XI.95 - ++++

DIFFERENTIAL DIAGNOSIS
In lichen planus, papules have a polygonal outline, a waxy sheen, a central umbilical depression, give the Wickham mesh phenomenon, are characterized by a chronic course and often intense itching. There are also no other manifestations of syphilis (enlarged lymph nodes, etc.), serological tests give a negative result.
In psoriasis, papules increase along the periphery, are surrounded by a mild inflammatory corolla, there is a triad of phenomena (stearin stain, psoriatic film and pinpoint bleeding. The surface of the papules is covered with abundant silvery-white scales, numerous cracks. Papules are located on typical areas of the body; dermatosis occurs chronically. With when scraping a psoriasimorphic syphilitic papule, only scales are removed, but the surface remains dry, dense, with a pronounced limited infiltrate.
With parapsoriasis, the papule is covered with a whole dry scale (“collodion film”), lagging behind along the edge; when scraping, diffuse bleeding is observed. The syphilitic papule flakes off from the center and forms a "Biett's collar" along the periphery of a dense, sharply limited nodule. Rashes of parapsoriasis last for many months, and often years.
Folliculitis on the external genitalia, in the inguinal-femoral folds and on the medial surfaces of the thighs appear in women due to skin irritation with vaginal discharge. Unlike syphilitic papules, folliculitis is soft in consistency, surrounded by an inflammatory red corolla, has a cone-shaped shape, often a micropustule in the center and is accompanied by subjective sensations (burning, pain, itching); serological tests are negative.
False syphilitic Lipschutz papules in appearance resemble a round shape, slightly pinkish in color, the size of a lentil, with a dry shiny surface, painless. They are located on the large pudendal lips and can extend to the perineum and medial surface of the thighs.
Genital warts are viral diseases, located mainly in the vulva and anus, but unlike wide warts, they have a thin stalk and consist of small pale red soft lobules, similar to cauliflower or “cockscomb”. Patients feel burning, pain.

FINAL DIAGNOSIS
Based on the differential diagnosis, the presence of positive serological tests can make the final diagnosis: Fresh secondary syphilis.

ETIOLOGY AND PATHOGENESIS
Syphilis refers to chronic infectious diseases, the causative agent of which is pale treponema, or spirochete, discovered on March 3, 1905 by F. Shaudin and E. Hoffmann. It belongs to the genus Traeponema, family Traeponemaceae, order Spirochaetalis.
Live pale treponema is a delicate spiral formation with tapering ends, having 8-14 uniform narrow and steep curls. The thickness of the treponema does not exceed 0.25 microns, the length varies between 6-20 microns, and the depth of the curls is 1-1.5 microns. At its ends are delicate wriggling flagella, which are sometimes found on the lateral surfaces. A feature of the pale spirochete is its movement: 1) around its longitudinal axis; 2)forward and backward; 3) makes a pendulum, flexion, and contractive movement.
Syphilis disease begins after the penetration of pale treponema into the body through the skin or mucous membrane with a damaged surface. Through saliva, tears, milk, sweat, urine, syphilis is not transmitted. Intact epithelium is an obstacle to the penetration of pale treponema. Infection with syphilis can be sexual, non-sexual and congenital.
Syphilis refers to chronic infectious diseases, characterized by a cyclic course and a change in active manifestations and remissions of various durations. This makes it possible to single out separate periods during syphilis: 1) incubation; 2) primary; 3) secondary and 4) tertiary. However, it is not possible to draw a sharp line between these periods of the disease and put the painful phenomena observed in syphilis into the scheme. It should be remembered that any division of the disease into periods is only an attempt to streamline our knowledge of its course.
After infection with syphilis by sexual or non-sexual means, some time passes during which it is impossible to detect either local or general phenomena. This time is called the incubation period, the duration of which is on average 21-24 days and culminating in the development of primary syphiloma at the site of penetration of pale treponema (sometimes the incubation period ranges from 10 to 40 or more days).
The primary period of syphilis begins from the moment of formation of primary syphiloma, followed by an increase in regional lymph nodes after 3-5 days and continues until the appearance of profuse rashes of the secondary period of syphilis. The duration of the primary period is 45-50 days. During the first three weeks of the existence of primary syphiloma, the Wasserman reaction is negative (negative phase) and only from the fourth week gradually turns into a positive phase, becoming sharply positive 2-3 weeks before the onset of secondary fresh fresh syphilis.
In the second half of the primary period, patients may experience weakness, lethargy, flying joint pain, anemia, headache, especially at night. At the end of the primary period of syphilis, there is an increase in peripheral lymph nodes - polyadenitis, which is of great importance in the diagnosis of syphilis. Such clinical symptoms, observed in the second half of the primary period of syphilis, are due to an increase in the number of pale treponemas and a decrease in the immunobiological resistance of the organism.
The secondary period of syphilis begins approximately 9-10 weeks after infection and 6-7 weeks after the onset of primary syphiloma. In the secondary period, there is an active spread of pale treponemas through the lymphatic and blood vessels with their predominant accumulation in the skin and mucous membranes and, to a lesser extent, in the internal organs and nervous system, increased reproduction of treponemas is accompanied by the appearance of spotty, papular, vesicular, pustular rashes, damage to the periosteum and bones, the development of iritis, iridocyclitis and enlarged lymph nodes (polyadenitis). A variety of clinical manifestations of the secondary period of syphilis proceed differently. In some cases, there is a violent reaction of the body with profuse rashes on the skin, meningeal symptoms, etc., and in others, the process is limited to mild efflorescences, which patients often do not betray serious significance. Another feature of the secondary period of syphilis is the benign course of syphilides, usually dissolving without a trace in a short time, especially quickly after specific therapy (except for pustular-ulcerative syphilides). The secondary period of syphilis can proceed indefinitely, alternating with remissions and relapses, but on average about 2-4 years, turning into a tertiary one. Syphilitic rashes that occur immediately after the end of the primary period of syphilis are characterized by abundance, random location, often polymorphism, accompanied by polyadenitis, often remaining primary syphiloma or the remains of its infiltrate, regional scleradenitis (bubo). The initial stage of secondary syphilis is called secondary fresh syphilis, the manifestations of which disappear spontaneously after a few weeks and a visible clinical recovery occurs. This stage is called the secondary latent (latent) period of syphilis, which can last from several days to many weeks and months. However, the well-being of this stage is deceptive, since the syphilitic infection has not disappeared, but is in a latent state, which is confirmed by positive serological reactions. In the absence of treatment, after latent syphilis, syphilitic rashes (relapse) appear, which differ from secondary fresh syphilis in the limitedness of the elements, large size, fading color, and a tendency to group. This stage is called secondary recurrent syphilis, in which there is usually no primary syphiloma and regional bubo, and polyadenitis is mild. In early relapses, clinical manifestations are occasionally encountered, occupying intermediate positions between secondary fresh and recurrent syphilis, which can be called combined secondary fresh and recurrent syphilis. These forms of the disease should be treated with sufficient caution.
Clinical recurrent forms of syphilis, apparently, are caused by the reproduction of pale trephine in the place of resolved syphilides, in which they were in a state of parabiosis. With syphilis, the mobility of infectious immunity plays a huge role, the decrease of which creates favorable conditions for the activation of pale treponema.
The tertiary, or gummous, period of syphilis develops in cases where spirochetes remain in the body due to insufficient or incorrect treatment and a changed immunobiological reactivity of the body. Tertiary syphilis most often develops in individuals who have not received antasyphilitic therapy. The first clinical signs of tertiary syphilis arise after several years of the existence of the secondary period, usually between 5 and 10 years after infection, but in some cases gummy elements are observed and much later (at 20-40 and even 60 years of illness).
The Tertiary period is characterized by limited but massive granulomas located in the skin itself or in the subcutaneous base, prone to necrotic decay and subsequent scarring, which often ends in significant destruction, deformation, dysfunction of organs, and even death if vital organs are involved in the process. (aorta, liver, brain, etc.). According to our data, gummy syphilis affects the internal organs, the central nervous system, and the musculoskeletal system much more often than the skin and mucous membranes. This stage also includes the tabes of the spinal cord and progressive paralysis, often accompanied by visceral syphilis. In gummy syphilides, pale treponemas are sometimes found in a small amount in the peripheral, not decomposed zone of the infiltrate.
Gummas develop in the same way as relapses of secondary syphilis. With a weakening of the immunobiological reactivity of the organism and increased infectious allergy, pale treponemas multiply in place of the resolved tracts or lymph nodes, from where they are carried with the bloodstream to various organs, in which single nodes characteristic of tertiary syphilis are formed. Apparently, a very long course of tertiary syphilis contributes to the weakening of the virulence of pale treponema, due to which relapses of tubercular and nodular syphilis are rarely recorded. It is customary to distinguish three stages of tertiary syphilis: 1) tertiary active syphilis; 2) tertiary latent, or hidden, syphilis; and 3) tertiary recurrent syphilis.

TREATMENT
Among all antisyphilitic drugs, penicillin and its derivatives, which have treponemocidal and treponemostatic properties, occupy the main place. Apparently, penicillin disrupts the enzyme systems of pale treponema, the process of its growth and reproduction. Penicillin is especially active on pale treponema during their reproduction.
„„Penicillin and its derivatives are effective in all forms of syphilis and contribute to the removal of pale trepanema from the surface of syphilides in an average of 10-12 hours.
Penicillin can be administered to patients subcutaneously, intramuscularly, intravenously, intralumbally and orally (phenyloxymethylpenicillin). In the treatment of syphilis, penicillin is administered intramuscularly in doses depending on body weight. The continuous administration of penicillin is due to the need to constantly maintain a certain concentration of the drug in the blood (0.06 IU per 1 mm of blood). To this end, patients during penicillin therapy need to reduce fluid intake.
In addition to soluble penicillin, which is rapidly excreted from the body, drugs are used that maintain the therapeutic concentration of the drug in the blood for 8-10 hours (ecmonovocillin and bicillins-1, 3, 4, 5 and 6).
R. Sazerak and K. Levaditi first proposed bismuth in 1921 for the specific treatment of syphilis. By their therapeutic effect, bismuth preparations take second place after penicillin. Any bismuth preparation should be evenly absorbed from the injection site and excreted from the body in sufficient quantities.
Bioquinol is a bright red 8% suspension of iodine-quinine-bismuth in neutral peach oil containing 25% bismuth, 56% iodine and 19% quinine. This combination of medicinal ingredients has a beneficial effect on the body: bismuth affects pale treponema, iodine promotes the resorption of syphilides, and quinine has tonic properties.
Bismoverol is a white preparation containing 7.5% suspension of bismuth salt of monobismuthic acid in sterilized and purified peach or almond oil; in 1 ml of bismoverol - 0.05 g of metallic bismuth. The preparation contains about 67% of metallic bismuth. Bismuth is excreted in urine and feces slowly; and its excretion ends 1.5-3 months after the cessation of treatment.
Pentabismol is a water-soluble preparation containing 47.9% bismuth; 1 ml of the drug contains 0.01 g of metallic bismuth. It is absorbed by tissues faster than biyoquinol and bismoverol, but it is also quickly excreted from the body.
Bismuth preparations are injected intramuscularly into the thickness of the buttocks in their upper outer quadrant, alternately to the left, then to the right side. After inserting a needle with a length of at least 5-6 cm, it is necessary to make sure that its end is not in the lumen of the vessel, since the introduction of an emulsion of bismuth into the vessel threatens the development of pulmonary embolism or deep gangrene of the buttocks. Therefore, bismuth preparations should be administered slowly, necessarily heated to body temperature. Before injection, the bottle with biyoquinol and bismoberol must be shaken thoroughly to obtain a uniform suspension of the drug.
In the treatment of patients with fresh secondary syphilis, 5 courses of combined treatment with penicillin and bismuth preparations are used:
1 course: penicillin and one of the bismuth preparations; break 1 month
2 course: penicillin (ecmonovocillin) and bismuth preparation; break 1 month
3rd course: ekmonovocillin (penicillin) and bismuth preparation; break 1 month
4 course: ecmonovocillin and bismuth preparation; break 1 month
5 course: ecmonovocillin or penicillin and bismuth preparation.
The heading dose of penicillin (ecmonovocillin) is calculated at the rate of 120,000 IU per 1 kg of the patient's body weight.

FORECAST
With an early start in the treatment of fresh secondary syphilis, with the passage of the full course of treatment, a complete cure of the patient is expected.

EPICRISIS
Patient x, 21 years old, complains of a rash on the large and small labia, pain, fever in the evenings up to 37.5-38.0 C, general weakness. For the first time, the patient discovered a rash on the labia majora and labia minora on October 10, 1995 (the rash is monomorphic, in the form of papules up to 5 mm in diameter, brownish-red in color, painless, there is no peripheral growth; some papules ulcerate with the formation of small ulcers with purulent discharge, painful). The patient has enlarged inguinal lymph nodes on both sides, up to 3 cm in diameter, painless on palpation, mobile, not soldered to surrounding tissues. The patient tried to be treated at home, using baths with chamomile and potassium permanganate, unsuccessfully, then she turned to a dermatologist at the place of residence and was sent to the city dermatovenerologic dispensary No. 1 with a diagnosis of fresh secondary syphilis. Currently receiving treatment with penicillin and bismuth preparations. The prognosis is good, the patient is expected to recover completely.

LITERATURE
1. Pototsky I.I., Torsuev N.A. Skin and venereal diseases.-Kyiv, ed. united "Vishcha school", 1978
2. Differential diagnosis of skin diseases.- B.A. Berenbein, A.A. Studitsin and others.- M.: Medicine, 1989.
3. Pathological diagnosis of skin diseases.- G.M. Tsvetkova, V.N. Mordovtsev.- M.: Medicine, 1986.

Donetsk State Medical University

Department of skin and venereal diseases

Head department prof. Romanenko V.N.

Lecturer Assoc. Kovalkova N.A.

Disease 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 AND

Education 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. Integuments are clean, pale pink in color. 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.

2011-03-18 20:04:16

Yury Romanov asks:

Romanov Yu.S. born in 1962 II gr. blood(+)
I quit active sports (volleyball) in March 2008. I smoked for almost 30 years, I quit a year ago.
Case history September 2008 - pain in the shoulders, forearms (more muscular), in the chest, between the shoulder blades, accompanied by a slight dry cough. The pain is not constant, with attacks from half an hour to 1.5-2 hours. .- "twists" his hands. The therapist sent him for a consultation with a pulmonologist and a neuropathologist. Diagnosis by a pulmonologist: COPD type 1-2. Take tests for uric acid, LE cells, coagulogram. From these tests, the excess of the norm for uric acid, the rest are normal. He prescribed allopurilic acid, meloxicam, fromilid uno (I don’t know why the antibiotic). Chest x-ray: no bone changes.
Assigned to: massage, vitamin B12, mucosat 20 amp, Olfen No. 10 in amp. After the use of these drugs, no improvement was observed. The pains either disappeared on their own for 2-3 weeks, then appeared for 1-2 weeks, but they were also paroxysmal. That is, the condition is excellent and suddenly, within 10-15 minutes, the condition is like at a temperature above 38-38.5 degrees. Over time, new ones were added symptoms are pain in the calf muscles, submandibular pain.
Passed tests for: helminths: toxocar. echinococcus, opisthorchis, ascaris, trichinosis-not found. Just in case, he drank 3 days of Vormil.
Tests for: Chlamydia, Giardia-negative, HIV, syphilis-negative, Toxoplasma-lgG-155.2 at a rate of less than 8 IU / ml. lgM-not detected.
Fibrobronchoscopy - diffuse endobronchitis with moderate mucosal atrophy.
Fibroesophagogastroduodenoscopy: d\z-peptic ulcer of the duodenal bulb 12. Hp-test-positive. Passed a course of treatment.
Analyzes for antibodies to native DNA: 1Y-29.0109Y.-0.48 POS.
2nd-27.05.09-0.32 positive
3rd-14.09.09-0.11-negative.
4th-23.02.2010-44IU/ml-posit.
5th-18.05.2010-20.04 IU/ml-neg.
6th-17.11.2010-33 IU/ml-position
Immunoglobulin class M: 2.67 at a rate of 0.4-2.3 (29.01.09)
SLE test - from 05/26/2009, and 11/17/2010 - negative. Analyzes for rheumatic tests were within the normal range.
There is a CT scan of the abdomen and an MRI of the lumbar spine. No pathologies.
During this time, neither the therapist nor the neuropathologist made an accurate diagnosis. Didn't go to other doctors. I passed almost 90% of the tests without referrals from doctors, by typing. Only once the variant sounded - SLE. I drank delagil for a month, 1 tablet each, with dolaren attacks.
Symptoms of aches in the muscles (90%) and joints (10%) of the arms and legs still appeared and disappeared for 10-15 days.
Since the autumn of 2010, muscle pains began with the shoulders and forearms, submandibular pains, pains in the chest and between the shoulder blades.
On 11/16/2010, he turned to a therapist in another hospital, because such pains were accompanied by depression. Constantly on painkillers, but you need to work, the impossibility of controlling the occurrence of seizures. They don’t give a hospital, there are no pronounced symptoms!
Direction for X-ray of the cervical, thoracic, right shoulders. joint. Based on the data, he was referred to a neuropathologist. The conclusion is osteochondrosis of the cervical and thoracic regions. Assigned - lidocaine in amp No. 10, vitamin B12, massage No. 10. The neuropathologist could not explain the above listed symptoms.
Consultation of a city rheumatologist-data in favor of SLE and rheumatoid arthritis – NO. Assigned: Olfen in amp. No. 10, Vitamins B1, B6, B12. Lyrica 1 ton 2 times a day. According to the consultations of a neuropathologist and a rheumatologist, the therapist prescribed:
Olfen No. 10, Lidocaine 2.0 No. 10, Prozerin 1.0 ml No. 10, Vitamin B12 No. 10, Gabalept 1 ton per month, massage.
Started treatment on 25.11.2010. From 1.12.2010, the symptoms began to change. The muscles below the elbows, hands, fingers began to hurt more strongly. Aches in the calf muscles, ankles, knees. Feeling of swelling of the arms and legs (below the knee joints). These symptoms appear from morning until bedtime + bouts of aches are added (as at a temperature of 38 degrees) also from half an hour to 1.5 -2 hours.
From 10.12.10 symmetrical pains appeared in the small joints of the hands, in the wrist joints, and the ankles. After sleep, stiffness was felt both in the hands and in the legs. Under load, pain in the ankles increased with recoil under the heel, in the knees. There was a crunch in the joints of the arms and legs, which had never been observed before. These symptoms persisted until rest. Didn't bother at night.
At the same time, paroxysmal pain disappeared.
Since the appointment with the doctor at a certain time did not take place and was postponed, and the pain did not go away, but intensified, he began to take METIPRED 4 mg once a day. By December 20, 2010, the condition improved. The pain became weaker, but it still manifests itself in the fingers and hands, ankles and knees. The puffiness subsided, but sometimes it is felt in the hands. Pain appeared in the shoulders and hips. The crunch in the joints did not go away. Pain is especially strong in places of sports injuries of the ankle of the left, right knee joint, fracture of the wrist of the right hand. I did blood tests and everything was normal. A detailed blood test, taking into account the intake of Metipred (day 4), all indicators are normal.
The attending therapist directs to the neuropathologist and the traumatologist - reception 12/21/10. I am tired of the lack of a diagnosis. It can be very bad, but I don’t know which doctor to turn to, I don’t even know who to take a sick leave to lie down. Tell me what to do or who to contact for help!
Joint consultation of a neuropathologist and a traumatologist:
Neurologist - d\z: multiple sclerosis? An MRI of the head was recommended.
Traumatologist - there are no data for trauma and orthopedic pathologies in the acute stage.
In words, he said that you need to contact a rheumatologist about mixed collagenosis.
December 24, 2010 - underwent an MRI of the brain, the result is below.
After undergoing an MRI, the neurologist sent me to the regional clinic to see a neurologist with a diagnosis of:
- discirculatory encephalopathy, cephalgia, Sd?
To a rheumatologist:
myasthenic syndrome, SLE, rheumatoid arthritis.
From 23.12.10 I caught a cold (pain in the nasopharynx, temperature 37.8) - I started taking Arbidol, Amoxil. Three days later I felt the absence of pain in the joints of the fingers, hands, ankles, it became easier in the knees when walking.
There was a slight stiffness in the morning, disappearing after 5-10 minutes, there was a crunch in the joints. Significantly improved mood and general condition.
26.12.10 - interrupted the intake of METIPRED, taking it for 14 days from a dose of 4 mg-7 days and lowering it to 1 mg by the 14th day.
Approximately from 08.01.11. again there were pains in the small joints of the hands, ankles. Again he began to take Metipred 2 mg 1 r / d. The condition is average, the joints are crunchy. From 16.01. I take 1 mg metipred, sometimes reducing dolaren when the pain increases. Pain in the left ankle and right knee joint is especially reflected when moving up the stairs.
Consultation of the chief rheumatologist-d\z: RA.
For confirmation, he was sent to the regional clinic in the department of rheumatology. On the basis of x-rays, osteoarthritis of the small joints of the hands and feet was diagnosed.
The prescribed course of treatment by the rheumatologist of the region: arcoxia 60, 1 ton for 10 days, mydocalm 150 mg. 1r\10 days, artron complex 1t.2 r\d, calcium D-3, topical ointment.
At present, after taking these medications, the condition has worsened. The joints of 3-4 fingers of the hands are sore, swollen. In the morning there is a slight stiffness in the hands for 10-15 minutes. The joints are slightly swollen, also pain in the wrists. Pain in the hip joints in the region of the left greater trochanter and both ischial tuberosities progresses. Pain when walking under load. both ankles.
Again he turned to the glurematologist of his city. He prescribed Olfen at 100 mg 1r / d, movalis 2 mg i.m. h / d., continue artron complex.
10 day course of treatment gave nothing.
Today I was at the reception again, prescribed Metipred 2 mg r / d to the above described drugs.
I am at a loss! Unofficially, he diagnoses RA, but does not officially confirm it - if visual symptoms appear, he will confirm the diagnosis, and since the tests are clean, and pain cannot be “put to work”!
Time is running out for treatment. Tell me what should I do? Go to Kyiv? And there, too, without clinical manifestations, they kick back! And to whom - to a private clinic or to a public hospital?
Thank you for your attention! Sorry for the confusion.
Regards, Yuri.

2013-02-12 15:08:33

Vyacheslav asks:

Good afternoon
Chronic HA VEB, as I think, for 5 years now has been a painful (more or less) daily test for me, causing lymphadenopathy in the ears, neck, submandibular nodes, which decreases in summer, increases in spring, causing chronic fatigue, more or less pronounced also seasonal.
Please help in prescribing treatment, because. to this day I have not treated anything, but, as I see it, the body is unlikely to cope on its own, and there will be a chronic process.
Briefly about myself: a man, born in 1980, Ukrainian, did not suffer from any chronic diseases, was not registered with any doctors for any diseases, I don’t smoke, I almost don’t drink alcohol, athletic build, 4th blood group Rh +
History of symptoms and illness.
In April 2007, my 4-year-old son, like his entire group in the kindergarten, fell ill with chickenpox. A lymph node inflamed behind his ear, fever, spots, then everything went away. At the same time, as it turned out, the persons in contact with me had infectious mononucleosis (not chickenpox), and after 14 days, I, expecting chickenpox (because I had not been sick in childhood), felt an increase in the lymph node behind my ear, like in a son, but there were no red ulcers, there were pharyngitis, the submandibular nodes and / or salivary glands swelled, on the back, on the back of the head and a little on the parietal, there were unpleasant sensations, as if internal pressure, or inflammation, and, it is this sensation that is still , periodically increasing, then almost disappearing, but it has been annoying me for 5 years terribly.
At first I did not understand that the problem with the right ear was due to the lymph node, I went to the ENT, I was prescribed antibiotic injections for otitis, immediately after which a rash appeared in the neck and shoulders (although I had never been allergic to anything), and I refused to prick them.
Treatment of pharyngitis with all sorts of rinses, despite the fact that I had it very rarely before, and went away in 3 days, then it lasted for 3 weeks, but the throat went away, but lymphodenopathy on the head (in the sense of feeling pressure on the back of the head below and behind ears) did not pass, although it decreased. This problem periodically became barely noticeable, but sometimes, especially with any cold / flu disease, it increased many times over.
I couldn’t understand what was happening to me, and I didn’t think about herpes, because I never, and still don’t have any classic herpetic manifestations (sores on the lips, etc.) and don’t.
Today the situation does not change, but, at the insistence of my relatives, I had to start an examination and take tests.
VERY PLEASE HELP IN THE INTERPRETATION OF THE ANALYSIS AND THE PURPOSE OF TREATMENT! And give advice on where it is treated, specifically, professionally, because. there is no such clinic in my region, and I myself am already an amateur in this matter. my email address: [email protected]
ANALYSIS CARRIED OUT:
1. Blood from a vein for viruses:
a) HIV negative
b) RV/syphilis - negative
c) Hepatitis B - negative
d) Hepatitis C - negative
2. Blood from a vein liver tests:
- Alanine aminotransferase ALT U / l (F: up to 34 M: up to 45) - 35.8 - norm
- Aspartate aminotransferase ACT U / l (W: up to 31 M: up to 35) - 15.4 - norm
- Alkaline phosphatase ALP U / l (Adults up to 258) - 152 - normal
- Gammaglutamyltransferase U / l (Male up to 55) - 41.0 - norm
- Total protein g / l (Adults - 65-85) - 72.3 - norm
- Total bilirubin µmol / l (Adults - 1.7 - 21.0) - 15.5 - normal
- Direct bilirubin µmol/l (0-5.3) - 2.2 - norm
- Indirect bilirubin µmol / l (Up to 21) - 13.3 - norm
3. Blood from a vein hematological analysis:
Leukocytes WBC G/l (4.0 - 9.0) 6.0 – norm
Absolute number of lymphocytes Lymph# G/l 1.2 - 3.0 2.5 - norm
Absolute content cells avg. solution Mid# G/l 0.1 - 0.6 0.6 - norm
Absolute content granulocytes Gran# G/l 1.2 - 6.8 2.9 - norm
Hemoglobin HGB g/L Male (- 140 - 180) - 141 - norm
Erythrocytes RBC T / l (3.6 - 5.1) - 4.83 - norm
Hematocrit HCT % Male - 40 - 48 - 45.3 normal
Mean cell volume of erythrocyte MCV fl (75 - 95) 93.9 - norm
Hemoglobin concentration in one erythrocyte MCH pg (28 - 34) 29.1 - normal
The average corpuscular concentration of hemoglobin in erythrocytes MCHCg / L (300 - 380) 311 - the norm
Coef. variations in the width of the distribution of erythr-in RDW-CV% (11.5 - 14.5) 13.2 - norm
Width of distribution erythr-in - standard deviation RDW-SD fl (35.0 - 56.0) 45.1 - norm
Platelets PLT G/l (150 – 420) 328- norm
Average platelet volume MPV fl (7 - 11) 9.6 - normal
Platelet distribution width PDW% (14 -18) 14.5 - normal
Thrombocrit PCT ml/L 0.15 - 0.40 0.314 - norm
Basophils % (0 - 1) 0 - normal
Eosinophils % (1 - 6) 1 - norm
Myelocytes % 0 0 - normal
Metamyelocytes % 0 - normal 0
Band % (1 - 5) 4 - norm
Segmented % (over 12 years old - 47 - 72) 47 - norm
Lymphocytes % (over 12 years old - 19 - 37) 39 - not the norm!
Monocytes % - (3 - 10) 9 - norm
Plasma cells % (0 - 1) 0 - normal
Virocytes % 0 0 - norm
ESR mm / h (Male - 1 - 10, Women - 2 - 15) - 20 is not the norm!
4. Blood from a vein analysis for the Epstein-Barr virus:
- mononucleosis heterophile antibodies - negative - normal
- IgM to EBV capsid antigen Od/ml (norm less than 0.9) - 0.11– norm
- IgG to capsid antigen EBV S/CO (norm less than 0.9) - 23.8 - not the norm!
- IgG to the nuclear antigen EBV S / CO (norm less than 0.9) - 38.4 - not the norm!
- EBV DNA (Epstein-Barr virus), PCR - not detected - normal

Responsible Agababov Ernest Danielovich:

Good afternoon Vyacheslav, you don’t only have blood tests, do you? There should also be instrumental research methods - X-ray, ultrasound, etc. in order to objectively assess your situation, you need to familiarize yourself with all the examinations done, send it to me by mail - [email protected].

Name of the patient: ______________

Clinical diagnosis (in Russian and Latin):

Lues secundaria recidiva

Complications ________________________________________

Related:

floor male

age 47 years old

Home address:

Place of work: disabled group 2

Job title _____________________________________________________

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

Clinical diagnosis (in Russian and Latin):

Secondary recurrent syphilis of the skin and mucous membranes

Lues secundaria recidiva

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

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

Height: 160 cm

Weight: 60 kg

SKIN

1. SKIN CHANGES

Color: ordinary

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.)

Syphilis is considered a shameful disease, as if only priestesses of love or those who use their services can pick it up. Actually it is not!

Firstly, there is also household syphilis, which can be infected by any person, even leading a truly monastic lifestyle. Second, have you ever asked your partner for HIV and syphilis test results? Hardly! So, if condoms protect against HIV, then this number does not always work with syphilis. So it turns out that the cause of the disease is not necessarily debauchery, although the main ways of infection are sexual and transplacental, that is, from mother to child.

"Gift" from Columbus?

Which stork brought syphilis to mankind, history is silent. It is not clear where it came from, an unidentified infection instantly acquired the character of a pandemic and plunged people into horror.

Disputes about the origin of syphilis have not subsided so far, - says Alexei Rodin, Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology, VolgGMU. - For the first time this venereal disease in Europe was documented in 1493, immediately after the return of Columbus from America. Supporters of the first version just believe that sailors-travelers brought the infection. But from where - from Haiti, from America, India or Africa? The disease was called "great smallpox", because, unlike natural (small) smallpox, it left large scars on the bodies of the victims. Another hypothesis - that syphilis was already in ancient times, but not diagnosed - is unlikely. Also popular is the assumption of the Americans that the "sexual plague" came out of Africa and is nothing more than a mutation of local tropical diseases.

After 300 years of mercury - to penicillin

Syphilis did not know for a long time what and how to treat, - continues the professor. - So, the famous Dutch philosopher Erasmus of Rotterdam "humanely" advised: "If a husband and wife are sick with syphilis, they should be burned." In the XV-XVII centuries. doctors refused to treat a shameful disease, and therefore the fight against venereal diseases fell on the shoulders of barbers and scammers who used mercury as a medicine, since many skin diseases, such as leprosy and scabies, were then treated with it.

After applying the mercury ointment, the patient was wrapped in a sheet, put in a barrel and steamed with dry steam. Before that, they were beaten with a whip, expelling immorality. The vast majority of people died after such miraculous procedures, the few survivors became disabled, but syphilis did not go away.

The next stage is the introduction of bismuth preparations, which are also very toxic. However, for the first time they made it possible to achieve a biological cure, that is, to remove the pale spirochete from the body. And only in 1943-1945, with the invention of penicillin, an effective treatment appeared. For a long time, until the 80s of the XX century, magic mold was taken along with bismuth preparations. But finally it was proved that bismuth is absolutely not needed in this situation. Doctors switched to "naked" penicillin - a modern effective treatment for this venereal disease.

In pre-revolutionary Tsaritsyn, syphilis was not treated

It is believed that syphilis came to our country in the 15th century from Lithuania. From the middle of the 19th century, a wave of illness swept over Tsarist Russia. According to Professor Rodin, entire villages were ill. In the Kursk region, there is still the village of Kurnosovka, which got its name from “failed noses”.

The disease also flourished in pre-revolutionary Tsaritsyn. After 1917, one could read in the local press that Dr. de Wez’s drug “will cure your syphilis at any stage,” but, according to the scientist, one can talk about serious scientific treatment and the formation of the profession of a dermatovenereologist only from the moment the Department of Dermatovenereology was created in 1938 year on the basis of the Stalingrad Medical Institute. Its first head was Professor Ioffe. Ezriy Izrailevich organized a society of dermatologists-venereologists, on his initiative in 1940 the building of a skin and venereal clinic was built at the regional hospital.

Special Illness

I would say that syphilis is a special disease, says doctor Alexei Rodin. - Here, for example, is a fact: almost all viruses have become resistant to antibiotics, and only the old-fashioned pale spirochete retains its fear of penicillin! Another feature is that the incidence of syphilis, if you look at the years, goes along the sinusoid. Every 10-15 years - a surge, then 10-15 years - a fall. It is believed that it depends on the activity of the sun. Now we are in decline, in 2014 there were 235 cases of syphilis in our region, in 2015 there are 188 cases so far. It is also unusual that a third of patients recover without any treatment, by themselves. There was such an experience conducted by the Americans. "Victims of science" were 400 blacks with primary signs of syphilis, they signed a contract under which they were not to be treated for 10 years. After 10 years, it turned out that a third of them had tertiary syphilis and neurosyphilis, a third had no manifestations, but the blood was positive (this is considered latent syphilis in Russia) and 30% were completely healthy. By the way, Reagan and Clinton officially apologized for this experience.

Insidiousness of the pale spirochete

Now there is an increase in the incidence of late forms of syphilis, the so-called neurosyphilis, there is an accumulation of cases of congenital syphilis, the dermatovenereologist states. - Pale spirochete may not make itself known for years and suddenly hit the vessels or the cerebral cortex. For example, a patient was treated with us, then for 10 years he worked as a driver in crowded Moscow, and suddenly, according to him, one fine morning he did not know where to go. He was diagnosed with neurosyphilis. Late syphilis began to appear in patients who underwent treatment in the 90s. Apparently, it makes sense to talk about undertreatment in due time. It is no secret that the people who come to us are just the surface part of the syphilis iceberg, I urge you not to be afraid and turn to specialists in time.

Do you know that:

"Pig planted" Italian doctor

Initially, syphilis was called lues, which means "pestilence", "disease". The modern name of the disease was given by the poem (and at the same time a medical treatise) by the Italian doctor, astronomer, writer Girolamo Fracastoro "Syphilis, or the Gallic Disease" (1530). It tells about how once a mythical swineherd named Siphil (ancient Greek συς - pig, φ?λος - amateur) dared to compare the nobility and wealth of earthly rulers with the gods of Olympus and was punished with a serious incurable disease, the name of which is came from the name of the hero.

Sick scientist confused everyone for 100 years

No matter how old the disease is, the causative agent of syphilis, pale spirochete (pale treponema), was discovered only in 1905! The microbe is named spirochete for its resemblance to a spiral, and pale because it can be seen under a microscope with weak staining.

A great confusion in the study of syphilis was made by the Scottish surgeon John Hunter. He injected himself into the urethra with pus from the urethra of a patient with gonorrhea and ... fell ill with syphilis. The doctor was so delighted that he didn’t even realize right away that his “donor” was ill with two diseases at once. As a result of this oversight, for more than 100 (!) years, the scientific community mistakenly believed that syphilis and gonorrhea are caused by the same pathogen.

Our reference

Known syphilitic people

Francisco Goya. The Spanish artist passionately loved not only art, but also women. The fact that he had syphilis has not been proven, then venereal diseases were not very different. But he is the description.

Abraham Lincoln, President of America. By his own admission, in his youth he had the misfortune to meet a pale spirochete. Moreover, he unwittingly infected his wife and three of his children.

Adolf Gitler. During the First World War, the Fuhrer, diagnosed with blindness, ended up in the infirmary. From the documents of the hospital it follows that the true Aryan was treated there for syphilis.

Guy de Maupassant. The writer in practice followed the conviction that loyalty and constancy are nonsense. Sexual revelry in brothels brought him to syphilis. A true Frenchman, he was not upset even when the disease, despite the treatment, began to progress. Maupassant self-irically remarked: "Finally, I have real syphilis, and not a miserable runny nose!"

Natalia Khairulina. Photos from open Internet sources