Published: 10/27/2021 16:15:00 Updated: 10/27/2021
How syphilis is transmitted and why it is dangerous are two questions that doctors are often asked. The disease is a sexually transmitted disease, has a long-term chronic course and affects all organs. Treatment is carried out by a venereologist and is based on taking antibacterial drugs. If treatment is neglected, the disease can last for several years, changing periods of exacerbation to a latent course without obvious symptoms.
Causes of the disease
The causative agent of syphilis is Treponema pallidum or Treponema pallidum.
This bacterium resembles a spiral in shape, it can move, and reproduces by division. When it enters the body, it settles in the lymph nodes. It begins to show up in the blood much later. Treponema is practically unviable in the environment. It does not tolerate heat, light, or drying, but at room temperature it remains mobile for up to 12 hours. Sensitive to antibiotics and almost all antiseptics. But treponema tolerates low temperatures well. It is an anaerobic - it does not require oxygen to live and reproduce.
Most often, syphilis is transmitted sexually, which makes it possible to classify it as a sexually transmitted disease. This method of infection accounts for up to 98% of all diagnosed cases.
However, there are known facts of transmission from an infected person, as well as among drug addicts who use the same syringe when injecting drugs, in everyday life when using toothbrushes or razors with blood residues on them.
Household transmission of syphilis is extremely rare and most often occurs through close contact with a patient who already has tertiary syphilis. Treponema pallidum is found in saliva only in the presence of ulcers in the oral cavity, but is absent in urine, sweat and feces.
The cause of syphilis infection can be the milk of a woman nursing her baby. There are also known cases of transmission of the disease from a patient to a fetus during pregnancy.
Congenital syphilis
It is transmitted from a sick mother when treponemes penetrate the placenta into the fetus. Syphilis infection can occur both during conception and much later. Regardless of the time of infection, pathological tissue changes are observed only in the VI-VII months of pregnancy, so active prevention of syphilis in the early stages will help give birth to a healthy child.
The possibility of transmitting pathogens through the father's sperm has not yet been proven, so all preventive measures usually concern the expectant mother. These include: identification of sick women in the early stages, full registration of pregnant women, monitoring the treatment of infected persons. In order to prevent the development of negative changes, mandatory regular examinations of pregnant women are carried out for the presence of treponemas and external signs of congenital syphilis.
Periods, stages, symptoms of syphilis
It all starts with the incubation period - the time from the moment of infection to the appearance of the first symptoms.
It lasts on average 21 days, but can sometimes decrease or extend. Primary syphilis begins when a chancre appears on the skin and continues until a specific rash appears, which occurs not only on the skin, but also on the mucous membranes. The average duration of this stage is 6-7 weeks. Another important sign is enlargement of the lymph nodes, but without signs of pain.
A hard chancre forms at the site where treponema enters the body. Most often these are the genitals. In appearance, these are painless ulcers with smooth, dense edges and minimal discharge. The size of chancre is small - from 10 to 20 mm, but can be larger or smaller. This symptom of syphilis disappears on its own, even without treatment, after 3-6 weeks from its onset. But this does not mean that the infected person has recovered and does not pose a risk of infection to those who have sexual contact with him. After the ulcers disappear, the disease continues.
Secondary syphilis usually lasts from 2 to 5 years. In this case, the causative agent of the disease no longer affects the lymphatic system, but the circulatory system, and spreads throughout the body through the bloodstream.
This stage of syphilis occurs unevenly: periods of strong manifestations are replaced by calm ones, when the infected person has practically no symptoms. Here, too, there are three periods:
- Fresh.
- Recurrent.
- Hidden.
The symptoms here are very varied, so often only tests can help make an accurate diagnosis.
The first thing that attracts attention is the rash. It does not cause any discomfort, does not itch or feel painful. The rashes have a regular shape, are clearly visible on the skin, and do not merge into one large spot. Peeling is absent or extremely rare. The rash disappears on its own and leaves no scars or stains. The main diagnostic sign is the presence of rashes on the palms and soles. Most often, the rash is roseola, that is, spots on the skin and mucous membranes have a pink or red tint. Other signs of syphilis at this stage include baldness, which can be focal or spread to the entire head.
Syphilis in women occurs with such a striking symptom as pigmentary syphilide, which is also called the “necklace of Venus”. This manifests itself in the form of the appearance of discolored areas of skin on the back and side surfaces of the neck. Sometimes the same discoloration occurs on the arms, chest, back, stomach, and lower back. If the vocal cords are affected, the voice becomes hoarse.
Tertiary syphilis is the last stage of the disease, which occurs in the absence of any treatment for previous symptoms. It can also be detected due to inadequate therapy, self-medication or incorrect diagnosis. This is rarely achieved now.
A noticeable decrease in the body’s immune forces begins, with damage to all organs. The main symptom is the appearance of syphilitic gummas, which resemble a node in the center of which there is a focus of tissue necrosis. A clear, viscous liquid constantly leaks from such a formation, but the patient does not experience any unpleasant sensations. The lifespan of gumma ranges from several weeks to several years.
Another sign of tertiary syphilis is damage to the nervous system. The patient begins to develop tabes dorsalis, paralysis and paresis appear. When joints and bones are affected, synovitis and osteoarthritis are observed. Myocarditis, hepatitis, gastritis, nephritis can also be diagnosed, and eye damage ultimately leads to complete blindness.
Tertiary syphilis
Tertiary syphilis is characterized by a long latent course. It can appear after 3-4 years (with complete absence of treatment, or with insufficient treatment). Most often, this form of pathology can be found in patients suffering from chronic alcoholism, tuberculosis or other infections.
During this period, a small amount of dense infiltrates, localized in the subcutaneous tissue or in deeper tissues, is found on the patient’s skin and mucous membranes. After some time, they disintegrate, and in their place painless ulcers appear, which scar only after a few months or years. It should be noted that such syphilides are not accompanied by subjective disorders and do not disturb the general condition of the patient. They contain very little pathogen, and therefore are practically non-contagious.
Diagnostics
To prevent the diagnosis of syphilis from showing a false positive or false negative result, it is necessary to do this only with the help of modern tests in a laboratory that has all the necessary equipment and reagents:
- Determination of antibodies to Treponema pallidum in the passive hemagglutination reaction (PHA) in the blood is one of the most popular methods for diagnosing both primary and secondary or tertiary syphilis. Used to confirm or refute the diagnosis at any stage of the disease.
- Determination of antibodies to Treponema pallidum in the blood using the ICL method is used for screening diagnosis of the disease before hospitalization, during a medical examination and obtaining medical certificates, as well as for the primary diagnosis of the disease in the presence of chancroid.
- Determination of class M antibodies (lgM) to Treponema pallidum using the enzyme immunoassay method (ELISA) in the blood allows one to determine the presence of the disease with a 100% result.
- Syphilis in men can be diagnosed by determining the DNA of the pathogen in urethral discharge using the PCR method. Also scraping of epithelial cells is carried out in women, but here it can be the cervical canal or discharge from the vagina.
- Determination of antibodies to Treponema pallidum in non-treponema tests (RPR, RMP) in the blood allows you to determine primary, secondary or tertiary syphilis, but it is recommended to use specific tests to confirm the diagnosis.
- Determination of Treponema pallidum DNA in blood, biological fluids, secretions from mucous membranes (except genitals), cerebrospinal fluid and effusion using the PCR method is done in the presence of such a clear symptom as chancroid, as well as during pregnancy. The test is recommended to be taken during treatment to monitor the effect of prescribed medications.
- Prescribing and monitoring the course of treatment for sexually transmitted diseases and sexually transmitted diseases.
An analysis for syphilis should be done during the primary period no earlier than 2 weeks from the moment of infection.
Until then, even the most sensitive test will show a negative result. The fact is that primary syphilis is divided into two periods - seronegative, when it cannot be detected, and seropositive, in which the disease can already be diagnosed. Specific serological reactions in people who have recovered from the disease will always be positive. Therefore, they are not used to monitor the effectiveness of prescribed therapy.
Primary syphilis
After the end of the incubation period, the characteristic first symptoms of syphilis appear. At the site of penetration of the treponemas, a hard chancre is formed, a specific round erosion or ulcer, with a hard, smooth bottom and “turned-up” edges. The size of the formations can vary from a couple of mm to several centimeters. Hard chancre can disappear without treatment. Erosions heal without a trace, ulcers leave flat scars.
The disappearance of chancre does not mean the end of the disease: primary syphilis only passes into a latent form, during which the patient is still infectious to sexual partners.
After the formation of hard chancre, local enlargement of the lymph nodes begins after 1-2 weeks. When palpated, they are dense, painless, and mobile; one is always larger than the others. After another 2 weeks, the serum (serological) reaction to syphilis becomes positive, from this moment primary syphilis passes from the seronegative stage to the seropositive stage. The end of the primary period: body temperature may rise to 37.8 - 380, sleep disturbances, muscle and headaches, and joint aches appear. Dense swelling of the labia (in women), the head of the penis and the scrotum in men is possible.
Prevention
Standard preventive measures include avoiding casual sex, using condoms, and to prevent occupational syphilis, wearing disposable latex gloves before examination, manipulation and surgery.
Condoms are not 100% protection - the chancre can be located extragenitally (pubis, perineum), and with secondary syphilis, a “necklace of Venus” is formed on the skin. In these cases, the infection from syphilis is transmitted by contact to the partner’s skin.
With syphilis, lifelong immunity is not formed. Having successfully recovered from this disease, you can become infected and get sick again. In this case, the disease will be just as severe. Therefore, there are no vaccinations against syphilis, and there cannot be.
History
There are three theories about the origin of syphilis, one more confused than the other: American, African and European.
An interesting point is this: there is a theory that syphilis was originally a disease (cutaneous spirochetosis) of South American llamas, which was transmitted to humans in an unknown way. And a genetic study of fossil treponemes confirms that the first European epidemic of syphilis in Naples in 1495 could have been imported by Columbus’s sailors.
Trouble in the study of the history of syphilis was introduced by John Hunter, an adherent of medicine and self-torture, who received primary syphiloma on his own head of the penis by injecting secretions of a patient with gonorrhea. Without thinking that the patient could be a proud carrier of two infectious agents, he concluded that gonorrhea and syphilis had a single cause.
How to treat syphilis?
The treatment of syphilis is approached in a comprehensive manner, taking into account many individual factors (age, gender of the patient, stage of development of the disease, the presence of concomitant diseases, general condition of the body, etc.). In addition, all sexual partners of the suspected patient should also be examined for the presence of syphilis and, if necessary, undergo a course of therapy.
If a patient has primary syphilis, then everyone who has had sexual intercourse with him over the past three months must undergo examination and tests. In the case of secondary syphilis - everyone who had contact with the patient over the past year. The timeliness of the therapy itself, as well as the correct selection of modern medications, is important for achieving success in the treatment of this disease.
The most effective method of treating syphilis is the introduction of water-soluble penicillins into the body. This therapy is carried out in a hospital setting for 24 days with injections every 3 hours. The causative agent of syphilis is quite sensitive to penicillin antibiotics, but there is a possibility of an allergic reaction to these drugs or the ineffectiveness of such therapy. In this case, penicillin is replaced with drugs of the tetracycline, macrolide, and fluoroquinolone groups. In addition to antibiotics, natural immune stimulants, vitamins, and immunostimulants are also indicated for syphilis.
Forecast
It all depends on the stage of development of the disease and the treatment method. If therapy was started in the early stages of the disease (primary, secondary and early latent syphilis) and is carried out using treponemocidal antibiotics, then in almost all cases without exception, a complete clinical cure occurs, and relapses of early syphilis and the occurrence of late forms of syphilis are prevented.
Treatment of syphilis in pregnant women in the first half of pregnancy in most cases guarantees the birth of a healthy baby. In the case of congenital syphilis, the prognosis is favorable if treatment of the disease was started in a timely manner. Treatment of later forms of the disease is less successful, since it only slows down the progression of the disease, but in all cases it can restore the impaired function of the affected organs and lead to negative serological reactions.
Consequences of syphilis
If left untreated, syphilis gradually spreads throughout the body and affects more and more healthy tissues and organs. Sometimes there is temporary relief, after which the patient’s condition sharply worsens. Complications of syphilis depend on its stage.
Primary syphilis can be complicated by the following conditions:
- tissue necrosis at the location of the chancre;
- balanitis;
- phimosis;
- paraphimosis
With secondary syphilis, the following complications are noted:
- damage to internal organs by syphilis;
- damage to the nervous system;
- bone damage.
Complications of tertiary syphilis are:
- damage to internal organs;
- brain damage;
- Treponema damage to the tissues of the neck and face;
- pathological fractures of bones when they are affected by syphilis;
- bleeding as a result of vascular rupture.
