Syphilis - a chronic infectious disease. When syphilis skin, mucous membranes, internal organs, musculoskeletal, immune and nervous systems. Pathogen – pale treponema.
Pale treponema (Treponema pallidium) belongs to the order Spirochaetales, family Spirochaetaceae, the genus Treponema. Morphologically pale treponema (treponema pallidum) differs from saprofitiruyuschih spirochetes.
The most frequent way of infection with syphilis – sexually, with various forms of sexual contacts.
Infection with syphilis is a small genital or extragenital skin defects, or through the mucosal epithelium in contact with a chancre, erosive papules on the skin and mucous membranes of genitals, mouth, wide condylomas, containing a significant amount of pale treponem.
In saliva pale treponema can be found only in the case when there are eruptions on the oral mucosa.
Syphilis can be transmitted through semen patient with his lack of visible changes in the genitals.
Rarely syphilis can occur in close household contact, in exceptional cases – through household items. Infection with syphilis through milk feeding women, patients with syphilis. No cases of syphilis through urine and sweat were observed. Syphilis (mistakenly used the word "syphilis") from the moment of infection is a common infectious disease, which lasts from untreated patients for many years and has a wavy flow with the change of periods of exacerbation.
During the exacerbation of the disease on the mucous membranes, skin, internal organs are observed in the active manifestations of syphilis.
One of the main causes of changes in the clinic, the duration of the incubation period, latent syphilis of course, is the frequent use of antibiotics, changes in the immune status of the organism and other factors. A classic for syphilis is characterized by the alternation of active manifestations of the disease with a latent period. Classification of flow of syphilis is divided into an incubation period, primary, secondary and tertiary periods.
Primary syphilis (syphilis I primaria) – c emergence stage syphilis chancre and enlarged lymph nodes.
Seronegative primary syphilis (syphilis I seronegativa) – syphilis with negative serological reactions during the course of therapy.
Primary antibody-positive (syphilis I seropositiva) – syphilis, with positive serological reactions.
Primary latent syphilis (syphilis I latens) – syphilis, the absence of clinical symptoms in patients who started treatment in the initial period of illness and his unfinished.
Secondary syphilis (syphilis II secundaria) – stage of syphilis, caused by hematogenous spread of pathogens (treponem) from the primary focus, manifested polymorphic rash (roseola, papules, pustules) on the skin and mucous membranes.
Fresh secondary syphilis (syphilis II recens) – the period of syphilis with multiple polymorphic eruptions on the skin and mucous membranes, often observed residual signs chancre.
Secondary recurrent syphilis (syphilis II recidiva) – the period of secondary syphilis, which is manifested few polymorphic grouped rashes and, occasionally, lesions of the nervous system.
Secondary latent syphilis (syphilis II latens) – a secondary period of syphilis, latent flowing.
Tertiary syphilis (syphilis III tertiaria) – for the next stage of secondary syphilis with destructive lesions of the internal organs and nervous system with the occurrence of these syphiloma.
Active tertiary syphilis manifests an active process of formation of tubercles, permitting the formation of ulcers, scars, the appearance of pigmentation.
Hidden tertiary syphilis - syphilis in individuals who have had active manifestations of tertiary syphilis.
Latent syphilis (syphilis latens) – syphilis, in which serological tests positive, but no signs of damage to the skin, mucous membranes and internal organs.
Early latent cifilis (syphilis latens praecox) – latent syphilis, since the infection which was less than 2 years.
Late latent syphilis (syphilis latens tarda) – latent syphilis, since the infection which took more than 2 years.
Unspecified latent syphilis (syphilis ignorata) – a disease with unknown prescription.
Syphilis household - syphilis infection which occurs through everyday.
Congenital syphilis - syphilis, where the infection came from the sick mother in utero.
Syphilis transfusion - transfusion of donor blood of a patient with syphilis in the recipient developing transfusion syphilis. Possible infection of medical personnel during examination of patients with syphilis, during surgery, treatment procedures, with autopsies (especially infants with early congenital syphilis).
Syphilis headless - Infection occurs when the treponema directly into the blood (through a wound, the study of blood). Typically absence chancre.
Syphilis of the nervous system - neurosyphilis (neurosyphilis): early (neurosyphilis praecox) – Prescription of illness up to 5 years later (neurosyphilis tarda) – more than 5 years.
Distinguish the following forms of early neurosyphilis:
latent latent syphilitic meningitis;
acute generalized syphilitic meningitis;
syphilitic hydrocephalus;
meningovaskulyarny early syphilis;
syphilitic meningomyelitis.
Form of late neurosyphilis:
late latent syphilitic meningitis;
Late diffuse meningovaskulyarny syphilis;
syphilis of the brain vessels (vascular syphilis);
gumma of the brain;
paralysis.
Visceral syphilis (syphilis visceralis) – syphilis, which struck the internal organs (heart, brain, spinal cord, lungs, liver, stomach, kidney).
Malignant syphilis - syphilis heavily flowing with a massive defeat of the internal organs and nervous system, characteristic of tertiary syphilis.
In the primary period appears the first clinical sign of syphilis - chancre (in the place where the pale treponema penetrated into the body). Chancre – a red spot, turns into a papule, then – in the erosion or ulcer, occurring at the site of entry pale treponema in the body. Chancre often localized on the genitals (women are often on the cervix), indicating that sexual transmission; much less frequently observed vnepolovye chancre, which may be located in any part of the skin or mucous membranes: the lips, tonsils, skin pubic area, thighs and scrotum , abdomen. 1-2 weeks after the chancre begin to grow next to his lymph nodes.
Disappearance chancre suggests that syphilis came to the latent stage, during which the body is rapid multiplication of pale treponem. The secondary period of syphilis usually occurs after 5.9 weeks after the chancre (primary syphiloma) and continues without treatment 3-5 years.
The flow of secondary syphilis undulating: the period of active manifestations replaced by a disguised form of syphilis.
For the latent period characterized by the absence of clinical signs of syphilis, and only seropositive blood flow indicate an infectious process.
Clinical signs of tertiary syphilis may occur many years later after a long asymptomatic course of disease after infection with syphilis. The main factors influencing the formation of tertiary syphilis, is the lack of or inadequate treatment of patients with earlier forms of syphilis.
Tests for syphilis are composed of clinical and laboratory data:
study at the pale treponem;
study of blood on the PB (Wasserman);
RIF (the reaction of the immune fluorescence);
RIBT (immobilization reaction of pale treponem).
Diagnosis of syphilis primary period of the study conducted by discharge chancre, punctate regional lymph nodes.
In the diagnosis of syphilis secondary period studied material papular, blackheads elements erosive and hypertrophic papules of the skin and mucous membranes.
Tests for syphilis bakterioskopicheskim method (microscopic) are carried out by detecting pale treponema in dark-field microscope.
By treponemnym methods for diagnosis of syphilis include:
Wasserman reaction (RW);
immunofluorescence (RIF).
RW (Wasserman) is of great importance to confirm the diagnosis of syphilis in the presence of active manifestations of the disease, identification of hidden (latent) syphilis, the effectiveness of the treatment of syphilis. RW is also important for the prevention of congenital syphilis.
Wassermann positive in 100% of patients with syphilis secondary period, with early congenital syphilis, in 70-80% of patients with tertiary syphilis.
Treponemnym method of testing for syphilis is also immunofluorescence (RIF). RIF is the most highly sensitive method of diagnosis of syphilis and becomes positive already in primary seronegative syphilis.
RIF is positive in secondary syphilis, congenital syphilis in 100%, with tertiary syphilis – in 95-100%, with late forms of syphilis (internal organs, syphilis of the nervous system) – in 97-100%.
Treatment of syphilis is based on the set in the world with relevant standards and is conducted only after the diagnosis and confirmation of his laboratory research methods.
Treatment of syphilis requires a doctor-venereologist account various factors, various indicators, complicating things. This largely determines the subsequent choice of treatment of syphilis.
In the treatment of syphilis-specific antibacterial drugs are used several groups and generations, and they are the foundation of therapy. При лечении сифилиса пациент также должен строго соблюдать рекомендованный режим (достаточный сон, рациональное питание, витамины, запрещение алкоголя), продолжительность интервалов между курсами лечения, что значительно повышает эффективность лечения сифилиса. Crucial to the successful treatment of syphilis is beyond the state of the therapy the patient, its reactivity, it is in the process of treatment is necessary to increase resistance to infection. To do this, drugs that stimulate protective responses of the organism.
Venereologist determine in each case, depending on the stage of syphilis, complications, concomitant diseases of other organs and systems, allergic background, body weight, percentage of absorbability and bioavailability of the drug, needed dose of medications, additional use of immunomodulators, enzymes, vitamin preparations, physiotherapy.
After the treatment of syphilis is required repeated clinical and serological monitoring of blood within a few months or years (depending on the stage of syphilis).
If after the treatment of syphilis during the year the blood does not become negative, the message state serorezistentnosti and assigned to treat syphilis.
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