Syphilis (syphilis) refers to infectious diseases, sexually transmitted in most cases. The causative agent of syphilis is a spiral-shaped microorganism Treponema pallidum(pale treponema), very vulnerable in the external environment, multiplies rapidly in the human body. Incubation period, that is time from infection to the onset of the first symptoms, approximately 4-6 weeks... It can be shortened up to 8 days or lengthened up to 180 with concomitant sexually transmitted diseases (,), if the patient is weakened by an immunodeficiency state () or took antibiotics. In the latter case, the primary manifestations of syphilis may be absent altogether.

Regardless of the length of the incubation period, the patient at this time is already infected with syphilis and is dangerous to others as a source of infection.

How can you get syphilis?

Syphilis is transmitted mainly through sexual contact - up to 98% of all infections. The pathogen enters the body through defects in the skin or mucous membranes of the genitals, anorectal loci, and mouth. However, about 20% of sexual partners who have been in contact with syphilis patients remain in good health. Risk of infection significantly decreases if there are no conditions necessary for the penetration of infection - microtraumas and a sufficient amount of infectious material; if sexual intercourse with a patient with syphilis was single; if syphilis (morphological manifestations of the disease) have a small contagiousness(the ability to infect). Some people are genetically immune to syphilis, because their body produces specific protein substances that can immobilize treponema pallidus and dissolve their protective membranes.

It is possible that the fetus becomes infected intrauterinely or during childbirth: then congenital syphilis is diagnosed.

The everyday route - through any objects contaminated with infectious material, handshakes or formal kisses - is very rare. The reason is the sensitivity of treponemes: as they dry out, the level of their contagiousness drops sharply. Get infected with syphilis through a kiss it is quite possible if one person has syphilitic elements on the lips, mucous membrane of the mouth or throat, on the tongue containing a sufficient number of virulent (that is, live and active) pathogens, and another person has scratches on the skin, for example, after shaving.

the causative agent of syphilis is pale treponema from the spirochete family

Routes of transmission of infectious material are very rare through medical instruments... Treponemes are unstable even under normal conditions, and when sterilized or treated with conventional disinfectant solutions, they die almost instantly. So all the stories about syphilis infection in gynecological and dental offices most likely belong to the category of oral folk art.

Transmission of syphilis with blood transfusions(blood transfusions) practically never occurs. The fact is that all donors must be tested for syphilis, and those who do not pass the test simply cannot donate blood. Even if we assume that there was an incident and there are treponemas in the donor blood, they will die when the material is preserved in a couple of days. The very presence of the pathogen in the blood is also rare, because Treponema pallidum appears in the bloodstream only during the period " treponemal sepsis»With secondary fresh syphilis. Infection is possible if a sufficient amount of the virulent pathogen is transmitted with direct blood transfusion from an infected donor, literally from a vein into a vein. Given that the indications for the procedure are extremely narrowed, the risk of contracting syphilis through blood is unlikely.

What makes you more likely to get syphilis?

Liquid discharge... Since treponemes prefer a moist environment, mother's milk, weeping syphilitic erosions and ulcers, sperm from the vagina contain a huge number of pathogens and therefore are most infectious. Salivary transmission is possible if there is syphilis(rash, chancres).
Elements of dry rash(spots, papules) are less contagious, in abscesses ( pustules) treponema can be found only at the edges of the formations, and in the pus they are not at all.
Disease period... With active syphilis, nonspecific erosions on the cervix and the head of the penis, vesicles of a herpetic rash and any inflammatory manifestations leading to defects in the skin or mucous membranes are contagious. In the period of tertiary syphilis, the possibility of infection through sexual contact is minimal, and papules and gummas specific for this stage are actually not contagious.

With regard to the spread of infection, latent syphilis is the most dangerous: people are unaware of their illness and do not take any measures to protect their partners.

Accompanying illnesses... Patients with gonorrhea and other STDs are more likely to become infected with syphilis, since the mucous membranes of their genitals are already damaged by previous inflammations. Treponemas multiply rapidly, but the primary lue is "masked" by the symptoms of other sexually transmitted diseases, and the patient becomes epidemically dangerous.
The state of the immune system... The likelihood of contracting syphilis is higher in people weakened by chronic diseases; AIDS patients; among alcoholics and drug addicts.

Classification

Syphilis can affect any organs and systems, but the manifestations of syphilis depend on the clinical period, symptoms, duration of the disease, patient's age and other variables. Therefore, the classification seems a little confusing, but in reality it is built quite logically.

Depending on from the length of time, which has passed since the moment of infection, distinguish between early syphilis - up to 5 years, more than 5 years - late syphilis.
By typical symptoms syphilis is divided into primary(hard chancre, scleradenitis and lymphadenitis), secondary(papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis) and tertiary(gum, damage to internal organs, bone and articular systems, late neurosyphilis).

chancre - an ulcer that develops at the site of introduction of the causative agent of syphilis

Primary syphilis according to the results of blood tests, may be seronegative and seropositive... Secondary according to the main symptoms are divided at the stage of syphilis - fresh and latent (recurrent), tertiary is differentiated as active and latent syphilis, when treponemas are in the form of cysts.
By preferential damage to systems and organs: neurosyphilis and visceral (organ) syphilis.
Separately - fetal syphilis and congenital late syphilis.

Primary syphilis

After the end of the incubation period, the characteristic first signs appear. In the place of penetration of treponema, a specific round erosion or ulcer is formed, with a hard, smooth bottom, "tucked" edges. The size of the formations can vary from a couple of mm to several centimeters. Hard chancres can disappear without treatment. Erosions heal without a trace, ulcers leave flat scars.

The disappeared chancres do not mean the end of the disease: primary syphilis only turns into a latent form, during which the patient is still infectious for sexual partners.

in the picture: chancres of genital localization in men and women

After the formation of a hard chancre, after 1-2 weeks begins local enlargement of lymph nodes... On palpation, they are dense, painless, mobile; one is always larger than the others. After another 2 weeks, it becomes positive serum (serological) reaction to syphilis, from this moment primary syphilis passes from the seronegative stage to the seropositive stage. End of the primary period: the body temperature may rise to 37.8 - 380, sleep disturbances, muscle and headaches, and joint aches appear. Available dense edema of the labia (in women), the head of the penis and scrotum in men.

Secondary syphilis

The secondary period begins approximately 5-9 weeks after the formation of a hard chancre, and lasts 3-5 years. The main symptoms syphilis at this stage - skin manifestations (rash), which appears with syphilitic bacteremia; wide condylomas, leukoderma and baldness, nail damage, syphilitic tonsillitis. Present generalized lymphadenitis: The nodes are dense, painless, the skin above them is of normal temperature ("cold" syphilitic lymphadenitis). Most patients do not notice any special deviations in well-being, but a rise in temperature to 37-37.50, a runny nose and a sore throat are possible. Because of these manifestations, the onset of secondary syphilis can be confused with the common cold, but at this time, lues affects all body systems.

syphilitic rash

The main signs of a rash (secondary fresh syphilis):

Formations are dense, the edges are clear;
The shape is correct, round;
Not prone to merging;
Do not peel off in the center;
They are located on visible mucous membranes and over the entire surface of the body, even on the palms and feet;
No itching or soreness;
They disappear without treatment, do not leave scars on the skin or mucous membranes.

Dermatology accepted special names for the morphological elements of the rash that can remain unchanged or transform in a certain order. First on the list - spot(macula) can go to stage tubercle(papula), bubble(vesicula), which is opened to form erosion either turns into abscess(pustula), and when the process spreads deep into ulcer... All of these elements disappear without a trace, in contrast to erosions (after healing, a spot first forms) and ulcers (the outcome is scarring). Thus, it is possible to find out what the primary morphological element was by trace marks on the skin, or to predict the development and outcome of existing skin manifestations.

For secondary fresh syphilis, the first signs are numerous punctate hemorrhages in the skin and mucous membranes; profuse rashes in the form of rounded pink spots(roseolae), symmetrical and bright, irregularly arranged - roseola rash. After 8-10 weeks, the spots turn pale and disappear without treatment, and fresh syphilis turns into secondary hidden syphilis, proceeding with exacerbations and remissions.

For the exacerbation stage ( recurrent syphilis) is characterized by the preferred localization of the elements of the rash on the skin of the extensor surfaces of the arms and legs, in the folds (groin areas, under the breasts, between the buttocks) and on the mucous membranes. There are much fewer spots, their color is more faded. The spots are combined with papular and pustular rashes, which are more often observed in debilitated patients. At the time of remission, all skin manifestations disappear. In a relapsing period, patients are especially contagious, even with household contacts.

Rash with secondary exacerbated syphilis polymorphic: consists of spots, papules and pustules at the same time. The elements are grouped and merged to form rings, garlands and half-arcs, which are called lenticular syphilides... After their disappearance, pigmentation remains. At this stage, it is difficult for a layperson to diagnose syphilis by external symptoms, since secondary recurrent syphilis can be similar to almost any skin disease.

Lenticular rash with secondary recurrent syphilis

Pustular (pustular) rash with secondary syphilis

Pustular syphilides are a sign of a malignant ongoing disease. More often observed during the period of secondary fresh syphilis, but one of the varieties is ectymatous- typical for secondary exacerbated syphilis. Ecthymes appear in debilitated patients about 5-6 months from the time of infection. They are located asymmetrically, usually on the lower legs in front, less often on the skin of the trunk and face. Syphilides, 5-10 in number, round, about 3 cm in diameter, with a deep abscess in the center. A gray-black crust forms above the pustule, underneath is an ulcer with necrotic masses and dense steep edges: ecthyma resembles funnels in shape. After that, deep dark scars remain, which eventually lose pigmentation and become white with a pearlescent shade.

Necrotic ulcers from pustular syphilis, secondary to tertiary stages of syphilis

Ectymes can pass into rupioid syphilides, with the spread of ulceration and tissue decay outward and inward. Center rupees multilayer "oyster" crusts are formed, surrounded by an annular ulcer; outside - a dense roll of reddish-violet color. Ectymes and rupees are not very infectious, during this period all serological tests for syphilis are negative.

Acne-like syphilides - abscesses 1-2 mm in size, localized in hair follicles or inside the sebaceous glands. The rash is localized on the back, chest, limbs; heal with the formation of small pigmented scars. Smallpox syphilides are not associated with hair follicles, they are in the form of lentils. Dense at the base, copper-red color. Syphilis, similar to impetigo- purulent inflammation of the skin. Occurs on the face and scalp, the size of the pustules is 5-7 mm.

Other manifestations of secondary syphilis

Syphilitic warts similar to warts with a wide base, more often formed in the fold between the buttocks and in the anus, under the armpits and between the toes, near the navel. In women - under the breasts, in men - near the root of the penis and on the scrotum.

Pigmented syphilide(spotted leucoderma literally translated from Latin - "white skin"). White spots up to 1 cm in size appear on the pigmented surface, which are located on the neck, for which they received the romantic name "necklace of Venus". Leucoderma is determined after 5-6 months. after infection with syphilis. Possible localization on the back and lower back, abdomen, arms, at the front edge of the armpits. The spots are not painful, scaly or inflamed; remain unchanged for a long time, even after specific treatment for syphilis.

Syphilitic baldness(alopecia). Hair loss can be localized or affect large areas of the scalp and body. On the head, small foci of incomplete alopecia are often observed, with rounded irregular outlines, mainly located on the back of the head and temples. On the face, first of all, attention is paid to the eyebrows: with syphilis, hairs first fall out from their inner part, located closer to the nose. These signs laid the foundation for imaging diagnostics and became known as “ omnibus syndrome". In the later stages of syphilis, a person loses absolutely all hair, even vellus hair.

Syphilitic sore throat- the result of damage to the mucous throat. Small (0.5 cm) spotty syphilides appear on the tonsils and soft palate, they are visible as bluish-red foci of sharp outlines; grow up to 2 cm, merge and form plaques. The color in the center changes rapidly, acquiring a grayish-white opal tint; the edges become scalloped, but retain their density and original color. Syphilis can cause pain when swallowing, a feeling of dryness and persistent sore throat. They arise together with a papular rash during the period of fresh secondary syphilis, or as an independent symptom of secondary exacerbated syphilis.

manifestations of syphilis on the lips (chancre) and tongue

Syphilis on the tongue, at the corners of the mouth due to constant irritation, they grow and rise above the mucous membranes and healthy skin, dense, grayish surface. They may erode or ulcerate, causing painful sensations. Papular syphilis on the vocal cords at first they are manifested by hoarseness, later a complete loss of voice is possible - aphonia.

Syphilitic nail damage(onychia and paronychia): papules are localized under the bed and at the base of the nail, visible as reddish-brown spots. Then the nail plate above them becomes whitish and brittle, begins to crumble. With purulent syphilis, severe pain is felt, the nail moves away from the bed. Subsequently, depressions in the form of craters form at the base, the nail thickens three or four times in comparison with the norm.

Tertiary period of syphilis

Tertiary syphilis is manifested by focal destruction of mucous membranes and skin, any parenchymal or hollow organs, large joints, and the nervous system. The main signs - papular rashes and gums degrading with rough scarring. Tertiary syphilis is rarely detected, develops within 5-15 years if no treatment has been carried out. Asymptomatic period ( latent syphilis) can last for more than two decades, is diagnosed only by serological tests between secondary and tertiary syphilis.

what can affect advanced syphilis

Papular elements dense and rounded, up to 1 cm in size. They are located in the depths of the skin, which becomes bluish-red over the papules. Papules appear at different times, are grouped into arcs, rings, elongated garlands. For tertiary syphilis, typical focus rashes: each element is identified separately and in its stage of development. The disintegration of papular syphiles begins from the center of the tubercle: rounded ulcers appear, the edges are steep, at the bottom there is necrosis, along the periphery there is a dense ridge. After healing, small dense scars with a pigmented border remain.

Serpinginous syphilis is grouped papules that are at different stages of development and spread to large areas of the skin. New formations appear on the periphery, merge with old ones, which at this time are already ulcerating and scarring. The sickle-shaped process seems to creep to healthy areas of the skin, leaving a trail of mosaic scars and foci of pigmentation. Numerous lumpy seals create a variegated picture true polymorphic rash, which is visible in the late periods of syphilis: different sizes, different morphological stages of the same elements - papules.

syphilitic gum on the face

Syphilitic gum... First, it is a dense knot, which is located deep in the skin or under it, mobile, up to 1.5 cm in size, painless. After 2-4 weeks, gum is fixed relative to the skin and rises above it as a rounded dark red tumor. Softening appears in the center, then a hole is formed and a sticky mass comes out. In place of the gum, a deep ulcer is formed, which can increase along the periphery and spread along an arc ( serpentine gummy syphilide), and in the "old" areas there is healing with the appearance of retracted scars, and ulceration in the new ones.

More often syphilitic gummas are located singly and are localized on the face, near the joints, on the legs in front. Closely located syphilides can merge to form gum pad and develop into impressive ulcers with hard, uneven edges. In debilitated patients, with a combination of syphilis with HIV, gonorrhea, viral hepatitis, the growth of gum in depth is possible - mutating or irradiating gum. They disfigure the appearance, can even lead to the loss of an eye, testicle, perforation and death of the nose.

Gum in the mouth and inside the nose disintegrate with destruction of the palate, tongue and nasal septum. Defects are formed: fistulas between the cavities of the nose and mouth (nasal voice, food can get into the nose), narrowing of the throat opening(difficulty swallowing), cosmetic problems - failed saddle nose. Language first it increases and becomes bumpy, after the formation of scars it shrivels, it becomes difficult for the patient to talk.

Visceral and neurosyphilis

At visceral tertiary syphilis, organ damage is observed, with the development neurosyphilis- symptoms from the central nervous system (CNS). During the secondary period, early syphilis of the central nervous system appears; it affects the brain, its vessels and membranes ( meningitis and meningoencephalitis). In the tertiary period, manifestations of late neurosyphilis are observed, these include atrophy of the optic nerve, tabes dorsum and progressive paralysis.

Dorsal tabes- manifestation of spinal cord syphilis: the patient literally does not feel the ground under his feet and cannot walk with his eyes closed.

Progressive paralysis the maximum manifests itself in one and a half to two decades after the onset of the disease. The main symptoms are mental disorders, from irritability and memory impairment to delusional states and dementia.

Optic nerve atrophy: with syphilis, one side is first affected, a little later, vision deteriorates in the other eye.

Gummas affecting the head brain are rarely observed. According to clinical signs, they are similar to tumors and are expressed by symptoms of brain compression - increased intracranial pressure, rare pulse, nausea and vomiting, prolonged headaches.

bone destruction in syphilis

Among the visceral forms, prevails syphilis of the heart and blood vessels(up to 94% of cases). Syphilitic mesaorthitis- inflammation of the muscle wall of the ascending and thoracic aorta. It is often found in men, accompanied by the expansion of the artery and the phenomena of cerebral ischemia (dizziness and fainting after exercise).

Syphilis liver(6%) leads to the development of hepatitis and liver failure. The total share of syphilis of the stomach and intestines, kidneys, endocrine glands and lungs does not exceed 2%. Bones and joints: arthritis, osteomyelitis and osteoporosis, the consequences of syphilis - irreversible deformities and blockade of joint mobility.

Congenital syphilis

Syphilis can be transmitted during pregnancy, from an infected mother to her baby at 10-16 weeks of age. Frequent complications are spontaneous abortions and fetal death before childbirth. Congenital syphilis, according to time criteria and symptoms, is divided into early and late.

Early congenital syphilis

Children who are clearly underweight, with wrinkled and flabby skin, resemble little old people. Deformation of the skull and its facial part ("Olympic forehead") is often combined with dropsy of the brain, meningitis. Present keratitis- inflammation of the cornea of the eyes, visible loss of eyelashes and eyebrows. Children 1-2 years of age develop syphilitic rash, localized around the genitals, anus, on the face and mucous membranes of the throat, mouth, nose. A healing rash forms scarring: Scars that look like white rays around the mouth are a sign of congenital lues.

Syphilitic pemphigus- a rash from vesicles, observed in a newborn a few hours or days after birth. It is localized on the palms, the skin of the feet, on the bends of the forearms - from the hands to the elbows, on the trunk.

Rhinitis, the causes of its occurrence are syphilis of the nasal mucosa. Small, purulent discharge appears, forming crusts around the nostrils. Breathing through the nose becomes problematic, the child is forced to breathe only through the mouth.

Osteochondritis, periostitis- inflammation and destruction of bones, periosteum, cartilage. It is more often determined on the legs and arms. Local swelling, pain and muscle tension are noted; then paralysis develops. During early congenital syphilis, destruction of the skeletal system is diagnosed in 80% of cases.

Late congenital syphilis

Late form manifests itself in the age period of 10-16 years. The main symptoms are visual impairment with the possible development of complete blindness, inflammation of the inner ear (labyrinthitis), followed by deafness. Skin and visceral gums are complicated by functional disorders of organs and scars disfiguring the appearance. Deformation of teeth, bones: the edges of the upper incisors have lunate notches, the legs are bent, due to the destruction of the septum, the nose is deformed (saddle). Problems with the endocrine system are common. The main manifestations of neurosyphilis are tabes dorsalis, epilepsy, speech disorders, progressive paralysis.

Congenital syphilis is characterized by a triad of symptoms Hutchinson:

teeth with an arched edge;

clouded cornea and photophobia;

labyrinthitis - tinnitus, loss of orientation in space, hearing loss.

How is syphilis diagnosed?

Diagnosis of syphilis is based on clinical manifestations characteristic of different forms and stages of the disease, and laboratory tests. Blood taken to conduct a serological (serum) test for syphilis. To neutralize teponemes in the human body, specific proteins are produced, which are determined in the blood serum of an infected or sick with syphilis.

RW analysis blood (Wasserman reaction) is considered obsolete. Can often be false positive for tuberculosis, tumors, malaria, systemic disease, and viral infections. Among women- after childbirth, during pregnancy, menstruation. The consumption of alcohol, fatty foods, some medications before donating blood to RW can also be the reason for an unreliable interpretation of the syphilis test.

Based on the ability of antibodies (immunoglobulins IgM and IgG) present in the blood of those infected with syphilis to interact with antigen proteins. If the reaction has passed - analysis positive, that is, the causative agents of syphilis are found in the body of this person. Negative ELISA - there are no antibodies to treponemes, there is no disease or infection.

The method is highly sensitive, applicable for the diagnosis of latent - hidden forms - syphilis and checking people in contact with the patient. Positive even before the first signs of syphilis appear (according to IgM - from the end of the incubation period), and can be determined after the complete disappearance of treponemes from the body (according to IgG). ELISA for VRDL antigen, which appears during alteration (“spoilage”) of cells due to syphilis, is used to monitor the effectiveness of treatment regimens.

RPHA (passive hemagglutination reaction)- gluing of erythrocytes with antigens on their surface Treponema pallidum, with specific antibody proteins. RPHA is positive for illness or infection with syphilis. Remains positive throughout the patient's life, even after complete recovery. To exclude a false-positive answer, RPHA is supplemented with ELISA and PCR tests.

Direct methods laboratory tests help to identify the pathogen microorganism, and not antibodies to it. With the help, you can determine the DNA of treponemes in the biomaterial. Microscopy smear from serous discharge of syphilitic rash - a technique for visual detection of treponemas.

Treatment and prevention

Treatment of syphilis is carried out taking into account the clinical stages of the disease and the susceptibility of patients to drugs. Seronegative early syphilis is easier to treat; with late variants of the disease, even the most modern therapy is not able to eliminate consequences of syphilis- scars, organ dysfunctions, bone deformities and disorders of the nervous system.

There are two main methods of treating syphilis: continuous(permanent) and intermittent(course). In the process, control analyzes of urine and blood are mandatory, the well-being of patients and the work of organ systems are monitored. Preference is given to complex therapy, which includes:

Antibiotics(specific treatment for syphilis);
Fortifying(immunomodulators, proteolytic enzymes, vitamin and mineral complexes);
Symptomatic agents (pain relievers, anti-inflammatory, hepatoprotectors).

Prescribe food with an increase in the proportion of complete proteins and a limited amount of fat, reduce physical activity. Prohibit sex, smoking and alcohol.

Psychotrauma, stress and insomnia negatively affect the treatment of syphilis.

Patients with early latent and contagious syphilis, the first course of 14-25 days, pass in the clinic, then are treated on an outpatient basis. Treat syphilis with penicillin antibiotics- sodium or potassium salt of benzylpenicillin, bicillins 1-5, phenoxymethylpenicillin are injected intramuscularly. A single dose is calculated based on the patient's weight; if there are inflammatory signs in the cerebrospinal fluid (spinal fluid), then the dosage is increased by 20%. The duration of the entire course is determined according to the stage and severity of the disease.

Permanent method: the starting course for seronegative primary syphilis will take 40-68 days; seropositive 76-125; secondary fresh syphilis 100-157.

Course treatment: tetracyclines ( doxycycline) or macrolides ( azithromycin), preparations based on bismuth - Bismovrol, Biyoquinol, and iodine - potassium or sodium iodide, calcium iodine. Cyanocobalamin (vit. B-12) and solution coamida enhance the effect of penicillin, increase the concentration of the antibiotic in the blood. Injections of pyrogenal or prodigiosan, autohemotherapy, aloe are used as a means of nonspecific therapy for syphilis, increasing the resistance to infection.

During pregnancy, syphilis is treated only with penicillin antibiotics, without drugs with bismuth salts.

Proactive(preventive) treatment: carry out as in the case of seronegative primary syphilis, if sexual contact with the infected was 2-16 weeks ago. One course of penicillin is used for drug prevention of syphilis, if the contact was no more than 2 weeks ago.

Prevention of syphilis- identification of the infected and the range of their sexual partners, preventive treatment and personal hygiene after intercourse. Testing for syphilis of people belonging to risk groups - doctors, teachers, staff of kindergartens and catering establishments.

Video: syphilis in the program “Life is great!”

Video: syphilis in the STD encyclopedia

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: 4-year student of the 8th group of the II medical faculty Seleznev A.A.

Co-curators: 4th year students of the 8th group of the II medical faculty Dokolin E.N. Shcherban E.V.

Donetsk, 1995

PASSPORT DATA

FULL NAME. x

Age 21year floor F

Education the average

Home address Donetsk-41

Place of work seamstress

Receipt date: 10.XI.95

Diagnosis on admission: fresh secondary syphilis

COMPLAINTS

The patient complains of a rash on the labia majora and labia minora, pain, fever in the evenings up to 37.5-38.0 C, general weakness.

ANAMNESIS OF DISEASE

For the first time, the patient discovered a rash on the labia majora and labia minora on October 10, 1995, tried to be treated at home, using trays with chamomile and potassium permanganate. Then there was pain in the groin area. She assumes that she was infected from her husband, after the onset of symptoms of the disease, she did not have sexual intercourse. She had last sexual contact with her husband about two months ago.

ANAMNESIS OF LIFE

Patient x, 21 years old, was born 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, has no children. Colds are more rare, Botkin's disease, malaria, typhoid fever, dysentery, tuberculosis, and other sexually transmitted diseases. Smokes up to 1/2 pack a day, does not abuse alcohol. Heredity is not burdened. She has had sexual intercourse since the age of nineteen; she has never had a promiscuous sex life.

Objective research

The general condition of the patient is satisfactory, the position in bed is active. The physique is normosthenic, of moderate nutrition. The skin is clean, pale pink in color. There is a postoperative scar (appendectomy) in the right iliac region. Dermographism is pink. The growth of nails and hair is unchanged. The oral mucosa is pink, the tongue is of normal size, slightly coated with yellow bloom.

Respiration rate 16 per minute, percussion sound over the lungs - clear pulmonary. Vesicular breathing, no pathological murmurs. Rhythmic pulse, 78 beats per minute, satisfactory filling, BP 130/80. The borders of the heart are not expanded, the tones are clear, clean.

The abdomen is soft, slightly painful in the iliac regions. The liver and spleen are not enlarged. Symptoms of irritation of the peritoneum, Georgivsky-Mussey, Ortner, Mayo-Robson, Shchetkin-Blumberg and Pasternatsky are negative.

Description of the lesion focus

On the labia majora and labia minora, there is symmetrically a monomorphic rash in the form of papules up to 5 mm in diameter, brownish-red in color, 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 welded to the surrounding tissues.

Name of the patient: ______________

Lues secundaria recidiva

Complications

Companion:

floor male

age 47 years

Home address:

Place of work: disabled person of 2 groups

Position

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

Secondary recurrent syphilis of the skin and mucous membranes

Lues secundaria recidiva

Accompanying illnesses: Amyotrophic neural Charcot-Marie syndrome in the form of tetraparesis with impaired locomotor function

complaints on the day of admission: makes no complaints

on the day of supervision: makes no complaints

Who sent the patient: CRH

Why:

Doesn't consider himself sick

_____________________________

Self-medication (than): not treated on its own

EPIDEMIOLOGICAL ANAMNESIS

From 16 years old

Sexual contacts: over the past two years, a permanent sexual partner - ___________ - has been undergoing treatment at the SOCVD for syphilis

Household contacts: does not indicate, lives alone

Donation: denies

LIFE STORY OF THE PATIENT

Education: graduated from 8 classes, vocational school

Past illnesses:

Injuries, operations: appendectomy 1970

Allergic diseases: absent

Not notes

Habitual intoxication:

Working conditions: does not work

Living conditions:

Family history: not married

OBJECTIVE STUDY

General state:

Position: active

Body type: normosthenic type

Growth: 160 cm

Weight: 60 Kg

SKIN COVER

1 SPECIES OF THE SKIN

Color: usual

Turgor, elasticity: not changed

Fine

Characteristics of sebum secretion: fine

Condition of hair, nails:

Dermographism: pink, various, persistent

You can download the full version of the medical history in dermatovenerology here

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 ________________________________________

Companion: Amyotrophic neural Charcot-Marie syndrome in the form of tetraparesis with impaired locomotor function

floor male

age 47 years

Home address: ______________________________

Place of work: disabled person of 2 groups

Position _____________________________________________________

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: Amyotrophic neural Charcot-Marie syndrome in the form of tetraparesis with impaired locomotor function

complaints on the day of admission: makes no complaints

on the day of supervision: makes no complaints

HISTORY OF THE DEVELOPMENT OF THIS DISEASE

Who sent the patient: Central Regional Hospital Pochinok

Why: detection in a blood test for RW 4+

When I felt sick: does not consider himself ill

What connects the onset of the disease _____________________________

From which area of the skin and mucous membranes did the disease begin _____________________________

How the disease has developed to date: In the middle of January 2005, there was a swelling and induration in the area of the penis. He did not seek medical help on this matter. 21.03.05. Appealed to the Pochinkovskaya Central Regional Hospital about the impossibility of opening the glans penis, where he was operated

Influence of postponed and existing diseases (neuropsychic trauma, 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 season, on nutrition, weather and meteorological conditions, on production factors, etc.): no

Treatment before admission to the clinic: before admission to the SOCVD, he received Penicillin 1 ml 6 times a day for 4 days

Self-medication (than): not treated on its own

Efficiency and tolerance of drugs (which the patient took on their own or as prescribed by a doctor for a real disease): no drug intolerance

EPIDEMIOLOGICAL ANAMNESIS

Sex life from what age: from 16 years old

Sexual contacts: over the past two years a regular sexual partner - _____________________ - has been undergoing treatment at the SOCVD for syphilis

Household contacts: does not indicate, lives alone

Donation: denies

LIFE STORY OF THE PATIENT

Physical and mental development: he began to walk and talk in his second year of life. In development, I did not lag behind peers

Education: graduated from 8 classes, vocational school

Past illnesses:"Children's" infections, ARVI sick annually

Injuries, operations: appendectomy 1970

Allergic diseases: absent

Drug intolerance: does not note

Hereditary complications and the presence of a similar disease in relatives: heredity is not burdened

Habitual intoxication: smokes from 18 years of age 10 cigarettes a day. Drinks alcohol in moderation

Working conditions: does not work

Living conditions: lives in a private house without amenities, follows the rules of personal hygiene

Family history: not married

OBJECTIVE STUDY

General state: satisfactory, clear consciousness

Position: active

Body type: normosthenic type

Growth: 160 cm

Weight: 60 Kg

SKIN COVER

1 SPECIES OF THE SKIN

Color: usual

Turgor, elasticity: not changed

Characteristic of perspiration of the skin: fine

Characteristics of sebum secretion: fine

Condition of hair, nails: the nails are not changed. Mixed alopecia

The condition of the subcutaneous fat: subcutaneous fat is moderately developed, evenly distributed

Dermographism: pink, various, persistent

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 inflammation: common. In the pharynx there is hyperemia with a bluish tinge, with clear boundaries (erythematous tonsillitis). On the torso, a roseolous rash of pale pink color, mainly localized on the lateral surfaces, asymmetrically. The foreskin is absent as a result of the circumcision carried out. On the head alopecia of a mixed nature.

Characteristics of each of the primary morphological and its description (describe in turn all the morphological elements). In the characteristic, indicate: localization, shape, color, size, character of boundaries, tendency to merge or to group. Infiltration characteristics (dense, soft, doughy). Characteristics of exudate (serous, hemorrhagic, purulent), specific signs or symptoms (with Nikolsky's, a triad of symptoms in psoriasis).

Spot - localized throughout the body with a predominant location on the back and lateral 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 a brown staining remains - a consequence of the formation of segments from decayed erythrocytes. There is no inclination to merge and grouping. The color of the spots is pale pink. The arrangement is not symmetrical. Allowed without a trace. Biederman's symptom is positive.

Characteristics of secondary morphological elements: peeling, pityriasis, small-, large-lamellar detachment, crack, deep, superficial, erosion, color, size, detachable, characteristic of boundaries, etc., characteristic of vegetation, lichenification, characteristic of three-fold pigmentation, crust - serous, hemorrhagic, purulent, color, density, etc. No.

Musculoskeletal system

The posture is correct. The physique is correct. The shoulders are level. The supraclavicular and subclavian fossa are equally expressed. There were no chest deformities. The 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 deformities. There is a slight atrophy of the muscles of the lower extremities, mainly of the left leg, which is associated with 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. Breathing of the abdominal type. Vesicular breathing, except for places where physiological bronchial breathing is heard. No wheezing.

The cardiovascular system

There are no deformities in the region of the heart. Apical impulse in the 5m intercostal space medially from the midclavicular line. The boundaries of relative dullness are normal. Heart sounds are clear, the rhythm is correct: 78 per minute. HELL: 120/80 mm Hg. The pulse is symmetrical, regular, with normal filling and tension. There is no pulse deficit.

Digestive system

The tongue is moist, coated with a white coating. The oral cavity requires sonation. In the pharynx, there is a hyperemia of the palatine arches, the posterior pharyngeal wall with clear boundaries, a bluish tinge. The abdomen is normal and symmetrical. In the right iliac region, there is a postoperative scar from an opendoctomy. The liver protrudes 1 cm from under the costal arch. Its percussion size is 9/10/11 cm. The spleen is not palpable, its percussion size is 6/8 cm. The chair is normal.

Genitourinary system

There was no visible edema in the lumbar region. Pasternatsky's symptom is negative. There are no dysuric disorders. Free urination.

Sense organs

The senses are not changed.

Neuropsychic status

Consciousness is clear. The mood is normal. Sleep is normal. The patient is oriented in personality, space and time.

Laboratory data

Survey plan

1. general blood test

2. general urine analysis

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 f / s

Leukocytes - 2 - 3 in f / s

5. Hbs Ag, HIV not detected

Basis of diagnosis

The diagnosis is based on:

1. Data from laboratory research methods: 04/12/05 Wasserman reaction revealed a sharply positive reaction (++++), microprecipitation reaction ++++

2. Data of clinical examination: in the pharynx hyperemia of the palatine arches, the posterior pharyngeal wall with clear boundaries, a bluish tinge (erythematous tonsillitis). On the torso, a roseolous rash of pale pink color, mainly localized on the lateral surfaces and the back, is symmetrical. On the head alopecia of a mixed nature.

Differential diagnosis

Roseolous (spotted) syphilis should be differentiated from:

1. Pink lichen. With pink lichen, the elements are located along the lines of tension of Langer's skin. Size 10 - 15 mm, with characteristic peeling in the center. Usually, a "maternal plaque" is detected - a spot of a larger size 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 for toxicoderma. It has a more pronounced bluish tint, a tendency to merge, peeling, and itching. The anamnesis contains indications of taking medications, food products, often causing allergic reactions.

Mixed alopecia should be differentiated from:

1. Alopecia after an infectious disease. At the same time, hair loss occurs quickly. The anamnesis contains data on the transferred infectious diseases.

2. Seborrheic alopecia. The condition of seborrhea is characteristic, hair loss develops slowly (over the years).

3. Alopecia areata. It is characterized by the presence of a small number of foci of alopecia up to 8-10 mm in diameter. Hair is completely missing.

Principles, methods and individual patient care

Penicillin sodium salt 1,000,000 U 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

Medical history of secondary syphilis

FULL NAME. x
Age 21 years sex F
Secondary education
Home address Donetsk-41
Workplace of a seamstress-minder
Date of receipt: 10.XI.95
Diagnosis on admission: fresh secondary syphilis

COMPLAINTS
The patient complains of a rash on the labia majora and labia minora, pain, fever in the evenings up to 37.5-38.0 C, general weakness.

ANAMNESIS OF DISEASE
For the first time, the patient discovered a rash on the labia majora and labia minora on October 10, 1995, tried to be treated at home, using trays with chamomile and potassium permanganate. Then there was pain in the groin area. She assumes that she was infected from her husband, after the onset of symptoms of the disease, she did not have sexual intercourse. She had last sexual contact with her husband about two months ago.

ANAMNESIS OF LIFE
Patient x, 21 years old, was born 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, has no children. Colds are more rare, Botkin's disease, malaria, typhoid fever, dysentery, tuberculosis, and other sexually transmitted diseases. Smokes up to 1/2 pack a day, does not abuse alcohol. Heredity is not burdened. She has had sexual intercourse since the age of nineteen; she has never had a promiscuous sex life.

OBJECTIVE RESEARCH
The general condition of the patient is satisfactory, the position in bed is active. The physique is normosthenic, of moderate nutrition. The skin is clean, pale pink in color. There is a postoperative scar (appendectomy) in the right iliac region. Dermographism is pink. The growth of nails and hair is unchanged. The oral mucosa is pink, the tongue is of normal size, slightly coated with yellow bloom.
Respiration rate 16 per minute, percussion sound over the lungs - clear pulmonary. Vesicular breathing, no pathological murmurs. Rhythmic pulse, 78 beats per minute, satisfactory filling, BP 130/80. The borders of the heart are not expanded, the tones are clear, clean.
The abdomen is soft, slightly painful in the iliac regions. The liver and spleen are not enlarged. Symptoms of irritation of the peritoneum, Georgivsky-Mussey, Ortner, Mayo-Robson, Shchetkin-Blumberg and Pasternatsky are negative.

DESCRIPTION OF FOCUS
On the labia majora and labia minora, there is symmetrically a monomorphic rash in the form of papules up to 5 mm in diameter, brownish-red in color, 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 welded to the surrounding tissues.

PROSPECTED DIAGNOSIS
Considering the localization of the lesions on the genitals of the organs, its nature (monomorphism, lack of peripheral growth, painlessness), the presence of enlarged inguinal lymph nodes, one can assume that the patient has a disease with fresh secondary syphilis. This disease must be differentiated with lichen planus, psoriasis, parapsoriasis, folliculitis, genital warts, pseudosyphilitic papules of Lipschutz.

DATA OF LABORATORY STUDIES
Blood and urine tests are normal
RW from 10.XI.95 - ++++

DIFFERENTIAL DIAGNOSIS
With lichen planus papules have polygonal outlines, waxy shine, central umbilical depression, give the phenomenon of Wickham mesh, 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 on the periphery, surrounded by a mild inflammatory corolla, there is a triad of phenomena (stearin spot, 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 is chronic. scraping the psoriasimorphic syphilitic papule removes only the scales, but the surface remains dry, dense, with a pronounced limited infiltration.
In parapsoriasis, the papule is covered with whole dry scales ("collodion film"), lagging behind along the edge; when scraping, diffuse bleeding is observed. The syphilitic papule peels off from the center and forms a "biett collar" along the periphery of a dense, sharply limited nodule. Rashes of parapsoriasis last for many months, and often years.
Folliculitis on the outer genital parts, in the groin-femoral folds and on the medial surfaces of the thighs appear in women due to skin irritation by vaginal discharge. Unlike syphilitic papules, folliculitis of a soft consistency, surrounded by an inflammatory red corolla, have a conical shape, often a micropustule in the center and are accompanied by subjective sensations (burning, pain, itching); serological reactions are negative.
Lipschutz's pseudosyphilitic papules in appearance resemble a round shape, slightly pinkish in color, the size of lentils, with a dry, shiny surface, painless. They are located on the labia majora and can extend to the perineum and medial thighs.
Genital warts belong to viral diseases, located mainly in the genital area and anus, but unlike wide warts, they have a thin stem and consist of small, pale red soft lobules, similar to cauliflower or “cock's comb”. Patients feel a burning sensation, pain.

FINAL DIAGNOSIS
On the basis of the differential diagnosis, the presence of positive serological samples, the final diagnosis can be made: 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. Hoffman. It belongs to the genus Traeponema, family Traeponemaceae, order Spirochaetalis.
Live treponema pale is a delicate spiral formation with tapering ends, which has 8-14 uniform narrow and steep curls. The thickness of the treponema does not exceed 0.25 microns, the length ranges from 6-20 microns, and the depth of the curls is 1-1.5 microns. At its ends, there 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. Syphilis is not transmitted through saliva, tears, milk, sweat, urine. Intact epithelium is an obstacle to the penetration of treponema pallidum. Infection with syphilis can be sexual, non-sex and congenital.
Syphilis refers to chronic infectious diseases, is characterized by a cyclical course and a change in active manifestations and remissions of varying duration. This makes it possible to distinguish 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 fit into the scheme the painful phenomena observed in syphilis. 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 sexually or non-sexually, some time passes, during which it is impossible to detect either local or general phenomena. This time is usually called the incubation period, the duration of which is on average 21-24 days and ends with the development of primary syphiloma at the site of the penetration of treponema pallidus (sometimes the incubation period ranges from 10 to 40 days or more).
The primary period of syphilis begins from the moment of the formation of the 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 it 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 body's immunobiological resistance.
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, pale treponema actively spreads along 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 the nervous system, the increased reproduction of treponemas is accompanied by the appearance of spotty, papular, vesicular, pustular eruptions and lesions of the periosteum bones, development of iritis, iridocyclitis and enlarged lymph nodes (polyadenitis). Various clinical manifestations of the secondary period of syphilis are uneven. 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 often patients do not betray serious significance. Another feature of the secondary period of syphilis is the benign course of syphilis, which usually dissolve 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 between remissions and relapses, but on average about 2-4 years, turning into tertiary. Syphilitic rashes that occur immediately after the end of the primary period of syphilis are characterized by an abundance, disorder of location, often polymorphism, accompanied by polyadenitis, often persisting primary syphiloma or remnants of its infiltrate, regional scleradenitis (bubo). The initial stage of secondary syphilis is called secondary fresh syphilis, the manifestations of which spontaneously disappear 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 tests. In the absence of treatment, after latent syphilis, syphilitic rashes (relapse) appear, which differ from secondary fresh syphilis by the limited elements, large size, faded color, a tendency to grouping. This stage is called secondary recurrent syphilis, in which there is usually no primary syphiloma and regional bubo, and polyadenitis is mild. With early relapses, clinical manifestations are occasionally encountered that occupy intermediate positions between secondary fresh and recurrent syphilis, which can be called a combined secondary fresh and recurrent syphilis. These forms of the disease should be treated with sufficient caution.
Clinical recurrent forms of syphilis, apparently, are covered by the multiplication of pale trepan on the site of resolved syphilides, in which they were in a state of parabiosis. In syphilis, the mobility of infectious immunity plays a huge role, a decrease in which creates favorable conditions for the activation of pale treponemas.
The tertiary, or gummy, period of syphilis develops in cases where spirochetes remain in the body due to insufficient or improper treatment and altered immunobiological reactivity of the body. Tertiary syphilis most often develops in people who have not received antasiphilitic therapy. The first clinical signs of tertiary syphilis appear after several years of the existence of a 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, organ dysfunction and even death if vital boundaries are involved in the process. (aorta, liver, brain, etc.). According to our data, gummy syphilis much more often affects the internal organs, the central nervous system, the musculoskeletal system than the skin and mucous membranes. This stage also includes tabes of the spinal cord and progressive paralysis, often accompanied by visceral syphilis. In gummy syphilides, pale treponemas are sometimes found in small quantities in the peripheral not disintegrated zone of the infiltrate.
Gummas develop in the same way as relapses of secondary syphilis. With a weakening of the immunobiological reactivity of the body and an increased infectious allergy, pale treponema multiplies at the site of the absorbed lymph nodes or lymph nodes, from where they are brought into various organs with blood flow, 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 treponemas, 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 latent, syphilis and 3) tertiary recurrent syphilis.

TREATMENT
Penicillin and its derivatives, which have treponemicidal and treponemostatic properties, occupy the main place among all anti-syphilitic drugs. Apparently, penicillin disrupts the enzyme systems of treponema pale, the process of its growth and reproduction. Penicillin is especially active on pale treponema during the period of their reproduction.
Penicillin and its derivatives are effective in all forms of syphilis and help to remove pale trepan from the surface of syphilis in an average of 10-12 hours.
Penicillin can be administered to patients subcutaneously, intramuscularly, intravenously, intralumbar and orally (phenyloxymethylpenicillin). When treating syphilis, penicillin is administered intramuscularly in doses depending on body weight. Continuous administration of penicillin is due to the need to constantly maintain a certain concentration of the drug in the blood (0.06 U in 1 mm of blood). For this purpose, patients during penicillin therapy need to reduce the intake of fluids.
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. In terms of their therapeutic effect, bismuth preparations rank second after penicillin. Any bismuth preparation should be evenly absorbed from the injection site and excreted in sufficient quantities from the body.
Biyoquinol 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, contains 7.5% suspension of bismuth salt of mono-bismuth tartaric acid in sterilized and purified peach or almond oil; in 1 ml of bismoverol - 0.05 g of metallic bismuth. The drug contains about 67% metallic bismuth. Bismuth is excreted in urine and feces slowly; and its elimination ends in 1.5-3 months after the termination of treatment.
Pentabismol is a water-soluble preparation containing 47.9% bismuth; 1 ml of the preparation contains 0.01 g of metallic bismuth. It is absorbed faster by tissues than bioquinol 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 in the left and in the right side. After the introduction of 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 a bismuth emulsion into the vessel threatens the development of pulmonary embolism or deep gangrene of the buttock. Therefore, bismuth preparations should be injected slowly, always warmed up to body temperature. Before injection, the vial with biloquinol 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
2nd course: penicillin (ekmonovocillin) and bismuth preparation; break 1 month
3rd course: ekmonovocillin (penicillin) and bismuth preparation; break 1 month
4 course: ekmonovocillin and bismuth preparation; break 1 month
5 course: ekmonovocillin or penicillin and bismuth preparation.
The course dose of penicillin (ekmonovocillin) is calculated at the rate of 120,000 units per 1 kg of the patient's body weight.

FORECAST
With an early start of treatment for fresh secondary syphilis, with 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 labia majora 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, painless, peripheral growth is absent; 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 welded to the surrounding tissues. The patient tried to be treated at home, using trays with chamomile and potassium permanganate, unsuccessfully, then she turned to the skin and venereologist at the place of residence and was sent to the city skin and venereal clinic No. 1 with a diagnosis of fresh secondary syphilis. He is currently receiving treatment with penicillin and bismuth preparations. The prognosis is favorable, the patient is expected to be completely cured.

LITERATURE
1. Pototsky I.I., Torsuev N.A. Skin and venereal diseases. Kiev, ed. obed. "Vishcha school", 1978
2. Differential diagnosis of skin diseases. - BA Berenbein, AA Studitsin et al. - M .: Medicine, 1989.
3. Pathomorphological diagnosis of skin diseases. - GM Tsvetkova, VN Mordovtsev. - M.: Medicine, 1986.

Lues secundaria recidiva

Complications ________________________________________

___________________________________________________

Companion:

floor male

age 47 years

Home address: ______________________________

Place of work: disabled person of 2 groups

Position _____________________________________________________

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

Clinical diagnosis (in Russian and Latin):

Secondary recurrent syphilis of the skin and mucous membranes

Luessecundariarecidiva

Accompanying illnesses: Amyotrophic neural Charcot-Marie syndrome in the form of tetraparesis with impaired locomotor function

complaints on the day of admission: makes no complaints

on the day of supervision: makes no complaints

HISTORY OF THE DEVELOPMENT OF THIS DISEASE

Who sent the patient: Central Regional Hospital Pochinok

Why: detection in a blood test for RW 4+

When I felt sick: does not consider himself ill

What connects the onset of the disease _____________________________

_______________________________________________________________

From which area of the skin and mucous membranes did the disease begin _____________________________

Influence of postponed and currently existing diseases (neuropsychic trauma, 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 season, on nutrition, weather and meteorological conditions, on production factors, etc.): no

Treatment before admission to the clinic: before admission to the SOCVD, he received Penicillin 1 ml 6 times a day for 4 days

Self-medication (than): not treated on its own

Efficiency and tolerance of drugs (which the patient took on their own or as prescribed by a doctor for a real disease): no drug intolerance

EPIDEMIOLOGICAL ANAMNESIS

Sex life from what age: from 16 years old

Sexual contacts: over the past two years a regular sexual partner - _____________________ - has been undergoing treatment at the SOCVD for syphilis

Household contacts: does not indicate, lives alone

Donation: denies

LIFE STORY OF THE PATIENT

Physical and mental development: he began to walk and talk in his second year of life. In development, I did not lag behind peers

Education: graduated from 8 classes, vocational school

Past illnesses:"Children's" infections, ARVI sick annually

Injuries, operations: appendectomy 1970

Allergic diseases: absent

Drug intolerance: does not note

Hereditary complications and the presence of a similar disease in relatives: heredity is not burdened

Habitual intoxication: smokes from 18 years of age 10 cigarettes a day. Drinks alcohol in moderation

Working conditions: does not work

Living conditions: lives in a private house without amenities, follows the rules of personal hygiene

Family history: not married

OBJECTIVE STUDY

General state: satisfactory, clear consciousness

Position: active

Body type: normosthenic type

Growth: 160 cm

Weight: 60 Kg

SKIN COVER

1 SPECIES OF THE SKIN

Color: usual

Turgor, elasticity: not changed

Characteristic of perspiration of the skin: fine

Characteristics of sebum secretion: fine

Condition of hair, nails: the nails are not changed. Mixed alopecia

The condition of the subcutaneous fat: subcutaneous fat is moderately developed, evenly distributed

Dermographism: pink, various, persistent

Description of all skin changes that are not related to the main pathological process (nevi, pigmentation, scars, etc.)

2.DESCRIPTION OF THE PATHOLOGICAL PROCESS

Musculoskeletal system

Respiratory system

The cardiovascular system

Digestive system

Genitourinary system

There was no visible edema in the lumbar region. Pasternatsky's symptom is negative. There are no dysuric disorders. Free urination.

Sense organs

The senses are not changed.

Neuropsychic status

Consciousness is clear. The mood is normal. Sleep is normal. The patient is oriented in personality, space and time.

Laboratory data

Survey plan

1. general blood test

2. general urine analysis

5. ELISA for IgM, G

7. HIV, Нвs Ag

Received results with date

1. UAC 13.04.05

Erythrocytes - 5.0 * 10 12 / l

HB - 124 g / l

Leukocytes - 5.2 * 10 9 / l

Eosonophiles - 1%

Neutrophils - 67%

Monocytes - 5%

Lymphocytes - 27%

ESR - 22 mm / h

Conclusion: the norm

2. ОАМ 13.04.05

Color - homogeneous - yellow

Specific gravity - 1010

Transparent

Epithelial cells - 1 - 4 in f / s

Protein - absent

Leukocytes - 2 - 3 in f / s

Conclusion: the norm

3. RMP 04/22/05.

RW 12.04.05

Title 1:20

5. Hbs Ag, HIV not detected

Basis of diagnosis

The diagnosis is based on:

1. Data from laboratory research methods: 04/12/05 Wasserman reaction revealed a sharply positive reaction (++++), microprecipitation reaction ++++

Differential diagnosis

Roseolous (spotted) syphilis should be differentiated from:

Mixed alopecia should be differentiated from:

1. Alopecia after an infectious disease. At the same time, hair loss occurs quickly. The anamnesis contains data on the transferred infectious diseases.

2. Seborrheic alopecia. The condition of seborrhea is characteristic, hair loss develops slowly (over the years).

3. Alopecia areata. It is characterized by the presence of a small number of foci of alopecia up to 8-10 mm in diameter. Hair is completely missing.

Principles, methods and individual patient care

Antibiotic therapy:

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

Vitamin therapy:

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

If the course of the venereal disease is not aggravated by anything, approximately four to five weeks after the treponema enters the body, the incubation period ends and the primary signs of syphilis appear. Unfortunately, this stage is not rare, since the initial period is difficult to determine without specific analyzes (only by signs or symptoms), therefore all photos showing the primary symptoms of syphilis could be taken only after the end of the incubation period.

Signs, manifestations and symptoms of the primary stage of the disease

It will not be news to anyone that the treatment of any disease will be the more successful the earlier it is started. That is why those diseases, the symptoms and signs of which are manifested in such a way that it is impossible not to notice them, cause less concern among doctors. As for the primary manifestations of syphilis, they are often left unattended by the patient. This is facilitated by many factors, the main of which is the location of the primary signs of syphilis, a photo of which is not always possible to take, as well as the absolute painlessness of the manifestations.

A symptom indicating that primary syphilis develops in the body is a hard chancre. This is an absolutely painless symptom, more often 1 than a group that does not itch, inflame or cause other discomfort. Photos showing such a manifestation show that it can be easily confused with a sign of more harmless formations, the symptoms of which occur on the human body. As a rule, the chancre first of all appears where there was contact with treponema pale - most often these are the genitals. If a person who suspects that one of his sexual partners could be infected with syphilis discovers signs or symptoms that he could see in the photo of patients with syphilis, then most often treatment begins in a timely manner. Otherwise, primary syphilis, a photo of which, like pictures of signs and symptoms, can be easily found on specialized sites, goes into secondary.

There is one more manifestation, the presence of which should prompt a person that a venereal disease is developing in his body. This symptom is lymphadenitis, i.e. inflammation of the lymph nodes. By itself, this symptom is by no means a specific manifestation of a sexually transmitted disease, although, of course, it requires some control and treatment. But if the inflammation of the lymph nodes, especially the inguinal ones, coincided with the appearance of a painless neoplasm on the genitals or the inner side of the thigh, this symptom most likely indicates the primary period of syphilis.

In addition to these signs, as well as symptoms, others are also possible, for example, general weakness, fever, rapid fatigue. As a rule, the manifestations are similar to the symptoms and signs of colds, and a person can even start taking antiviral drugs on their own, unaware of their ineffectiveness.

Another sign indicating the presence of treponema in the body and which cannot be seen in the photo or picture is a positive serological reaction. It should be noted that this is a specific symptom of exactly 1 period, since from the moment of infection the indicators are seronegative, moreover, they remain seronegative throughout the entire incubation period and the first 7-10 days of stage 1. Also, the medical histories of some patients indicate that seronegative reactions, as a symptom, are possible throughout the entire period of the disease. In addition, in recent years, the period of seronegative reactions has been steadily increasing, which prevents the timely detection and treatment of the disease.

As can be seen from the listed signs of the primary stage of the disease, it is quite difficult to detect it. This leads to the fact that the disease progresses, gradually passing into the secondary stage. By the way, the disappearance of the manifestations characteristic of 1 syphilis does not mean that the body managed to cope with the disease on its own and treatment is not required - it only indicates the aggravation of the condition and the transition of the disease into the secondary period.

Treatment of primary syphilis

Both primary and secondary syphilis are treated in the same way - with antibiotics. True, stage 1 is treated much faster, since the photos indicate that serious changes (at least those that are noticeable) do not occur with the human body, while in the secondary stage, internal organs invariably suffer and during treatment one should pay attention not only to general stabilization work of the body, but also for the treatment of individual organs and systems. The most important thing that ensures the success of treatment of both the first and any other stages of a sexually transmitted disease is absolute adherence to the recommended prescriptions.

Remember that the course of treatment should last as long as it is written in the medical history, and not until the symptoms of the disease disappear. In addition, it is advisable to prescribe prophylactic treatment of all sexual partners with whom the patient had contact for six months before the discovery of the disease, or within 4-5 weeks before the appearance of a solid chancre (the date is established according to the history of the disease). As a rule, the medical history of primary syphilis does not contain any surprises and the conventional antibiotic therapy will soon bring positive results.

Complications of primary syphilis

As a rule, primary syphilis, pictures of which can be easily found on specialized sites, is easily treatable and after a few weeks only records in the medical history remind of the disease. Primary seronegative syphilis is the easiest to treat, since this is the very initial period of the disease, but specific tests are required to detect it, which are extremely rare. Stage 1 does not carry specific complications in the form of damage to organs or body systems.