Tertiary syphilis: symptoms, diagnosis and treatment. Tertiary syphilis and its manifestations in men and women. Main characteristic signs of the disease

Syphilis is an infectious disease that affects the mucous membranes, skin, as well as the bone, cardiovascular and nervous systems of the body. The disease is usually divided into three stages, the latest of which is tertiary syphilis. It develops in the 7th year of infection in the absence of proper treatment of the disease in the early stages or too late diagnosis.

Peculiarities

The tertiary stage of syphilis develops due to insufficiency or lack of treatment of the initial stages of the disease. It is accompanied by the formation of infiltrates or granulomas in the mucous membranes, skin and internal organs of a person. The resulting granulomas provoke tissue destruction. If treatment is not started in time, there is a high probability of severe complications, including death.

Today, this type of syphilis is extremely rare. Most cases of the disease are detected in the early stages. Tertiary syphilis can develop due to improper use of medications prescribed by a doctor or insufficient dosage.

Syphilis develops as a result of the activity of Treponema pallidum. These microorganisms settle in intercellular spaces, blood vessels or nerve fibers. Most often, the disease affects people suffering from alcoholism or chronic diseases. The risk group also includes young children and the elderly.

There are several factors that contribute to the development of the disease:

• Unfavorable human living conditions.
• Presence of injuries or chronic diseases.
• Reduced immunity due to long-term illness.
• Constant mental and physical overload.
• Improper or insufficient nutrition.

The disease develops quite quickly. Therefore, it is important to take appropriate measures as soon as possible.

Note! According to statistics, the disease most often affects people aged 20 to 30 years. The number of men and women is approximately equal.

Cutaneous syphilis and its symptoms

The most common form of the disease is cutaneous syphilis. It is characterized by the formation of syphilides, which lie under the skin. The following types of such formations are distinguished:

• Tuberculate.
• Gummous.
• Erythema.

Each of these formations has its own characteristics and is localized in different parts of the body. Depending on this, the symptoms of tertiary syphilis will be determined.

Tuberous syphilides

They are small nodules that are located under the skin. Their diameter does not exceed 7 mm. The largest number of such formations is observed in the area of ​​the limbs, lower back, face, head or back. Such syphilides have a red-brown tint. After some syphilides heal, new ones may form in their place.

At the very beginning of the disease, tiny nodules appear, the diameter of which does not exceed 3 mm. Gradually they begin to increase in size. Over time, ulcers will appear in their place. After healing, scars remain.

Experts distinguish several types of tubercular syphilides:

• Grouped. The formations fit tightly to each other, but do not merge into a single whole. One group includes no more than 40 nodules. Often such groups form long chains that can close into a circle. Such syphilides are found in the area of ​​the face, back and lower extremities.
• Serpening. Nodules appear sequentially. Those that existed previously are scarred. Such formations occupy an impressive area of ​​skin. A mosaic scar forms in the center of the lesion. Small scars gradually form around it.
• Dwarf. Their formation is observed 15 years after the onset of the disease, when the late tertiary period of syphilis begins. Small round formations of a red hue form on the surface of the skin. They are grouped into figures resembling papules of secondary syphilis. Ulcers do not form at the site of syphilides. After healing, scars may form, which smooth out over time.
• Diffuse. This is the rarest form of cutaneous syphilis. The resulting syphilides can be localized in any part of the body, but most often on the hands and soles. Several nodules gradually merge into one infiltrative area, which has a reddish tint and an oval shape. The diameter of such a section does not exceed 10 cm. They are never divided into separate tubercles. Deep cracks can form on the surface of such an area, which cause pain.

Note! In some cases, tertiary syphilis can affect the human psyche. Often the patient experiences attacks of rage, depression and even paranoia. At such a moment, it is important not to leave the victim alone.

Gummous syphilides

Gummy formations are larger in size. They are painted dark red. They adhere tightly to the subcutaneous tissue. Such syphilides bring severe pain. Gummy syphilides often appear singly.

Syphilides are most often localized in the sternum, thighs, upper limbs, and genitals. The newly appeared formations are similar in size to a pine nut. They can be easily moved under the skin. The epithelium over the tubercle acquires a dark red tint. There is a noticeable lilac spot in the center. Later, an ulcer appears in its place. At its bottom there is a necrotic core, the withdrawal of which leads to the appearance of a scar.

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In some cases, gummas can resolve without the formation of ulcers. In such a situation, after the node is reduced, it is completely replaced by dense tissue.

Erythema

Erythema or tertiary roseola is considered the rarest manifestation of tertiary syphilis. It is a light pink spot. Such spots can be grouped. They fold into various geometric shapes with an area of ​​5 to 15 cm.

Most often, erythema can be observed on the buttocks, lower back, abdomen or back. As a rule, they always appear in the same place. Such areas may peel off over time.

Neurosyphilis

If the source of infection is in the brain tissue, then the entire nervous system is affected. With this form of tertiary syphilis, the symptoms will depend on the form of the disease:

• Meningitis. This form develops five years after infection. Gummous formations begin to form around the vessels of the brain. The disease is accompanied by a significant increase in body temperature, severe headaches, dizziness, attacks of vomiting and nausea, and a person reacts painfully to bright light. If the auditory nerve is involved in the process, then a significant decrease in hearing occurs.
• Meningoencephalitis. This form of the disease can develop even 30 years after infection. Most often it is observed in representatives of the stronger sex. In this case, the same symptoms appear as with the meningitis form of the disease. In addition to them, mental disorders appear. A person may be tormented by hallucinations and unmotivated attacks of aggression.
• Tabes dorsalis. With this type of disease, the horns of the spinal cord are damaged. In this case, the limbs may lose sensitivity, muscle atrophy occurs, vision decreases, and the process of urination and defecation is disrupted. Often accompanied by vascular lesions. There are three stages of this form of the disease:
  • Neuralgic. It is characterized by shooting pains in the lower extremities, which are paroxysmal in nature. Pain may be felt from the stomach and intestines.
  • Ataxic. Manifests itself in an uncertain, shaky gait. The condition is aggravated if a person walks with his eyes closed.
  • Paralytic. Tendon reflexes disappear, muscle tone decreases, and the pupils stop responding to light.
• Paralysis. At the same time, all the signs of dementia appear; a person may lose the simplest everyday skills. Often this form of syphilis is combined with tabes dorsalis.
• Vascular. An inflammatory process begins in the lining of small arteries. It leads to the formation of blood clots. As a result, the lumen of the blood vessels narrows to critical values, and certain areas of the brain begin to soften. This form of the disease often occurs in young men. The main signs of such a lesion are headaches, dizziness, and seizures that resemble epileptic seizures. If treatment of tertiary syphilis of this form is started in a timely manner, the prognosis is favorable.

Note! In some cases, neurosyphilis can occur in a latent form. Signs of the disease are revealed only during a medical examination.

Damage to the osteoarticular apparatus

The manifestation of tertiary syphilis in the form of damage to joints and bones occurs rarely. Gummas appear in flat bones or the diaphysis of large long bones. Formations are often found in the bones of the skull, humerus and ulna, and tibia. Gummas can be concentrated in the periosteum, spongy or cortical substance. There are several types of the disease:

• Periostitis. It is characterized by pain in the bones, which worsens at night. On palpation, swelling is detected. If proper treatment is not carried out, then tubercles or thickenings form at the site of the swelling, which are visible on x-rays.
• Osteoperiostitis. The inflammatory process originates in the periosteum. Later it spreads to the entire bone tissue. In this case, the person is tormented by severe attacks of boring pain, which become especially unbearable at night. On palpation, a swelling is felt in the periosteum area, which subsequently develops into rough growths with boat-shaped depressions. There is a high probability of ulcer formation.
• Osteomyelitis. This form of tertiary syphilis occurs due to the fact that gummas are concentrated in the bone substance. The inflammation soon spreads to the bone marrow. The process can also occur in reverse. The main symptoms are increased body temperature and pain.

Tertiary syphilis can also affect the joints. In this case, hydrarthrosis, osteoarthritis, and arthralgia develop. Severe pain appears that is not associated with movement.

Note! Symptoms of joint damage may persist even after appropriate treatment. Relief comes from taking medications containing potassium iodide.

Visceral syphilis

This type of tertiary syphilis can have the most serious consequences. The appearance of gummous formations can be observed in any internal organs. In this case, severe disruptions occur in metabolism. Most often, the disease affects the cardiovascular system or liver.

One of the manifestations of this form of syphilis is aortitis. In this case, foci of infection appear in the lining of the aorta. Later they are replaced by connective tissue. The problem may be accompanied by significant narrowing of the heart vessels, aneurysm or aortic valve insufficiency.

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In the early stages, the disease may be asymptomatic. Later, symptoms similar to those of coronary heart disease appear. Painful sensations in the chest area and heart murmurs appear.

Syphilis can also affect the liver. This form of the disease most often appears between the ages of 35 and 50 years. There are four forms of this problem:

• Focal gummous hepatitis. The peripheral parts of the liver are primarily affected. Gummas are localized under the liver capsule, which leads to a change in the size of the organ.
• Interstitial hepatitis. Pathological processes originate around the lobes of the liver.
• Miliary hepatitis.
• Chronic epithelial hepatitis.

Hepatitis with syphilis has similar symptoms. Painful sensations appear in the hypochondrium area, a person suffers from attacks of nausea, the sclera turns yellow, and normal bowel function is disrupted. Diagnosis is complicated by the fact that symptoms manifest themselves simultaneously in several organs.

Diagnostic techniques

The tertiary stage of syphilis can be determined after a thorough examination and interview of the patient, as well as appropriate diagnostic measures. When interviewing a person, the specialist must find out the symptoms of the problem and the measures that were taken previously. During the examination, the doctor determines the presence of manifestations of the disease. At this point, it is important to correctly distinguish them from tuberculosis, mycosis and other diseases.

Among the main diagnostic techniques, the following are used:

• Laboratory tests of blood samples. First, a nontreponemal analysis is performed. After this, a treponemal study is carried out for control. This is the only way to make an accurate diagnosis.
• Bacterioscopic examination. Samples taken from lymph nodes or from the bottom of ulcers are checked for the presence of traces of treponema.
• Cerebrospinal fluid examination. Such an examination is carried out if neurosyphilis is suspected. An increased content of protein, monocytes and lymphocytes in the sample is detected.

Only after a complete diagnosis will a specialist be able to make a reliable diagnosis. Based on this, a competent treatment program will be developed in the future.

Treatment of the disease

It is necessary to start treatment as early as possible. Only in this case is a successful treatment possible. The main therapeutic method is the use of drugs containing benzalpenicillin. Thanks to this, the functioning of internal organs and systems occurs. If a patient exhibits an allergic reaction to penicillin antibiotics, they are replaced with Doxycycline, Ceftriaxone or Amoxicillin. In rare cases, there is an allergy to all antibiotics. In such a situation, medications from the macrolide group are used for treatment. Good results are obtained with the use of Summed, Josamycin, Clarithromycin.

If tertiary syphilis is not accompanied by damage to internal organs, then the following methods of using penicillin antibiotics can be used:

• Novocaine salt of penicillin is used. It is administered in equal doses 4 times a day for 28 days. After the first two weeks, a break is taken for 14 days. After this, the drug is resumed.
• The specialist prescribes water-soluble penicillin. It is also injected into the patient’s blood 4 times a day for 28 days. If necessary, the course of treatment is repeated, but procaine-penicillin is used. It is administered over 10 days.
• Procaine-penicillin. The course of treatment with this drug is 20 days. After this, a ten-day break is taken, after which the use of the medication is resumed for another 10 days.

If the disease is accompanied by damage to internal organs, then comprehensive treatment of tertiary syphilis is carried out. The following techniques can be used:

• The first two weeks a preparatory stage is carried out, during which the patient is prescribed Tetracycline or Erythromycin. After this, the patient is administered penicillin for 28 days.
• After the preparatory stage using Tetracycline or Erythromycin, treatment is carried out using novocaine salt of penicillin.
• At the end of the preparatory stage, treatment is carried out using procaine-penicillin.

Treatment of neurosyphilis is also carried out with the use of penicillin antibacterial drugs. Six months after the end of the main course of treatment, repeated laboratory tests are carried out. This is the only way to monitor the success of therapy.

Specific drugs and their dosage are determined by a specialist based on the form and severity of the disease. Sometimes it is necessary to use several courses of therapy to achieve results.

Note! If gummy nodes are found in the brain or spinal cord, then Prednisolone is prescribed simultaneously with antibacterial therapy. This enhances the effectiveness of antibiotics and reduces the likelihood of symptoms reverting.

On average, treatment for tertiary syphilis takes from two months to several years. Everything will depend on the complications that arise and how sensitive the patient is to the drugs used. During treatment, the patient is advised to avoid sexual intercourse without using a condom. It is necessary to undergo periodic examinations for preventive purposes.

Syphilis, even in the last phase, can be cured. The sooner treatment is started, the greater the chance of successful treatment. Always be attentive to your health and consult a doctor at the first unpleasant symptoms.

The infection is caused by the bacterium Treponema pallidum. The source of infection is a person infected with syphilis.

Nowadays, tertiary, or late, is extremely rare. It mainly affects patients who have not undergone or have not completed the course of treatment. This form of syphilis is practically not contagious. However, the disease can be fatal.

The main ways of contracting syphilis

There are several routes of infection:

1. In 90% of cases, the disease is transmitted through any type of sexual contact.
2. When receiving a blood transfusion from a donor infected with an infection.
3. From an infected mother to a child during pregnancy and breastfeeding.
4. Through saliva.
5. When using one syringe.
6. Through medical instruments.

The greatest threat is borne by patients with. Patients with tertiary syphilis rarely infect others. For the disease to begin to develop, it is enough for a couple of bacteria to enter a damaged area of ​​skin or wound.

In an infected patient, treponema pallidum is found in the cerebrospinal fluid, saliva, male semen, lymph, tears and breast milk.

The concept of tertiary syphilis

Syphilis is an infectious venereal disease, the symptoms of which depend on the stage of development.

The disease develops in several stages:

• lasts from two to three months. At this stage, the patient develops a hard chancre in the area of ​​infection;
• secondary the period lasts from three to four years. At this stage, the patient's body becomes covered with a rash;
• at tertiary syphilis the infection penetrates deep inside and affects the internal organs, brain and bones. This period occurs approximately seven years after infection.

Factors leading to the development of tertiary syphilis

• infection occurred in childhood or old age;
• treatment not started on time;
• the patient did not complete the course of treatment;
• frequent change of sexual partners;
• severely reduced immunity;
• all kinds .

Tertiary syphilis is fatal in half the cases. This is due to the fact that during this period the tissues in which the granulomas are located are destroyed and compressed.

Symptoms of tertiary syphilis

This form of the disease affects almost all human systems and organs.

The disease can take decades to develop. During this period, the patient may lose hearing, vision and even lose his mind.

Tertiary syphilis can be active or latent.

The main characteristic signs of the disease:

Diagnosis of tertiary syphilis

The disease is diagnosed based on the clinical picture and laboratory results:

During treatment, specialists monitor the condition of the patient’s body. Biochemical tests, urine and blood tests, ECG and ultrasound are regularly done.

After completing the course of treatment, the patient is observed for another five years. If during this period the patient has no symptoms of the disease, the person is considered to be completely healthy.

Tertiary syphilis is a very advanced stage. Treatment will only help slow down the effect on the body and increase life expectancy. Full recovery at this stage is almost impossible.

Without treatment for tertiary syphilis, the life of an infected person is shortened by half and ends in painful death.

Complications of tertiary syphilis

In approximately 25% of cases, due to complications, death occurs. In the third stage, almost all vital organs are destroyed.

The sexually transmitted disease syphilis is characterized by three stages, and the last (tertiary) is the most severe in terms of clinical manifestations and symptoms.

In each patient, the manifestations of syphilitic infection are very diverse; different manifestations of infection appear at different years of life. However, the last period of the disease is characterized by a state of pronounced dysfunction of all internal organs and systems of the body.

The last tertiary stage of the disease occurs when infection lasts from five to eight years.

Currently, tertiary syphilis occurs in 60% of patients who have not received specific treatment previously, and in 15% of patients who have not followed the entire treatment regimen throughout treatment.

It is also worth noting that most often the tertiary period of syphilitic infection occurs in patients who did not previously comply with the regularity of medical examinations. Advanced cases of the disease occur in patients who have not previously been seen by doctors and have not undergone appropriate screening tests over the past 5-10 years.

Nowadays, venereologists are extremely attentive to the examination of patients with a pronounced clinical picture of syphilis. This is explained by the fact that at a later stage, therapy is lengthy and expensive.

Every year, venereologists discover new methods that are effective even at later stages. In this article, we will answer all the most frequently asked questions to doctors about whether tertiary syphilis can be completely cured if detected late, how much it costs to treat this form of infection in modern clinics, and how exactly to treat tertiary syphilis is recommended by experienced venereologists.

Symptoms of tertiary syphilis include severe skin symptoms, severe complications from internal organs, and neurological pathologies. With a long course and inaction on the part of the patient, treponemal infection ends in death.

A typical sign of the last stage of the disease is tertiary syphilides - compactions and granulomas in any tissues and organs. These formations are noticeable only in the form of areas of compaction under the skin, which to the touch resemble tubercles or nodes, completely painless when touched or pressed.

Tuberous syphilides on the skin appear in the form of elevations up to a centimeter in size and are also distinguished by their color - a slight red or burgundy tint.

Such nodular granulomas may gradually appear under the skin one after another. However, they do not merge into a common conglomerate.

As compaction occurs, tissue necrosis in the center and transition to an ulcerative defect is observed. After healing of such ulcers, scar marks often remain on the patient's body, with or without a rim of pigmentation. With large areas of syphilis, areas of mosaic scars form on the skin, which are clearly visible when examined by a doctor.

Also, against the background of long-term reproduction of treponemal infection, such as tertiary gummous formations appear in the tissues of internal organs, bone or connective tissue structures. Such gummas initially resemble a compaction in the form of a knot under the skin or in the area of ​​large or small joints. Most often, these formations are single, less often multiple, and can be localized both in the area of ​​the upper or lower extremities, and on the face.

When palpating syphilitic gummas, patients do not experience pain or discomfort; in the first weeks, such nodular formations are mobile under the skin, but as the gumma increases in size, they fuse tightly with the surrounding tissues. Over time, the gummous areas become softer in the center, a hole appears through which the contents, similar to a jelly-like jelly, are separated. After all the contents are released, the ulcerative defect gradually heals, and a scar remains on the skin in the form of a scar.

Complications of tertiary syphilis

Against the background of rapidly progressing damage to all internal organs and tissues in the tertiary period, syphilitic gummies appear not only on the skin, but also under the skin in the tissue, cartilage, bones, blood vessels, and muscles.

Against the background of damage to mucous tissues, a long-term complicated course of inflammatory diseases of the nasal and oral cavity, larynx and pharynx is observed. The symptoms resemble a runny nose and sore throat, with gradual destruction of the cartilage of the nasal cavity and acute inflammation of the tonsils and pharynx. When the bone and cartilaginous structures of the nasal cavity are damaged due to syphilitic infection, patients experience subsidence and deformation of the nose, constant bleeding and suppuration.

Today's cases of tertiary syphilis are observed after infection for more than ten years.

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Such patients are most often admitted to intensive care units of hospitals with severe pathology of the heart and blood vessels, heart attacks and inflammation of the aorta and heart muscle, with impaired cerebral blood flow, ischemia and stroke attacks, or with severe neurological symptoms.

When the digestive organs are affected, severe cases of gastritis with ruptured ulcers in the stomach are observed. When the bones and cartilages of the lower and upper extremities are affected, patients are admitted with osteomyelitis or osteoporosis, inflammation in the bones or fractures due to excessive fragility.

It is not surprising that due to the extensive symptoms of a disease such as tertiary syphilis, diagnosis consists of a complete, comprehensive examination of the patient.

How is tertiary syphilis diagnosed?

Treatment of tertiary syphilis is developed only after a thorough examination. First of all, laboratory tests are carried out to identify treponemal infection and interview the patient to determine the duration of infection.

For the study, blood is used and at least three tests are performed. The Wasserman screening reaction can be negative under certain conditions, but the RIF and RIBT tests for late-stage syphilis are positive in 94% of cases. Additionally, studies of cardiac function and the condition of blood vessels, liver and stomach are carried out.

If there are symptoms of damage to the nervous structures, a study of the cerebrospinal fluid and an encephalogram are performed. If the cartilaginous elements of the nose are damaged, the nasal cavities, nasal septum, pharynx, and larynx are examined with special instruments.

Treatment Basics

Quite often you can hear questions from patients about how a venereologist treats tertiary syphilis and whether the disease can be treated when the course lasts for more than ten years.

Note that at present, all patients with confirmed treponemal infection are indicated for serious treatment, and in the case of a long course of the disease, therapy is longer. . Based on the results of sensitivity tests, at least 2 drugs are used to choose from.

Most often, erythromycin or tetracycline and derivatives are used for treatment, which are then replaced by large doses of penicillins.

As therapy progresses, mandatory monitoring of liver and kidney function indicators, monitoring of heart function and the general condition of the patient is carried out. Also, to strengthen the properties of the immune system, preparations of herbal complexes, vitamin compounds and minerals are indicated.

In case of complications from the functioning of internal organs, digestive and intestinal motility disorders, inflammatory processes in the respiratory organs, memory impairment and manifestations of brain damage, symptomatic therapy under the supervision of tests is indicated.

Relatives and loved ones of patients often ask whether tertiary syphilis can be treated at the stage of pronounced clinical manifestations of the disease. Let us answer that in our time, venereologists have the opportunity to provide treatment even at the stage of tertiary manifestations of the disease, but in this case long-term therapy is indicated, strictly within the walls of a medical institution and under the supervision of experienced specialists.

You should not take risks and do home treatment, because the risk of death with tertiary syphilis is extremely high. Currently, guarantees of effective treatment and qualified medical care can only be obtained by contacting real professionals.

If you don't know who to turn to, the Venereology Guide is ready to help you.

Our specialists help each patient with the choice of a modern clinic and an experienced venereologist for quality treatment and follow-up.

Contact the “Venereology Guide” and you are guaranteed to appreciate the European level of medical services.

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The pathological process of syphilis goes through three stages, and in most cases it is diagnosed and cured in the first and second.

But if the disease has entered the tertiary, final stage, the damage covers all organs and systems. By what signs is the tertiary form determined and can it be cured?

Pathogenesis

The pathological process of syphilis, a severe infectious venereal disease, occurs in several stages.

The initial (primary) period passes from the moment of infection and lasts from 10 days to 3 months with the formation of a hard chancre at the site of introduction of Treponema pallidum.

At the next, secondary stage, which can last up to 4 years, disseminated (scattered) rashes appear and all organs and systems are involved in the infectious process.

Without adequate treatment, but under the influence of immunity to a foreign antigen, the pale spirochete, forming spores and cysts, becomes non-virulent and the disease enters a latent phase with remissions and relapses.

The tertiary form develops approximately 7 years after the onset of infection.

Its manifestations are particularly severe and in half of the cases end in death, but in terms of the frequency of cases, this is a rare form, since modern venereology identifies and treats the disease at the primary or secondary stage.

The photo shows what tertiary syphilis looks like

Predisposing factors and causes of the tertiary stage:

• inadequate antibacterial and symptomatic therapy (incomplete course of treatment, insufficient dosages of drugs);
• concomitant pathologies;
• extreme degree of immune depletion;
• chronic alcohol or drug exposure;
• senile, childhood.

At this stage, the sick person ceases to be infectious to others, because a small number of strains of Treponema pallidum, deeply embedded in the granulomas, die with their decay.

Symptoms of tertiary syphilis

Tertiary syphilis is characterized by an undulating course: a protracted latent period is replaced by rare relapses.

The main clinical sign of this stage is the appearance of gumma (or tertiary syphilide), a local painless nodular formation without signs of an acute inflammatory process.

Gumma is located in a limited area under the skin or mucous membrane, slowly regresses and is replaced by scar tissue.

Without treatment, tertiary syphilides gradually increase in size, over time they spontaneously open and come out, forming ulcerations and persistent irreversible deformation. In addition to the skin and mucous membranes, gumma can affect nearby bone structures.

The main signs of tertiary syphilis are the formed syphilides. According to pathomorphological characteristics, they are gumous and tuberculate.

Tuberous syphilide

Tuberous gumma is a nodular hemispherical or flat dense infiltrate up to 8 mm protruding above the skin (“cherry pit”).

In the tertiary period of syphilis, gummas are located locally and asymmetrically, do not merge with each other, and each individual element can be at different stages of maturity.

As the disease progresses after necrotic processes, the gumma resolves, and in place of the tubercular syphilide, a smooth, flat and round ulceration forms, which leaves a scar with a hyperpigmented border on the skin.

Multiple, grouped, but not merging formations after resolution represent a single mosaic scar.

Repeated rashes never form in modified areas.

Quite rarely, tubercular syphilides exist in other forms:

1. Creeping gumma is the formation of a single, continuous scar from closely spaced and periodically resolved rashes.
2. The site is a fusion of dwarf rashes - syphilides in one continuous plaque.

Gummous syphilide

Gummy syphilides are very rarely multiple. Usually this is a single painless node that forms in the subcutaneous fat layer and is localized on the forehead, in the area of ​​​​the legs and forearms, on the knee or elbow joints.

At the initial stage, the gumma remains mobile, not fused with nearby tissues. Subsequently, as it increases in size, it grows together, and a hole is formed at its central point, from which a gelatinous liquid leaks out.

Afterwards, the hole gradually expands, and a crater-shaped ulcer with a necrotic core at the bottom grows in place of the node. Over time, it resolves and a star-shaped, retracted scar forms.

Localization of tertiary syphilis

Syphilitic gummas can form in any area, but most often they are localized on the mucous membrane of the soft palate, tongue, pharynx and nasal cavity.

In the soft palate, the formation of gumma leads to thickening and discoloration of the mucous membrane, which, after resolution, turns into a perforated hole.

Tertiary syphilis in the nasal cavity, as a rule, manifests itself as gumma on the nasal septum. With the growth of gumma, mucous secretions are replaced by purulent ones. Due to stagnation and drying into crusts, free breathing becomes impossible.

After the gumma resolves, the bone septum, consisting of the vomer and ethmoid bone, is destroyed.

This cosmetic defect can be seen in all illustrations and photographs of patients with the classic tertiary form: a saddle-shaped, flattened and deformed nose, a depressed, wide bridge of the nose.

Tertiary syphilis of the tongue can manifest itself in two forms:

1. Single gumma. The tissues of the tongue become wrinkled and significantly decrease in size. After decay, an extreme degree of nasal sound appears, chewing is difficult and part of the food bolus easily penetrates the nasal cavity.
2. Sclerosing glossitis. It manifests itself as diffuse compactions, which then merge and form a continuous, nodular gumma, which, with progression, affects the entire mucous and submucosal tissue of the tongue, periosteum, and bone. Hypertrophied scar tissue changes the configuration of the tongue and significantly increases its volume.

In the pharynx, gumma is usually localized along the back wall, causing significant discomfort and pain when swallowing.

After the gumma resolves, the walls of the pharynx become deformed, and a pathological communication occurs between the oral and nasal cavities.

General clinical manifestations are nonspecific: weakness, attacks of palpitations and shortness of breath, moderate pain at the site of gumma formation.

In the tertiary form of the disease, internal organs, bone structures, joints and nerve tissues are simultaneously affected along with the mucous membranes.

Loss statistics:

• cardiovascular system – 85%;
• organs of the gastrointestinal tract – 7%;
• liver and lung tissues – 3%;
• other organs – 5%.

Untreated, complicated forms of the disease in 35% of cases end in death in the first two years.

How tertiary syphilis affects the psyche

In the primary and secondary forms of the disease, damage occurs to the brain, and in the tertiary form, damage occurs to the central nervous system (neurosyphilis).

Various morphological changes affect brain structures, vessels, membranes and lead to severe psychoneurological disorders.

The initial, pseudoasthenic stage is manifested by weakness, attacks of headaches, fatigue, and decreased performance. The patient begins to perform actions unusual for him, to show rudeness and tactlessness.

Afterwards, the clinical picture worsens: speech disorders increase (slurred speech, repetition of syllables), unsteadiness of gait, staggering, handwriting becomes illegible.

In 95% of cases, patients with the tertiary form experience mental insanity and extreme mental instability, which are expressed by depression, fits of rage, euphoria, paranoia, hallucinations, twilight states of consciousness, stupor and absurd delusions of grandeur.

Feature of mental damage at the last stage: pathological extremely bright, colorful perception of the surrounding world.

Treatment program

The diagnosis of “tertiary syphilis” can be made on the basis of clinical and laboratory data. Research methods:

• taking anamnesis;
• physical examination;
• RIBT study - reaction to the degree of immobilization of the causative agent of Treponema pallidum;
• RIF study - immunofluorescence reaction for the presence of antitreponemal antibodies;
• trial treatment;
• To diagnose somatic lesions, ECG, ultrasound, gastro- and pharyngoscopy, chest X-ray, and lumbar puncture to examine cerebrospinal fluid are performed.

Treatment of tertiary syphilis is carried out exclusively in specialized hospitals.

Tertiary syphilis, like its complications, cannot be completely cured, so the course of therapy is aimed at improving the quality of life and preventing further general infection.

Combinations of 4th and 5th generation bacterial agents in combination with iodine-containing drugs are shown.

In the first two weeks, the patient is prescribed a course of erythromycin and tetracycline drugs. Afterwards, drugs of the penicillin group and symptomatic drugs are added.

The duration of the course and dosage are determined by the attending physician individually, taking into account the duration of the disease, the degree of infection and the severity of complications, the age and physical condition of the patient.

The tertiary period of syphilis is not mandatory. Previously, tertiary syphilis developed in 5-40% of untreated and poorly treated patients. Recently, tertiary syphilis is rarely registered due to more effective therapy, dispensary activities, and a high percentage of detection and treatment of patients with latent syphilis.

In the typical (“classical”) course of syphilitic infection, the tertiary period of syphilis develops after the secondary period. In the overwhelming majority of patients, a latent period is observed between the secondary and tertiary periods of syphilis, and only in some cases tertiary syphilis follows directly after secondary syphilis. Most often, tertiary syphilis develops in the 3rd-5th year of the disease, later its frequency progressively and rapidly decreases. Cases of the development of clinical manifestations of tertiary syphilis have been described 50-60 years after infection.

The development of tertiary syphilitic lesions is facilitated by a decrease in the body’s reactivity, common severe diseases, and chronic intoxication. Mechanical, chemical and thermal injuries to the skin also provoke the appearance of tertiary syphilides. There are tertiary active and tertiary latent syphilis.

Symptoms

Clinical manifestations of tertiary syphilis are localized, organ-based. They are characterized not by proliferative, but by destructive changes. They leave behind scars or cicatricial atrophy. Tertiary syphilis lesions in the form of tubercles and gummas can develop in any organs and tissues, but most often the skin, mucous membranes, bones, vascular and nervous systems, and internal organs are affected.

If the patient does not indicate the presence of previous syphilis, it can be quite difficult to determine the disease. X-rays and laboratory tests confirm the diagnosis of syphilis, but in this case the tests may be false negative. Therefore, it is best to turn to professionals. If you have any symptoms of bone or joint disease and questionable test results, you should consult a specialist before treatment. The Clinic of Traumatology and Orthopedics in Moscow has earned a good reputation among both patients and doctors, thanks primarily to its doctors who daily perform both diagnosis and treatment of diseases of the musculoskeletal system.

Skin syphilides of the tertiary period are tubercles and gummas, which are pathohistologically a chronic infectious granuloma. They differ from each other only in size - tubercles - the size of a hemp grain to a pea, gumma - from a pea to a walnut, and the depth of their occurrence - tubercles - in the skin itself, gumma - in the subcutaneous base. The rashes of tertiary syphilis are not as numerous as the elements during the secondary period, they are located mainly on one side of the body, tend to cluster, and form deep infiltrates and ulcers. The rash does not cause subjective sensations - pain, itching.

Patients with tertiary syphilis are less contagious and are practically not dangerous to others.

Lymph nodes in tertiary syphilis are not involved in the process. Serological reactions in 35-40% of patients with active tertiary syphilis are negative. Therefore, to establish or confirm the diagnosis of tertiary syphilis, it is necessary to examine the blood for RIF and RIBT (immunofluorescence and treponemal immobilization reaction), which are positive in almost all cases of this period of syphilis.

When examined in a dark field with a light microscope, treponema pallidum cannot be detected. This can be explained by the fact that as a result of the manifestation of infectious immunity in tertiary syphilides, there are extremely few pale treponemas. Along with this, the necrotic disintegration of granuloma due to high tissue sensitization also contributes to the reduction in the number of treponemas in tertiary syphilis.

The tubercles of tertiary syphilis do not appear all at once, but in spurts, their development is slow. In connection with the above, the tuberculate elements are at different stages of development, causing secondary, evolutionary polymorphism. The course of tubercular syphilide is quite long and, without treatment, drags on for several months or even years.

Syphilitic tubercles of tertiary syphilis are hemispherical in shape, dark red in color, and have a dense consistency. The evolution of the tubercle is twofold: either it ulcerates and a scar remains in its place, or ulceration does not occur and cicatricial atrophy develops at the site of the tubercle. The ulcer of tubercular syphilis in tertiary syphilis is round in shape, its edges are not undermined, the bottom is covered with yellowish necrotic masses. The scar is mosaic in relief (different depths of individual scars) and color (the presence of scars of different colors - pink, brown, whitish). New bumps never appear on the scar.

Grouped tuberculate syphilide is more common than other types of tertiary syphilis rashes and is a group of few (10-20-30 elements) non-merging tubercles in a limited area of ​​skin. The tubercles can be grouped into shapes and form rings, concentric arcs, etc.

Serpiginating (creeping) tubercular syphilide of tertiary syphilis is characterized by the spread of the lesion over the surface either eccentrically or in any one direction. Initially, a group of tubercles appears, which merge and undergo slow evolution. The appearance of new elements occurs in repeated outbreaks. Old tubercles of tertiary syphilis undergo reverse development, and new ones appear nearby, and the lesion spreads, sometimes covering large surfaces, leaving behind a continuous mosaic scar. Since the tubercles tend to merge, the growth line of the lesion is represented by a ridge-like border in the form of scallops or concentric arcs.

In cases where the tubercles of tertiary syphilis merge, forming continuous infiltrates in the form of plaques of round or scalloped outlines, they call tubercular syphilis a “platform”. The diameter of the plaques reaches 5-6 cm, their edges are clear, the color is dark red, the surface is smooth, in some places it peels, and in others it ulcerates. Tuberous syphilide “platform” is often localized on the palms and soles. On the lips and in the nose area, the infiltrate does not have clear boundaries.

Dwarf tubercular syphilide is a rare rash of tertiary syphilis, observed in the late period of tertiary syphilis. Its elements are small in size (from millet to hemp grains), they do not ulcerate, and after their regression, slight cicatricial atrophy of the skin remains. The tubercles of this syphilide are few in number (10-20 elements), they are grouped, localized in a limited small area of ​​​​the skin.

Syphilitic gumma is an inflammatory nodule of spherical shape, dense consistency, the skin over it is copper-red in color. Sizes range from pea to walnut. Gummas of the tertiary period of syphilis gradually increase in size, their color acquires brownish or bluish shades. Over time, a fluctuation appears in the center of the gumma. Then the gumma is opened. A small amount of clear, viscous, glue-like liquid is released from the resulting fistula opening. The name "gumma" comes from the Latin " gummi" - gum, Greek - " commidion"- thick sap that appears on the surface of the bark of many trees when it is damaged and usually hardens quickly.

The opening of the gumma of tertiary syphilis increases in size and turns into an ulcer. A round-shaped gummous ulcer with dense, raised, raised, uncut edges. A characteristic clinical sign of an ulcer is a gummous core - dirty gray or grayish-yellow necrotic masses firmly fixed at the bottom of the ulcer. After the gummy core is rejected, granulations appear and ultimately, the ulcer scars. In some cases, the gumma does not ulcerate, leaving behind cicatricial atrophy.

As a rule, gumma in tertiary syphilis does not cause subjective sensations. However, in places exposed to mechanical or chemical irritation (corners of the mouth, genitals, near joints), gummas can be painful.

The duration of existence of gummas in tertiary syphilis varies widely - from several weeks to several months, and in rare cases - years.

Types of gummas

1. single (solitary),
2. grouped,
3. in the form of a diffuse gummous infiltrate up to 6-8 cm in size, sometimes more.

Gummas located close to the extensor surfaces of large joints (knees, elbows, etc.) in rare cases may undergo fibrosis. These fibrous gummas, or periarticular nodules, are painless, dense (the consistency of cartilage) nodes 1.5-2 cm in diameter, the color of the skin over them is not changed.

Lesions of the mucous membranes in the tertiary period of syphilis occur on the soft and hard palate, nasal mucosa, and less often on the back wall of the pharynx and tongue. Here gummas, gummous diffuse infiltration and tubercles can form. Lesions are accompanied by tissue destruction, the formation of ulcers and scars. Gummous lesions of the mucous membrane of the hard palate usually develop secondary to the transition of the inflammatory process from the bone and periosteum to it. Ultimately, separation of the bony sequestrum leads to perforation of the hard palate. A round-shaped perforation hole connects the oral cavity with the nasal cavity.

The nasal mucosa is usually affected secondarily when the pathological process spreads from the bone and, to a lesser extent, from the cartilaginous part of the nasal septum. A perforation may form in the nasal septum. With significant destruction of the bone part of the septum and especially the upper part, the nose becomes deformed - it becomes saddle-shaped.

Gummy lesions of the tongue in tertiary syphilis can be in the form of either limited, nodular, or diffuse interstitial and necrotizing glossitis. With superficial diffuse glossitis, the mucous membrane becomes smooth due to smoothing of the papillae, red or whitish. Upon palpation, a compaction is noted in the upper layer of the tongue. Deep sclerotic glossitis, caused by diffuse gummous infiltration around the submucosal vessels and in the connective tissue between muscle fibers, at the first stage of the process is characterized by a general or partial enlargement of the tongue, thickening, loss of elasticity and firmness. The tongue barely fits in the oral cavity, its surface is lobed. The mucous membrane is smooth, bluish-red in color or thickened, whitish. In the second stage, the infiltrate is replaced by scar connective tissue. The tongue decreases in size, becomes hard, and inactive, which makes phonation and chewing difficult. With partial damage, the tongue becomes bent and takes on an asymmetrical shape. A sclerotic tongue is easily injured, causing painful erosions, cracks and ulcers.

In the tertiary period of syphilis, tertiary roseola sometimes occurs. It is small in number, ring-shaped, 5 cm in diameter or more.

Tertiary syphilis rarely recurs.

Tertiary syphilis was last modified: October 23rd, 2017 by Maria Saletskaya