Tertiary syphilis: symptoms, diagnosis and treatment. Tertiary syphilis and its manifestations in men and women The 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 very last 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 for 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 you do not start therapy on 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 early. Tertiary syphilis can develop due to improper use of medications prescribed by a doctor or insufficient dosage.

Syphilis develops as a result of the vital activity of pale treponema. These microorganisms live 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 living conditions of a person.
The presence of injuries or chronic diseases.
Reduced immunity due to prolonged illness.
Constant mental and physical overload.
Improper or insufficient nutrition.

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

Note! According to statistics, the disease most often affects people between the ages of 20 and 30. 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. There are the following types of such formations:

Lumpy.
Gummy.
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 also 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 limbs, lower back, face, head or back. Such syphilis have a reddish-brown tint. After some syphilides have healed, 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 at the same time they do not merge into a single whole. One group includes no more than 40 knots. Often such groups form long chains that can be closed in a circle. Such syphilides are found in the face, back and lower extremities.
Serpening. The nodules appear sequentially. Those that existed earlier are scarred. Such formations occupy an impressive area of the skin. A mosaic scar is formed 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 rounded formations of a red tint are formed on the surface of the skin. They are grouped into figures resembling papules of secondary syphilis. Ulcers are not formed at the site of syphilis. After healing, scars may form, which smoothen over time.
Diffuse. It is the rarest form of cutaneous syphilis. Formed syphilis 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 site 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 bouts of rage, depression and even paranoia. At such a moment, it is important not to leave the victim alone.

Gummy syphilides

Gummy formations are larger. They are colored dark red. They adhere tightly to the subcutaneous tissue. Such syphilis bring intense pain. Gummy syphilides often appear singly.

Syphilides are most often localized in the sternum, thighs, upper limbs, 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 becomes dark red. A lilac speck is noticeable in the center. Later, an ulcer appears in its place. At its bottom there is a necrotic rod, the discharge of which leads to the appearance of a scar.

Read also on the topic

What is the prevention of syphilis infection?

In some cases, gummas can pass without ulceration. In such a situation, after reducing the node, 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 cluster. They fold into various geometric shapes ranging from 5 to 15 cm.

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

Neurosyphilis

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

Meningitis. This form develops five years after infection. Gummy formations begin to form around the vessels of the brain. The disease is accompanied by a significant increase in body temperature, severe headaches, dizziness, bouts of vomiting and nausea, a person reacts painfully to bright light. If the auditory nerve is involved, a significant hearing loss occurs.
Meningoencephalitis. This form of the disease can develop even 30 years after infection. Most often it is observed in the stronger sex. In this case, the same symptoms appear, one hundred and in the meningitis form of the disease. In addition to them, mental disorders appear. A person can be tormented by hallucinations, unmotivated attacks of aggression.
Dorsal tabes. With this type of disease, the horns of the spinal cord are damaged. In this case, the limbs can 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 can be felt in the stomach and intestines.
- Ataxic. It manifests itself in an unsure, shaky gait. The condition is aggravated if a person walks with their eyes closed.
- Paralytic. Tendon reflexes disappear, muscle tone decreases, pupils stop responding to light.
Paralysis. At the same time, all the signs of dementia are manifested, a person can lose the simplest everyday skills. Often this form of syphilis is combined with tabes dorsalis.
Vascular. An inflammatory process arises in the membrane of small arteries. It leads to the formation of blood clots. As a result, the lumen of the vessels narrows to critical values, certain areas of the brain begin to soften. This form of the disease is common in young men. The main signs of such a lesion are headaches, dizziness, seizures that resemble epileptic seizures. If the treatment of tertiary syphilis of this form is started in a timely manner, then the prognosis is favorable.

Note! In some cases, neurosyphilis can be latent. Signs of the disease are detected only during a medical examination.

The defeat of the osteoarticular apparatus

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

Periostitis. It is characterized by bone pain that worsens at night. On palpation, swelling is found. If proper treatment is not carried out, then bumps or thickenings are formed at the site of the swelling, which are visible on x-rays.
Osteoperiostitis. The inflammatory process originates in the periosteum. Later, it goes to the entire bone tissue. In this case, a person is tormented by severe attacks of boring pain, which become especially unbearable at night. On palpation, a swelling is felt in the periosteum, which subsequently develops into rough growths with cutter-like depressions. The likelihood of ulceration is high.
Osteomyelitis. This form of tertiary syphilis occurs due to the fact that gum is concentrated in the bone substance. The inflammation soon spreads to the bone marrow. The process can also occur in the reverse order. The main symptoms are fever and pain.

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

Note! Joint symptoms may persist even after appropriate treatment. Relief is brought by taking medications containing potassium iodide.

Visceral syphilis

This type of tertiary syphilis can have the most serious consequences. The appearance of gummy formations can be observed in any internal organs. At the same time, severe malfunctions occur in the 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 aortic membrane. Later, they are displaced by connective tissue. The problem may be accompanied by significant vasoconstriction of the heart, aneurysm, or aortic valve insufficiency.

Read also on the topic

Ways of infection with treponema pale, symptoms of infection, treatment

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

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

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

Hepatitis with syphilis has similar symptoms. Painful sensations appear in the hypochondrium, a person suffers from bouts of nausea, the sclera turn yellow, and the normal functioning of the intestines is disrupted. Diagnosis is made difficult by the fact that the symptomatology manifests itself simultaneously from several organs.

Diagnostic techniques

It is possible to determine the tertiary stage of syphilis after a thorough examination and questioning of the patient, as well as carrying out appropriate diagnostic measures. During a survey of a person, a specialist must find out the symptoms of the problem and the measures that were taken earlier. 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. A non-treponemal analysis is performed first. After that, a treponemal study is also carried out for control. This is the only way to make an accurate diagnosis.
Bacterioscopic examination. Samples taken from the lymph nodes or from the bottom of the ulcers are checked for 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 full diagnosis will a specialist be able to make a reliable diagnosis. Based on this, a competent treatment program will be developed in the future.

Disease therapy

It is necessary to start treatment as early as possible. Only in this case is a successful cure possible. The main therapeutic technique is the use of drugs containing benzalpenicillin. Thanks to this, the work of internal organs and systems is being adjusted. If the patient has a manifestation of an allergic reaction to antibiotics of the penicillin series, then 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. A good result is given by the use of Summamed, Josamycin, Clarithromycin.

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

Used novocaine penicillin salt. 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 that, taking 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 already used. It is administered for 10 days.
Procaine-penicillin. The course of treatment with such a drug is 20 days. After this, a ten-day break is made, after which the use of the medication is resumed for another 10 days.

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

The first two weeks, a preparatory stage is carried out, in which the patient is prescribed Tetracycline or Erythromycin. After that, penicillin is administered to the patient for 28 days.
After the preparatory stage with the use of Tetracycline or Erythromycin, treatment is carried out with the use of novocaine penicillin salt.
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 antibacterial drugs of the penicillin series. Six months after the end of the main course of treatment, repeated laboratory tests are carried out. This is the only way to control 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 apply several courses of therapy to achieve a result.

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

On average, therapy for tertiary syphilis takes from two months to several years. Everything will depend on the complications that have appeared and how sensitive the patient is to the drugs used. During treatment, the patient is advised to refuse sexual intercourse without using a condom. It is necessary to periodically undergo a preventive examination.

Syphilis, even in the last phase, can be cured. The sooner you start therapy, the more chances for a successful cure. Always be attentive to your health and see your 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.

These days, tertiary, or late, is extremely rare. It mainly affects patients who have not completed 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 ways of infection:

In 90% of cases, the disease is transmitted through any type of sexual contact.
With a blood transfusion from an infected donor.
From an infected mother to her baby during pregnancy and breastfeeding.
Through saliva.
When using one syringe.
Through medical instruments.

The greatest threat comes from 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 get into the damaged area of the skin or wound.

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

Tertiary syphilis concept

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 is 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;
not started treatment on time;
the patient has not completed the course of treatment;
frequent change of sexual partners;
severely reduced immunity;
all kinds.

Tertiary syphilis disease is fatal in half of 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

With this form of the disease, almost all human systems and organs are affected.

The disease can develop for decades. 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:

Diagnostics of the tertiary syphilis

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

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

After the end of the course of treatment, the patient is observed for another five years... If during this period the patient has no symptoms of the disease, it is considered that the person is 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 nearly impossible.

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

Complications of tertiary syphilis

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

For venereal disease, syphilis is characterized by three stages of the course, 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 disorders of the functioning of all internal organs and systems of the body.

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

Currently, tertiary syphilis occurs in 60% of patients who have not received specific treatment before, and in 15% of patients who did not follow the entire therapy regimen during treatment.

It is also worth noting that the most common tertiary period of syphilitic infection occurs in patients who did not follow the regularity of medical examinations at all. Advanced cases of the disease occur in patients who have not previously been observed by doctors and have not taken 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 long and expensive.

Every year, venereologists discover new effective methods even at later stages. In this article, we will answer all the most frequently asked questions of doctors about whether it is possible to completely cure tertiary syphilis with late detection, how much does it cost to treat this form of infection in modern clinics and how to treat tertiary syphilis is recommended by experienced venereologists.

Symptoms of tertiary syphilis are severe skin symptoms, severe complications from internal organs, neurological pathologies. With a prolonged course and inaction on the part of the patient, treponemal infection is fatal.

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

Lumpy 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 shade.

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

As compaction progresses, tissue necrosis in the center is observed and the transition to an ulcerative defect. 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 prolonged reproduction of treponemal infection in the tissues of internal organs, bone or connective tissue structures, such as tertiary gummy formations appear. Such gummas at first resemble a seal 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, can be localized both in the area of the upper or lower extremities, and on the face.

When feeling syphilitic gum, patients do not experience pain or discomfort, for the first weeks such nodular formations are mobile under the skin, however, as the size of the gum increases, they grow tightly with the surrounding tissues. Over time, the gummy areas become softer in the center, a hole appears through which the contents are separated, similar to a jelly-like jelly. After the release of all the contents, the ulcer defect gradually overgrows, and a scar in the form of a scar remains on the skin.

Complications of tertiary syphilis

Against the background of a rapidly progressing lesion of all internal organs and tissues in the Tertiary period, syphilitic gummy ones appear not only on the skin, but also under the skin in fiber, in cartilage, bones, blood vessels, and muscles.

Against the background of damage to mucous tissues, there is a prolonged complicated course of inflammatory diseases of the nasal cavity and mouth, larynx and pharynx. Symptoms resemble a runny nose and sore throat, with a gradual destruction of the cartilage of the nasal cavity and acute inflammation of the tonsils and pharynx. With damage to the bone and cartilaginous structures of the nasal cavity due to syphilitic infection, patients experience subsidence and deformities of the nose, constant bleeding and suppuration.

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

IT'S IMPORTANT TO KNOW!

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.

With damage to the digestive system, severe cases of gastritis with ruptured ulcers in the stomach are observed. If the bones and cartilage of the lower and upper extremities are affected, patients are presented 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, the diagnosis consists in a complete, comprehensive examination of the patient.

How is tertiary syphilis diagnosed?

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

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

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

Basics of treatment

Quite often, you can hear questions from patients about how a venereologist treats tertiary syphilis and whether the disease is treated with a course of ten years or more.

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

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

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

In case of complications from the work of internal organs, impaired digestion and intestinal motility, inflammatory processes in the respiratory organs, memory impairment and manifestations of brain damage, symptomatic therapy is indicated under the control of analyzes.

Relatives and friends of patients are often asked whether tertiary syphilis is treatable at the stage of pronounced clinical manifestations of the disease. We will answer that in our time, venereologists have the opportunity to provide treatment even at the stage of tertiary manifestations of the disease, however, therapy in this case is indicated for a long time, strictly within the walls of a medical institution and under the supervision of experienced specialists.

You should not take the risk and engage in home treatment, because the risk of death in tertiary syphilis is extremely high. Currently, you can get guarantees of effective treatment and qualified medical care only when you turn to real professionals.

If you do not know who to contact, 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.

Refer to the Venereology Guide and you are guaranteed to appreciate the European level of medical services.

BOOK AN APPOINTMENT:

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

But if the disease has entered the tertiary, final stage, the defeat covers all organs and systems. What are the criteria for determining the tertiary form and whether it can be cured.

Pathogenesis

The pathological process in syphilis, a severe infectious venereal disease, takes place 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 the introduction of pale treponema.

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

Without adequate treatment, but under the influence of immunity on a foreign antigen, the pale spirochete, forming spores and cysts, becomes non-virulent and the disease enters a latent (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 are fatal, but in terms of the frequency of cases it is a rare form, since modern venereology detects 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 dosage of drugs);
concomitant pathologies;
extreme depletion of immunity;
chronic alcoholic or narcotic effects;
senile, children's age.

At this stage, the sick person ceases to be infectious to others, because a few strains of pale treponema, deeply embedded in granulomas, die with their decay.

Symptoms of tertiary syphilis

Tertiary syphilis is characterized by an undulating course: a prolonged latency period is replaced by rare relapses.

The main clinical sign of this stage is the appearance of gum (or tertiary syphilis), 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, over time, spontaneously open and go out, forming ulceration and persistent irreversible deformation. In addition to skin and mucous membranes, gum can affect nearby bone structures.

The main signs of tertiary syphilis are syphilis formed. According to the pathomorphological characteristics, they are humous and lumpy.

Tuberous syphilis

Tuberous gum is a knotty, hemispherical or flat dense infiltrate up to 8 mm protruding above the skin ("cherry pit").

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

With the course of the disease, after necrotic processes, gum is resolved, and in place of tubercular syphilis, an even, gently sloping and rounded 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 are never formed on the modified areas.

Rarely enough, tuberous syphilides exist in other forms:

Creeping gum - the formation of a single, continuous scar from closely spaced and periodically resolved rashes.
The site is the confluence of dwarf eruptions - syphilides in one continuous plaque.

Gummy 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 lower legs and forearms, on the knee or elbow joints.

At the initial stage, gum remains mobile, not soldered to nearby tissues. Subsequently, with an increase in size, it coalesces, and a hole is formed at its central point, from which a gelatinous liquid seeps out.

After that, the hole gradually widens, and a crater-shaped ulcer with a necrotic rod at the bottom grows in place of the node. Over time, it resolves and a star-shaped, retracted scar is formed.

Localization of tertiary syphilis

Syphilitic gums can form anywhere, but most often they are localized on the mucous membrane of the soft palate, tongue, pharynx and nasal cavity.

On the soft palate, the formation of gum leads to a 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 a gum on the nasal septum. With the growth of gum, mucous secretions are replaced by purulent ones. Free breathing becomes impossible from stagnation and drying into crusts.

After the resolution of the gumma, the bone septum, consisting of the vomer and ethmoid bone, collapses.

Such a cosmetic defect can be seen in all illustrations and photos of patients with a classic tertiary shape: 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:

Single gumma. The tissues of the tongue become shriveled, significantly reduced in size. After disintegration, an extreme degree of nasalism appears, chewing is difficult and part of the food lump freely penetrates into the nasal cavity.
Sclerosing glossitis. It manifests itself as diffuse seals, which then merge and form a continuous, nodular gum, which, with progression, affects the entire mucous and submucous tissue of the tongue, periosteum, and bone. Hypertrophied scar tissue changes the configuration of the tongue and significantly increases its volume.

In the pharynx, gum, as a rule, is localized along the back wall, causing significant discomfort and pain when swallowing.

After the resolution of the gum, the walls of the pharynx are deformed, and a pathological message arises 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 gum formation.

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

Loss statistics:

cardiovascular system - 85%;
organs of the gastrointestinal tract - 7%;
liver tissue, lungs - 3%;
other organs - 5%.

Untreated, complicated forms of the disease in 35% of cases are fatal in the first two years.

How tertiary syphilis affects the psyche

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

Various morphological changes cover the brain structures, vessels, membranes and lead to severe neuropsychiatric disorders.

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

After the clinical picture is aggravated: speech disorders increase (blurred speech, repetition of syllables), uncertainty of gait appears, staggering, handwriting becomes illegible.

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

A peculiarity of mental damage at the last stage: pathological, exceptionally 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:

collection of anamnesis;
physical examination;
RIBT study - reaction of the degree of immobilization of the causative agent of treponema pallidum;
RIF study - the reaction of immunofluorescence for the presence of antitreponemal antibodies;
trial treatment;
for the diagnosis of somatic lesions, ECG, ultrasound, gastro- and pharyngoscopy, pulmonary radiography, lumbar puncture for the study of cerebrospinal fluid are performed.

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

Tertiary syphilis, like its complications, is not completely treated, therefore, 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 preparations are shown.

In the first two weeks, the patient is prescribed a course of drugs of the erythromycin and tetracycline series. After connecting drugs of the penicillin group, symptomatic agents.

The duration of the course, dosages 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 optional. Previously, tertiary syphilis developed in 5-40% of untreated and poorly treated patients. Recently, tertiary syphilis is rarely recorded due to more effective therapy, dispensary events, a large percentage of detection and treatment of patients with latent syphilis.

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

The development of tertiary syphilitic lesions is facilitated by a decrease in the reactivity of the body, general serious diseases, and chronic intoxication. Mechanical, chemical and thermal trauma to the skin also provoke the appearance of tertiary syphilides. Distinguish between tertiary active and tertiary latent syphilis.

Symptoms

Clinical manifestations of tertiary syphilis are localized, organ. They are not characterized by proliferative, but destructive changes. They leave behind scars or cicatricial atrophy. Lesions of tertiary syphilis 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 previously transferred 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 can be false negative. Therefore, it is best to turn to professionals. If you have any symptoms of bone or joint disease and questionable research results, before being treated, you should come for a consultation with a specialist. The clinic of traumatology and orthopedics in Moscow has earned a good reputation both among patients and doctors, thanks primarily to its doctors, who daily diagnose and treat diseases of the musculoskeletal system.

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

Patients with tertiary syphilis are slightly infectious, they 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 (the reaction of immunofluorescence and immobilization of treponema), which are positive in almost all cases of this period of syphilis.

When examined in a dark field of a light microscope, it is not possible to detect pale treponemas. This can be explained by the fact that as a result of the manifestation of infectious immunity in tertiary syphilis, pale treponemas are extremely small. Along with this, a decrease in the number of treponemas in tertiary syphilis is also facilitated by the necrotic disintegration of granulomas due to high tissue sensitization.

The tubercles of tertiary syphilis do not appear all at the same time, but jerky, their development is slow. In connection with the above, tubercle elements are at different stages of development, causing secondary, evolutionary polymorphism. The course of tubercular syphilis is long enough and without treatment is delayed for several months or even years.

Syphilitic tubercles of tertiary syphilis are hemispherical, dark red, dense. 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 in the place 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 occurrence of individual scars) and color (the presence of scars of various colors - pink, brown, whitish). New tubercles never appear on the scar.

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

Serpiginating (creeping) tubercular syphilis of tertiary syphilis is characterized by the spread of the lesion on the surface either eccentrically, or in any one direction. First, 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 are prone to merging, the growth line of the focus is represented by a ridge-like border in the form of scallops or concentric arcs.

In those cases when the tubercles of tertiary syphilis merge, forming continuous infiltrates in the form of plaques of round or scalloped outlines, they create a "platform" for tubercle syphilis. The diameter of the plaques reaches 5-6 cm, their edges are clear, the color is dark red, the surface is smooth, in places it peels off, and in places it ulcerates. Tuberous syphilis "platform" is more often localized on the palms and soles. On the lips and in the area of the nose, the infiltration has no clear boundaries.

Dwarf tubercular syphilis 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 grain), they do not ulcerate, after their regression, there is a slight cicatricial atrophy of the skin. The tubercles of this syphilis are few in number (10-20 elements), they are grouped, localized on a limited small area of the skin.

Syphilitic gum is an inflammatory node of a spherical shape, of a dense consistency, the skin above it is copper-red. 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, fluctuation appears in the center of the gum. Then the gum is opened. A small amount of a transparent, viscous, glue-like liquid is released from the resulting fistulous opening. The name "gumma" comes from the Latin " gummi"- gum, Greek -" kommidion"- a thick sap that appears in many trees on the surface of the bark 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 gummy ulcer of a round shape with dense, roller-like raised uncovered edges. A characteristic clinical sign of an ulcer is a gummy core - dirty gray or grayish-yellow necrotic masses, firmly fixed at the bottom of the ulcer. After rejection of the gummy core, granulations appear and ultimately, the ulcer is scarred. In some cases, the gum does not ulcerate, leaving behind cicatricial atrophy.

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

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

Types of gum

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

Gummas located near the extensor surfaces of large joints (knee, elbow, etc.), in rare cases, can undergo fibrosis. These fibrous gums, or periarticular nodosities, are painless, dense (cartilage consistency) nodes 1.5-2 cm in diameter, the color of the skin above them is not changed.

Lesions of the mucous membranes in the tertiary period of syphilis are found on the soft and hard palate, nasal mucosa, less often on the back of the pharynx and tongue. Gummas, gummy diffuse infiltration and tubercles can form here. Lesions are accompanied by tissue destruction, ulceration and scarring. Gummy lesions of the mucous membrane of the hard palate usually develop a second time when the inflammatory process from the bone and periosteum passes to it. Ultimately, the separation of bone sequestration leads to perforation of the hard palate. A round perforation 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. Perforation may form in the nasal septum.With significant destruction of the bony part of the septum, and especially the upper part, the nose deforms - it becomes saddle-shaped.

Gummy lesions of the tongue in tertiary syphilis can be in the form or limited, nodular, or diffuse interstitial and necrotic glossitis. With superficial diffuse glossitis, the mucous membrane becomes smooth due to the smoothing of the papillae, red or whitish. On palpation, a seal is noted in the upper layer of the tongue. Deep sclerotic glossitis, caused by diffuse gummy infiltration around the vessels of the submucosa 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, compaction, loss of elasticity and elasticity. The tongue barely fits in the oral cavity, its surface is lobular. The mucous membrane is smooth, bluish-red or thickened, whitish. In the second stage, the infiltrate is replaced by scar connective tissue. The tongue decreases in size, becomes hard, inactive, which makes phonation and chewing difficult. With a partial defeat, the tongue is bent, acquires an asymmetric shape. A sclerosed tongue is easily injured, painful erosion, cracks and ulcers occur.

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

Tertiary syphilis rarely recurs.

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