Early and late latent syphilis. Allergy to penicillin

Syphilis can also occur in a latent form.

This variant of the course of the disease is called latent syphilis. Hidden syphilis From the moment of infection, it takes a latent course and is asymptomatic, but blood tests for syphilis are positive.

In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.

If it is impossible to determine the type of latent syphilis, the venereologist puts preliminary diagnosis latent unspecified syphilis, the diagnosis can be clarified during examination and treatment.

The presence of treponemal syphilitic infection in a latent form is not observed in all patients; in 75% of cases after infection, at the end of the incubation period, the period of the first manifestations of the disease begins.

In some patients, after infection, the infection is present in the body for years, however, there are no clinical symptoms of the disease. This kind of flow is called hidden.

Currently, leading experts in the field of medicine and science believe that the rate of development of the disease and the frequency of cases of transition to a latent course of the disease is influenced by several factors.

First of all, this is the state of the immune system, frequency of administration medicines, antibiotics during infection and concomitant pathology.

It has been proven that taking any antibacterial drugs for syphilis lengthens the incubation period of the syphilitic system by different periods for every patient.

When the first signs of the disease appear, which may be extremely similar to a cold or flu-like condition, taking antibiotics can actually cause the disease to transform into latent syphilis, which will not appear for months.

Ordinary syphilis develops when Treponema pallidum, the causative agent of this disease, enters the human body. During their activity, the patient develops symptoms of syphilis: rash, bumps, gummas, and so on.

At the same time, the patient’s immunity does not stand aside: as with any infection, it secretes antibodies (protective proteins) and also sends cells of the immune system to the places where bacteria multiply.

Thanks to these measures, most Treponema pallidums die. However, the most tenacious bacteria remain, which change their shape so that the immune system can no longer recognize them.

In its cystic form, treponema pallidum cannot be active, but it can reproduce

This type of “masked” treponema pallidum is called cystic forms or L-forms. In this form, treponema pallidum cannot be active, but it can reproduce.

As a result, when the immune system “loses its vigilance,” secretly multiplying bacteria enter the bloodstream and repeatedly harm the body.

The same thing happens with improper treatment of syphilis. If the antibiotic is chosen incorrectly or in the wrong dose, not all Treponema pallidums die - the survivors disguise themselves and remain invisible until better times.

Definition and causes

Diagnosis, latent syphilis in clinical practice is placed if the patient has no specific symptoms on mucous membranes and skin, no visible lesions internal organs, but according to the results of laboratory tests, antibodies to the pallidum spirochete are detected.

Diagnosis of this form of syphilis is considered the most difficult, since patients do not have the slightest suspicion of infection. Typically, pathology is detected during examination for another disease.

In addition, strains of Treponema pallidum are so insidious that they masquerade as chlamydia or gonorrhea, and if the pathogen is particularly cunning, patients develop signs indicating stomatitis, bronchial asthma, sore throat, but not for syphilis.

In the vast majority of cases, specialists attribute the development of latent syphilis in patients to attempts at self-medication with a persistent reluctance to consult a doctor after casual sexual intercourse.

There are few people who feel a sore throat or severe runny nose They will decide that this is the result of casual sexual contact and will immediately consult a doctor.

Most begin to treat themselves, being completely confident in their actions and knowledge of medicine. And the most dangerous thing is to be treated with antibiotics.

Illiterate and uncontrolled use of antibacterial drugs leads to the formation of new strains that are insensitive to the drugs. And in the case of syphilis, treponema pallidum degenerates into a cyst, which allows it to survive an unfavorable period without loss or harm to the colony.

As a result, the disease is not cured, but goes into a latent form, which is several times more dangerous.

One of the main reasons for the prevalence of latent syphilis among ordinary people is the illiteracy of people and their not entirely adequate attitude towards their health.

The fact is that a person, suspecting he has a cold or initial stage development of a sore throat, without prior consultation with a specialist, begins to uncontrollably take antibiotics.

But these medications hide the main symptoms of syphilis. In other words, syphilis is not curable, but heals and proceeds in a latent form.

Classification

The main classification of latent syphilis identifies the following forms:

• Early – diagnosed if less than 2 years have passed since infection;
• Late – diagnosed if more than 10 years have passed since the infection;
• Unspecified (ignored, unknown) – recorded if the time of infection cannot be determined;
• Congenital - diagnosed in children infected by sick mothers, but without characteristic symptoms.

In addition, latent syphilis can have forms that are the active component of the latent course after inadequate therapy, these are:

• Primary, developing without any symptoms in patients who started treatment in a timely manner, but did not receive effective therapy;
• Secondary, developing with secondary syphilis, in the complete absence of characteristic symptoms;
• Tertiary, given to patients who have suffered the active third phase of syphilis.

Early latent syphilis

Early latent syphilis in clinical practice is considered the most dangerous form diseases. The patient, unaware of his condition, infects the people around him. And what’s most unpleasant is that not only sexual partners, but also loved ones living nearby can become infected.

The presence of this form of disease can only be determined during a preventive examination or during examination for another disease. A blood test for the Wasserman reaction is required for any examination or hospitalization of patients with various pathologies.

This makes it possible to identify some forms of latent syphilis. But the analysis of the serological reaction does not always give accurate results, so patients must undergo other tests.

When examining patients with suspected early latent syphilis, compactions and enlargements are often detected lymph nodes Short-term skin rashes are also possible, which did not cause concern due to their transience.

Quite often the nervous system suffers from the early latent form. Patients have wall disorders blood vessels and membranes of the brain.

Late latent syphilis

Late latent syphilis is diagnosed if more than 2 years have passed since infection. This form is distinguished by its safety for those around the patient.

Late latent syphilis does not cause skin rashes, but significantly destroys internal organs and negatively affects work nervous system.

In the vast majority of cases, late latent syphilis is found in elderly people with symptoms rheumatoid arthritis, myocarditis or coronary disease hearts.

The following manifestations are considered indicators of late latent syphilis:

It should be noted that the latent form of syphilis is divided into several subtypes:

• early latent syphilis;
• late;
• unspecified.

Typically, the early form of latent syphilis is detected within 2 years after infection. This form is considered the most dangerous, since an infected person poses a danger to others.

After all, not only his sexual partners, but also people living with him under the same roof can become infected with this disease.

This disease is mainly detected when medical examinations or during an examination of a patient who has complaints of a completely different disease. The Wasserman reaction is carried out, however, this study does not always give an accurate answer, so the patient is also subjected to a number of other additional laboratory and clinical examinations.

During clinical examination Enlarged and somewhat dense lymph nodes are often found on the patient’s body. During the consultation, patients suddenly begin to remember that at a certain period of time rashes appeared on their body, which went away on their own.

All these symptoms indicate the presence of the causative agent of latent syphilis in the patient’s body.

In some cases, early latent syphilis affects internal organs, such as:

• liver;
• stomach;
• thyroid gland;
• joints.

The central nervous system can also be affected by early latent syphilis. The nervous system, and in particular the lining of the brain and the walls of blood vessels, is affected within 5 years after the moment of infection.

Syphilis is divided into several periods of the disease:

• initial, or incubation;
• primary;
• secondary;
• tertiary

Each period is divided into sub-periods. Latent syphilis refers to the secondary period of the disease.

Secondary is divided into three types:

Early appears 10 days after a person becomes infected. It is dangerous because a person, without knowing it, infects the people around him.

Such syphilis often turns into active syphilis, in which it appears large number rashes, there are many treponemas in them, due to which a person becomes infected.

To learn about latent syphilis, you need to go through necessary research, so you can find out what is leaking in you in a latent form dangerous disease, which is transmitted through contact and household contact.

The patient is immediately isolated from others until his body is completely rid of harmful bacteria.

A person learns about the late form of syphilis after 2 years. Such patients are not dangerous to others, they do not become infected.

But latent syphilis is dangerous because it is often diagnosed at a late stage, when it is in the active phase, it can affect internal organs, the nervous system, tubercles and low-infectious gummas appear on the skin.

Often the doctor cannot say exactly when a person became infected and how long latent syphilis lasts.

Symptoms and signs of latent syphilis

The latent form of syphilis has no visual visible symptoms and signs. This makes latent syphilis dangerous for sexual partners, for the immediate environment (the likelihood of infection through household means), for the unborn child (if syphilis is in a pregnant woman).

Symptoms of latent syphilis can occur in a person according to the signs of some other diseases:

• body temperature rises to 38 degrees, for no apparent reason and regularly;
• causeless weight loss;
• psychological disorders depression, apathy;
• a state of weakness throughout the body;
• enlargement and hardening of lymph nodes.

Symptoms and diagnosis

The course of latent syphilis has virtually no effect on the health of patients. But, there are several signs by which patients may suspect the consequences of the vital activity of Treponema pallidum.

If a person has noticed symptoms such as:

• regular increase in body temperature;
• enlargement and hardening of lymph nodes;
• insurmountable weakness;
• a feeling of apathy towards everything around you;
• causeless weight loss.

There are also clear signs of a nervous system disorder, which means it’s worth thinking about the causes of this condition. These may not be sexually transmitted diseases, but they may also be the consequences of ill-considered sexual intercourse, which resulted in infection with Treponema pallidum and the development of latent syphilis.

Making a diagnosis of latent syphilis is quite complex process. The doctor may be confused by the patient's secrecy, symptoms indicating other diseases, and false positive test results.

A detailed medical history is of great importance, the results of which can reveal not only the presence of suspicious sexual contacts, but also the appearance in the past of patients of erosion on the genitals or oral cavity, taking antibiotics associated with a disease with suspicious symptoms, and much more.

Serological blood tests are required. Indicators ELISA, RIBT, RIF, and other specific tests help identify the presence of Treponema pallidum.

A consultation with a neurologist, gastroenterologist and proctologist is required to confirm or rule out damage to internal organs and disorders of the nervous system.

In practice, we have to deal with patients in whom the presence of syphilis is established only on the basis of positive serological reactions in the absence of any clinical data (on the skin, mucous membranes, internal organs, nervous system, musculoskeletal system) indicating the presence in the body of a patient with a specific infection. Many authors provide statistical data according to which the number of patients with latent syphilis has increased in many countries. For example, latent (latent) syphilis is detected in 90% of patients during preventive examinations, in antenatal clinics and somatic hospitals. This is explained both by a more thorough examination of the population (i.e., improved diagnosis) and a true increase in the number of patients (including due to the widespread use of antibiotics by the population for intercurrent diseases and manifestations of syphilis, which are interpreted by the patient themselves not as symptoms venereal disease, but as, for example, the manifestation of allergies, colds, etc.).

Latent syphilis is divided into early, late and unspecified.

Latent late syphilis (syphilis lateus tarda) is epidemiologically less dangerous than early forms, since when the process is activated, it manifests itself either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of low-infectious tertiary syphilides (tubercles and gummas).

Symptoms and diagnosis

The following data can help in diagnosing latent syphilis:

Before starting treatment for a latent form of syphilis, it is very important for a person suspected of having this disease to undergo a complete diagnosis. To do this, he needs to provide a venereologist full information about sexual partners.

The doctor also needs to determine the presence of single erosions in the genital area, mouth or on the skin.

When diagnosing a disease, it is important to take into account the patient’s age and lifestyle.

When diagnosing, it is very important to examine not only the patient himself, but also his sexual partner. In this way, early latent syphilis can be detected. The main confirmation of the presence of the disease is serological reactions.

Diagnosis of latent syphilis is carried out using the following serological methods:

Treponema pallidum immobilization reaction (TPI). For this analysis, the patient's blood serum and a suspension of Treponema pallidum are used. They are mixed and see how the treponemes behave. Once in the blood of a person with syphilis, treponemes are immobile. And once they enter the blood of a healthy person, they are active, swim for a long time, and are ready to infect. The accuracy of this testing is 95%.

Making a diagnosis of latent syphilis is not an easy task for a doctor, since there is the possibility of a false-positive reaction to syphilis.

1. Indirect hemagglutination reaction (IPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
2. Enzyme-linked immunosorbent assay (ELISA). A special enzyme is added to the prepared patient's blood serum. If the serum changes color, the patient is recognized as having syphilis.
3. RIF (immunofluorescence reaction). The presence of Treponema pallidum is indicated by a specific glow.

The unusual type of Treponema pallidum itself also helps in determining the presence of the syphilis virus in the blood. Under a microscope you can see that Treponema pallidum has the shape of a spiral.

The size of the curls towards the end of the treponema decreases, the spaces between the curls increase. Movement in liquid media is slow and graceful.

A peculiarity of Treponema pallidum is its ability to maintain its spiral shape even under the pressure of its environment.

For elderly people, treatment for syphilis based on serological methods alone is not prescribed. They undergo additional examinations by a neurologist, ophthalmologist and otolaryngologist.

The determination of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times.

When a disease is detected, specific therapy is carried out taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high risk of fetal infection, birth defects, miscarriage, or premature birth.

The venereologist collects information about sexual partners, whether there have been previous cases of single erosions in the genitals, in the oral cavity, on the skin, whether the person took antibiotics for diseases similar to syphilis.

The age and sex life of the patient are taken into account. After examining the patient, they notice scars and lumps that remain after syphiloma. It is also often observed that the lymph nodes are enlarged and lymphadenitis develops.

It is important that not only you, but also your partner are examined, perhaps this is the whole problem, this way early syphilis can be identified. The diagnosis is confirmed based on a serological reaction.

The patient has elevated reagin titers. If a person has used antibiotics, reagin levels may decrease.

Sexual partners who have an advanced form of syphilis often do not have different symptoms at all.

It is very difficult for a doctor to accurately diagnose latent syphilis; false positive reactions may occur due to the fact that a person has had bronchitis, malaria, chronic cystitis, tonsillitis, pyelonephritis, cirrhosis, hepatitis, pulmonary tuberculosis, or rheumatism.

The patient must undergo all tests for latent syphilis several times; they must be repeated after a somatic illness in order to eliminate the chronic infection in time.

Where can I get tested for latent syphilis and who should I contact?

It is no coincidence that the latent course of syphilis is the cause of the epidemiologically dangerous and rapid spread of the disease. Prevention of infection involves not only medical examinations, but also timely application see doctors if you suspect you have been infected with syphilis.

Treatment

Treatment for latent syphilis is selected by a venereologist after a thorough examination and confirmation of the diagnosis. Early latent syphilis is cured fairly quickly, after several courses of antibacterial therapy. Late latent syphilis and other forms require a more complex treatment regimen.

Therapy for latent syphilis is accompanied by attacks of fever and severe internal discomfort. This is the result of effective destruction of Treponema pallidum.

After latent syphilis is detected, treatment cannot be delayed even for a day, since the insidious latent form can lead to serious consequences.

According to existing instructions and treatment regimens for syphilis, all patients with early latent syphilis undergo the same treatment. In cases where, through history or confrontation data, it is possible to establish how long ago the infection has existed, the outcome of the disease can be predicted (naturally, the shorter the duration of the disease, the more favorable the prognosis and outcome of therapy).

Treatment of latent syphilis should begin only after the diagnosis has been confirmed. It is carried out using antibiotics of the penicillin group.

If treatment began at the initial stage of the disease, then somewhere by the end of the second course of therapy, an improvement is noticeable. Treat more running forms much more difficult.

A significant increase in body temperature at the beginning of treatment only indicates the effectiveness of therapy. Fever is a sign that harmful microorganisms are being destroyed at a rapid pace. Over time, this unpleasant symptom also passes.

After completing the course of treatment, you must continue to undergo complete examinations with a doctor. It is very important to carry out serological monitoring and this will last until the indicators of this analysis return to normal.

The treatment regimen for latent syphilis is to prevent the disease from becoming severe.

When infected for less than two years, treatment of early latent syphilis is aimed at eliminating the transition of syphilis to the secondary form and eliminating the epidemiological danger to others, family members and partners.

In cases where the patient has been infected for more than two years, and doctors determine late latent syphilis, treatment is aimed at eliminating all pathologies of internal organs and preventing the most severe complications - neurosyphilis, heart attacks and strokes.

The main treatment for syphilis is systemic antibiotic therapy with penicillins, or drugs of other groups for allergies and lack of sensitivity to treponemes.

Depending on the severity of organ damage, manifestations of symptoms from the heart and nervous system, a treatment regimen is also formed. In addition, drugs are used to correct the protective properties of the immune system.

Treatment of latent syphilis should be carried out according to a scheme that must correspond to the type of disease and timing of infection.

Syphilis is a disease that can be treated long period. Latent syphilis is treated according to the same rules and schemes as other forms of syphilis. All family members should undergo examination and undergo a complex of treatment for prevention.

Treatment of latent syphilis is carried out with drugs of the penicillin group:

• the drug benzathine penicillin - 1 time per day for 3 days (for the early stage);
• benzylpenicillin sodium salt- 2 times a day, course of treatment 28 calendar days. After 2 weeks, a second course of treatment is carried out.

In case of allergy to penicillin, the patient is administered macrolides, fluoroquinolones and tetracyclines. Also, when treating a disease, in addition to antibiotics, vitamins and immunostimulants are prescribed to the patient. If necessary, the patient is prescribed extracts medicinal herbs: Echinacea, Eleutherococcus, Aralia.

Treatment of syphilis today is practiced by 2 methods of treating this disease, this is a continuous method and a course method.

Comprehensive curative therapy consists of the following:

• antibiotics;
• general body-strengthening drugs;
• symptomatic drugs;
• multivitamins;
• probiotics.

At the time of therapy, the patient is prescribed a diet whose diet is dominated by protein food and limiting the consumption of fats and carbohydrates.

During this period, smoking and drinking alcohol are contraindicated, and it is also necessary to reduce physical activity on the body.

How to treat syphilis while pregnant? Women during pregnancy are treated only with antibiotics of the penicillin group. Penicillins do not affect intrauterine development of the fetus.

How to treat syphilis while breastfeeding? At the time of treatment it is necessary to refuse breastfeeding or in case emergency limit treatment minimum period and doses.

Stress, depression and insomnia will have a negative impact on the treatment of the disease.

People who refuse treatment for latent syphilis or have not completed the entire course of treatment medications, lose their health, which will already be restored.

The consequences of syphilis in female body may be:

• developing syphilitic gangrene;
• infectious syphilitic vaginitis;
• syphilitic infectious endocervicitis of the cervix.

The consequences of syphilis in male body may be:

• syphilitic balanitis;
• syphilitic balanoposthitis of the glans penis;
• phimosis and paraphimosis of the foreskin;
• syphilitic infectious gangrenization of the head of the penis;
• phagedenism of the penis.

Therapy for latent early syphilis is carried out using the same treatment methods as the usual forms of this disease. With a correctly, adequately selected treatment regimen, the disease can be completely cured.

Therapy for latent late syphilis is much more difficult, since both the internal organs and the brain have been exposed to structural changes that are difficult to treat.

Treatment for latent syphilis is the same as for its other forms. Any syphilis can only be treated with antibiotics, and the doses and timing depend on the duration of the disease.

During treatment, patients undergo a course of injections (most often penicillin). For early latent syphilis, 1 course of injections is carried out, which lasts several weeks; for late syphilis, 2 courses are carried out, lasting 2 to 3 weeks.

Early latent syphilis is most often treated at home (outpatient). Treatment of late latent syphilis is most often carried out in a hospital (inpatient), because when advanced disease the risk of complications is much higher.

In addition, regardless of the stage of the disease, pregnant women with syphilis must be sent to the hospital. Syphilis is dangerous for an unborn child: the fetus can become infected and even die, in which case a frozen pregnancy will develop. This will eventually lead to miscarriage or stillbirth.

During the treatment of latent syphilis (as well as its other forms!), the patient is prohibited from any sexual contact, kissing, or using common hygiene items or utensils.

Latent syphilis is no better than manifested syphilis and is very dangerous if left untreated! Therefore, it is important to be attentive to your health - if you suspect venereal infection Contact a specialized doctor immediately. If treatment for latent syphilis is started on time, it is completely curable.

Today, treating syphilis is not difficult for doctors. But one point should be understood.

When they talk about treating latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformities, cardiovascular disorders, nervous system disorders.

At the current stage of development of medicine, this is impossible to do.

Antibacterial drugs are used to treat latent syphilis. The treatment regimen is selected individually, taking into account the stage of the disease and concomitant pathology.

Additionally, medications are prescribed that boost immunity, since syphilis weakens it.

Approximate treatment regimens for latent syphilis are presented in the table:

Taking any medications is possible only after consulting a doctor. Self-medication is unacceptable! The frequency of taking medications and the duration of therapy are determined by the treating doctor.

It is important to prevent the disease in time before it becomes complicated. During treatment, they prevent the development of neurosyphilis, protect somatic organs from different types damage.

Latent forms of syphilis are treated with antibiotics from the Penicillin group. First, the patient has a sharp rise in high temperature body, this indicates that the disease has worsened.

Whether the treatment is effective or not, serological studies will help determine whether the cerebrospinal fluid has returned to normal. A negative serological reaction should be observed, this indicates successful treatment. The late form is best treated with bioquinol.

Complications of latent syphilis for the body

Latent syphilis is also dangerous due to its possible serious complications. Untimely treatment of this disease can lead to an even greater spread of infection throughout the body and damage to internal organs.

Even if there is a temporary improvement, the disease continues to progress in its development.

Complications early form syphilis are:

• severe damage to the optic and auditory nerves occurs, which leads to blindness and deafness;
• the functionality of many internal organs is impaired.

If the late form of syphilis is not treated, the following may occur:

• sclerosis of lung tissue;
• suppurative process in the lungs.

Prevention of syphilis is one of the effective ways avoid infection. You should choose your partner carefully and very carefully. It is recommended in any case to use protective equipment.

If contact does occur, after sexual intercourse the contact areas should be treated with an antiseptic or antibiotic. You should also not use by common means hygiene.

Be healthy!

When people hide infection with syphilis, try to treat themselves, or do not know about hidden syphilis in the body and do not undergo drug treatment, the infection spreads to the internal organs and tissues of the entire body and begins to destroy healthy condition organs and systems.

As a result, the body weakens and the person loses working capacity. Improvement occurs periodically general condition, but this improvement does not last long.

Complications of latent syphilis at an early stage:

• early development of neurosyphilis, which destroys optic nerve, leads to blindness. And also auditory nerve which causes deafness;
• in men, the testicles are affected and their reproductive function is destroyed;
• internal organs are destroyed human body and systems.

Complications of latent syphilis at a late stage:

• aortic valve pathology;
• pathology of the walls of the aorta, which causes expansion of some of its sections;
• sclerosis of pulmonary tissues, chronic stage suppuration of the lungs.

Complications that can turn healthy person in a disabled person:

• deformation of the palate and inability to eat;
• destruction of the nose, which makes it impossible to breathe normally;
• destruction bone tissue, which hinders movement.

Complications and prevention

Latent syphilis is venereal disease, which is more than 90 percent transmitted through sexual contact.

Preventive methods for syphilis are:

• regular sexual partner;
• using a condom during sexual intercourse;
• douche antiseptics after sexual intercourse that was not protected by a condom;
• when planning pregnancy, mandatory examination both partners;
• abstain from sex at the moment drug treatment antibiotics;
• healthy lifestyle;
• properly balanced diet;
• maintaining intimate hygiene;
• regular examination by a gynecologist, urologist and venereologist;
• Maintain a healthy immune system at all times.

To avoid various infections, you must follow some rules.

1. Be selective in choosing sexual partners.
2. Use condoms during sex.
3. Use only your own personal hygiene items.
4. Do not rely on false positive results, but consult a doctor at the first signs of illness.

Remember that syphilis is not only a private matter of a citizen. If a person knows about his syphilis disease, he hides it and infects another, then he may incur criminal liability.

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A variant of the development of syphilitic infection in which no clinical manifestations of the disease are detected, but positive results are observed laboratory research for syphilis. Diagnosis of latent syphilis is complex and is based on medical history, results of a thorough examination of the patient, positive specific reactions to syphilis (RIBT, RIF, RPR test), identification pathological changes from the cerebrospinal fluid. To exclude false-positive reactions, multiple studies are practiced, repeated diagnostics after treatment of concomitant somatic pathology and sanitation of infectious foci. Treatment of latent syphilis is carried out with penicillin preparations.

General information

Modern venereology is faced with an increase in cases of latent syphilis around the world. First of all, this may be due to widespread use antibiotics. Patients with undiagnosed initial manifestations syphilis, on their own or as prescribed by a doctor, undergo antibiotic therapy, believing that they are sick with another sexually transmitted disease (gonorrhea, trichomoniasis, chlamydia), ARVI, colds, sore throat or stomatitis. As a result of such treatment, syphilis is not cured, but becomes latent.

Many authors indicate that the relative increase in the incidence of latent syphilis may be due to its more frequent detection in connection with the accepted practice lately in hospitals and antenatal clinics with mass screening for syphilis. According to statistics, about 90% of latent syphilis is diagnosed during preventive examinations.

Classification of latent syphilis

Early latent syphilis corresponds to the period from primary syphilis to recurrent secondary syphilis (approximately 2 years from the time of infection). Although patients do not show symptoms of syphilis, from an epidemiological point of view they are potentially dangerous to others. This is due to the fact that at any moment early latent syphilis can develop into active form diseases with various skin rashes containing large number Treponema pallidum and are a source of infection. Establishing a diagnosis of early latent syphilis requires anti-epidemic measures aimed at identifying the patient’s household and sexual contacts, isolating him and treating him until the body is completely sanitized.

Late latent syphilis is diagnosed when possible infection more than 2 years. Patients with late latent syphilis are not considered infectiously dangerous, since when the disease progresses to active phase its manifestations correspond to the clinical picture of tertiary syphilis with damage to internal organs and the nervous system (neurosyphilis), skin manifestations in the form of low-infectious gummas and tubercles (tertiary syphilides).

Unspecified (unknown) latent syphilis includes cases of the disease when the patient does not have any information about the duration of his infection and the doctor cannot determine the timing of the disease.

Diagnosis of latent syphilis

In establishing the type of latent syphilis and the duration of the disease, the venereologist is helped by carefully collected anamnestic data. They may contain an indication not only of sexual contact suspicious for syphilis, but also of single erosions in the genital area or on the oral mucosa, rashes on the skin, and use of antibiotics in connection with any disease similar to syphilis. manifestations of syphilis. The patient's age and sexual behavior are also taken into account. When examining a patient with suspected latent syphilis, a scar or residual induration is often discovered that has formed after the resolution of primary syphiloma ( chancre). Enlarged and fibrotic lymph nodes after suffering from lymphadenitis can be detected.

Confrontation can be of great help in diagnosing latent syphilis - identifying and testing for syphilis persons who have sexual contact with the patient. Detection of an early form of the disease in a sexual partner indicates early latent syphilis. Sexual partners of patients with late latent syphilis often do not show any signs of this disease, and late latent syphilis is less often observed.

The diagnosis of latent syphilis must be confirmed by the results of serological tests. As a rule, such patients have a high titer of reagins. However, in individuals who received antibacterial therapy, it may be low. The RPR test should be supplemented by RIF, RIBT and PCR diagnostics. Usually, with early latent syphilis, the result of RIF is sharply positive, while RIBT in some patients may be negative.

Diagnosis of latent syphilis presents to the doctor difficult task, since the false-positive nature of reactions to syphilis cannot be excluded. This reaction may be due to previous malaria, the presence of infectious focus(chronic sinusitis, tonsillitis, bronchitis, chronic cystitis or pyelonephritis, etc.), chronic lesions liver (alcoholic liver disease, chronic hepatitis or cirrhosis), rheumatism, pulmonary tuberculosis. Therefore, tests for syphilis are carried out several times with a break, and they are repeated after treatment. somatic diseases and elimination of foci of chronic infection.

Additionally, cerebrospinal fluid taken from the patient by lumbar puncture is tested for syphilis. Pathology in the cerebrospinal fluid indicates latent syphilitic meningitis and is more often observed with late latent syphilis.

Patients with latent syphilis in mandatory consult a therapist (gastroenterologist) and a neurologist to identify or exclude intercurrent diseases, syphilitic lesions of somatic organs and the nervous system.

Treatment of latent syphilis

Treatment of early latent syphilis is aimed at preventing its transition to an active form, which poses an epidemiological danger to others. The main goal of treatment of late latent syphilis is the prevention of neurosyphilis and lesions of somatic organs.

Therapy for latent syphilis, like other forms of the disease, is carried out mainly by systemic penicillin therapy. At the same time, in patients with early latent syphilis, an exacerbation of a temperature reaction may be observed at the beginning of treatment, which is additional confirmation of a correctly established diagnosis.

The effectiveness of treatment for latent syphilis is assessed by reducing titers in the results of serological reactions and normalizing cerebrospinal fluid parameters. During the treatment of early latent syphilis, by the end of 1-2 courses of penicillin therapy, negativity of serological reactions and rapid sanitization of the cerebrospinal fluid are usually observed. With late latent syphilis, negative serological reactions occur only towards the end of treatment or do not occur at all, despite the therapy; changes in the cerebrospinal fluid persist for a long time and regress slowly. Therefore, it is preferable to begin therapy for the late form of latent syphilis with preparatory treatment with bismuth preparations.

Syphilis is a tricky disease. Each period of development of this infection has such individual symptoms that doctors previously considered them various diseases. Syphilis disguises itself as many diseases: from a common cold to severe lesions kidneys, liver. Treponema pallidum, which is the causative agent of syphilis, secretes an anesthetic substance, so the infected person does not feel any itching or pain.

Treponema pallidum feels comfortable in a humid environment and at a temperature of 36.8 degrees. At unfavorable conditions it hides in a capsule, the so-called cyto-forms and L-forms. In this state, syphilis is not active, does not reproduce, it sleeps. Waiting for favorable changes in environment. But they don't work on him harmful factors. This is what he is - syphilis, the insidious enemy of humanity. Often the causes of latent syphilis are self-medication or infection with syphilis during antibiotic treatment for another infectious disease.

Types of syphilis

Syphilis is divided into several periods of the disease:

• initial, or incubation;
• primary;
• secondary;
• tertiary.

Each period is divided into sub-periods. Latent syphilis refers to secondary period course of the disease.

Secondary is divided into three types:

1. Syphilis is fresh. Characterized by bright rashes and other clinical manifestations.
2. Hidden (latent) syphilis. There are no external signs of his presence. It is asymptomatic and can only be determined by laboratory tests.
3. Recurrent syphilis. The rash reappears on the patient’s body after the previous disappearance of all symptoms.

In a patient with latent syphilis, the incubation and primary periods, due to the use of antibiotics and good immunity, are weak. expressed form. A person does not experience any discomfort; he lives and works, infecting others. The latent form of syphilis is often discovered by chance when taking mandatory tests. medical tests at the clinic. Regular checkups A gynecologist allows you to recognize the disease in time and begin adequate treatment.

Latent syphilis is divided into three stages according to timing:

1. Early latent syphilis. The duration of the disease is up to 24 months.
2. Late latent syphilis. The duration of the disease is more than 24 months.
3. Unspecified (ignored) latent syphilis. The doctor cannot determine the time when the patient became infected with syphilis.

When treated with non-extended-release penicillins, it is possible to determine the timing of syphilis infection. If a person has early latent syphilis, he will have a fever and general signs intoxication. They will be caused by the remains of destroyed Treponema pallidum. At later latent syphilis does not increase the temperature, there are no signs of intoxication.

Why is it necessary to establish the timing of syphilis infection?

Establishing the timing of syphilis disease is of practical importance. Those sick with early latent syphilis are contagious and are active carriers of infection, included in the epidemiological risk group. It is necessary to examine all those who have been in contact with the infected person and identify possible carriers of the disease. Patients with late latent syphilis are not dangerous epidemiologically.

Identification of persons with whom the infected person was in contact, as well as their testing for syphilis, is also necessary in case of unspecified latent form.

When syphilis attacks the human body, its goal is to penetrate. Treponema pallidum sheds its membrane membrane, which allows it to pass through the capillaries and enter the nucleus of phagocytes. How amazing nature is! Phagocytes are our protection. They catch and eat foreign bacteria and viruses. And syphilis attacks them. Checkmate immune system! In latent (latent) syphilis, the treponema is hidden in the membrane membrane of phagocytes. That is, the virus destroys the phagocyte itself and walks around in its “clothes.” The body’s immune forces are not activated, since such a treponema is mistaken for one of our own and is not recognized.

Signs of latent syphilis

Although on skin and mucous membranes there are no rashes or ulcers; syphilis penetrates at this stage into the internal organs, nervous system, and bones. They are being stepped on pathological processes. Patients with suspected asymptomatic syphilis are examined especially thoroughly in order to make such a diagnosis or refuse it.

Indirect signs of early latent syphilis are:

• the presence in the medical history of early rashes of an undiagnosed nature;
• treatment of other STIs (the diseases often go together);
• detection of active syphilis in a sexual partner;
• enlarged lymph nodes in the groin area;
• finding a scar at the site of the supposed chancre;
• When analyzing the cerebrospinal fluid, inflammatory reactions are detected.

Indirect signs of late latent syphilis:

• analysis of the cerebrospinal fluid revealed degenerative changes;
• low titer of reagins with sharply positive results according to classical serological reactions.

TO indirect signs latent syphilis for both early and late types also includes:

• temporary or prolonged increase in temperature up to 38 degrees, the cause of which has not been established;
• weight loss, depressed mood, general weakness and other signs of intoxication;
• enlargement of peripheral lymph nodes: they become dense and round, but there is no discomfort when palpating the lymph nodes.

Diagnosis of latent syphilis

Diagnosis of latent syphilis is carried out using the following serological methods:

Treponema pallidum immobilization reaction (TPI). For this analysis, the patient's blood serum and a suspension of Treponema pallidum are used. They are mixed and see how the treponemes behave. Once in the blood of a person with syphilis, treponemes are immobile. And when they enter the blood of a healthy person, they are active, swim for a long time, and are ready to infect. The accuracy of this testing is 95%.

Making a diagnosis of latent syphilis is not an easy task for a doctor, since there is the possibility of a false-positive reaction to syphilis.

1. Indirect hemagglutination reaction (IPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
2. Enzyme-linked immunosorbent assay (ELISA). A special enzyme is added to the prepared patient’s blood serum. If the serum changes color, the patient is recognized as having syphilis.
3. RIF (immunofluorescence reaction). The presence of Treponema pallidum is indicated by a specific glow.

The unusual type of Treponema pallidum itself also helps in determining the presence of the syphilis virus in the blood. Under a microscope you can see that Treponema pallidum has the shape of a spiral. The size of the curls towards the end of the treponema decreases, the spaces between the curls increase. Movement in liquid media is slow and graceful.

A peculiarity of Treponema pallidum is its ability to maintain its spiral shape even under the pressure of its environment. For elderly people, treatment for syphilis based on serological methods alone is not prescribed. They pass additional examinations from a neurologist, ophthalmologist and otolaryngologist.

The determination of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times. When a disease is detected, specific therapy is carried out taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high probability of infection of the fetus, the formation birth defects, miscarriage or premature birth.

Treatment

Today, treating syphilis is not difficult for doctors. But one point should be understood. When they talk about the treatment of latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformations, disorders cardiovascular activity, nervous system disorder. At the current stage of medical development, this is impossible to do.

Used in the treatment of latent syphilis antibacterial drugs. The treatment regimen is selected individually, taking into account the stage of the disease and concomitant pathology. Additionally, medications are prescribed that boost immunity, since syphilis weakens it.

Approximate treatment regimens for latent syphilis are presented in the table:

Taking any medications is possible only after consulting a doctor. Self-medication is unacceptable! The frequency of taking medications and the duration of therapy are determined by the treating doctor.

Taking a vitamin complex. Help fight infection

Pyrotherapy. The patient is given special drugs, increasing body temperature. A slight fever is beneficial. At a temperature not exceeding 38.5 degrees, blood circulation improves, the work of the immune defense increases, and the bacteria weakens, making it easier for medications to cope with it.

Risk group:

• drug users using injections;
• HIV-infected;
• people who have multiple sexual partners.

Prevention

To avoid various infections, you must follow some rules.

1. Be selective in choosing sexual partners.
2. Use condoms during sex.
3. Use only your own personal hygiene items.
4. Do not rely on false positive results, but consult a doctor at the first signs of illness.

Remember that syphilis is not only a private matter of a citizen. If a person knows about his syphilis disease, he hides it and infects another, then he may incur criminal liability.

Conclusions

Cannot be used independently antimicrobials. This can cause microorganisms to hide, form capsules, or penetrate cells. Syphilis takes on a latent form.

Latent syphilis is a difficult disease to diagnose. Correct treatment can only be prescribed by a doctor based on complex tests. You should not fall for articles on pseudo-medical sites that describe how syphilis can be cured with sage flowers and other herbs.

Treatment of syphilis at home does not lead to recovery. On the contrary, serious complications may arise. Every third person with late latent syphilis dies from syphilitic heart disease.

Hidden or latent syphilis is a pathology of the human body that is caused by Treponema pallidum and can be early, late or unspecified. The most main characteristic latent period - a positive reaction of a serological test without any external or clinical manifestations. Skin, mucous membranes, internal systems and organs are not affected in the latent form of syphilis, but the condition requires treatment. However, the data of a serological study alone for making a diagnosis and prescribing treatment for latent form it is not enough - indirect data is also used, for example, a confirmed diagnosis in a sexual partner or medical history data. Medical statistics indicates that latent syphilis has become more common in recent years - approximately 2-5 times. Hidden period syphilis causes the most concern among doctors, since its carrier is capable of transmitting Treponema pallidum to all his sexual partners, without realizing it, and therefore often without taking action additional measures precautions without seeking treatment. Some experts believe that the number of people who are not ill with the latent form has increased, but the cases of identifying such patients have increased, since diagnostic techniques for this sexually transmitted disease are constantly being improved.

Classification of latent forms of the disease

The International Classification of Causes of Mortality, Injuries and Diseases identifies the following types:

Latent early is a period characterized by an acquired form, and its duration should be no more than two years, in the absence of treatment. There are no clinical manifestations, signs and symptoms characteristic of the disease are not recorded, serological tests are positive. In terms of time, the early latent form covers the period from the moment when primary seropositive syphilis was detected until secondary recurrent syphilis appeared. Again, clinical manifestations on the skin and mucous membranes are absent in the latent form in any case.

This period, in contrast to the later period, is characterized by a sudden transformation of the latent form into a normal one, in which rashes appear that are dangerous to others. Almost half of all cases of detection of the latent period of syphilis are accidental and are associated with mass serological studies of the population. Most often these are people of both sexes under the age of 40 - i.e. those who are active sex life, not particularly caring about the constancy of partners. Enough large percentage the likelihood that the sexual partner of a patient with an early latent form of a sexually transmitted disease will have its own early active stage and will also need treatment.

Late latent syphilis, the treatment of which is already a more difficult process than in early period, is found in those who became infected with treponema two or more years ago, in the absence of clinical manifestations, normal cerebrospinal fluid and positive serological blood tests. Patients with the late form are practically not dangerous in terms of the spread of the disease; the period of their illness usually lasts for many years and 99% of cases of the late form are detected by chance.

The remaining percentage are family partners of those who have the disease in the active period.

It is quite difficult to diagnose the late period in latent stage and its differentiation from the early one. For an accurate diagnosis, taking into account complete absence manifestations, at least two analyzes are required - RIF and RIBT. More often late form detected in people over 40 years of age, with 2/3 of them - married couples. The anamnesis of such patients does not show any signs of contagious forms of the disease, and any studies do not reveal manifestations of the breakdown of syphilides on the skin. Also missing characteristic pathologies internal organs and nervous system.

The latent unspecified period is diagnosed in the case when no examinations help to establish when the infection occurred, and the patient himself does not have such information. Often signs and symptoms that help identify early or late stage the disease is not enough - in this case the venereologist can also write down an unspecified form in the diagnosis. It is in the group of patients of an unspecified type that false-positive reactions of nonspecific serological tests most often occur. Any venereologist will prefer to diagnose the patient with an unspecified form of latent syphilis if he has even the slightest doubt about differentiating the early and late periods.

Treatment of latent syphilis

Since there are no signs of latent syphilis, treatment cannot begin at the earliest early stages. Of course, the most simple option There would be treatment for the early form, which gives 100% positive results, but it is only possible if the disease is accidentally detected. And treatment of the late period is often started only because the symptoms of late latent syphilis tend to develop into symptoms of the active stage.

Treatment of the latent period is no different from traditional antibacterial treatment of this disease. The only significant difference is that sexual partners of patients with latent forms do not need specific preventive treatment, like partners of patients with conventional forms.

Latent syphilis is diagnosed in the absence of signs of the disease, and serological reactions in the blood are positive. This form occurs in patients who have had active diseases in the past that resolved on their own or as a result of specific treatment.

Table of contents:

Forms and periods of latent syphilis

Signs of early latent syphilis

1. About the rescheduled primary syphilis may indicate lumps or scars on the genitals and enlarged regional lymph nodes.
2. In 75% of cases, serological reactions are strongly positive. 20% of patients have a low titer. Positive RIF is observed in 100% of cases. Serological reaction titers decrease when concomitant diseases are treated with antibiotics.
3. When treated with penicillin, a third of patients experience increased body temperature, muscle pain, etc. This is due to the massive death of the pathogen. Side effects are quickly eliminated.
4. With the development of latent syphilitic in the cerebrospinal fluid, an increase in protein, positive reactions to globulin fractions and cytosis are observed. Cerebrospinal fluid quickly sanitized with specific therapy.

Treatment of early latent syphilis

Therapy is carried out according to. Its goal is to quickly destroy the pathogen in the patient’s body. Negativity of seroreactions occurs quite quickly when specific treatment. The extinction or complete negation of seroreactions is the only confirmation of the effectiveness of treatment.

Timely diagnosis during the period of early latent syphilis and effective treatment give a favorable prognosis.

Late latent syphilis

In patients infected more than two years ago, who have no symptoms of the disease, and serological tests are positive, late latent syphilis is diagnosed. It is mainly detected during a routine examination.

These patients are less dangerous epidemiologically, since tertiary syphilides are not so contagious. They contain minimum quantity pathogen.

The disease is mainly detected in patients over 40 years of age. Moreover, approximately 65% ​​of them are married.

When interviewing the patient, they find out the timing of probable infection and the presence of symptoms indicating manifestations of infectious syphilis in the past.

Signs of late latent syphilis

1. During the examination, traces of previously resolved syphilides are not detected. During the examination, there were no signs of specific damage to the nervous system and internal organs.
2. To diagnose late latent syphilis, the following serological tests are used: RIF, RIBT, RPGA and ELISA. RIBT and RIF are always positive.

In some cases, serological tests are repeated several months later.

Treatment of late latent syphilis

Therapy of this form is carried out according to. The goal of treatment is to prevent the development of specific damage to internal organs and the nervous system. Patients need to consult a therapist and a neurologist. Negative seroreactions during the treatment period occur extremely slowly. In some cases, seroreactions remain positive after treatment.

Latent unspecified syphilis

Latent unspecified syphilis is diagnosed in the absence of information about the timing and circumstances of infection, as well as in the presence positive result serological studies. These patients require careful clinical and serological evaluation. RPGA, RIF, RIF-abs, ELISA, RIBT are mandatory.

In patients with unspecified and late syphilis, false-positive nonspecific serological reactions are often detected.

In case timely treatment external manifestations diseases disappear quickly enough. In the most advanced cases, restoring health becomes almost impossible.

After suffering from an illness, it is necessary to take a very responsible approach to the issue of pregnancy planning. It should be taken into account that for full recovery the health of future parents will take more than a year. Therefore, it is very important to take precautions to exclude the possibility of infection.