Syphilis

Description:

Syphilis - the most serious and dangerous illness of group of venereal diseases to which except syphilis carry gonorrhea, trichomoniasis, a venereal ulcer (шанкроид) and an inguinal lymphopathy. Syphilis is a chronic recurrent infectious disease which affects all bodies and tissues of the person. It is transferred in the basic sexually and, unlike other venereal diseases, even vnutriutrobno.
History of syphilis contains not one century, and sources of its primary emergence are not up to the end known.
Most of researchers connect developing of syphilis in Europe with return in 1493 of Columbus's eskada from Central America where sailors and soldiers caught from the native population. Having returned to Spain, they as a part of hired army of the French king Charles VIII took part in campaigns across Europe. This army was accompanied by many women of easy virtue.  All this also created conditions for bystry spread of a disease in Europe at the end of the 15th century.
As if there was not, but in the XV-XVI centuries in Europe there were whole epidemics of syphilis. Not for nothing in those days it was compared to terrible infections, calling "great smallpox" and "sexual plague". Covering one country for another, syphilis received names "Spanish", "Italian", "French", and in Russia (arose at the tsar Ivan III) - the "Polish" disease.
1530 the Italian doctor and the poet D. Frakastoro in the poem described torments of the shepherd Sifilos. For the attitude towards the goddess of love Verena and god Apollo he was punished by the French disease which soon began to call by the name of the shepherd. The term "lyues" was assembly for all group заразнвх venereal diseases in the beginning, and then began to be used for designation of syphilis.

Syphilis reasons:

The causative agent of syphilis - the pale treponema - received such name because badly gives in to coloring. In vitro it is investigated by a special method against a dark background.
Pale treponema - a microorganism which has an appearance of a thin spiral 8-14 microns long and 0,3 microns thick, from 8-15 by uniform curls. The wavy movement is characteristic of a treponema, it as if is screwed in in deep layers of skin through its slightest damages. On long distances the parasite moves current of a lymph and blood.
The pale treponema can live and breed only in the conditions of tissues of the person or an animal. in external environment it rather quickly perishes under effect of oxygen, solar radiation and drying. Perniciously high temperature, soap solution, various acids and alkalis affects it. It maintains the wet environment and low temperatures better.
The pale treponema transverse fission breeds. Researches under a supermicroscope show that the activator has complex structure. It can form the special forms, so-called cysts very steady against medicinal influence and unfavorable conditions of the environment.
The pale treponema lives in the wet environment, in particular, on the objects contaminated by saliva or other allocations of the patient longer (a toothbrush, a sponge, a towel, ware, a stub, etc.). The case of infection of the fourteen-year-old boy who finished smoking the cigarette thrown by the patient is described.
With increase in sanitary literacy and improvement of living conditions cases of not sexual infection with syphilis are extremely rare.
Practically always catch syphilis sexually at accidental contacts.
There is no Vrozhdennogy immunity, or immunity, to syphilis. Having got on skin, the pale treponema through the slightest damages gets into its thickness, into fabrics, and then into very poorly oxygenated lymph where there are favorable conditions for its development. The activator is capable to get through the unimpaired mucous membrane which, unlike skin, has no protective corneous layer.
Hypodermic lymph nodes are the first serious barrier to a treponema on its way to internals. There is defense reaction thanks to which a part of activators perishes. However the survived treponemas continue to breed and get into the sick chest canal, and from there into circulatory system.

Syphilis symptoms:

From the moment of infection with syphilis before emergence of the first symptoms of a disease there passes about 1 month, sometimes - it is more. Longer incubation interval can be explained with the fact that the patient at this moment for some reason accepted antibiotics. At the same time the patient can already infect the sexual partners. The activator is transferred to other person with sperm or a vaginal secret in an incubation interval, is more rare - with saliva.
The incubation interval comes to an end to emergence of a sore or erosion (sometimes they happen a little) on site primary implementation of a pale treponema. Superficial sores or erosion are painless, have rounded shape, with a pure bright red firm bottom. The chancre nazvatsya firm because about osnovaniyakozhny defect the uploteniye is probed.
As a rule, the hard ulcer voznikt on generative organs or the neighboring sites: a pubis, a crotch, in inguinal or femoral folds. Sometimes he is in an oral cavity, in an eye corner, on skin of a trunk or in other places. At elderly people, at alcoholics, and other persons with reduced immunity, accession of a purulent or mephitic gangrene is possible. Are in that case formed painful to a gnoya or necrotic ulcers, men have a phymosis or a paraphimosis.
After emergence of a chancre in patients pozhkozhny lymph nodes increase and condensed, arises limfoadenit, or a so-called syphilitic bubo. However these phenomena are expressed not at all patients, and at some localizations of their chancre does not happen at all.
Soon the chancre begins to live without any traces or leaving a superficial hem. However it does not mean treatment. Pale treponemas continue to breed, get into vessels and fabrics. In response to it immunity reactions which lead to changes of physical and chemical properties of blood become more active. Wassermann reaction is based on these changes. It will melt positive in 6-7 weeks from the infection moment.
Only sometimes Wassermann reaction happens positive at other diseases. Then the reaction of an immobilization of a pale treponema (RIPT) resort to other tests, for example.
In 9-10 weeks from the infection moment when the hard ulcer already began to live, the patient has a rash. It is not preceded by an itch or any other subjective symptoms. Rash indicates the beginning of the secondary period of syphilis. By this time quite often regional and other hypodermic lymph nodes increase.
Rash usually happens three types: spotty, nodular and pustulous. The last meets very seldom.
Menocelis (syphilitic roseola) are small krugla light pink spots which when pressing disappear. Nodular rash (a syphilitic papule) consists of copper-colored or brownish small knots which act over the surface of skin a little. Papules can reach the sizes of a big coin. Owing to chronic irritation they turn into massive plaques, so-called flat condylomas. In wet folds of a crotch, about an anus and on generative organs they begin to become wet, their surface collapses and the discharge with a large number of pale treponemas comes to a surface. These papules are extremely infectious. Sometimes papules are localized on almonds and a soft palate, forming a picture of syphilitic quinsy. Unlike usual quinsy, it is not followed by pain when swallowing. On phonatory bands of a papule will stop the reason of hoarseness of a voice.
Quite often at patients head, eyebrows hair and even eyelashes drop out. At syphilitic baldness hair drop out small sites more often.
Rash rather quickly izchezat without any therapy, syphilis gets the hidden current which can last several months, sometimes - years. During this period it is possible to reveal a disease by means of serological tests which all this period become sharply positive at all patients.
Then the disease passes into the tertiary period. In deep layers of skin and hypodermic cellulose small firm hillocks or big, of the size of egg, nodes, so-called gummas which break up and turn further into ulcers are formed. They long do not begin to live and leave behind the rough, disfiguring hems. In the tertiary period internals, in particular, cardiovascular system, a liver, kidneys, lungs, digestive tract are surprised. Especially hard damage of an aorta proceeds. Its wall under the influence of big dynamic loads stretches, on this place aneurism which under the pressure sometimes collapses a thorax and acts over a body surface in the form of the big pulsing tumor is formed. A syphilitic aortic aneurysm - a heavy complication. Owing to a sudden rupture of a wall of aneurism there is massive bleeding which is deadly.
The tertiary period is also characterized by not less severe defeat of a nervous system which depend on localization of the center. Defeat back (back tabes) and a brain (the progressing paralysis) is characteristic.
At back to tabes coordination of movements is broken, the atrophy of an optic nerve and a blindness develops, sexual function up to impotence is broken, there are expressed pains, so-called tabic crises.
In case of the progressing paralysis in a brain there are centers of a softening and a necrosis which lead to a serious mental illness: the patient loses to everything interest, criticality to a situation decreases. Eventually, the disease comes to an end with weak-mindedness.

Inborn syphilis:

Pale treponemas pass from mother to a fruit through an umbilical vein and lymphatic cracks. The fruit which quickly develops krovosnabzhatsya actively, and pale treponemas densely plant his internals (if mother has an active syphilis). In such cases the fruit most often perishes, there is a late abortion or a still birth. Sometimes the child is born live, and the disease proves on 4-5 year of his life 9 early inborn syphilis). Not isklecheno and more after its manifestation. Pozny inborn syphilis usually happens if at mother the latent form is had.
Symptoms of a disease at early inborn syphilis can arise in the first weeks of life. On palms, feet and other body parts bubbles, okramlenny are formed by a copper-colored nimbus.
Around natural foramens firm dark red sites of skin which become covered by cracks (diffusion syphilitic infiltrate) over time are observed.
The liver and spleen at such children are increased, and on x-ray films of bones structural changes in region of growth come to light. Persistent cold is characteristic of this form of syphilis. Sometimes children have a spotty or knotty rash, as at adults in the secondary period of syphilis. Papules more often happen on a mucous membrane of a mouth. The specified stage is very infectious.
Sometimes children with early inborn syphilis are born premature. At defeat of a meninx such meningeal phenomena as causeless shout, concern, spasms are observed, owing to behind these symptoms true syphilitic meningitis forms.
Late inborn syphilis a long time can proceed in the erased form. Children during this period of a malozarazna for people around. Symptoms of a disease remind tertiary syphilis of adults, namely: gummas, damages of bones and joints, cardiovascular and nervous system. But the most typical is Getchinson's triad called by the name of the English syphilologist: defeat of a cornea of an eye (a parenchymatous keratitis), syphilitic deafness, a peculiar damage of upper average teeth which get a chisel form.

Treatment of Syphilis:

The pale treponema is a nearly one microorganism which remained despite high sensitivity to penicillin so far. The syphilitic activator has no protivopenitsillivy protection which is so strongly developed at other microorganisms. Even in modern medicine, with a wide choice of new antibiotics, the penicillin therapy concerning syphilis is completely justified. However quite big percent of patients has an allergy to penicillin, and in these a case purpose of other classes of antibacterial drugs, for example macroleads (erythromycin) and tetracyclines, and also cephalosporins will be justified.  It is revealed that aminoglycosides suppress reproduction of a syphilitic infection only in very high doses which have effect on a human body and therefore their use in the form of monotherapy at syphilis is not reasonable. Streptocides do not exert any impact on a pale treponema at all.
Treatment of neurosyphilis demands purpose of penicillin in a combination of a peroral or intramuscular way of introduction to their endolumbar introduction. Need of endolyumbaldny administration of penicillin causes requirements to skills of medical staff in a lotnosheniya of this manipulation, and it is problematic in the conditions of dermatovenerologichesky service. Use of antibiotics of other groups having ability to get through gematoentsefalitechsky barter is in that case possible. Cephalosporins can be for this purpose used. At widespread syphilis in tertiary the period in combination with the expressed resistance of a treponema to standard therapy and at the satisfactory general condition of the patient allowing moderate toxicity of the carried-out treatment addition to antibiotics of derivatives of arsenic (Myarsenolum, Novarsenolum) or bismuth derivatives can become possible (бийохинол). However, it is not possible to buy these drugs in the general pharmacy chain in connection with their toxicity and rare use.
At the diagnosed syphilis it is necessary to reveal and carry out surely treatment of all sexual partners of the patient.
In case of patients with primary syphilis all persons which had sexual contacts with the patient within the last 3 months are exposed to treatment. In case of secondary syphilis — all persons which had sexual contacts with the patient within the last year.