Throat syphilis

Description:

Syphilis of a throat is observed considerably less than nose or a throat. Exclusively seldom the throat is surprised at inborn syphilis.

Throat syphilis reason:

The question of an etiology of syphilis was considered in the sections devoted to syphilis of a nose and syphilis of a throat, here we will only remind that this venereal disease is caused by the pale treponema opened in 1905 by F.Schaudinn and E.Hoffmann. In rare instances at throat syphilis primary affect (chancre) is localized on an epiglottis and a cherpalonadgortanny fold where the activator gets from an external source of infection through an oral cavity with saliva. In the secondary period acquired by infection with syphilis damage of a throat arises rather often (a hematogenous way) and it is shown in the form of a diffusion erythema, being combined, as a rule, with similar reaction of a mucous membrane of a nose, oral cavity and throat. At secondary inborn syphilis damage of a throat and at babies which, however, passes unnoticed is possible. In the tertiary period damage of a throat is shown by the most expressed changes, however at this stage of a syphilitic infection the throat is surprised seldom. Neurosyphilis can be shown by paresis or paralysis of internal muscles of a throat, most often abductors that leads to a throat stenosis as a result of dominance of the adductors innervated by recurrent nerves (Gerhard's syndrome).

Pathological anatomy. Primary syphilis of a throat is shown in the form of a dirty-gray ulcer with raised edges of cartilaginous density and a regional cervical limfoadenit. At secondary syphilis of a throat on her mucous membrane there are characteristic mucous plaques in the form of whitish spots adjoining to diffusion sites of a hyperemia. In the tertiary period there are diffusion subepithelial infiltrates in the form of gummous educations which, being exposed to disintegration, turn into deep crateriform ulcers with abruptly breaking edges and a dirty-gray bottom. Accession of consecutive infection causes throat hypostasis, a perichondritis and a necrosis of her cartilages. After recovery this process comes to the end with a massive cicatricial disfiguration of a throat and се with a stenosis.

Throat syphilis symptoms:

Characteristic of syphilis of a throat (unlike other her inflammatory diseases) is the considerable disproportion between the expressed destructive changes and very weak subjective feelings. Only after accession of consecutive infection there is an expressed pain syndrome with an otodiniya and a dysphagy. The dysphonia is observed in the secondary period when there is a diffusion catarrh of a mucous membrane, and in the tertiary period when destructive process concerns the voice device.

Respiratory function of a throat begins to suffer only in the tertiary period when the cavity of the larynx is filled with one or the set of infiltrates, their gummous disintegration, ulcers and hems stenosing a throat.

At a laringoskopiya in primary period find the increased epiglottis and cherpalonadgortanny folds which appeared on their surface of an ulcer and also regional limfoadenit: painless increased lymph nodes, possessing a dense and elastic consistence, can be exposed to disintegration with formation of skin fistulas. At secondary syphilis of a throat of her mucous membrane gains bright red color (a syphilitic enantema — at simultaneous damage of an oral cavity and throat). On a mucous membrane grayish-white plaques with equal borders are formed or the papules towering over other a mucous membrane which are located on an epiglottis and cherpalonadgortanny folds are more rare at the edges of voice folds. In certain cases on a mucous membrane there are small erosion. As rules, quickly pass secondary syphilides of a throat, but within the next two years can recur.

In the tertiary period in a throat find the infiltrates of red and cyanotic color arising usually in anticipation of a throat, sometimes in the field of a respiratory crack (breath difficulty) or in subdepository space. Each such infiltrate (single or in number of two-three) forms a syphiloma which it is long (weeks and months) remains in an original form, and then quickly breaks up, forming the ulcer which is coming to the end with scarring.

The clinical course of syphilis of a throat is defined by the disease nature (the reason of its emergence) and a stage at which there was a damage of a throat. At timely begun treatment specific inflammatory process can be liquidated without the subsequent permanent organic lesions of a throat, and the greatest efficiency can be reached if treatment is begun in primary or secondary stage of syphilis. At tertiary syphilis it is also possible to prevent considerable destructions of a throat, however if they did not occur yet, or there was no accession of consecutive infection. In the latter case these destructions practically neotvratima.

Diagnosis:

The diagnosis of the systemic syphilitic infection is established on the basis of the known symptoms and serological tests. Difficulties at the same time can arise at so-called seronegative syphilis. At such form of syphilis or when it it is long the beginning specific disease in a throat proceeds unnoticed, especially at secondary syphilis at a stage of diffusion erythematic manifestations, it can be accepted for banal laryngitis. Suspicions of syphilis of a throat can arise at detection on a mucous membrane of peculiar mucous plaques of grayish-white color and papules which, however, can be confused with afta, herpes or a pemphigus of a throat. At emergence of doubts in the diagnosis to the patient carry out serological tests and direct to the dermatovenerologist.

In the tertiary period at a diffusion infiltrative form of syphilis of a throat the last can be mistakenly taken for HGL, however single infiltrate like circumscripta has to cause suspicion of throat syphilis always. Quite often at an ulceration of a gumma or at emergence of a secondary perichondritis these phenomena mix with tuberculosis of a throat or throat cancer therefore for statement of the final diagnosis of the patient for carrying out differential diagnosis it has to be inspected by methods, specific to these diseases (a X-ray analysis of lungs, serological tests, a biopsy, etc.). At differential diagnosis it is worth to remember about a possibility of existence of so-called mikst, i.e. combinations of syphilis and tuberculosis of a throat, syphilis and paradise of a throat, as well as the fact that in the tertiary period serological tests can be negative, and a biopsy — not to yield convincing results. In these cases carry out diagnosis ех by jubantibus with antisyphilitic treatment.

Treatment of syphilis of a throat:

Treatment сифилиас throats has to be early and vigorous to prevent destructive effects in a throat. It is carried out in the corresponding hospital. The otorhinolaryngologist controls an objective condition of a throat, estimates its functions, especially respiratory, and if necessary renders emergency to the help at emergence of respiratory obstruction. At emergence of cicatricial stenoses of a throat make the corresponding plastic surgeries on their elimination, but only after final treatment from syphilis and numerous obtaining seronegative results.

The forecast at syphilis of a throat concerns generally a condition of its function which can suffer in a varying degree depending on those destructive changes which arise in the tertiary period of syphilis, as from action of actually syphilitic damages of a throat, so especially at for the second time the joined infection. As for the forecast concerning the general condition of the patient and his life, it entirely depends on a stage of a disease and the carried-out treatment and can be established only by the corresponding specialist.