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SYPHILIS. PRIMARY PERIOD OF SYPHILIS

Currently, there is a large group of sexually transmitted infections (STIs).



STI classification (WHO, 1982)



Bacterial nature

1. Syphilis and other treponematoses (pint, frambesia, bejel)

2. Gonorrhea

3. Soft chancre

4. Venereal lymphogranulomatosis

5. Donovanosis

6. Urogenital chlamydia and Reiter’s disease

7. Urogenital mycoplasmosis (including ureaplasmosis)

8. Gardnerellosis (bacterial vaginosis)

9. Urogenital shigellosis of homosexuals

10. Sepsis of the newborn (caused by group B streptococcus)

Viral nature

1. Genital herpes

2. HIV infection

3. CMV infection

4. Genital warts and laryngeal papillomatosis in children

5. Molluscum contagiosum

6. Hepatitis B, C

Protozoal nature

1. Urogenital trichomoniasis

2. Sexually transmitted amoebiasis (especially among homosexuals)

3. Giardiasis, sexually transmitted (especially among homosexuals)

Fungal nature

1. Urogenital candidiasis

Parasitic nature

1. Scabies

2. Pubic lice

The founder of syphilology is the French venereologist Philippe Ricord (Ph. Ricord, 1800-1889), who proposed the periodization and staging of the course of syphilis, which is still recognized.

The founder of Russian venereology is Veniamin Mikhailovich Tarnovsky (1837 - 1906). The problem of venereology was dedicated by A.G. Polotebnov A.I. Pospelov, N.A. Chernogubov, I.I. Austrian and many others.

Syphilis is a chronic infectious venereal disease caused by pale treponema, affecting all human organs and tissues, characterized by a progressive course and able to be inherited. The term "syphilis" first appeared in a poem by an outstanding Italian scientist, doctor, poet and astronomer Dis. Fracastro "On syphilis, or Gali disease" (1530). By the name of the shepherd Syphilus described in the poem, the disease was given the name "syphilis" (from the Greek. Sus - pig, philos - friend).

Etiopathogenesis

Structure. The causative agent of syphilis is pale treponema (spirochete). Opened on March 3, 1905 by F. Schaudinn and E. Hoffman. According to the classification of Bergey (1980), it belongs to the order Spirochetales in the genus Treponema. The name "pale" treponema received due to the weak ability to perceive color. Pale treponema is a spiral-shaped microorganism with a length of 7-14 microns and a diameter of 0.2 - 0.5 microns with uniform curls, the height of which decreases towards the ends of the treponema. The number of curls during the movement of pale treponema can vary (an average of 8-14), and therefore the thickness of the spirochete changes.

An electron microscopic examination revealed that the pale treponema is covered outside with a case; at the ends there are capitate formations to which fibrils are attached (superficial and deep), with the help of which it moves and on which the nature of its movement depends. Under the cover is the cell wall, under it is the cytoplasmic membrane; both of them consist of three layers. The cover, the cell wall and the cytoplasmic membrane are called the periplast, inside which the axial filament and the protoplasmic layer pass, where small granules (ribosomes), sometimes mesosomes and a nuclear vacuole, are interspersed.

The movements of pale treponema. Pale treponema has the ability to rotational, translational, pendulum-like and wave-like movements. The smooth progressive movements of pale treponema are an important differential diagnostic sign.

Reproduction. It is proved that pale spirochete can be divided in half or into several parts, i.e. fragmented; sexual reproduction is not excluded.

Under adverse conditions, pale treponema forms cysts or passes into L-forms (survival forms of pale treponema).

Treponema pallidum does not grow on ordinary nutrient media. A number of researchers, for example, Ya. G. Shereshevsky, Wasserman, Ovchinnikov achieved the growth of pale treponema, but at the same time it lost its pathogenicity. Cultural pale treponema is thicker than pathogenic and somewhat different from it in its biological properties.

Three main antigens of pale treponema have been identified: a thermolabile protein that breaks down when heated to 76-78 degrees, a thermostable polysaccharide that can withstand heating up to 100 degrees, and lipoid AH identical in its properties to the bovine heart lipoid extract.

The resistance of pale treponema to external influences is small. On household items, it retains its infectivity until it dries. The optimum growth temperature of pale treponema is 36.7 - 37 degrees. At a temperature of 40 degrees and above, the activity of pale treponema rises, then it dies; at a temperature of 55 degrees, it dies within 15 minutes. Low temperature does not have a detrimental effect on it. Storage of pale treponema at a temperature of -20 degrees is one of the methods of keeping it for infection of rabbits and for the immobilization reaction. Pale treponemas are well preserved in the tissue of corpses. Citrate blood, containing pale treponema and stored at a temperature of 4-6 degrees, remains contagious for rabbits for 3 days. Outside the body, pale treponema is very sensitive to various chemicals.

It should be borne in mind that there are other pathogenic treponemas, this must be considered when making a diagnosis. These include: treponema - pint pathogens, badges; in the oral cavity - Tr. macrodentium; Similar to pale treponema Tr. refringens, Tr. balanidis, Tr. bronchiale, Tr. buccale and a number of other treponemes that do not have a special name. On microscopic examination, they are difficult to distinguish from pale treponema. The presence of cross-immunity between them is proven. It is often difficult to distinguish them serologically. It is easier to recognize frequently occurring, especially in contaminated genital tract ulcers Tr. refringens. It is thicker than pale treponema. Her curls are much rougher, her movements are fast, she is rare in the depths of tissues; easily painted with a solution of methylene blue, fuchsin.

Conditions and routes of infection.

Long-term clinical observations and experimental work on the reproduction of Lues in animals indicate that infection depends on:

1) the freshness of the infectious material;

2) virulence of pale treponemas;

3) violation of the integrity of the epidermis or epithelium of the mucous membranes. M.V. Milich (1972) emphasizes the presence of a natural body barrier of active immune defense. Penetration of pale treponema through intact skin and mucous membranes was not confirmed in an experiment on rabbits.

M.V. Milach (! 972) concludes that fluctuations in possible non-infection occur within 5.7 - 41.1%; with single sexual contacts - in 45%, with multiple sexual contacts - in 30%.

Ways of infection:

- direct (sexual, close household contact);

- transfusion;

- transplacental.

The most common route of infection is through the sexual, with various forms of sexual contact (per vaginum, per anum, per os).

Especially contagious are patients with such manifestations of syphilis as erosive or ulcerative chancroid, erosive papules (wide warts), in which a large number of pale treponemas are usually found.
In pustular syphilis they are much smaller and they are located in the deeper layers of the skin. Gum and tubercles of tertiary syphilis, despite their infectivity proved in the experiment, are practically not contagious, since pale treponemas are found in insignificant quantities only in the marginal zone of the non-disintegrated infiltrate.

Immunity for syphilis. Re- and superinfection.

Congenital immunity to syphilis does not exist.

With syphilitic infection, the so-called non-sterile (infectious) immunity develops in the patient's body. It occurs as a response of the body to pale treponema and exists as long as there is a pathogen in the body. Non-sterile (infectious) immunity is accompanied by an infectious allergy. The most important immunity factor is phagocytosis. With Lues, antibodies are formed in response to the presence of an antigen (pale treponema) in the body. At the beginning of the disease, large antibodies of the IgM and IgA classes are detected; in late forms of acquired and congenital - antibodies of the IgG class.

Persistent immunity does not develop in a person cured of syphilis, therefore re-infection (reinfection) is possible.

When diagnosing reinfection, the following basic criteria should be adhered to:

1) the reliability of the first infection;

2) compliance with the terms of negation of standard serological reactions;

3) the disappearance of syphilis during therapy.

Reinfection is confirmed by:

1) the presence of pale treponema in syphilis;

2) the positive results of serological reactions;

3) a high titer of reagins.

4) the results of confrontation (identification of sexual partners) are also taken into account.

Superinfection is the condition of a patient Lues, in which new portions of pale treponem (re-infection of an untreated patient) enter his body, as if layering of a new syphilitic infection on an existing one.

The general course of syphilis.

The reaction of the body to the introduction of the causative agent of syphilis of pale treponema is complex and diverse: infection may not occur, the classic course of the disease, as well as a possibly asymptomatic course of the pathology.

Infection may not occur if a small portion of the pathogen enters the body or if the serum of practically healthy people shows a high level of thermolabile treponemostatic and treponemocidal substances, which can cause immobility, and in some cases, the lysis of pale treponemas.

With a long asymptomatic course of syphilis, the patient, as it were, “skips” the early active forms of the disease. At the same time, it is not possible to diagnose early latent syphilis, because standard serological blood reactions remain negative. In these cases, it is likely that pale treponema transforms into the L-form, polymembrane phagosomes. In such patients, syphilis is diagnosed as latent, unspecified or latent late almost always by accident many years after infection according to the results of standard serological reactions, as well as according to the reactions: RIBT and RIF, according to the presence of late, typical for the tertiary period of syphilis skin lesions, musculoskeletal system, nervous system or internal organs in the absence of anamnestic data on syphilis.

In the epidemiology of syphilis, its classical course is of particular importance, in which 4 periods are distinguished: incubation (3-4 weeks) and 3 clinical (primary, secondary and tertiary). They successively replace each other.

Syphilis Classification



I. Syphilis acquired II. Congenital syphilis

(syphilis aquisita) (syphilis congenita)

1. Manifest (activa) 1. Manifest (activa)

- early (praecox, up to 5 years old) - early (praecox, up to 2 years old)

- infectious; - infectious;

- late (tarda, 5 years or more) - late (tarda, 2 years or more)

- non-contagious; -non-contagious;

2. Hidden (latens) 2. Hidden (latens)

- early (up to 2 years) - infectious; - early (up to 2 years) -

- late (2 years or more) epidemiologically contagious;

- non-contagious. - late (2 years or more)

non-contagious.

Acquired Manifest Syphilis



I. Primary syphilis (average 6-8 weeks):

1. primary seronegative (3-4 weeks);

2. primary seropositive (3-4 weeks);

3. primary hidden.

II. Secondary syphilis:

1. secondary fresh (several weeks);

2. secondary hidden;

3. secondary relapse (occurs on average after 4 months from

moment of infection and more).

III. Tertiary syphilis:

1. active

2. hidden

IIIa. - visceral;

- nervous system;

- dorsal dryness (tabes dorsalis);

-progressive paralysis (paralysis progressiva).

The incubation period begins from the moment of infection until the appearance of a solid chancre (syphiloma or primary affect). With syphilis, it is equal to an average of 3-4 weeks. Shortening the incubation period to 10-15 days and lengthening it to 60-80 days are extremely rare and are observed, according to published data, in no more than 2% of cases. Relative lengthening of the incubation period when patients use antibiotics for intercurrent diseases, sometimes in order to prevent possible infection. The incubation period is significantly shortened during repeated infections with syphilis (superinfection); at several entrance gates; drug addicts, drug addicts, alcohol abusers, patients with tuberculosis, anemia, i.e. people with weakened body defenses.

The incubation period ends with the appearance of a hard chancre in place of a pale treponema. During this period, pale spirochetes that enter the body quickly spread, usually via the lymphogenous-hematogenous route, and sometimes neurogenically (epi-, peri- and endoneuritis). Due to the insufficient concentration of lipoid antibody regions, classical serological reactions (CSF) in the incubation period of syphilis, as well as in the next 3 weeks of Lues I, are negative.
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SYPHILIS. PRIMARY PERIOD OF SYPHILIS

  1. The primary period of syphilis
    The primary period of syphilis begins with the onset of hard chancre or primary syphiloma. It lasts 6-8 weeks. Initially, at the site of introduction of pale treponema into the body, a small reddish spot or papule appears. Within a few days, this element increases to the size of a pea, at the same time a dense sclerotic infiltrate (primary
  2. The course of the incubation and primary periods of syphilis
    The incubation period. This period begins from the moment of infection and lasts until the appearance of primary syphiloma - an average of 30–32 days. It is possible to shorten and lengthen the incubation period compared to the indicated average duration. The early stages of syphilis are characterized by partial inhibition of cellular immunity, which contributes to the reproduction and spread of pathogens in
  3. The primary period of syphilis
    {foto24}
  4. Clinical manifestations of the primary period of syphilis
    Primary syphiloma is the first clinical manifestation of the disease that occurs at the site of the introduction of pale treponemas through the skin and mucous membranes (in the area of ​​the entrance gate). The appearance of an erosive or ulcerative defect is preceded by the appearance of a small hyperimic inflammatory spot, which after 2-3 days turns into a papule. Shortly after the appearance of the papule, the epidermis covering it
  5. The course of the secondary and tertiary periods of syphilis. Malignant course of syphilis
    Secondary period. This period begins with the onset of the first generalized rashes (on average 2.5 months after infection) and lasts in most cases for 2–4 years. The duration of the secondary period is individual and is determined by the characteristics of the patient's immune system. In the secondary period, the most pronounced wave-like course of syphilis, i.e., alternation
  6. Primary syphilis
    The mucous membrane of the oral cavity is involved in the pathological process in all forms of syphilis. Syphilitic manifestations on the mucous membrane of the oral cavity, especially in the early periods of syphilis, are the most dangerous from the epidemiological point of view. This is facilitated by frequent erosion and ulceration of syphilitic rashes, in the discharge of which a large number of pale
  7. CONGENITAL SYPHILIS. TREATMENT AND PREVENTION OF SYPHILIS
    The fact of transmission of syphilis to offspring was established in the late 15th - early 16th centuries. For several centuries, the question of the mechanism of transmission of syphilitic infection remained unclear. For centuries, the germinative hypothesis was dominant, according to which syphilis is transmitted to the fetus only by the father through a sperm that directly infects the egg cell. According to this view, a child with syphilis
  8. Primary syphilis and its treatment
    It begins with the formation of a hard chancre (ulcus durum, primary syphiloma) at the site of introduction of the pathogen, which is described on any part of the body, but is most often formed on the genitals, then the anal region, oral region, thoracic nipple in women follow, in decreasing order. d. A clinically typical solid chancre is solitary erosion (ulcer) with the absence of island-inflammatory phenomena, having
  9. Congenital syphilis. Fetal syphilis
    Under the influence of treponem, changes that occur in the placenta make it functionally inferior, as a result of which its intrauterine death occurs at the 6-7th month of pregnancy. The dead fruit is pushed out on the 3-4th day, usually in a macerated state. The macerated fruit, compared with a normally developing fruit of the same age, has significantly smaller sizes and weights. Leather
  10. Serodiagnosis of the secondary period of syphilis
    With Lues II recens, a sharply positive result for all standard serological reactions is observed in almost 100% of cases; The titer of reagins is the highest (1: 160; 1: 240; 1: 320), RIF 4+; RIBT gives a positive result in more than half of patients, but the percentage of treponemal immobilization is low (40-60%). With Lues II recidiva, a positive result for standard serological reactions
  11. SECONDARY PERIOD OF SYPHILIS
    Secondary Lues begins 9-12 weeks after the introduction of pale treponema or 6-8 weeks after the onset of primary syphiloma due to generalization of the infection, when blood CSF becomes sharply positive in almost 98-100% of patients. It lasts from 2 to 5 years, divided into: secondary fresh (Lues II recens); secondary hidden (Lues II latens); вторичный
  12. Поражение костей и суставов при вторичном периоде сифилиса
    Поражение костей и суставов при Lues II подтверждает системное течение инфекционного процесса. В результате проникновения бледных трепонем и сенсибилизации к ним в костях и суставах возникают воспалительные специфические изменения с доброкачественным течением. В костях по типу периостита или остиопериостита с болями, усиливающимися ночью или днем в состоянии покоя. В отличие от ревматических
  13. Третичный период сифилиса. Клинические проявления
    Бугорковый сифилид. Типичными местами его локализации являются разгибательная поверхность верхних конечностей, туловище, лицо. Очаг поражения занимает небольшой участок кожи, располагается асимметрично. Основной морфологический элемент бугоркового сифилида – бугорок (плотное, полушаровидное, бесполостное образование округлой формы, плотноэластической консистенции). Сгруппированный
  14. Третичный сифилис. Врожденный сифилис.
    Третичный сифилис. Врожденный
  15. Лечение больных сифилисом. Критерий излеченности. Диспансеризация больных сифилисом
    {foto28}
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