Late syphilis is a type of special infection in which no medical manifestations of the disease are detected, but laboratory tests for syphilis are positive. Diagnosis of latent syphilis is a rather complicated process, which is based on information from the anamnesis, the results of a painstaking examination of the patient, and positive test reactions to the pathogen.
In order to exclude a false-positive result of the analysis, repeated research is practiced, secondary diagnostics after the treatment of concomitant somatic pathology and the sanitation of infectious foci. Syphilis is treated with penicillin-based drugs.
Routes of infection and the cause of the disease
The only reason for the occurrence of pathology is the ingestion of the causative agent of the disease, namely the bacteria Treponema pallidum (treponema pallidum), into the human body. Late syphilis is a sexually transmitted disease characterized by the latent nature of the development of clinical symptoms. Currently, doctors are increasingly recording cases of the development of this form in people.pathology.
There are the following ways of getting syphilis:
- contaminated blood transfusion;
- sexual intercourse without the use of contraceptives, only the use of condoms can protect the genitals from contact with the mucous membranes of venereal disease pathogens;
- frequent change of partners;
- violation of personal hygiene rules, use of other people's household items;
- intrauterine infection of the fetus by the mother who is the carrier of the infection;
- infection with a bacterium that passes when the baby passes through the birth canal of a woman; this way of transmission is the most dangerous for the life of the child, as the mucous membranes of the eyes and genitals of the baby are affected.
Symptoms and signs
Late syphilis is the last stage of the disease, in which treatment is not as easy as in the primary and secondary stages. This is the final, most difficult period of the pathology. The disease can manifest itself 10-30 years after the initial infection. There are many signs of late congenital syphilis. The main thing is that the disease leads to a deterioration in the condition of the whole organism.
Complications may include:
- Delayed neurosyphilis is a brain disease that causes disturbances in the nervous system and severe headache. The disease affects the walls of blood vessels, which narrow, causing endarteritis to form.
- Infection and inflammation of the membranes around the head and spinalbrain, which interferes with the normal blood supply.
- Hearing loss - changes in the composition of the cerebrospinal fluid, which leads to poor filtration of the substance.
- Loss of vision, photophobia - due to damage to visual analyzers by syphilis.
- Psychological changes - schizophrenia, personality disorder, dementia.
- Heart disease, stroke, high blood pressure, irregular heartbeat. Visceral syphilis also leads to arthritis.
- Diseases of the pulmonary tract - pneumonia, bronchiectasis. Changes appear when the respiratory organs are affected by syphilis, which causes gummas and formations around the vessels. This leads to pain in the chest, in the side, which is accompanied by coughing.
- Weakening of muscles and joints, impaired coordination - when the disease of the central nervous system is affected, nerve cells lose their ability to send and receive signals.
- Formation of gums on different parts of the body - most often on the limbs.
Signs and symptoms of late syphilis may not be very pronounced and go unnoticed by the patient for a long time. Nevertheless, during the latent period, the disease spreads further and further throughout the body.
Stages
At the last stage of syphilis, all human organs suffer. In especially severe cases, symptoms appear on the bones and blood vessels. Suffer first:
- mucous membranes;
- leather;
- musculoskeletal system;
- nervous system;
In the late stage of syphilis, gums begin to appear on the mucous membranes of the body, and sometimes tubercles appear on the skinwith characteristic peeling. Subsequently, they can transform into ulcers. Rashes appear on the tongue, and the more there are, the more difficult it will be for a person to speak and eat. But the most significant danger is ulcers on the hard palate, which injure cartilage and bone tissue.
Because of this, complications of late syphilis appear in a person: speech is seriously impaired, and other diseases arise due to purulent discharge. Gummas can also appear on human skin, while being deep under the layer of the epidermis. Characteristic scars begin to appear on the skin, which are very difficult to miss. They can be either single or formed in groups.
Due to the defeat of the skeleton, a person becomes disabled for life. At first, gummas are formed above the periosteum, but then they spread and capture an increasing part of the musculoskeletal system. They eventually grow into a tumor that can only be removed by surgery. Sometimes the bone marrow can also suffer.
In the modern world, neurosyphilis is the most common type of organ damage. The pathogen directly enters the brain. Very often, the patient has severe headaches, impaired coordination, symptoms such as dizziness, vomiting, sleep disturbance, visual and auditory hallucinations appear. Sometimes the patient may stop recognizing his relatives and friends, but this is quite rare.
Research
In establishing the diagnosis, ordinary serological tests can be of invaluable help,which are determined as "positive" in late syphilis. An essential diagnostic role is played by the study of cerebrospinal fluid, x-rays, consultation and examination by a general practitioner, ophthalmologist, otolaryngologist, neuropathologist and other experts.
Differential Diagnosis
Numerical reactions play a significant role in the differential diagnosis of late syphilis and inert antibody transfer. In he althy people, antibody titers will decrease, and unexpected negative serological interactions occur within 4-5 months. In the presence of infection, antibody titers are stable or their increase can be traced.
In the early post-infection period, serological interactions after testing for late syphilis may be negative despite the presence of the bacterium in the body. For this reason, diagnosis is not recommended in the first 10 days after the birth of children or possible infection.
Treatment
Early treatment with penicillin is important because prolonged exposure to the disease can cause life-threatening consequences. In the period of the main, secondary or late stage of the disease, patients usually receive intramuscular administration of "Benzathine" penicillin G. Tertiary syphilis will require two injections at weekly intervals. Neurosyphilis requires parenteral penicillin every 4 hours for 2 weeks to clear the bacterium from the CNS.
Why pathology is urgenttreat?
Treating late syphilis will prevent further damage to body systems. Babies exposed to syphilis after childbirth should receive antibiotics.
Fever, nausea and headache may occur on the first day of treatment. This is called the Jarisch-Herxheimer reaction. This does not mean that treatment should be stopped. Penicillin G, administered parenterally, is the most effective drug for treating people in all stages of syphilis. The type of medication used, the dose and duration of treatment depend on the stage and clinical manifestations of the disease.
Treatment of late latent syphilis and the tertiary stage of pathology requires longer therapy. An extended duration of treatment is required for those with latent syphilis of unknown stage.
Which drugs should I use?
Parenteral penicillin G has been used effectively to achieve clinical resolution (i.e. wound healing and prevention of sexual transmission) and to prevent late complications. The treatment is carried out by taking medications and antibiotics: injections of penicillin. Penicillin is one of the most widely used antibiotics and is usually effective in treating syphilis. For people who are allergic to penicillin, another antibiotic may be prescribed, for example: Doxycycline, Azithromycin, Ceftriaxone.
Dosage
The dose of the drug is prescribed by the doctor in each case individually. The standard dosage is as follows:
- Recommended dose for adults: "Benzathine" (penicillin G 24000000 IU) in a single dose 14 times a day.
- Recommended dose for infants and children: Benzathine (penicillin G 50,000 units) in a single dose 8 times a day.
- Recommended Dose for Pregnant Women: Pregnant women with syphilis are suggested to use Benzathine (penicillin G 2.4 million units) once IM and Procaine (penicillin 1.2 million units) IM once a day at within 10 days.
When the penicillin preparations "Benzathine" or "Procaine" cannot be used (for example, due to an allergy to the active substance) or are not available (for example, due to depleted supplies), it is suggested that "Erythromycin" be used with caution 500mg orally four times a day for 14 days, or Ceftriaxone 1g IM once daily for 10-14 days, or Azithromycin 2g once a day.
Child dosage
Babies under 1 month of age who are diagnosed with syphilis must have reproductive birth certificates and information about maternal illness to assess whether they have congenital or acquired syphilis. Infants and children 1 month of age and older with primary and secondary syphilis should be managed and monitored by a pediatrician and an infectious disease specialist.
Other recommendations
All persons suffering from late syphilis should be tested for HIV infection. Especially in those geographical areas where the prevalence of this pathology is especially high. Individuals who have primary or secondary syphilis should be retested for HIV after 3 months if the first test was negative.
Persons with syphilis and symptoms or signs suggestive of neurological disease (eg, cranial nerve dysfunction, meningitis, stroke, and hearing loss) or eye disease (eg, uveitis, iritis, neuroretinitis and optic neuritis) must undergo a comprehensive diagnosis, which includes a complete ophthalmological examination of the condition of the eyes, as well as a deep otological examination.
During therapy, it is not recommended to have sex until the treatment is completed. You can start sexual relations after a blood test confirms that the disease has been cured. Therapy may take several months.
