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Primary syphilis: symptoms, treatment

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Primary syphilis Primary syphilis is the period from the beginning of the first clinical manifestations in the area of ​​infection to the beginning of the development of generalized lesions of the skin and internal organs. Its average duration is several weeks. There are seronegative and seropositive periods of primary syphilis. The therapy started at the stage of primary syphilis is effective enough and prevents the development of the next stages of syphilis (secondary, tertiary) or its recurrence.



Symptoms of primary syphilis

The so-called Hutchinson triad is characteristic of primary syphilis: hard chancre, lymphadenitis, and lymphangitis. The international classification of diseases proposes to distinguish the following forms of primary syphilis:

  • syphilis of the genitals proper;
  • syphilis of various other localization;
  • syphilis of the anus.

The main and first sign of primary syphilis is a hard chancre. The most current variant of syphilis infection today is the sexual way, and the proportion of domestic infection is low. Therefore, the most common localization of hard chancre is the genital area. In the place of penetration of pale treponema into the human body, often on the skin or mucous membrane of the genitalia, a rigid chancre develops. It can be detected:

  • on the genital lips (both small and large);
  • less commonly on the skin of the pubic area, the lower part of the anterior abdominal wall, in rare cases on the inner femoral surface;
  • on the foreskin or glans penis;
  • in homosexuals - in the anus;
  • on the back of the spike;
  • in women, on the cervix or vaginal walls.

The cases of hard chancre that are located outside the genitals are called extragenital. they are difficult to diagnose, since they are often not visible when viewed visually. That is why the period of primary syphilis can be missed and left without proper treatment.

The structure of a hard chancre is quite characteristic, which makes it possible to exclude some similar diseases already at the stage of clinical examination. Typical features are:

  • erosion of the correct oval or round shape (sometimes resembles a saucer);
  • the boundaries of this element with a healthy cloth are clear and even;
  • solid chancre sizes rarely exceed 10 millimeters;
  • the bottom of erosion is located slightly below the edges, that is, the edges of the chancre slightly rise;
  • the color of the primary affect is purple-red or dull-pink;
  • a small amount of secreted secretion from the chancre creates the impression of a so-called lacquered surface;
  • for any location, hard chancre is not a typical pain, even with strong pressure during the inspection process there is only a slight discomfort.

A rarer version of hard chancre is considered ulcerated. In this case, not an erosive defect is formed, but an ulcerative, that is, deeper. In this case, the depth of the primary affect is more pronounced, in place of the ulcerative variant of a hard chancre, not epithelial, but connective tissue (scar) forms.

Currently, much more often there are multiple primary syphilitic affects, the prevalence of ulcerative variants, the frequent accession of secondary purulent bacterial flora with the development of co-infection. Considering the spread of homosexual relationships, syphilis of the anal zone in men and also chancre of the oral cavity in women are increasingly being registered as a result of various extraordinary variants of sexual intercourse.

To date, such variants of primary syphilitic affect as indurative edema, felon and amygdalitis are extremely rarely registered.

Amygdolite is a specific syphilitic tonsillitis , which is typical in the case of oral sex or domestic infection with syphilis (using common dishes, towels, sponge). The main difference from many other options for angina is the one-sided nature of the pathological process. The mucous membrane of the mouth is little changed, the main signs are observed on one of the tonsils. The affected amygdala is swollen, of a purple-red hue; erosion or ulceration may occur. As with the typical location of the chancre, pain syndrome is not characteristic of the extragenital variant (amygdalite).

Specific felon in primary syphilis is very much similar to the classical surgical option. In the differential diagnosis help to suspect a specific process of dense infiltration and the absence of the classic acute inflammatory erythema. Panaritium in primary syphilis often appears as a result of occupational infection and non-compliance with safety regulations (in obstetrician-gynecologists, nurses, pathologists).

Inductive edema can be detected in those parts of the body where there is a pronounced network of lymphatic vessels. This is the region of the labia and scrotum. It is clear that the dominant feature of this variant of primary syphilis is edema without disturbing the integrity of the skin.

The next major symptom of primary syphilis is a lesion of regional lymph node groups closest to the primary affect, namely regional lymphadenitis. It occurs 2 weeks later than the actual primary affect and received the name of the accompanying bubo.

Lymph nodes increase in size by a few centimeters, are quite elastic (less dense), are not soldered to each other and with the surrounding soft tissues, are completely painless and the skin above them has no visual and morphological changes.

Mostly marked bilateral formation of regional lymphadenitis, only very rarely - one-sided. Lymphadenitis significantly more slowly undergoes reverse development than the solid chancre itself. It is in the regional lymph nodes that pale treponema persists for a long time, it is from here that the infection can be generalized with the development of the next stage of syphilis, the secondary.

The third and final mandatory sign of primary syphilis is a lesion of the vascular wall, namely the lymphatic network. Syphilitic lymphangitis looks like a dense and thick cord, visible to the naked eye upon visual inspection and clearly felt on palpation, but painless. This is a kind of path that connects the primary syphilitic affect and the nearest group of lymph nodes.

Syphilitic lesions of the oral cavity have some features of the external structure, namely:

  • the chancre can be located on any part of the mucous, but mainly localized in the corner of the mouth, on the red border and tongue;
  • the ulcerative variant of chancre dominates;
  • tissue swelling is more pronounced, so the lip bulges noticeably, which is impossible not to notice;
  • when a chancre forms in the corner of the mouth, it often has no characteristic signs and resembles a pick;
  • the chancre in the tongue protrudes above the surface of the tongue due to significant infiltration.


Diagnosis of primary syphilis

The final diagnosis can be made as a result of obtaining combined information: clinical symptoms and laboratory data.

The fundamental research at any stage of syphilis is the Wassermann reaction. When a chancre occurs, it is negative (up to 1 month of illness). Over the course of the disease, antibodies accumulate and the reaction becomes positive, that is, seroconversion occurs and the seronegative period is replaced by seropositive.

The actual causative agent of syphilis can be detected in the discharge from the chancre by direct microscopy in a dark field, which is irrefutable evidence of syphilis.

Treatment of primary syphilis

Based on the use of antibacterial drugs for a specific pattern and a certain duration. Despite the growing antibiotic resistance, pale treponema is still highly sensitive to the oldest antibiotic, penicillin. In domestic medical practice, the most widespread are three options for the treatment of primary syphilis:

  • combination of bismuth and bitillin;
  • a combination of penicillin and bismuth;
  • use only penicillin and non-specific therapy.

The dose of penicillin and the number of treatment courses (from 2 to 5) is calculated individually, based on a positive or negative Wasserman reaction. The duration of the course of treatment is several weeks. The first course of penicillin therapy is preferably carried out in stationary conditions. When conducting repeated courses of treatment, penicillin can be replaced by bicillin-3 or bicillin-5. Nonspecific therapy implies the inclusion of non-specific immunomodulators (FIBS, aloe, vitreous body) into a complex of measures.

During the period of treatment, the person should stop having sex, especially if they have promiscuous sex with several partners. It is necessary to follow the rules of hygiene and allocate household items (towels, sponges, dishes) for the sole use to exclude the possibility of domestic contamination.

All contingents of individuals, even children and pregnant women, are subject to preventive treatment of primary syphilis. A woman in an interesting position needs to receive a full course of treatment, since vertical transmission of syphilis to the fetus and the birth of a child with congenital syphilis are possible (severe neurological and bone disorders).

In children, mental and physical development is possible as a result of the progression of syphilis, therefore an individual course of treatment is selected taking into account the age and body weight of a small patient.

It is necessary to complete the full course of treatment, otherwise primary syphilis will not disappear spontaneously, but will be transformed into secondary and tertiary syphilis.


| 8 May 2015 | | 1 949 | Infectious diseases
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  • | Svetlana | June 4, 2015

    Hello! Tell me, I had syphilis 10 years ago, now I’m pregnant and I donated blood, Eds came back negative, IFA KP 5.1, does this mean I need to undergo treatment again?

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Billy Cruz: I'm dying I feel sick. I've got pimples all over me. Genitals have sites all over them. I've been going to the doctors for over a year with these symptoms. All the doctor did is call security to escort me out. I went to all the doctors I could find. The others tricked me. Threatened to their me in a mental health ward. Said I was making it up. Refused to treat me. I've seen about 10-15 doctors. I now can't walk on my right knee. In the last month or started to become sore out of no where and unbearable pain. I can't walk or put weight on it. I have had arthritic pain for over a year. The doctor doesn't care. I'm sick right now experiencing low abdominal pain. Pressure that hurts. I never would have put myself in that position. Ihave a strict no sleeping around policy. a guy forced himself on me at my house after telling him no for months one night he forced my clothes off but that's another story. Of why. But I went to the er emergency they told me to go to the doctor. The doctor won't treat me. I literally have a recording of the last time I went to the doctor and he kiddish me or when I asked for a swab of the genital blister that had never been tagged cause the doctors refused to. Then I asked to get it tasted by the people he called and they reached it for general tests now anything atheistic to that area. I found out a week later. That was the only time I had the sores them self tested because they won't. They injected me and blacklisted my name to the doctors from a secret society. The person that raped me said they know the real estate as she is his aunty and my dv abusive ex friends. He even told me the scare in his chest is from a satanic ritual they cute his heart out in when he was for in an oval in Sydney

aaudumber k: Thanks sir, but I have give 3 penicillin injection in 3 weeks each and three month after again I have test of TPHA but Titre is same 1.1260 as before three months earlier should I have take treatment FOR LIFE long 3 months each and which specilist doctor i should take treatment And the same my 3 month baBy is having congenital syphilis Advice Plz give number

Lazlum: @UCLA Health ,if i dont have any STDs and i sleep with 100 females(never gonna happen) who dont have any STDs can we get STDs?

Lisa Young: I discovered the details in this Herpes guide *4HerpesCure. Com* very helpful. I learned the natural and other several Herpes remedies. I favor the natural way of treating them and I found out on this guide the solutions that work successfully.

Kar3n: Is also very important not to have a cheating partner, cuz who knows where other girls have been. I witness a friends mom being transmitted HIV by her husband, who got it from a lover. Is not a matter of jealousy to me, but cleanliness.

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