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Secondary syphilis

Secondary syphilis photo This period of syphilis corresponds to the generalization of the infectious process. Persistent in the lymph nodes in the period of primary syphilis, pale treponema enters the bloodstream with the blood flow spreads to new areas of the skin and internal organs. As a rule, in this phase of the infectious process, a person feels signs of general malaise (low-grade fever, weakness, moderate intensity of pain in muscles and joints, especially at night). The above symptoms are mainly observed in women and debilitated patients.

Specific lesions in secondary syphilis are observed in all areas of the skin (syphilis), most mucous membranes and in some internal organs.

The results of serological diagnosis at the stage of secondary syphilis are positive. In domestic practice, such reactions as immobilization of pale treponema (RIBT) or immunofluorescent reaction (RIF) are used.

Symptoms of skin lesions

All secondary affects on the skin, the so-called syphilis, have a number of similar properties regardless of their location:

  • Elements of the rash are dense to the touch, not accompanied by ulcerative and necrotic changes, gradually decreasing in size without scar formation.
  • There are no subjective discomfort (itching and tingling).
  • Signs of inflammatory changes (pain, redness, swelling) are usually absent, which makes it possible to distinguish syphilides from other skin diseases.
  • Elements of the rash do not have a tendency to merge, as well as peripheral growth, clearly separated from healthy tissue.
  • Any syphilide contains a significant number of pale treponema cells, which can be used for laboratory confirmation of the diagnosis.
  • Syphilides can be represented by various elements of the rash (from roseol to pustules). The simultaneous appearance of various elements of the skin rash is called true polymorphism. In the case of repeated episodes of secondary syphilis, it is possible to gradually add elements of the rash, that is, earlier elements of the rash dry up, new ones appear. This phenomenon is called false polymorphism.

Most often in the case of secondary syphilis such an element of the skin rash occurs as syphilitic roseola or spotted syphilide. This element of the rash is located in the surface layers of the skin. It has a pale pink or deep pink tint. Roseola in secondary syphilis gradually appear (over several days or weeks) symmetrically and focally. Roseola does not merge, not accompanied by pruritus. When pressed, disappear, but then reappear. Only with a very long pressure, roseola changes color from pink to yellow, which is associated with hemolysis of red blood cells. Roseola also disappears gradually and in the same order as they appeared. In rare cases, syphilitic roseola is accompanied by fine lamellar peeling. In some patients, after the onset of treatment of secondary syphilis, an aggravation of clinical manifestations occurs: the number of elements of the rash and the deterioration of the general condition increase (Yarish-Lukashevich reaction).

Also a fairly common variant of a rash in the case of secondary syphilis is a papule (or papular syphilide). This variant of syphilide is most characteristic of the recurrent course of secondary syphilis (in the absence of proper treatment or not completing the full course). This is a dense, protruding above the surface of the skin education, oval or round shape, measuring up to 1 centimeter. As a rule, syphilitic papules appear even more slowly than roseola. Completion of the full cycle of the formation and reverse development of papular syphilide may be delayed for 2-3 months. As well as for roseol, periodic spilling is characteristic, that is, new elements of syphilitic rash may appear on the same skin area. For papules characteristic dark red color: from purple to bluish. It is for the papular variant of the rash that peeling resembling a collar is typical - the so-called Bietta collar (plates of desquamated epithelium do not reach the edge of the papule and form a peculiar scalloped edge). Also, a characteristic symptom of a syphilitic papule is the feeling that the patient has a sharp pain with strong pressure with a special probe in the center of the papule (a symptom of Yadasson). Already after the resorption of papular syphilides, considerable pigmentation persists for a long time. This variant of syphilitic skin rash can appear on any part of the skin, including the soles, palms and even the hairy areas of the head. In many patients there is an accumulation of syphilitic papules in the form of rings, bands or arcs.

Currently, there are not only classical syphilitic papules, but also some other options: wide warts, seborrheic, nummular, psoriasoform, moist. The following characteristic features of such atypical variants of syphilitic papules are distinguished:

  • Numular syphilide has a more dense texture, brown tint and a flat spherical surface.
  • Psoriasoform syphilide occurs in areas of the skin, where the greatest number of sebaceous glands (head and face). The elements are covered with yellow-gray fat scales, therefore they resemble psoriatic plaque; This variant of syphilides is observed in the form of the so-called Venus crown (boundary of the skin of the facial area and the scalp).
  • Syphilides of the palms and soles are characterized by unusual and rather pronounced keratinization, sometimes even corn-like changes are formed.
  • Moist syphilide forms in places of increased perspiration (natural skin folds) and maceration, in its place erosion is quickly formed, which tends to grow along the periphery and merge with neighboring elements. Mild burning and itching.
  • Widespread warts are formed on the site of long-existing erosion, characterized by uneven and uneven growth of the edges of the skin defect in the form of "cauliflower".
  • Miliary syphilide is characterized by very small (several millimeters) elements of the rash, which are arranged in the form of a ring, surrounding the hair follicle.

The syphilitic pustule (or pustular syphilide) is a rather rare phenomenon in the clinical picture of modern syphilis, which indicates a malignant course. It is observed mainly in debilitated patients. Accompanied by a deterioration in the general condition of a person. There are the following options for syphilitic pustules:

  • acne - resembles a rash of acne , has a conical shape, quickly transformed into a crust and a scar;
  • Oppen-shaped - an element of a circular form with retraction in the center (hence the comparison with smallpox), the transition to a crust that is not falling out for a long time; after it pigmentation is possible;
  • impetiform - a larger defect from which a multi-layered brown crust is formed, surrounded by an infiltration zone;
  • ektimatozny - very large, tends to peripheral growth, very deep erosion slowly turns into a black crust and is replaced by an extensive scar;
  • rupioid - large erosion in shape remotely resembling an oyster shell; three zones are characteristic (crust - infiltrative roller - oval ulceration zone).

In the later stages of (especially untreated) secondary syphilis, hypopigmentation (syphilitic leucoderma) is often observed. Its appearance is noted on the skin of the trunk and limbs, the classic version is on the neck (the necklace of Venus). Very often combined with alopecia (baldness). It lasts a very long time - up to several years.

Syphilitic alopecia (baldness) can be both diffuse and small-focal; cover both the scalp and the area of ​​the mustache, beard, eyelashes and eyebrows. With a cursory visual inspection, there are multiple small foci of hair loss that do not merge. A typical Pincus trait is also a different length of eyelashes on one eye. Perhaps in severe and neglected cases of diffuse alopecia, when the appearance of the hair is similar to fur, which thoroughly ate the mole. After the treatment, the hair grows quite quickly and the hairy covering returns to its original state within a few months.

The defeat of the mucous membranes in the case of secondary syphilis

Syphilides can be detected, first of all, on the mucous membrane of the pharynx and larynx, as well as the genitals. They represent a particular danger in the household route of infection, as they contain a significant amount of the pathogen.

On the mucous membrane of the oropharynx, syphilitic lesion is characterized by the formation of a specific erythematous or papular tonsillitis. The erythematous variant of syphilitic angina is characterized by congestive hyperemia, a feeling of discomfort (but not pain) when swallowing. When papular syphilitic angina papules have a characteristic appearance of "opal plaques."

In both cases, the elements of syphilitic rash spread beyond the tonsils to the soft and hard palate, palatine arches, tongue and inner surface of the cheeks. It is this in combination with the unchanged general condition of a person that makes it possible to distinguish the syphilitic process from the banal bacterial tonsillitis and diphtheria.

Syphilitic spots or papules form on the mucous membrane of the larynx (the vocal cords proper, the subglottic space). The vocal cords do not close completely, which is manifested by hoarseness, a decrease in the volume of the voice up to a complete loss of voice. Against the background of a specific treatment, the voice is restored within a few months.

Other lesions in secondary syphilis

The lesion of the digestive tract (stomach and liver) is functional and rather quickly undergoes reverse development under the influence of specific treatment.

More serious disorders in the bone and nervous system. A person with secondary syphilis feels aching pain in the long bones of the limbs, large joints, which are aggravated during the nighttime and are practically not arrested by traditional analgesics. An inflammatory reaction of the outer shell of the bone (periosteum) may occur. Deformities of bones and joints at this stage of the syphilitic process are absent.

Damage to the central nervous system, namely the brain and its membranes, is often not manifested clinically, but can be detected in the study of cerebrospinal fluid. The danger of such a latent process is the lack of timely treatment and the development of severe irreversible complications.

Treatment of secondary syphilis, as well as primary, is the appointment of special combined courses of penicillin.


| 9 May 2015 | | 1,295 | Infectious diseases
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