Late syphilis is a type of special infection in which no medical manifestations of the disease are detected, however, positive results of laboratory tests for syphilis are traced. Diagnosis of latent syphilis is a rather complicated process, which is based on information from the anamnesis, the results of painstaking examination of the patient, positive reactions of the samples to the pathogen.
In order to exclude a false positive result of the analysis, repeated studies are practiced, secondary diagnostics after treatment of concomitant somatic pathology and rehabilitation of infectious foci. Syphilis therapy is carried out on the basis of penicillin.
Ways of infection and the cause of the disease
The only reason for the occurrence of the pathology is the ingestion of the causative agent of the disease, namely the bacteria Treponema pallidum (pale treponema). Late syphilis is a sexually transmitted disease characterized by the latent nature of the development of clinical symptoms. Currently, doctors are increasingly documenting cases of the development of this form of pathology in people.
The following syphilis infections are available :
- transfusion of infected blood;
- entry into sexual relations without the use of contraceptives, only the use of condoms can protect the genitals from getting on the mucous membranes of pathogens of sexually transmitted diseases;
- frequent change of partners;
- violation of personal hygiene rules, the use of other people's household items;
- intrauterine infection of the fetus by the mother who is the carrier of the infection;
- bacterial infection that occurs when a baby passes through the birth canal of a woman; this route of transmission of infection is most dangerous for the life of the child, as the mucous membranes of the eyes and genitals of the infant 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 occur 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:
- Late neurosyphilis is a brain disease that provokes disorders in the nervous system and severe headache. The disease affects the walls of blood vessels, which are narrowing, due to which endarteritis forms.
- Infection and inflammation of the membranes around the brain and spinal cord, which interferes with normal blood supply.
- Hearing loss - the composition of the cerebrospinal fluid changes, which leads to poor filtration of the substance.
- Loss of vision, photophobia - due to syphilis lesion of visual analyzers.
- Psychological changes - schizophrenia, personality disorder, dementia.
- Heart disease, stroke, high blood pressure, heart rhythm disturbance. Visceral syphilis also leads to arthritis.
- Pulmonary diseases - pneumonia, bronchiectasis. Changes occur when the respiratory system is affected by syphilis, due to which gum and formations appear around the vessels. This leads to chest pains in the side, which are accompanied by a cough.
- Weakening of muscles and joints, impaired coordination - when the central nervous system is affected, nerve cells lose their ability to send and receive signals.
- The formation of gum in 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, in the latent period, the disease spreads further and further through 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. First of all suffer:
- mucous membranes;
- leather;
- musculoskeletal system;
- nervous system;
At a late stage of syphilis, gumma begin to appear on the mucous membranes of the body, and sometimes tubercles with characteristic peeling appear on the skin. Subsequently, they can turn into ulcers. Rashes appear in the language, 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 in the hard palate, which injure cartilage and bone tissue.
Because of this, a person has complications of late syphilis: speech is seriously impaired, and other diseases arise due to purulent discharge. Gummas can also appear on human skin, while being deep under the epidermis layer. Characteristic scars begin to appear on the skin, which are very difficult not to notice. They can be both single and formed in groups.
Due to the defeat of the skeleton, a person receives disability for life. At first, gum form over the nasal cuticle, but then spread and capture an increasingly large part of the musculoskeletal system. Ultimately, they grow to a tumor that can only be removed surgically. Bone marrow can sometimes suffer.
In the modern world, neurosyphilis is the most common type of organ damage. The causative agent directly enters the brain. Very often, the patient has severe headaches, coordination is disturbed, 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
Ordinary serological reactions that are considered “positive” in late syphilis can be invaluable in establishing a diagnosis. A significant diagnostic role is played by the study of cerebrospinal fluid, x-rays, counseling and examination by a therapist, ophthalmologist, otolaryngologist, neuropathologist and other experts.
Differential diagnosis
In the differential diagnosis of late syphilis and inert antibody transmission, numerical reactions play a significant role. In healthy people, antibody titers will decrease, and over the course of 4-5 months, an unexpected negation of serological interactions occurs. In the presence of infection, antibody titers are strong or an increase is observed.
In the first time after infection, serological interactions after tests for late syphilis can be negative, despite the presence of bacteria in the body. For this reason, diagnosis is not recommended in the first 10 days after the birth of children or a possible infection.
Treatment
Early treatment with penicillin is important, because the prolonged effect of this disease can cause life-threatening consequences. During the period of the main, secondary or late stage of the pathology, patients, as a rule, receive intramuscular injection of Pencillin G. Benzatin. Tertiary syphilis will require two injections at weekly intervals. Neurosyphilis requires parenteral penicillin every 4 hours for 2 weeks, this is necessary to remove bacteria from the central nervous system.
Why should pathology be treated immediately?
Treatment of late syphilis will prevent further damage to the body systems. Children who have been infected with syphilis after childbirth should receive antibiotic therapy.
Fever, nausea, and headache may occur on the first day of treatment. This is called the Jarisch-Herksheimer reaction. This does not mean that treatment should be discontinued. Penicillin G, administered parenterally, is the most effective drug for treating people at 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 the pathology requires longer treatment. Increased duration of treatment is required for people with latent syphilis of unknown stage.
What drugs should be used?
Parenteral penicillin G is used effectively to achieve clinical resolution (i.e. wound healing and prevention of sexual transmission of infection) and prevention of late complications. Treatment is with medications and antibiotics: penicillin injections. 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 can be prescribed, for example: Doxycycline, Azithromycin, Ceftriaxone.
Dosage
The dose of the drug is prescribed by the doctor in each individual case individually. The standard dosage is as follows:
- The recommended dose for adults: "Benzatin" (penicillin G 24000000 UNITS) in a single dose 14 times a day.
- Recommended dose for infants and children: "Benzatin" (penicillin G 50,000 units) in a single dose 8 times a day.
- Recommended dose for pregnant women: pregnant women with syphilis are encouraged to use "Benzatin" (penicillin G 2.4 million units) once intramuscularly and "Procaine" (penicillin 1.2 million units) intramuscularly once a day for 10 days.
When the penicillin series "Benzatin" or "Procaine" cannot be used (for example, because of an allergy to the active substance) or are not available (for example, because of depleted supplies), it is suggested to use 500 mg of Erythromycin with caution four times per day for 14 days, or Ceftriaxone 1 g intramuscularly once daily for 10-14 days, or Azithromycin 2 g once a day.
Dosage for children
Infants younger than 1 month of age who are diagnosed with syphilis should have reproductive birth certificates and maternal illness information to assess whether they have congenital or acquired syphilis. Infants, as well as children 1 month old and older with primary and secondary syphilis, should be managed and supervised by a pediatrician as well as a specialist in infectious diseases.
Other recommendations
All people with late syphilis should be tested for HIV. Especially in those geographical areas where the prevalence of this pathology is especially high. Persons who have primary or secondary syphilis should be re-tested for HIV after 3 months if the results of the first test were negative.
Persons who have syphilis, as well as symptoms or signs indicating a neurological disease (e.g., cranial nerve dysfunction, meningitis, stroke and hearing loss), or ophthalmic diseases (e.g., uveitis, iritis, neuroretinitis, and visual neuritis), must undergo a comprehensive diagnosis, which includes a complete ophthalmological study of the condition of the eyes, as well as a deep otological examination.
During therapy, it is not recommended to live sexually until treatment is complete. You can start a sexual relationship after a blood test, confirming that the disease has been cured. Therapy may take several months.