Plumbing

Secondary syphilis causes symptoms treatment and prevention. Various manifestations of secondary syphilis and treatment of the disease

On average 2-3 months after infection or 6-7 weeks after the onset of chancre as a result of hematogenous dissemination of pale treponema, on the skin and mucous membranes the first generalized rash appears.
Bones, muscles, joints, internal organs, blood and lymphatic vessels, organs of hearing, vision, nervous and endocrine systems are affected.
Secondary fresh syphilis (syphilis secundaria recens) sets in, which lasts an average of 2-2.5 months, after which the rash spontaneously regresses even without treatment and the disease passes into secondary latent syphilis (syphilis secundaria latens, lues II latens), which can last from several days to several months, followed by a second and subsequent outbreaks of new eruptions.
The reappearance of rashes (return of the disease) occurs after 3-6 months and occurs secondary recurrent syphilis(suphilis secundaria recidiva). In the future, relapses of secondary syphilis alternate with latent periods for 3-5 years, and sometimes more.
A wavy course is characteristic, that is, a change in the active clinical manifestations of the disease with latent (latent) periods (syphilis latens), which is due to a change in immunobiological reactions and the appearance of corresponding reactions of infectious allergies. Regardless of the nature of the elements, secondary syphilides have distinctive features that make it possible to recognize and differentiate them with various dermatoses similar in clinical picture. Benign course - spontaneous and traceless resolution of elements even in the absence of treatment after an average of 2-3 months. Less often, scars remain after ulceration of pustular elements.

When prescribing a specific treatment, syphilides quickly resolve and disappear, which is often used in practice as a diagnostic technique - "trial treatment" (therapia ex yuvantibus). The general condition is not violated. There are no subjective sensations (pain, itching, burning), which are often observed in skin diseases. Slightly pronounced itching sometimes occurs in the presence of rashes on the scalp and in the folds of the skin. Rashes appear paroxysmal, as a result of which the elements of the rash are at various stages of development (evolutionary or false polymorphism). However, the simultaneous occurrence of various morphological elements of the rash in the patient is possible.
For example, roseola and papules or papules and vesicles (true polymorphism). Rashes of the secondary period have a rounded shape, sharply delimited from healthy skin, located focally, not prone to peripheral growth and fusion. The rash without signs of acute inflammation, stagnant copper-red color with a brownish tinge, contains a large number of pale treponema. Then the color becomes more faded, in the words of the French syphilidologists "boring".
The presence of a dense infiltrate at the base of syphilides, excluding roseolous rashes, is characteristic. Serological blood tests are sharply positive with a high titer of reagins 1:160 and 1:320 in almost 100% of cases in patients with secondary fresh syphilis.
In 96-98% with a low titer of reagins 1:5-1:20 in patients with secondary recurrent syphilis.
RIF (immunofluorescence reaction) is sharply positive in almost 100% of cases.
RIBT (treponema pallidum immobilization reaction) positive in 60-80% patients with secondary fresh syphilis and in 80-100% of secondary recurrent.
In 50% of cases with secondary recurrent syphilis, pathological changes in the cerebrospinal fluid are observed in the absence of a clinical picture of meningitis (latent latent syphilitic meningitis).
Clinical features of secondary fresh syphilis:

rashes are localized in the trunk area;
they are small, small in size;
elements are abundant, arranged randomly, scattered;
there is no tendency to group and merge;
symmetrically arranged;
characteristic bright color;
do not peel off;
in 75-80% of patients, a hard chancre or its remains are detected;
regional scleradenitis is observed in 22-30% of patients;
pronounced polyscleradenitis - in 88-90%.

Features of secondary recurrent syphilis

The sizes are large.
quantity.
asymmetrical arrangement.
Rashes tend to group and merge with the formation of figures, garlands, arcs, circles, rings.
They have a pale, slightly pronounced color.
Slightly pronounced polyadenitis is revealed.

Spotted (macular) syphilide (syphilitic roseola)

The most common skin lesion at the beginning of the secondary period of syphilis. With secondary fresh syphilis, spotted (roseolous) rashes appear after the end of the primary period of syphilis. Localized on the lateral surfaces of the trunk, chest, abdomen, less often on the upper and lower extremities and extremely rarely on the face, scalp, palms, soles. They have the appearance of a rounded pink-red spot up to 4-10 mm in diameter, blurred outlines and fuzzy borders. The spots do not rise, plentiful, do not peel, do not tend to merge, are arranged randomly, but focally, symmetrically, there is no tendency to grouping. Appear gradually (full development within 8-10 days and persist for 3-4 weeks). With prolonged existence, roseolous rashes acquire a yellowish-brown color. With diascopy, roseolas temporarily disappear or turn pale. In patients with secondary fresh syphilis, after the start of treatment (the first injections of penicillin or taking other antibiotics), an exacerbation reaction (the Herxheimer-Yarish-Lukashevich reaction) usually occurs, which is accompanied by high fever, increased inflammation of patchy rashes. Roseola becomes rich pink-red, well manifested and often occurs in places where it was absent before the start of therapy. In addition to the typical syphilitic roseola, varieties are less common: granular (follicular), (roseola granulata seu follicularis) - point elevations in the form of granularity at the opening of the hair follicles; confluent roseola, (roseola confluens) - spots merge and solid erythematous areas appear; flaky roseola - lamellar scales appear on the surface of roseola in the form of crumpled tissue paper with a somewhat sunken center; elevating (towering) roseola, (roseola elevata), synonyms: roseola urticaria (roseola urticata), exudative (roseola exudativa), papular (roseola papulosa) - the spots are exudative in nature and rise above the surface of normal skin, resemble a blister, but there is no itching. Spotty rashes in secondary recurrent syphilis: roseola in a small amount; asymmetrically located on separate areas of the skin and mucous membranes; are large; have a tendency to group with the formation of figures in the form of arcs, rings, semi-arcs; characterized by a cyanotic tint. In case of difficulty in recognizing secondary syphilitic roseola, the Z.I. Sinelnikov test is used (3-5 ml of a 0.5% nicotine solution is injected intravenously and previously unclear syphilitic spots become bright and noticeable).

Differential diagnosis of spotted (macular) syphilis (syphilitic roseola)

Measles. The incubation period is from 6 to 17 days. In the first 1-3 days of the disease, small, irregularly shaped pinkish-red spots appear on the mucous membrane of the soft and hard palate, 1-3 mm in diameter (measles enanthema), which then merge. Small, grayish-white papules 1-2 mm in diameter with a narrow corolla of hyperemia along the periphery are formed on the mucous membrane of the cheeks, lips, gums - a pathognomonic symptom (Belsky-Filatov-Koplik spots). Subsequently, individual pink spots and papules appear on the face, neck, torso, upper and lower extremities. The onset is acute: fever up to + 38 + 39 "C, fever, intoxication, profuse mucopurulent discharge from the nose, cough, hoarseness, conjunctivitis (lacrimation, photophobia), vomiting, abdominal pain. Rubella. On the face, behind the ears, there are round or oval, not rising pale pink spots, which then spread throughout the body. On the oral mucosa, hard palate, rashes are defined as single, small, pale pink spots (Forksheimer's spots). 3 days before the rash appears, weakness, malaise, headache, chills, myalgia, runny nose, dry cough, photophobia, lacrimation are observed. A characteristic and early symptom is an increase in lymph nodes, primarily the occipital and posterior cervical.

Papular syphilis

Frequent manifestation of secondary syphilis. However, if spotty rashes are a frequent manifestation of secondary fresh syphilis, then papular rashes are secondary recurrent syphilis. Characteristic features of papular rashes: clearly demarcated, hemispherical shape, stagnant red (red-copper) ham color and isolated location. There is no trend towards peripheral growth. On palpation, dense elastic consistency, painless. The sizes distinguish between lenticular (the most common), milliary and nummular papular syphilis. Lenticular (lenticular) papular syphilis (syphilis papulosa lenticularis). Lentil sizes up to 3-5 mm in diameter, irregular rounded outlines and sharp borders. Hemispherical shape (kind of "plateau"). There is no trend towards peripheral growth. Merging tendency. On palpation, dense elastic consistency. The color is pinkish-red, and later becomes copper-red, ham. The surface is smooth, shiny (pressure of the infiltrate on the epidermis). Jerky appearance (different stages of development) and can be combined with other secondary syphilis (more often with roseola). With regression, slight peeling in the center, then along the periphery in the form of a corolla ("Biette's collar"). After 4-8 weeks spontaneously resolve and temporary pigmentation remains. There are no subjective sensations, but when pressing on the central part of the papule with a blunt probe, pain is noted (Yadasson's symptom). With secondary fresh syphilis, papules are smaller in large numbers. Randomly, but symmetrically located throughout the skin (trunk, limbs), not grouped. Secondary fresh syphilis may begin with the appearance of grouped papular elements in the anogenital and axillary regions and resemble elements of secondary recurrent syphilis (changes in immunity in such patients). The so-called regional papules are described - they appear soon after a hard chancre, long before other manifestations, which is obviously an expression of a superinfection that occurred during the incubation period. In secondary recurrent syphilis, papules are few, limited, larger, grouped in the form of rings, circles (syphilis papulosa lenticularis orbicularis), garlands, arcs (syphilis papulosa lenticularis gyrata). Sometimes ring-shaped papular rashes appear several years after infection (syphilis papulosa tardiva).
Clinical varieties of secondary papular syphilides:

Psoriasiform syphilis(syphilis psoriasiformis). On the surface of the papules are abundant, silvery-white, easily removable, lamellar scales. Around the papules, a copper-red corolla of the infiltrate is revealed.
seborrheic papular syphilis(syphilis papulosa seborroica) - in persons with oily seborrhea on skin areas rich in sebaceous glands (scalp, nasolabial, chin, nasobuccal folds), on the border of the forehead and scalp (Venus crown, corona veneris). Papules with an uneven surface, covered with greasy scales and gray-yellow crusts.
Ring-shaped, circinary or orbicular papular syphilides(syphilis papulosa annularis, circinata, orbicularis). On the back of the head, scrotum, penis - syphilitic papules arranged in an annular form in the form of a roller. In the center, the skin is of normal color or hyperpigmented. New papules may appear, gradually acquiring the shape of a ring.
Miliary, small papular or lichenoid syphilides(syphilis papulosa miliaris seu lichen syphiliticus). A rare manifestation of secondary recurrent syphilis. It is observed mainly in elderly people with concomitant diseases (malaria, cirrhosis of the liver, tuberculosis), chronic intoxication (alcoholism, drug addiction). May arise both primary and secondary from previous roseola. Rashes are localized on the trunk, upper and lower extremities around the sebaceous hair follicles in the form of plaques, grouped arcs. Papules the size of a millet grain, round or cone-shaped, dense texture, copper-red color with a brownish tint. On the surface of individual papules, scales or horny spines are noted. Characteristic of small papular syphilis is resistance even after antisyphilitic therapy. Without treatment, they can last up to 2 months. After resorption, persistent atrophic scars remain. The presence of abundant miliary syphilis in patients indicates a severe course of syphilis. Often there may be weakness, malaise, fever, itching.
Weeping papular syphilis(syphilis papulosa madidans). In places of skin with excessive sweating (genital organs, perineum, inguinal-femoral, inguinal-scrotal, axillary and other skin folds, anal area), maceration of the epidermis is noted, which becomes whitish in color. As a result of irritation, the stratum corneum of the epidermis is rejected and erosive papules (syphilis papulosa erosiva) are formed. If a secondary infection joins, ulcerative papules (syphilis papulosa ulcerosa) occur. Often worried about itching, soreness. In areas of the skin with friction and prolonged irritation (folds, perineum, anus, genitals), due to the growth of the papillary dermis, weeping papules increase, become red-bluish in color. They have a wide dense base, a bumpy surface, a grayish coating. Hypertrophic vegetative papules, wide condylomas (condilomata lata) are formed. Separate papules as a result of irritation increase in size, merge and turn into extensive plaques with scalloped outlines. A plaque-like papular sifidid (syphilis papulosa laminoideus) is formed. Subjectively itching.
Coin-shaped (nummular) papular syphilis(syphilis papulosa nummularis). It is observed in patients with secondary recurrent syphilis. Papules appear in small numbers on any part of the skin. They are grouped, large, regular round shape with a pronounced infiltrate, the color of "raw ham" (bluish-red). There is slight peeling on the surface. After the resolution of coin-like papules, a long-lasting brownish-dark (black) pigmentation remains. Often, combined with roseola, lenticular and pustular syphilis.
Corymbiform syphilides(syphilis papulosa corymbiformis). A large, coin-shaped papule appears, surrounded by randomly scattered small papules. In appearance, it resembles a picture of an exploding bomb or shell ("bomb", "blasting" syphilis, "bomben syphilid").
Cockade papular syphilis(syphilis papulosa en cocarde). One large papule is surrounded by a corolla of infiltrate, consisting of merged small papules. At the same time, a strip of normal skin resembling a cockade remains between the central papule and the corolla of the infiltrate.
Papular syphilis of the palms and soles, palmoplantar syphilis(syphilis papulosa palmaris et plantaris). It is observed in secondary fresh syphilis, but is more common in secondary recurrent. Initially, red-violet-yellow papules appear on the palms and soles with dense infiltration at the base, which do not rise above the level of the skin. Dense scales appear on their surface. In the central part, the stratum corneum cracks and a collar-shaped peeling ("Biett's collar") is formed. Papules the size of lentils, flat, dense, yellowish-red or reddish-brown, clearly demarcated, without signs of inflammation.

There are clinical varieties of palmar-plantar syphilis.

Lenticular type (syphilis papulosa lenticularis palmaris et plantaris) - papules the size of lentils, dense, red-yellow in color with horny scales on the surface.
Ring-shaped type (syphilis papulosa orbicularis palmaris et plantaris) - nodules are arranged in the form of garlands, arcs, rings, sometimes have bizarre outlines. The presence of such rashes is a sign of recurrent syphilis.
Horny type (comua syphilitica) - rounded papules with a stratum corneum on the surface and in appearance resemble an ordinary corn. At first they are stagnant red, soft consistency. In the future, the stratum corneum thickens in the form of a callus (clavus syphilitica) or a large wart (verruca syphilitica).
Wide type (syphilis papulosa en nappe) - rounded or irregular plaques of various sizes up to 5-6 cm in diameter are formed with thick horny layers on the surface. This variety is extremely rare.
Ragadiform papules (syphilis papulosa rhagadiformis) - papules are located in the natural folds of the skin (corners of the mouth, nasolabial, interdigital folds), where deep painful cracks form. A persistent flow (constant mechanical irritation) is characteristic.

Differential diagnosis of papular syphilis

Psoriasis. Rashes are localized on the extensor surfaces of the elbow and knee joints, the scalp. It is characterized by a chronic course with frequent relapses. The papules are pink in color and tend to grow and merge with subsequent plaque formation. Abundant, silvery-white scales, cracks are noted on the surface. When scraping the surface of the papules, symptoms characteristic of psoriasis are revealed: "stearin stain", "terminal film", "blood dew". In the progressive stage, new rashes appear in the places of trauma (Kebner's symptom, "isomorphic reaction"). The nail plates are affected - turbidity, longitudinal and transverse furrows, pinpoint impressions ("thimble" symptom).
Lichen planus. Characterized by a chronic course. Rashes are localized on the flexion surfaces of the limbs, torso, mucous membranes of the mouth and genitals. Papules are bluish-red with a violet tint, polygonal, dense, flat, with an umbilical depression in the center. When lubricating the surface of the papules with water or liquid paraffin, a transverse striation in the form of a grid is determined (Wickham's symptom). Subjectively severe itching.
Hemorrhoids (varices haemorrhoides). In the anus, varicose hemorrhoidal veins are noted in the form of soft nodes of a red-bluish color, prone to bleeding. Their surface is smooth and covered with a mucous membrane of the rectum. There is no infiltrate at the base. Subjectively painful.
Genital warts (condi lomata acuminata). Localized in the genital area, anus, perineum. They consist of small individual lobules in the form of a "cockscomb". On the surface papillary growths (reminiscent of "cauliflower"), which are located on a thin stalk. They are pink-red, soft, and bleed easily. As a result of mechanical friction, they can erode. The disease is viral in nature with an incubation period of 7 weeks to 9 months. Predisposing factors are discharge from the urethra, vagina, rectum (gonorrhea, trichomonas, chlamydia, etc.), which contribute to maceration and skin irritation.

Pustular (pustular) syphilide

A rare manifestation of the secondary period of syphilis and indicates a severe and malignant course. The appearance of pustular rashes is accompanied by disorders of the general condition (fever, headache, irritability). It is observed in patients with concomitant diseases (hypovitaminosis, malaria, tuberculosis, Botkin's disease) and intoxications (alcohol, nicotine). There are superficial pustular syphilis (acne-like, smallpox, impetiginous) - in patients with secondary fresh syphilis and deep (ecthymoid, rupioid) - are observed during relapses of the disease.

Acne (acneiform) syphilide
Frequent manifestation of pustular syphilis in secondary fresh syphilis. Usually associated with roseola and papules. Differs in the distribution and abundance of rashes throughout the body (acne syphilitica disseminata). Sometimes accompanied by fever. It is characterized by a slow course, meager rashes, the temperature does not rise (acne syphilitica conferta). Localization of rashes is associated with the sebaceous glands and hair follicles (scalp, forehead, chest, interscapular region). The appearance of a rash may be preceded by fever, chills, arthralgia. Clinically, pinhead-sized follicular papules are demarcated from healthy skin. At the top of the papule, a conical or spherical pustule 0.2-0.3 cm in diameter is determined with purulent exudate, which shrinks into a yellowish-brown crust. After 1.5-2 weeks, the crusts fall off and barely noticeable, depressed, pigmented scars remain. Rashes exist up to 1-2 months.
Differential diagnosis of acneiform (acneiform) syphilis
Papulonecrotic tuberculosis. Mostly occurs in adolescence. A feature is a long chronic course. In patients with tuberculosis of the lymph nodes, lungs, flat, dense, superficial or deep, pale pink nodules with necrosis in the center appear on the extensor surfaces of the limbs, face, buttocks. After their resolution, "stamped" scars remain. Tuberculin tests are positive. Acne iodine and bromide. Anamnesis data (taking medications containing iodine, bromine) help in the correct diagnosis. The rash is localized mainly on the face, neck, shoulders, buttocks. Large pustules appear with an acutely inflammatory corolla along the periphery, at the base of which there is no dense infiltrate, as well as erythematous, bullous, nodular, urticarial elements. There is a rapid regression of the manifestations of the disease after discontinuation of iodine or bromine preparations.
Smallpox pustular syphilis
Rashes are localized on the face, trunk, flexion surfaces of the limbs. In the amount of 10-20, pea-sized spherical or hemispherical pustules appear with an umbilical depression in the center and serous-purulent contents, along the periphery of which there is a copper-red delimited infiltrate. After 5-7 days, the content shrinks into a crust, which is located on an infiltrated base, and in this form the element exists for a long time. Scars do not remain, but sometimes a superficial scar is formed. The emergence of new elements occurs within 5-7 weeks. Often there is general weakness, moderate fever.
Differential diagnosis of pox-like pustular syphilis
Chicken pox. After prodromal phenomena (malaise, headache, loss of appetite, runny nose, cough), round or oval pink-red spots up to 2-4 mm in diameter appear on the scalp, trunk, inguinal and axillary areas, from single to several hundred. They transform into papules. Some turn into single-chamber vesicles with transparent contents. Vesicles dry up and yellow-brown crusts form.
Impetiginous pustular syphilis
It is detected in secondary fresh syphilis with spotty and papular rashes. Dense dark red papules up to 1 cm or more in diameter appear on the scalp, face, chest, back and flexor surface of the limbs. In the center, a superficial pustule with an infiltrate forms, which shrinks into yellowish-brown layered crusts surrounded by a dark red corolla. As a result of the constant flow of exudate from the depths of the pustule, the crust rises and reaches a significant size. After regression, a superficial pigmented scar remains. At the bottom of the pustule, the papillary layer can grow with the formation of warty, vegetative granulations (syphilis framboesiformis).
Differential diagnosis of impetiginous pustular syphilis
Vulgar impetigo. Children are sick. It is characterized by a rapid onset of the disease and the spread of rashes in open areas of the body (face, hands, shins, feet) in the form of flat conflicts with light, then cloudy contents and a rim of hyperemia along the periphery. The content shrinks with the formation of dirty gray crusts, which fall off leaving a depigmented spot. Conflicts tend to merge and form large foci with irregular outlines. With the appointment of therapy, the rashes regress after 1-2 weeks.
Syphilitic ecthyma
Severe malignant form of pustular syphilis. Occurs 5-8 months after infection, as well as at a later date of secondary recurrent syphilis. Often accompanied by general malaise, fever, bone and muscle pain, purulent iritis and other disorders. It can be observed with secondary fresh syphilis simultaneously with spotty and papular rashes. Rashes are localized on the lower extremities, especially on the shins, less often on the face, trunk, where a deep large pustule appears with regular or rounded outlines and a copper-red infiltrate along the periphery. The pustule dries into a dense, grayish-brown or black crust, which, as it were, is immersed to one or another depth - superficial and deep ecthymas (ecthyma syphiliticum superficiale et ecthyma syphiliticum profundum). After removing the crust, a deep ulcer with steep edges and surrounded by an infiltrated, dense, dark red roller is exposed. At the bottom of the ulcer, yellowish-gray necrotic masses and purulent discharge are noted. Elements appear in a small amount (no more than 6-8), asymmetrically arranged, prone to peripheral growth and decay. When healing, a pigmented scar remains.
Differential diagnosis of syphilitic ecthyma
Vulgar ecthyma. Persons of young age are ill. More often on the lower leg there is a bubble with purulent or purulent-hemorrhagic contents and the presence of an acute inflammatory reaction of the skin around. There is no dense infiltrate at the base of the pustule. After opening, a yellowish-dirty crust is formed, which, when rejected, reveals a rounded ulcer (ecthymatous ulcer) with steep edges and purulent masses at the bottom. With early and adequate treatment, the ulcer scars within 1-2 weeks, followed by the formation of a scar.
Syphilitic rupee
It is a type of ecthyma. Occurs in the late stages of secondary recurrent syphilis, not earlier than 2-3 years after infection. May be combined with other syphilides. Accompanied by significant violations of the general condition. It is located on the limbs, torso, less often on the face, head. A single, massive, layered, cone-shaped crust is formed up to 2 cm high and up to 5-6 cm in diameter, which is initially dirty brown in color, and then brown-black (reminiscent of an oyster shell). After removing the crust, a deep ulcer with sheer, infiltrated edges and a bloody-purulent bottom is revealed. There are 3 zones: in the center - a rupioid crust, along the periphery - a roller of papular purple-red infiltrate, and between them - an annular zone of ulceration. It is characterized by a slow course and a tendency to spread both in depth and along the periphery. After healing, a deep pigmented scar remains. The clinical picture of the rupee is typical and difficult to confuse with other dermatoses.

Vesicular (herpetiform) syphilis

A rare and severe form of the secondary period of syphilis. It can occur both in secondary fresh and secondary recurrent syphilis. Possible combinations with papular, impetiginous syphilis, wide warts, as well as tuberculous rashes of the tertiary period of syphilis. Difficult to treat. Has a tendency to relapse. It is noted in persons with reduced reactivity after suffering or concomitant diseases (Botkin's disease, tuberculosis, malaria). Round, reddish plaques (merged papular elements) up to 10-20 mm in diameter appear on the trunk, limbs, and face. Small grouped vesicles with serous contents are noted on the surface. The bubbles open and small erosions are formed, which are covered with layered crusts, which occurs as a result of the successive drying of the seeping liquid. After the crusts fall off, small pigment spots and scars remain.

Differential diagnosis of vesicular (herpetiform) syphilis

Simple vesicular versicolor. The appearance of rashes is preceded by burning, soreness, itching, after which grouped vesicles with transparent contents appear on the edematous hyperemic skin, which become cloudy after a few days. After opening the bubbles, pink erosions are formed with small scalloped outlines and serous discharge on the surface. Subjectively itching, burning, soreness. It is characterized by a chronic relapsing course.
Pemphigus vulgaris. The mucous membrane of the mouth and the red border of the lips are primarily affected. Then, after 1-9 months or more, the skin is involved in the process. Small or large bubbles with a flabby tire appear, which quickly open up and form bright red, weeping erosions with a grayish coating. The symptom of N.V. Nikolsky (1896) is positive. Microscopic examination in smears-imprints from the bottom of erosions reveals Tzank cells. Without treatment, the disease progresses and the rash becomes generalized. The general condition is broken. Gastrointestinal and nervous disorders occur. Loss of protein (plasmorrhea) and intoxication lead to cachexia, and the latter to death.

Syphilitic leukoderma (syphilis pigmentosa)

It is observed in secondary recurrent syphilis and occurs for 4-6 months of the disease, less often in the second half of 1 year of the disease. It exists for a long time and disappears after 6-12 months, and sometimes after 2-4 years even after antisyphilitic therapy. It is more commonly seen in women than in men. Often combined with syphilitic alopecia and other manifestations of the secondary period of syphilis. Preferential localization on the back and side of the neck ("necklace of Venus"), on the front wall of the armpits, upper chest, abdomen, back, lower back, limbs. Against the background of somewhat hyperpigmented skin, round or oval depigmented spots appear from 3-4 to 10 mm in diameter, the number of which gradually increases. Syphilitic leukoderma does not cause subjective sensations, does not peel off. Patients often show changes in the cerebrospinal fluid, and therefore many authors believe that the presence of syphilitic leukoderma indicates deep neurotrophic disorders in the body.
There are three types of syphilitic leukoderma:

spotted- large white spots are isolated from each other and surrounded by a wide halo of hyperpigmented skin, do not tend to merge.
Mesh(lace) - a large number of white spots appear, prone to increase and merge. Narrow grayish stripes remain between the spots, which resemble a mesh or lace.
Marble- against the background of slightly hyperpigmented skin, weakly expressed borders between depigmented spots and surrounding skin are revealed, which acquires a characteristic appearance of "dirty" skin.

Differential diagnosis of syphilitic leukoderma (syphilis pigmentosa)

Vitiligo. There are single or multiple depigmented spots of various shapes and sizes, ivory, prone to peripheral growth. On the edge of the thickening of the pigment (brown border). The hair in the lesions becomes discolored. Under the influence of solar insolation, new, previously not noticeable foci of depigmented skin may appear.
Secondary leucoderma. It can occur at the sites of rashes with pityriasis versicolor, where depigmented spots of various sizes and shapes are formed, which merge into foci with scalloped outlines. Near areas of depigmentation, light brown, pink spots with slight peeling can be found. After lubrication with iodine (Balzer test), the affected areas are more intensely stained compared to healthy skin.

Syphilitic alopecia (syphilitic alopecia)

A characteristic symptom of secondary recurrent syphilis, but can often occur with secondary fresh syphilis. With syphilitic alopecia, the skin in the foci does not peel off, without signs of inflammation, the follicular apparatus is preserved. There are no subjective sensations. Without antisyphilitic treatment can exist for a long time. After the appointment of specific therapy, hair loss stops in 10-15 days and they gradually grow back over several months.
There are 3 varieties of syphilitic alopecia.

Small focal alopecia
On the scalp in the occipital and temporal regions, less often - on the beard, eyebrows, eyelashes, a large number of small foci of baldness appear. They are irregularly rounded, not prone to fusion, up to 10-15 mm in diameter. In the foci of alopecia, there is a sharp thinning of the hair. Not all hair falls out. Therefore, the scalp resembles "moth-eaten fur." Hair loss in the area of \u200b\u200bthe eyelashes is called "omnibus" or "tram" syphilis. As a result of partial loss of eyelashes and the successive growth of new ones, they are of different lengths - "stepped" eyelashes (Pinkus sign). Differential diagnosis of alopecia areata
Alopecia areata. The centers of alopecia are large, correctly rounded with clear boundaries, in the amount of 1-3. Hair is completely absent. On the periphery are easily pulled out. The skin is smooth, shiny, reminiscent of a billiard ball. Superficial trichophytosis of the scalp. Children of school age are ill. Foci of various sizes and irregular foma, indistinct. Mild inflammation and desquamation are noted. The hair is broken off at the level of the skin ("black dots") and at a distance of 2-3 mm from the surface of the skin, healthy. Trichophyton tonsurans is found. Superficial microsporia of the scalp. Children are sick. Foci of irregular shape, erythematous-scaly, with fuzzy edges. The hair is broken off at a distance of 5-8 mm above the skin level. They appear to be healthy. Fragments of hair are surrounded by a gray sheath (fungal spores). Microsporum ferrugineum is found.

diffuse alopecia
Acutely there is a continuous thinning of the hair without changing the skin in the temporal region and subsequent spread.
Differential diagnosis of diffuse alopecia
Favus of the scalp Erythematous spots appear on the scalp, which after 15 days turn into scooters. Skutula is a saucer-shaped, dry, bright yellow element, 2-4 mm in diameter, in the depressed center of which a hair sticks out. Hair dull, ash-gray. The outbreaks are spreading. After regression - atrophy, persistent hair loss. A "mouse" ("barn") smell emanates from patients. The fungus Trichophyton Schonleinii is found.
Mixed syphilitic alopecia
The combination of small-focal alopecia with diffuse.

Syphilitic lesions of the mucous membranes

Spotted (macular, roseolous) syphilide of mucous membranes
Rashes are localized on the arches, soft palate, tonsils, buccal mucosa in the form of separate, round, symmetrical, bluish-red spots with a smooth surface, 3-5 mm in diameter. May be associated with patchy, papular skin rashes. At the confluence, extensive continuous lesions (syphilitic erythematous angina, angyna erythematosa syphilitica) can form, which acquire a stagnant red color with a copper tint, have a smooth surface, clearly defined borders and slightly rise. Subjectively slight soreness and awkwardness when swallowing. If edema appears with erythematous angina, then a more persistent form of the lesion occurs with a protracted course, which is referred to as angyna syphilitica erythematosa infiltrata. With the formation of a superficial infiltrate, the lesions acquire a grayish color (plaques opalines), which is a transitional form of erythematous and papular syphilis. Due to desquamation of the epithelium, erosions occur on the surface of the rashes with localization on the lips, tongue, gums, mucous membranes of the external genital organs. They are round or oval in shape, 2-5 mm in size, with a red or grayish-white surface, a small serous discharge, clear boundaries.
Differential diagnosis of spotted (macular, roseolous) syphilis of mucous membranes
Banal catarrhal angina. Sudden start. Subfebrile temperature, general weakness, headache, malaise, pain when swallowing are noted. An objective examination of the tonsils hyperemic, edematous. Lymph nodes in the area of the angle of the lower jaw and along the anterior edge of the sternocleidomastoid muscle are enlarged, painful.
Toxidermia fixed. Erythematous spots appear on the oral mucosa, oval in shape, 2-3 cm in diameter. Bubbles or blisters appear in the center of some, which then open with the formation of painful erosions. Rashes simultaneously appear on the skin, external genitalia, in the anus. In history, the relationship of the occurrence of a rash after taking medications (sulfonamides, penicillin, tetracycline), after the abolition of which the process regresses within 7-10 days. With widespread toxidermia, the general condition is disturbed - fever, chills, coma, dyspepsia. In the case of repeated administration of the same drugs, the process recurs in the same areas, but can also be localized in others.
Papular syphilide of mucous membranes
The most common manifestation of the secondary period of syphilis is on the oral mucosa. Papules occur on the tonsils, arches, soft palate and are located focally. They are rounded, up to 10 mm in diameter, with a smooth surface, dense texture, delimited. The color of the papules is dark red with a bluish tinge. Usually papules do not rise above the level of the mucous membrane ("opal plaques" - the term of the French authors), painless. After some time, the epithelium covering the papule is saturated with exudate and the papule becomes grayish-white with a red rim around the periphery. When plaque is removed from the surface of the papule with a spatula, red erosion is exposed, in the discharge of which a large number of pale treponemas are found. When the papules are irritated by spicy food, teeth, alcohol, they increase along the periphery, merge and form yellow-white plaques with scalloped outlines, which are eroded. Erosions can turn into painful dirty gray ulcers with an uneven surface and purulent plaque, which are often accompanied by bleeding. There are papulo-erosive (syphilis papulo-erosiva mucosae) and papulo-ulcerative (syphilis papulo-ulcerosa mucosae) syphilis of the mucous membranes. With prolonged trauma, the papules hypertrophy and the surface becomes uneven, granular, dirty yellow (white) in color. Sometimes red (white) vegetations appear on the surface of the papules, which, with prolonged irritation, take on a tumor-like appearance (syphilis papulosa mucosae vegetans). When localized on the back of the tongue, syphilitic papules differ in their appearance. In some cases, in the area of the papule, the filiform papillae of the tongue are clearly expressed and the papule protrudes above the mucosa in the form of uneven gray foci. However, more often filiform papillae are absent, papules are pinkish-bluish, oval or irregular in shape, their surface is smooth ("polished"). They are located, as it were, below the level of the mucosa - plaques of a "sloping meadow", "glossy" papules, "alopecia of the tongue". With folded glossitis, papules are localized in the region of crests of folds - the furrows of the tongue deepen, the edges thicken, they become V-shaped, resembling deep cracks. Most often, with secondary recurrent syphilis, papules are located on the tonsils (syphilitic papular tonsillitis, angina papulosa syphilitica). In the mouths of lacunae, they look like a whitish coating, resembling nonspecific tonsillitis. In most cases, papules merge and cover the vast surfaces of the tonsils with a transition to the arches surrounding the mucous membrane (soft palate, lateral columns of the pharynx, retromalar space).
Differential diagnosis of papular mucosal syphilis
Diphtheria. Acute infectious disease. It is manifested by fibrous inflammation of the upper respiratory tract at the sites of infection and toxic damage to the cardiovascular, nervous and other systems. The incubation period is from 2-5 to 10 days. The throat, larynx, bronchi, nose, conjunctiva, oral and genital mucosa, and skin are often affected. An acute onset is characteristic - malaise, headaches, intoxication, decreased appetite, fever up to + 38 + 39 ° С. There is a bilateral increase in regional lymph nodes - dense, painful, not soldered to the underlying tissues, the size of a hazelnut. On the tonsils and pharynx, there is hyperemia, edema, a fibrous film tightly soldered to the underlying tissues, which is not removed, and when you try to remove it, bleeding occurs. Characterized by a progressive course. Fibrous plaques pass to the arches, tongue, back wall of the pharynx, nasal mucosa, larynx. Lymph nodes are enlarged. Intoxication increases and the disease turns into severe widespread diphtheria.
Leukoplakia. On the buccal mucosa, mainly in the corners of the mouth, lower lip, less often on the tongue, due to prolonged chemical irritation, a rounded plaque of various sizes is formed without signs of inflammation with a grayish-white coating on the surface, which is not removed by scraping. Characterized by a chronic course. In the secondary period of syphilis, in particular with secondary recurrent syphilis, damage to the larynx (syphilitic laryngitis) is noted. Its main symptom is prolonged painless hoarseness, reaching up to aphonia in the absence of colds.
Catarrhal syphilitic laryngitis
Uniform congestive hyperemia of the mucosa with a brownish tint is determined. True and false folds are slightly thickened and do not close completely. During phonation, a gap remains. There is hoarseness and in some cases even aphonia (manifestation of spotted syphilis) in the absence of acute inflammatory phenomena. Antisyphilitic treatment leads to a rapid clinical effect. Catarrhal specific laryngitis may be the first symptom of secondary syphilis, for which patients are unsuccessfully treated by therapists, otolaryngologists.
Papular syphilitic laryngitis
In the area of the free edge of the epiglottis, laryngeal surface and scoop-epiglottic folds, single, flat, oval, grayish-white papules 3-7 mm in diameter appear, elevated, not prone to erosion and ulceration. When papules occur against the background of laryngitis, hoarseness is noted. Papular laryngitis may be the only manifestation of recurrence. In the process of treatment, hoarseness decreases and the voice is restored after 1-1.5 months. In the diagnosis of syphilitic rashes on the oral mucosa, the presence of other clinical manifestations of secondary syphilis on the skin is important. In the malignant course of the secondary period of syphilis, pustular-ulcerative elements may appear on the soft palate, tonsils and other areas. They look like large edematous infiltrates. After disintegration, a rounded or irregular deep ulcer is formed with purulent discharge and necrotic masses on the surface. Part of the soft palate may be destroyed. There is fever, painful and difficult swallowing.
Pustular-ulcerative syphilis
There are painful solitary deep ulcers with a limited compacted base, undermined edges, 4-15 mm in diameter, with an uneven bottom, yellow-gray purulent decay. The ulcer increases along the periphery. After the regression, a sunken, irregularly shaped scar remains.

In recent years, some features of the clinical course of the secondary period of syphilis have been observed. Poor symptoms - single papules on the oral mucosa. Not a typical clinic - frequent localization of papules only on the genitals and in the perianal region. Peeling of papules by the type of "wafer". Cases of the appearance of only hypertrophic papules in the vulva. Frequent erythematous-papular tonsillitis. Early terms of the appearance of specific alopecia and leukoderma. Cases with a characteristic clinic, but negative serological reactions, which often become positive only in the course of treatment.

The current course of secondary fresh syphilis: polymorphic (roseolous-papular, roseolous-pustular) rashes occur more often; there is abundant confluent roseola with subjective sensations (itching, burning, soreness); spotted rashes appear on the face, palms, soles; cases of papular rashes on the palms and soles (especially in women) have become more frequent, wide warts have become less common; increased cases of atypical lesions of the oral mucosa (lack of clear boundaries, infiltration, painful rashes); polyadenitis is mild or absent; often there are features of the dynamics of standard serological reactions - negative CSR and positive RIF, RIBT.

The current course of secondary recurrent syphilis: the clinical manifestations of early relapses are similar to both manifestations of secondary fresh and recurrent syphilis; a bright, profuse, small, monomorphic rash is more common; cases of papular and erosive-ulcerative rashes on the genitals, scrotum and in the anogenital region have become more frequent; pustular rashes in weakened people occur on unchanged skin, followed by the formation of a specific infiltrate.

The above features of the clinical picture of the secondary period of syphilis cause difficulties in the differential diagnosis of secondary fresh and secondary recurrent syphilis, are the cause of diagnostic errors and therefore, when making a diagnosis, serological reactions using RIF, RIBT are of great importance.

A feature of syphilis is that the patient may first suspect this disease in himself only after the symptoms of the secondary stage have appeared. This is because during the initial stage of the disease, symptoms may disappear even without treatment.

The sooner the disease is diagnosed, the more successful the treatment will be. Secondary syphilis begins at the time of the spread of pale treponema throughout the body. What are the symptoms, consider in more detail.

Often, secondary syphilis begins with a general malaise, which can be similar to the common cold or SARS. This is due to the fact that the spirochete bacterium has already spread throughout the body through the blood, that is, the general intoxication of the body has begun. Symptoms may be:

Body aches;
Hyperthermia (increased body temperature);
Headache;
Twists joints;
Minor muscle pain;
Chills;
Cough;
Runny nose.

syphilides

roseola. Changes occur in the vessels. Pinkish spots appear all over the body. Gradually, the rash may become slightly pale or become bluish. It is not inflammatory in nature. They are oval or round in shape. The rash is the same up to 1.5 cm, scattered throughout the body. The outlines are indistinct. The surface is smooth. The spots are not peeling. Appear gradually at 10 pieces per week. After maturation, they turn brown, then disappear under the influence of immunity. There are other types:
Flaky - sinks in the center, covered with lamellar scales;
Rising - similar to a blister in that it rises above the level of the skin;
On the mucous membranes - it is delimited from normal tissue, they have a red or cyanotic color, but are poorly visible on the genitals;
Papular. A large concentration of spirochetes in the foci of inflammation. Dense elastic dermal papules that protrude above the skin are rounded. The borders are clear, sizes up to 5 mm are copper-colored. At first they are smooth, shiny, but gradually peeling begins from the center of the papule, gradually moving towards the edges, this phenomenon is called Biett's collar. After maturation, brown hyperpigmentation remains for a long time;
Seborrheic - the so-called crown of Venus, which is located on the border of the hair on the head. It also manifests itself where the content of the sebaceous glands is increased: the scalp, the area of \u200b\u200bthe mouth and nasolabial triangle. Miliary papular syphilis is characterized by small nodules in the sebaceous glands. The size of a grain of millet up to 2 mm. It differs from seborrhea with a brownish border, density, and the absence of oily peeling. Poorly treatable, so it stays on the body for a long time;
Lenticular is the most common form. Smooth seals look like a truncated cone, similar in size to lentils. Yadasson's symptom is manifested by sharp pain when pressing on the center of this papule. They appear profusely throughout the body. Often symmetrically located on the face, head;
Coin-shaped - large rounded nummular papules look like five-kopeck coins. Quite dense single formations, prone to grouping, have a brown or bluish-red color. After them there are scars, pigments;
Psoriasiform - on the surface of the papules, silvery-white lamellar scales resembling a psoriasis rash, but more dense;
Syphilis of the palms and soles is a symptom that looks like calluses. Nodules crack during growth, this leads to the appearance of a border along the edges;
Wide warts - due to constant friction and high humidity, they appear around the anus, genitals, in the folds. Merge with each other, grow above the surface of the skin in width and height in the form of large eroded tubercles;
Vesicular. A lot of bubbles appear with a clear liquid inside on the surface of a reddish plaque. Vesicles burst, then erosions appear and after they dry, crusts form. After curing syphilis, there are many scars on pigmentation;
Pustular. Rarely seen in severe immunocompromised forms of syphilis. It looks like dermatoses, but differs in that there is a characteristic copper-red roller along the edges;
Acne - conical pustules with a dense base in the hair follicle. The dried crust disappears after a while, a scar appears;
Smallpox - pustules the size of peas appear in debilitated patients with syphilis in small quantities. It looks like smallpox after drying out, then an atrophic scar remains;
Impetiginous - suppurates in layers, sometimes reaching huge corrosive sizes. But after the cure, there remains a disappearing pigmentation;
Ecthyma - layered dense thick pustules reach a size of 3 cm. If you tear off the crust, an ulcer with blue edges will appear;
Rupiah is a variety of ecthyma 3 to 5 cm in size. A large ulcer is covered with a dirty cone-shaped crust;
Nail - pustules form on the nail and near the nail fold.

Leukoderma

Appears on the neck, called the necklace of Venus. Symptom in the form of spots, have a round or oval shape. The pigment is whitish in color, then increases, but then fades over time. It is formed due to a violation of pigment formation. Most patients with syphilis with this symptom have pathologies of the spinal cord. There are three forms:

Spotted - spots are located separately from each other;
Lacy - merge with each other and, due to the different stage of formation, look like lace;
Marble - if the pigment around the colorless spots is not very pronounced.

Peeling does not occur, acute manifestations too.

Alopecia

Abnormal hair loss is called alopecia. This symptom is not only on the head - on the eyelashes, mustache, eyebrows, etc. This is due to the fact that pale treponema with syphilis disrupts the nutrition of the hair. Happens:

Small focal. The hair falls out in chunks on the head. The spots are mainly on the temples and the back of the head;
diffuse. It starts from the temples, the whole head gradually grows bald. This happens in very severe cases of the disease;
mixed;
On the eyebrows - omnibus syphilides;
On the eyelashes - stepped (sign of Pinkus).

Lymph nodes are enlarged throughout the body. The symptom is caused by the fact that syphilis moves along with the lymph and blood. Spirochete begins to multiply diligently precisely in the lymph nodes.

Nervous System Disorders

Syphilis affects blood vessels, membranes of the brain. This can lead to meningitis. Neurosyphilis is manifested by a violation of the autonomic nervous system. A person can become inadequate, lose orientation in space. Possible memory loss. Increased aggression also takes place.

Bones and joints

With secondary syphilis, disturbances in the bone apparatus begin. Appears:

Pain - in the bones and joints;
Hydroartosis - joints swell, the skin on them turns red;
Periostitis - inflammation of the periosteum;
Osteoperostitis is inflammation of the eye socket.

At this stage, changes in the internal organs begin. The liver, heart, stomach and kidneys are usually affected. But if left untreated, irreversible changes will also appear in other organs.

Conclusion

Symptoms do not appear the same at different periods of secondary syphilis. Separate the early, latent and recurrent periods. In the early period, the rash appears abundantly and is localized throughout the body. During the latent period, the disease, due to the work of the immune system, is suppressed, and the manifestations become invisible. Then a relapse appears - the rash has a paler color, manifests itself in smaller quantities.

Periods of latent and recurrent secondary syphilis can be repeated repeatedly over 5 years.

If no treatment measures are taken during this period, the disease turns into tertiary syphilis. His scary photos can be found on the Internet, and then changes begin that cannot be cured. Therefore, be attentive to yourself and your loved ones - be treated on time.

Secondary syphilis begins some time after the primary disease. Pale treponema affects 80% of the skin, spreads to mucous membranes and affects the functioning of internal organs. The infectious process seriously affects the patient's quality of life.

What is secondary syphilis

To make it easier to understand what secondary syphilis is, let's analyze the stages of the pathology. Violation proceeds in 4 stages:

Incubation. After infection, it may take 2-3 weeks before the patient notices discomfort and symptoms of syphilis.
Primary. Treponema contributes to the formation of a hard chancre. In the next week, the reactions of the nodes of the lymphatic system will join it.
Secondary. Begins a few months after infection. Extensive rashes appear on the body due to the spread of treponema throughout the body. The capillaries begin to undergo an inflammatory reaction.
Tertiary. In the body there is a strong inflammation or syphilitic gum. Healthy tissues are destroyed and serious defects are formed, such as the destruction of the palate or the collapse of the nose.

It is best to start treating syphilis at a latent stage, but at this stage only a doctor can detect it.

The tertiary form of inflammation ends in severe disability or failure of vital organs.

Secondary syphilis occurs due to untimely initiation of treatment. A few months after the appearance of pale treponema in the body, symptoms of the disease appear. In rare cases, the secondary stage is asymptomatic. In the body, the infection can live up to 5 years.

Relapse is dangerous because it is easily transmitted from one person to another. Even in the absence of sexual contact, there is a risk of infection of loved ones. It is possible to transmit treponema through personal hygiene products. For example, through linen, a toothbrush, a washcloth and other things. Symptoms of secondary syphilis will be acute, so the patient should seek medical attention as soon as possible if discomfort is detected. Medical assistance is provided in a hospital setting.

The secondary form is characterized by profuse skin rashes. At this time, treponemas affect the circulatory and lymphatic systems, spreading throughout the body.

Signs and symptoms of secondary syphilis

An aggravation of the disease is easy to detect, as a rash spreads throughout the body. However, skin lesions should not be neglected, since the same changes occur with the internal organs of a person. First of all, the gastrointestinal tract suffers, then the functioning of the respiratory, reproductive systems and visceral organs is disrupted.

The main symptoms of secondary syphilis are:

rash on mucous membranes and skin;
change in skin color;
syphilides (inflammatory elements) on mucous membranes and skin;
hair loss.

An asymptomatic form of sexually transmitted disease occurs in patients who use strong antibiotics to treat a disorder. The medications previously prescribed by the doctor are not able to completely eliminate treponema, so the infection proceeds in a latent form.

Rash

Most patients have spotted syphilis, a red-pink rash on the skin and mucous membranes throughout the body. Most redness is observed on the sides and abdomen.

Each spot (roseola) has a diameter of 2 to 15 mm, the rashes do not merge with each other and have a clear line. On palpation, pain is felt, but there should be no itching or fever. The surface of the spot does not form a build-up, so it practically does not protrude above the skin. When pressed on the roseola, it turns pale and becomes a normal skin color. Even during the period of therapy, the skin does not peel off, this is a distinctive feature of the rash with syphilis.

Roseolas appear rather slowly, their distribution period is 2-3 days. With secondary syphilis, the spots are asymmetrical and large. The rash may group into rings or other patterns. Roseolas stay on the body from several weeks to 3 months.

Then they disappear even without medical treatment, but this does not mean that the disease has passed. After some time, a relapse will reappear, which will aggravate the patient's condition.

Papular syphilis

Papular syphilide is a papule that appears due to the accumulation of cellular infiltrate and is located in the upper dermis. Inflammations protrude above the surface of the skin, have a round or oval shape. They have a dense texture and stay on the body for several months. Papules are located on the trunk, face, palms, mucous membranes, scalp and genitals.

Syphilis recurs through:

Miliary papular syphilis. The patient has small bubbles near the sebaceous glands. They are covered with scales, have a pale color and a dense texture. With syphilis, they are located mainly on the back, abdomen and chest. Miliary papular syphilis appears in immunocompromised people. This group includes people with chronic diseases and those who abuse alcohol. This type of rash is resistant to medicines, so it stays on the skin for a long time.
Lenticular papular syphilis. Rashes take the form of a shortened cone and a smooth surface. Their color can be pink, yellow or blue. When you press them, you feel a sharp pain. Papules are located on the head or neck, outwardly resemble psoriasis.
Numular papular syphilis. The appearance of large flat rashes about 2 cm in size indicates nummular syphilis. They will have a brown or blue tint, and may be combined with other types of rashes. After treatment at the site of the papules, there is a possibility of pigmentation or scarring, and skin atrophy may also occur.

Pupular syphilides are contagious because they contain a lot of pathogenic trace elements.

In this case, even shaking hands, kissing or hugging can cause infection with syphilis.

Pustular syphilis

Doctors note that in their practice, patients with pastular syphilis were extremely rare. The rash is diagnosed in people with pathologically low immunity or malignant tumors. Treponema depresses the general condition of the body, so the patient suffers from headache, weakness and fever.

Pustular syphilis has its own classification, it can be acne-like, impetigious, pox-like, and also have the form of syphilitic ecthyma or rupee.

Acne syphilis is located on the head, neck and upper body. Scanty rashes do not affect the general condition of the patient. The pustules are small and eventually form a crust that falls off on its own. Smallpox syphilis occurs in debilitated patients. Pustules do not exceed the size of a pea, they can easily be confused with smallpox.

Impetiginous syphilis has a brown tint, rashes can suppurate, and then shrink into a crust. The pustules are large and may merge with each other. Syphilis is located on the hairy areas of the body and heals for a long time. At the site of the formation of pustules, age spots will remain, with time they will pass.

Sphilistic ecthyma is one of the most severe forms of the disease. It is observed in patients 5-6 months after infection. Large pustules reach a diameter of 3 or more centimeters. They are covered with a crust and have a large seal. Rashes rise above the skin, have a blue tint. This sign of syphilis occurs in pregnant women and men with immunodeficiency. The photo on the right shows what ecthyma looks like.

The rupee reaches a diameter of 5 cm. From a deep ulcer, blood or pus will periodically be released. During the progression of syphilis, it occurs on the legs and is combined with other syphilides.

Alopecia

During syphilis, the rash can be combined with partial baldness. Hair begins to fall out due to the influence of treponema on the bulbs. Pathogenic microorganisms provoke inflammation of the follicle, in connection with this, the nutrition of the hair stops and it falls out.

Diffuse alopecia with syphilis is rare. During this, the hair falls out evenly starting from the temples. In addition, the hair becomes dry and looks like a wig.

Hair growth will resume a few months after the start of treatment.

Diagnosis of the secondary period of syphilis

The appointment of medications is possible only after compiling a complete clinical picture and conducting laboratory tests. Despite the fact that characteristic symptoms appear during syphilis, the doctor must verify the presence of a sexually transmitted disease and confirm the diagnosis.

For this purpose, a scraping is taken from the affected cavity. Biological material is examined under a microscope for the presence of treponema. An immunological study is also carried out, which allows you to determine the exact form of the rash.

Features of the treatment of secondary syphilis

Patients with a confirmed diagnosis are prohibited from having sex during treatment. Also, people with syphilis are advised to be more careful to prevent infection of those around them. A person should use a personal towel, cutlery, dishes and soap. If you have a sexual partner, it is recommended to sleep in different beds and avoid physical contact.

Few people can follow such rules, therefore, so that the disease does not affect other family members, patients are placed in a hospital.

Secondary syphilis is treated with antibiotics. For a quick effect and maximum relief of the state of health, drugs are administered intravenously. The most effective against treponema penicillin drugs. Injections with this component are done every 3 hours.

When treating at home, binicillin is prescribed. It is used 1 time in 2 days. In the presence of allergies or side effects, azithromycin, tetracycline, or doxycycline are prescribed. Treatment of secondary syphilis should be comprehensive, since strong antibiotics can adversely affect the condition of some internal organs. Therefore, in addition to them, immunostimulants, multivitamins and probiotics are prescribed.

To improve the functioning of the immune system, doctors may recommend methyluracil or pyrogenal. Multivitamin complexes are suitable for almost any.

Abundant skin rashes that appear during syphilis must be treated periodically.

For this, heparin ointment or chlorhexidine is used. Local preparations accelerate the process of resorption and healing.

Prevention methods

An advanced form of syphilis can lead to serious health problems. Therefore, everyone should study in advance preventive measures that help prevent the disease:

the use of barrier contraceptives during intercourse, they are needed regardless of whether vaginal, oral or anal sex is practiced;
the use of preventive drugs that improve the functioning of the immune system;
regular full medical examination and delivery of the necessary tests;
use of personal hygiene products;
refusal to visit a public bath, sauna or pool during a period of malaise.

There is also an urgent prevention of syphilis, it is used immediately after unprotected intercourse. In this case, it is necessary to urinate and rinse the genitals with a disinfectant. Immediately after that, visit the dermatovenerologic dispensary. Most of them work around the clock, so the examination is carried out at any time.

Syphilis can seriously affect your health, so if you have any suspicions, seek help from a doctor.

Secondary syphilis is a period that fully corresponds to the generalization of the infectious process. Pale treponema, which is localized in the lymph nodes, gradually enters the bloodstream and spreads through the bloodstream to other vital organs, as well as to new areas of the skin. The secondary period of syphilis is characterized by the appearance of such signs - a slight temperature, moderate pain in the muscle structures and joints (with a tendency to increase at night), weakness. Specific lesions characteristic of pathology appear in all areas of the human skin, most of the mucous membranes, as well as certain internal organs.

Periods

Secondary syphilis has 3 periods of development - fresh, latent (also called latent) and recurrent. Fresh secondary syphilis begins to progress immediately after the primary. It is characterized by an increase in the rash and the preservation of the remnants of a hard chancre. If you do not carry out the required and adequate treatment, then its symptoms can persist for 2-4 months. After this period, the disease flows into a latent form. All symptoms of pathology disappear. But if at this time a serological blood test is carried out, then its results will be sharply positive.

Further, after 1–3 months, secondary recurrent syphilis begins to progress. The first signs appear on the skin - a rash appears, but less abundant than during the fresh period. Appearance (hair loss) is also possible. A characteristic feature of this stage is syphilitic leukoderma. Unpigmented spots appear on the neck, the number of which increases with time. But there are no other signs that could begin to disturb a person. If the pathology is not treated again, then the latent period again sets in. The number of relapses, as a rule, reaches four.

In the case of further development of the secondary period of syphilis, a polymorphic protruding rash begins to appear on the skin, represented by pustular, papular and roseolous elements. Roseolous are localized mainly on the neck, so this symptom is called the "necklace of Venus." Papules are located on the palms, soles, chest, in the perianal region, and on the genitals.

Symptoms

The main signs of the general type of secondary syphilis (features of pathological elements):

dense structure;
subjective sensations are not noted;
dark red shade of pathological elements;
unexpressed peeling;
clear contours;
elements may spontaneously disappear.

General signs:

benign course;
high contagiousness of secondary syphilides;
serological reaction in secondary syphilis is sharply positive;
if secondary syphilis is treated in a timely manner, pathological syphilides quickly disappear.

Rash with secondary syphilis is of the following types:

roseolous syphilide. Symptoms of secondary syphilis of this stage are most often manifested in humans. The appearance of such pathological elements indicates that pale treponema began to spread throughout the body. On the skin, spots of a pale pink hue are formed, which do not have sharp outlines. The shape of the elements is most often rounded or oval. The maximum size is up to 1.5 cm. The spots do not rise above the surface of the epidermis, and also do not tend to merge. Localized mainly on the neck and lateral surfaces of the body;
papular syphilis. This stage is characterized by the formation of elastic round nodules, also referred to as papules. At first, the elements are smooth and have a natural sheen. But after a couple of days, the surface of the formations begins to peel off slightly. Papules do not have a specific localization, therefore they form on any part of the skin;
palmoplantar syphilis. One of the most common varieties of papular syphilis. On the surface of the soles or palms, thickened nodules are formed that resemble corns. They have an upward trend. As the formation increases, it can crack, which leads to the appearance of a specific border around the circumference. The similarity of such pathological formations with corns becomes the reason that a person does not go to the doctor in a timely manner;
syphilitic leukoderma. Such a manifestation is extremely rare at this time, but still takes place. Pathological elements form on the neck, so this symptom is called the “necklace of Venus”. Against the background of brownish darkening of the skin, oval light foci are formed.

Treatment

Therapy for secondary syphilis is aimed at eliminating the underlying disease, as well as the elements of the rash. Therefore, it must be only complex. The most effective method of treatment is the introduction of water-soluble penicillins. This enables doctors to maintain the optimal concentration of the antibiotic in the bloodstream.

Specific therapy is carried out for 24 days from the moment the pathology is detected. The drug is injected into the body every three hours. Therefore, it is advisable to hospitalize the patient in a hospital where doctors can monitor his condition. If the patient is allergic to penicillin, then resort to the use of alternative drugs.

It is also worth noting that during the treatment of secondary syphilis, it is also important to treat diseases that have developed against its background. It is important to increase the reactivity of the immune system, therefore, immunostimulating drugs are prescribed for this purpose. Doctors also adjust the patient's diet - it should include the required amount of vitamins, minerals and nutrients.

Prevention

Prevention of syphilis includes several main areas:

medical prophylactic treatment;
prevention during sex;
urgent prevention of syphilis. There is a certain preventive complex, which is more often carried out in dispensaries. It includes: immediate urination, washing the genitals with water and laundry soap, followed by wiping them with disinfectant solutions. Next, a solution of chlorhexidine or protargol is injected into the urethra;
protection against the transmission of syphilis by household means. Each person should use individual utensils, personal hygiene products. When visiting a bath or sauna, use only your personal belongings;
as a preventive measure, it is necessary to regularly donate blood for a serological test (with syphilis, the reaction is sharply positive - from one to four pluses), as well as visit a doctor for an examination (it is recommended to undergo a complete examination every six months).

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Diseases with similar symptoms:

A disease that is characterized by a violation of the integrity of the liver tissues due to their acute or chronic damage is called liver failure. This disease is considered complex, due to the fact that after liver damage, metabolic processes are disturbed. If you do not take appropriate measures to cure the disease, then under certain conditions, liver failure can quickly and rapidly develop and lead to death.

What is Secondary Syphilis

- the stage of the course of syphilis, which occurs after the primary period of syphilis and is characterized by a generalized spread of the causative agent of syphilis (treponema pallidum) throughout the body.

With secondary syphilis, the infection spreads in the body through the lymphatic and blood vessels, respectively, the secondary period of syphilis is characterized by a variety of clinical manifestations in the form of localized or diffuse lesions of the skin and mucous membranes (roseola, papules, pustules), generalized lymphadenopathy and damage to internal organs - i.e. where the localization of spirochetes occurred.

It starts 3-4 months after infection and can last for several years, alternating with latent early syphilis - within a few months, rashes are observed that spontaneously disappear and reappear after a while.

Causes of syphilis

Pale treponema

Secondary syphilis naturally replaces the primary period of this disease 9–12 weeks after infection with the pathogen. The causative agent of the disease is the bacterium Treponema pallidum (Latin name Treponema pallidum).

This is a microorganism that has a long and thin body curved with curls and a transparent color. According to these morphological features, it belongs to the order Spirochaetales or spirochetes - pathogenic microbes that cause a number of serious diseases in humans and animals.

Types of rash in secondary syphilis

Depending on the presence of clinical manifestations and the period of the course of the disease, there are three stages or types of secondary syphilis:

The secondary period of syphilis without adequate treatment can last indefinitely, but usually takes an average of 3 to 5 years. Its duration depends on the activity of the immune system of a sick person, his lifestyle, nutrition, the presence or absence of other infectious or chronic diseases.

Secondary syphilis is divided into 3 stages - fresh secondary, latent (latent) and recurrent syphilis. The first phase replaces the primary period and is expressed by the complete disappearance of all signs of a hard chancre (or primary syphilis).

But it is characterized by the spread of a rash over the surface of the entire body of patients and multiple inflammatory lesions of the lymph nodes.

Pronounced symptoms typical of the fresh secondary and recurrent period of syphilis - there are several types of syphilis. Characteristic rashes on the outer layer of the skin and mucous membranes in people with syphilis most often appear in the form of:

Syphilitic roseola (spotted syphilides). This is a rash in the form of rounded small (about 0.5 - 1 cm in diameter) spots of pale pink color. With pressure on the affected areas of the skin, roseola temporarily disappear. Most often they are in the back, sides, arms and legs (hands and feet), as well as on the face. Usually roseolas do not appear all at once, but gradually, several pieces are added every day. There are also rarer types of this syphilitic rash - rising and scaly roseola. The first resembles a blister and rises slightly above the surface of the skin, and the second is covered with small scales.
papular syphilis. This is a rash in the form of small (3 - 5 mm) papules of a bright red hue. This type of syphilitic rash is characterized by peeling, spreading from the center to the periphery, the so-called "Biett's collar". Disappeared papular rashes leave behind noticeable pigmented traces.
Pustular syphilis. These are cavity elements of a small nodular rash, which often merge into one and are distinguished by the presence of purulent contents in them. In the future, it, as a rule, dries up and leaves behind a yellowish dry crust.
Syphilitic leukoderma. These are rashes in the form of whitish pigmented spots surrounded by a dark border, which are localized on the occipital and lateral parts of the neck of patients. Because of its location, this pigmented syphilis is called the "necklace of Venus."
Wide warts. These are papular growths that are found in patients in the anus and genitals.

Also, with secondary syphilis, there is a violation of the nutrition of the hair roots, which is expressed in partial baldness of patients. In this case, the hair can fall out both evenly over the entire surface of the head, and in separate strands.

Baldness also affects the eyebrows and eyelashes. With secondary syphilis, papular syphilitic rashes can also be located in the oral cavity and pharynx, affecting the vocal cords.

This leads to the formation of hoarseness characteristic of secondary syphilis.

Syphilis can affect any organs and systems, but the manifestations of syphilis depend on the clinical period, symptoms, duration of illness, age of the patient, and other variables. Therefore, the classification seems a little confusing, but in reality it is built very logically.

Depending on the length of time that has passed since the moment of infection, early syphilis is distinguished - up to 5 years, more than 5 years - late syphilis.
According to typical symptoms, syphilis is divided into primary (hard chancre, scleradenitis and lymphadenitis), secondary (papular and pustular rash, spread of the disease to all internal organs, early neurosyphilis) and tertiary (gummas, damage to internal organs, bone and joint systems, late neurosyphilis).

chancre - an ulcer that develops at the site of introduction of the causative agent of syphilis

Primary syphilis, according to the results of blood tests, can be seronegative and seropositive. Secondary according to the main symptoms are divided into stages of syphilis - fresh and latent (recurrent), tertiary are differentiated as active and latent syphilis, when treponemas are in the form of cysts.
By predominant damage to systems and organs: neurosyphilis and visceral (organ) syphilis.
Separately - fetal syphilis and congenital late syphilis.

Stages of syphilis

The second stage of syphilis develops in 70-90% of cases. This happens because most patients do not notice or do not attach importance to the initial manifestations of syphilis - hard chancre (primary syphilitic ulcer), lymphadenitis (inflammation of the lymph node) and lymphangitis (inflammation of the lymphatic vessel). People do not suspect that they are sick, and therefore rarely go to the doctor. Time is lost, treatment is not started, and syphilis enters a secondary phase.

Usually, secondary syphilis develops 1.5-2 months after the appearance of a hard chancre - that is, 2.5-3 months after infection.

The onset of secondary syphilis or "breakthrough" of the infection

The secondary stage of syphilis begins when a huge amount of syphilis bacteria first accumulate in the lymphatic system and then simultaneously exit into the blood. This "breakthrough" of infection is accompanied by a general reaction from the body:

the patient's temperature rises (usually up to 37.0 - 37.9);
frequent headaches begin;
there is a feeling of weakness in the whole body, weakness;
pains in the bones and joints may begin - the body seems to “break”.

These symptoms are generally flu-like and are not unique to syphilis. This condition develops in the last week of the existence of a hard chancre. After 5-7 days, the “flu-like condition” disappears, and a rash appears on the body - the first characteristic sign of secondary syphilis. After a few days, the hard chancre also disappears, and only a rash remains.

The secondary period of syphilis is characterized by three main stages of development:

secondary fresh;
secondary latent;
secondary recurrent syphilis.

The progression of fresh syphilis begins immediately after the primary form of the disease. Symptoms of a secondary disease at this stage can be described as an increased formation of a rash on the skin and mucous membranes, while the remains of a hard chancre are preserved.

If secondary fresh syphilis is not treated during this period, then symptoms may appear within 3-4 months.

At the end of the period, the symptoms of secondary syphilis may disappear, but this does not mean that the disease has stopped and recovery has begun. This phenomenon only indicates the beginning of a new stage in the development of the disease. This stage is called latent or latent.

After about three months, secondary syphilis, the symptoms of which were invisible for some time, flows into the third phase of the development of the disease at this stage.

The new appearance of a rash on the skin and mucous surfaces indicates the development of secondary recurrent syphilis. The rash with secondary syphilis at this stage still appears somewhat less than, for example, with fresh syphilis.

Since secondary syphilis is a generalized form of the disease, we can talk about a significant content of treponemas (spirochetes) in the patient's blood.

And even more of them in skin rashes. This phenomenon allows us to say that it is at the second stage of syphilis that a sick person poses the greatest threat to others.

The first signs of syphilis - primary syphilis

What are the first signs of syphilis? In the case of the classic variant of the Lewis current, this is a hard chancre and enlarged lymph nodes. By the end of the primary period, patients are concerned about the following symptoms:

headache
general malaise
pain in muscles, bones, arthralgia
heat
decreased hemoglobin (anemia)
increase in white blood cells

Main symptoms

The disease is undulating:

Secondary syphilis often manifests itself as common, similar to influenza or SARS symptoms. So, the patient develops malaise and aches in the bones and joints, chills and an increase in body temperature of a sick person will also be characteristic.

Headache is often present. The fact that the symptoms are similar to the common influenza ones, of course, complicates the diagnosis, however, the presence of symptoms that are characteristic features of secondary syphilis allow specialists to correctly diagnose the patient.

Such exceptional characteristics are myalgia and arthralgia with an increase in their manifestations at night.
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About a week after the onset of these symptoms, the patient notices the appearance of a secondary type of skin rash characteristic of syphilis.

Rash (secondary syphilis) is distinguished by a high level of polymorphism. It is also characterized by a number of positive qualities: it does not give peripheral growth, has a benign course, and does not provoke the destruction of surrounding tissues.

The rash is characterized by a rounded shape with a clear line of restriction from the skin around. Sometimes the rash can cause mild itching.

Acute inflammatory signs are almost always absent, and healing is easy, leaving no scars in the healed areas.
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