Syphilis – Syn .: Lues, syphilis.
Def .: Infectious, systemic, chronic disease. It can last for many years with periods of clinical changes (symptomatic syphilis) and periods of asymptomatic disease (latent syphilis).
Etiol .: The disease is caused by a pale spirochete Treponema pallidum. The most common infection occurs through sexual contact with an infected sexual partner with whom there are syphilitic lesions on the mucous membranes or skin, through the bloodstream – through blood transfusion, and as a vertical infection – infection of the child in utero by a sick mother (congenital syphilis).
We distinguish: early syphilis (lues recens) – from the moment of infection to the second year; late syphilis (lues tarda) over the second year.
DIG. 21.16. Primary symptom on the lower lip (courtesy of Prof. B. Chodynicka).
Early period syphilis (Fig. 21.16)
Syn.: Lues primaria.
Def .: Syphilis, which lasts from the 3rd to the 9th week after infection.
Locale: Most often on the genitals in men – the inner foreskin, the gut groove and the glans, and in women the larger and smaller labia, the posterior commissure, the vaginal walls and on the cervix. The primary symptom may occur around the anus, groin, mouth, upper or lower lip, as well as the tongue and palate.
Clinical: Appearance is a characteristic symptom primary ulcer (ulcus primarius). The time before the onset of the primary symptom is the incubation period. Approximately 3 weeks after infection, the primary symptom appears at the spirochete intrusion – painless inflammatory infiltratethat quickly turns into an ulcer. A typical primary ulcer is a single lesion with a round or oval shape and smooth edges. The bottom of the ulcer is covered with a small amount of serous discharge and has a cartilaginous, hard base. After 2-6 weeks, the primary ulcer disappears by itself, usually leaving no trace. A few days after the onset of the primary symptom, the local lymph nodes increase in size, are elastic, hard, painless, and mobile in relation to the surface and the skin. Ulceration in the area of the mucous membranes of the cavity in the mouth is painful and is accompanied by enlarged lymph nodes. There are also atypical symptoms: multiple, with inflammatory or necrotic reactions, with a location different from that given below.
DIG. 21.17. Period II syphilis. Papular rash (courtesy of Prof. B. Chodynicka).
Complicated: In men – paraphimosis and phimosis. The swelling has hardened.
Healing: Penicillin, Tetracyclines, Erythromycin and Third Generation Cephalosporins. The first-line drugs are: benzathine penicillin, procaine penicillin, benzyl penicillin. Doxycycline, tetracycline, erythromycin, azithromycin, ceftriaxone are used. After the end of the treatment process, all patients undergo control clinical and serological examinations.
DIG. 21.18. Period II syphilis. Flat sticks (courtesy of Prof. B. Chodynicka).
Early stage II syphilis (Fig. 21.17 and 21.18)
Syn.: Lues secondary.
Def .: Syphilis, which starts at 9-10 week from infection and lasts up to two years.
Localization: Sexual organs, anus, hairy skin of the head, face, hands and feet, torso, genital area, palatine arches, uvula, tonsils, mucosa of cheeks and lips, tongue. They can also affect the vaginal and cervical mucosa, and in men, the glans and the inner plate of the foreskin.
Clinical: The most characteristic of the second stage syphilis are rashes affecting the skin and mucous membranes, resolving spontaneously without leaving any traces. First syphilis rash, early, is characterized by the sowing of small-speckled blooms, of the same shape – round or oval, pink or red in color, arranged symmetrically. Early rash is discrete, has no symptoms, it subsides or gradually becomes a recurrent rash. The early rash spreads evenly over the sides of the trunk and upper limbs. Recurrent rash starts around week 16 and may relapse for up to two years. The lesions are varied, multiform, asymmetrical, with a tendency to blend and occupy the hands and soles. Recurrent rash coexists with papular rash, psoriasis-like, lichen-like or acne-like. Hypertrophied syphilitic papules – flat condylomas (condylomata lata) occur in irritated areas, mainly around the genitals and anus, often coalesce and form extensive, oozing eruptions with a wide, infiltrated base and papillary surface. Mucosal lesions appear as ulcerative spots, papules or papules, erosions. They do not cause discomfort, but are very contagious. Skin rashes are accompanied by general symptoms in the form of an increase in body temperature, muscle and joint pains, headaches.
Recon: In the diagnosis of syphilis, apart from the clinical picture, laboratory tests play a decisive role. See – chapter XXXIII. (Purchase of the urogenital package for intimate diseases – 14 pathogens, which will allow the assessment of syphilis infection).
Healing: Penicillin, Tetracyclines, Erythromycin and Third Generation Cephalosporins. The first-line drugs are: benzathine penicillin, procaine penicillin and penicillinabenzyl penicillin. In case of penicillin hypersensitivity, doxycycline, tetracycline, erythromycin, azithromycin, ceftriaxone are used. After the end of the treatment process, all patients undergo control clinical and serological examinations.
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