What is latent syphilis. Latent syphilis - how to quickly identify and effectively treat the disease? Latent unspecified syphilis

Latent (latent) syphilis is an asymptomatic development syphilitic infection, which does not have any external signs and manifestations of internal lesions. At the same time, the pathogen is present in the body, easily detected during appropriate laboratory tests, and as it becomes more active, it begins to manifest itself externally and internally, causing serious complications due to the neglect of the disease.

The increase in the incidence of latent syphilis is due to the active use of antibiotics at an early stage of undiagnosed syphilitic infection, the symptoms of which are taken for signs of other sexually transmitted diseases, acute respiratory or colds. As a result, syphilis is “driven” inside and in 90% of cases it is discovered by chance during medical examinations.

Latent syphilis develops for various reasons and can have several variants of the course:

1. As a form of the primary period of the disease in which infection occurs by direct penetration of the pathogen into the blood - through wounds or injections. With this route of infection, a hard chancre does not form on the skin - the first sign of a syphilitic infection. Other names for this type of syphilis are headless.
2. As part of later stages of the disease, which proceed paroxysmal - with a periodic change of the active and latent phases.
3. As a type of atypical development of infection, which is not diagnosed even in laboratory studies. Symptoms develop only at the last stage, when severe lesions of the skin and internal organs occur.

The development of the classic is determined by the penetration of a certain type of bacteria - pale treponema. It is their vigorous activity that leads to the appearance of symptoms of a syphilitic infection - characteristic rashes, gums, and other skin and internal pathologies. As a result of the attack immune system most pathogenic bacteria are killed. But the strongest survive and change shape, which is why the immune system stops recognizing them. At the same time, treponemas become inactive, but continue to develop, which leads to a latent course of syphilis. When the immune system weakens, the bacteria become active and cause a second exacerbation of the disease.

How the infection is transmitted

Latent syphilis, unlike ordinary syphilis, is practically not transmitted household way, because it does not manifest itself as the most contagious symptom of infection - syphilitic rash. All other routes of infection remain, including:

• unprotected sexual intercourse of all kinds;
• breast-feeding;
• penetration of infected saliva, blood.

The most dangerous in terms of infection is a person who has latent syphilis for no more than 2 years. Then the degree of its contagiousness is significantly reduced.

At the same time, the asymptomatic course of the infection can make it hidden not only for others, but also for the patient himself. Therefore, it can be a source of infection without even knowing it and presenting a great danger to those who are in close contact with it (especially for sexual partners and family members).

If latent syphilis is detected in workers in those areas in which contact with a large number of people is expected, for the duration of treatment they are relieved of their duties with the issuance of a sick leave. After recovery, no restrictions on professional activities are established, since bangs do not pose a danger in terms of infection.

Varieties of latent syphilis

The asymptomatic form of syphilitic infection is divided into 3 types depending on the duration of the course of the disease. In accordance with this sign, latent syphilis is isolated:

• early - diagnosed when a maximum of 2 years have passed since the penetration of bacteria into the body;
• late - is set after exceeding the specified 2-year period;
• unspecified - determined if the duration of infection is not established.

The degree of damage to the body and the prescribed course of treatment depend on the duration of the course of the infection.

Early latent syphilis

This phase is the period between the initial and repeated manifestations of infection. At this time, the infected person has no signs of the disease, but he can become a source of infection if his biological fluids (blood, saliva, semen, vaginal secretions) enter the body of another person.

A characteristic feature of this stage is its unpredictability - the latent form can easily become active. This will lead to the rapid appearance of hard chancre and other external lesions. They become an additional and most open source of bacteria, which makes the patient contagious even with ordinary contact.

If a focus of early latent syphilis is detected, special anti-epidemic measures are necessarily taken. Their goal is:

• isolation and treatment of the infected;
• identification and investigation of all persons in contact with him.

Early latent syphilis most often affects persons under 35 years of age, promiscuous in sexual intercourse. Irrefutable evidence of infection is the detection of infection in a partner.

late latent syphilis

This stage is determined if more than 2 years have passed between penetration into the body and the detection of a syphilitic infection. At the same time, there are also no external signs of the disease and symptoms of internal lesions, but the corresponding laboratory tests show positive results.

Late latent syphilis is almost always detected during tests during a physical examination. The rest identified are relatives and relatives of the infected. Such patients do not pose a danger in terms of infection, since tertiary syphilitic rashes practically do not contain pathogenic bacteria, and those that exist quickly die.

Signs of late latent syphilis are not detected by visual examination, there are no complaints of deterioration in well-being. Treatment of this stage is aimed at preventing the development of internal and external lesions. In some cases, at the end of the course, the test results remain positive, which is not a dangerous sign.

Unspecified latent syphilis

In situations where the subject cannot report the time and circumstances of infection, unspecified latent syphilis is diagnosed based on laboratory tests.

Clinical examination of such patients is carried out carefully and repeatedly. At the same time, false-positive reactions are quite often detected, which is due to the presence of antibodies in many concomitant diseases - hepatitis, kidney failure, oncological lesions, diabetes, tuberculosis, as well as during pregnancy and menstruation in women, with alcohol abuse and addiction to fatty foods.

Diagnostic methods

The absence of symptoms significantly complicates the establishment of latent syphilis. The diagnosis is most often based on the results of appropriate tests and anamnesis.

The following information is of decisive importance in the preparation of an anamnesis:

• When did the infection occur?
• syphilis is diagnosed for the first time or the disease is repeated;
• what treatment the patient underwent, and whether there was any at all;
• whether antibiotics have been taken within the last 2-3 years;
• whether rashes or other changes in the skin were observed.

An external examination is also carried out to identify:

• syphilitic eruptions all over the body, including the scalp;
• scars after previous similar skin lesions;
• syphilitic leukoderma on the neck;
• change in the size of the lymph nodes;
• hair loss.

In addition, sexual partners, all family members, and other persons in close contact with the patient are examined for the presence of infection.

But the decisive factor for the diagnosis is the appropriate laboratory blood tests. In this case, the diagnosis can be complicated by the possibility of obtaining a false positive or false negative result.

If the test results are doubtful, a lumbar puncture is performed, the examination of which may show the presence of latent syphilitic meningitis, characteristic of the late latent stage.

With the final diagnosis of the disease, it is imperative to undergo examinations by a therapist and a neuropathologist. This is necessary to establish the presence or absence of concomitant (attached) pathologies.

Treatment of latent syphilis

The latent form of syphilitic infection is treated by the same methods as any type of syphilis - exclusively with antibiotics (systemic penicillin therapy). The terms of treatment and dosage of the drug are determined by the duration of the disease and the degree of damage to the body:

• with early latent syphilis, 1 course of penicillin injections lasting 2-3 weeks is sufficient, which is carried out at home (outpatient) conditions (if necessary, the course is repeated);
• with late latent syphilis, 2 courses lasting 2-3 weeks each are required, while treatment is performed in a hospital, since this form is characterized by high probability the development of complications.

At the beginning of treatment of the early form, an increase in temperature should appear, which indicates the correct diagnosis.

Pregnant women with latent syphilis must be hospitalized for appropriate treatment and constant monitoring of the fetus. Since the infection has an extremely negative effect on the condition of the child and can lead to his death, it is necessary to notice a missed pregnancy in time and provide timely assistance to the woman.

During the treatment period, all contacts of the patient are significantly limited. He is forbidden to kiss, have sex in any form, share utensils, etc.

The main task of the treatment of early latent syphilis is to prevent the development of the active stage, in which the patient becomes a source of infection. Treatment of late involves the exclusion of complications, especially neurosyphilis and neurological lesions.

To evaluate the results of treatment, indicators are monitored:

• titers that are reflected in the test results and should decrease;
• cerebrospinal fluid, which should return to normal.

Normal indicators of all laboratory tests during antibiotic therapy with penicillin for early latent syphilis usually appear after 1 course. With late, it is not always possible to achieve them, and regardless of the duration of therapy. Pathological processes in this case persist for a long time, and the regression is very slow. Often, to speed up recovery from late latent syphilis, preliminary therapy with bismuth preparations is first carried out.

Forecast for life

The results of treatment, the duration and quality of the future life of a patient with latent syphilis are largely determined by the duration of the infection and the adequacy of its treatment. The sooner the disease is detected, the less harm it will have time to cause to the body.

Complications of late latent syphilis often become such pathologies:

• paralysis;
• personality disorder;
• vision loss;
• destruction of the liver;
• heart disease.

These or other negative effects of infection can cause a significant reduction in life expectancy, but the results are always individual.

If latent syphilis is detected in a timely manner and competent treatment is carried out, a person can be completely cured. Then the disease will not affect the duration and quality of life. Therefore, at the slightest suspicion, you should immediately seek medical help.

In the video, the doctor talks about modern methods treatment of syphilis.

This disease has been known for a long time, since the end of the 15th century. Refers to chronic venereal diseases.

The cause of syphilis is Treponema pallidum, which, having entered the human body, begins to actively multiply and spreads through the circulatory system to all organs and systems.

That is why this disease needs to undergo long-term therapy, and often, even after a seemingly complete recovery, a positive result can be seen in tests for its detection.

How can a woman get syphilis?

Basically, infection with the causative agent of syphilis occurs sexually. Moreover, in the case of a single unprotected sexual intercourse, the probability of contracting syphilis is about 30%.

However, do not forget about the contact-household transmission of syphilis.

So, for example, you can get infected by contact with wet things of a sick person, or through saliva when kissing, common items (for example, through cutlery).

Pregnancy after syphilis

Since the disease has a high percentage of the probability of transmitting the pathogen from mother to child, a pregnant woman with a history of syphilis will undergo constant monitoring throughout the entire gestational period.

History of syphilis and pregnancy

If the expectant mother undergoes a full course of therapeutic treatment and passes all the necessary tests that confirm that the disease has been defeated, her chance for a healthy pregnancy will increase significantly.

However, couples who have undergone all the necessary procedures and studies, it is still worth waiting with pregnancy planning for at least the next year or two.

After all, it will take time to restore the body after antibiotic therapy.

How does pregnancy proceed after cured syphilis?

There are several options for the course of the gestational period in a woman with a history of syphilis.
For example:

1. If pregnancy occurred after a long period of time after infection and 2.5-3 years after the successful completion of the course of treatment, the woman has never had a positive test result. In this case, of course, there is a possibility of infection of the fetus, but it is small. To reduce it, the expectant mother will undergo preventive treatment during pregnancy. Most likely this will happen at 20-24 weeks, when the drugs can penetrate the placental barrier. In addition, once a trimester, you will need to take the necessary package of tests to detect syphilis, which will also be taken from a newborn.
2. If, a woman became pregnant after completing a full course of therapy, but positive reactions remained in the analyzes. Here the probability of an unfavorable outcome is slightly higher than in the first case. However, if a pregnant woman is properly monitored and undergoes preventive treatment at 20-24 weeks, the risk of infection of the child will be reduced to a minimum. For the entire gestational period, she will have to regularly (every 3 months) take the necessary tests. After delivery, the newborn will also undergo a preventive examination to identify this disease.
3. If pregnancy occurred after infection, but the expectant mother did not receive therapeutic treatment. In this case, the pregnant woman must go to the hospital for treatment. Then she will regularly take tests, and at 20-24 weeks, to reduce intrauterine infection of the fetus, she will undergo mandatory preventive therapy. If, despite the measures taken, infection occurs, the outcome is likely to be disastrous. The child, although it will survive, will be born into the world with various lesions of the skin, eyes and internal organs.

Preventive measures during the gestational period after syphilis.

• A pregnant woman who has had syphilis must undergo the necessary studies at 20-24 weeks.

1. Analysis for chlamydia, trichomoniasis, herpes;
2. Analysis for syphilis, HIV, hepatitis B, C;
3. Buck seeding for sensitivity to antibacterial agents;
4. PCR smear.

• If a woman has undergone a course of therapy, but the studies on the disease are still positive, in addition to passing the tests that are standard in this case, she will be moved to an isolated birth box or to the observation department during childbirth;
• In the case when the tests for the transferred disease are negative and the expectant mother has ceased to be registered with a venereologist, the passage of the gestational period and childbirth for her will not differ from other women.

What complications can arise with conception, pregnancy and delivery after syphilis?

Due to the fact that the development of medicine is in front of leaps and bounds, today there are practically no cases when cured syphilis somehow affected the reproductive function of a woman or the health of her newborn child.

A much greater danger is the situation when the expectant mother becomes infected with syphilis during the gestational period.

In this case, the likelihood of a late miscarriage or stillbirth is much higher.

As for conception, unlike trichomoniasis, chlamydia and gonorrhea, cured syphilis does not affect conception in any way.

This is due to the fact that as a result of syphilis, there is no blockage of the fallopian tubes and the development of chronic inflammation in the female reproductive organs.

However, it should be borne in mind that in medical practice there are still cases when, even after several years, after undergoing a full special course of therapy, women, due to illness, give birth to children with various health disorders.

That is why, both the gestational period and delivery, in a future mother who has cured this disease, should take place under especially close regular monitoring.

What is the probability of infection of the unborn child by a mother who cured syphilis before pregnancy?

The risk of infection of the fetus by a woman who has had syphilis depends on several factors. So, for example:

• If she was infected with syphilis more than 3 years ago, completed a full course of therapeutic treatment, and her tests for syphilis (MR/MP) at the end of treatment were negative, only one test (MR) will need to be performed during the gestational period:

1. if it is negative, then the probability of infection of the fetus is very low (approximately equal to zero). A woman who is expecting a baby during the gestational period will not need to undergo additional preventive treatment;
2. if, during the gestational period, the result of the study is positive or doubtful, the woman will be asked to undergo preventive therapy.

• If the expectant mother had syphilis less than 3 years ago, also underwent treatment, and at the end of therapy her tests for syphilis (MR / RV) were negative, during the gestational period she will have to undergo one study (MR):

1. if its result is negative, the expectant mother will not need to undergo preventive therapy;
2. if the result is positive or doubtful, the woman will be asked to undergo prophylactic treatment, since in this case the risk of infection of the unborn child is more likely.

• If the expectant mother had syphilis less than 3 years ago, underwent a course of necessary therapeutic treatment, but her research results are still positive, she will be asked to undergo treatment during the gestational period in order to reduce the likelihood of infection of the child.

For a child whose mother has been ill with syphilis, the supervision of doctors is carried out especially carefully.

In a child without signs of congenital syphilis, during the first year of life, every three months, blood is taken for analysis to detect the disease.

In this case, the first time - immediately after birth from the umbilical cord. Here, antibodies to the pathogen that the child received from the mother can be detected. Further, the number of antibodies should gradually decrease.

If this does not happen or the amount of antibodies increases, the child is infected. In this case, he is treated in a hospital.

Such therapy can be carried out immediately after the birth of the baby, if he has signs of a congenital form of the disease.

A common sexually transmitted disease - syphilis - is caused by a microorganism - pale spirochete. It has several stages of development, as well as many clinical manifestations. In Russia, in the late 90s of the twentieth century, a real epidemic of this disease began, when out of 100,000 people fell ill per year, 277 people. Gradually, the incidence is decreasing, but the problem is still relevant.

In some cases, there is a latent form of syphilis, in which there are no external manifestations of the disease.

Why does latent syphilis occur?

The causative agent of the disease - pale spirochete - under normal conditions has a typical spiral shape. However, under adverse environmental factors, it forms forms that promote survival - cysts and L-forms. These modified treponemas can persist for a long time in the lymph nodes of an infected person, his cerebrospinal fluid, without causing any signs of illness. Then they are activated, and there is a relapse of the disease. These forms are formed due to improper antibiotic treatment, the individual characteristics of the patient and other factors. Especially important is the self-treatment of patients for a disease that they consider gonorrhea, but in fact it is an early stage of syphilis.

The cyst form is the cause of latent syphilis. It also causes a lengthening of the incubation period. This form is resistant to many drugs used to treat this disease.

How is latent syphilis transmitted? In nine cases out of ten, the route of transmission is sexual. Much less common is the household route (for example, when using one spoon), transfusion (with the transfusion of infected blood and its components), and transplacental (from mother to fetus). This disease is detected most often during a blood test for the so-called Wasserman reaction, which is determined for each admitted to the hospital, as well as when registering with a antenatal clinic for pregnancy.

The source of infection is only a sick person, especially in the secondary period.

Latent period of syphilis

This is the time after infection of a person with treponema pallidum, when there are positive serological tests (blood tests are changed), but symptoms are not determined:

• rash on the skin and mucous membranes;
• changes in the heart, liver, thyroid gland and other organs;
• pathology nervous system and musculoskeletal system and others.

Usually changes in the blood appear two months after contact with the carrier. From this moment, the period of the disease is counted in a latent form.

Early latent syphilis occurs within two years of infection. It may not appear immediately, or it may be the result of a regression of early symptoms of the disease, when an apparent recovery occurs. There are no clinical symptoms of latent syphilis, it is characterized by a negative test of cerebrospinal fluid (cerebrospinal fluid). It is diagnosed using serological tests.

Latent late syphilis is characterized by a sudden activation of the process after a period of imaginary well-being. It can be accompanied by damage to organs and tissues, the nervous system. There are low-contagious elements of the skin rash.

What is latent unspecified syphilis?

In this case, neither the patient nor the doctor can determine when the infection occurred, since there were no clinical symptoms of the disease, and it was revealed, most likely, as a result of a blood test.

There is also the possibility of a false positive result of the Wasserman reaction. This happens in the presence of a chronic infection (sinusitis, caries, tonsillitis, pyelonephritis and others), malaria, liver diseases (hepatitis, cirrhosis), pulmonary tuberculosis, rheumatism. An acute false-positive reaction occurs in women during menstruation, in the third trimester of pregnancy, in the first week after childbirth, myocardial infarction, acute diseases, injuries and poisoning. These changes disappear on their own within 1-6 months.

If a positive reaction is detected, more specific tests are necessarily carried out, including polymerase chain reaction, which determines the antigen of pale treponema.

Early latent form

This form covers all forms by terms from primary seropositive (hard chancre) to secondary recurrent (skin rashes, then their disappearance - a secondary latent period, and relapses for two years), but there are no external signs of syphilis. Thus, the disease can be recorded in the period between the disappearance of the hard chancre (end of the primary period) until the onset of the formation of rashes (the beginning of the secondary period) or be observed at the moments of remission in secondary syphilis.

At any time, the latent course can be replaced by a clinically pronounced one.

Since all of the listed forms are contagious, due to the coincidence in time with them, the early latent variant is also considered dangerous for others and all the prescribed anti-epidemic measures (identification, diagnosis, treatment of contact persons) are carried out.

How to detect the disease:

• the most reliable evidence is contact with a patient with active syphilis during the previous 2 years, while the probability of infection reaches 100%;
• to find out the presence of unprotected sexual intercourse over the past two years, to clarify whether the patient had subtle symptoms, such as sores on the body or mucous membranes, hair loss, eyelashes, a rash of unknown origin;
• to clarify whether the patient did not go to the doctor at that time for any reason that worried him, whether he took antibiotics, whether he received blood or its components;
• examine the genitals in search of a scar left after a hard chancre, assess the condition of the peripheral lymph nodes;
• serological tests in high titer, but not necessarily, immunofluorescent analysis (ELISA), direct hemagglutination test (DPHA), immunofluorescence test (RIF) are positive.

late latent form

The disease is detected most often by chance, for example, during hospitalization for another reason, when a blood test is taken (“unknown syphilis”). Usually these are people aged 50 years and older, their sexual partners do not have syphilis. Thus, the late latent period is considered non-contagious. In terms of timing, it corresponds to the end of the secondary period and the entire Tertiary.

Confirmation of the diagnosis in this group of patients is more difficult, because they have concomitant diseases (rheumatoid arthritis and many others). These diseases are the cause of a false positive blood reaction.

To make a diagnosis, you should ask the patient all the same questions as with the early latent variant, only change the condition: all these events must have occurred more than two years ago. Serological tests help in the diagnosis: more often they are positive, the titer is low, and ELISA and RPHA are positive.

When confirming the diagnosis of latent syphilis, ELISA and RPHA are of decisive importance, because serological tests (rapid diagnostics) can be false positive.

Of these diagnostic methods, the confirmatory reaction is RPHA.

With latent syphilis, a puncture of the cerebrospinal fluid (CSF) is also indicated. As a result, latent syphilitic meningitis can be detected. Clinically, it does not manifest itself or is accompanied by minor headaches, hearing loss.

The study of cerebrospinal fluid is prescribed in the following cases:

• signs of changes in the nervous system or eyes;
• pathology of internal organs, the presence of gums;
• ineffectiveness of penicillin therapy;
• association with HIV infection.

What are the consequences of late latent syphilis?

Most often, syphilis has an undulating course with alternating remissions and exacerbations. However, sometimes its long course without symptoms is observed, ending several years after infection with syphilis of the brain, nerves, or internal tissues and organs. This option is associated with the presence in the blood of strong treponemostatic factors resembling antibodies.

How does the hidden late period manifest itself in this case:

• rash on the outer integument of the body in the form of tubercles and nodules, sometimes with the formation of ulcers;
• bone damage in the form of osteomyelitis (inflammation of the substance of the bone and bone marrow) or osteoperiostitis (inflammation of the periosteum and surrounding tissues);
• joint changes in the form of osteoarthritis or hydrarthrosis (fluid accumulation);
• mesaortitis, hepatitis, nephrosclerosis, pathology of the stomach, lungs, intestines;
• violation of the activity of the brain and peripheral nervous system.

Pain in the legs with latent late syphilis may result from damage to the bones, joints, or nerves.

Latent syphilis and pregnancy

If a woman has a positive serological reaction during pregnancy, but there are no clinical signs of the disease, she must definitely donate blood for ELISA and RPHA. If the diagnosis of "latent syphilis" is confirmed, she is prescribed treatment according to general schemes. Lack of therapy entails serious consequences for the child: congenital deformities, abortion and many others.

If the disease is cured before 20 weeks of pregnancy, childbirth proceeds as usual. If the treatment was started later, then the decision on natural or artificial delivery is made by doctors based on many concomitant factors.

Treatment

Specific treatment is prescribed only after confirmation of the diagnosis by a laboratory method. The sexual partners of the patient are examined, if they have negative laboratory tests, then they are not prescribed treatment for the purpose of prevention.

Treatment of latent syphilis is carried out according to the same rules as its other forms.

Long-acting drugs are used - Benzathine penicillin, as well as Benzylpenicillin sodium salt.

Fever at the beginning of penicillin therapy is indirect evidence of a correctly established diagnosis. It accompanies the mass death of microorganisms and the release of their toxins into the blood. Then the state of health of patients is normalized. With a late form, such a reaction may be absent.

How to treat latent syphilis:

• in the early form, Benzathine penicillin G is injected at a dose of 2,400,000 units, two-stage, into the muscle once a day, only 3 injections;
• with a late form: Benzylpenicillin sodium salt is injected into the muscle at 600 thousand units. twice a day for 28 days, two weeks later, the same course is carried out for another 14 days.

In case of intolerance to these antibiotics, semi-synthetic penicillins (Oxacillin, Amoxicillin), tetracyclines (Doxycycline), macrolides (Erythromycin, Azithromycin), cephalosporins (Ceftriaxone) can be prescribed.

Latent syphilis during pregnancy is treated according to general rules, since the drugs of the penicillin group are not dangerous to the fetus.

Monitoring the effectiveness of treatment

After treatment of early latent syphilis, serological control (ELISA, RPHA) is carried out regularly until the indicators are completely normal, and then twice more with an interval of three months.

With late latent syphilis, if RPHA and ELISA remained positive, the follow-up period is 3 years. Tests are carried out every six months, the decision to deregister is made on the basis of a set of clinical and laboratory data. Usually, in the late period of the disease, the restoration of normal blood and cerebrospinal fluid is very slow.

At the end of the observation, a complete examination of the patient is carried out again, examination by a therapist, a neurologist, an otorhinolaryngologist and an oculist.

After the disappearance of all clinical and laboratory manifestations of the disease, patients can be allowed to work in children's institutions and enterprises Catering. But once transferred and cured, the disease does not leave stable immunity, so re-infection is possible.

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A variant in the development of a syphilitic infection in which no clinical manifestations of the disease are detected, but positive laboratory tests for syphilis are observed. Diagnosis of latent syphilis is complex and is based on anamnesis data, the results of a thorough examination of the patient, positive specific reactions to syphilis (RIBT, RIF, RPR-test), detection of pathological changes in the cerebrospinal fluid. To exclude false-positive reactions, multiple studies are practiced, re-diagnosis after treatment of concomitant somatic pathology and sanitation of infectious foci. Latent syphilis is treated with penicillin preparations.

General information

Modern venereology is faced with an increase in cases of latent syphilis around the world. First of all, this may be due to the widespread use of antibiotics. Patients with undiagnosed initial manifestations of syphilis, on their own or as prescribed by a doctor, undergo antibiotic therapy, believing that they are sick with another sexually transmitted disease (gonorrhea, trichomoniasis, chlamydia), SARS, colds, tonsillitis or stomatitis. As a result of such treatment, syphilis is not cured, but acquires a latent course.

Many authors point out that the relative increase in the incidence of latent syphilis may be due to its more frequent detection in connection with the adopted in recent times in hospitals and antenatal clinics by mass screening for syphilis. According to statistics, about 90% of latent syphilis is diagnosed during preventive examinations.

Classification of latent syphilis

Early latent syphilis corresponds to the period from primary syphilis to recurrent secondary syphilis (approximately within 2 years from the time of infection). Although patients do not have manifestations of syphilis, they are epidemiologically potentially dangerous to others. This is due to the fact that at any time, early latent syphilis can turn into an active form of the disease with various skin rashes containing a large number of pale treponemas and being a source of infection. Establishing a diagnosis of early latent syphilis requires anti-epidemic measures aimed at identifying the patient's household and sexual contacts, isolating him and treating him until the body is completely sanitized.

Late latent syphilis is diagnosed when the duration of possible infection is more than 2 years. Patients with late latent syphilis are not considered dangerous in terms of infection, since when the disease enters the active phase, its manifestations correspond to the clinic of tertiary syphilis with damage to internal organs and the nervous system (neurosyphilis), skin manifestations in the form of low-infectious gums and tubercles (tertiary syphilides).

Unspecified (unspecified) latent syphilis includes cases of the disease when the patient does not have any information about the duration of his infection and the doctor cannot establish the timing of the disease.

Diagnosis of latent syphilis

In establishing the type of latent syphilis and the duration of the disease, the venereologist is helped by carefully collected anamnestic data. They may contain an indication not only of sexual contact suspicious of syphilis, but also of single erosions in the genital area or on the oral mucosa, skin rashes noted in the past in the patient, antibiotics taken in connection with any disease similar to manifestations of syphilis. The age of the patient and his sexual behavior are also taken into account. When examining a patient with suspected latent syphilis, a scar or residual induration is often found, formed after the resolution of the primary syphiloma (hard chancre). Lymph nodes enlarged and fibrosed after suffering lymphadenitis can be detected.

Confrontation can be of great help in diagnosing latent syphilis - the identification and examination for syphilis of persons who are in sexual contact with the patient. Identification of an early form of the disease in a sexual partner testifies in favor of early latent syphilis. In sexual partners of patients with late latent syphilis, no signs of this disease are often detected, and late latent syphilis is less common.

The diagnosis of latent syphilis must be confirmed by the results of serological tests. As a rule, such patients have a high titer of reagins. However, in individuals receiving antibiotic therapy, it may be low. The RPR test should be supplemented with RIF, RIBT and PCR diagnostics. Usually, with early latent syphilis, the result of RIF is sharply positive, while RIBT in some patients may be negative.

Diagnosis of latent syphilis is a difficult task for the doctor, since it is impossible to exclude the false positive nature of reactions to syphilis. Such a reaction may be due to previous malaria, the presence of an infectious focus in the patient (chronic sinusitis, tonsillitis, bronchitis, chronic cystitis or pyelonephritis, etc.), chronic liver damage (alcoholic liver disease, chronic hepatitis or cirrhosis), rheumatism, pulmonary tuberculosis. Therefore, studies for syphilis are carried out several times with a break, they are repeated after the treatment of somatic diseases and the elimination of foci of chronic infection.

Additionally, a cerebrospinal fluid taken from a patient by lumbar puncture is tested for syphilis. Pathology in the cerebrospinal fluid indicates latent syphilitic meningitis and is more often observed with late latent syphilis.

Patients with latent syphilis are required to consult a therapist (gastroenterologist) and a neurologist to identify or exclude intercurrent diseases, syphilitic lesions of somatic organs and the nervous system.

Treatment of latent syphilis

Treatment of early latent syphilis is aimed at preventing its transition to an active form, which is an epidemiological danger to others. The main goal of the treatment of late latent syphilis is the prevention of neurosyphilis and lesions of somatic organs.

Therapy of latent syphilis, like other forms of the disease, is carried out mainly by systemic penicillin therapy. At the same time, in patients with early latent syphilis, at the beginning of treatment, a temperature reaction of exacerbation may be observed, which is additional confirmation of a correctly established diagnosis.

The effectiveness of the treatment of latent syphilis is assessed by a decrease in titers in the results of serological reactions and the normalization of cerebrospinal fluid parameters. During the treatment of early latent syphilis, by the end of the 1-2 course of penicillin therapy, negative serological reactions and rapid sanitation of the cerebrospinal fluid are usually noted. With late latent syphilis, negative serological reactions occur only at the end of treatment or do not occur at all, despite ongoing therapy; changes in the cerebrospinal fluid persist for a long time and regress slowly. Therefore, it is preferable to start therapy of a late form of latent syphilis with preparatory treatment with bismuth preparations.

Latent syphilis is a special type of sexually transmitted disease. This pathology is most often detected by chance, for example, during a preventive examination with blood sampling for testing for syphilis. What is the difference between this form of the disease and is there any hope for recovery?

The latent form of syphilis is very common today. The disease itself has declined over the past 10 years.

This is due to informing the population about the need to use condoms, improving the quality of medical services. However, such statistics can also be associated with the transition of the disease to a latent, difficult-to-diagnose form.

The main reasons for the development of such a disease are:

• promiscuous sex life;
• improper treatment for primary infection;
• uncontrolled use of antibiotics;
• incorrect diagnosis and treatment (for example, syphilis can be confused with other STIs, tonsillitis, and even SARS).

The price of screening for syphilis is low, so it is recommended to take tests from time to time to identify the problem in a timely manner.

Symptoms and manifestations

The difficulty of detecting the disease lies in the fact that it practically does not manifest itself in any way. Even those few symptoms of latent syphilis that can be noticed can be attributed to other types of diseases. This is due to the fact that such signs are non-specific.

Most often, the following symptoms are found:

1. Slight increase in body temperature. The patient develops subfebrile condition of a temporary or permanent nature.
2. Prostration. Progressive intoxication of the body provokes weakness, lethargy, loss of appetite and similar symptoms.
3. Enlarged lymph nodes. Lymph nodes react to any inflammatory processes in the body, and therefore, with syphilis, their swelling and soreness, an increase in the periphery, are observed.

Chancres, ulcers, or rashes are extremely rare. Existing non-specific symptoms can be perceived as a common cold, which leads to the transition hidden form syphilis to a new stage.

Forms of the disease

In modern venereology, latent forms of syphilis are divided into 3 types:

• early;
• late;
• unspecified.

The main classification includes the first two forms. When it is impossible to find out the exact timing of human infection, the disease is classified as unspecified until the situation is clarified.

Early

Early latent syphilis has no obvious symptoms, but it remains dangerous for other people, as they can become infected when the disease becomes active. From the moment of infection of the patient passes no more than 2 years. When examining antibody titers, the result is most often positive.

Other signs of latent syphilis at this stage may go unnoticed or not perceived properly. So, in some patients, a history of ulcerative defects is established on the oral mucosa (when infected through a kiss) or genitals (when infected through sexual contact). Also, during the first two years, rashes on the body can be observed.

In general, the early form covers the period of the course of the disease from the primary to the secondary recurrent phase. It is impossible to rely completely on the results of serological examinations, as they can give a negative result at first.

Late

Latent late syphilis is a long-standing form of the disease. Several years have passed since the infection. When diagnosing, a period of time of 3-5 years is taken into account.

During this time, the patient does not show any active symptoms, such as rashes or ulcers. However, it is important to recall similar cases in history more than two years ago.

A few years ago, the patient could have ulcerative formations on the body, suspicious rashes that appeared after contact with a person with syphilis. Chancres may indicate the presence of ulcers earlier.

For people around, late syphilis is considered harmless. During this period, the manifestations of the activation of the disease are aimed at the defeat of the internal systems of the body. In other words, the clinical symptoms resemble tertiary syphilis.

unspecified

A much more difficult task is to determine the type of disease, when the patient cannot accurately determine the moment of his infection, and the symptoms remain blurred. This is the so-called hidden unspecified syphilis. Until the exact type of the disease is clarified, a person is considered potentially dangerous in terms of infection.

To clarify the diagnosis, it is necessary to recall all cases of possible infection over the past 5-8 years. You should also conduct an examination of the patient's permanent sexual partner, because with an early form, the patient is able to infect him. If the corresponding signs are not revealed according to the results of diagnostic measures, most likely the disease belongs to the late form.

Diagnostics

Modern techniques facilitate the task of diagnosing and determining the specific form of sexually transmitted diseases. In order to find out the presence of a disease in a patient and correctly classify it, it is necessary to undergo whole line research.

The most effective and commonly used techniques are presented in the table:

The basis of diagnosis is serological studies that allow detecting latent syphilis titers and antibodies to them. However, the results of such studies in some cases may be false positive.

It is also necessary to take into account the seroresistance of some people. That is why it is necessary to conduct a detailed differential diagnosis.

Treatment Methods

Since syphilis is a chronic disease, when its latent course is detected, it is necessary to direct efforts to prevent an exacerbation of the disease. Otherwise, there is a possibility of developing neurosyphilis, as well as renewed risks of infecting other people.

Drug therapy is divided into 3 parts:

1. symptomatic. Facilitates the course of the disease by eliminating symptoms, for example, by taking antipyretics, NSAIDs, using wound healing ointments.
2. Etiotropic. Antibiotic group drugs are used, for example, penicillins, tetracyclines, ceftriaxone, etc.
3. pathogenetic. Elimination of the consequences of the disease with the help of immunomodulators and various anti-inflammatory drugs.

Hidden treatment late syphilis it is necessary to carry out sequentially, starting with the appointment of bismuth preparations, and only then switch to the standard therapy regimen.

Monitoring the effectiveness of therapy is carried out by taking samples of biomaterial for re-testing. With an early form, positive changes are observed from the very beginning of treatment, with a late one - only by the end of the course or are absent altogether.

Who to contact

It is essential to differentiate syphilis from other diseases that may present with similar symptoms and interfere with serological test responses. It is also worth considering that such a pathology, as it develops, has a negative effect on internal organs, since syphilis is a chronic systemic disease. With the timely detection of such influences, it is possible to slow down the course of the disease and prevent some complications.

For the most accurate compilation of the clinical picture, it is recommended to immediately seek advice from several specialists. Even if your doctor has not given you a referral, you should not ignore this recommendation.

Late forms of syphilis are manifested in malfunctions of the gastrointestinal tract, liver, lungs, etc. In addition, this will determine the cause of false positive reactions to some tests.

In general, it is worth visiting specialists in such areas:

• venereologist;
• cardiologist;
• gastroenterologist;
• urologist;
• neurologist;
• otolaryngologist.

Prevention

The fight against syphilis of any type is a fight for life. It is best to direct efforts to prevent infection with this dangerous disease.

Instructions for the prevention of syphilis, in particular the development of its latent form, implies the following rules:

• do not be promiscuous, always use condoms;
• monitor your health and the health of your regular sexual partner;
• take control tests annually;
• after contact with a sick person, go to the hospital for a preventive course of treatment;
• if you suspect a disease, complete a full course of examination;
• do not take antibiotics without a doctor's prescription and for no obvious reason.

It is important that each person is aware of the need to undergo a preventive medical examination at least once a year and use a condom during sex. This will significantly reduce the spread of the disease among the population and will allow timely detection of it in already infected carriers.

The appointment of appropriate treatment for them makes the disease safe in terms of infection and protects against the development of negative consequences. For more information on the topic of latent syphilis, watch the video in this article.