Hidden diagnosis. Latent syphilis: treatment and prevention of the asymptomatic form

Syphilis is a tricky disease. Each period of development of this infection has such individual symptoms that doctors used to consider them different diseases. Syphilis disguises itself as many diseases: from a common cold to severe damage to the kidneys and liver. Pale treponema, which is the causative agent of syphilis, releases an anesthetic, so the infected person does not feel any itching or pain.

Pale treponema feels comfortable in a humid environment and at a temperature of 36.8 degrees. At adverse conditions it hides in a capsule, the so-called cyto-forms and L-forms. In this state, syphilis is not active, does not multiply, it sleeps. Looking forward to favorable changes in the environment. But harmful factors do not act on it. Such is he - syphilis is an insidious enemy of mankind. Often the causes of latent syphilis are self-medication or infection with syphilis during antibiotic treatment of another infectious disease.

Varieties of syphilis

Syphilis is divided into several periods of the course of the disease:

• initial, or incubation;
• primary;
• secondary;
• tertiary.

Each period is divided into sub-periods. Latent syphilis refers to the secondary period of the course of the disease.

Secondary is divided into three types:

1. Syphilis fresh. It is characterized by bright rashes and other clinical manifestations.
2. Latent (latent) syphilis. There is no outward sign of his presence. It is asymptomatic, determined only by laboratory tests.
3. Recurrent syphilis. The rash reappears on the patient's body after the previous disappearance of all symptoms.

In a patient with latent syphilis, the incubation and primary periods, due to the use of antibiotics and good immunity, pass in a mild form. A person does not experience discomfort, lives and works, infecting others. The latent form of syphilis is often discovered by chance during mandatory medical tests at the clinic. Regular examinations by a gynecologist allow you to recognize the disease in time and begin adequate treatment.

Latent syphilis is divided into three stages by timing:

1. Early latent syphilis. The duration of the disease is up to 24 months.
2. Late latent syphilis. The duration of the disease is over 24 months.
3. Unspecified (ignorant) latent syphilis. The doctor cannot establish the timing when the patient contracted syphilis.

When treating with non-prolonged penicillins, it is possible to establish the timing of infection with syphilis. If a person has early latent syphilis, then his temperature will rise and there will be general signs of intoxication. They will be caused by the remains of the destroyed pale treponema. In the later stages of latent syphilis, the temperature does not rise, there are no signs of intoxication.

Why is it necessary to establish the timing of infection with syphilis?

Establishing the timing of syphilis is of practical importance. Patients with early latent syphilis are contagious and are active carriers of the infection, which are included in the epidemiological risk group. It is necessary to conduct a survey of all those who have been in contact with the infected and identify possible carriers of the disease. Patients with late latent syphilis are not epidemiologically dangerous.

Establishing the persons with whom the infected person came into contact, as well as passing tests for syphilis by them, is also necessary with an unspecified latent form.

When syphilis attacks human body, his goal is to infiltrate. Pale treponema sheds its membranous membrane, which allows it to pass through the capillaries and enter the nucleus of phagocytes. How amazing is nature! Phagocytes are our guard. They catch and eat foreign bacteria and viruses. And syphilis attacks them. Checkmate the immune system! With latent (latent) syphilis, treponema is hidden in the membrane sheath of phagocytes. That is, the virus destroys the phagocyte itself, and walks in its “clothes”. The immune forces of the body are not included, since they take such a treponema as their own and do not recognize it.

Signs of latent syphilis

Although no rashes or ulcers are observed on the skin and mucous membranes, syphilis penetrates at this stage into the internal organs, nervous system, and bones. Pathological processes occur in them. Patients with suspected asymptomatic syphilis are examined especially thoroughly in order to make such a diagnosis or refuse it.

Indirect signs of early latent syphilis are:

• the presence in the medical history of early rashes of an undiagnosed nature;
• treatment of other STIs (diseases often go together);
• detection of active syphilis in a sexual partner;
• swollen lymph nodes in the groin area;
• finding a scar at the site of the alleged hard chancre;
• when analyzing the cerebrospinal fluid, inflammatory reactions are detected.

Indirect signs of late latent syphilis:

• analysis of cerebrospinal fluid revealed degenerative changes;
• low titer of reagins with sharply positive results according to classical serological tests.

Indirect signs of latent syphilis for both early and late species also include:

• temporary or prolonged increase in temperature up to 38 degrees, the cause of which has not been established;
• weight loss, depressed mood, general weakness and other signs of intoxication;
• an increase in peripheral lymph nodes: they become dense and rounded, but there are no unpleasant sensations on palpation of the lymph nodes.

Diagnosis of latent syphilis

Diagnosis of the latent form of syphilis is carried out using the following serological methods:

Treponema pallidum immobilization reaction (RIBT). For this analysis, the patient's blood serum and a suspension of pale treponema are used. They are mixed and see how the treponemas behave. Getting into the blood of a person with syphilis, treponemas are immobile. And getting into the blood healthy person, they are active, swim for a long time, they are ready to infect. The accuracy of this test is 95%.

Diagnosis of latent syphilis is not an easy task for the doctor, as there is a possibility of a false positive reaction to syphilis.

1. The reaction of indirect hemagglutination (RPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
2. Enzyme immunoassay (ELISA). A special enzyme is added to the patient's prepared blood serum. If the serum replaces the color, then the patient is recognized as having syphilis.
3. RIF (immunofluorescence reaction). The presence of pale treponema is indicated by a specific glow.

Helps in determining the presence of the syphilis virus in the blood and itself unusual view pale treponema. Under a microscope, you can see that pale treponema has the appearance of a spiral. The size of the curls decreases towards the end of the treponema, and the spaces between the curls increase. Movement in liquid media is slow and graceful.

A feature of pale treponema is its ability to maintain its spiral shape even under the pressure of its environment. Elderly people are not treated for syphilis based on serological methods alone. They undergo additional examinations by a neuropathologist, an oculist and an otolaryngologist.

The definition of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times. When a disease is detected, specific therapy is carried out, taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high chance of fetal infection, birth defects, miscarriage, or premature birth.

Treatment

Today, the treatment of syphilis is not difficult for doctors. But one thing should be understood. When they talk about the treatment of latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformities, cardiovascular disorders, disorder nervous system. At the current stage of development of medicine, this is impossible to do.

In the treatment of latent syphilis, antibacterial drugs are used. The treatment regimen is selected individually, taking into account the stage of the disease and comorbidities. Additionally, drugs are prescribed that raise immunity, since syphilis weakens it.

Approximate treatment regimens for latent syphilis are presented in the table:

Taking any medication is possible only after consulting a doctor. Self-medication is unacceptable! Frequency of reception medicines and the duration of therapy are determined by the attending doctor.

Reception of a vitamin complex. Help fight infection

Pyrotherapy. The patient is given special drugs that increase body temperature. A little fever is helpful. At a temperature not exceeding 38.5 degrees, blood circulation improves, the work of the immune defense increases, and the bacterium weakens, it is easier for drugs to cope with it.

Risk group:

• drug users using injections;
• HIV-infected;
• people who have multiple sexual partners.

Prevention

In order to avoid various infections, you must follow some rules.

1. Be selective in choosing sexual partners.
2. Use condoms during sex.
3. Use only your own personal hygiene items.
4. Don't hope for false positive results and see a doctor at the first sign of illness.

Remember that syphilis is not only a personal matter of a citizen. If a person is aware of his illness with syphilis, he hides it and infects another, then he may be held criminally liable.

conclusions

Do not use antimicrobials on your own. This can cause the microorganisms to hide by forming capsules or to enter the cells. Syphilis takes on a latent form.

Latent syphilis is a difficult disease to diagnose. Proper Treatment can only be prescribed by a doctor based on complex tests. Do not fall for articles in pseudo-medical sites that describe how syphilis is cured with sage flowers and other herbs.

Treatment of syphilis at home does not lead to recovery. On the contrary, serious complications can arise. Every third person with late latent syphilis dies from syphilitic heart disease.

Syphilis is an insidious disease, usually within three to four weeks a person infected with a pale spirochete does not even know about the disease.

If in the ordinary course of the disease after incubation period you can detect the first symptoms: a hard chancre, an increase in lymph nodes, then with a latent form it does not manifest itself in any way, but tests for syphilis give a positive result.

There are three forms of latent syphilis:

• early;
• late;
• Undifferentiated.

If less than two years have passed from the moment of infection, then an early form is diagnosed. If the disease is detected after this period, then a late form is diagnosed. But when an infected person cannot accurately remember the moment of infection, and as a result of research it is impossible to determine early or late syphilis in a patient, then they speak of an undifferentiated form.

The most dangerous form of syphilis for others is considered early. During this period, the patient is an active source of infection. If the disease has passed into a late form, then the risk of infecting others is significantly reduced, in most cases, generally absent.

In the early form of syphilis, the primary signs either do not appear at all or are expressed so implicitly that the person does not pay attention to them. Often this is due to the fact that the patient during the incubation period took antibiotics to treat other diseases. In this case, doses of antibiotics do not destroy the pale spirochete, but only delay its development and pervert the course of the disease.

Also on the change in the spirochete, adverse factors also have environment and self-medication. Unfortunately, the uncontrolled use of antibiotics has led to an increase in latent forms, which contributes to the spread of the disease.

Symptoms

With early latent syphilis, the manifestation of the first symptoms of the disease, such as the appearance of a hard chancre, rashes, swollen lymph nodes, may be absent or be so small that the patient does not notice them. Usually, if symptoms appear, they pass on their own and quickly.

Sometimes a person takes this form of syphilis for another disease and begins to self-medicate, which aggravates the course of the disease.

You should consult a doctor if you have had casual sex in the past two years, after which:

• Small hard abrasions and sores appear, completely clean and not painful;
• Periodically, the body temperature rises to subfebrile, while no obvious catarrhal symptoms are observed. Usually this temperature lasts for several days;
• General malaise, anemia, asymptomatic weight loss, loss of strength;
• Headaches and bone pains that worsen during sleep;
• Enlarged lymph nodes that do not hurt or suppurate;
• The manifestation of an atypical reaction for you to penicillin drugs, such as vomiting, migraine, tachycardia, fever. In this case, the symptoms disappear after taking regular aspirin.

But even these manifestations cannot indicate the presence of a disease; laboratory tests are required to make a diagnosis. Very often, early latent syphilis is discovered quite by accident, when taking tests for a hospital, obtaining a medical certificate, and registering during pregnancy.

Diagnostics

To make a correct diagnosis, it is important to collect as complete an anamnesis as possible over the past two years. In this case, the patient is asked the following:

• Did serological tests and what are their results;
• Whether there were rashes, ulcers on the genitals, on the mucous surfaces in the mouth;
• Have you taken antibiotics?
• Have you self-treated for .

A visual examination of the patient is carried out for the presence of hard chancres, residual effects of polyscleradenitis, and an increase in lymph nodes.

Be sure to do the Wasserman reaction, with a positive result, additional tests are carried out. Since in some cases it can be positive even in the absence of the disease. A positive result for several serological tests is required to confirm the diagnosis. Such as:

• Immunoassay (ELISA);
• Immunization reaction of poor trepanemas (RIBT);
• Immunofluorescence reaction (RIF);
• The reaction of passive hemagglutination (RHA).

At the same time, in early syphilis most patients have very high titers. In almost all patients with this form of syphilis, the RIF reaction will be positive.

Sometimes in the early phase of latent syphilis, reactions may be negative if other signs are present. In this case, for the timely recognition of the disease, an analysis of the cerebrospinal fluid is taken.

Treatment

The earlier latent syphilis is diagnosed, the higher the chances of a positive result. Treatment is carried out under strict medical supervision according to approved schemes and instructions. Usually the patient is placed in a hospital, but they can also be treated on an outpatient basis.

Therapeutic treatment includes taking antibiotics, immunomodulators, antipyretic, anti-inflammatory drugs.

Prevention

To reduce the risk of the disease, it is necessary to take a responsible approach to the choice of sexual partners. In casual relationships, do not allow sexual intercourse without the use of condoms. Do not use other people's personal hygiene items.

To prevent the disease, it is important to carefully monitor your health. Once a year, undergo a medical examination with a study of titers for syphilis. In case of a positive reaction, it is necessary to contact a venereologist as soon as possible. Do not use antibiotics without medical prescription.

If there was sexual contact with a patient with syphilis, you should consult a doctor for preventive treatment within a week. When a disease is detected, it is mandatory to conduct a survey of all sexual partners of the patient and their family members.

You should not engage in treatment on your own, since in the case of improperly selected therapy, the disease can become chronic. And then it will be very difficult to cure syphilis.

It is also important to be sure that there is no hidden form of the disease when planning pregnancy, since in most cases this causes miscarriage, premature birth, the birth of babies with developmental anomalies and congenital syphilis.

Latent syphilis is diagnosed in the absence of signs of the disease, and serological reactions in the blood are positive. This form occurs in patients who in the past actively manifested diseases that resolved on their own, or as a result of specific treatment.

Forms and periods of latent syphilis

Signs of early latent syphilis

1. Seizures or scars on the genitals and an increase in regional lymph nodes may indicate the transferred primary syphilis.
2. In 75% of cases, serological reactions are sharply positive. In 20% of patients, there is a low titer. Positive RIF is observed in 100% of cases. Titers of serological reactions are reduced in the treatment of concomitant diseases with antibiotics.
3. When treated with penicillin, a third of patients experience an increase in body temperature, and muscle pain, and. This is due to the mass death of the pathogen. Side effects are quickly eliminated.
4. With the development of latent syphilitic in the cerebrospinal fluid, there is an increase in protein, positive reactions to globulin fractions and cytosis. The cerebrospinal fluid is quickly sanitized with specific therapy.

Treatment of early latent syphilis

The therapy is carried out according to. Its purpose is the rapid destruction of the pathogen in the patient's body. Negative seroreactions occur quite quickly with specific treatment. The extinction or complete negativity of seroreactions is the only confirmation of the effectiveness of treatment.

Timely diagnosis during early latent syphilis and effective treatment provide a favorable prognosis.

late latent syphilis

Patients who became infected more than two years ago, who have no symptoms of the disease, and serological tests are positive, are diagnosed with late latent syphilis. Basically, it is detected during a preventive examination.

These patients are less epidemiologically dangerous, since tertiary syphilides are not so contagious. They contain the minimum amount of the pathogen.

The disease is mainly detected in patients older than 40 years. At the same time, approximately 65% ​​of them are married.

When interviewing a patient, they find out the timing of probable infection and the presence of symptoms indicating manifestations of infectious syphilis in the past.

Signs of late latent syphilis

1. During the examination, traces of previously resolved syphilides are not determined. On examination, signs of a specific lesion of the nervous system and internal organs missing.
2. For the diagnosis of late latent syphilis, the following serological tests are used: RIF, RIBT, RPHA and ELISA. RIBT and RIF are always positive.

In some cases, serological studies are repeated after several months.

Treatment of late latent syphilis

Therapy of this form is carried out according to. The goal of treatment is to prevent the development of a specific lesion of internal organs and the nervous system. Patients need to consult a therapist and a neurologist. Negative seroreactions during the treatment period is extremely slow. In some cases, seroreactions remain positive after treatment.

Latent unspecified syphilis

Latent unspecified syphilis is diagnosed in the absence of information about the timing and circumstances of infection, as well as in the presence of a positive result of serological tests. These patients require careful clinical and serological evaluation. Mandatory are the production of RPHA, RIF, RIF-abs, ELISA, RIBT.

In patients with unspecified and late syphilis, false positive nonspecific serological reactions are often detected.

In the case of timely treatment, the external manifestations of the disease disappear quickly enough. In the most advanced cases, it becomes almost impossible to restore health.

After the illness, it is necessary to take a very responsible approach to the issue of pregnancy planning. It should be borne in mind that it will take more than a year to fully restore the health of future parents. Therefore, it is very important to take precautions to exclude the possibility of infection.

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, when adverse factors external environment 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. A particularly important role is played by self-treatment of patients for a disease that they consider to be, 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 during.

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 of the nervous system and the 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, because clinical symptoms there was no disease, but it was most likely revealed 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 a polymerase chain reaction that determines the antigen of pale treponema.

Early latent form

This form covers all forms from primary seropositive (hard chancre) to secondary recurrent (skin rashes, then their disappearance - secondary latent period, and relapses for two years), but external signs syphilis are absent. 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. in a laboratory way. 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. She accompanies mass death 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 public catering establishments. But once transferred and cured, the disease does not leave stable immunity, so re-infection is possible.

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 recent mass screening for syphilis in hospitals and antenatal clinics. 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 mucous membrane noted in the past in the patient. oral cavity, skin rashes, taking antibiotics in connection with any disease similar to the 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 liquor are saved 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.