Syphilis in women is a chronic venereal disease that is caused by pale treponema and is sexually transmitted in 90-99% of cases. It is manifested by specific skin rashes, enlarged lymph nodes, slow, progressive damage to various organs and systems. Clinical data, results of physical examination, microscopic and serological diagnostics are used to diagnose syphilis. Specific treatment involves the appointment of antitreponemal drugs selected in accordance with the stage and features of the course of the disease.
Although the first documentary mention of syphilis was recorded in the XV-XVI centuries, its causative agent was discovered only in 1905 by the Austrians Fritz Schaudin and Erich Hoffmann. In recent years, there has been a tendency to reduce the incidence of syphilis. The high-risk group consists of prostitutes, homosexuals and people who lead a promiscuous sex life. Syphilis is more often detected in 20-39-year-old patients. Women get sick less often than men. The increase in the incidence is noted in summer and autumn after unprotected sex with casual acquaintances on tourist trips and on summer vacation.
Causes of syphilis in women
The disease is caused by pale treponema (pale spirochete, Treponema pallidum), which got its name due to its characteristic thin spiral shape and low sensitivity to dyes. Being a tissue parasite, the microorganism remains viable when it penetrates into cells and their nuclei. Spirochetes have an increased tropicity to connective, nervous and lymphoid tissue. The pathogen exists in the human body in several forms:
- Classical spirillary form. It has a high pathogenicity. It is detected in the infectious stages of syphilis. It is highly sensitive to temperature rise above +55 ° C, drying, treatment with alcohol and antiseptics, therefore it quickly dies in the external environment.
- The form of long-term survival (cyst-like with a protective shell and a filterable L-form). Pathogens are highly resistant to antibacterial drugs, are detected at latent and late stages.
A woman becomes infected with syphilis through damage to the skin or mucous membranes. Infection usually occurs sexually during unprotected vaginal, anal, oral sex with an infected partner. The pathogen can also be transmitted by household means (through kisses, cigarettes, underwear, personal accessories and objects used by the sick person), through the placenta (from an infected pregnant woman to a fetus) and hematogenically during transfusion of infected donor blood or using contaminated syringes, needles, droppers, etc. (the microorganism persists in fresh blood for up to 3-4 days).
Syphilis is characterized by a stage course with alternating latent and clinically pronounced periods. The pathogen penetrates into the lymphatic system and spreads by lymphogenic, hematogenic, neurogenic pathways. A few hours after infection, treponemas are detected in lymph nodes, blood, tissues, where they begin to actively multiply. As the pathogen accumulates and its toxins act, the disease manifests clinically. First, the lymph nodes are enlarged and compacted, after which a solid chancre or an atypical variant of the primary syphiloma is formed at the site of the primary introduction. Antibodies attacking treponem are intensively produced in the body: microorganisms die massively in the blood, resulting in intoxication. An increase in the concentration of antibodies in the tissues causes local inflammation, which is manifested by generalized rashes. Untreated syphilis flows in waves with periodic weakening of humoral immunity and recurrent rash. Subsequently, granulomatous inflammation develops, causing gross organic changes in various organs and tissues.
The classification takes into account the stage of the disease, the features of tissue and organ damage, serological data. There are the following forms of syphilis in women:
1 Primary (with the appearance of a solid chancre):
- Seronegative — with negative results of serological tests
- Seropositive — with positive results of serological tests
2 Secondary (with generalized rashes):
- Fresh (early) — the first generalization of the rash
- Hidden — the period between rashes
- Repeated (recurrent), previously treated or untreated — repeated generalization of the rash
3 Hidden with positive serological tests, the presence of traces of primary syphiloma, but without generalized rash and gross organ pathology:
- Early — when the disease is up to 2 years old
- Late — with a prescription of syphilis of 2 years or more
4 Tertiary (with tubercular syphilis, gum and organ lesions):
- Active — the period of exacerbation
- Hidden — the carrier of L-forms
Visceral syphilis affects the aorta, heart valves, bones, joints, etc. Syphilitic damage to the nervous system (neurosyphilis) is also distinguished separately, which is manifested by increasing dementia (progressive paralysis), decreased sensitivity, muscle hypotension, other neurological symptoms (spinal dryness), etc. There are several forms of the disease that occur with transplacental infection — fetal syphilis, placenta, early, late and latent congenital syphilis.
Signs of syphilis in women
The incubation asymptomatic period lasts from 2 to 12 weeks (on average 21-28 days). The disease manifests itself in the form of a primary syphiloma (solid chancre) — a dense and painless to the touch dark red node up to 1.0 cm in diameter, located at the site of the initial penetration of the pathogen. On the surface of the nodule there is a rounded ulcer with a hard cartilaginous bottom and raised edges. In women, the chancre is most often located on the vulva, the walls of the vagina, the cervix, in the anal zone, much less often — in the oral cavity, on the lips, nipples. After 28-35 days, the chancre disappears on its own, leaving a small scar, atrophy, less often — unchanged skin.
With an atypical course of primary syphilis, multiple painful ulceration may appear, from which, with additional infection of the focus, pus may separate. At this stage, a woman can detect enlarged painless lymph nodes (inguinal, cervical, axillary). With the household method of infection, the primary syphiloma is placed on “atypical” areas of the skin or mucous membranes at the site of direct penetration of treponema, and with hemotransfusion there is no at all.
21-42 days after the initial manifestation of syphilis, a generalized rash occurs in the form of spots, nodules, vesicles, pustules. They are most pronounced in the collar zone (“Venus necklace”), on the palmar and plantar surfaces. Secondary syphilides contain a large number of microorganisms and are highly contagious. In addition to the characteristic rashes, a woman may find enlarged, compacted, painless lymph nodes. There is weakness, malaise, conjunctivitis, runny nose, sore throat, cough, the temperature rises to 37 ° C or slightly higher. The elements of the rash and catarrhal manifestations disappear on their own in a few weeks, and the asymptomatic phase of syphilis begins. Without etiotropic treatment, relapses of rash on the skin and mucous membranes, focal hair loss, damage to the nervous system, parenchyma of the kidneys and liver are possible. With a latent course, there are no symptoms pathognomonic for secondary syphilis.
After 3-6, and in some cases even more years from the moment of infection, tertiary syphilis develops. Surface bumps the size of a cherry stone or subcutaneous gum with a diameter of 3-4 cm are formed . Usually they have a dense structure, clear boundaries, are not accompanied by pain, burning, itching. The maturation period of syphilis in tertiary cutaneous syphilis lasts from several weeks to several months. Tubercles are resolved by dry necrosis or in the form of ulceration with uncovered edges, smooth clean bottom, dense elastic infiltration of tissues. In their place there is a slightly sinking scar with a pigmented border. After spontaneous opening of gum, ulcers with a viscous discharge are formed, and then characteristic stellate scars. When affected by granulomatous inflammation of the internal organs and nervous system, sensitivity is impaired, a woman is worried about muscle weakness, joint pain, loss of vision, memory impairment, shortness of breath, chest pain, etc.
Primary and secondary syphilis in women can cause infection of other family members, lead to intrauterine infection or death of the child. Syphilitic meningitis is extremely dangerous, in which there is a high probability of death. In the absence of adequate treatment, the disease turns into tertiary syphilis in 1/3 of cases. Its most serious complications, in addition to gross cosmetic skin defects, are blindness, paresis and paralysis, pathological bone fractures, dementia, fatal bleeding when large vessels rupture.
To diagnose syphilis in women in gynecology, anamnestic and epidemiological data, the results of physical examination and tests are used. The comprehensive diagnostic plan includes:
- Gynecologist’s examination. In primary syphilis, during a gynecological examination, a hard chancre is detected on the mucous membrane of the external genitalia, vagina, and cervix. In women with latent or secondary syphilis, the doctor may detect a scar or tissue atrophy at the site of the primary syphiloma.
- Physical examination. Syphilis is manifested by a specific skin rash corresponding to the stage of development of the disease. Lymphadenopathy is characteristic.
- Laboratory diagnostics. Under microscopy, treponema is detected in the separated syphilis, punctate of lymph nodes, cerebrospinal fluid. Positive results of the RPR test, Wasserman reaction (RW), RIBT, RPGA, RIF, ELISA are specific markers of the disease. The sensitivity of these methods ranges from 90 to 98%. These PCR studies are important for seronegative forms of syphilis and monitoring the effectiveness of treatment.
The differential diagnosis of syphilis in women depends on the stage of the disease. Solid chancre sometimes needs to be distinguished from cervical erosion, secondary syphilis — from skin diseases, tertiary syphilis clinic — from tuberculosis, inflammatory and volumetric processes, angina, etc. If necessary, a dermatovenerologist, an infectious disease specialist, a neurologist, a cardiologist, a phthisiologist, a gastroenterologist, an oculist, an otorhinolaryngologist are involved in the diagnosis and instrumental examination is prescribed — ultrasound of the abdominal cavity, ECG, lung radiography, MRI or CT, gastroscopy, etc. If the diagnosis of syphilis is confirmed, the woman is examined for other STIs.
Treatment of syphilis in women
The main task of therapy is the destruction of the pathogen. Patients are prescribed a course of benzylpenicillin, bicillin or other antibiotics. The treponemocidal concentration of the drug should be maintained for 7-10 days or more, depending on the duration of the disease. The grounds for prescribing a course of anti-treponema therapy are:
- Clinical picture, which is confirmed by laboratory. In such situations, a scheme corresponding to a specific stage of syphilis is used.
- Close domestic or sexual contact with a patient who has been diagnosed with one of the early forms of syphilis, or transfusion of infected blood. The antibacterial course is carried out proactively in the absence of clinical and laboratory signs of the disease and the prescription of contact or hemotransfusion no later than 90 days.
- Pregnancy. Therapy is prescribed to pregnant women with a newly diagnosed diagnosis or treated for syphilis in the presence of positive serological tests.
- Identification of foci characteristic of syphilis in internal organs. Trial treatment is carried out for diagnostic purposes.
In addition to specific therapy, women with tertiary syphilis are additionally prescribed symptomatic treatment (nonsteroidal anti-inflammatory drugs, nootropics, etc.).
Prognosis and prevention
With primary and secondary syphilis, the prognosis of the disease is favorable. 24 hours after the appointment of etiotropic therapy, the patient becomes non-contagious. A woman develops non-sterile (infectious) immunity to syphilis with the possibility of re-infection (reinfection). Tertiary syphilis is accompanied by severe systemic and organ lesions, mortality at this stage reaches 25%. After completion of the course of treatment, control serological tests are carried out within the time limits established by the protocols. To prevent infection, it is recommended to avoid sexual relations with casual partners or use condoms during such contacts. If there is a syphilis patient in the environment, it is necessary to allocate separate dishes to him, exclude the sharing of hygiene items, close physical contacts and kisses.