Syphilis is a chronic infectious disease. With syphilis, the skin, mucous membranes, internal organs, musculoskeletal, immune, and nervous systems are affected. The causative agent is pale treponema.


Pale treponema (Treponema pallidium) belongs to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically, pale treponema (pallid spirochete) differs from saprophytic spirochetes.

The most common route of infection with syphilis is sexual, with various forms of sexual contact.

Infection with syphilis occurs through small genital or extragenital lesions of the skin, or through the epithelium of the mucous membrane upon contact with hard chancre, erosive papules on the skin and mucous membranes of the genital organs, oral cavity, broad condylomas containing a significant number of pale treponemas.

In saliva, pale treponemas can only be found when there are rashes on the oral mucosa.

Syphilis can be contracted through the semen of a sick person in the absence of visible changes on the genitals.

Rarely, infection with syphilis can occur through close household contact, in exceptional cases through household items. Possible infection with syphilis through the milk of a nursing woman with syphilis. There were no cases of syphilis infection through urine and sweat. Syphilis (falsely use the word “syphilis”) from the moment of infection is a common infectious disease that lasts for many years in untreated patients and is characterized by an undulating course with alternating periods of exacerbation.

During an exacerbation of the disease, active manifestations of syphilis are observed on the mucous membranes, skin, and internal organs.

One of the main reasons for changes in the clinic, the duration of the incubation period, the latent course of syphilis, is the frequent use of antibiotics, changes in the body’s immune status and other factors. The classical course of syphilis is characterized by the alternation of active manifestations of the disease with a latent period. The classification of the course of syphilis is divided into the incubation period, primary, secondary and tertiary periods.

Primary syphilis (syphilis I primaria) – the stage of syphilis with the appearance of a hard chancre and enlargement of the lymph nodes.

  • Seronegative primary syphilis (syphilis I seronegativa) – syphilis with negative serological reactions during the course of therapy.
  • Primary seropositive (syphilis I seropositiva) – syphilis with positive serological reactions.
  • Primary latent syphilis (syphilis I latens) – syphilis with no clinical manifestations in patients who started treatment in the primary period of the disease and did not complete it.

Secondary syphilis (syphilis II secundaria) is a stage of syphilis caused by hematogenous spread of pathogens (treponema) from the primary focus, manifested by polymorphic rashes (roseola, papules, pustules) on the skin and mucous membranes.

  • Fresh secondary syphilis (syphilis II recens) – a period of syphilis with multiple polymorphic rashes on the skin and mucous membranes; not infrequently there are residual signs of hard chancre.
  • Secondary recurrent syphilis (syphilis II recidiva) is a period of secondary syphilis, which is manifested by a few polymorphic grouped rashes and, sometimes, damage to the nervous system.
  • Secondary latent syphilis (syphilis II latens) – the secondary period of syphilis, which proceeds latently.

Tertiary syphilis (syphilis III tertiaria) is the stage following secondary syphilis with destructive lesions of internal organs and the nervous system with the appearance of syphilitic gums in them.

  • Active tertiary syphilis is manifested by an active process of the formation of tubercles, which resolve with the formation of ulcers, scars, and the appearance of pigmentation.
  • Latent tertiary syphilis is syphilis in persons who have had active manifestations of tertiary syphilis.

Latent syphilis (syphilis latens) – syphilis, in which serological reactions are positive, but there are no signs of damage to the skin, mucous membranes and internal organs.

  • Early latent syphilis (syphilis latens praecox) is latent syphilis that has been less than 2 years since infection.
  • Late latent syphilis (syphilis latens tarda) is latent syphilis that has been more than 2 years since infection.
  • Unspecified latent syphilis (syphilis ignorata) is a disease with an unknown age.

Household syphilis – syphilis, the infection of which occurs in the household way.

Congenital syphilis – syphilis, in which infection occurred from a sick mother during fetal development.

Transfusion syphilis – transfusion syphilis develops in the recipient when donor blood is transfused with syphilis. Infection of medical personnel is possible when examining patients with syphilis, during surgery, performing medical procedures, during autopsy (especially newborns with early congenital syphilis).

Syphilis headless – infection occurs when treponema enters directly into the blood (through a wound, in a blood test). The absence of a hard chancre is characteristic.

Syphilis of the nervous system – neurosyphilis (neurosyphilis): early (neurosyphilis praecox) – disease duration up to 5 years, late (neurosyphilis tarda) – more than 5 years.

There are the followingforms of early neurosyphilis :

  • hidden latent syphilitic meningitis;
  • acute generalized syphilitic meningitis;
  • syphilitic hydrocephalus;
  • early meningovascular syphilis;
  • syphilitic meningomyelitis.

Forms of late neurosyphilis :

  • late latent syphilitic meningitis;
  • late diffuse meningovascular syphilis;
  • syphilis of cerebral vessels (vascular syphilis);
  • brain gumma;
  • progressive paralysis.

Visceral syphilis (syphilis visceralis) – syphilis, in which the internal organs (heart, brain, spinal cord, lungs, liver, stomach, kidneys) are affected.

Syphilis malignant is a severe syphilis with a massive lesion of internal organs and the nervous system, characteristic of tertiary syphilis.

In the primary period, the first clinical sign of syphilis appears –hard chancre (in the place where pale treponema entered the body). A hard chancre is a red spot that turns into a papule, then into an erosion or ulcer that occurs at the site of penetration of pale treponema into the body. Hard chancre is more often localized on the genitals (in women often on the cervix), which indicates sexual infection; much less common are extra-sexual chancres, which can be located on any part of the skin or mucous membranes: lips, tonsils, on the skin of the pubis, thighs, scrotum, abdomen. After 1-2 weeks, after the appearance of a hard chancre, the lymph nodes closest to it begin to increase.

The disappearance of a hard chancre indicates that syphilis has passed into a latent stage, during which pale treponemas are rapidly multiplying in the body. The secondary period of syphilis traditionally begins 5–9 weeks after the appearance of a hard chancre (primary syphiloma) and continues without treatment for 3–5 years.

The course of secondary syphilis is undulating: the period of active manifestations is replaced by a latent form of syphilis.

The latent period is characterized by the absence of clinical signs of syphilis and only positive serological blood tests indicate the course of the infectious process.

Clinical signs of tertiary syphilis may appear many years later after a long asymptomatic course of the disease from the moment of infection with syphilis. The main reason influencing the formation of tertiary syphilis is the absence or inadequate treatment of patients with earlier forms of syphilis.

Tests for syphilis consist of clinical and laboratory data:

  • research on pale treponema;
  • blood test for RV (Wasserman reaction);
  • RIF (immune fluorescence reaction);
  • RIBT (treponema pallidum immobilization reaction).

Diagnosis of syphilis of the primary period is carried out by examining a detachable hard chancre, punctate of regional lymph nodes.

In the diagnosis of syphilis of the secondary period, the material of papular, pustular elements, erosive and hypertrophic papules of the skin and mucous membranes is used.

Analyzes for syphilis by the bacterioscopic method (microscopic) are carried out by detecting pale treponema in a dark-field microscope.

Treponemal methods for diagnosing syphilis include:

  • Wasserman reaction (RW);
  • immunofluorescence reaction (RIF).
  • RW (Wasserman reaction) is of great importance for confirming the diagnosis of syphilis in the presence of active manifestations of the disease, detecting latent (latent) syphilis, and the effectiveness of the treatment of syphilis. RW is also important for the prevention of congenital syphilis.

The Wasserman reaction is positive in 100% of patients with syphilis of the secondary period, with early congenital syphilis, in 70–80% of patients with tertiary syphilis.

Treponemal test method for syphilis is also an immunofluorescence test (RIF). RIF is the most highly sensitive method for diagnosing syphilis and becomes positive even with primary seronegative syphilis.

RIF is positive in secondary syphilis, congenital syphilis in 100%, in tertiary syphilis – in 95-100%, in late forms of syphilis (internal organs, syphilis of the nervous system) – in 97-100%.

The treatment of syphilis is based on the relevant standards established in the world and is carried out only after the diagnosis has been established and confirmed by laboratory research methods.

The treatment of syphilis requires the venereologist to take into account various factors, various indicators, complicating moments. This, in many respects, determines the subsequent choice of the method of treatment of syphilis.

In the treatment of syphilis, specific antibacterial products of several groups and generations are used and they are the basis of therapy. In the treatment of syphilis, the patient must also strictly observe the recommended regimen (sufficient sleep, rational nutrition, vitamins, alcohol prohibition), the duration of the intervals between courses of treatment, which significantly increases the effectiveness of the treatment of syphilis. Essential for the successful treatment of syphilis is, in addition to ongoing therapy, the condition of the patient’s body, its reactivity, therefore, in the course of treatment, it will be necessary to increase resistance to infection. For this, products are prescribed that stimulate the protective reactions of the body.

The venereologist determines in each case, depending on the stage of syphilis, complications, concomitant diseases from other organs and systems, allergic background, body weight, the percentage of absorption and bioavailability of the drug, the necessary doses of medications, the additional use of immunomodulators, enzymes, vitamin products, physiotherapy.

After the end of the treatment of syphilis, repeated clinical and serological blood control is required for several months or years (depending on the stage of syphilis).

If, after the treatment of syphilis for a year, the blood does not become negative, the state of seroresistance is ascertained and additional treatment for syphilis is prescribed.

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