On what day does a hard chancre appear. How is syphilis transmitted and how does the disease manifest itself in women? The incubation period and its symptoms

Syphilis is an ancient disease known since ancient Greece. Many treatises and scientific papers have been written about the disease. They suffered from it at all times, regardless of class and status. Until now, scientists are looking for methods of quick and painless treatment, early diagnosis and possible elimination of consequences.

The causative agent of syphilis is Treponema pallidum from the family Spirochaetaceae, the genus Treponem, previously called the spirochete. This corkscrew-like microorganism is literally screwed into the body of the victim.

Currently, practical medicine knows the following ways of contracting syphilis:

• Sexually. The most common way, registered in 95% of cases of detected infections, while women are most often affected;
• Household way. Most often through personal items used by different people, as well as through cutlery and dishes;
• In utero from mother to fetus through the placenta or during passage through the birth canal. Sometimes a second generation infection occurs - from a healthy woman already infected at birth, who has undergone treatment, a mutated gene is transmitted to her child;
• Transfusion method, that is, when transfusing infected donor blood in violation of the rules of transfusion. An extremely rare accident, usually due to negligence during direct transfusion;
• Medically, during medical examinations or procedures due to contact with tools or equipment with an untreated antiseptic. This path was observed often until the moment when disposable devices, especially syringes and droppers, entered life.

In the last two cases, there is no barrier preventing the penetration of pale treponema into the human body. But these cases are extremely rare. In the first cases of direct contact with the patient, whether it be domestic or sexual, infection depends on many reasons, because one in five remains absolutely healthy after possible ways of infection.

This is due to the fact that there is individual immunity to syphilis, a high level of immunity, and the absence of microcracks.

There is a professional way of infection, when by chance the medical staff is infected. This happens among dentists, gynecologists, surgeons, pathologists, salon cosmetologists who neglect protection methods.

Learn more about the disease syphilis from this video of the Live Healthy program.

The disease has several stages of development. Based on the data on the time of infection, the stage of syphilis is established. Between each stage there is a latent period when there are no characteristic symptoms of the disease.

Doctors classify the disease into three stages:

• Primary or early;
• secondary;
• Tertiary.

With early syphilis, a sick person develops a hard chancre at the site of the introduction of pale treponema - an ulcer without much pain, similar to a mosquito bite or a wart. A month and a half later, the ulcer disappears without any scarring.

The primary period lasts from 10 to 100 days after infection. Chancre releases, when pressed, a large number of microorganisms that are dangerous to others. Often at an early stage of the development of the disease, the lymph nodes in the neck and in the inguinal regions increase. Localization of hard chancre: genitals, lips, anus, rectum, perineum, oral cavity.

The secondary stage of the disease is characterized by the complete spread of infection throughout the body. Lymph nodes are enlarged all over the patient's body.

The main symptoms of secondary syphilis are:

• Decreased appetite;
• Pain in bones, joints and muscles;
• Violation of visual acuity;
• Headache;
• Hearing loss;
• General weakness;
• A sore throat;
• Increase in body temperature;
• Nausea;
• Small pink rash.

These symptoms may manifest themselves in combination or singly. 1% of those infected have all the symptoms at the same time.

There is fresh, recurrent and latent periods of secondary disease. Years later, in the absence of the necessary treatment, tertiary syphilis manifests itself. This happens to those people who are negligent about their health and do not visit medical institutions for prevention.

Tertiary syphilis has 3 forms of development:

Mild syphilis at a late stage of development manifests itself many years after infection. The patient is tormented by severe boring pains in the bones, gummas appear - soft scars.

Tertiary syphilis of the cardiovascular form occurs more than 10 years after infection.

The characteristic symptoms are:

• Rough cough;
• Pain in the sternum;
• Paralysis of complete or partial vocal cords;
• Frequent respiratory tract infections.

Neurosyphilis is the worst form of the disease.

At the same time, it manifests itself in the form:

• Meningitis vascular neurosyphilis;
• Asymptomatic veiled neurosyphilis;
• Dorsal tabes;
• parenchymatosis.

There are even less common forms of tertiary syphilis. The disease is cyclical, periods of exacerbation are replaced by false remission.

Tertiary syphilis behaves less actively, the immune system suppresses pale treponema, which prevents it from multiplying outside its carrier. However, the immune system weakens over time, and the person again becomes a source of infection, while gradually dying. Between periods, as already mentioned, there is a latent period when there are no symptoms of the disease.

Sometimes the disease passes unnoticed by the infected, since at present almost all diseases are treated with various antibiotics, which, acting on pale treponema, suppress and kill it.

Often the question arises of how long syphilis manifests itself. It is known that the contagiousness of the disease depends on the period of its development. Infection occurs asymptomatically, when neither partner is aware of the disease.

The incubation period can last from a week to 3 months. On average, after 3 weeks, the disease manifests itself slowly, but with an increasing effect. The manifestation of infection depends on the immunity of a person and his gender, on age and the presence of other diseases.

Low reactivity is associated with other diseases and the use of medications that lubricate the clinical picture of syphilis.

The main and true sign of the disease can be perceived as an increase in lymph nodes in the groin and neck after unprotected sex with an untested partner or after a direct blood transfusion.

The second clear sign will be the occurrence of weeping sores or erosive abrasions in intimate places or the oral cavity.

If an accidental sexual contact has occurred and there is a suspicion of an infection, then it is imperative to undergo an analysis to detect syphilis. This will help to identify it at an early stage, prevent infection of loved ones, and help to quickly get rid of the disease.

In modern conditions, the disease is no longer so terrible and is easily treated. Early treatment will prevent complications and destruction of the body.

Sourced from www.vekzhivu.com

When diagnosing syphilis in a victim, experts mean a chronic venereal disease that affects the skin and mucous membranes on the body, internal organs, bone tissues, and the central nervous system. The formation of the disease is provoked by a pale spirochete, which, being outside the human body, is characterized by poor resistance to alcohol, soapy water, and high temperature conditions. At the same time, syphilis is a very dangerous condition, since the causative agent of the disease is able to penetrate the human body through damage even invisible to the eye.

Consider syphilis and its distribution. It is not for nothing that the disease is called venereal, since the disease is transmitted from the carrier to the victim, with the exception of only 5% of cases, through sexual contact. In this case, infection occurs not only in the process of vaginal contact, but also during anal, oral intercourse. Also, syphilis can be:

• Household - this form is extremely rare, because even if treponema gets on personal hygiene items, it quickly dies.
• Congenital (observed in infants) - infection occurs either during gestation or during labor. The lactation period is also quite dangerous if the mother is sick with syphilis.
• Another rare method is blood transfusion. Modern medicine carefully examines donors, moreover, when the substance is preserved, the pathogen dies within five days. An increased danger is only a direct transfusion from the carrier, which occurs infrequently.

But even if contact with the carrier has taken place, manifestations of syphilis may be absent in 20% of cases - infection does not occur, since there are no necessary conditions for this. In particular, the number of viral agents in the infected biomaterial can be very small, the absence of microtrauma or individual immunity plays a role. The risk of infection increases when a patient has primary or secondary syphilis, accompanied by erosive and weeping elements of pathological rashes. If we are talking about late pathology - latent or tertiary - in the process of contact with a carrier, infection occurs very rarely.

Since a syphilitic rash can form in any area of ​​the skin or mucous membrane, condoms cannot be considered reliable protection, they only reduce the risk of infection, also protecting against urogenital infections that usually accompany the underlying disease.

As for how long syphilis manifests itself, it is important to have an idea about the incubation period. On average, its duration is from three to four weeks, but the interval can be reduced to two weeks or increased to six months if the victim takes antimicrobials for any reason. It should be understood that even in the case of the active development of pathology, symptoms at first may be absent. Laboratory studies can determine the presence of the disease only two to four weeks after its primary period has begun. Accordingly, all partners of the carrier who had sexual contact with him during this period are at risk of infection, hence the need to test for syphilis.

The standard primary signs of pathology are the formation of a hard chancre along with an increase in the size of the lymph nodes. A chancre is an ulcer or an erosive lesion of a rounded shape, characterized by clear boundaries. Usually it has a red tint, secretes a serous substance, while acquiring a "lacquered" appearance. The secretions contain an increased number of pathogens; when examining the liquid, they can be detected even in cases where there is nothing suspicious in the blood during laboratory tests. The base of the chancre is solid, its edges are slightly raised, forming a shape similar to a shallow saucer. Usually syphiloma is not accompanied by pain or other uncomfortable symptoms.

There are many places for the formation of syphiloma - it can be the genitals, oral cavity or anus, it all depends on the type of sexual contact. The formation of primary symptoms takes place in stages:

• From the moment the pathogen enters the body to the formation of the considered symptom, it usually takes from two to six weeks.
• An increase in the lymph nodes that are closest to the syphiloma usually begins after seven days.
• After another three to six weeks, the sores heal so that there are no visible symptoms.

There are a number of additional signs that accompany the formation of a hard chancre, in this case, the first manifestations include:

• sleep problems, the formation of insomnia;
• fever (high body temperature);
• headache and joint pain, discomfort in the bones;
• general malaise;
• swelling of the genitals.

Atypical symptoms of the pathology include the appearance of amygdalitis chancres in the areas of the tonsils, the formation of panaritium chancres on the fingers, indurative swelling in the area of ​​the labia, regional lymphadenitis and lymphangitis.

Characterizing syphilis, it can be attributed to systemic pathologies that can completely affect the body. External clinical manifestations are often similar to symptoms characteristic of other diseases, respectively, accurate diagnosis includes laboratory studies of the skin and blood sampling for the Wasserman reaction. What specific symptoms of the pathology will appear in the victim depends largely on a number of factors, including his age category, lifestyle, immune status, and other individual characteristics.

The development of syphilis occurs in three periods - primary, secondary, tertiary. They are preceded by a three-week asymptomatic - incubation - period. Consider how syphilis manifests itself in different periods of formation.

We discussed the incubation and primary periods above. Perhaps it should be added that during the incubation period the carrier is not infectious, so that the Wasserman reaction will also show a negative result. With regard to primary syphilis, at this stage in the development of the disease, the patient becomes contagious. Now about the chancre - its disappearance occurs without any treatment, while a scar is formed in the place of the syphiloma. At this stage, increased attention is required - even in the case when the chancre completely disappears, one cannot talk about healing, since the development of the disease continues.

After the treponemas enter the lymph nodes, they are carried throughout the body along with the blood flow. The presence of a primary period of pathology can be indicated by both unilateral and bilateral enlargement of the lymph nodes, usually observed in the inguinal zone. They differ in dense elastic consistency, mobility and painlessness. In the first half of this period, the Wasserman reaction, along with other blood tests, continues to be negative. However, in the second half of the period - usually this is the sixth or seventh week from the onset of infection - blood tests show a positive result, revealing the presence of syphilis in the body. The above weakness, fever and pain occur at the end of the primary stage of syphilis - these signs can be considered harbingers of the formation of a generalized rash, which marks the beginning of the secondary stage of pathology.

About ten weeks after infection of the body - the typical development of pathology in syphilis is implied - signs appear on the skin that indicate a fresh secondary stage of the disease. We are talking about a syphilitic rash, including pustules and spots, nodules. None of these elements cause discomfort. The rash disappears after a few weeks, without requiring the use of any medications. After it passes, we can talk about the onset of secondary latent syphilis. It is characterized by certain manifestations, among which:

• syphilitic rash;
• hair loss;
• discolored spots on the skin of the neck;
• a positive Wasserman reaction, along with other tests performed for syphilis.

Any of the elements of the rash at this stage is highly contagious, but completely painless.

A feature of the secondary period of syphilis is an increased risk relative to the possibility of domestic infection. The duration of this stage is usually two to four years.

Let's see how tertiary syphilis manifests itself. Usually this stage is formed after five or more years from the moment of infection. The main features that characterize the tertiary stage include:

• The formation of gums - foci - in bone tissues, skin, liver and brain, lungs and heart muscle, and even eyes. Gummas are subject to decay, as a result of which the destruction of the site on which they were formed also occurs.
• The appearance of ulcers on the mucous layers of the sky and the back of the pharynx, nasal cavity.
• Possible damage to the nasal septum and its gradual destruction.
• The symptoms of this stage are closely related to the destruction of nerve cells in both the spinal cord and the brain, they manifest themselves in dementia and the appearance of progressive paralysis.

At this time, visible lesions hardly include spirochete pallidum and are therefore rarely contagious. When conducting the Wasserman reaction and other laboratory studies, a weakly positive or negative reaction is noted. Regardless of the syphilitic signs, each of the stages of the pathology is curable. However, at the third stage, the disease not only affects, but can also destroy many human organs, and cell restoration is impossible. Quite often in such a case, the victim becomes disabled for the rest of his life.

The main symptom of syphilis is a rash, the appearance of which is not accompanied by discomfort. At the initial stage of the pathology, it is a hard chancre; at the secondary stage, syphilis can manifest itself with a variety of elements, from pink spots to papules and pustules. Centimeter-wide patches of gray, blue or red hues may appear on the skin. In this case, all types of rash can form simultaneously, most often localized on the hands or soles of the feet. Usually, pain or itching is completely absent. An unpleasant sensation occurs in very rare cases, when probing the papules.

Given the almost complete absence of discomfort, the victims often ignore the rash. In addition, it passes on its own, and therefore therapeutic measures are activated with a considerable delay. Nevertheless, syphilitic rashes have a number of characteristic features:

• The rash is copper colored.
• The lesion that accompanies the rash is peeling or the formation of dirty brown, gray scabs.
• The rash can both disappear and reappear - here the ratio of pale treponema and antibodies contained in the blood plays an important role.
• If there is a relapse, the rash can change. It becomes larger, ovals or circles form on the skin and mucous membranes. Such development can be observed within four or five years - all the time while secondary syphilis will proceed.
• In the presence of tertiary syphilis, subcutaneous seals occur. Their diameter can reach 1.5 cm. Such seals transform into ulcers over time. On the skin, tubercles can form, forming circles, in the center of which ulcerative lesions appear and necrosis is formed.

Given all the dangers of the disease, when suspicious symptoms appear, an immediate appeal to a venereologist is necessary to make an accurate diagnosis and develop a therapeutic regimen.

When comparing the signs of pathology that develops in representatives of different sexes, it can be noted that the main differences are in the localization of foci of syphilis. In men, lesions focus on the scrotum or penis, in women - on the labia minora and the vaginal mucosa. If anal and oral sex takes place in love affairs, negative phenomena are concentrated on the sphincter, oral mucosa, throat, lips and tongue. The skin of the neck or chest may suffer.

In the fairer sex, the formation of a hard chancre occurs most often on the vaginal walls or on the uterine neck, in the area of ​​the labia. The problem with the definition of the disease at the initial stages of development is possible when syphiloma is formed on the uterine neck. Much less often, a chancre is formed on the chest or in the mouth, on the thighs or in the perineum. Most often, one chancre is formed, but the formation of two at once, and sometimes more syphilomas, is not an exception.

If you do not pay attention to the symptoms that indicate the formation of a problem, syphilis can be in the body for not just years - decades! At the same time, its course is undulating, and over time, lesions take on a dangerous and severe character. Is it possible to independently identify signs of syphilis? Undoubtedly, if you follow a number of existing recommendations:

• If suspicious contact has taken place, two or three weeks after it, the whole body should be carefully examined. In this period, the main attention should be paid to the possibility of the formation of a painless hard chancre.
• If a chancre or a similar formation is found, it will be necessary to mentally analyze your condition. In this case, we are talking about primary syphilis, so attention should be paid to fever and fever, headaches, insomnia and muscle pain.
• The next step is palpation of the lymph nodes, primarily the most characteristic ones. Their increase, especially if there is a formation resembling a hard chancre, is a possible sign of syphilis. When probing, the lymph nodes should be mobile and elastic, fairly dense, but painless.

To confirm the presence of syphilis, it is necessary to contact a venereologist at the same time when the chancre was first discovered - only timely treatment prevents complications of the pathology.

In the process of carrying a child, a woman infected with syphilis is able to infect the fetus from the tenth week of pregnancy through the placenta. If secondary syphilis occurs, the infection of the child is one hundred percent, in the presence of late forms of pathology, infection does not occur so often. Rarely, infection of the fetus occurs in the case of primary syphilis in the mother. If the fetus is infected with syphilis, the consequences can be catastrophic - the death of the fetus with spontaneous abortion is possible. The possibility of a stillborn child is not ruled out. In the case when the baby is still born, he still has symptoms of congenital pathology in childhood, depending on when exactly the mother was infected. Congenital pathology can be early or late. The first includes infection of the fetus, infants and young children:

• Fetal syphilis leads to its death in the sixth or seventh month, death occurs due to exposure to the toxins of the causative agent of the pathology.
• At the age of a child up to a year, in the case when signs of pathology are visible, we can talk about the unviability of the baby. Immediately after its birth, a lesion of the skin occurs - syphilitic pemphigus. A syphilitic rhinitis is observed, damage to the bone tissue, spleen or liver is often diagnosed. If the brain is affected, meningoencephalitis is formed.
• With congenital syphilis in babies from one to five years old, the signs resemble secondary syphilis, the symptoms include a syphilitic rash on the mucous and skin layers.

With late congenital syphilis, which manifests itself from 5 to 15 years, eye damage is observed, deafness develops, problems appear in the internal organs, and the central nervous system is affected.

Preventive measures for congenital syphilis include mandatory tests for the presence of pathology, which are carried out three times during pregnancy. With a positive result, it is necessary to visit a venereologist - a specialist decides on the preservation of pregnancy and the treatment of pathology. With an increased risk of developing congenital syphilis, the pregnancy can be terminated in accordance with medical indications. Women who have had syphilis should plan to conceive no earlier than five years after the final cure.

Based on materials venerbol.ru

Syphilis can be latent for a long time. In order to prevent the transmission of the disease, it is worth knowing how syphilis manifests itself, the features of its course, symptoms and treatment rules. Venereal diseases are dangerous pathologies that can lead to serious health complications. The fact is that many of them are not accompanied by symptoms at the initial stage, for this reason the disease can simply not be noticed, and at this time it gradually affects the internal organs. One such disease is syphilis. It can appear in women and men.

• Causes
• Symptoms
• Rash with syphilis
• Forms
  • Primary
  • Secondary
  • Tertiary
• Diagnostics
• Types of studies for the diagnosis of syphilis
• Features of treatment
• Prevention
  • Emergency prevention of syphilis
  • Prevention of syphilis in pregnant women

Photo of the stages of the development of the disease

The development of syphilis can occur for various reasons, but sexual contact is considered the most important. Often, infection occurs during sex with an infected sexual partner. The causative agent of the disease - pale treponema, penetrates through the mucous membrane and damaged skin.

In the future, the bacteria quickly enter the structure of the lymph nodes, where they instantly multiply and, together with the blood flow, spread throughout the body. As a result, they settle in the internal organs, bones, joints and in the central nervous system.

The manifestation of syphilis can provoke other reasons:

• it can manifest itself in a woman and a man after using contaminated personal hygiene items - shower and bath products, towels, linen, brushes, washcloths, dishes with saliva particles;
• the risk of infection is increased during professional contacts. This disease can be picked up while working in the laboratory, in hospitals. Especially often, infection occurs with careless handling of medical instruments, cutting and stabbing objects, which can damage the skin of hands, fingers and come into contact with the dangerous microflora of the virus.

The disease is especially dangerous during pregnancy and for women who are planning childbirth. The fact is that an infection in the body (treponema pale) can develop for a long time without signs, at which time it can have a negative impact on the development of the unborn child.

The main danger of syphilis is that at the initial stage this disease does not manifest itself in any way and is not accompanied by symptoms. For this reason, many simply do not notice the presence of a pathological process, and in the meantime, the infection spreads to internal organs, systems, and bone tissue.

The incubation period of the disease is on average 2 to 6 weeks. However, sometimes it may not develop for years, this may be when taking antibiotic drugs, during the treatment of infectious colds. During this period, laboratory tests will not be able to give a reliable result.

Syphilis manifests itself as internal and superficial lesions. Common symptoms include the following conditions:

• hard chancre and enlarged lymph nodes - these symptoms are the most important. It is they who 100% confirm that the pathogen has entered the body. A hard chancre is a smooth, painless ulcer, a dense infiltrate. The formation has rounded slightly raised edges with a diameter of about 1 centimeter. Accompanied by a bluish-red color, may have pain. Within a week after the onset of chancre, an increase in lymph nodes is observed;
• headaches, symptoms of general malaise are observed;
• pain in the muscles and joints;
• temperature increase;
• reduced hemoglobin level;
• increase in leukocytes in the blood;
• induration edema may form;
• felon. Accompanied by inflammation of the nail bed. The condition may last for several weeks;
• amygdalitis may be noted. During it, there is swelling of the reddened tonsils, difficulty in swallowing.

It is important to remember that syphilis infection can occur through any form of sexual intercourse. Therefore, oral sex, during which condoms are rarely used, is especially dangerous when infected.

So primary syphiloma is formed at the site of the introduction of pale treponema, with oral infection, the chancre will be located in the mouth or throat. Moreover, if a partner has a chancre in the oral cavity, you can get infected without sex, just through a kiss.

If the infection occurred during anal intercourse, the chancre is localized in the anus. At the same time, it often looks atypical, and, in shape, is not round, but slit-like.

For the penetration of infection, contact of the pathogen with the mucous membranes is not always necessary. The skin can also become an entrance gate for infection, especially if it is damaged. Hard chancre in such situations is often localized on the skin of the thighs, face or abdomen.

Approximately 3-4 weeks after the incubation period, skin rashes may be observed. They are not accompanied by a sensation of itching, pain. Skin manifestations of syphilis have a dark red color, have a dense texture, straight edges without peeling.

The rash can be of different types:

1. Roseolous. During a rash of this type, small oval or round spots (about one and a half cm) are formed. They are located on the entire surface of the body, arms, legs. Their borders are not pronounced, do not blur and do not rise above the skin;
2. Papular. Round formations with a pale pink color. The size of the rashes is 1 centimeter. The surface is smooth, there are small peelings. The main locations are the area of ​​the soles of the feet, on the palms, on the surface of the mucous membranes of the genitals. Sometimes there is a pale rash all over the body;
3. Condylomas. These are connected papules that have ulcers;
4. Leucoderma. This condition is characterized by the appearance of white spots against the background of darkening of the skin. Over time, they acquire a brown-yellow color. Localized rashes on the neck, armpits, chest, arms;
5. Angina of an arthematous type. Eruptions appear on the area of ​​the oral mucosa, near the pharynx, on the surface of the hard palate. The pale treponema bacteria themselves are located inside the cavity of the papules;
6. Alopecia. On the surface of the scalp, a large number of rashes with a diameter of 1-2 mm are formed. Over time, hair loss occurs in these places.

In order to understand how the varieties of the rash can manifest themselves and how they look, it is worth viewing the photo.

Syphilis can occur in several forms, and each of them can have distinctive features. For this reason, it is worth more carefully studying the manifestations of each.

The primary form is early latent syphilis. It usually occurs a few weeks after infection.

Patients with primary syphilis do not immediately notice its manifestations. For this reason, the disease can go to the internal organs, tissues, systems and cause serious health complications.

During the initial form of syphilis, symptoms appear:

• the appearance of specific ulcers with rounded shapes, which are also called chancres;
• after about 2 weeks, the chancres completely disappear. This means that pathogenic bacteria have entered the body;
• damage to the lymph nodes is manifested, and their increase is also observed;
• the primary form affects the internal organs and systems.

At 11 weeks of infection, symptoms of secondary syphilis appear. This form is accompanied by the appearance of syphilitic infectious lesions in the form of spots, rashes, abscesses, nodes on the skin.

Formations do not have pain, discomfort. If timely treatment is not carried out, then they completely disappear over time. This means that the disease goes into a latent form. Over time, secondary syphilis may reappear, during which all characteristic signs may reappear.

The secondary stage can take up to 4 years. At the same time, it is accompanied by serious health complications.

Approximately 5 years after the secondary stage, the disease passes into the tertiary. It is considered the most severe, during which the following complications may occur:

• severe damage to internal organs;
• the appearance of foci (threshing floor) on the skin;
• foci can be observed on the mucous membranes and internal organs - on the heart, liver, lungs, brain. They also affect bones and eyes;
• often the disease affects the mucous layer of the nose. Lesions lead to the complete destruction of the nasal septum;
• at this stage dementia, progressive paralysis is manifested.

Diagnosis should be carried out immediately, as the first symptoms of syphilis appeared. Of course, this ailment can proceed in a latent form for a long time, but still, if you start treating it at the initial stage, you can quickly eliminate all its unpleasant manifestations.

It is also worth starting an examination if you have recently had sexual contact with a carrier of the disease. In these cases, infection is most likely to be confirmed. And in order to get the most accurate results, laboratories conduct blood tests, which are taken from a vein.

Modern serological and immunological examinations of blood make it possible to identify the disease with maximum accuracy within a few weeks from the time of infection. The test allows you to identify the disease with an accuracy of 99.8-100%.

There are many types of tests that can detect the presence of a pathogen in the body. However, serological tests are usually diagnostic criteria for syphilis.

The principle of serological reactions is to detect antibodies to pale treponema in the blood. At the same time, if little time has passed since the moment of infection, the body may not yet have time to develop antibodies. Such syphilis is called primary seronegative and presents difficulties in diagnosis. In this case, in the presence of a hard chancre, a preliminary diagnosis is made on the basis of the clinical picture and interview data. In the future, the patient is required to retake tests to confirm the infection.

At the stage of tertiary syphilis, the body's immune response may be low. At the same time, standard research methods do not detect the presence of antibodies in the blood. This happens in about a third of cases of tertiary syphilis. Additional tests are required to establish an accurate and definitive diagnosis in this situation.

Diagnosis may require the following blood tests:

• RPR and MP;
• Linked immunosorbent assay;
• Immunofluorescence reaction;
• Reaction of an immobilization of pale treponemas;
• The reaction of passive hemagglutination.

The previously popular classical Wasserman reaction is not used today due to its low efficiency in comparison with RPR. In the old fashioned way, this test may continue to be called the RW.

Tests are divided into non-treponemal (RPR and microprecipitation reaction) and treponemal (RIF, RIBT, RPHA, ELISA).

Non-treponemal, that is, not determining the presence of the pathogen itself, are cheaper than treponemal. However, such tests are less effective and, if positive, require additional testing. Consider the principles of each of the analyzes and the degree of their effectiveness for diagnosis.

RPR- screening research method. It is used to diagnose early asymptomatic forms of the disease. It is this study that is used in preventive tests.

RPR is not accurate enough to make a definitive diagnosis.

A positive RPR is not diagnostic and requires additional testing. In some cases, such an analysis can give false positive results:

• Diabetes;
• Tuberculosis;
• Malignant neoplasms;
• Alcohol and drug abuse;
• Viral hepatitis;
• Acute inflammatory diseases;
• recent vaccination;
• Pregnancy.

Eating fatty foods and alcohol before testing can also cause a false positive result.

ELISA- the most accurate analysis for seropositive forms of syphilis. It detects the presence of antibodies, which is a clear criterion for making a diagnosis.

REEF, or an immunofluorescence reaction detects the presence of pale treponemas themselves in the blood. This is a complex and expensive analysis, so it is used only when there is a clear indication. For example, with severe symptoms with negative RPR and ELISA.

RIBT- Another complex study that most accurately determines the presence of infection. With it, the blood is examined under a microscope for the presence of pathogens, which are previously immobilized with special antibodies.

RIBT is highly effective in syphilis. Apply it even if other tests did not give a positive result.

RPGA- an accurate treponemal test, quite often used to diagnose the disease. When it is carried out, sheep erythrocytes, processed in a special way, are introduced into the serum. Red blood cells stick together and settle to the bottom with a positive result.

Syphilis that appears on the skin is usually treated with penicillin-based drugs. Treponema pale, unlike other bacteria, has not lost its sensitivity to this substance, for this reason penicillin and its derivatives are prescribed to treat this disease.

• if the skin has ulcers with a hard frame, then penicillin preparations are prescribed. Daily injections;
• Injections are made immediately in two buttocks. First, injections of Penicillin are given, and then Bicillin-3;
• the use of antihistamines is additionally prescribed;
• in the primary form, injections are given within 16 days;
• during the secondary form, injections of water-soluble Penicillin or Doxycycline are prescribed, and Ceftriaxone is also recommended;
• in the secondary form, injections are made for 32 days, while antibiotics are taken.
• the tertiary form is treated with injections of Penicillin with Bioquinol. The course is long, it is set by the doctor.

Therapy of syphilis requires mandatory control.

The effectiveness of antibiotics is checked using ELISA - the criterion is a decrease in antibody titers to pale treponema.

If the titer does not decrease, this means that the antibiotic is ineffective against this strain of the pathogen. In this case, the attending physician changes the drug and treatment regimen.

After the end of the course of therapy, the patient retakes tests to confirm the absence of infection. Sometimes there are cases of so-called seroresistant syphilis. This is a form of the disease in which, against the background of a complete cure, serological tests remain positive. Such cases require special attention to the level of titers: if they are reduced by less than four times, additional treatment is required.

If, after six months of therapy, the tests show an infection, but the titer of reagins is reduced by four times or more, they speak of a slowdown in seroreactions. These patients are followed up for another six months.

At the discretion of the doctor, restorative treatment may be recommended. In general, additional therapy with true or relative seroresistance can last from six months to one and a half years. In addition, such patients are consulted by an immunologist - seroresistant syphilis may be the result of pathologies of the immune system.

Be sure to follow the prevention, which will help protect against this dangerous disease. This also applies to women who plan to have children, a successful pregnancy and childbirth depends on this. Otherwise, in the future we should expect congenital syphilis in children, which can cause serious harm to a fragile children's body.

The following preventive measures must be observed:

• personal hygiene;
• protected sexual intercourse, the use of barrier contraception (condoms);
• do not lead a promiscuous sex life;
• use of personal hygiene items;
• regular visits to the doctor.

Sexually active people are advised to take an RPR screening test for syphilis at least once every six months. Since there is a high risk of infection through unprotected oral sex, it is important to remember the need for barrier contraception during any sexual intercourse.

If the giving partner is male, regular condoms are used.

When it comes to a woman, you can use the so-called "female condoms". They are a thin latex napkin that covers the female genitalia during oral sex.

In addition to early prevention, there is an emergency. It is aimed at preventing the development of the disease after a dangerous contact has taken place.

The primary stage of such prevention is a thorough washing and douching of the mucous membranes. For douching, antiseptic solutions are used, for example, Chlorhexidine and Miramistin.

The next stage requires antibiotic therapy and is carried out strictly according to the prescription of a venereologist. The specialist in this situation prescribes a loading dose of antibacterial drugs that are taken once. Treatment can be with pills or injections.

Remember! You can not take antibiotics on your own and without consultation.

A person without medical education does not know the exact and correct dosages of drugs. Not all antibiotics are effective against pale treponema. In addition, uncontrolled use of antibiotics is associated with the risk of developing allergic reactions and complications from their use.

If during pregnancy a woman was at risk of contracting syphilis, prophylaxis is essential. In this case, the possible negative effect of antibiotics on the fetus is lower than the potential harm of syphilis for the unborn child.

Taking antibiotics in this case is carried out strictly under the supervision of doctors. For the prevention of syphilis in pregnant women, drugs with the least toxic effect on the fetus are used.

Be sure to remember that syphilis is a dangerous disease that causes serious health problems. This disease can be cured at almost any stage, but the sooner the better. Moreover, in the early stages, the disease is eliminated with maximum accuracy without health problems.

• Gardnerellosis
• Condylomatosis
• Thrush
• Syphilis
• Trichomoniasis
• Balanoposthitis
• Herpes
• Gonorrhea
• Mycoplasmosis
• Ureaplasmosis
• Urethritis
• Chlamydia

According to onvenerolog.ru

How quickly does the chancre appear. Primary period of syphilis. primary syphiloma.

Hard chancre is the primary stage of syphilis. Syphilis refers to a number of infectious diseases and has 3 stages. Its causative agent is pale treponema. Hard chancre is also known as primary syphiloma, and it occurs at the place through which the pathogen entered the body.

• What does hard chancre look like
• Atypical form of the disease
• The main aspects of therapy

Hard chancre, or primary syphilis, is formed on the 3rd-4th week after the penetration of pale treponema. The causes of infection, as a rule, are the same - sexual contact with an infected person, the use of common hygiene products. Hard chancre is the most benign form of syphilitic infection because:

• its localization is limited (most often found on the penis or in the oral cavity);
• the active form is characterized by scarcity and monomorphism;
• education does not affect the internal organs;
• effective and relatively easy to treat.

Most often, signs of a hard chancre appear in the genital area. However, in 10% of cases, a hard chancre may appear on the oral mucosa, on the tongue, on the lip, on the chest in women, on the tonsils.

A hard chancre begins with a reddish spot with smooth edges (what primary syphilis looks like can be seen in photos 1, 2). The spot diameter is not more than 15 mm. The spot has a regular round or oval shape. It does not cause any discomfort to the patient, does not itch or burn. However, if a bacterial infection is attached, complications may occur. The latter is evidenced by uneven edges of the formation, pain when touched.

Photo 1 and photo 2. Localization of a hard chancre in the genital area.

After a few days, the spot becomes a flat papule, and a little later it turns into a state of erosion or ulcers (less often) with a compacted base. The bottom of the ulcer is flush with the skin around or slightly rises above it.

In the vast majority of cases, hard chancre takes the form of erosion. Ulcer formation occurs due to:

• the patient has other chronic infections;
• intoxication of the body;
• therapy using topical irritants;
• neglect of personal hygiene measures;
• adolescent or elderly patient.

There are 3 types of hard chancre depending on the size of the formation:

1. Dwarf - 1-3 mm.
2. Medium - 10-20 mm.
3. Giant - 40-50 mm. As a rule, it appears on the thighs, on the pubis, on the face and forearms.

In addition, hard chancre is classified according to the number of formations on the patient's body:

1. Single type.
2. Multiple type. In this case, the chancre is formed simultaneously or sequentially in several locations through which pale treponema entered the body.

In addition to the solid form of the chancre, a soft chancre is also isolated. It differs somewhat in morphology from solid. Hard and soft chancre are symptoms of a syphilitic infection.

In rare cases, people who contract syphilis from a sick person may develop an atypical chancre. These include:

• edema is indurative;
• amygdalitis;
• chancre-panacir.

Indurative edema is localized in the area of ​​the foreskin (in men) or labia (in women). The affected area increases 2-3 times over time, becomes dense and cyanotic. At the same time, swelling does not cause pain.

As mentioned above, sometimes the symptoms of the disease can appear on the tonsils. However, amygdalitis is different from the usual form of chancre. There is a sharp increase in the size of the amygdala, and on the one hand. The body of the amygdala becomes hard and inflamed. This phenomenon can be mistaken for one of the symptoms of angina.

The symptoms of the chancre-felon are almost identical to those of the common panaritium. This complicates the diagnosis of hard chancre. Chancre panaritium appears on the phalanges of the fingers. The lesion is characterized by bluish-red edema with further ulceration with pus formation. With this type of primary syphilis, the infected person feels a throbbing or shooting pain in the affected area.

If a person is diagnosed with "hard chancre", he is prescribed treatment in a hospital or on an outpatient basis. Since the main and most common way of transmission of the infection is sexual, any sexual contact to the patient during treatment should be stopped. In addition, all previous and current sexual partners of the patient should undergo examination and, if necessary, therapy, even if they do not have any symptoms.

Primary syphilis is treated with antibiotics of the penicillin group, since pale treponema is sensitive to them. Benzylpenicillin and ampicillin are often injected.

A hard chancre is an early stage of a syphilitic infection.

Having started treatment at this stage, the infected person will recover easily and quickly, preventing the infection from progressing and eliminating the possibility of complications.

As soon as formations similar in morphology to a hard chancre are found on the body in characteristic places of localization, a person should immediately seek advice from a dermatovenereologist.

If a person has had sexual intercourse with a suspected carrier of the causative agent of syphilis, he should also contact a specialist to take preventive measures to avoid infection.

Hard chancre is a symptom of primary syphilis. It is also called primary syphiloma or erosion. Hard chancre appears in men and women about three weeks after the introduction of the causative agent of the disease, treponema pallidum, into the body. Its symptoms are erosive or ulcerative formation on the skin or mucous membranes.

Hard chancre has the following features:

• characterized by limited localization;
• does not affect the internal organs and systems of the body;
• responds well to treatment.

The hard chancre got its name from the type of base of the formed ulcer or erosion. The duration of the existence of primary syphiloma is from six to eight weeks.

Localization of primary syphiloma can be absolutely any. A hard chancre in a person appears directly at the site of introduction of pale treponema into the human body after a certain time after infection. Its most common localization is the external genital organs - in women the labia, clitoris, in men the head, base and trunk of the penis, the outer or inner sheets of the foreskin. In some cases, a hard chancre is formed on the internal mucous membranes: in the urethra in men, on the walls of the vagina or cervix in women.

In ten percent of all cases, an extragenital location of the chancre is observed. Hard chancre in women and men can be localized:

• in the oral cavity;
• in the language;
• on the border of the lips;
• on the tonsils in the throat;
• on the mammary glands of women.

Outwardly, a hard chancre looks like a reddish spot with clearly defined, even edges, up to 1.5 centimeters in size. It has the shape of a geometrically correct circle or oval. Sheer or undermined edges indicate a bacterial complication.

Symptoms of hard chancre are only external. It does not disturb the patient in any way, does not cause any pain. Complications develop only if a bacterial infection has joined the lesion.

After a few days, the redness turns into a flat papule, and after a while - into erosion or an ulcer with a compacted base. Hard chancre has a bottom, which is located on the same level with the skin or slightly raised above.

In almost 90% of cases in women and men, a hard chancre looks like erosion. An ulcer forms:

• when the body is weakened as a result of concomitant chronic diseases;
• as a result of intoxication;
• when self-medicating with local irritants;
• in case of non-observance of elementary rules of personal hygiene;
• in young or elderly patients.

When formed in men on the penis, a hard chancre is covered on top with a transparent, dense detachable film. It is in it that pale treponemas are located, which are then used to determine syphilis. If a hard chancre is located on an open area of ​​the body, then on top it is covered with a dense brownish film.

Hard chancre in size is:

• from 1 to 3 mm - dwarf, it is considered the most dangerous from an epidemiological point of view;
• from 1 to 2 cm - medium;
• up to 4-5 cm - gigantic, localized on the skin of the thighs, pubis, forearms or face.

Hard chancre in humans can vary in the number of morphological units, that is, it can be single and multiple. If multiple chancres are present, then they can appear all at once at the same time or sequentially, one after another, after some time. If there are multiple lesions on the skin, then a hard chancre occurs in several places at once, that is, where pale treponema enters the body. Multiple chancres most often occur during repeated sexual intercourse with a partner with syphilis.

Rarely, men and women infected with syphilis have a hard chancre in an atypical form. These include:

• amygdalitis;
• indurative edema;
• chancre-panacir.

Chancre-amygdalite is very different from the usual hard chancre on the tonsils. He has other outward symptoms. In most cases, amygdalitis looks like a unilateral enlargement of the tonsil, which occurs very abruptly. It becomes dense to the touch and hyperemic. This symptom is sometimes confused with manifestations of angina.

Indurative edema occurs in the area of ​​the labia in women or the foreskin in men. The affected area, unlike a typical hard chancre, after a while increases in size by two to three times, becomes dense to the touch and acquires a bluish tint. Edema is non-painful, it is not accompanied by acute inflammatory symptoms.

Chancre panaritium is the most atypical manifestation, its danger lies in the fact that the symptoms completely coincide with the usual panaritium, and it looks exactly the same. This can lead to misdiagnosis. The chancre panaritium is characterized by localization on the distal phalanx of the thumb or index finger. A bluish-red swelling appears on the affected area, which turns into an ulcer with a purulent coating on the bottom and uneven deep edges. For chancre-panaritium, symptoms such as throbbing or shooting pains are characteristic. Most often, it occurs in gynecologists and operating surgeons who are in direct contact with the body of a person infected with syphilis, thus, chancre panaritium in most cases is the result of occupational infection.

Syphilis in the form of chancre-panaritium is very rarely detected on time, and therefore the diagnosis becomes known already in the second stage of the disease. Timely detection of atypical chancre is very important, since the primary stage of syphilis is treated most effectively.

A hard chancre in a person infected with syphilis is treated in an inpatient or outpatient setting. Throughout the course of therapy, a cessation of any sexual contact is required. It is necessary to treat all sexual partners of a person with syphilis, no matter how many there were. The fact is that the probability of their infection with pale treponema is extremely high.

Treatment of hard chancre is carried out with antibacterial drugs of the penicillin group, since the causative agent of syphilis has not lost sensitivity to them. Most often, these are injectable forms of ampicillin and benzylpenicillin.

You need to know that a hard chancre in itself is not dangerous. It allows you to identify syphilis at its earliest stage. Therefore, timely treatment makes it possible to prevent the further development of the disease and the occurrence of complications. If you find a formation on the skin that resembles the description of a hard chancre, you should immediately consult a doctor for examination.

After suspicious unprotected sexual intercourse, prophylactic treatment may be prescribed, which will prevent the penetration of the causative agent of syphilis into the body. To do this, without delay, contact a dermatovenereologist.

Primary syphilis is manifested by swollen lymph nodes and hard chancre. What is a hard chancre? These are the symptoms of syphilis, which are round ulcers with a diameter of about one centimeter on the patient's body.

In color, they are red with blue, sometimes they are painful, but basically the patient does not perceive pain at the site of erosion. The first signs of syphilis in men: the formation of a chancre on the head of the penis, and in women, the symptoms of syphilis appear on the walls of the uterus and on the external genitalia. Also, these sores are on the pubis, near the anus, on the tongue and lips.

Syphilis develops quickly, and the lymph nodes become inflamed and enlarged first, and then the formation of a hard chancre.

It can resolve on its own, even without medical treatment after one to two months. It passes almost without a trace, although if the sores are large, dark spots may remain.

A chancre with syphilis is a focus of syphiloma, which is formed at the site of treponema in the body.

Chancre got its name from the French word, which means ulcer, erosion. In some infectious diseases there is a chancre, but in the disease of syphilis, this erosion is the first sign of syphilis in the first stage. The formation of a hard chancre, on the body after a little more than 4 weeks, from the moment of infection with this disease. During this period, the spirochete infection manages to get into many organs and into the lymph, while starting to multiply, which causes an inflammatory process and a temperature may appear.

They are classified by type, size, number of sores on the body, their location.

• erosive is erosion that affects the layers of the mucous system;
• ulcerative chancre - these are ulcers that penetrate into the deeper layers of tissues.

According to the quantitative classification, chancre is divided into:

• a single one is a chancre, which consists of one sore;
• multiple is erosion, which consists of many ulcers, and create a single wound.

Syphilomas of hard chancre in size are:

• small (dwarf) - diameter less than 10 mm;
• medium - diameter from 20 mm;
• large (giant) - diameter 50 mm and above.

Place of occurrence of hard chancre on the body:

• extragenital - it affects the tongue, anus, chest, throat, legs, gums;
• genital - these are erosions that appear on the genitals of a sick person;
• bipolar are chancres that simultaneously appear on the genitals and other parts of the body.

By the end of the primary period of syphilis, the chancre becomes a form of the disease that:

• has localization in specific places, in the oral cavity and on the genitals;
• has a non-multiple form;
• does not affect internal organs;
• It is quite easy to treat and does not leave behind consequences.

In people who have contracted syphilis infections and at the same time have reduced immunity, an ulcerative lesion appears necessarily. Also, the formation of ulcers on the body occurs with chronic infections, toxicity of the body and for age-related reasons. As a result of self-treatment of syphilis, purulent erosions are formed, which, after attenuation, leave age spots and scars.

It begins to develop with redness, which does not cause itching and pain. After 48 - 72 hours, a bump begins to form from this redness and a papule forms. At this point, the epithelium from the chancre may peel off, and the infected person begins to feel pain for the first time.

In the following hours and days, the syphiloma becomes larger, spreading around the circumference. A hard crust begins to form on the papule, under which an ulcer forms. Over time, the crust is rejected and a sign of syphilis appears - a hard chancre.

The shape of the chancre is slightly raised, with clear round edges. Sometimes these edges are oval. The surface of the chancre is smooth, sometimes has a grayish coating, but mostly the color of the chancre is red.

The shape of the chancre is different:

• nodule shape - this ulcer has clear boundaries. This ulcer grows into the deep layers of the tissue and retains its clear boundaries. This chancre is localized on the foreskin of the penis;
• the form of a plate or a coin - the chancre is localized on the upper layers of the tissue and is located on the labia, the shaft of the penis, on the scrotum;
• leaf-shaped form - erosion has clear boundary lines and is located mainly on the head of the phallus.

In addition to hard chancre, there is also atypical chancre and many of its types:

• indurated edema is a large seal that forms on the foreskin of the penis, the genitals in women and in the area of ​​​​the lips on the face of a person;
• Panaritium is a chancre that develops on the nails and does not heal for several months. Perhaps even rejection of the nail;
• lymph nodes - increase in this period. Depending on which part of the body a chancre has formed, the lymph nodes closest to the chancre become inflamed;
• a bubo is a lymph node that has a mobile shape and does not have painful signs and is closest to the chancre: on the patient's neck, if the chancre is in the tonsils, and in the inguinal part of the body, if the chancre is on the penis, in the genital area;
• polyadenitis is an inflammation and compaction of all lymph nodes, from that moment it can be considered that symptoms of secondary syphilis began to appear.

Complications of syphilis in the first period are very serious for women, as well as serious consequences for the male part of the population.

• on large and small labia;
• on the clitoris;
• on the walls of the cervix;
• in the area between the anus and the vagina.

On the walls of the vagina, a hard chancre with syphilis occurs very rarely, since the acidity of the vagina has a detrimental effect on treponema.

Very often, the chancre of syphilis is formed on the cervix. This chancre is invisible and is diagnosed mainly in the second stage of the development of the disease.

Over 10 percent of women with syphilis in the first stage have a hard chancre on the walls of the cervix. Syphilis chancre is detected only at the time of examination of the uterus with the help of medical equipment. This examination is carried out by a gynecologist or venereologist.

In the oral cavity, a chancre is formed on the tongue, lips, soft palate and tonsils. There are frequent cases of ulcers on the gums, cheeks, fingers and chest.

Diagnosis of syphilis consists of several types of examinations and tests:

• serological diagnosis is the detection of treponema bacteria from a hard chancre scraping. According to the results of this examination, the doctor makes a diagnosis;
• treponema immobilization reaction;
• immunofluorescence reaction;
• Wasserman reaction;
• microreaction on glass;
• linked immunosorbent assay;
• microprecipitation reaction;
• passive hemagglutination reaction.

Syphilis is a sexually transmitted disease that occurs in the classical form. Syphilis is a hard chancre, the main symptom of this disease. A hard chancre is a symptom of only primary syphilis.

Syphilis in the first stage of its development is manifested in an increase in lymph nodes and hard chancre. Toward the end of this period, the following symptoms become:

• a state of general malaise;
• persistent headache;
• elevated temperature;
• pain in muscle tissues;
• aches and pain in the bones;
• low hemoglobin;
• a significant increase in leukocytes.

A syphilis chancre tends to pass on its own and leave no traces, so people who self-medicate may assume a cure for syphilis.

This is a delusion, because the disappearance of a hard chancre precedes secondary syphilis, which is much more dangerous than syphilis in the first stage of development and the treatment of this type is much more complicated and lengthy.

Complications of a syphilitic chancre can penetrate other infections into the chancre, which leads to painful symptoms and the accumulation of pus in this place.

There are several reasons for infection:

• chancre injury;
• poor hygiene;
• diabetes mellitus disease;
• HIV infection;
• development of tuberculosis in the body.

In the female body develops:

• syphilitic gangrene;
• infectious vaginitis;
• inflammatory bartholinitis;
• cervical endocervicitis.

Complications in the male body lead to:

• balanitis;
• balanoposthitis of the head of the penis;
• phimosis of the foreskin;
• paraphimosis of the foreskin;
• gangrenization of the head of the penis;
• phagedenism of the penis.

At the primary stage, the task is to cure the infection and prevent syphilis from moving into the second stage. Hard chancre, treatment should be carried out as early as possible.

The main drugs that are used in the treatment are antibiotics of different groups and directions:

• penicillins;
• macroliths;
• tetracyclines;
• fluoroquinolones.

Together with antibiotics in the treatment process involved:

• antifungal drugs;
• immunomodulators;
• multivitamins;
• probiotics.

The treatment regimen for syphiloma is prescribed by the attending physician, based on the diagnosis and test results.

With a course method of treatment, tetracyclines and drugs based on bismuth and iodine are added to penicillins. This complex of drugs is able to increase the action of the antibiotic in the body.

With the diagnosis of syphilis, both sexual partners are treated.

At the time of therapy, the patient is prescribed food, the diet of which is dominated by protein foods and a restriction in the consumption of fats and carbohydrates.

During this period, smoking and drinking alcohol are contraindicated, and it is also necessary to reduce physical stress on the body.

The main condition for quality treatment is the observance of the rules of personal hygiene and during the treatment period - not to have sex.

Treat chancre with antibiotics:

• Extencillin - intramuscular injections, it is enough to carry out the procedure twice;
• Bicillin - injections, twice, after 5 calendar days;
• Erythromycin - take 0.5 mg 4 times a day;
• Doxycycline - 0.5 mg taken 4 times a day.

For local treatment of hard chancre, lotions are needed on the chancre from benzylpenicillin and dimexide preparations.

It is necessary to lubricate the syphilitic chancre with heparin ointment, erythromycin ointment, ointment based on mercury and bismuth. Synthomycin ointment and levorin ointment contribute to the separation of pus from the ulcer.

Chancres that are in the mouth must be rinsed with solutions:

A hard chancre is a very important sign in recognizing syphilis in the body. The earlier an infection in the body is detected, the faster the treatment of the disease will begin, and the duration of the course of drug treatment may be minimal. In this case, treatment with folk remedies and self-treatment are contraindicated.

Only a competent doctor will be able to establish a diagnosis and prescribe the necessary treatment. Fulfillment of all doctor's prescriptions, a healthy lifestyle, hygiene, will give a positive result in curing syphilis at the first stage of the disease.

clinical picture. Primary syphilis is characterized by the development of a hard chancre (ulcus durum, primary syphiloma) and regional lymphangitis and lymphadenitis at the site of the introduction of pale treponema. Sometimes, between the chancre and enlarged regional lymph nodes, one can see and palpate a strand of regional lymphangitis.

Thus, the clinical manifestations of the primary period of syphilis are represented by three elements: hard chancre, regional lymphadenitis and regional lymphangitis.

At the end of the primary period, general flu-like disorders are sometimes observed: headache, osteoarticular and muscle pain, general weakness, insomnia, fever.

Hard chancre often persists until the onset of the secondary period and heals soon, rarely exists for up to several weeks and after the appearance of a generalized rash, even less often heals before the onset of secondary manifestations. It depends mainly on its size. Associated regional lymphadenitis usually occurs 7 to 10 days after the onset of the chancre. Hard chancre is a very characteristic erosion or ulcer, but it does not immediately take on these features. After the expiration of the incubation period, a red spot first appears at the site of treponema introduction, which then turns into a dense nodule with sharply defined borders. Within 7–10 days, the nodule significantly increases in size, and the infiltration of its base takes on the character of a specific compaction. Due to malnutrition of the epidermis caused by vascular damage characteristic of syphilis, necrotization occurs in the center of the infiltrate and erosion or an ulcer is formed.

The main clinical signs of a typical hard chancre: erosion (ulcer) with no acute inflammation; loneliness or singularity; correct (rounded or oval) outlines; clear boundaries; size - with a small coin; elevation of the element above the surrounding healthy skin (mucous membrane); smooth, shiny ("varnished") bottom; sloping (saucer-shaped) edges; bluish-red color of the bottom; scanty serous discharge; dense elastic (“cartilaginous”) infiltrate at the base (knotty, lamellar, leaf-shaped); painlessness; resistance to local disinfectant and anti-inflammatory therapy.

Along with the described classical form of hard chancre, there are various deviations in one or more of its listed signs, which creates quite numerous varieties of primary syphiloma. Multiple chancres are rare (about 1/5 of patients). Their number rarely exceeds 10. The multiplicity of chancres is explained by the presence of numerous small violations of the integrity of the skin or mucous membrane in the patient at the time of infection. Concomitant skin diseases, such as eczema or scabies, can play a decisive role, especially when localized on the genitals. It is characteristic that no matter how numerous hard chancres are, they are all in the same stage of development if they were the result of the simultaneous penetration of infection through several entrance gates. These are the so-called twin chancres. If infection occurred at different times (for example, as a result of repeated sexual contacts with an interval of several days), then chancres will appear at different times and differ from each other in the degree of maturity. These are the so-called successive chancres. Giant hard chancres are usually located in places with abundant subcutaneous fatty tissue: in the pubis, abdomen. Their size can reach a child's palm. The dwarf hard chancre is extremely small in size - up to a poppy seed, however, under a magnifying glass, all the characteristic signs of primary syphiloma are found. Diphtheritic hard chancres covered with a grayish necrotic film are very common. Cortical hard chancre is observed in places where the discharge dries easily: on the face (nose, chin), on the skin of the lips, sometimes on the abdomen, the shaft of the penis. It may have a great resemblance to pyodermic elements: impetigo, ecthyma. Slit-like chancres, resembling a crack in shape, sheets of a book, are usually localized in small folds of the skin: in the corners of the mouth, in the interdigital folds, in the anus. Folman's erosive chancre does not have a clear seal at the base, it is usually localized on the glans penis. Hard chancres located at the external opening of the urethra, in the folds of the anus and on the tonsils, may be accompanied by considerable soreness. The localization of a hard chancre depends on the route of infection of a given patient with syphilis. With sexual infection, a hard chancre occurs, as a rule, on the genitals or on adjacent areas (pubis, abdomen, inner thighs, perineum, anus). Chancres on the cervix occur in 12% of sick women. In this regard, it is of great importance to examine women with suspected syphilis using a vaginal speculum. In some cases, with sexual infection, a hard chancre is located extragenitally (for example, on the lips, tongue, mammary glands, fingers). Extragenital chancres can be located on any part of the skin and mucous membranes. The second place after the genital organs in terms of the frequency of localization of primary syphiloma is occupied by the oral mucosa (lips, gums, tongue, soft palate, tonsils). Other localizations of hard chancre are rare.

Atypical hard chancres include indurative edema, chancre-amygdalite and chancre-panaritium .

Indurated edema usually occurs on the labia or on the foreskin. The affected area increases by 2-4 times, becomes dense, the skin acquires a stagnant cyanotic color or retains its normal color. The painlessness of the lesion and the absence of acute inflammatory phenomena are characteristic, which distinguishes indurative edema from processes such as bartholinitis or inflammatory phimosis (such diagnoses are most often made by patients).

Chancre amygdalite should be distinguished from erosive (ulcerative) hard chancre on the tonsils. Chancre-amygdalitis is characterized only by a sharp, usually unilateral enlargement of the tonsils. The tonsil is dense, there are no acute inflammatory phenomena. Chancre amygdalitis is very similar to indurative edema. This atypical chancre is often mistaken for a banal sore throat. L1ancre-panaritium is the most atypical of all chancres. It really is very similar to a banal panaritium: on the distal phalanx, more often than the index or thumb of the hand, against the background of bluish-red edematous skin, there is a deep ulcer with uneven, overhanging, as if gnawed edges and purulent-necrotic plaque. Chancre panaritium is accompanied by sharp, “shooting” pains. Most often it occurs in surgeons, gynecologists, pathologists and is the result of occupational infection, rarely diagnosed in a timely manner. Usually the diagnosis of syphilis is made after the appearance of rashes of the secondary period.

Chancre panaritium should not be confused with the typical chancres on the finger. Histologically, a typical chancre is an infiltrative-erosive or infiltrative-ulcerative formation with characteristic changes in the vessels of the dermis. It has a number of pathohistological features: the absence of the epidermis (and part of the dermis) in the central zone of the preparation due to the formation of foci and zones of necrosis; in the dermis - a dense infiltrate of lymphocytes and plasma cells, along the periphery the infiltrate has a perivascular location; changes in the blood and lymphatic vessels of the dermis in the form of proliferation and infiltration of all membranes (panvasculitis) with obliteration and thrombosis of some vessels; many pale treponemas in all areas (especially in the walls of the vessels and in their circumference).

When spirochetes have penetrated, for which an insignificant, completely imperceptible violation of the integrity of the skin is enough. After the first incubation period, most often at the end of the second week, a small nodule appears. It very often, but not always, ulcerates. Gradually turns into an extremely dense, cartilaginous hardness infiltrate, which forms the base and edge of the developing ulcer. This phenomenon is called hard chancre in men and women. Photos, the initial stage as the primary signs will be considered in the article.

Specific signs of a hard chancre with syphilis are the following moments of changes in the skin. The rash, which is also an infiltrate, is mostly flat, sharply demarcated. To the touch, it gives the impression that there is a hard plaque in the skin. But depending on the location of its localization, the nature of the rash can be very different.

Usually there is only one primary eruption. But relatively often there are several hard chancres. Moreover, they are all in the same stage of development, since they all appear simultaneously depending on the same infection. Further transfers in the same patient from one chancre are not observed, since after infection, immunity to a new infection soon sets in. Moving to another place of the skin, as opposed to a soft chancre, is not observed with this primary sign of syphilis.

The size of the hard chancre varies over a very wide range. Its surface can be covered with a thin, moist luster, as if eroded epithelium, which is especially characteristic. When palpated, a cartilaginous density infiltrate is felt. With a more pronounced erosion surface, the skin appears dark red, as if granular. When ulcerated, the ulcer is always smaller than a hard roller, and has a dense base. With ulceration, it may be the case, depending on the method of formation:

1. With ulcerated sclerosis.
2. With sclerosed ulceration.

In the latter case, the situation may be different. First, a very small nodule formed at the site of infection can turn into a vesicle and an ulcer before the actual syphilitic infiltrate is detected.

On the other hand, an existing vesicle, especially a vesicle, can serve as a site for entry of spirochetes, which is relatively common. In this case, an ulcer quickly forms.

It plays the most important role in the origin of infiltrating, sclerosing ulcers. It may have existed prior to the infection with syphilis or was acquired at the same time as it. With this simultaneous infection: a soft and hard chancre, which is not uncommon, a soft chancre develops first. It has a much shorter incubation period of only a few days. Hardening, as a result of simultaneous infection with syphilis, is detected after 2-3 weeks. The base and circumference of the soft ulcer are compacted: a "mixed chancre" (chancre mixte) is obtained.

Not only that, a chancre ulcer may heal before a lump develops. "Mixed chancre" deserves special attention. Namely, it must be remembered that with the presence of a soft chancre ulcer, the possibility of simultaneous infection with syphilis cannot be ruled out before the expiration of several weeks.

Ulcerative sclerosis, that is, a successively decaying syphilitic infiltrate, can lead to the formation of:

• then flat,
• sometimes deep or crater-like,
• either smooth or having a pitted bottom,
• then a gangrenous or serpiginous ulcer.

It is only important to remember that a hard chancre ulcer is never so sharply delimited and such a regular round shape as a soft chancre ulcer. And that it always has a hard bottom and a hard roller. It is also characteristic that on the edge surrounding the ulcer, a very narrow strip always appears red, eroded, devoid of epithelium.

Depending on the location, the chancre may present some differences. So, when localized in the coronal sulcus, sclerosis often appears as a dense roller, sometimes running parallel to the entire length of the sulcus. Often this results in phimosis or paraphimosis. Sclerosis, hidden by phimosis, is felt by palpation mostly in the form of limited hardening.

Of the mucous membranes, the site of sclerosis is mainly:

All mucosal scleroses quickly disintegrate into deep, crater-like ulcers with a dense bottom and ridge. Each place of the skin and visible mucous membranes can be the site of localization of primary sclerosis.

If sclerosis sits on the edge of the foreskin, then ulceration is formed in the form of a crack on a dense ring perpendicular to the opening of the preputial sac.

A particularly peculiar picture is obtained when, as a consistent condition, a significant, diffuse inflammatory swelling appears on the genital organ.

Then the penis takes on a completely shapeless appearance and appears to be testy-edematous to the touch (indurated edema).

A similar condition occurs on the vulva.

If sclerosis sits on the finger, then the primary lesion often has the appearance of paronychia or panaritium; recognition can be extremely difficult.

Often, primary sclerosis occurs on the lip and on the nipple, where it forms a dense, limited, eroded and ulcerated tumor.

The most important sign of every syphilitic primary manifestation is, without a doubt, the presence of spirochetes.

According to zdos.ru

A chancre is a serious, chronic infection caused by the bacterium Treponema pallidum (treponema pallidum). The disease is transmitted sexually. In the absence of treatment, the infection has a long-term character, when exacerbations are replaced by periods of remission. In men and women, specific local inflammations appear in all organs.

The incubation period lasts from the moment of infection until the appearance of a skin lesion. The duration of this interval is about 3-4 weeks (may vary from 10 to 80 days). The latent period is lengthened by taking antibiotics.

In primary syphilis, primary syphiloma forms at the site of entry of treponema pallidum. The secondary stage begins 9-10 weeks after infection and lasts 3 to 5 years. It is characterized by changes in the skin, mucous membranes, internal organs and the central nervous system.

Half of patients develop tertiary syphilis many years after contact with the pathogen. Irreversible lesions affect the bones, joints, skin and mucous membranes.

The development of syphilis takes place in four stages:

• Primary.
• Secondary.
• Latent.
• Late (tertiary).

At the beginning of the disease, a skin lesion appears. It is a painless ulcer with firm borders. Chancre occurs at the site of infection. There are no signs of inflammation around it. The central part of the wound is covered with a gray-yellow thick coating. Its diameter ranges from 10 to 20 mm.

Usually chancre is located on the external genitalia in men and women. It affects the glans penis, foreskin, less often the skin of the scrotum and pubis, large and small labia. In medical practice, cases of syphiloma in the anal canal, in the oral cavity, on the tongue, lips, nipples or in the throat are described. Thus, this hard ulcer can appear anywhere on the body.

Appearing approximately 21 days after exposure, the chancre usually heals within 6 weeks even without medication. An increase in the lymph nodes located in the groin, under the armpits and on the neck occurs within a week after the formation of syphiloma.

How long does it take for symptoms of secondary syphilis to appear?

Signs of the secondary stage of the disease are observed within 6 weeks - 6 months after exposure. During this period, the skin of men and women is covered with a rash in which active forms of bacteria are present. A skin rash is pustules and blisters on mucous membranes and other parts of the body. Often. For example, the palms, soles of the feet, face and scalp are affected.

Ulcers on the mucous membranes and in the folds of the skin merge into one large wound, which becomes covered with a gray-pink bloom over time. Spotted syphilis on the mucous membrane is a typical diagnostic sign (appears on the lips, inside the nasal cavity, vulva and vagina).

At this stage, other systemic symptoms of the disease are also characteristic:

1. headache;
2. fever;
3. fatigue;
4. weight loss;
5. a sore throat;
6. focal alopecia;
7. swollen lymph nodes;
8. loss of appetite.

The human immune system is able to overcome these symptoms without treatment, but they may reappear after 1-2 years. The body of men and women is not able to completely cope with the infection, but it can eliminate the symptoms for a while.

Late stages of treponema pallidum infection

Without treatment, syphilis can go into a latent (hidden) stage. In this case, the tests for Treponema pallidum are positive, but there are no outward signs of the disease. This stage is quite long and takes several years.

Some people never have any symptoms again, but in 30-50% of untreated patients, the disease progresses to tertiary (late) syphilis.

At this stage, there is a slow destruction of the nervous and circulatory system. Bacterial toxins stimulate severe damage to the heart and aorta, brain and eyes, bones and joints. Irreversible destruction of organs and systems ends with the death of the patient.

In the late period of syphilis, bacterial cell clusters (infectious granulomas) develop in various tissues of the body. Skin granulomas are called gummas. Such syphilitic chronic infiltrates in the form of a node disintegrate, causing irreversible damage. For example, disintegration of a granuloma in soft or hard palate causes tissue perforation.

Diagnosis of hard chancre

Laboratory diagnosis of infectious material is carried out in a dark-field microscope. Blood tests for syphilis are now increasingly used, but the disease can only be detected in the blood 4 to 6 weeks after the onset of a chancre.

In a sick mother who neglects treatment, in 80-85% of cases, the fetus becomes infected in the uterus, as treponema passes through the placental barrier. Thus, the baby is born with symptoms of congenital syphilis.

During the primary stage of syphilis in men, the following complications are possible:

1. balanitis;
2. balanoposthitis;
3. inflammatory phimosis;
4. paraphimosis;
5. phagedenic ulcer.

On the 3-5th month of the disease, hair begins to fall out intensively (syphilitic alopecia). The resulting foci of inflammation, osteomyelitis, osteoarthritis and other destructive processes are a direct consequence of the influence of tertiary syphilis on the body.

Treatment of the disease

The gold standard of treatment is daily intramuscular injections of procaine penicillin. The dosage and duration of therapy largely depends on the clinical picture: the size and location of the hard chancre, secondary mucous manifestations, neurosyphilis. If there are no pronounced symptoms, then the dosage is determined in accordance with the serological results of the tests.

An alternative treatment option is a single injection of benzathine penicillin, which can fight primary and secondary syphilis. This injection is also recommended for partners with whom the patient had unprotected sexual contacts in order to prevent their disease.

For many, the phrase "hard chancre" is associated with syphilis. But not everyone knows exactly what it is, in fact. Chancre, that is, an ulcer, is the very first sign of syphilis. It differs from most other ulcers, and has characteristic features of manifestation, time of occurrence and developmental features.

We tell everything about hard chancre: what it looks like, why it appears, how it differs from other ulcers and what is its danger.

The content of the article:

Photo: syphilitic chancre Photo: what a hard chancre looks like in men Photo: what a hard chancre looks like in women

A hard chancre in primary syphilis appears where the syphilitic bacteria have invaded the body. It is formed exactly at the place where there are skin lesions and where the infected liquid (sperm, cervical secret) has got.

When treponemas penetrate the skin or mucous membranes, cells of the immune system come to the site of invasion. They surround treponemas and try to limit their spread - a dense "ring" is formed around the bacteria, an ulcer is formed.

At the bottom of the ulcer, a liquid is released with a large number of syphilitic bacteria and cells of the immune system that come to fight treponema.

But when does a hard chancre appear - immediately after infection or later?

A hard chancre appears about a month after infection. It lasts for about 1.5 - 2 months, and then disappears. In recent days, rashes all over the body (a manifestation of the secondary stage of syphilis) join the hard chancre. A chancre usually resolves three to four days after the rash appears, less often it persists for several weeks, and even more rarely it disappears before the rash appears.

An ulcer in the area of ​​treponema invasion does not form immediately. Initially, a reddish spot appears at this place, which subsequently thickens and turns into a nodule. The spot and nodule are absolutely painless, have an even shape and sharp borders. Gradually, within seven to ten days, the nodule grows in size and thickens, and then ulcerates. Superficial ulceration is called erosion, deep ulceration is called an ulcer.

The syphilitic chancre remains unchanged for about three to four weeks, and then gradually begins to heal. If during this period you try to “squeeze out” or cauterize it using aggressive chemical solutions, then this can further damage the ulcer. Then some other infection will join it, and the chancre will heal longer and harder.

The area of ​​​​the future syphilitic chancre directly depends on the area where the treponemas got. Most often, a syphilitic ulcer is formed on the genitals and neighboring areas (on the skin of the groin, abdomen, thighs, near the anus).

• penis skin
• foreskin
• place of the coronal sulcus or frenulum
• scrotum

Photo: chancre in the mouth
Photo: hard chancre on the lip
Photo: hard chancre on the tongue
Photo: hard chancre on the cheek Photo: hard chancre on the tonsil
Photo: hard chancre on the gum

Special attention should be paid to hard chancre in women.

As a rule, they have a hard chancre occurs:

• on the labia
• on the clitoris
• in the area between the entrance to the vagina and the anus
• on the cervix

It is interesting that hard chancre almost does not occur on the walls of the vagina (this is due to the increased acidity of the vagina, and pale treponema does not tolerate such conditions very well).

However, syphilitic chancre often occurs on the cervix. That is why the initial stage of syphilis in women can be so difficult to diagnose: the chancre remains invisible, and patients seek medical help only in the secondary period of syphilis.

Almost 10% of women with primary syphilis have a chancre on the cervix

A chancre on the cervix cannot be seen during a simple examination of the genitals. It can only be detected by a separate study: examining the cervix in the mirrors. This study can only be carried out by a doctor: a gynecologist or a dermatovenereologist.

The second most common area is the oral mucosa. Chancre can be found on the lips, tongue, cheeks, gums, soft palate and tonsils - the photo can be viewed on the right.

Also, the primary ulcer of syphilis can form on the female breast, fingers and any other areas of the skin where there are microdamages.

The "standard" hard chancre has characteristic external features and signs.

Outcome: we can say that a hard chancre is a small, round, shiny ulcer that has a seal at its base, and is absolutely painless.

Hard chancre does not always proceed normally. Some of its manifestations may differ from the usual course. This allows syphilis to masquerade as other diseases. Therefore, it is never possible to accurately diagnose only by external manifestations or by photo. To diagnose syphilis, it is always necessary to take tests.

Chancres are not always single. Very rarely, multiple ulcers form. This usually happens in people with a lot of skin lesions or skin infections (scabies, eczema, acne). But in this case, the number of ulcers usually does not exceed 10.

Sometimes in medicine there are giant chancres and dwarf chancres. Giant chancres can reach the size of a child's hand, and dwarf chancres - with a small grain. But in addition to size, hard chancres retain all other common features.

The ulcer is not always smooth and shiny. Sometimes there is a gray film or crust on the chancre (if the chancre has formed on the exposed part of the skin and is prone to drying out).

Slit-like chancres are quite rare. Such ulcers are located in small folds of the skin: in the corners of the mouth, between the fingers, in the anus.

There is a type of chancre that does not have a seal under it. Such a chancre is called Folman's chancre and is usually located on the head of the penis.

Sometimes the chancre can be painful. This occurs in two cases:

• if it is near the urethra, in the anus or on the tonsils,
• if another infection joins it (in this case, it can suppurate and become inflamed, affecting the surrounding tissues).

Sometimes there are syphilitic chancres that are not at all like the usual ones. They're called atypical. However, atypical chancres retain all the features of "classic chancres": they are the first signs of syphilis, appear one month after infection and persist for 3-7 weeks.

Atypical syphilitic chancres include:

• pygmy chancre;
• huge chancre;
• slit-like chancre;
• indurativny hypostasis (severe hypostasis of a part of generative organs);
• chancre-amygdalite (on the tonsil);
• chancre panaritium (on the finger).

More information about all varieties of atypical chancre can be found in the article "Primary syphilis".

What are the complications of syphilitic chancre? This is, first of all, the accession of another infection. This situation leads to pain, increased swelling, and also to the formation of pus in the area of ​​​​the hard chancre.

The infection can join for the following reasons:

• additional trauma to the hard chancre,
• non-observance of personal hygiene,
• the presence of diseases that suppress the immune system (diabetes mellitus, tuberculosis, HIV infection).

Among women in such a situation may develop:

• bartholinitis (inflammation of the gonads);
• vaginitis;
• endocervicitis (in the presence of a chancre on the cervix).

• balanitis and balanoposthitis (with a chancre on the head of the penis);
• phimosis (complete closure of the head with inflamed foreskin) and paraphimosis (clamping of the head with inflamed flesh);
• in more severe cases, gangrenization (tissue necrosis) and phagedenism (complete destruction of tissue or penis)./li>

The last two complications are very rare and tend to occur in people who are severely immunocompromised.

Sometimes a hard chancre may not appear at all. This only happens if the bacterium has entered the bloodstream directly. This sometimes occurs with blood transfusions or poorly cleaned medical instruments.

In this case, syphilis appears immediately from secondary syphilitic rashes and is called "headless". In the future, it develops in the same way as the "classic" syphilis.

If primary syphilis proceeds as standard, without complications, then there are no traces left after healing of a hard chancre. Sometimes light or dark spots may remain in its place, but later they disappear on their own.

If another infection joins the hard chancre, and the ulcer becomes deep, then a scar may remain in its place. You can get rid of such a scar with the help of plastic correction.

A hard chancre is a very important sign by which syphilis can be suspected in time, which means that treatment can be started quickly. Therefore, it makes sense to pay attention to ulcers that appeared for no particular reason or do not heal for a long time.

Unfortunately, a hard chancre can also appear in an inconspicuous place - on the cervix, in the anus or under the scrotum. In this case, a person can detect manifestations of syphilis in himself only in the secondary period. This is worse - because the disease will have time to cause more damage to the body.

Chancre with syphilis can be confused with other ulcers that are not related to syphilis. More information about the differences between hard chancre and various skin lesions can be found in the article "Primary syphilis".

Based on materials from polovye-infekcii.ru

How quickly does the chancre appear. Primary period of syphilis. primary syphiloma.

Hard chancre is the primary stage of syphilis. Syphilis refers to a number of infectious diseases and has 3 stages. Its causative agent is pale treponema. Hard chancre is also known as primary syphiloma, and it occurs at the place through which the pathogen entered the body.

• What does hard chancre look like
• Atypical form of the disease
• The main aspects of therapy

Hard chancre, or primary syphilis, is formed on the 3rd-4th week after the penetration of pale treponema. The causes of infection, as a rule, are the same - sexual contact with an infected person, the use of common hygiene products. Hard chancre is the most benign form of syphilitic infection because:

• its localization is limited (most often found on the penis or in the oral cavity);
• the active form is characterized by scarcity and monomorphism;
• education does not affect the internal organs;
• effective and relatively easy to treat.

Most often, signs of a hard chancre appear in the genital area. However, in 10% of cases, a hard chancre may appear on the oral mucosa, on the tongue, on the lip, on the chest in women, on the tonsils.

A hard chancre begins with a reddish spot with smooth edges (what primary syphilis looks like can be seen in photos 1, 2). The spot diameter is not more than 15 mm. The spot has a regular round or oval shape. It does not cause any discomfort to the patient, does not itch or burn. However, if a bacterial infection is attached, complications may occur. The latter is evidenced by uneven edges of the formation, pain when touched.

Photo 1 and photo 2. Localization of a hard chancre in the genital area.

After a few days, the spot becomes a flat papule, and a little later it turns into a state of erosion or ulcers (less often) with a compacted base. The bottom of the ulcer is flush with the skin around or slightly rises above it.

In the vast majority of cases, hard chancre takes the form of erosion. Ulcer formation occurs due to:

• the patient has other chronic infections;
• intoxication of the body;
• therapy using topical irritants;
• neglect of personal hygiene measures;
• adolescent or elderly patient.

There are 3 types of hard chancre depending on the size of the formation:

1. Dwarf - 1-3 mm.
2. Medium - 10-20 mm.
3. Giant - 40-50 mm. As a rule, it appears on the thighs, on the pubis, on the face and forearms.

In addition, hard chancre is classified according to the number of formations on the patient's body:

1. Single type.
2. Multiple type. In this case, the chancre is formed simultaneously or sequentially in several locations through which pale treponema entered the body.

In addition to the solid form of the chancre, a soft chancre is also isolated. It differs somewhat in morphology from solid. Hard and soft chancre are symptoms of a syphilitic infection.

In rare cases, people who contract syphilis from a sick person may develop an atypical chancre. These include:

• edema is indurative;
• amygdalitis;
• chancre-panacir.

Indurative edema is localized in the area of ​​the foreskin (in men) or labia (in women). The affected area increases 2-3 times over time, becomes dense and cyanotic. At the same time, swelling does not cause pain.

As mentioned above, sometimes the symptoms of the disease can appear on the tonsils. However, amygdalitis is different from the usual form of chancre. There is a sharp increase in the size of the amygdala, and on the one hand. The body of the amygdala becomes hard and inflamed. This phenomenon can be mistaken for one of the symptoms of angina.

The symptoms of the chancre-felon are almost identical to those of the common panaritium. This complicates the diagnosis of hard chancre. Chancre panaritium appears on the phalanges of the fingers. The lesion is characterized by bluish-red edema with further ulceration with pus formation. With this type of primary syphilis, the infected person feels a throbbing or shooting pain in the affected area.

If a person is diagnosed with "hard chancre", he is prescribed treatment in a hospital or on an outpatient basis. Since the main and most common way of transmission of the infection is sexual, any sexual contact to the patient during treatment should be stopped. In addition, all previous and current sexual partners of the patient should undergo examination and, if necessary, therapy, even if they do not have any symptoms.

Primary syphilis is treated with antibiotics of the penicillin group, since pale treponema is sensitive to them. Benzylpenicillin and ampicillin are often injected.

A hard chancre is an early stage of a syphilitic infection.

Having started treatment at this stage, the infected person will recover easily and quickly, preventing the infection from progressing and eliminating the possibility of complications.

As soon as formations similar in morphology to a hard chancre are found on the body in characteristic places of localization, a person should immediately seek advice from a dermatovenereologist.

If a person has had sexual intercourse with a suspected carrier of the causative agent of syphilis, he should also contact a specialist to take preventive measures to avoid infection.

Hard chancre is a symptom of primary syphilis. It is also called primary syphiloma or erosion. Hard chancre appears in men and women about three weeks after the introduction of the causative agent of the disease, treponema pallidum, into the body. Its symptoms are erosive or ulcerative formation on the skin or mucous membranes.

Hard chancre has the following features:

• characterized by limited localization;
• does not affect the internal organs and systems of the body;
• responds well to treatment.

The hard chancre got its name from the type of base of the formed ulcer or erosion. The duration of the existence of primary syphiloma is from six to eight weeks.

Localization of primary syphiloma can be absolutely any. A hard chancre in a person appears directly at the site of introduction of pale treponema into the human body after a certain time after infection. Its most common localization is the external genital organs - in women the labia, clitoris, in men the head, base and trunk of the penis, the outer or inner sheets of the foreskin. In some cases, a hard chancre is formed on the internal mucous membranes: in the urethra in men, on the walls of the vagina or cervix in women.

In ten percent of all cases, an extragenital location of the chancre is observed. Hard chancre in women and men can be localized:

• in the oral cavity;
• in the language;
• on the border of the lips;
• on the tonsils in the throat;
• on the mammary glands of women.

Outwardly, a hard chancre looks like a reddish spot with clearly defined, even edges, up to 1.5 centimeters in size. It has the shape of a geometrically correct circle or oval. Sheer or undermined edges indicate a bacterial complication.

Symptoms of hard chancre are only external. It does not disturb the patient in any way, does not cause any pain. Complications develop only if a bacterial infection has joined the lesion.

After a few days, the redness turns into a flat papule, and after a while - into erosion or an ulcer with a compacted base. Hard chancre has a bottom, which is located on the same level with the skin or slightly raised above.

In almost 90% of cases in women and men, a hard chancre looks like erosion. An ulcer forms:

• when the body is weakened as a result of concomitant chronic diseases;
• as a result of intoxication;
• when self-medicating with local irritants;
• in case of non-observance of elementary rules of personal hygiene;
• in young or elderly patients.

When formed in men on the penis, a hard chancre is covered on top with a transparent, dense detachable film. It is in it that pale treponemas are located, which are then used to determine syphilis. If a hard chancre is located on an open area of ​​the body, then on top it is covered with a dense brownish film.

Hard chancre in size is:

• from 1 to 3 mm - dwarf, it is considered the most dangerous from an epidemiological point of view;
• from 1 to 2 cm - medium;
• up to 4-5 cm - gigantic, localized on the skin of the thighs, pubis, forearms or face.

Hard chancre in humans can vary in the number of morphological units, that is, it can be single and multiple. If multiple chancres are present, then they can appear all at once at the same time or sequentially, one after another, after some time. If there are multiple lesions on the skin, then a hard chancre occurs in several places at once, that is, where pale treponema enters the body. Multiple chancres most often occur during repeated sexual intercourse with a partner with syphilis.

Rarely, men and women infected with syphilis have a hard chancre in an atypical form. These include:

• amygdalitis;
• indurative edema;
• chancre-panacir.

Chancre-amygdalite is very different from the usual hard chancre on the tonsils. He has other outward symptoms. In most cases, amygdalitis looks like a unilateral enlargement of the tonsil, which occurs very abruptly. It becomes dense to the touch and hyperemic. This symptom is sometimes confused with manifestations of angina.

Indurative edema occurs in the area of ​​the labia in women or the foreskin in men. The affected area, unlike a typical hard chancre, after a while increases in size by two to three times, becomes dense to the touch and acquires a bluish tint. Edema is non-painful, it is not accompanied by acute inflammatory symptoms.

Chancre panaritium is the most atypical manifestation, its danger lies in the fact that the symptoms completely coincide with the usual panaritium, and it looks exactly the same. This can lead to misdiagnosis. The chancre panaritium is characterized by localization on the distal phalanx of the thumb or index finger. A bluish-red swelling appears on the affected area, which turns into an ulcer with a purulent coating on the bottom and uneven deep edges. For chancre-panaritium, symptoms such as throbbing or shooting pains are characteristic. Most often, it occurs in gynecologists and operating surgeons who are in direct contact with the body of a person infected with syphilis, thus, chancre panaritium in most cases is the result of occupational infection.

Syphilis in the form of chancre-panaritium is very rarely detected on time, and therefore the diagnosis becomes known already in the second stage of the disease. Timely detection of atypical chancre is very important, since the primary stage of syphilis is treated most effectively.

A hard chancre in a person infected with syphilis is treated in an inpatient or outpatient setting. Throughout the course of therapy, a cessation of any sexual contact is required. It is necessary to treat all sexual partners of a person with syphilis, no matter how many there were. The fact is that the probability of their infection with pale treponema is extremely high.

Treatment of hard chancre is carried out with antibacterial drugs of the penicillin group, since the causative agent of syphilis has not lost sensitivity to them. Most often, these are injectable forms of ampicillin and benzylpenicillin.

You need to know that a hard chancre in itself is not dangerous. It allows you to identify syphilis at its earliest stage. Therefore, timely treatment makes it possible to prevent the further development of the disease and the occurrence of complications. If you find a formation on the skin that resembles the description of a hard chancre, you should immediately consult a doctor for examination.

After suspicious unprotected sexual intercourse, prophylactic treatment may be prescribed, which will prevent the penetration of the causative agent of syphilis into the body. To do this, without delay, contact a dermatovenereologist.

Primary syphilis is manifested by swollen lymph nodes and hard chancre. What is a hard chancre? These are the symptoms of syphilis, which are round ulcers with a diameter of about one centimeter on the patient's body.

In color, they are red with blue, sometimes they are painful, but basically the patient does not perceive pain at the site of erosion. The first signs of syphilis in men: the formation of a chancre on the head of the penis, and in women, the symptoms of syphilis appear on the walls of the uterus and on the external genitalia. Also, these sores are on the pubis, near the anus, on the tongue and lips.

Syphilis develops quickly, and the lymph nodes become inflamed and enlarged first, and then the formation of a hard chancre.

It can resolve on its own, even without medical treatment after one to two months. It passes almost without a trace, although if the sores are large, dark spots may remain.

A chancre with syphilis is a focus of syphiloma, which is formed at the site of treponema in the body.

Chancre got its name from the French word, which means ulcer, erosion. In some infectious diseases there is a chancre, but in the disease of syphilis, this erosion is the first sign of syphilis in the first stage. The formation of a hard chancre, on the body after a little more than 4 weeks, from the moment of infection with this disease. During this period, the spirochete infection manages to get into many organs and into the lymph, while starting to multiply, which causes an inflammatory process and a temperature may appear.

They are classified by type, size, number of sores on the body, their location.

• erosive is erosion that affects the layers of the mucous system;
• ulcerative chancre - these are ulcers that penetrate into the deeper layers of tissues.

According to the quantitative classification, chancre is divided into:

• a single one is a chancre, which consists of one sore;
• multiple is erosion, which consists of many ulcers, and create a single wound.

Syphilomas of hard chancre in size are:

• small (dwarf) - diameter less than 10 mm;
• medium - diameter from 20 mm;
• large (giant) - diameter 50 mm and above.

Place of occurrence of hard chancre on the body:

• extragenital - it affects the tongue, anus, chest, throat, legs, gums;
• genital - these are erosions that appear on the genitals of a sick person;
• bipolar are chancres that simultaneously appear on the genitals and other parts of the body.

By the end of the primary period of syphilis, the chancre becomes a form of the disease that:

• has localization in specific places, in the oral cavity and on the genitals;
• has a non-multiple form;
• does not affect internal organs;
• It is quite easy to treat and does not leave behind consequences.

In people who have contracted syphilis infections and at the same time have reduced immunity, an ulcerative lesion appears necessarily. Also, the formation of ulcers on the body occurs with chronic infections, toxicity of the body and for age-related reasons. As a result of self-treatment of syphilis, purulent erosions are formed, which, after attenuation, leave age spots and scars.

It begins to develop with redness, which does not cause itching and pain. After 48 - 72 hours, a bump begins to form from this redness and a papule forms. At this point, the epithelium from the chancre may peel off, and the infected person begins to feel pain for the first time.

In the following hours and days, the syphiloma becomes larger, spreading around the circumference. A hard crust begins to form on the papule, under which an ulcer forms. Over time, the crust is rejected and a sign of syphilis appears - a hard chancre.

The shape of the chancre is slightly raised, with clear round edges. Sometimes these edges are oval. The surface of the chancre is smooth, sometimes has a grayish coating, but mostly the color of the chancre is red.

The shape of the chancre is different:

• nodule shape - this ulcer has clear boundaries. This ulcer grows into the deep layers of the tissue and retains its clear boundaries. This chancre is localized on the foreskin of the penis;
• the form of a plate or a coin - the chancre is localized on the upper layers of the tissue and is located on the labia, the shaft of the penis, on the scrotum;
• leaf-shaped form - erosion has clear boundary lines and is located mainly on the head of the phallus.

In addition to hard chancre, there is also atypical chancre and many of its types:

• indurated edema is a large seal that forms on the foreskin of the penis, the genitals in women and in the area of ​​​​the lips on the face of a person;
• Panaritium is a chancre that develops on the nails and does not heal for several months. Perhaps even rejection of the nail;
• lymph nodes - increase in this period. Depending on which part of the body a chancre has formed, the lymph nodes closest to the chancre become inflamed;
• a bubo is a lymph node that has a mobile shape and does not have painful signs and is closest to the chancre: on the patient's neck, if the chancre is in the tonsils, and in the inguinal part of the body, if the chancre is on the penis, in the genital area;
• polyadenitis is an inflammation and compaction of all lymph nodes, from that moment it can be considered that symptoms of secondary syphilis began to appear.

Complications of syphilis in the first period are very serious for women, as well as serious consequences for the male part of the population.

• on large and small labia;
• on the clitoris;
• on the walls of the cervix;
• in the area between the anus and the vagina.

On the walls of the vagina, a hard chancre with syphilis occurs very rarely, since the acidity of the vagina has a detrimental effect on treponema.

Very often, the chancre of syphilis is formed on the cervix. This chancre is invisible and is diagnosed mainly in the second stage of the development of the disease.

Over 10 percent of women with syphilis in the first stage have a hard chancre on the walls of the cervix. Syphilis chancre is detected only at the time of examination of the uterus with the help of medical equipment. This examination is carried out by a gynecologist or venereologist.

In the oral cavity, a chancre is formed on the tongue, lips, soft palate and tonsils. There are frequent cases of ulcers on the gums, cheeks, fingers and chest.

Diagnosis of syphilis consists of several types of examinations and tests:

• serological diagnosis is the detection of treponema bacteria from a hard chancre scraping. According to the results of this examination, the doctor makes a diagnosis;
• treponema immobilization reaction;
• immunofluorescence reaction;
• Wasserman reaction;
• microreaction on glass;
• linked immunosorbent assay;
• microprecipitation reaction;
• passive hemagglutination reaction.

Syphilis is a sexually transmitted disease that occurs in the classical form. Syphilis is a hard chancre, the main symptom of this disease. A hard chancre is a symptom of only primary syphilis.

Syphilis in the first stage of its development is manifested in an increase in lymph nodes and hard chancre. Toward the end of this period, the following symptoms become:

• a state of general malaise;
• persistent headache;
• elevated temperature;
• pain in muscle tissues;
• aches and pain in the bones;
• low hemoglobin;
• a significant increase in leukocytes.

A syphilis chancre tends to pass on its own and leave no traces, so people who self-medicate may assume a cure for syphilis.

This is a delusion, because the disappearance of a hard chancre precedes secondary syphilis, which is much more dangerous than syphilis in the first stage of development and the treatment of this type is much more complicated and lengthy.

Complications of a syphilitic chancre can penetrate other infections into the chancre, which leads to painful symptoms and the accumulation of pus in this place.

There are several reasons for infection:

• chancre injury;
• poor hygiene;
• diabetes mellitus disease;
• HIV infection;
• development of tuberculosis in the body.

In the female body develops:

• syphilitic gangrene;
• infectious vaginitis;
• inflammatory bartholinitis;
• cervical endocervicitis.

Complications in the male body lead to:

• balanitis;
• balanoposthitis of the head of the penis;
• phimosis of the foreskin;
• paraphimosis of the foreskin;
• gangrenization of the head of the penis;
• phagedenism of the penis.

At the primary stage, the task is to cure the infection and prevent syphilis from moving into the second stage. Hard chancre, treatment should be carried out as early as possible.

The main drugs that are used in the treatment are antibiotics of different groups and directions:

• penicillins;
• macroliths;
• tetracyclines;
• fluoroquinolones.

Together with antibiotics in the treatment process involved:

• antifungal drugs;
• immunomodulators;
• multivitamins;
• probiotics.

The treatment regimen for syphiloma is prescribed by the attending physician, based on the diagnosis and test results.

With a course method of treatment, tetracyclines and drugs based on bismuth and iodine are added to penicillins. This complex of drugs is able to increase the action of the antibiotic in the body.

With the diagnosis of syphilis, both sexual partners are treated.

At the time of therapy, the patient is prescribed food, the diet of which is dominated by protein foods and a restriction in the consumption of fats and carbohydrates.

During this period, smoking and drinking alcohol are contraindicated, and it is also necessary to reduce physical stress on the body.

The main condition for quality treatment is the observance of the rules of personal hygiene and during the treatment period - not to have sex.

Treat chancre with antibiotics:

• Extencillin - intramuscular injections, it is enough to carry out the procedure twice;
• Bicillin - injections, twice, after 5 calendar days;
• Erythromycin - take 0.5 mg 4 times a day;
• Doxycycline - 0.5 mg taken 4 times a day.

For local treatment of hard chancre, lotions are needed on the chancre from benzylpenicillin and dimexide preparations.

It is necessary to lubricate the syphilitic chancre with heparin ointment, erythromycin ointment, ointment based on mercury and bismuth. Synthomycin ointment and levorin ointment contribute to the separation of pus from the ulcer.

Chancres that are in the mouth must be rinsed with solutions:

A hard chancre is a very important sign in recognizing syphilis in the body. The earlier an infection in the body is detected, the faster the treatment of the disease will begin, and the duration of the course of drug treatment may be minimal. In this case, treatment with folk remedies and self-treatment are contraindicated.

Only a competent doctor will be able to establish a diagnosis and prescribe the necessary treatment. Fulfillment of all doctor's prescriptions, a healthy lifestyle, hygiene, will give a positive result in curing syphilis at the first stage of the disease.

clinical picture. Primary syphilis is characterized by the development of a hard chancre (ulcus durum, primary syphiloma) and regional lymphangitis and lymphadenitis at the site of the introduction of pale treponema. Sometimes, between the chancre and enlarged regional lymph nodes, one can see and palpate a strand of regional lymphangitis.

Thus, the clinical manifestations of the primary period of syphilis are represented by three elements: hard chancre, regional lymphadenitis and regional lymphangitis.

At the end of the primary period, general flu-like disorders are sometimes observed: headache, osteoarticular and muscle pain, general weakness, insomnia, fever.

Hard chancre often persists until the onset of the secondary period and heals soon, rarely exists for up to several weeks and after the appearance of a generalized rash, even less often heals before the onset of secondary manifestations. It depends mainly on its size. Associated regional lymphadenitis usually occurs 7 to 10 days after the onset of the chancre. Hard chancre is a very characteristic erosion or ulcer, but it does not immediately take on these features. After the expiration of the incubation period, a red spot first appears at the site of treponema introduction, which then turns into a dense nodule with sharply defined borders. Within 7–10 days, the nodule significantly increases in size, and the infiltration of its base takes on the character of a specific compaction. Due to malnutrition of the epidermis caused by vascular damage characteristic of syphilis, necrotization occurs in the center of the infiltrate and erosion or an ulcer is formed.

The main clinical signs of a typical hard chancre: erosion (ulcer) with no acute inflammation; loneliness or singularity; correct (rounded or oval) outlines; clear boundaries; size - with a small coin; elevation of the element above the surrounding healthy skin (mucous membrane); smooth, shiny ("varnished") bottom; sloping (saucer-shaped) edges; bluish-red color of the bottom; scanty serous discharge; dense elastic (“cartilaginous”) infiltrate at the base (knotty, lamellar, leaf-shaped); painlessness; resistance to local disinfectant and anti-inflammatory therapy.

Along with the described classical form of hard chancre, there are various deviations in one or more of its listed signs, which creates quite numerous varieties of primary syphiloma. Multiple chancres are rare (about 1/5 of patients). Their number rarely exceeds 10. The multiplicity of chancres is explained by the presence of numerous small violations of the integrity of the skin or mucous membrane in the patient at the time of infection. Concomitant skin diseases, such as eczema or scabies, can play a decisive role, especially when localized on the genitals. It is characteristic that no matter how numerous hard chancres are, they are all in the same stage of development if they were the result of the simultaneous penetration of infection through several entrance gates. These are the so-called twin chancres. If infection occurred at different times (for example, as a result of repeated sexual contacts with an interval of several days), then chancres will appear at different times and differ from each other in the degree of maturity. These are the so-called successive chancres. Giant hard chancres are usually located in places with abundant subcutaneous fatty tissue: in the pubis, abdomen. Their size can reach a child's palm. The dwarf hard chancre is extremely small in size - up to a poppy seed, however, under a magnifying glass, all the characteristic signs of primary syphiloma are found. Diphtheritic hard chancres covered with a grayish necrotic film are very common. Cortical hard chancre is observed in places where the discharge dries easily: on the face (nose, chin), on the skin of the lips, sometimes on the abdomen, the shaft of the penis. It may have a great resemblance to pyodermic elements: impetigo, ecthyma. Slit-like chancres, resembling a crack in shape, sheets of a book, are usually localized in small folds of the skin: in the corners of the mouth, in the interdigital folds, in the anus. Folman's erosive chancre does not have a clear seal at the base, it is usually localized on the glans penis. Hard chancres located at the external opening of the urethra, in the folds of the anus and on the tonsils, may be accompanied by considerable soreness. The localization of a hard chancre depends on the route of infection of a given patient with syphilis. With sexual infection, a hard chancre occurs, as a rule, on the genitals or on adjacent areas (pubis, abdomen, inner thighs, perineum, anus). Chancres on the cervix occur in 12% of sick women. In this regard, it is of great importance to examine women with suspected syphilis using a vaginal speculum. In some cases, with sexual infection, a hard chancre is located extragenitally (for example, on the lips, tongue, mammary glands, fingers). Extragenital chancres can be located on any part of the skin and mucous membranes. The second place after the genital organs in terms of the frequency of localization of primary syphiloma is occupied by the oral mucosa (lips, gums, tongue, soft palate, tonsils). Other localizations of hard chancre are rare.

Atypical hard chancres include indurative edema, chancre-amygdalite and chancre-panaritium .

Indurated edema usually occurs on the labia or on the foreskin. The affected area increases by 2-4 times, becomes dense, the skin acquires a stagnant cyanotic color or retains its normal color. The painlessness of the lesion and the absence of acute inflammatory phenomena are characteristic, which distinguishes indurative edema from processes such as bartholinitis or inflammatory phimosis (such diagnoses are most often made by patients).

Chancre amygdalite should be distinguished from erosive (ulcerative) hard chancre on the tonsils. Chancre-amygdalitis is characterized only by a sharp, usually unilateral enlargement of the tonsils. The tonsil is dense, there are no acute inflammatory phenomena. Chancre amygdalitis is very similar to indurative edema. This atypical chancre is often mistaken for a banal sore throat. L1ancre-panaritium is the most atypical of all chancres. It really is very similar to a banal panaritium: on the distal phalanx, more often than the index or thumb of the hand, against the background of bluish-red edematous skin, there is a deep ulcer with uneven, overhanging, as if gnawed edges and purulent-necrotic plaque. Chancre panaritium is accompanied by sharp, “shooting” pains. Most often it occurs in surgeons, gynecologists, pathologists and is the result of occupational infection, rarely diagnosed in a timely manner. Usually the diagnosis of syphilis is made after the appearance of rashes of the secondary period.

Chancre panaritium should not be confused with the typical chancres on the finger. Histologically, a typical chancre is an infiltrative-erosive or infiltrative-ulcerative formation with characteristic changes in the vessels of the dermis. It has a number of pathohistological features: the absence of the epidermis (and part of the dermis) in the central zone of the preparation due to the formation of foci and zones of necrosis; in the dermis - a dense infiltrate of lymphocytes and plasma cells, along the periphery the infiltrate has a perivascular location; changes in the blood and lymphatic vessels of the dermis in the form of proliferation and infiltration of all membranes (panvasculitis) with obliteration and thrombosis of some vessels; many pale treponemas in all areas (especially in the walls of the vessels and in their circumference).

When spirochetes have penetrated, for which an insignificant, completely imperceptible violation of the integrity of the skin is enough. After the first incubation period, most often at the end of the second week, a small nodule appears. It very often, but not always, ulcerates. Gradually turns into an extremely dense, cartilaginous hardness infiltrate, which forms the base and edge of the developing ulcer. This phenomenon is called hard chancre in men and women. Photos, the initial stage as the primary signs will be considered in the article.

Specific signs of a hard chancre with syphilis are the following moments of changes in the skin. The rash, which is also an infiltrate, is mostly flat, sharply demarcated. To the touch, it gives the impression that there is a hard plaque in the skin. But depending on the location of its localization, the nature of the rash can be very different.

Usually there is only one primary eruption. But relatively often there are several hard chancres. Moreover, they are all in the same stage of development, since they all appear simultaneously depending on the same infection. Further transfers in the same patient from one chancre are not observed, since after infection, immunity to a new infection soon sets in. Moving to another place of the skin, as opposed to a soft chancre, is not observed with this primary sign of syphilis.

The size of the hard chancre varies over a very wide range. Its surface can be covered with a thin, moist luster, as if eroded epithelium, which is especially characteristic. When palpated, a cartilaginous density infiltrate is felt. With a more pronounced erosion surface, the skin appears dark red, as if granular. When ulcerated, the ulcer is always smaller than a hard roller, and has a dense base. With ulceration, it may be the case, depending on the method of formation:

1. With ulcerated sclerosis.
2. With sclerosed ulceration.

In the latter case, the situation may be different. First, a very small nodule formed at the site of infection can turn into a vesicle and an ulcer before the actual syphilitic infiltrate is detected.

On the other hand, an existing vesicle, especially a vesicle, can serve as a site for entry of spirochetes, which is relatively common. In this case, an ulcer quickly forms.

It plays the most important role in the origin of infiltrating, sclerosing ulcers. It may have existed prior to the infection with syphilis or was acquired at the same time as it. With this simultaneous infection: a soft and hard chancre, which is not uncommon, a soft chancre develops first. It has a much shorter incubation period of only a few days. Hardening, as a result of simultaneous infection with syphilis, is detected after 2-3 weeks. The base and circumference of the soft ulcer are compacted: a "mixed chancre" (chancre mixte) is obtained.

Not only that, a chancre ulcer may heal before a lump develops. "Mixed chancre" deserves special attention. Namely, it must be remembered that with the presence of a soft chancre ulcer, the possibility of simultaneous infection with syphilis cannot be ruled out before the expiration of several weeks.

Ulcerative sclerosis, that is, a successively decaying syphilitic infiltrate, can lead to the formation of:

• then flat,
• sometimes deep or crater-like,
• either smooth or having a pitted bottom,
• then a gangrenous or serpiginous ulcer.

It is only important to remember that a hard chancre ulcer is never so sharply delimited and such a regular round shape as a soft chancre ulcer. And that it always has a hard bottom and a hard roller. It is also characteristic that on the edge surrounding the ulcer, a very narrow strip always appears red, eroded, devoid of epithelium.

Depending on the location, the chancre may present some differences. So, when localized in the coronal sulcus, sclerosis often appears as a dense roller, sometimes running parallel to the entire length of the sulcus. Often this results in phimosis or paraphimosis. Sclerosis, hidden by phimosis, is felt by palpation mostly in the form of limited hardening.

Of the mucous membranes, the site of sclerosis is mainly:

All mucosal scleroses quickly disintegrate into deep, crater-like ulcers with a dense bottom and ridge. Each place of the skin and visible mucous membranes can be the site of localization of primary sclerosis.

If sclerosis sits on the edge of the foreskin, then ulceration is formed in the form of a crack on a dense ring perpendicular to the opening of the preputial sac.

A particularly peculiar picture is obtained when, as a consistent condition, a significant, diffuse inflammatory swelling appears on the genital organ.

Then the penis takes on a completely shapeless appearance and appears to be testy-edematous to the touch (indurated edema).

A similar condition occurs on the vulva.

If sclerosis sits on the finger, then the primary lesion often has the appearance of paronychia or panaritium; recognition can be extremely difficult.

Often, primary sclerosis occurs on the lip and on the nipple, where it forms a dense, limited, eroded and ulcerated tumor.

The most important sign of every syphilitic primary manifestation is, without a doubt, the presence of spirochetes.

According to zdos.ru

A chancre is a serious, chronic infection caused by the bacterium Treponema pallidum (treponema pallidum). The disease is transmitted sexually. In the absence of treatment, the infection has a long-term character, when exacerbations are replaced by periods of remission. In men and women, specific local inflammations appear in all organs.

The incubation period lasts from the moment of infection until the appearance of a skin lesion. The duration of this interval is about 3-4 weeks (may vary from 10 to 80 days). The latent period is lengthened by taking antibiotics.

In primary syphilis, primary syphiloma forms at the site of entry of treponema pallidum. The secondary stage begins 9-10 weeks after infection and lasts 3 to 5 years. It is characterized by changes in the skin, mucous membranes, internal organs and the central nervous system.

Half of patients develop tertiary syphilis many years after contact with the pathogen. Irreversible lesions affect the bones, joints, skin and mucous membranes.

The development of syphilis takes place in four stages:

At the beginning of the disease, a skin lesion appears. It is a painless ulcer with firm borders. Chancre occurs at the site of infection. There are no signs of inflammation around it. The central part of the wound is covered with a gray-yellow thick coating. Its diameter ranges from 10 to 20 mm.

Usually chancre is located on the external genitalia in men and women. It affects the glans penis, foreskin, less often the skin of the scrotum and pubis, large and small labia. In medical practice, cases of syphiloma in the anal canal, in the oral cavity, on the tongue, lips, nipples or in the throat are described. Thus, this hard ulcer can appear anywhere on the body.

Appearing approximately 21 days after exposure, the chancre usually heals within 6 weeks even without medication. An increase in the lymph nodes located in the groin, under the armpits and on the neck occurs within a week after the formation of syphiloma.

Signs of the secondary stage of the disease are observed within 6 weeks - 6 months after exposure. During this period, the skin of men and women is covered with a rash in which active forms of bacteria are present. A skin rash is pustules and blisters on mucous membranes and other parts of the body. Often. For example, the palms, soles of the feet, face and scalp are affected.

Ulcers on the mucous membranes and in the folds of the skin merge into one large wound, which becomes covered with a gray-pink bloom over time. Spotted syphilis on the mucous membrane is a typical diagnostic sign (appears on the lips, inside the nasal cavity, vulva and vagina).

At this stage, other systemic symptoms of the disease are also characteristic:

1. headache;
2. fever;
3. fatigue;
4. weight loss;
5. a sore throat;
6. focal alopecia;
7. swollen lymph nodes;
8. loss of appetite.

The human immune system is able to overcome these symptoms without treatment, but they may reappear after 1-2 years. The body of men and women is not able to completely cope with the infection, but it can eliminate the symptoms for a while.

Without treatment, syphilis can go into a latent (hidden) stage. In this case, the tests for Treponema pallidum are positive, but there are no outward signs of the disease. This stage is quite long and takes several years.

Some people never have any symptoms again, but in 30-50% of untreated patients, the disease progresses to tertiary (late) syphilis.

At this stage, there is a slow destruction of the nervous and circulatory system. Bacterial toxins stimulate severe damage to the heart and aorta, brain and eyes, bones and joints. Irreversible destruction of organs and systems ends with the death of the patient.

In the late period of syphilis, bacterial cell clusters (infectious granulomas) develop in various tissues of the body. Skin granulomas are called gummas. Such syphilitic chronic infiltrates in the form of a node disintegrate, causing irreversible damage. For example, disintegration of a granuloma in soft or hard palate causes tissue perforation.

Laboratory diagnosis of infectious material is carried out in a dark-field microscope. Blood tests for syphilis are now increasingly used, but the disease can only be detected in the blood 4 to 6 weeks after the onset of a chancre.

In a sick mother who neglects treatment, in 80-85% of cases, the fetus becomes infected in the uterus, as treponema passes through the placental barrier. Thus, the baby is born with symptoms of congenital syphilis.

During the primary stage of syphilis in men, the following complications are possible:

1. balanitis;
2. balanoposthitis;
3. inflammatory phimosis;
4. paraphimosis;
5. phagedenic ulcer.

On the 3-5th month of the disease, hair begins to fall out intensively (syphilitic alopecia). The resulting foci of inflammation, osteomyelitis, osteoarthritis and other destructive processes are a direct consequence of the influence of tertiary syphilis on the body.

The gold standard of treatment is daily intramuscular injections of procaine penicillin. The dosage and duration of therapy largely depends on the clinical picture: the size and location of the hard chancre, secondary mucous manifestations, neurosyphilis. If there are no pronounced symptoms, then the dosage is determined in accordance with the serological results of the tests.

An alternative treatment option is a single injection of benzathine penicillin, which can fight primary and secondary syphilis. This injection is also recommended for partners with whom the patient had unprotected sexual contacts in order to prevent their disease.

According to zpppstop.ru

A syphilitic chancre is an ulcerative or erosive formation that appears in the primary stage of infection with syphilis, and is its main symptom. There are 13 varieties of hard chancre in syphilis: ordinary and atypical. Treatment of syphilis is carried out with the help of medications and compliance with a special regimen.

The appearance of a syphilitic chancre is the first sign of the disease

Syphilitic chancres are dark red, evenly shaped ulcers with clear borders and slightly raised edges that appear after infection with syphilis. You can see what this formation looks like in the photo:

There are 10 main forms of hard chancre:

• unit;
• multiple;
• giant;
• dwarf;
• diphtheritic;
• cortical;
• slit-like;
• erosive;
• burn;
• herpetiform.

Unlike trypanosomal, hard syphilitic chancre, as usual, is not accompanied by severe symptoms. It does not itch, is not accompanied by burning, it hurts only when localized near the urethra or anus.

A solitary chancre, also known as the "common" or "simple" chancre, is the classic presentation of syphilis, found in most infections. Their diameter is 2-3 cm, the edges are clear, slightly raised.

A simple chancre can be localized in different areas:

1. genitally: on the penis in men, on the large and small labia, as well as in the vagina in women, in some cases - on the cervix.
2. extragenital: on the face, on the legs and on the pubis, in the armpits, near the anus, on the chest in women, in the mouth - on the tongue, on the gums, in the throat, on the lips.

In most cases, hard chancres are located on the genitals

The genital location of syphilomas is more common: about 90% of all cases of the disease are accompanied by hard chancres in the genital area.

Multiple ulcers are formed very rarely: in 8-12% of cases. There are 2 subspecies of profuse syphilomas: twin chancres that appear when infected at the same time, and successive hard chancres that occur when infected at different times.

Factors that provoke the formation of a large number of syphilomas include:

• skin injuries;
• ulcerative formations on the skin;
• skin infections: scabies, eczema;
• acne disease.

Multiple chancres can occur bipolar

Unlike single syphilomas, multiple chancres can be localized bipolar: both in the genital and in the extragenital region at the same time. The number of ulcers depends on the specifics of the patient's body, and ranges from 2 to 10 pieces.

Large and very large syphilomas occur in 10-15% of cases of syphilis infection. In diameter, they can reach 4-5 cm or more, coinciding in size with a child's palm.

Giant chancres occur in areas rich in subcutaneous fat:

• on the pubis;
• on the stomach;
• on the hips;
• on the scrotum;
• on the forearms.

Giant chancre occurs in 1 in 10 cases

Aside from its size, a giant syphilitic ulcer is no different from a normal one.

Dwarf called syphiloma the size of a poppy seed, in diameter not exceeding 1-5 mm. Such ulcerative formations can only be seen with the help of a magnifying glass.

Dwarf hard chancres are often located:

1. In the oral cavity: on the tongue and gums, on the palate, in the throat.
2. On the external genitalia: on the large and small labia, on the penis.
3. In the armpits and anus.
4. Inside the vagina and on the cervix in women.

Pygmy chancre most often occurs in the oral cavity

In medical practice, primary syphilomas of small sizes are rare. In women, a dwarf ulcer is formed 3-4 times more often than in men.

Hard chancres with an unusual appearance are called diphtheritic: unlike simple ulcers that have a smooth and shiny surface, they are covered with a necrotic film of an ash-grayish hue.

Diphtheritic chancre differs from other types of a kind of film

Syphilomas of this type are common, and can be localized in any area.

Hard chancres with crusting on the surface occur in areas where the ulceration can easily dry out:

• on the face (on the nose, chin, skin of the lips);
• on the shaft of the penis;
• on the abdomen, especially in the lower part.

Cortical chancre most often occurs on the thinnest skin

Visually, the cortical type of syphiloma may resemble ecthyma or impetigo.

Slit-shaped chancres visually resemble a crack or book sheets.

They are located in small skin folds:

• in the corners of the mouth;
• in the folds between the fingers;
• in pubic folds;
• in the anus.

Slit-like chancres are rare and resemble cracks in shape.

They are very rare: only 5-7% of cases of syphilis. Slit-like chancres are more common in men.

Erosive chancre, also known as Folman's balanitis, is a primary syphiloma that does not have a clear seal at the base and combines many sharply limited erosions, partially merging with each other.

It is found exclusively in the genital area:

• on the head of the penis in men;
• on the labia in women.

Erosive chancre appears exclusively on the genitals

In 87% of cases of Folman's erosive chancre, it appears in men.

Burn, or combustioform hard chancre is an erosion on a leaf-like base, which has a weak, unexpressed compaction at the base. This type of erosion is prone to strong peripheral growth.

Burn chancre is predisposed to the most rapid growth

In the process of growth, the burn syphiloma loses even contours and the correct shape, and its bottom becomes granular, with a pronounced red tint.

Chancre herpetiformis has a strong resemblance to genital herpes. This erosive formation resembles Folman's balanitis: it consists of many grouped erosions with sharp edges, located side by side in a small area.

Chancre herpetiformis has many grouped erosions in a small area

Small erosions that make up the chancre herpetiformis have a fuzzy seal at the base. This type of syphiloma differs from burn and erosive ones in the correct form, as well as in the absence of fusion between the constituent parts.

Atypical chancres are types of syphilomas that differ from the usual types in one or more ways.

These include:

1. Chancre panaritium: an ulcer with jagged edges that appears on the fingers. Most often found on the index and thumb, accompanied by shooting pain, swelling, blueness and suppuration. This is an "occupational disease" of surgeons and gynecologists who violate safety regulations.
2. Indurative edema: chancre in the genital area, provoking severe swelling, blue skin and swelling of the genitals. Occurs on the labia and foreskin. Not accompanied by pain and inflammation.
3. Amygdalitis: unilateral, rarely bilateral chancre, located on the tonsils. Enlarges and deforms the tonsil on which it is located, can cause pain. The color of the tissues of the tonsil does not change, so the disease can be confused with a sore throat.

Primary syphiloma is formed after the incubation period: 3-4 weeks after infection. It occurs in places with skin lesions in which the natural body fluid infected with bacteria has fallen: sperm, the secret of the uterine cervix.

Ulcer formation does not appear immediately. Initially, a red spot appears on the infected area, under the influence of treponema and cells of the immune system, it thickens and turns into a nodule. Compaction is not accompanied by pain and discomfort, so it often goes unnoticed by the patient.

Over the next 7-10 days, the nodule develops: it increases in size, thickens and then ulcerates. Ulceration can be of two types: superficial, in the form of erosion, or deep, in the form of an ulcer. An ulcer or erosion takes its final form: it acquires clear, pronounced boundaries, an even oval or round shape.

At the bottom of the manifested syphiloma, a liquid is released that contains a large number of pale treponemas and cells of the immune system. The bottom itself acquires a pronounced red tint with bluish notes.

This type of hard chancre persists for 1-2 months, after which the healing and tightening process begins. This signals the transition of the disease to a secondary, more dangerous and severe stage.

3-4 days before the disappearance of the chancre, multiple rashes appear on the patient's body, often accompanied by burning and itching.

The initial stage of syphilis, accompanied by hard chancres, is a disease that is easily amenable to antibiotic therapy. Before the transition of the disease to the secondary stage, it is easy to cure it without complications and damage to the body.

Before the start of treatment and after its completion, diagnostic measures are taken to recognize the disease and its causative agent:

• immunofluorescence reaction;
• polymerase chain reaction for pale treponema;
• general and biochemical blood tests.

Primary syphilis is treated with the penicillin group of antibiotics: pale treponema develops resistance to penicillin 3-4 times slower than to other groups of antibiotics. The medicine can be in the form of tablets, injections or ointments.

In case of intolerance to penicillin, it can be replaced with the following drugs:

• Erythromycin;
• Chlortetracycline;
• Chloramphenicol;
• Streptomycin.

In addition to drug treatment, a special regimen should be observed:

1. Refrain from sexual intercourse during treatment.

When a chancre appears, this indicates that the incubation period is over and syphilis begins to actively develop in the human body, it is important not to miss this moment, but to carefully consider your health. Remember that the more time is lost, the more likely it is that after a certain period of time it will disappear, but the disease will remain in the body.

The answer to the question, after what time does the chancre appear, cannot be unambiguous. First of all, the answer to it depends on what type of chancre is meant (the time for solid syphiloma and chancroid is significantly different). In addition, in the direction of increasing the incubation period, the patient's strong immunity or the use of broad-spectrum antibiotic drugs that he was treated at the time of infection can serve. And the weakening of the body, the presence of somatic diseases, etc. leads to the fact that the chancre appears after a shorter amount of time.

How long does it take for a chancre to appear?

A solid neoplasm, indicating that syphilis has appeared in the human body, signals the primary period of the disease and is one of its first signs. As a rule, a chancre appears a few weeks after the pale treponema enters the inside, while the minimum period recorded in medical practice was 8 days, and the maximum was 5 months. In the absence of additional factors or aggravating circumstances, we are usually talking about a 20-40 day incubation period.

Chancroid is also a sexual infection, which, however, rarely appears among residents of Russia, although abroad it can be more common than syphilis. Its incubation period is usually about a week, and under certain conditions it may well be reduced to 2, and sometimes even one day. From the point of view of the timeliness of the prescribed treatment, chancroid is more indicative, since pain sensations appear with it, forcing the patient to consult a doctor.

Thus, how many days will pass from the moment of infection to the onset of the first signs depends, first of all, on what kind of disease develops in the human body. And considering how many factors can affect the duration of the incubation period, no one can name specific dates.

Syphilitic chancres occur at the initial stage of infection, and are the result of the introduction of pale treponema. What does a hard syphilitic chancre look like in men and women?

The causative agents of this infection:

• able to move in 3 planes;
• have the ability to form L-shapes;
• have resistance to the therapy used;
• resistant to frost;
• sensitive to drying and exposure to direct sunlight;
• do not retain virulence to certain chemicals;
• are able to acquire a state of endocytobiosis, in which they become protected by a membrane, and remain latent for a long period until the immune system weakens or another factor provokes reactivation of the pathogen;
• survive in external conditions up to 37 ° C (at a temperature of 60 ° C they die after 15 minutes, at 100 ° C - instantly).

Predominant infection occurs through direct contact:

• most often - sexual;
• during childbirth;
• during blood transfusion;
• during surgical interventions;
• in rare cases - with a kiss.

Indirect infection is also possible through:

• use of linen or towels infected;
• toothbrush;
• dental instruments;
• other items that have not been boiled or treated with appropriate solutions.

What is the initial stage of syphilis?

Primary syphilis is the initial stage of this infection. It is characterized by the formation of a chancre most often in the genital area. Concomitant disease - lymphadenitis. Atypical and extragenital syphilis may occur.

The very initial stage of infection can be:

• seronegative - in this case, serological reactions are negative;
• seropositive - a positive reaction.

The pathogenesis of the onset of infection has not yet been studied scientifically, since the introduction of treponema causes complex and diverse reactions in individual cases. So long ago the opinion was established that a healthy person without open wounds cannot become infected from a sick person.

However, the domestic syphilidologist M.V. Milic, after analyzing all his own practical knowledge and having studied a lot of reliable literature, determined that infection does not occur only in 49-57%.

This percentage variation is associated with infection factors:

• frequency of sexual intercourse with an infected person;
• localization of the disease;
• the severity of the disease;
• existing factors that can serve as "entrance gates", incl. weak immunity;
• a large number of penetrating pale treponemas;
• their high degree of virulence.

Note! Initially, the disease may be asymptomatic (headless syphilis), but then primary syphiloma (chancre) is still formed.

The period of infection can vary between 2-12 weeks. A hard syphilitic chancre appears in the affected area and penetration of pale treponema.

It usually appears on the genitals, but more and more cases are reported in patients on:

• stomach
• face;
• hips;
• fingers.

Where does hard syphilitic chancre appear in men:

• in the mouth;
• on the coronal sulcus;
• on the scrotum;
• on the head of the penis;
• in persons with non-traditional sexual orientation - in the anus.

The smaller the diameter of the chancre, and the greater their number, the more contagious the infected person is.

If in men the presence of a chancre can be determined almost immediately, then in women it occurs:

• inside the vagina;
• on the clitoris;
• on the labia.

Note! In the first case, at the initial stage of the disease, the chancre can be detected only during a gynecological examination. At the same time, the initial stage is dangerous for both partners, and neglected cases sometimes cause death.

The danger of the disease and indicates the need for timely diagnosis. Initially, the chancre looks like a red spot, turning into erosion over time.

• the diameter on the mucous membrane or skin reaches 5 cm;
• color varies from red to burgundy;
• becomes an oval dense infiltrate;
• a plaque of yellow pus appears;
• clear raised borders form around the chancre;
• does not bring itching, discomfort and pain;
• in some cases, when pressed, purulent contents are released.

Important! Within a month, the chancre heals, and after that all visible signs disappear. But this does not indicate recovery. Most likely, the disease took a latent form.

Photo

The description may not give a clear understanding of what a hard syphilitic chancre looks like. The presented photo will help to accurately determine its visual signs.

Places of localization

By localization, solid syphilitic chancres are:

1. Extragenital. These are formed in atypical places, namely: chest, tongue, gums, throat, pubis, legs, anus, abdomen.
2. Genital. This already includes chancres of typical localization. Formed on the genitals.
3. Bipolar. This type is characterized by the occurrence both on the genitals and on other parts of the body at the same time. In this case, treponemas cause a benign formation in the form of a hard chancre in the case of a latent period, since the places of localization are limited. In the active form, there is no monomorphic, numerous occurrence of formations. Internal organs are not seriously affected.

Types of syphilitic chancre

Depending on the specific type of syphilitic chancre, a clinical picture is formed and further treatment tactics are determined.

The distinction between types of chancre is determined according to the symptoms:

• A giant solid form often occurs in an area characterized by a large accumulation of fatty tissue under the epidermis. Its size can be compared with the size of a child's palm.
• Dwarf. Its average value is comparable to the size of a poppy seed.
• Cortical. Occurs in the lips, nose.
• Diphtheritic. A common species characterized by the formation of a gray film on the chancre.
• slit-like. From the name it becomes clear that such a chancre looks like a crack. Occurs between the fingers, in the corners of the mouth and anus.

Symptoms and signs of syphilitic chancre

The opinion is erroneous that the chancre always indicates the active reproduction of treponemas and the inability to stop the process. In fact, it occurs only at the initial stage of the disease, when infectious spirochetes are not characterized by rapid reproduction.

What does a syphilitic chancre look like:

IT IS IMPORTANT TO KNOW!

Note! Some do not consider chancre to be a true manifestation due to the fact that a neoplasm occurs on the skin or mucous membrane that does not cause any discomfort, and sclerotic changes are asymptomatic. As soon as it disappears, the second stage of syphilis sets in. At the site of disappearance, rounded scars may occur.

Atypical form of chancre

The described signs are characteristic of a typical form of chancre.

But there is also an atypical one in the following forms:

1. Chancre panaritium. The main symptoms are similar to those of ordinary panaritium, only pale spirochetes, and not ordinary bacteria, act as the causative agent. Before the ulcer, the phalanges of the fingers in the periungual zone become inflamed and redden. There is severe pain, disturbing the patient even at rest.
2. Inductive edema. This form occurs in an erosive form on the face in the lip area and on the labia majora, scrotum and foreskin. It is characterized by severe swelling of the lymph nodes. Seal - pale pink with a bluish tinge, extending far beyond the chancre. The lack of adequate therapy causes the presence of inductive edema for several months.
3. Amygdalitis. Chancre affects the area of ​​the tonsils, and often occurs after oral intercourse. First, the submandibular lymph nodes swell, then the tonsils, which gradually thicken. The patient develops a sore throat that prevents normal swallowing and speaking. It is possible to differentiate the clinical picture of amygdalitis from angina immediately if the patient has a unilateral lesion of the tonsils, and therapy for angina does not give the proper result.
4. Extragenital education. It can be combined with genital, then such a chancre is called bipolar. It is extremely rare. Serological reactions are always positive. If it is not combined with genital ones, then the places of localization are the mucous membranes of the tongue, soft palate, lips, gums. Rarely - on the mucous membrane of the nose and cheeks, as well as on the skin of the abdomen, thighs and other parts of the body.
5. Mixed atypical form. The most severe of all atypical forms due to the fact that the body is infected with several types of pale treponema at the same time. First, a soft formation appears with a short incubation period, then a hard chancre with the corresponding symptoms.

Without specific therapy in patients, syphilitic chancre heals in 3-6 weeks. If treatment was started with the use of benzylpenicillin, this period is reduced to two weeks.

The infiltrate itself heals after a much longer period (up to several months). If the patient had an ulcerative form of the chancre, an oblong or rounded scar without irregularities on the surface forms in its place. After complete healing of the syphilitic chancre, only temporary pigmentation remains. The chancre is completely absorbed.

Note! The healing of a bipolar extragenital chancre is somewhat different. All signs proceed much faster, and serological reactions can be positive at an earlier date. The incubation period is reduced, as are the signs of the primary form (up to 20 days). After that, polyadenitis, baldness and other signs of a secondary form occur.

If a patient has a formation of a non-bipolar or other atypical form, at least 2-3 weeks should pass from the moment it appears until the onset of signs of secondary syphilis.

Sedimentary serological reactions, Wasserman or others give an accurate result, but they are not used for donors or pregnant women.

At 3-4 weeks, the lymph nodes increase, polyadenitis appears.

Signs of polyadenitis during secondary syphilis:

• lymph nodes - compacted;
• painless;
• have an elastic texture;
• the condition of the skin over the lymph nodes does not change;
• they are not soldered to each other and to the surrounding skin.

For one and a half months from the moment the syphilitic chancre occurs, the patient will experience:

• aching cephalalgia;
• weakness of unknown origin;
• myalgia;
• arthralgia;
• lumbago;
• causeless hyperthermia;
• symptoms of progressive anemia.

Chancres of the secondary form on the penis are complicated spontaneously or after mechanical damage. Balanitis or balanopasitis appears.

Note! Phagedenism (including red) and gangrenization are rarely formed. Red phagedenism leads to serious destruction of the affected tissues, and is accompanied by septicopyemia and intoxication.

Diagnostic methods

All this points to the need for correct and timely diagnosis. Initially, it is differentiated from other skin or inflammatory diseases. Based on the symptoms and history, the proposed diagnosis is determined. Then laboratory tests are scheduled.

Serological reactions are:

• lipid;
• group treponemal;
• species-specific group treponemal.

Lipid (they are also called reaginic), are divided into 3 groups:

• microreactions using lipid antigens - these include: RPR, VDRL, MRP and other express tests;
• Wasserman reaction;
• sedimentary reactions.

Group treponemal methods include the following methods:

• CSC with Reiter's protein antigen;

Which groups belong to species-specific protein treponemal reactions:

• RPGA;
• RIF with absorption and its variations.

Such a large range of reactions is due to various practical purposes (primary diagnosis, control of therapy, reaction of the examination, etc.)

It is impossible to independently diagnose syphilis only on external signs, it is necessary to consult a highly qualified venereologist (or infectious disease specialist), who will determine the necessary analysis method, or a set of serological reactions (including screening tests) and rapid tests. By the way, the results of the latter are determined already after 30-40 minutes, but with such a high risk of obtaining false positive results.

Note! Most often, a passive hemagglutination reaction is prescribed. The probability of obtaining a false negative result is 0-0.4%. The sensitivity of this method is extremely high. For the most accurate result, 2 or more analyzes are prescribed.

Treatment of hard syphilitic chancre

Treatment is possible on an outpatient and inpatient basis. Contact with the patient is prohibited. If a chancre is diagnosed in one partner, both should be treated.

The doctor prescribes antibiotic therapy with drugs of the penicillin group in the form of injections. It is to such agents that pale treponema is most sensitive. Extencillin acts as a base agent, and Erythromycin or Doxycycline tablets act as an additional agent. Perhaps the use of parenteral agents: Benzylpenicillin and Ampicillin.

Outside, tissue needs to be restored. This will help eliminate additional infection with another infection and resolve the symptoms of a syphilitic chancre. Tissues will regenerate faster if solutions of Benzylpenicillin or Dimexide are used, as well as heparin or levorin ointment.

For the oral cavity, rinse with solutions:

• Furacilina;
• Gramicidin;
• based on boric acid.

The treatment regimen in a particular case is determined only by the attending physician.

The primary period of syphilis develops 3-4 weeks after infection. In terms of duration, this is the shortest period (6-8 weeks) of the disease. Characterized benign course, since the process is limited to damage to the skin and less often to the mucous membranes in the absence of practically functional and organic changes on the part of internal organs, systems, tissues and the musculoskeletal system. Active manifestations are monomorphic, not numerous with predominant localization in the genital and perigenital sweetness. It is manifested by the development of hard chancre, regional scleradenitis, lymphangitis and positive classical serological reactions. Finally, this is the most favorable period for the treatment of the disease.

Chancre(ulcus durum). Synonyms: primary syphiloma, primary sclerosis, primary affect. From the moment of formation of a hard chancre, the primary stage of syphilis begins, which usually lasts 6-8 weeks.

At the site of the introduction of pale treponema into the skin or mucous membrane, after 3-4 weeks, a erosion or superficial ulcer(the first sign of syphilis). Initially, a well-defined rounded erythema with a diameter of 0.7-1.5 cm appears, which does not cause subjective sensations and quickly (after 2-3 days) turns into a flat papule with slight peeling and slight compaction of its base. A few days later, erosion appears more often on the surface of the papule, less often an ulcer with a compacted base. Erosive chancre is formed in 55-60% of patients, ulcerative - in 40-45%. The resulting chancre increases in size within 1-2 weeks, then after 4-5 weeks, even without treatment, erosion epithelizes, and the ulcer scars after 6-8 weeks.

Erosive chancre has a round or oval shape 0.8-1.6 cm in size. The bottom is bright red (the color of fresh meat) or dirty gray (the color of spoiled fat), the edges are clearly limited, not undermined, are on the same level with the skin, without signs of acute inflammation in the periphery. Serous, transparent, opalescent discharge from the erosion surface, in a small amount. The erosion bottom is smooth and shiny. At the base of the chancre, a clearly limited leaf-shaped (reminiscent of a piece of thick paper embedded in the tissue), or lamellar (reminiscent of flat cartilage in consistency), or nodular (hemispherical knot resembling cartilage in consistency) painless compaction of dense elastic consistency is palpable. To determine the compaction, the erosion base is grasped with two fingers, slightly lifted and squeezed.

After epithelialization of the chancre, a pigment spot temporarily remains, then disappearing without a trace. The infiltrate at the base of the erosion persists for several weeks, and sometimes months, followed by its complete resorption.

Ulcerative hard chancre- a deeper skin defect (within the dermis), which develops more often in weakened individuals suffering from chronic somatic, infectious diseases and alcoholism, as well as in patients as a result of ongoing irritant therapy and the addition of a secondary infection with erosive chancres. The ulcer has a saucer-shaped shape with sloping edges, regular outlines, without acute inflammatory phenomena in the circumference. Its bottom is often dirty yellow, sometimes with small hemorrhages; more abundant discharge than with erosive chancre. Compaction at the base of the ulcer is more pronounced, nodular, painless. The ulcer heals with a rounded scar with a smooth surface, hypochromic, with a narrow hyperchromic rim around the periphery.

Chancre is most often the size of a lentil to a ten-coin. Sometimes it reaches a five-kopeck coin in diameter (giant chancre) or does not exceed the size of a pin (2-3 mm) head (pygmy chancre). Chancres located in the pubis, lower abdomen, chin and on the inner surface of the thigh are more often gigantic, with a pronounced seal at the base. Sometimes erosion can increase over the surface, its bottom becomes dark red and granular with a slight lamellar seal at the base, resembling a burn. This type of primary sclerosis is called burn chancre (ulcus durum combustiforme).

The number of hard chancres fluctuates from 1 to 50 or more. Multiple chancres are observed in 50-61% of patients with primary syphilis. They occur as a result of the simultaneous penetration of the pathogen into the skin and mucous membranes in several places or. due to successive re-infections for the first 10-14 days, until infectious immunity has developed.

Primary syphiloma may appear on the skin and mucous membranes in any area, but more often on the genitals: in men - on the penis, scrotum, less often on the skin of the pubis, inner thighs; in women - on the large and small labia, clitoris, frenulum, cervix (11 - 12% of cases) and extremely rarely on the wall of the vagina. Therefore, according to localization, Fournier divided chancres into genital, extragenital and perigenital.

Extragenital chancre most often localized on the mucous membranes of the lips, gums, tongue, tonsils, soft palate, rarely cheeks and nose, on the skin of the thighs, abdomen and other parts of the body. In the same person, chancres can appear simultaneously on the genitals and any other area of ​​\u200b\u200bthe skin or mucous membranes. The combination of genital and extragenital location of primary syphilomas is called bipolar chancre. It rarely occurs. There are some features in the course of syphilitic infection with bipolar hard chancres: shortening of the incubation period, earlier positive serological reactions in primary syphilis, shortening to 15-20 days of the primary period of syphilis, the sequential occurrence of genital and extragenital chancres in the early formation of polyadenitis, the appearance of baldness, etc. d.

Clinical manifestation of hard chancre depends on the localization of the process and anatomical features affected areas. On the head of the penis, the chancre is often erosive, small in size, regular in shape, with a slight lamellar seal; in the head sulcus - ulcerative, large, with a powerful infiltrate at the base; in the area of ​​the frenulum of the penis - a longitudinal shape, bleeds during erection, with a seal at the base in the form of a cord; along the edge of the foreskin - chancre with a linear arrangement, multiple, erosive; on the inner leaf of the foreskin - a seal in the form of a visor and the presence of a symptom of "tarsal cartilage" (when, with bleeding coming from pressure, the chancre looks like the tarsal cartilage of the upper eyelid); on the crown of the head, the chancre is shaped like a swallow's nest.

Approximately 6.9% of patients with chancre have endourethral location in the form of a funnel. It is significantly compacted, painful on palpation and during urination, with scanty serous-bloody discharge. During healing, cicatricial narrowing of the urethra may occur.

Chancre in the anus, located in folds, has the form of a crack or a rocket shape with a slight compaction at the base. It is often painful on palpation, often bleeding during defecation. Primary sclerosis, located deep in the anal folds of the mucosa, becomes visible when the folds are straightened and also has a rocket-like, slit-like shape, and when located in the region of the internal sphincter, it is oval.

Erosive (about 79%) predominate, less often ulcerative chancre. With the localization of a hard chancre on the mucous membrane of the rectum, pale treponema is detected only after a thorough cleaning of the surface of the chancre from the remnants of the intestinal contents.

In women, erosive chancres are mainly observed in the region of the labia majora, sometimes indurated edema; at the entrance to the vagina - chancres are mostly small in size. On the cervix (8-12% of cases), chancres most often have the character of erosions of oval or rounded outlines, sometimes ring-shaped or crescent-shaped, intense red in color, with a flat bottom, sharp boundaries, with scanty serous or serous-purulent discharge. They are located more often on the anterior lip, usually single and erosive.

In the region of the nipple of the mammary gland single chancres predominate in the form of erosions with a lamellar seal at the base, covered with a crust, crescent-shaped, and when located in the folds of the skin and at the base of the nipple, they look like a crescent-shaped fissured ulcer. When localized on the red border of the lips, chancres prevail in the form of erosion or an ulcer covered with a tightly seated crust, very reminiscent of herpetic lesions. In some patients, the chancres hypertrophy, 4 painful cracks appear. When located in the corners of the mouth, the chancre has a slit-like shape with everted non-contiguous dense edges. Chancres of the lips are accompanied by a pronounced increase in the submandibular and submental lymph nodes.

Chancre on the tongue by nature, they can be erosive (the bottom is smooth, shiny, bright red in color, with a lamellar seal) and ulcerative (saucer-shaped, with a significant seal). Sometimes the primary affect manifests itself as a linear crack or sclerosis of the tip of the tongue.

Chancre tonsils represent a typical erosion or ulcer, located on a compacted tonsil, without signs of inflammation. This causes pain or difficulty in swallowing. The chancre of the gums is located at the neck of the tooth and has a crescent shape.

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A chancre is a morphological element on the skin or mucous membranes in some infectious diseases that looks like an ulcer. Chancre appears as a result of sexual contact with a sick person.

The chancre is classified in different ways, usually some individual characteristic is taken as the basis.

According to the depth of tissue damage, a chancre is distinguished:

1. Erosive (more superficial);
2. Ulcerative (deeper).

By the number of elements, chancre is classified into:

1. Single;
2. Multiple.

By location, chancre is extragenital (in the mouth - on the tongue, in the throat, on the gums, on the lip, on the face, on the pubis, on the leg, on the mammary gland, near the anus, etc.), genital (up to 90% of all cases, with the localization of a skin or mucous defect on the penis, in the vagina, on the large or small labia, in 10-20% of women - on the cervix) or bipolar. 75% of extragenital primary syphilomas are located in the head, face and throat. Theoretically, they can occur in various places, recently there has been a tendency to increase the frequency of extragenital location.

The size of the chancre is divided into:

1. Dwarf (up to 1 cm);
2. Medium size (1 - 2 cm);
3. Giant (up to 4 - 5 cm).

The gigantic size of erosion is characteristic when it is located on the hips, pubis, abdomen, scrotum, forearms.

According to the characteristics of the bottom of the defect, one can distinguish:

• - it is caused by pale treponema and is the primary stage of syphilis, therefore its other name is syphilitic. Synonyms - primary affect, primary sclerosis, primary syphiloma, primary erosion. Externally, the chancre undergoes a number of changes from a small red spot to an ulcer with a seal at the base. Its bottom has a meat-red color, it is covered with a dense shiny transparent film (it contains a lot of treponemas), and if the defect is on the open surface, the film acquires a brownish tint. Such a chancre in the photo has a geometrically correct shape and smooth edges. Seal at the base of the ulcer to the touch resembles the cartilage of the auricle. It is quite clearly delimited from the surrounding tissues. With syphilis, the chancre does not cause pain. After epithelialization, a pigment spot remains at the site of the defect for some time, which then disappears.
• - caused by Ducrey's streptobacillus, its other name is venereal ulcer, chancroid or third venereal disease. This chancre also changes in its development a number of successive stages from a small red edematous spot to an ulcer with uneven raised and edematous edges. The bottom of the ulcer in the photo looks uneven, meat-red in color, pus is abundantly separated from it. A soft chancre has the same typical locations as a hard chancre. Chancroid is always accompanied by a significant increase in regional lymph nodes.

The shape of the chancre can be divided into typical and atypical (this applies to syphilitic chancre).

Among the atypical forms are:

• Chancre panaritium with localization of the defect on the fingers, most often the thumb and forefinger. This disease is considered an occupational pathology among operating gynecologists and surgeons. The chancre of panaritium hurts a lot, the pains are in the nature of shooting. The skin at the site of the lesion swells, becomes cyanotic, an ulcer is visible on the photo. The edges of the ulcer are uneven, and at the bottom of it there is purulent contents. The chancre panaritium, due to its external resemblance to the banal panaritium, is rarely detected on time, most often already retrospectively, in the second stage of syphilis. Such a chancre must be distinguished from a boil.
• Indurative edema is located on the labia in women, in men - in the area of ​​the foreskin. In the photo, the genitals are swollen and greatly enlarged (2-3 times), the tissues feel dense to the touch, the skin sometimes changes color to bluish-purple. Despite the clinically pronounced outward changes, the genital organs do not hurt and are not accompanied by acute inflammatory changes.
• Chancre amygdalite is located in the throat, in the region of the tonsils. Most often, only the right or only the left side is affected. Externally, the amygdalitis chancre differs from the primary ulcerative or erosive chancre on the tonsils. The affected tonsil in the photo is sharply enlarged in size, and this asymmetry is immediately noticeable upon examination. However, the amygdalitis chancre does not cause pain at all, and the mucous membrane over the tonsil does not change color. When probing, the lesion is quite dense. Chancre amygdalitis can sometimes be confused with a sore throat.

Association with syphilis

Syphilis is one of the classic. Therefore, when the term "chancre" is used, first of all they mean its syphilitic origin.

As a primary syphiloma, it appears briefly in the first period of the disease. At this stage, the infection is most easily treated. If you skip the chancre or do not attach importance to it, you can miss the favorable moment for therapy, and syphilis will turn into a secondary one, when pale treponemas begin to actively multiply in the body.

The latent period in primary syphilis is accompanied by joint and muscle pain, malaise, fever, swollen lymph nodes. The primary period of infection ends with the spontaneous resolution of the primary syphiloma, and at the time of the appearance of secondary syphilides in the form of a rash.

Methods of treatment

At the first suspicion of chancre, it is urgent to consult a doctor. Early treatment is most effective and prevents possible complications.

Chancre of different types requires specific treatment. Since all its varieties are caused by bacteria, antibiotics form the basis of therapy.

Chancre with its syphilitic origin is usually treated with penicillin antibiotics. For injection, parenteral forms of benzylpenicillin and ampicillin are usually used. Chancre can be treated both on an outpatient and inpatient basis, it is important to do this under the supervision of a laboratory examination and strictly follow the doctor's prescriptions. If a chancre is found in one of the sexual partners, the second should also be examined and undergo a preventive course of treatment. Without treatment, the chancre may disappear on its own after some time, but then the disease will move into the second, more dangerous and severe stage.

A chancre caused by Ducrey's streptobacillus requires broad-spectrum antibiotics. The therapy regimen can be based on one of the following means:

• Ceftriaxone;
• Ciprofloxacin;
• Azithromycin (Sumamed);
• Erythromycin etc.

Chancre also responds well to sulfonamide therapy (biseptol, bactrim), their course duration is 7-14 days. Without treatment, the chancroid progresses, and the patient's condition worsens more and more. Additionally, the appointment of immunocorrective and restorative agents, vitamins is required, in advanced cases - surgical intervention.

Careful attention to any incomprehensible morphological elements in the genital area will prevent many complications.

Discussion is closed.

Unfortunately, not everyone tries to protect themselves from various diseases. It is for this reason that some people become victims of the most dangerous diseases. Some of these diseases can even lead to death. One such dangerous disease is syphilis. On the initial development of syphilis on the body of a sick person appear chancre.

What is primary syphilis?

Primary syphilis called the initial stage of syphilis, which develops after infection with pale treponema. Primary syphilis begins with formations on the skin, as well as with penetration inside. With primary syphilis, a hard chancre appears on the body. These formations can form both on the skin and on the mucous membranes.

Currently, modern medicine has identified some differences regarding the clinical picture of primary syphilis, compared with those manifestations that were noticed before.

For example, earlier at the initial stage of development of syphilis, the chancre was formed in a single amount in almost 90% of patients. Currently, chancres began to appear on the skin in the amount of two formations. In addition, the chancres began to increase in size.

In another article on our site we discussed.

Solid syphilitic chancre - the initial stage of syphilis

Primary chancre at the very beginning, it looks like a red spot, which eventually turns into erosion.

The main signs of a hard syphilitic chancre:

• The diameter of the spot on the skin or mucous membrane can reach 5 cm.
• The shape of the spot is oval.
• Education has clear boundaries.
• The color of the spot is red or burgundy.
• The presence of yellow purulent plaque.

Hard syphilitic chancre is never accompanied by pain or itching. Many people simply do not notice it because of this on their body. If you press lightly on the stain from the side, then a yellow liquid may stand out from it.

Healing of a hard chancre occurs within a month. After that, this formation on the body does not leave any visible marks. But, despite this, it is worth noting that the disappearance of a hard chancre indicates that the disease can take a latent form.

Among women

Syphilitic hard chancre in women is a very dangerous venereal disease. Even at the initial stages of its development, syphilis is a serious infection for sexual partners, and at an advanced stage, the disease can cause death.

In order for the treatment to give some positive result, the chancre in a woman must be identified at the initial stages of its formation.

The period of manifestation of chancre after infection usually takes about 3 weeks. In women, a hard chancre may form on the labia or clitoris. However, it is much more difficult to detect a formation if it is localized inside the vagina. Such a chancre can be noticed only by chance during a gynecological examination. It is for this reason that you should not neglect regular visits to a female doctor.

In men

Solid syphilitic chancre in men, as a rule, manifests itself in the area of ​​\u200b\u200bthe genital organ. To be more specific, it affects the head of the penis, the coronal sulcus and the scrotum.

If a man is a supporter of non-traditional sexual orientation, then formations may appear in the anus and in the mouth. In size, chancre in men can be both miniature and giant. Moreover, it is worth noting that the most contagious are miniature chancres, which are only a few millimeters in diameter.

The first symptoms of a hard syphilitic chancre may appear both 2 weeks after infection and 3 months later. A hard chancre is formed, usually in the place that was subject to the introduction of pale treponema, the main provocateur of the disease.

The most common sites of infection are the genital organs of a person. However, at present, more and more cases have begun to occur when the chancre appears on the abdomen, thighs, face and fingers.

External distinguishing features of a solid syphilitic chancre:

• Formation of fleshy erosion.
• The diameter of the formation can reach several cm.
• Erosion has raised edges.
• The stain has a burgundy or red tint.
• A liquid is released from erosion, which externally makes it lacquered.
• The base of the formation is a dense infiltrate.

Photo

IT IS IMPORTANT TO KNOW!

As a rule, syphilitic chancre is divided into the following types, which differ in symptoms:

• Giant hard chancre most often formed at the site, which is characterized by abundant fatty tissue under the skin. The size of such a chancre can reach the size of a child's palm.
• Dwarf hard chancre differs in its size, which can reach the size of a poppy seed.
• Diphtheritic chancre differs in that its surface is covered with a gray film, like diphtheria. This species is very common.
• Cortical hard chancre It is formed on those parts of the body where the discharge easily dries out (nose, lips, face).
• The slit-like chancre looks like a crack. Most often, this type is formed in the corners of the mouth, between the fingers and in the anus.

Symptoms of a syphilitic chancre

As mentioned earlier, at the first stage of the development of syphilis, a hard chancre forms on the body.

The main symptoms of the initial stage of syphilitic chancre:

• The formation of a spot of red-brown spots (most often on the genitals).
• No inflammation.
• The ulcer can be up to 5 cm in diameter.
• The presence of yellow plaque in the center of the ulcer.

After a few weeks, all these symptoms may disappear, but this only indicates that the second stage of the disease will soon come.

Atypical form

Primary syphilis is characterized by the appearance of an atypical form of hard chancre.

Atypical hard chancres have a number of some features:

• The formation of syphiloma, which differ in their compaction. It differs from ordinary edema in that after pressing on the formation, there are no pits on the body.
• Amygdalitis- the formation of a chancre, which is painful and located in the throat of a person. Amygdalitis is very easy to confuse with a common sore throat. But it differs from angina in the absence of temperature and an increase in only one tonsil.
• Chancre panaritium characterized by a purulent process that manifests itself at the fingertips. This type of chancre is accompanied by the presence of severe pain and even fever.
• Syphiloma-herpes. In this form, the head of the penis and the inner leaf of the foreskin become inflamed.

Atypical forms of chancre create serious problems in diagnosis. They are also capable of causing serious complications aimed at blood circulation and tissue trophism.

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Healing of syphilitic chancre

Earlier it was said that the healing of a syphilitic chancre does not mean the disappearance of the disease. Healing of syphilitic chancre most often occurs after 1-2 months after its formation on the body.

The ulcer heals on its own, even if the patient did not seek the help of a specialist and did not use any methods of treatment. After healing, only a pigment spot or a small scar remains at the site of the ulcer.

How long does it take for symptoms of secondary syphilis to appear?

Secondary syphilis is a process that is fully consistent with the development of infection in the body. This type of syphilis follows almost immediately after the manifestation of the primary, that is, 2-3 months after pale treponema enters the body. Secondary syphilis can affect the somatic organs, limbs and nervous system of a person.

Diagnostics

Most often, the diagnosis of the disease at the first symptoms does not cause any special complications. Despite this, it is necessary to conduct a laboratory study. This process is able to detect the presence of pale treponema. For such studies, a smear or scraping is usually taken from the surface of the resulting erosion.

Differential diagnosis is carried out:

• In the presence of traumatic erosion, which was formed on the patient's genitals.
• In the presence of the usual allergic balanitis, which can occur in a person who does not follow the basic rules of personal hygiene.
• In the presence of gangrenous balanoposthitis.
• In the presence of a soft chancre.
• In the presence of genital lichen.
• In the presence of scabies ecthyma.
• In the presence of an ulcerative process.
• With the formation of ulcers on the labia in girls who are actively sexually active.

Treatment

It should be noted right away that the initial syphilis can be completely cured if treatment begins at the initial stages of the development of the disease. Before and after treatment, special studies should be carried out through a complex of serological reactions. In addition, the microprecipitation reaction is also included in the process.

Most commonly used in the treatment of primary syphilis penicillin and its derivatives. This drug is the only one to which the main causative agent of syphilis has developed resistance more slowly than to other drugs. If the patient does not tolerate penicillin derivatives, then others are selected for him.

Means that are also able to fight syphilis:

If the treatment is outpatient, then the following drugs are used:

• Extencillin.
• Bicillin 1.
• Bicillin 3.
• Bicillin 5.

If the treatment is stationary, then drugs are used, which include the sodium salt of penicillin. If the patient has intolerance to penicillin, then the drugs listed above are used.

At the present stage, the diagnosis and treatment of syphilis is characterized by the use of new methods and highly effective drugs that prevent serious complications. The classification of the disease existing in Russia is based mainly on the epidemiological features and the specifics of the clinical manifestations of different periods of the course of the disease. Depending on this, primary syphilis, secondary and tertiary are distinguished. They, in turn, are subdivided into their respective subspecies.

The cause of the disease and its characteristics

The cause of syphilis, or the causative agent, is Treponema pallidum, belonging to the Spirochaetaecae family, which does not perceive staining. This property, as well as the presence of curls (on average 8-20 or more), which differ in width, uniformity and bending angle, and characteristic movements (rotational, flexion, undulating and translational, like a whip in case of attachment to cells) are important for laboratory diagnostics.

The wall of pale treponema consists of biochemical components (protein, lipid and polysaccharide), which have a complex composition and have antigenic (allergenic) properties. Microorganisms multiply within an average of 32 hours by dividing into many pieces of one curl, able to pass through the bacterial filter.

The causative agent under adverse conditions can be transformed into one of 2 forms of survival. One of them is cysts, which have a stable protective shell. They also have antigenic properties and are determined by serological (immune) reactions, which remain positive for many years after the transferred early form.

The second form of existence under adverse conditions is L-forms, which do not contain a cell wall, their metabolism is sharply reduced, they are not capable of cell division, but retain intensive DNA synthesis. Under appropriate conditions for life, they are quickly restored to their usual spiral shape.

The resistance of L-forms to antibiotics can increase by several tens and hundreds of thousands of times. In addition, they do not have antigenic properties or the latter are very reduced. In this regard, by means of classical serological reactions, the causative agent of the disease cannot be detected. In this case (in the later stages), it is necessary to carry out RIF (immune fluorescence reaction) or RIT (treponema immobilization reaction).

Pale treponema is characterized by low resistance to the influence of the external environment. The optimal conditions for its existence are high humidity and a temperature of 37˚C. Outside the human body at a temperature of about 42˚C, it dies after 3-6 hours, and at 55˚C - within 15 minutes.

In blood or serum at 4˚C, the duration of its survival is at least 1 day. For this reason, fresh donated blood and its preparations are currently not used, despite laboratory control. A significant absence of treponema in canned blood is noted after 5 days of storage.

The microorganism retains its activity on various objects only until they dry out, quickly dies under the influence of acids and alkalis and does not survive in products such as vinegar, sour wines, sour milk and kefir, kvass and sour carbonated drinks (lemonade).

Ways of infection and mechanisms of development of primary syphilis

The source of infection is only a sick person. The main conditions for infection are the presence of even imperceptible damage to the stratum corneum of the skin or the integumentary epithelial layer of the mucous membrane and the introduction of at least two pathogens through them into the body. According to some clinicians, mucosal damage is not necessary.

There are two ways of getting syphilis:

• direct - sexual contact (most often - 90-95% of cases), kissing, biting, breastfeeding, caring for a child or a sick person, professional (medical personnel when examining patients, operations and manipulations, attending childbirth, with musicians through common wind instruments, etc.), intrauterine infection of the fetus, transfusion infection (transfusion of blood and its preparations);
• indirect - infection through various wet common items, linen, etc. in everyday life, in kindergartens, military units, hairdressers and beauty salons, in medical institutions (mainly dental and gynecological rooms).

Men suffer from primary syphilis 2-6 times more often than women. In the latter, secondary and latent (latent) syphilis is more common, which are often discovered by chance only during examinations and mandatory serological tests in gynecological consultations and departments.

The first clinical symptoms of primary syphilis appear on average 3-4 weeks after the pathogen enters the damaged skin surface or mucous membranes (incubation period). This period can be reduced to 10-15 days or increased to 2.5-3 months, and sometimes up to six months, especially when taking low doses of antibiotics. The decrease in the duration of the incubation period is affected by:

• senile or early childhood;
• unfavorable living and working conditions;
• severe psycho-emotional stress, mental or physical overwork;
• malnutrition;
• concomitant chronic diseases, diabetes mellitus;
• acute and chronic infectious diseases;
• chronic intoxications (industrial, nicotine, alcoholic, narcotic);
• re-infection through repeated sexual contact with sick partners.

An increase in the duration of the incubation period of primary syphilis is observed in people with high protective properties of the body, when taking antibiotics or antibacterial agents for any inflammatory diseases, in the presence of genetic immunity to the causative agent of the disease (very rarely).

After pale treponema enters the body, their intensive division (reproduction) occurs at the site of introduction, where the first and main symptom of the primary period of syphilis, syphiloma, develops. Pathogenic microorganisms quickly spread by lymph and blood to all tissues and organs. A small number of them penetrate into the lymph of the perineural (around the nerve fibers) spaces and along them into the parts of the central nervous system.

This process is accompanied by a change in the reactivity of the whole organism, that is, an allergic reaction of tissues, and in parallel - an increase in immune defense against an infectious agent. Allergy and immune response are two phenomena of a single universal biological reaction of the body under the influence of an infectious agent, which subsequently manifests itself as clinical symptoms of primary syphilis.

Clinical picture of the disease

A specific sign of primary syphilis is a positive laboratory serological reaction. However, the entire incubation period and the first week, even up to the 10th day of the first period, it remains negative. Moreover, in some patients it is negative throughout the disease, which greatly affects the timely diagnosis and treatment of syphilis. In recent years, this has been observed in an increasing number of patients.

The results of the serological reaction are taken into account in the classification, in which primary syphilis is divided into:

• seronegative;
• seropositive;
• hidden.

Syphilis primary seronegative- this is only such a form of the disease, which throughout the entire period of the course of treatment is characterized by persistent negative results of standard serological tests carried out regularly and at least every 5 days. This does not take into account the results of immunofluorescence and Colmer reactions, which are a modification (cold mode) of the classical Wasserman serological test. If classical reactions gave at least one weakly positive result, primary syphilis is classified as seropositive.

After the end of the incubation period, two main signs of the disease develop:

• Primary syphiloma, or hard chancre, primary sclerosis, primary ulcer, primary erosion.
• Damage to the lymphatic vessels and nodes.

Roseolous rash in primary syphilis does not occur. Sometimes there are isolated cases of the so-called "headless" syphilis, when the latter manifests itself already in the secondary period (bypassing the primary) 3 months after infection. A symptom of secondary syphilis is a rash. This occurs mainly as a result of deep injections with infected needles, intravenous transfusion of infected blood and its preparations, after operations or manipulations with an infected instrument.

Primary syphiloma

Hard chancre occurs on average in 85% of infected people and is an erosive or ulcerative formation on the skin or mucous membranes at the site of inoculation (implementation) of pale treponema. This is not a true morphological element of the disease. It is preceded by "primary sclerosis", which in most cases goes unnoticed not only by the patient himself, but also by the dermatologist. This change begins with the appearance of a small speck of red color due to capillary expansion, which, within 2-3 days, transforms into a painless hemispherical papule (dense formation without a cavity, slightly rising above the skin) with a diameter of several millimeters to 1.5 cm, covered with a small number of scales of the horny epithelium.

Over several days, peripheral growth of the papule, thickening and crusting occur. After spontaneous rejection or removal of the latter, the disturbed skin surface is exposed, that is, erosion or a superficially located ulcer with a seal at the base, which are the chancre.

Syphiloma is rarely painful. More often it does not cause any subjective sensations. After reaching a certain size, it is not prone to further peripheral growth. The average diameter of the chancre is 1-2 cm, but sometimes there are "dwarf" (up to 1-2 mm) or "giant" (up to 4-5 cm) formations. The first are formed in the case of penetration of treponema into the depth of the hair follicles and are localized in those areas of the skin in which the follicular apparatus is well developed. They are very dangerous because they are almost invisible and therefore are a source of infection. Large elements are usually located on the face, thighs (inner surface), on the forearm, in the lower parts of the skin of the abdomen, on the pubis.

Primary ulcer or erosion can be oval or round geometrically regular shape with even and well-defined borders. The bottom of the formation is located at the level of the surface of the surrounding healthy skin or somewhat deepened. In the latter version, the chancre acquires a "saucer-shaped" shape.

Its surface is smooth, bright red in color, sometimes covered with a dull grayish-yellow coating. Against this background, there may be petechial (pinpoint) hemorrhages in the center. Sometimes plaque is located only in the central sections of the ulcer and is separated from healthy areas of the skin by a red rim.

In open areas of the body, the ulcerative surface is covered with a dense brownish crust, and on the mucous membranes - with a transparent or whitish serous discharge, which gives it a kind of "lacquer" sheen. The amount of this discharge increases sharply when the surface of the chancre is irritated. It contains a large amount of the pathogen and is used for smears for microscopic examination.

Primary syphiloma is called a "hard" chancre due to the fact that it is delimited from the surrounding healthy tissues at the base by a soft elastic seal that extends beyond the ulcerative or erosive surface by several millimeters. Depending on the shape, three types of this seal are distinguished:

• nodular, having the appearance of a hemispherical formation with clear boundaries and deeply penetrating into the tissues; such a seal is determined during a routine visual examination and is called the "visor" symptom; as a rule, it is localized in the region of the coronal sulcus and on the inner surface of the foreskin, which violates the displacement of the latter and leads to phimosis;
• lamellar - comparable to a coin at the base of a syphiloma, placed on the labia majora, the stem section of the penis or in the region of the outer surface of the foreskin;
• leaf-shaped - not a very solid base, similar to a thick paper sheet; occurs when localized on the glans penis.

Varieties and various options for hard chancre in primary syphilis

Special varieties of primary education are:

• Combustiform (burn) hard chancre, which is an erosion on a leaf-like base with a tendency to peripheral growth. As erosion increases, the correct outlines of its boundaries are lost, and the bottom acquires a granular red color.
• Folman's balanitis (symptom complex) is a rare clinical variety of chancre in the form of multiple small erosions without pronounced compaction. Its localization is the glans penis and labia majora. The development of this symptom complex in primary syphilis is facilitated by the use of antibiotics orally during the incubation period or the application of external agents with antibiotics to syphiloma at the initial stage of its development.
• Chancre herpetiformis, which has a significant resemblance to genital herpes. It is a grouped small erosion with a fuzzy compaction at the base.

Depending on the anatomical specifics of the location of the primary syphiloma, different options for its formation are possible. So, on the head of the penis, it is expressed by erosion with a slight lamellar base, in the region of the coronal sulcus - a large ulcer with a nodular seal, in the region of the frenulum of the penis, it looks like a strand with a dense base, bleeding during erection. When localized on the distal border of the foreskin, syphilomas are usually multiple and linear in nature, and on the inner sheet it looks like an infiltrate like a rolling plate (“hinged” chancre); removal of the head is difficult and is accompanied by tears.

Localization of syphilomas in primary syphilis

Primary syphilomas can be single or multiple. The latter are characterized by simultaneous or sequential development. The condition for their simultaneous development is the presence of multiple defects of the mucous membrane or skin, for example, with concomitant skin diseases accompanied by itching, injury or cracks. Successively occurring chancres vary in degree of density and size and are observed during repeated sexual intercourse with a sick partner.

Recently, bipolar formations have become more common, that is, on two parts of the body distant from each other (on the external genitalia and on the mammary gland or on the lips), and “kissing” ulcers - in the area of ​​\u200b\u200bcontacting surfaces of the labia minora, as well as chancre - "imprints" on the penis in the area of ​​the crown, which very often lead to the development of balanoposthitis. Such forms are accompanied by a shorter incubation period and an earlier appearance of seropositive reactions.

Localization of primary syphiloma depends on the method of infection. Most often it appears on the external genitalia. On the mucous membranes of the genital organs, the chancre can be located in men in the area of ​​​​the external opening of the urethra. In these cases, there is an increase in inguinal lymph nodes, painful urination, serous - bloody discharge, which is often confused with gonorrhea. As a result of the healing of the ulcer, a stricture (narrowing) of the urethra may form.

With primary syphilis in women, erosion can form on the mucous membranes of the cervix - in the region of the upper lip (more often) of the vaginal part of the cervix, in the area of ​​​​the external pharynx of the cervical canal. It has the appearance of a round limited erosion with a bright red shiny surface or covered with a grayish-yellow coating and serous or serous-purulent discharge. Much less often, the primary formation occurs on the mucous membrane of the walls of the vagina.

With perverted sexual contacts on any part of the skin and mucous membranes, extragenital (extra-sexual) single and multiple syphilomas can develop, which occurs (according to various sources) in 1.5-10% of cases of infection. For example, it may occur:

• primary syphilis on the face (in the area of ​​the red border of the lips, more often on the lower, in the corners of the mouth, on the eyelids, chin);
• in the folds of the skin located around the anus (often resembles a normal crack);
• on the skin of the mammary glands (in the areola or nipples);
• in the armpit, on the navel, on the skin of the second (more often) phalanx of the fingers.

Extragenital hard chancre is characterized by more rapid formation of erosion or ulcers, soreness, prolonged course and a significant increase in peripheral lymph nodes.

During oral sex, primary syphilis of the oral cavity develops with localization in the region of the middle 1/3 of the tongue, on the tonsils, on the mucous membrane of the gums, at the neck of one or more teeth, on the back of the throat. In cases of anal sex in both men and women, primary syphiloma may occur not only on the skin in the anus, but also, in more rare cases, on the mucous membrane of the lower rectum. They are accompanied by pain during the act of defecation, bloody discharge mixed with mucus or pus. Such syphilomas often have to be differentiated from an ulcerated rectal polyp, hemorrhoids, and even a malignant neoplasm.

Damage to the lymph nodes and lymph vessels

The second main symptom of primary syphilis is lymphadenitis (enlargement) of regional lymph nodes, or the accompanying "bubo", scleradenitis. It is important in the differential diagnosis of primary syphilis and persists for 3 to 5 months even with adequate specific therapy and secondary syphilis.

The main symptom of syphilitic scleradenitis is the absence of acute inflammation and pain. As a rule, a symptom called the Rikor Pleiad is found. It is expressed in an increase in several lymph nodes up to 1-2 cm, however, the node closest to the syphiloma is large in comparison with those more distant from it. The lymph nodes show no signs of inflammation. They have a round or oval shape and a densely elastic consistency, they are not soldered to each other and to the surrounding tissues, that is, they are located in isolation.

Scleradenitis develops, as a rule, at the end of the first week after the formation of syphiloma. With an extension of the incubation period, which occurs in cases of concomitant intoxication of the body, taking antibacterial, antiviral or immune drugs, etc., lymphadenitis may appear before the formation of the chancre or simultaneously with it. Lymph nodes can increase from the location of the primary focus, from the opposite (cross) or from both sides.

If the primary chancre is located in the vulva, the inguinal nodes react, on the chin and lower lip - submandibular and cervical, in the areas of the upper lip and tonsils - submandibular, anterior and cervical, on the tongue - sublingual, in the region of the outer corners of the eyes or on the eyelids - anterior, in the region of the mammary glands - parasternal and axillary, on the fingers of the hands - elbows and axillaries, on the lower extremities - inguinal and popliteal. Regional lymphadenitis during external examination is not detected in the case of localization of syphiloma on the walls of the vagina, cervix or rectum, since in these cases the lymph nodes of the small pelvis react.

By the end of the primary stage of syphilis, syphilitic polyadenitis develops, that is, a widespread increase in the lymph nodes of the submandibular, cervical, axillary, inguinal, etc. Their magnitude is less than with regional lymphadenitis, and the farther from the primary focus, the smaller they are. Polyadenitis, like regional lymphadenitis, persists for a long time even with the use of specific therapy.

Syphilitic damage to the lymphatic vessels (lymphangitis) is not an obligatory symptom. In relatively rare cases, it manifests itself as a lesion of small lymphatic vessels mainly in the area of ​​​​the primary focus and is accompanied by painless swelling of the surrounding tissues, which persists for several weeks. Larger affected lymphatic vessels may be seen as firm, painless subcutaneous tourniquets.

Complications of primary syphilis

The main complication is the transition of the disease to the secondary stage in the absence of specific adequate therapy. Other complications are associated with primary syphiloma:

Ulcer formation

Erosion usually forms first. An ulcer in some cases is already considered a complication. Its development is facilitated by factors such as self-use of external irritating drugs, violation of hygiene rules, childhood or old age, concomitant chronic diseases, especially diabetes, anemia and chronic intoxication that weaken the body.

Balanitis (inflammatory process of the head) or balanoposthitis (inflammation in the region of the inner leaf of the foreskin, as well as the head)

They arise as a result of the addition of purulent or other opportunistic flora, including fungal, if personal hygiene is not observed, mechanical damage or irritation, weakened reactivity of the body. These complications are manifested in acute inflammatory processes around the chancre - redness, the appearance of additional small erosive areas, tissue swelling, soreness, purulent or purulent bloody discharge. All this may be similar to the usual banal balanoposthitis and makes it difficult to diagnose the underlying disease.

Phimosis (inability to move the foreskin to remove the head of the penis) and paraphimosis

Phimosis occurs as a result of swelling of the glans and foreskin or scarring of the foreskin after the ulcer has healed. These changes lead to a narrowing of its ring and prevent the removal of the head. With forcible removal, an infringement of the head (paraphimosis) occurs, which, if timely assistance is not provided, leads to its necrosis (necrosis).

Gangrenization

A rare complication of chancre that occurs on its own or as a result of activation of saprophytic spirochetes and bacilli (fusispirillosis infection) with weakened immunity. In addition, staphylococcal and streptococcal infections also join them. The complication is manifested by rapidly spreading necrosis along the surface and deep into the syphiloma. A scab of a dirty yellowish-gray or black color appears on the surface. When it is removed, an ulcerative surface with bright red granulations is exposed.

Gangrenization develops only within the syphilitic ulcer, and after healing, following the rejection of the scab, a scar is formed. Gangrenization is accompanied by a deterioration in the general condition, fever and chills, headache, the appearance of soreness in regional lymph nodes, and sometimes hyperemia (redness) of the skin above them.

Fagedinism

A rarer but more severe complication of primary syphilis caused by the same bacterial flora. It is characterized by the spread of tissue necrosis not only within the boundaries of the ulcerative surface, but also with the involvement of healthy tissues surrounding it. In addition, necrosis after rejection of the scab does not stop. Gangrene is increasingly spreading to healthy areas, resulting in severe bleeding, destruction of the wall of the urethra, followed by its cicatricial narrowing, complete destruction of the foreskin and even the head of the penis. Fagedinism is accompanied by the same general symptoms as with gangrenization, but more pronounced.

Diagnostics

As a rule, establishing a diagnosis with the appearance of a characteristic syphiloma does not cause any difficulties. Nevertheless, its laboratory confirmation is necessary by microscopic detection of pale treponema in a smear or scraping from an erosive (ulcerative) surface or in a punctate from a regional maximally large lymph node. Sometimes these studies have to be performed for several days before the onset of the epithelialization process. In addition, sometimes (relatively rarely) it becomes necessary to conduct a histological examination of tissues from a hard chancre.

Classical serological tests become positive only by the end of the 3rd week or by the beginning of the next month of illness, so their use for early diagnosis is less important.

Differential diagnosis of primary syphilis is carried out with:

• traumatic erosion of the genital organs;
• with banal, allergic or trichomonas balanitis and balanoposthitis that occurs in people who do not observe normal hygiene;
• with gangrenous balanoposthitis, which can develop independently or as a complication of the diseases listed above;
• with soft chancre, genital herpetic lichen, scabies ecthyma, complicated by staphylococcal, streptococcal or fungal infection;
• with ulcerative processes caused by or gonococcal infection;
• with acute ulcers of the labia in girls who are not sexually active;
• with malignant neoplasm and some other diseases.

How to treat primary syphilis

The disease is completely curable if timely adequate therapy is carried out in the early stages, that is, during the period of primary syphilis. Before and after the course of treatment, studies are carried out using CSR (a complex of serological reactions), including a microprecipitation reaction (MRP).

Treatment of primary syphilis is carried out with penicillin and its derivatives (according to the developed schemes), since this is the only antibiotic to which the causative agent of the disease develops resistance much more slowly and weakly compared to the others. In case of intolerance to antibiotics, penicillin derivatives, others are selected. The descending sequence of the effectiveness of the latter: Erythromycin or Carbomycin (macrolide group), Chlortetracycline (Aureomycin), Chloramphenicol, Streptomycin.

For outpatient treatment, long-acting penicillin preparations are used:

• foreign production - Retarpen and Extencillin;
• domestic preparations of bicillin - Bicillin 1 (one-component), which is a dibenzylethylenediamine penicillin salt, Bitsillin 3, including the previous one, as well as novocaine and sodium salts of penicillin, and Bitsillin 5, consisting of the first and novocaine salts.

In the conditions of inpatient treatment, penicillin sodium salt is mainly used, which is characterized by rapid excretion and provision of an initial high concentration of the antibiotic in the body. If it is impossible to use penicillin derivatives, alternative antibiotics (listed above) are used.