Syphilis can also occur in a latent form.
This variant of the course of the disease is called latent syphilis. Latent syphilis from the moment of infection takes a latent course, is asymptomatic, but blood tests for syphilis are positive.
In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.
If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent, unspecified syphilis, and the diagnosis can be clarified during the examination and treatment.
Ordinary syphilis develops when pale treponemas, the causative agents of this disease, enter the human body. During their activity, the patient develops symptoms of syphilis: rash, bumps, gummas, and so on.
At the same time, the patient's immunity does not stand aside: as with any infection, it secretes antibodies (protective proteins), and also sends cells of the immune system to the breeding sites of bacteria.
Thanks to these measures, the majority of pale treponemas die. However, the most tenacious bacteria remain, which change their shape so that the immune system no longer recognizes them.
In the cystic form, pale treponema cannot be active, but it can multiply
This type of "masked" pale treponema is called cystic forms or L-forms. In this form, pale treponema cannot be active, but it can multiply.
As a result, when the immune system “loses its vigilance”, secretly breeding bacteria enter the bloodstream and harm the body again.
The same thing happens when improper treatment syphilis. If the antibiotic is chosen incorrectly or in the wrong dose, not all pale treponemas die - the survivors are masked and remain invisible until better times.
False-negative (false-negative) results occur at high concentrations of antibodies, which inhibits agglutination (the prozone effect), which can be avoided with serial dilutions
serum.
The average rate of false-negative non-treponemal tests (VDRL) in secondary syphilis is about 1%. False-negative results of non-treponemal tests must be distinguished from negative non-treponemal tests at various periods of the course of syphilis, when the body has not yet developed antibodies or when the amount of antibodies is significantly reduced due to a decrease in the amount of lipid antigen.
The frequency of negative non-treponemal tests in different periods of syphilis
Reasons for a false positive test
Bacteriology
Treponema pallidum subsp. pallidum is a spiral-shaped, Gram-negative, highly mobile bacterium. Three other human diseases that are caused by Treponema pallidum include yaws (subsp. pertenue), pinta (subsp. carateum), and bejel (subsp. endemicum).
Unlike the subspecies pallidum, they do not cause neurological disease. Man is the only known natural reservoir for the subspecies pallidum.
It cannot survive without a host for more than a few days. This is because its small genome (1.14 MDa) is unable to code for the metabolic pathways that are required to produce most of its macronutrients.
It has a slow doubling time of over 30 hours.
This is the name of the presence of a positive reaction to syphilis according to a serological examination in the actual absence of the disease. Find out the reasons for the body's reaction to the test in this article. It is important to distinguish false positive syphilis from seroresistant and seropositive syphilis.
Is it possible to have a positive reaction in a blood test in the absence of syphilis?
Yes, you can get a false positive if you:
diabetes;
pregnancy;
oncological diseases;
tuberculosis;
alcoholism or drug addiction;
you have recently been vaccinated.
If you receive a positive blood test for syphilis, you should immediately undergo a detailed examination by a venereologist in order to start treatment as soon as possible.
False positive nontreponemal tests
The main reasons for biological false-positive reactions are related to the fact that when conducting non-treponemal tests, antibodies to cardiolipin are determined (the main component of mitochondrial lipids, especially the heart muscle - hence the name), which appears in the body when tissues are destroyed during
some diseases and conditions.
Thus, non-treponemal tests determine the so-called reagin antibodies, which the body has developed not against the causative agent of syphilis - pale treponema, but against the consequences of a syphilitic infection.
However, reaginic antibodies are produced not only to the lipids of destroyed tissues, but also to the lipids of the membrane of pale treponema, but more than 200 antigens have been identified that are similar in composition to the lipid antigen of pale treponema.
False positive treponemal
tests
The causes of false positive treponemal tests are unknown. Their percentage is very low.
It is noted that false positive treponemal tests are most common in systemic lupus erythematosus and in Lyme disease (borreliosis). Since antitreponemal antibodies are produced by immunological memory cells for quite a long time, there are hypotheses about a short-term contact of the body with pale treponema, which did not lead to infection with syphilis, but caused the production of antitreponemal
antibodies.
Undoubtedly, the appearance of positive non-treponemal and treponemal tests in non-venereal trepanematoses is not considered as a false positive biological reaction, but does not confirm the presence of syphilis.
Physicians who encounter various manifestations of disease point to biological false prerequisites. The proportion of people who received a false positive test for syphilis actually had lupus.
The same group includes bejel and relapsing fever, leptospirosis, leptospira. However, having received such a conclusion, the doctor cannot immediately ascertain the presence of the disease, if there are also no external signs.
A re-examination is required. The absence of symptoms a second time and a negative result only indicates that the person received an erroneous sentence.
It remains to find an alternative disease, which so far skillfully hides and does not allow itself to be detected visually.
The state of the body in this moment may also lead to false positive results. LPR can result from a concussion, regular menstruation, significant trauma or gout.
Technical failures are also rare, but they cause a false positive analysis for syphilis. Lab technician errors or equipment failure will result in an incorrect result.
Non-recognition of serological false-positive reactions for syphilis can have negative prognostic and social consequences. Don't just trust your intuition. The diagnosis requires confirmation or competent refutation.
Decision makers may be due to technical errors and errors in the performance of research, as well as the quality of reagents. Despite the numerous advantages of diagnosticums for RPHA, ELISA and RIF and their modifications used for the diagnosis of syphilis, in some cases, unreliable test results are noted.
This may be due to both the insufficient level of qualification and professional responsibility of the personnel (so-called non-biological or technical errors), and the characteristics of the tested samples (biological errors).
Classification of methods for laboratory diagnosis of the disease
The causative agents of endemic treponematoses (yaws, pinta, bejel) are treponemas that have genus-specific antigens similar to those of T.pallidum. In this regard, the antibodies formed against them are able to cross-react with the antigen of the causative agent of syphilis.
Biological false positive Wasserman reaction
- dark-field microscopy (detection of treponema on a dark background);
- RIT-test - infection of rabbits with the test material;
- polymerase chain reaction (PCR), which detects sections of the genetic material of a microorganism.
Nontreponemal:
- complement fixation reaction with cardiolipin antigen (RSKk);
- microprecipitation reaction (RMP);
- rapid plasma reagin test (RPR);
- test with toluidine red.
Treponemal:
- complement fixation reaction with treponemal antigen (RSKt);
- treponem immobilization reaction (RIT or RIBT);
- immunofluorescence reaction (RIF);
- passive hemagglutination reaction (RPHA);
- enzyme immunoassay (ELISA);
- immunoblotting.
In the initial stage, you can use the bacterioscopic method, based on the determination of the pathogen - pale treponema - under a microscope. In the future, serological tests based on the determination of microbial antigens and antibodies produced by the body in biological material are widely used.
Bacteriological research is not carried out, since the causative agent of syphilis grows very poorly on nutrient media under artificial conditions.
All methods for detecting treponema, that is, types of tests for syphilis, are divided into two large groups:
1. Direct, which directly detect the microbe itself:
2. Indirect (serological), based on the detection of antibodies to the microbe, which are produced by the body in response to infection.
Serological tests are divided into two groups
Nontreponemal:
Treponemal:
The methods of these analyzes are quite complex, so we will focus mainly on when they are carried out and how accurate information they give.
Let's say right away that the basis for diagnosing syphilis is serological methods. What is the name of the analysis for syphilis: in each case, the examination may include different methods. Below we will describe them in more detail.
False-positive reactions of treponemal and non-treponemal tests can be observed in infectious diseases, the causative agents of which have antigenic similarity with pale treponema.
These are relapsing fever, leptospirosis, tick-borne borreliosis, tropical treponematoses (yaws, bejel, pint), as well as inflammatory processes caused by saprophytic treponemas of the oral cavity and genitals.
The causative agents of endemic treponematoses (yaws, pinta, bejel) are treponemas that have genus-specific antigens similar to those of T.pallidum. In this regard, the antibodies formed against them are able to cross-react with the antigen of the causative agent of syphilis.
Russia is not a territory endemic for this group of diseases. These infections occur mainly in Africa, Latin America and South Asia, and cases are rare in the practice of medical institutions.
A patient with a positive serological test for syphilis coming from a country with endemic treponematoses should be tested for syphilis and given antisyphilitic treatment if not previously given.
What is Latent Syphilis
The development of latent syphilis is no different from the causes of infection with the classic form of the disease. Bacteria - pale treponemas - enter the patient's body. Microorganisms begin to multiply. But after the incubation period, the latent form of the disease does not show symptoms.
Syphilis can also occur in a latent form.
This variant of the course of the disease is called latent syphilis. Latent syphilis from the moment of infection takes a latent course, is asymptomatic, but blood tests for syphilis are positive.
In venereological practice, it is customary to distinguish between early and late latent syphilis: if the patient became infected with syphilis less than 2 years ago, they speak of early latent syphilis, and if more than 2 years ago, then late.
If it is impossible to determine the type of latent syphilis, the venereologist makes a preliminary diagnosis of latent, unspecified syphilis, and the diagnosis can be clarified during the examination and treatment.
Reasons for development
Latent syphilis develops for various reasons and can have several course options:
One of the main reasons for the prevalence of latent syphilis among ordinary people is the illiteracy of people and their not entirely adequate attitude to their health.
The fact is that a person, having suspected a cold or the initial stage of the development of a sore throat, without prior consultation with a specialist, begins to take antibiotics uncontrollably.
But these medications hide the main symptoms of syphilis. In other words, syphilis is not cured, but healed and proceeds in a latent form.
According to some experts, the latent form of syphilis has become widespread due to the misuse of drugs.
Antibiotics are often taken in high doses and without a doctor's prescription. Any antibacterial agent from a series of tetracyclines, penicillins, macrolides and fluoroquinolones can change the nature of the course of the disease and the regular alternation of its stages.
And in the absence of treatment, syphilis can have latent periods, for example, in its secondary and tertiary form. At certain intervals, clinical manifestations of infection are absent.
Treponema pale is transmitted through unprotected sexual intercourse. You can also get infected at home - when using common dishes, hygiene items, towels. The most contagious person who has signs of primary and secondary forms of the disease.
Classification
The asymptomatic form of syphilitic infection is divided into 3 types depending on the duration of the course of the disease. In accordance with this sign, latent syphilis is isolated:
Syphilis is divided into several periods of the course of the disease:
- initial, or incubation;
- primary;
- secondary;
- tertiary.
Each period is divided into sub-periods. Latent syphilis refers to secondary period the course of the disease.
Secondary is divided into three types:
It should be noted that the latent form of syphilis is divided into several subspecies:
- early latent syphilis;
- late;
- unspecified.
Usually, an early form of latent syphilis is detected within 2 years after infection. This form is considered the most dangerous, since an infected person poses a danger to other people.
After all, not only his sexual partners can become infected with this disease, but also people living with him under the same roof.
This disease is mainly detected during medical examinations or during examination of a patient who has complaints of a completely different disease. The Wasserman reaction is carried out, however, this study does not always give an accurate answer, therefore the patient is also subjected to a number of other additional laboratory and clinical examinations.
During a clinical examination of a patient, enlarged and somewhat compacted lymph nodes are often found on the body. During the consultation, patients suddenly begin to remember that at a certain period of time rashes appeared on their body, which disappeared on their own.
All these symptoms indicate the presence in the patient's body of the causative agent of latent syphilis.
In some cases, early latent syphilis affects internal organs, such as:
- liver;
- stomach;
- thyroid;
- joints.
The central nervous system can also suffer from early latent syphilis. The nervous system, and in particular the membrane of the brain and the walls of blood vessels, is affected within 5 years after the moment of infection.
Allocate late and early latent syphilis. The classification is approximate, because there are often cases when the disease cannot be attributed to any of the above types:
Symptoms of latent syphilis in the first case are the presence of a painless ulcerative formation in the genital area or on the mucous membranes of the oral cavity. Serological tests give a positive result. Wasserman's reaction over the past 3 years has been negative.
Early latent syphilis is also called if the rash appeared in the last year. The facts of the presence of erosions in the genital area may not be confirmed. With a positive result of the serological reaction, in this case we are talking about latent secondary syphilis.
The late form of the disease is diagnosed if more than 3 years ago the patient had unprotected sex with infected treponema pallidum. In this case, it is possible to establish the presence of an ulcerative defect in the genital area and skin rashes more than 4 years old.
In other cases, the diagnosis sounds like undifferentiated latent syphilis.
To confirm the stage, the patient must remember all unprotected sexual intercourse that has occurred over the past 8-10 years. It is mandatory to examine the partner and identify syphilitic rashes and gums in him. If any, it is an early form of infection.
With a trial introduction of penicillin antibiotics, the disintegration of treponemas begins, accompanied by signs of intoxication of the body.
Usually, latent syphilis is classified into several forms, depending on the severity of the symptoms:
- Primary.
- Secondary.
- Secondary early hidden.
- Secondary late latent syphilis.
- Tertiary.
- Congenital.
Primary syphilis has the most pronounced property to be transmitted from sick people to healthy people through direct contact. Severe forms have a lower degree of infection, but changes in human systems are already becoming clearly visible.
Symptoms and signs of latent syphilis
The latent form of syphilis has no visually visible symptoms and signs. This hidden syphilis is dangerous for sexual partners, for the immediate environment (the likelihood of infection in a domestic way), for an unborn child (if a pregnant woman has syphilis).
Symptoms of latent syphilis can occur in humans, according to the signs of some other diseases:
- body temperature rises to 38 degrees, for no apparent reason and regularly;
- causeless weight loss;
- psychological disorders depression, apathy;
- a state of weakness throughout the body;
- enlargement and hardening of the lymph nodes.
Diagnostic methods
The absence of symptoms significantly complicates the establishment of latent syphilis. The diagnosis is most often based on the results of appropriate tests and anamnesis.
The following information is of decisive importance in the preparation of an anamnesis:
- When did the infection occur?
- syphilis is diagnosed for the first time or the disease is repeated;
- what treatment the patient underwent, and whether there was any at all;
- whether antibiotics have been taken within the last 2-3 years;
- whether rashes or other changes in the skin were observed.
An external examination is also carried out to identify:
- syphilitic eruptions all over the body, including the scalp;
- scars after previous similar skin lesions;
- syphilitic leukoderma on the neck;
- change in the size of the lymph nodes;
- hair loss.
In addition, sexual partners, all family members, and other persons in close contact with the patient are examined for the presence of infection.
But the decisive factor for the diagnosis is the appropriate laboratory blood tests. In this case, the diagnosis can be complicated by the possibility of obtaining a false positive or false negative result.
If the test results are doubtful, a lumbar puncture is performed, the examination of which may show the presence of latent syphilitic meningitis, characteristic of the late latent stage.
With the final diagnosis of the disease, it is imperative to undergo examinations by a therapist and a neuropathologist. This is necessary to establish the presence or absence of concomitant (attached) pathologies.
Diagnosis of the latent form of syphilis is carried out using the following serological methods:
Pale treponema immobilization reaction (RIBT). For this analysis, the patient's blood serum and a suspension of pale treponema are used.
They are mixed and see how the treponemas behave. Getting into the blood of a person with syphilis, treponemas are immobile.
And when they get into the blood of a healthy person, they are active, swim for a long time, they are ready to infect. The accuracy of this test is 95%.
Diagnosis of latent syphilis is not an easy task for the doctor, as there is a possibility of a false positive reaction to syphilis.
- The reaction of indirect hemagglutination (RPHA). For this analysis, special red blood cells with antigens of the causative agent of syphilis are prepared. These red blood cells are mixed with the patient's serum. If a patient has syphilis, the red blood cells stick together.
- Enzyme immunoassay (ELISA). A special enzyme is added to the patient's prepared blood serum. If the serum replaces the color, then the patient is recognized as having syphilis.
- RIF (immunofluorescence reaction). The presence of pale treponema is indicated by a specific glow.
It helps in determining the presence of the syphilis virus in the blood and the unusual type of pale treponema itself. Under a microscope, you can see that pale treponema has the appearance of a spiral.
The size of the curls decreases towards the end of the treponema, and the spaces between the curls increase. Movement in liquid media is slow and graceful.
A feature of pale treponema is its ability to maintain its spiral shape even under the pressure of its environment. Elderly people are not treated for syphilis based on serological methods alone.
They undergo additional examinations by a neuropathologist, an oculist and an otolaryngologist.
The definition of syphilis in pregnant women deserves special attention. During pregnancy, all women donate blood for syphilis three times.
When a disease is detected, specific therapy is carried out, taking into account the duration of pregnancy and the stage of the disease. If syphilis is not treated, there is a high chance of fetal infection, birth defects, miscarriage, or premature birth.
Before starting treatment for a latent form of syphilis, it is very important for a person with suspicion of this disease to undergo a complete diagnosis. To do this, he needs to provide the venereologist with complete information about sexual partners.
The doctor also needs to determine the presence of single erosions in the genital area, mouth, or on the skin.
When diagnosing a disease, it is important to take into account the age of the patient and his lifestyle.
When diagnosing, it is very important to examine not only the patient himself, but also his sexual partner. Thus, early latent syphilis can be detected. The main confirmation of the presence of the disease are serological reactions.
Diagnosis of the latent course of treponemal infection is based not only on a laboratory study of blood and smears, but also on a complete survey of the patient, clarifying the smallest details of all diseases in recent years.
First of all, the venereologist specifies the circle of persons with whom the patient had contact, sexual relations or contact in everyday life and family, finds out the scope of activity, work, which is extremely important for medical personnel.
Often, patients are referred to a venereologist after revealing latent syphilis at an annual physical examination or staging in a antenatal clinic. After the first positive analysis - the Wasserman reaction - additional methods for determining treponema in the blood are shown.
Currently, the diagnosis of syphilis is made only after receiving at least three positive test results from the following list: RIF immune reaction, RIBT reaction to exclude false results, immunoblot to determine the titer of antibodies to the causative agent of treponema, PCR test to detect cellular material and DNA of the causative agent of syphilis .
With neurological symptoms, the cerebrospinal fluid is additionally examined. With signs of damage to internal organs, blood biochemistry, kidney and liver tests, a cardiogram, a study of the heart and blood vessels are shown.
Pathology with obvious forms is perfectly noticeable, it is easy to identify it and assume what kind of ailment the patient is tormented by. In their absence, serodiagnostic studies come to the rescue (recognition of the reaction when mixing the blood serum of the infected and the reagent).
Methods for diagnosing latent syphilis are usually distinguished into:
The first ones include microscopy, infection with rabbit material, culture, and PCR diagnostics. The methods use several types per patient, each individually cannot give an accurate result.
They have their drawbacks: long duration, impossibility of detection at certain stages, or they are expensive. Therefore, serological methods are used.
This includes various reactions of human blood to the proposed reagents. None of the indirect methods can also give an accurate answer to the presence of a microbe, and therefore the diagnosis is made only after two or more methods have been carried out.
Where to get tested for latent syphilis and who to contact?
It is no coincidence that the latent course of syphilis is the cause of the epidemiologically dangerous and rapid spread of the disease. Prevention of infection consists not only in medical examinations, but also in timely access to doctors if syphilis infection is suspected.
Treatment
The latent form of syphilitic infection is treated by the same methods as any type of syphilis - exclusively with antibiotics (systemic penicillin therapy). The terms of treatment and dosage of the drug are determined by the duration of the disease and the degree of damage to the body:
- with early latent syphilis, 1 course of penicillin injections lasting 2-3 weeks is sufficient, which is carried out at home (outpatient) conditions (if necessary, the course is repeated);
- with late latent syphilis, 2 courses lasting 2-3 weeks each are required, while the treatment is performed in a hospital, since this form is characterized by a high likelihood of complications.
At the beginning of treatment of the early form, an increase in temperature should appear, which indicates the correct diagnosis.
Pregnant women with latent syphilis must be hospitalized for appropriate treatment and constant monitoring of the fetus.
Since the infection has an extremely negative effect on the condition of the child and can lead to his death, it is necessary to notice a missed pregnancy in time and provide timely assistance to the woman.
During the treatment period, all contacts of the patient are significantly limited. He is forbidden to kiss, have sex in any form, share utensils, etc.
Patients are always interested in questions about how to treat a latent infection and whether it is possible to fully recover. Therapy is carried out by venereologists. Each patient is prescribed individual treatment depending on the form of the disease, the patient's condition, possible contraindications.
Today, the treatment of syphilis is not difficult for doctors. But one thing should be understood.
When they talk about the treatment of latent syphilis, they mean fighting the infection, but not the consequences of syphilis: bone deformities, cardiovascular disorders, and nervous system disorders.
At the current stage of development of medicine, this is impossible to do.
In the treatment of latent syphilis, antibacterial drugs are used. The treatment regimen is selected individually, taking into account the stage of the disease and comorbidities. Additionally, drugs are prescribed that raise immunity, since syphilis weakens it.
Approximate treatment regimens for latent syphilis are presented in the table:
Taking any medication is possible only after consulting a doctor. Self-medication is unacceptable! The frequency of taking medications and the duration of therapy are determined by the attending doctor.
Treatment of the latent form of syphilis should be started only after the diagnosis has been confirmed. It is carried out with the use of antibiotics of the penicillin group.
If treatment began at the initial stage of the development of the disease, then somewhere by the end of the second course of therapy, an improvement is noticeable. It is much more difficult to treat more advanced forms.
A significant increase in body temperature at the beginning of the course of treatment speaks only about the effectiveness of therapy. Fever is a sign that harmful microorganisms are rapidly being destroyed. Over time, this unpleasant symptom also disappears.
After completing the course of treatment, it is necessary to continue to undergo full examinations with a doctor. It is very important to carry out serological control and this will last until the indicators of this analysis return to normal.
The treatment regimen is to prevent the transition of syphilis to a severe form.
With an infection of less than two years, treatment is aimed at eliminating the transition of syphilis to a secondary form and eliminating the epidemiological danger to others, family members and partners.
In cases where the patient has been infected for more than two years, and doctors determine late latent syphilis, the treatment regimen is aimed at eliminating all pathologies of the internal organs and preventing the most serious complications - neurosyphilis, heart attacks and strokes.
The main treatment for syphilis is systemic antibiotic therapy with penicillins or drugs of other groups for allergies and lack of sensitivity to treponema.
The treatment regimen is also developed depending on the severity of the organ damage, the manifestations of symptoms from the heart and nervous system. In addition, drugs are used to correct the protective properties of the immune system.
Important. The bacterium that causes this disorder remains one of the few organisms that cannot defend itself against penicillin.
Therefore, therapy with this substance works great in our time. Taking the right dose of the drug for a long time helps to completely rid the body of the infection.
Erythromycin is another drug with the same effect, it is used for allergic reactions of the patient to penicillin drugs.
Treatment of late latent syphilis is carried out with penicillin in combination with antibacterial drugs that are injected into the muscles and orally.
With latent syphilis, treatment is prescribed only after an accurate diagnosis has been established by laboratory methods. It is also necessary to examine the intimate partners of the infected, and if their tests are negative, therapy is not prescribed.
Treatment of latent syphilis should take place according to the scheme, which should correspond to the type of disease and the timing of infection with it.
Syphilis is a disease that is treated for a long period. Latent syphilis is treated according to the same rules and schemes as other forms of syphilis. All family members should be examined and undergo a complex of treatment for prevention.
A variant in the development of a syphilitic infection in which no clinical manifestations of the disease are detected, but positive laboratory tests for syphilis are observed. Diagnosis of latent syphilis is complex and is based on anamnesis data, the results of a thorough examination of the patient, positive specific reactions to syphilis (RIBT, RIF, RPR-test), detection of pathological changes in the cerebrospinal fluid. To exclude false-positive reactions, multiple studies are practiced, re-diagnosis after treatment of concomitant somatic pathology and sanitation of infectious foci. Latent syphilis is treated with penicillin preparations.
General information
Modern venereology is faced with an increase in cases of latent syphilis around the world. First of all, this may be due to the widespread use of antibiotics. Patients with undiagnosed initial manifestations of syphilis, on their own or as prescribed by a doctor, undergo antibiotic therapy, believing that they are sick with another sexually transmitted disease (gonorrhea, trichomoniasis, chlamydia), SARS, colds, tonsillitis or stomatitis. As a result of such treatment, syphilis is not cured, but acquires a latent course.
Many authors point out that the relative increase in the incidence of latent syphilis may be due to its more frequent detection in connection with the recent mass screening for syphilis in hospitals and antenatal clinics. According to statistics, about 90% of latent syphilis is diagnosed during preventive examinations.
Classification of latent syphilis
Early latent syphilis corresponds to the period from primary syphilis to recurrent secondary syphilis (approximately within 2 years from the time of infection). Although patients do not have manifestations of syphilis, they are epidemiologically potentially dangerous to others. This is due to the fact that at any time early latent syphilis can turn into an active form of the disease with various skin rashes containing a large number of pale treponemas and being a source of infection. Establishing a diagnosis of early latent syphilis requires anti-epidemic measures aimed at identifying the patient's household and sexual contacts, isolating him and treating him until the body is completely sanitized.
Late latent syphilis is diagnosed when the duration of possible infection is more than 2 years. Patients with late latent syphilis are not considered dangerous in terms of infection, since when the disease enters the active phase, its manifestations correspond to the clinic of tertiary syphilis with damage to internal organs and the nervous system (neurosyphilis), skin manifestations in the form of low-infectious gums and tubercles (tertiary syphilides).
Unspecified (unspecified) latent syphilis includes cases of the disease when the patient does not have any information about the duration of his infection and the doctor cannot establish the timing of the disease.
Diagnosis of latent syphilis
In establishing the type of latent syphilis and the duration of the disease, the venereologist is helped by carefully collected anamnestic data. They may contain an indication not only of sexual contact that is suspicious of syphilis, but also of single erosions in the genital area or on the oral mucosa, skin rashes, antibiotics noted in the past in the patient in connection with any disease similar to manifestations of syphilis. The age of the patient and his sexual behavior are also taken into account. When examining a patient with suspected latent syphilis, a scar or residual induration is often found, formed after the resolution of the primary syphiloma (hard chancre). Lymph nodes enlarged and fibrosed after suffering lymphadenitis can be detected.
Confrontation can be of great help in diagnosing latent syphilis - the identification and examination for syphilis of persons who are in sexual contact with the patient. Identification of an early form of the disease in a sexual partner testifies in favor of early latent syphilis. In sexual partners of patients with late latent syphilis, no signs of this disease are often detected, and late latent syphilis is less common.
The diagnosis of latent syphilis must be confirmed by the results of serological tests. As a rule, such patients have a high titer of reagins. However, in individuals receiving antibiotic therapy, it may be low. The RPR test should be supplemented with RIF, RIBT and PCR diagnostics. Usually, with early latent syphilis, the result of RIF is sharply positive, while RIBT in some patients may be negative.
Diagnosis of latent syphilis is a difficult task for the doctor, since it is impossible to exclude the false positive nature of reactions to syphilis. Such a reaction may be due to previous malaria, the presence of an infectious focus in the patient (chronic sinusitis, tonsillitis, bronchitis, chronic cystitis or pyelonephritis, etc.), chronic liver damage (alcoholic liver disease, chronic hepatitis or cirrhosis), rheumatism, pulmonary tuberculosis. Therefore, studies for syphilis are carried out several times with a break, they are repeated after the treatment of somatic diseases and the elimination of foci of chronic infection.
Additionally, a cerebrospinal fluid taken from a patient by lumbar puncture is tested for syphilis. Pathology in the cerebrospinal fluid indicates latent syphilitic meningitis and is more often observed with late latent syphilis.
Patients with latent syphilis are required to consult a therapist (gastroenterologist) and a neurologist to identify or exclude intercurrent diseases, syphilitic lesions of somatic organs and the nervous system.
Treatment of latent syphilis
Treatment of early latent syphilis is aimed at preventing its transition to an active form, which is an epidemiological danger to others. The main goal of the treatment of late latent syphilis is the prevention of neurosyphilis and lesions of somatic organs.
Therapy of latent syphilis, like other forms of the disease, is carried out mainly by systemic penicillin therapy. At the same time, in patients with early latent syphilis, at the beginning of treatment, a temperature reaction of exacerbation may be observed, which is additional confirmation of a correctly established diagnosis.
The effectiveness of the treatment of latent syphilis is assessed by a decrease in titers in the results of serological reactions and the normalization of cerebrospinal fluid parameters. During the treatment of early latent syphilis, by the end of the 1-2 course of penicillin therapy, negative serological reactions and rapid sanitation of the cerebrospinal fluid are usually noted. With late latent syphilis, negative serological reactions occur only at the end of treatment or do not occur at all, despite ongoing therapy; changes in the liquor are saved long time and regress slowly. Therefore, it is preferable to start therapy of a late form of latent syphilis with preparatory treatment with bismuth preparations.
Latent syphilis refers to the course of a syphilitic infection without external, visceral and neurological manifestations. With latent syphilis
- manifest signs of the disease on the skin and mucous membranes are not determined,
- specific lesions of internal organs are not detected,
- there are no pathological changes in the cerebrospinal fluid.
The diagnosis is established only on the basis of positive screening (non-treponemal) and specific (treponemal) serological tests.
Since the patient has no clinical symptoms, the correct assessment of positive serological reactions and the diagnosis of latent syphilis is a responsible task facing the venereologist.
Latent syphilis may be a special form of asymptomatic syphilitic infection from the moment the patient is infected with treponema pallidum.
Also, latent syphilis can occur in patients who have had active manifestations of syphilis in the past, resolved either on their own or under the influence of insufficient specific treatment.
Latent syphilis in Russia
Although the overall incidence of syphilis is currently decreasing, the number of patients with latent (low-symptomatic and asymptomatic) forms of infection is increasing. During recent years among all registered cases of syphilis increases specific gravity latent forms of syphilis with a predominance of early latent syphilis. The high proportion of latent syphilis has always been considered an unfavorable epidemiological indicator, it is a kind of time bomb. In the Russian Federation in 2009, among all clinical forms of syphilis, early latent accounted for 30%.
To date, the wide spread of latent forms of syphilis has posed a number of medical and medical and social problems that require new approaches to the diagnosis, treatment and prevention of this disease.
Clinical classification
The international statistical classification of diseases provides for the division of latent (latent) syphilis into congenital latent syphilis and acquired latent syphilis.
According to this classification, acquired latent syphilis is divided into early, late and unspecified.
- early latent syphilis is established in patients with a disease duration of up to 2 years from the moment of infection,
- late hidden - over 2 years,
- unspecified - in the absence of reliable data on the timing of infection and prescription of the syphilitic process.
All these types of syphilis are latent, without clinical manifestations, with unchanged cerebrospinal fluid, but with positive non-treponemal and treponemal serological tests in the blood.
Early latent syphilis
Early latent syphilis (lues latens recens) is acquired syphilis without clinical manifestations, with a positive serological reaction and a negative test of cerebrospinal fluid, less than two years old after infection.
Early latent syphilis is diagnosed if, during the previous year, patients:
a) documented seroconversion has been observed,
b) symptoms and signs of primary or secondary syphilis have been identified,
c) sexual contacts with partners with primary, secondary or latent syphilis have been confirmed.
Patients with early latent syphilis should be considered epidemically dangerous, since they may develop infectious manifestations of the disease.
The diagnosis is established on the basis of the results of a study of blood serum using serological methods (non-treponemal and treponemal tests) and anamnestic data. In some cases, the diagnosis of syphilis is helped by objective examination data (a scar at the site of the former primary syphiloma, swollen lymph nodes), as well as the appearance of an exacerbation temperature reaction (Jarish-Herxheimer reaction) after the start of specific treatment.
In favor of early latent syphilis, in addition to the period of infection up to 2 years, may indicate:
- anamnesis data (presence during the last 1-2 years of erosions or ulcers on the genitals, rashes on the skin of the body, a sharp thinning of the hair in the temporo-parietal region);
- clinical examination data (the presence of a scar or induration at the site of the former chancre, an increase in regional lymph nodes depending on the location of the former chancre);
- high antibody titers in standard serological tests (from 1:40 to 1:320) in most patients with positive RIT, RIF-abs, ELISA in all patients;
- reference to casual sex
- detection of active or early latent syphilis in at least one sexual partner;
- the appearance of a temperature reaction of exacerbation (Herksheimer-Lukashevich) after the first injections of penicillin in every second or third patient
- the presence of dynamics of negative CSR by the end of the course of treatment of the patient.
Patients with early latent syphilis are most often identified as sources of infection of sexual partners, during preventive examinations, and less often apply on their own.
late latent syphilis
Late latent syphilis (syphilis latens tarda) is acquired syphilis without clinical manifestations, with a positive serological reaction and a negative test of cerebrospinal fluid, two years or more after infection.
The diagnosis of late latent syphilis is based on
- anamnesis data (indication of questionable sexual relations 2–5 years ago or more);
- confrontations (sex partners are healthy);
- the absence of traces of previously resolved syphilides on the skin of the genital organs, trunk, limbs - no signs of syphilis are detected on the skin and mucous membranes of the subject;
- low antibody titers in the Wasserman reaction (1:20, 1:10.3+–2+);
- the absence of an exacerbation reaction to the introduction of the first doses of penicillin and a pronounced dynamics of CSR negativity during the first 6 months from the start of treatment. Most patients are older than 40-50 years.
Hidden late syphilis is epidemiologically less dangerous than early forms, since when the process is activated, it manifests either by damage to internal organs and the nervous system, or (with skin rashes) by the appearance of low-infectious tertiary syphilides - tubercles and gums. Patients with late latent syphilis often develop late syphilis of the cardiovascular and central nervous system, which in approximately 1/3 of cases is the direct cause of their death.
Persons with suspected late latent syphilis must consult a general practitioner, ophthalmologist, otolaryngologist, neuropathologist and radiologist.
In all patients with late latent syphilis, RIF and RIT are sharply positive. Therefore, the examination of complex diagnostic cases is carried out using RIF and RIBT.
Patients with late latent syphilis, as a rule, are detected during preventive examinations (in somatic hospitals, at blood transfusion stations, etc.); sometimes as family contacts of patients with late forms of syphilis.
Unspecified latent syphilis
Unspecified latent syphilis is a transient diagnosis, when at the beginning it is impossible to establish the timing of infection, but in the course of treatment and clinical observation, the diagnosis should be clarified (early or late). The diagnosis of latent unspecified syphilis is made in cases where neither the doctor nor the patient knows and cannot determine when and under what circumstances the infection occurred.
Differential Diagnosis
Differentiating early latent syphilis from late and unspecified is a very responsible task, the correct solution of which determines the completeness of anti-epidemic measures and the usefulness of the treatment. Patients with latent forms of syphilis, in addition to consulting related specialists (neuropathologists, cardiologists, oculists, etc.), must be subjected to targeted laboratory examination using modern molecular genetic, hardware and other studies.
The analysis of many indicators contributes to the correct diagnosis. These include
- history data,
- serological data,
- the presence in the past of active manifestations of syphilis or their absence,
- the presence or absence of the Herxheimer-Yarish reaction after the start of antibiotic therapy,
- dynamics of serological reactions,
- results of examination of sexual partners and close household contacts.
In the differential diagnosis of latent syphilis, the timely and correct recognition of false positive serological reactions (LPSR) in the blood plays a decisive role. Early latent syphilis must be differentiated from biological false-positive syphilis serological reactions that occur in the following conditions:
- pregnancy,
- autoimmune diseases,
- HIV infection
- liver disease, etc.
An urgent task remains the development of more precise diagnostic criteria for making a diagnosis other than syphilis and accompanied by LPSR and for differentiating these conditions from early latent syphilis.
Tests for latent syphilis
Latent syphilis can only be detected as a result of a serological study. Asymptomatic individuals with suspected occult syphilis should be tested with a non-treponemal test as well as two treponemal tests (ELISA + TPHA or ELISA + RIFabs). This reduces the percentage of incorrect diagnostic conclusions in case of erroneous results of one of the tests. In case of discrepancies in the results of treponemal tests, a third (confirmatory) test should also be performed, for which it is recommended to use RIBT.
Isolated determination of IgG and IgM antibodies by ELISA allows you to determine the possible duration of the disease with latent syphilis. A positive IgM ELISA testifies to early latent syphilis (approximately up to 2-3 months from the moment of infection). However, a negative IgM antibody test result does not rule out a diagnosis of early latent syphilis. It may be due to insufficient sensitivity of test systems for the detection of IgM antibodies to pale treponema. At the same time, isolated positivity of IgM ELISA may be the only serological marker of the disease and makes it possible to detect early latent syphilis in recent infection.
The main diagnostic measures (mandatory, 100% probability):
Complete blood count in the course of treatment;
General analysis of urine in the dynamics of treatment;
Non-treponemal - RMP with cardiolipin antigen or its modifications: RW, VDRL and others.
In cases of ambiguity in the data of serological studies (especially in elderly and senile people), in the absence of anamnesis data and clinical manifestations of syphilis on the skin, visible mucous membranes, as well as changes in the nervous system, internal organs, specific treatment only on the basis of positive serological reactions not assigned.
Such people need dispensary observation with periodic examination by a general practitioner, neuropathologist, ophthalmologist, otolaryngologist, including X-ray and cerebrospinal fluid examinations.
Further management
Examination for syphilis of sexual partners (contacts).
Clinical - serological control: during the first year every 3 months, then 1 time in 6 months.
Indicators of treatment efficacy and safety of diagnostic and treatment methods
1. The criterion for the effectiveness of treatment is a decrease in RMP titers;
2. Criteria for the safety of treatment - monitoring of clinical laboratory studies before and after treatment ( general analysis blood, urinalysis)
Latent syphilis (lues) is a latent form of an infectious disease caused by pale treponema. It differs from ordinary syphilis in the absence of visible manifestations and symptoms. The patient is not worried about anything, but he is a carrier of the infection.
Diagnosis of latent syphilis is difficult, since the latent course gives negative serological reactions. Thus, the tests show that the patient is healthy, although spirochetes are present in the body. False-positive results are especially dangerous because the disease can manifest itself abruptly and the patient becomes contagious to his partner.
The main reason for the development of any form of sexually transmitted disease is the ingestion of pale treponema into the patient's body.
The infection is transmitted sexually, upon contact of the mucosa with a chancre formed as a result of the progression of the disease. You can also become infected through blood during transfusion, injections with one syringe. Domestic transmission is unlikely.
Latent syphilis develops for several reasons. First of all, this is taking antibiotics for another reason, for example, for the treatment of tonsillitis or gonorrhea, trichomoniasis. The antibacterial drug inhibits the activity of spirochetes and translates the disease into a latent form. If the dosage of the drug is insufficient, the infectious agent survives.
Pathology is often diagnosed by chance during the incubation period. From the moment of infection to the formation of a hard chancre, it can take from several days to 6 months. If sick at it time will pass preventive examination for, the pathological process can be detected.
How long the disease lasts depends on the lifestyle and immunity of the patient. When the immune system is weakened, for example, against the background of SARS or as a result of the addition of another STD, the pathology quickly manifests itself.
Pathogens and incubation period
The causative agent of latent syphilis is pale treponema, a microorganism of the genus spirochetes. This is a gram-negative bacterium sensitive to antibiotics of the penicillin group, which was discovered by German microbiologists in 1905. Previously, lues was considered a fatal disease, but now it is completely curable.
Primary LUES appears 3-4 weeks after infection, in most cases.
The secondary form can proceed secretly for years, when the patient does not observe ulcers on the genitals, but spirochetes cause changes in the body, affecting the internal organs.
If a latent lues develops, the pathological process proceeds latently for months, until triggering factors appear:
- infections;
- weakening of the immune system;
- hypothermia.
The pathology manifests itself in waves, with periodic remissions and exacerbations.
Latent syphilis is latent, asymptomatic. The patient is not worried. But once the symptoms appear, characteristic of the stage of the disease. Primary syphilis is accompanied by the appearance of a hard chancre. This is an ulcer in the zone of active reproduction of spirochetes.
The chancre may not be accessible to the patient if it is located in the vagina or on the cervix, in the urethra, deep in the perineum, in the throat. The sore does not hurt and does not bother in any way, so the pathology proceeds asymptomatically.
Is latent syphilis contagious? The source of infection is an ulcer, upon contact with which infection occurs. If there is no ulcer, sexual transmission is not possible.
If the primary form of pathology is not diagnosed and not treated, the disease passes into a secondary form, which is asymptomatic and is accompanied by relapses.
The exacerbation of the secondary disease passes with the manifestation of rashes on the skin and mucous membranes, which turn pale and disappear on their own. In other cases, the rashes become wet, merge into ulcers, which are very contagious to others.
Accompanied by damage to internal organs, signs of intoxication of the body develop, the patient suffers from the appearance of gum on the skin and organs, which leave behind visible scars.
With the development of the patient, paresis and paralysis of the limbs, memory problems, mood swings are disturbing. Such symptoms indicate damage to the brain and central nervous system by spirochetes.
The latent course of the disease can cause congenital syphilis in a child, since the mother does not know about her illness before conception. During gestation, immunity weakens and the infection escalates, infecting the baby in the womb.
Possible Complications
The atypical form of the disease, especially the secondary and tertiary stages, is dangerous for its complications. Due to the absence of symptoms, the patient does not go to the doctor for a long time, and spirochetes actively divide, affecting new tissues of the body. Lack of treatment leads to the following complications:
- The formation of gum.
- Syphilitic meningitis and dementia.
- Damage to internal organs.
- Violation of the reproductive function.
- Formation of fistulas in the genital area.
- Termination of pregnancy, stillbirth, fetal malformations.
Venereology successfully treats lues, but due to delayed therapy, there is a possibility of developing the following consequences:
- Deformities resulting from the formation of ulcers and gums.
- Fusion of the urethra.
- Inflammation of the genital organs and the formation of adhesions.
- Deformation of the genitals.
- Dementia that cannot be corrected.
- Irreversible disorders of the nervous system, paresis, paralysis.
The latent form of venereal pathology is especially dangerous. Therefore, patients who are sexually risky should be regularly tested for STDs.
A sexually transmitted disease during pregnancy is dangerous, both for the mother herself and for the child. The latent course leads to the formation of multiple deformities in the child. Most often, such a pregnancy ends in stillbirth, but if the fetus survives, then it is born with various developmental disorders, both physical and mental.
Varieties and classification
Latent syphilis is divided into early and late. The early form corresponds to the period of time from infection to the development of a recurrent secondary disease, lasts two years, there are no manifestations of the disease. But at any time, the infection recurs and rashes appear on the skin and mucous membranes.
It is possible to identify an early form of pathology only through laboratory tests, as well as when collecting an anamnesis. It is necessary to establish whether the patient communicated with someone who is a carrier of pale treponema and in what period of time this happened.
A late type of pathology is diagnosed if the infection has passed more than 2 years ago, it is not contagious to others. In the late form, damage to internal organs and the nervous system occurs, neurosyphilis develops. In severe cases, the membranes of the brain are affected.
There is also an unspecified type of venereal pathology. This diagnosis is established in the event that it is not possible to establish the period of infection.
Diagnosis of latent syphilis
The examination of the patient begins with the collection of anamnesis and examination for the presence of chancre, scars. Detailed information about unprotected intercourse, sores on the genitals and other symptoms that have passed on their own will help to establish the statute of limitations for the pathological process.
Necessarily carried out palpation of the lymph nodes, which helps to suspect lymphadenitis, inflammation of the lymph nodes. Palpation of the mucous membranes helps to detect seals or scars left from the chancre.
To identify the pathogen, laboratory tests and serological reactions are prescribed. But tests are often false negative, especially in patients treated with antibiotics. Therefore, the survey should be comprehensive, and combine the following studies:
- RW or RPR;
- RIBT;
- RPGA;
It is important to note that reactions to syphilis can also be false-positive against the background of other diseases, so it is imperative to carry out differential diagnosis with other diseases: liver damage, tuberculosis, rheumatism, chronic infections in the body.
False-positive serological reactions are also observed in patients who have recently completed treatment.
A late pathological process is diagnosed by puncture of the cerebrospinal fluid or cerebrospinal fluid. Neurosyphilis caused by spirochetes is the only neurological pathology in which there is a change in the composition of the CSF.
With the use of cerebrospinal fluid, serological reactions and biochemical analyzes are carried out. Small changes in the composition of the CSF will indicate the development of the primary or secondary stage of the pathological process.
Diagnosis is supplemented by consultation with other narrow specialists, except for a venereologist. Connected gastroenterology, neurology. Such an examination allows you to detect complications of the latent course of syphilis and eliminate them in time.
Latent syphilis is treated only with antibiotics. Prescribe drugs of the penicillin group. In the presence of allergies, they are replaced with macrolides, tetracyclines. Antibiotics of the cephalosporin group are also an alternative, but they cannot be used for penicillin intolerance due to the risk of developing a cross-reaction.
The goal of therapy for a latent form of pathology is to eliminate the infection and prevent the development of neurosyphilis, as well as damage to internal organs. The late appearance of STDs leads to a severe impairment of the patient's quality of life.
The treatment regimen is selected individually. A person must strictly follow the doctor's recommendations. It is strictly forbidden to prematurely stop taking antibiotics, as such actions lead to a hidden course of infection.
An example of a treatment regimen:
- Benzylpenicillin G 2.4 ml intramuscularly 1 injection for 6 days.
- For allergies, Tetracycline 500 mg 4 times a day, the course of treatment is a month.
If penicillin is ineffective in the advanced form of the pathology, a second course is prescribed ceftriaxone 1 gram per day intramuscularly for 14 days.
Immunocompromised patients are shown immunotherapy, for example, Timalin intramuscularly.