Pharynx syphilis

If in the first half of the XX century. Syphilis of the pharynx was extremely rare, in the last decade of the last century and at the beginning of the 21st century. The number of this localization of syphilis is steadily increasing, as is the total number of genital forms of this venereal disease.

Due to the large morphological diversity of tissues that make up the throat, its lesions with syphilis differ by a number of features that are not inherent in other localization of this disease. In addition, many saprophytes and conditionally pathogenic species of microorganisms are vegetating in the mouth and pharynx, which significantly modify the classical picture of syphilis and often serve as sources of secondary infection. It should also be pointed to the fact that both primary and secondary manifestations of syphilis have a special tropism to the lymphadenoid formations of the pharynx, in particular to the palatine tonsils.

[1], [2], [3], [4], [5], [6],

The cause of syphilis of the pharynx

The causative agent of syphilis is the pale treponema, which has the form of a thin spiral filament with a length of 4 to 14 microns with fine uniform curls. Infection occurs with close contact of a healthy person with a patient who has at the time of contact one or another infectious form of syphilis. The most contagious are patients in the primary and secondary periods of syphilis. The manifestations of the late (tertiary) period are almost not contagious because of the small number of treponemes in the lesions.

The primary period of syphilis is characterized by the onset of primary chancre, which is primarily localized in the palatine tonsils, then in the soft palate and palatine arch. In rare cases, it may occur in the area of the nasopharyngeal opening of the auditory tube as an infection brought on by catheterization; in extremely rare cases with syphilis of the pharynx, one can find a primary chancre in two different places of the pharynx. Often, the primary chancre remains unnoticed against the background of a secondary infection. The most frequent infection with syphilis of the pharynx occurs with kisses and oral sex. Infection through an infected object (a glass, a spoon, a toothbrush, etc.) occurs extremely rarely, if at all this way of transmission of infection is possible. In addition to the sexual and domestic way of infection with syphilis, in rare cases a transfusion path is observed when the infection is transmitted by transfusion of contaminated blood.

Hard chancre occurs in the primary period of syphilis 3-4 weeks after infection at the site of the introduction of pale treponema with the simultaneous appearance of regional lymphadenitis. Hard chancre, or primary syphilloma, is a small, painless erosion (0.5-1 cm) or a round or oval ulcer, with even margins and a dense infiltrate at the base, with a smooth shiny surface of red color. Inflammatory phenomena in its circumference are absent. When you feel from both sides of the edges of the ulcer under the fingers, a cartilaginous density is felt, which is typical of the primary syphilidae. However, in the throat, the manifestations of primary syphilis have characteristics and can manifest themselves in different clinical forms.

Throat lesions with congenital syphilis

There are early and late manifestations.

Early signs appear no later than 5-6 months after the birth of the child and are similar to those pathomorphological elements that arise in the secondary period of acquired syphilis. In addition, the newborn has a persistent syphilitic rhinitis, a pseudomembranous lesion of the mucous membrane, pharynx, simulating diphtheria, skin stigmata resembling the pemphigus of the palmar and plantar surfaces with lamellar desquamation of the epidermis, deep cracks in the region of the lips, which subsequently transform into the characteristic for congenital syphilis radial scars in the corners of the mouth, and other signs of congenital syphilis.

Late symptoms appear in adolescence or adolescence. They are manifested by signs characteristic of pharyngeal lesions of tertiary syphilis, which are associated with congenital syphilitic lesions of the nose, ear, teeth, eyes, internal organon, and various functional impairments of the sense organs and movements.

Symptoms of pharynx syphilis

Anginous form manifests itself in the form of acute unilateral prolonged tonsillitis with a rise in body temperature to 38 ° C and moderate pain in the pharynx during swallowing. The amygdala is sharply hyperemic and enlarged. The primary chancre, as a rule, is hidden behind a triangular fold or in a padmindalic fossa. At the same time, regional lymphadenitis develops.

Erosive form is characterized by the appearance on one of the tonsils of surface erosion with cylindrical rounded edges, covered with gray exudate. When palpation creates a specific for primary syphilitic affect sensation cartilaginous density of the bottom of erosion.

The ulcer form is manifested by the appearance on the surface of the palatine tonsils of a round ulcer whose bottom is covered with a false gray film (syphilitic diphtheria). This form is characterized by a rise in body temperature up to 38 ° C and higher, expressed by dysphagia, spontaneous and when swallowed by pain in the throat, unilateral, respectively, the side of otalgia, contracture of the temporomandibular joint, drooling. According to manifestations this form is very similar to a peritonsillar abscess.

The pseudophlegonous form resembles the clinical course of peritonsillar phlegmon, and this is often misleading the ENT doctor. Diagnostic puncture of the prospective phlegmon or a trial autopsy of the result does not bring, the body temperature continues to hold at a high level (39-40 ° C), subjective and unilateral objective signs of "phlegmon" increase, and then resort to massive doses of penicillin, which, of course, with syphilis rapidly improves the general condition of the patient and leads to a visible normalization of the inflammatory process in the pharynx. In fact, in this case, if it's a syphilitic infection, it's just an apparent recovery, while a specific process continues.

Gangrenous form occurs with superinfection with fusospiral microbiota. In this case granular growths (very rare) or gangrene of the amygdala appear on the surface of the amygdala: the patient's condition deteriorates sharply, signs of a general septic condition appear, the body temperature reaches 39-40.5 ° C, there are chills, profuse sweat, tonsil and surrounding it tissues undergo gangrenous decomposition, caused by symbiosis of anaerobes with conditionally pathogenic aerobes and pale treponema. The peculiarity of the syphilitic chancre of pharyngeal localization is its prolonged course and the absence of the effect of any symptomatic treatment. After 4-6 weeks, the primary chancre of palatine tonsils undergoes scarring, but the syphilitic process continues for many months in the form of scattered throughout the mucosa, roseol and generalized adenopathy.

All the above pharyngeal manifestations of primary syphilis are accompanied by a characteristic one-sided regional lymphadenitis: a sharp increase in one lymph node with many smaller nodes in its circumference, absence of periadenitis, increased, density and painlessness of the nodes. In the process, all other lymph nodes of the neck are quickly involved, which will give the impression of infectious mononucleosis.

Diagnosis of pharynx syphilis

Diagnosis of pharynx syphilis is quick and easy, if from the very beginning the doctor suspected that the patient had a solid chancre. However, the polymorphism of syphilitic manifestations in the pharynx and the lack of experience in diagnosing syphilides ad oculus often lead to diagnostic errors in which such diagnoses as vulgar angina, diphtheritic angina, Vincent's angina, etc. Can occur. Hard chancroid can be confused with the chancroid-like Mouret amygdalite, tuberculosis ulcer and ennatelyoma amygdala and many other ulcerative and productive processes developing in the palatine tonsils. The most effective method of early diagnosis of syphilis in solid chancroid, wherever it occurs, is the electron microscopy of a pathological material to identify in situ pale trenoneema, which is especially important given that known serological reactions (for example, Wasserman) become positive only after 3 -4 weeks after the appearance of a solid chancre.

The secondary period of syphilis lasts 3-4 years and arises in the event that the primary period has gone unnoticed. There is generalization of the process with skin and mucous membrane damage in the form of characteristic rashes (syphilides: roseol, papules, pustules containing pale treponema), disturbance of the general state of the organism (malaise, weakness, subfebrile condition, headaches, etc.), changes in blood (leukocytosis , anemia, increased ESR, positive serological reactions); possible damage to internal organs and bones.

On the mucous membrane of the oral cavity, soft palate, tonsils and especially on the palatine arches against the background of a healthy mucous membrane there are sharply delimited erythematous and papular syphilis, while the posterior wall of the pharynx remains intact. They soon take on-white color due to swelling and maceration of the epithelium and resemble light burns of the mucous membrane that arise when it comes into contact with a concentrated solution of silver nitrate. Papules are surrounded by a bright red rim. In smokers or in persons with dental diseases (caries, periodontitis, chronic stomatitis, etc.) due to the presence of pathogenic microbiota in the oral cavity, the papules quickly ulcerate, become painful and can be transformed into condylomoid formations. Secondary syphilis of the mucous membrane of the upper respiratory tract and genital organs are extremely contagious.

In the secondary period of syphilis, the following forms of lesion of the pharynx are distinguished.

The erythematous-opalescent form of syphilitic pharyngitis is characterized by hyperemia of the mucous membrane of throat, palatine tonsils and the free edge of palatine arch and soft palate. Enanthema can have a bright diffuse character, as with scarlet fever, sometimes captures only individual sections of the mucous membrane or not at all expressed, causing only tenderness in the pharynx at night, without a temperature reaction. The emerging syphilitic enanthemum does not respond to any symptomatic treatment, as well as headaches not removed by analgesics.

The hypertrophic form touches the lymphoid apparatus of the pharynx and captures completely the entire lymphadenoid ring of the pharynx. The lingual and palatine tonsils are the most affected. The defeat of the lymphoid apparatus of the pharynx and larynx causes the occurrence of a cough indomitable by any means and leads to dysphonia (hoarseness of voice) and aphonia. At the same time, regional adenopathy with lesions of submaxillary, cervical, occipital and pre-tracheal lymph nodes develops. These pathological changes continue for a long time (in contrast to banal inflammatory processes) and do not yield to the usual therapeutic effects.

Diagnosis of pharynx syphilis in the secondary period, carried out only on the basis of an endoscopic picture, is not always an easy task, since a large number of diseases of the oral cavity and pharynx of a non-specific nature can compete in appearance with the same number of atypical oropharyngeal forms of the second syphilis period. To such diseases, from which it is necessary to differentiate the syphilitic lesions of the pharynx arising in the second period of syphilis, vulgar angina, angina of herpetic (viral) etiology, aphthous bufararingeal processes, some specific (non-linguistic) diseases of the tongue (tuberculosis, complicated forms of "geographical" language, malignant tumors and banal inflammatory reactions), aphthous stomatitis, leukoplakia, medicinal stomatitis, etc. An important diagnostic sign of syphilitic of lesions of the pharynx is a manifestation of the inflammatory response only at the edges of the palatine arches or soft palate. The main rule for diagnosis of syphilis is the conduct of serological reactions in all diseases of the mucous membrane of the oral cavity and pharynx, regardless of their seemingly "safe" appearance.

The tertiary period of syphilis develops 3-4 years later (occasionally in 10-25 years) in patients who have not received a full-fledged treatment during the course of the course of the course. This period is characterized by damage to the skin, mucous membrane, internal organs (visceral syphilis, most often manifested by syphilitic aortitis), bones, as well as the nervous system - neurosyphilis (syphilitic meningitis, dorsal, progressive paralysis, etc.). A typical morphological element for this period of syphilis is the appearance on the skin, mucosa and other tissues of dense small formations (tubercles) or large (gum), prone to decay and ulceration. The tertiary period of pharynx syphilis can occur in three clinical and pathomorphological forms: classical gummy, diffuse syphilitic, and early jazerno-serpeptiform.

The hummus form passes through 4 stages:

1. the stage of formation of dense, painless syphilis, palpation well differentiated and not soldered to surrounding tissues, the size of pea grain to nut fruit;
2. a stage of softening, during which for 2-3 weeks or several months in the center of the syphilide (gum) a necrosis zone is formed, creating a sense of fluctuation;
3. the stage of ulceration of gum and breakthrough of its contents outwards; the ulcer is a deep rounded cavity with steep margins, an uneven bottom covered with the remains of disintegrated tissues;
4. the stage of scarring through the formation of granulation tissue.

Gunma can be located on the back wall of the pharynx, on the palatine tonsils, on the soft sky, leaving behind a tissue defect.

The gum of the palatine curtain has the form of a hemisphere, it quickly ulcerates and leaves behind a rounded through perforation of the soft palate at the base of the tongue, often destroying it. In this case, there are open nasal and liquid food in the nose. The gumma of the hard palate develops more slowly and leads to the destruction of the palatine bones, leaving behind a wide course in the nasal cavity. The defeat of palatine tonsils leads to its total destruction with the seizure of surrounding tissues and subsequent significant cicatricial deformation of the pharynx. In the Tertiary, specific adenopathy is absent, but if regional lymphadenitis occurs, it indicates secondary infection of the affected areas of the pharynx.

Gumma of hard and soft palate is more common in the form of a diffuse diffuse infiltrate, less often in the form of a limited gummy tumor. The process of forming a gummy infiltrate begins imperceptibly and painlessly from thickening and consolidation of the soft palate, which loses mobility, becomes rigid and does not react with a typical movement when the sound "L" is pronounced. The infiltrate will acquire a cyanotic-red color and is clearly distinguished against the background of the remaining unmodified mucosa. In the future, the soft-palm gum rapidly disintegrates with the formation of deep, sharply outlined ulcers and perforations. The defeat of the bones of the hard palate occurs in the form of diffuse or limited syphilitic osteoperiostitis leading to necrosis and melting of bone tissue and perforation of the sky. Destructive changes in the soft and hard palate lead to a number of functional disorders, which include swallowing disorders, nasal openness and violation of the blocking function of the soft palate.

In the absence of timely treatment, there is a further destruction of the soft tissues and bone formations of the pharynx: total destruction of the bottom of the nasal cavity, palatine tonsils, palatine arches, the root of the tongue, etc. Capture by necrotic process of large vessels (for example, lingual artery, internal and external carotid, ascending palatine arteries , as well as the tonsillar artery) leads to nrofuznym, often fatal bleeding.

After healing of gum-ulcer lesions, dense scars and fusions are formed in different directions between the pharyngeal walls, yawn and soft sky, which often lead to pharyngeal stenosis or complete atresia, resulting in gross functional disorders that require plastic surgical procedures in the future. Scars after deep ulcers, formed on the back wall of the pharynx, have a characteristic stellate shape and are the cause of the development of severe atrophic pharyngitis. The fusion of the soft palate with the posterior wall of the pharynx leads to a partial or complete dissociation of the oropharynx with a nasopharynx, resulting in a disruption of nasal breathing, an act of swallowing, and dysphonia appears in the form of closed nasal congestion. The appearance of scars in the area of the nasopharyngeal opening of the auditory tube causes disturbances in its function and the corresponding hearing disorders.

Diffuse syphilomatous form is the most common form of the pharynx lesion in the tertiary period of syphilis. It is characterized by multiple lesions of the pharynx, which are in different stages of their development and subsequent multiple scar process. In the initial stage, this form can be taken for granulomatous hypertrophic pharyngitis or Isambert's disease, observed in patients with advanced forms of tuberculosis of the larynx. This form occurs with an increase in body temperature and regional lymphadenitis. A more extensive syphilitic ulcer can be taken for pharyngeal carcinoma, in which early metastasis to the cervical lymph nodes is observed.

The early form of pharyngeal syphilis (Syphylis tubero-ulcerosa serpiginosa) occurs very rarely and is characterized by the simultaneous appearance of syphilis characteristic of secondary and tertiary syphilis, with an extensive creeping shallow ulcer located mainly along the edge of the tongue and the soft palate.

All of the above forms of pharyngeal syphilis leave behind extensive cicatricial changes that entail pronounced functional abnormalities both with respect to the act of swallowing, and voice and speech formation.

[7], [8], [9], [10], [11],

Treatment of syphilis of the pharynx

Treatment of pharynx syphilis is carried out in conjunction with general specific treatment in the dermal-venereal department according to special procedures in accordance with the instructions approved by the Ministry of Health of Ukraine.

Prognosis for pharynx syphilis

The prognosis for fresh forms of syphilis and timely treatment for life is favorable, but its consequences for many vital functions, especially for the nervous system and internal organs, the lesions of which are directly determined by syphilitic infection, can lead to profound disability of patients and their premature death.