Secondary syphilis: symptoms

Manifestations of the secondary period of syphilis are characterized by an extraordinary variety of morphological elements, a predominant lesion of the skin, visible mucous membranes and to a lesser extent - changes in the internal organs, nervous system, musculoskeletal system. In this period there is generalization of syphilitic infection, reaching its highest development. Rashes on the skin and mucous membranes are called secondary syphilis. They have a number of common features:

• rashes are everywhere;
• after resolution, secondary syphilis does not leave a trace (with the exception of some forms of pustular and papular syphilis), ie, the good quality of the flow is noted;
• absence of febrile symptoms;
• absence of subjective sensations;
• absence of acute inflammatory phenomena;
• In all forms of secondary syphilis, positive serological reactions are noted;
• the rapid disappearance of syphilis under the influence of antisyphilitic treatment.

Separation of the secondary period of syphilis to fresh and relapsing is important in terms of choosing the amount of treatment and carrying out anti-epidemic measures. Secondary fresh syphilis is characterized by an abundance of rashes, small size of elements, brightness of color, absence of grouping of syphilis and their dispersion. Elements are large, small, pale in color, tend to group and form arcs, rings, shapes. The intervals between attacks of secondary syphilis, when rashes on the skin and mucous membranes are absent, are called secondary latent syphilis. Eruptions of the secondary period during the first half of the year are accompanied by a specific polyadenitis.

There are 5 groups of skin changes, its appendages and mucous membranes: spotted syphilis (syphilitic roseola); papular syphilis; pustular syphilis; syphilitic baldness; syphilitic leukoderma.

Syphilitic roseola. This form is the most common syphiloid of the secondary period. Syphilitic roseola morphologically represents a stain the size of a lentil to a fingernail of a little finger, irregularly rounded outlines, with a smooth surface, disappearing when pressed. Distinguish between fresh and recurrent roseola. Fresh roseola occurs immediately after the termination of the primary period, i.e. 6-8 pellets after the appearance of a solid chancre, and its full development usually reaches within 10 days. Roseous spots with fresh secondary syphilis are abundant, arranged irregularly, most often on the trunk (especially on its lateral surfaces) and on the limbs. In secondary recurrent syphilis, rose-olympic rash appears after 4-6 months (the first relapse of the secondary period of syphilis) or 1-3 years (the second or third relapse of the secondary period of syphilis).

In addition to the typical, the following varieties of syphilitic roseola are distinguished: edematous (urticarum), draining, recurrent (large but size) and annular (in the form of rings, arches).

Roseous spots are also found on the mucous membranes, most often located in the soft palate and tonsils. They are called erythematous syphilitic sore throat. Clinically, they manifest draining erythematous areas of dark red with a cyanotic shade, sharply delimited from the surrounding healthy mucous membrane. The defeat does not cause subjective sensations and is not accompanied by fever (with rare exception) and other common phenomena.

Papular syphilis. The main morphological element of the papular syphilide is the papule, sharply delimited from the surrounding healthy skin and protruding above its level. Papular syphilis is mainly observed in secondary relapse syphilis.

In practice, there are the following varieties of papular syphilis:

• lenticular (lenticular) syphilis, represented by a round, round papule, as large as lentil, cyanotic-red, densely-elastic consistency, with a smooth shiny surface. Over time, the papules become yellowish-brown in color, flattened, scant peeling occurs on the surface, first in the center, and then along the periphery in the form of a collar (Biette collar). This form of syphilis is more common in the secondary fresh syphilis;
• miliary syphylid, characterized by its small size (with poppy seed) and conical shape. The consistency of the element is dense, red or reddish-brown. It often manifests itself in weakened patients;
• nummular, or coin-like, characterized by a significant amount of papules (with a large coin and more), a tendency to group;
• ring-shaped, characterized by a ring-shaped arrangement of papules;
• seborrhoeic: papules are localized on seborrheal areas (face, head, edge of forehead) and are distinguished by fatty scales on their surface;
• erosive (wetting): papules are located on areas of the skin with increased humidity and sweating (genitals, perineums, axillary hollows, under the mammary glands in women) and are distinguished by a whitish macerated, erosive or wet surface. They are very contagious;
• Wide condylomas (vegetative papules), located in places of friction, physiological irritation (genitals, anus of the anus). They differ in large sizes, vegetation (overgrowth) and eroded surface. They are also very contagious;
• horny papules (syphilitic corns), which are characterized by a powerful development of the stratum corneum on the surface, are very similar to corns. They are often located on the soles;
• psoriasiform papules, often found in the secondary recurrent period of syphilis and characterized by pronounced desquamation on the surface, which is very similar to psoriasis.

Papular eruptions on the mucous membranes clinically correspond to erosive (wetting) papules. In the oral cavity, the erosive papular syphilis usually occupies the area of the soft palate and tonsils (syphilitic papular sinus). Papular eruptions on the mucous membrane of the larynx lead to hoarseness of the voice. Papules can not only erode, but also ulcerate. As a result of joining the secondary infection, soreness and a zone of hyperemia in the circumference of the papular elements are noted. Papules located in the corners of the mouth, often eroded and become painful (syphilitic zaeda).

Pustular syphilis is a rare manifestation of secondary syphilis. They are usually observed in a secondary relapse period in weakened patients with a severe (malignant) course of the process.

There are five varieties of pustular syphilis: - Acne: small conical pustules appear on a dense papular base, similar to simple eels. They quickly shrink into crusts, forming papule-cortical elements;

• impetiginous: superficial pustules formed in the center of the papules and rapidly shrinking into the crust, sometimes, merging, they form large plaques;
• ospennovididy: differs spherical pustules the size of a pea, the center of which quickly withers into the crust. Pustules are located on a dense base, which resembles an element when smallpox;
• syphilitic ecthima: represents a deep round pustule, which quickly withers into a thick crust, with the rejection of which there is an ulcer with steeply cut edges and a peripheral ridge of a specific inflorescence of purplish-cyanotic color. Ectims are usually single, they leave a scar;
• syphilitic rupee is an ectmoid-like element that results from the eccentric growth of the infiltrate and its subsequent suppuration. In this case, conical, layered superficial crusts are formed. Usually single, heal, leaving a scar.

Pustule-ulcer syphilis can rarely be located on mucous membranes. With the localization of tonsils and a soft sky, the process looks like a pustular-ulcerative sore throat.

Syphilitic baldness is usually observed with secondary recurrent syphilis. There are two clinical varieties of syphilitic baldness - diffuse and small-focal. When combined in the same patient, they speak of a mixed form.

Hair loss in syphilis is associated with the development of a specific infiltrate in the hair follicle, which leads to trophic disturbances. On the other hand, pale spirochetes in the infiltrate can have a toxic effect on the hair follicles.

Diffuse syphilitic baldness in the clinical plan does not differ from alopecia of other etiology. The scalp is affected by the scalp. Attention is drawn to the acute onset and rapid course of the process, sometimes on the head or pubic the amount of hair left is counted in units.

With a small-fruited species, multiple small foci of alopecia of irregularly rounded outlines appear randomly scattered over the head (especially in the region of the temples and occiput). This clinical picture is compared with "fur, eaten moth". A distinctive feature of such alopecia is that the hair in the lesions do not fall out completely, there is a sharp thinning of the hair. The skin in the foci of alopecia is not inflamed, it does not peel and the follicular apparatus is fully preserved.

The defeat of the eyebrows and eyelashes is characterized by their gradual loss and successive growth. As a result, they have different lengths - "step-like" eyelashes (a symptom of Pinkus). Syphilitic alopecia exists for several months, after which a complete restoration of the hair cover takes place.

Syphilitic leukoderma (pigment syphilide) is characteristic of secondary recurrent syphilis and is more common in women. Leukoderma mainly appears in patients with cerebral pathology. Elements are often located on the lateral and posterior surfaces of the neck (the "necklace of Venus"), but can be found on the chest, shoulder girdle, back, abdomen, lower back. In the affected areas, initially gradually increasing diffuse hyperpigmentation appears, in due course hypopigmented round spots are noted on its background. Syphilitic leukoderma can be spotted, laced or mixed.

One of the frequent symptoms of secondary syphilis is polyadenitis.

In the secondary period, internal organs (gastritis, nephrozonephritis, myocarditis, hepatitis), the nervous system (early neurosyphilis) and the musculoskeletal system (polyarthritis synovitis, diffuse periostitis, painful swelling with a testicle consistency and nocturnal pains in the bones) may be involved in the pathological process. .

[1], [2], [3]