Syphilitic rash

The second stage of syphilis, a dangerous sexually transmitted disease, is the syphilitic rash. It is a typical reddish-pinkish skin rash that usually does not spread over the whole body, but appears locally.

Syphilitic rash is temporary and usually disappears after a couple of months. In general, this symptom is quite insidious, because it is often mistaken for a common allergy and, accordingly, is incorrectly treated. That is why you should in any case contact doctors - to determine the exact type and origin of the rash. [1]

Epidemiology

The incidence of syphilis is characterized by structural heterogeneity. In general, there is a downward trend in the incidence of the disease, but the epidemiological situation is still unfavorable, both among adult patients and minor children.

The global infection rate is still considered to be quite high. According to statistics for the year 2000, about 250 million people on the planet had sexually transmitted infections. At the same time, about 2 million patients are diagnosed with syphilis every year.

By 2015, the syphilis incidence rate had slightly decreased to 2-3 per hundred thousand people. However, there was a pronounced "rejuvenation" of the diseased contingent - for example, syphilis is registered about 4.5 times more often among young people than among middle-aged and older people.

At the end of the last century, the epidemiologic statistics of syphilitic morbidity in the post-Soviet countries were equated with negative statistics. For example, according to 1997 data, its level was 277 cases per hundred thousand population. The measures taken made it possible to reduce this indicator, and by 2011 it was about 30 cases per hundred thousand.

Syphilis is most often seen in young people between 20 and 29 years of age. Men and women get the disease at about the same rate.

Causes of the syphilitic rash

Syphilitic rash occurs under the influence of the corresponding pathogen - pale spirochete, which received its "name" because of the indistinct, pale color after treatment with special dyes. Pathogenic microorganism has been known to science since 1905: it is able to develop only in the absence of air, and in the external environment quickly enough dies. Cold allows the spirochete to survive a little longer than in a warm environment.

To date, medicine has information about three varieties of syphilitic pathogen:

• Treponema pallidum - causes the classic form of syphilis;
• Treponema pallidum endemicum - causes an endemic form of syphilis;
• Treponema pallidum pertenue - causes tropical granuloma.

The causative agent is detected and identified through laboratory analysis of material taken from the diseased person.

Specialists talk about several possible ways of transmission. However, some of them are common, while others are extremely rare (but still possible):

• In sexual transmission, infection is associated with unprotected sexual intercourse;
• In the household route, the infection enters the body through common items;
• The transplacental route infects the fetus from the expectant mother through the circulatory system.

Most patients have a sexual route of infection, but household infection is the least common. This is most likely due to the fact that the infection dies quickly enough outside the body.

There are known cases of transplacental infection, which occurs when a pregnant woman has syphilis. Often such infection becomes a factor in the development of congenital form of the disease in the baby, or the fetus dies in the first trimester of pregnancy. [2]

Risk factors

Specialists note that the identification of possible risk factors helps to develop preventive measures suitable for a specific target group. One of the underlying causes is considered by health professionals to be the dangerous, risky sexual behavior of young people. However, there are also a number of factors that are closely linked to this cause. These are social and economic aspects that affect a large part of the population:

• financial difficulties;
• unfavorable microsociety, decline in moral and ethical values;
• Increased interest in alcohol and drugs;
• promiscuous sexual life with frequent change of partners, casual sexual contacts with unfamiliar people.

Among young people, the following factors are considered particularly significant:

• early sexual activity;
• family problems;
• Early use of alcohol, drugs, or other psychoactive drugs;
• Neglect of barrier contraceptive methods;
• Lack of information on prevention of sexually transmitted infections.

People with no fixed abode, as well as people who use drugs or psychoactive substances have an increased risk of morbidity. The latter cause disinhibition, inability to morally control their own actions.

There are also some peculiarities of factors concerning socially adapted groups. Seemingly prosperous people often neglect their own health: according to statistics, every second urogynecology patient does not hurry to seek medical help. A visit to the doctor follows approximately within two months of the first sign, so treatment becomes somewhat longer and more problematic.

Pathogenesis

The pathogenetic moments associated with the appearance of syphilitic rash are explained by the body's response to the introduction of pale treponema. Polymorphic processes closely related to the stage of syphilis occur in the infected organism.

The classical form of the disease is divided into such periods as incubation, primary, secondary (which is characterized by syphilitic rash) and tertiary.

Incubation in syphilis lasts about 3 to 4 weeks, but this period can be shortened to 1.5 to 2 weeks or lengthened to 3 to 6 months. A short term of incubation is sometimes seen with infection from multiple sources of disease. A prolonged term may occur if the patient has been receiving antibiotic therapy for some other pathology (e.g. Maxillary sinusitis or bronchitis, etc.).

Next, a hard chancre appears, which signifies the beginning of primary syphilis. How long before the syphilitic rash appears? Its appearance is associated with the onset of secondary syphilis, which most often occurs six or seven weeks after the appearance of the chancre, or 2.5 months after infection. The appearance of characteristic rashes is associated with hematogenous spread of the virus and systemic damage to the body. In addition to the rash, other organs and systems are affected during this period, including the nervous and bone systems, kidneys, liver, and others.

The roseo-papular-pustular rash is largely due to the immune response of the body. After some time it disappears, and the pathology acquires a latent course - until the next relapse or until the development of the tertiary form of syphilis.

Symptoms of the syphilitic rash

The clinical picture of secondary syphilis is mainly represented by rashes on the skin and mucous membranes. Syphilitic rash is diverse in its clinical manifestation: it can be spots, papules, vesicles, pustules, which can occur on almost any area of the skin.

What does a syphilitic rash look like? The fact is that all secondary syphilides are characterized by such distinctive signs:

• Specific color. Only at the initial stage of development, the syphilitic rash is characterized by a bright pink color. After time, it becomes brownish-pale, reddish-cherry or copper, red-yellow, bluish-red, pale pink, which largely depends on the localization.
• Limitation. The elements of the syphilitic rash are not particularly characterized by peripheral growth. They do not merge with each other and appear limited.
• Diversity. Often different variants of the syphilitic rash can be observed at the same time - for example, spots, papules and pustules coexist together. In addition, the diversity of rashes is complemented by the presence of elements that go through different stages of development.
• Benignity. In most cases, there is resolution of secondary elements without subsequent persistent marks or scarring. Does the syphilitic rash itch? No. The presence of syphilitic rash is not complicated by general pathologic symptoms and is not accompanied by itching or burning sensations characteristic of other dermatopathologies.
• Absence of an acute inflammatory process. The areas affected by the syphilitic rash show no signs of inflammation.
• High infectiousness. The presence of a rash indicates a high degree of human infectiousness, especially when erosions and ulcers are present.

The first signs of syphilitic rash are not always visible: in some patients, the disease has a latent or subtle course. It is not uncommon for the skin rash to be vague, but lymph node enlargement and/or fever are present.

Syphilitic rash on the face somewhat resembles acne, and nodular "blackheads" or spots may be seen on the trunk. The palm and plantar surfaces are usually covered with reddish-copper-colored spots.

The elements of the rash appear singly, without tendency to unite, without flaking or itching sensations. They disappear without medication about a few weeks after their appearance, but then reappear with a new outbreak.

Syphilitic rashes on the body in areas of regular friction and sweating are particularly prone to spreading and ulceration. These areas include the genitals and perineum, axillae, toe area, neck, and the area under the breasts.

When mucous tissues are affected, the rash is found on the soft palate, tonsils, genitalia: here the elements are not always isolated and are sometimes combined into solid islands. Rashes in the ligaments and larynx often cause vocal disturbances, hoarseness or hoarseness. Small ulcers may appear in the mouth and hard-to-heal "sores" may appear at the corners of the lips.

Small focal hair loss on the scalp, eyelashes and eyebrows is possible: this symptom is registered in every seventh case of the disease. The affected areas have the appearance of "fur, which ate a moth": there are no signs of inflammation, itching and peeling. Since the eyelashes alternately fall out and grow back, a closer look will reveal their different lengths. [3]

Syphilitic rash in men

Signs of syphilitic rash in men are not very different from those in female patients. Rashes are more often pale, located in symmetry. Other characteristic signs are as follows:

• The elements of the rash are not painful, itchy, and hardly bothersome;
• have a dense surface, clear boundaries, without mutual fusion;
• tend to heal on their own (no scarring remains).

Sometimes additional symptomatology is also observed:

• pain in the head;
• lymphadenopathy;
• subfebrile fever;
• joint pain, muscle pain;
• Hair loss (focal or diffuse);
• change of voice;
• Extensive condylomas in the genital and anus area.

In the secondary relapse period, a typical syphilitic nodular rash is found on the head of the penis, in the perineum and anus, and in the axillae. Appearing nodules increase, begin to get wet, forming wounds. If there is friction, such elements merge and grow like a cauliflower. There is no pain, but overgrowths can cause considerable physical discomfort - for example, interfere with walking. Due to the accumulation of bacteria, there is an unpleasant odor.

Syphilitic rash in women

A characteristic feature of the syphilitic rash in women is the appearance of areas of "discoloration" or leucoderma on the side of the neck. This symptom is called "lace" or "Venus' necklace" and indicates that there is damage to the nervous system and abnormalities in skin pigmentation. In some patients, discolored areas are found in the back, lower back, arms and legs. The spots do not peel, do not hurt, there are no signs of inflammation.

Every woman who is planning a pregnancy, or who is pregnant, should definitely be tested for syphilis. Pale Treponema is able to penetrate into the fetus, which will lead to the development of extremely unfavorable consequences. Thus, in patients with syphilis in 25% there is stillbirth, in 30% of cases, the newborn baby dies immediately after birth. Sometimes infected children are born without signs of pathology. Nevertheless, if the necessary treatment is not carried out, the symptoms may appear within a few weeks. If untreated, babies either die or are severely underweight and underdeveloped.

Stages

The first stage of the syphilitic rash starts about a month after the spirochete has entered the body. At this stage, the first suspicious signs of rashes can already be seen: pinkish small spots, which after a while take on the appearance of ulcers. After two weeks, the spots disappear to reappear. This rash may appear and disappear periodically over several years.

The second stage is characterized by bumpy syphilitic rashes of pinkish color, bluish-burgundy pustules. This stage may last 3-4 years.

The third stage is characterized by syphilitic rashes in the form of lumpy subcutaneous seals. The foci form ring-shaped elements with ulcers inside. The areas of density have a diameter of up to 20 mm and are characterized by a brownish color. An ulcer is also present in the center of the element.

If we consider the disease as a whole, syphilitic rash is a symptom of secondary syphilis.

Forms

Syphilitic rash is a typical symptom of the secondary form of syphilis, represented by different types of rashes. The most common rashes are spots (also called roseolae) or small nodules (papules).

Most often, patients have rosacea, which are small roundish-oval spots with jagged borders. The color varies from pinkish to bright crimson (even within the same organism). If the spot is pressed, it temporarily disappears.

The spots are located separately, not united with each other. There is no desquamation, skin density and relief are not changed. The diametric size of the roseolae varies from 2 to 15 mm. Predominant localization: back, chest, abdomen, sometimes - forehead. If the pathology is not treated, the spots disappear after about three weeks.

Recurrent rosaceous rashes in the form of reddish-blue patches may appear within six to three years of infection. In many patients, such a rash is found in the oral cavity, on the tonsils, sometimes may resemble tonsillitis - however, there is no sore throat or fever. If the elements affect the vocal cords, there may be a hoarseness in the voice.

Papules are formed as a result of an inflammatory reaction in the upper skin layers. They have the appearance of dense individual tubercles with clear outlines. Their shape can be hemispherical or cone-shaped.

Papules are also limited from each other, but their fusion is possible, for example, against the background of constant friction with elements of clothing or skin folds. If this happens, then the central part of the "fusion" as if resorbed, so the pathological elements look flashy and diverse. From above, the rash is glossy, pinkish or reddish-blue in color. After resolution, the papules are covered with scales, can ulcerate, forming extensive condylomas. The most common localization of papules: back, forehead, perioral area, occiput. They are never found on the outside of the hand.

The papular syphilitic rash, in turn, is divided into such varieties:

• Lenticular rash may appear both at the beginning of the secondary form of the disease and during relapses. Elements of the rash have the form of nodules with a diametric size of up to five millimeters. The surface is flattened, smooth, with the gradual appearance of desquamation. At the initial stage of the disease, these rashes often occur in the forehead.
• Miliary rash is localized in the mouths of hair follicles and has the appearance of nodules with sizes up to two millimeters. The elements are rounded, compacted, the color is pale pinkish. Can occur anywhere where hair growth is present.
• Coin-shaped papules occur during a recurrence of syphilis. It is a hemispherical induration with a diametric size of about 25 millimeters, reddish-blue or brownish in color. Papules are usually few, can be present in groups, combined with other pathologic elements.

The syphilitic rash on the palms of the hands and feet looks like brownish, yellowish spots with clearly defined outlines. Sometimes these rashes resemble calluses.

Complications and consequences

The period of the disease in which multiple syphilitic rashes begin to appear on different parts of the body and on mucous tissues is called secondary syphilis. This stage is quite dangerous and, if the disease is not stopped, it can develop extremely negative and irreversible consequences.

From the moment the rash appears, a gradual affection of all systems and organs in the body begins.

In the absence of treatment, the secondary form of syphilis can last about 2-5 years, and the pathological process can spread to the brain, affecting the nervous system. Thus, neurosyphilis, ocular syphilis often develops. Signs of neurosyphilis are usually as follows:

• severe pain in the head;
• muscle coordination problems;
• loss of the ability to move the limbs (paralysis, paresthesias);
• mental disorders.

When the eyes are affected, a person may lose their vision completely.

In turn, late neurosyphilis and visceral syphilis can become complicated:

• with skeletal muscle damage;
• decreased intelligence, memory impairment, dementia;
• meningitis;
• with membranous glomerulonephritis;
• an ugly change in appearance;
• severe cardiovascular damage.

People who have been infected with syphilis are not protected against the possibility of re-infection - no specific immunity is developed. Therefore, care must be taken when choosing a sexual partner. Since painful elements can have a hidden localization - for example, inside the vagina, rectum, mouth, without the results of laboratory tests can not be 100% sure of the absence of infection.

Diagnostics of the syphilitic rash

To make a diagnosis and further differential diagnosis, laboratory tests are considered basic. But first the doctor will perform other diagnostic measures, for example:

• collecting anamnestic data about the patient, studying the history of the disease help to determine the most likely cause of the disease;
• A thorough physical examination involves a general assessment of the skin and mucous membranes.

The patient must be interviewed. The doctor needs to know when and under what circumstances the first signs of syphilitic rash appeared and whether there were other suspicious symptoms.

How to recognize a syphilitic rash? Externally, it is possible to determine the disease, but not always. In most patients, the diagnosis of syphilis is established after taking a blood test. Some patients are examined with secretions taken from ulcerated formations.

Tests that confirm or refute the presence of syphilitic infection may be as follows:

• Nontreponemal tests are based on the detection of antibodies produced by the body as a reaction to the lipid substances that make up the treponema envelope. Antibodies most often appear in the blood about a week and a half after the formation of the chancre. This is a screening test, which is not time-consuming or resource-intensive, but it is not confirmatory: it only indicates the need for further diagnosis. It can also be used to confirm the success of treatment measures.
• Treponemal tests are similar to the above, but the antigen in this case is a treponema. The method is more expensive, requires some time and can be used to confirm the diagnosis.
• ELISA is an enzyme-linked immunosorbent assay that is based on antigen-antibody complex formation. When antibodies are present in the serum, a complex is formed. For the analysis, specific labeling is used to determine the antibody population.
• Immunofluorescence is a technique based on the ability of a microorganism to be secreted if antibodies are present in the blood.
• Immunoblotting is a highly accurate modern method used for diagnosis. Thanks to this diagnosis, both the presence and type of antibodies are determined, which helps to clarify the stage of the disease. Immunoblotting is especially recommended for asymptomatic syphilis.
• The serologic reaction method is one of the most common tests. It is used for prophylactic purposes, for diagnosis at any stage of the syphilitic rash, for confirmation of recovery, for treatment monitoring, etc. The test is based on the antigenic structure of the pathogen. The test is based on the antigenic structure of the pathogen.
• The Wassermann reaction with complement binding is a standard serologic test that is more than a hundred years old. The results depend on the stage of syphilitic rash: at the stage of syphilitic rash, the results are most plausible. Initial and tertiary stages often give questionable results.
• Immune adhesion test - based on the interaction between the causative agent and human serum. If the patient has syphilis, the treponeme receptor system is adsorbed on the erythrocyte surface. A typical, easily identifiable suspension is formed. The method is complex and not always truthful.
• Hemagglutination reaction - only possible if antibodies have been developed. The test is highly accurate and sensitive, so it is widely used.
• PCR is a polymerase chain reaction technique based on the detection of nucleic acid particles of a microorganism. It is one of the variants of molecular genetic research.

Laboratory determination of the disease is quite complex. Only the treating doctor interprets the results.

Instrumental diagnostics is prescribed to assess the state of internal organs and the central nervous system, to determine complications.

In principle, it is not difficult to distinguish syphilitic rash from other skin pathologies: rashes do not cause some discomfort, as there is no burning, itching, no peeling and inflammatory signs. The main elements of the rash are characterized by roundness, even outlines, and their structure is prone to polymorphism. If you press on the spot, it becomes lighter, but then again becomes reddish-pinkish. Within a day, about a dozen new elements can be formed. They do not protrude above the skin surface, have no structural differences, but do not tend to merge. [4]

Differential diagnosis

Differential diagnosis is carried out if there are doubts in the initial diagnosis. The disease is distinguished from such similar pathologies:

• toxic form of dermatitis (rash tends to merge, itching is present);
• Pink lichen (symmetrical spots that appear after the primary, maternal plaque);
• Allergic reaction (traditional allergic rash, itching and flaking);
• flea bites, lice bites, et cetera;
• rubella (the rash covers the whole body, including the face and neck, and disappears after three days);
• Measles (spots tend to merge, unequal in diameter, accompanied by respiratory and intoxication signs);
• typhus (characteristic sign - when smearing the rash with iodine solution, its darkening is observed).

Treatment of the syphilitic rash

Treatment for syphilitic rash involves general therapy of the underlying pathology - syphilis. This disease is curable at almost all stages - although, in severe cases, there may still be negative consequences of the disease. The choice of drugs is always individual and depends on the stage and severity of the pathology, the presence of complications. The main drugs are antibiotics:

• Macrolides (Erythromycin, Midekamycin);
• Tetracyclines (Tetracycline);
• Streptomycin, Ciprofloxacin;
• fluoroquinolones (Ofloxacin);
• Azithromycin.

In complicated cases, treatment may continue for several years, with repeated courses of antibiotic therapy and periodic monitoring of the dynamics of cure. When the nervous system is affected, antibiotics alone are no longer sufficient: drugs containing bismuth or arsenic are prescribed, such as Myarsenol, Biyoquinol, Novarsenol.

If syphilitic rash is detected in a pregnant patient, she is given two therapeutic courses - inpatient and outpatient. In general, such treatment takes 5-6 months and includes intramuscular administration of penicillin antibiotics - in particular, Oxacillin, Bicillin, Ampicillin, Doxacillin. The regimen also includes the administration of antihistamines.

In addition to antibiotic therapy, patients are prescribed multivitamin complexes, biostimulants, immunomodulating drugs, ultraviolet irradiation procedures.

Pyrogenal, Prodigiosan are used to stimulate blood and lymph flow. If syphilitic rash is complicated by ulcers, treatment with Benzylpenicillin solution with Dimexid, Acetamin ointment is performed. To treat mucous membranes use Furacilin, Gramicidin, boric acid. Men treat the penis with such means as Sulema, and the urethra is lubricated with preparations Protargol, Gibitan. Women make spritzings with solutions of potassium permanganate, the external genitals are treated with Sulema. [5]

Medications and treatment regimens for syphilitic rash

Outpatient therapy is most often accompanied by the use of these treatment regimens:

1. Retarpene or Extencillin 2.4 mln IU in/m once a week. Duration of treatment is 4 weeks (four injections). Or Bicillin-1 2.4 million IU/m once every five days. The course will require 5 injections.
2. Bicillin-3 at 2.4 million units or Bicillin-5 at 1.5 million units intramuscularly, twice a week. The number of injections is 10-12.
3. Penicillin novocaine salt 600 thousand U/m twice a day, or Penicillin procaine v/m once a day 1.2 million U, for 20-28 days, which depends on the duration of the infectious disease.

Inpatient treatment may be represented by the following antibiotic therapy regimens:

1. Benzylpenicillin sodium salt 1 mln U/m 4 times a day with an interval of 6 hours, for 20-28 days.
2. Benzylpenicillin sodium salt 1 million units 4 times a day intramuscularly for 7-10 days with further appointment of outpatient therapy Retarpen or Extencillin 2.4 million units (two injections with a weekly interval).

Half an hour before the first antibiotic injection, the patient is administered an antihistamine - for example, Diazolin, Dimedrol, Suprastin, etc.

Treatment is not carried out with all antibiotics at once: the doctor individually selects those drugs that are best suited to the patient, taking into account their tolerance and effectiveness. Syphilis patients with allergic processes such as bronchial asthma, hay fever, etc. Require a special approach to treatment.

Bicillin is not administered to people suffering from hypertension, diseases of digestive or endocrine system, hematopoietic organs, as well as tuberculosis and myocardial infarction. Weakened patients, elderly people from 55 years of age and children are not administered a single dose exceeding 1.2 million units.

A third-generation cephalosporin, Ceftriaxone, is often the standby drug for the treatment of syphilitic rash. Its mechanism of action is similar to Penicillin: it disrupts the synthesis of the cell wall of the pathogenic microorganism.

In the treatment of syphilis, injectable medications are commonly used. Tablets (antibiotics) are rarely prescribed, primarily because of their lower efficacy. [6]

Prevention

Prevention of syphilitic rash is generally the same as for syphilis or other venereal pathologies. It consists in monitoring the health status of patients after cure, registering all detected cases of the disease. After the course of syphilis therapy, patients are placed on dispensary registration in a polyclinic institution: each stage of the disease implies a different accounting term, which is clearly defined and labeled in the medical rules. To prevent further spread of the infectious agent, all sexual relations of the patient are taken into account. It is obligatory to carry out preventive treatment of those who were in close contact with a sick person. During the therapeutic course, all patients are forbidden to be sexually active and to donate blood.

When a syphilitic case is detected, the doctor prescribes treatment for both the patient and his sexual partner, regardless of the presence of a rash or other signs of syphilis. The reason for this is that the pathogenic agent remains in the partner's body, which can lead to a recurrence of infection - even if the infection is latent.

Individual prevention methods involve the use of barrier methods of contraception during all sexual intercourse. A stable sexual life with one constant partner is encouraged.

If any suspicious symptoms appear in either partner, you should immediately visit a doctor for diagnosis, without waiting for the appearance of obvious signs of the disease - in particular, syphilitic rash. Early diagnosis and treatment is the key to successful and rapid cure, without the development of adverse health consequences.

Forecast

The prognosis of the disease directly depends on the stage at which treatment was started. An important role is when the patient sought medical help, how clearly he followed the doctor's instructions. If the syphilitic rash is diagnosed immediately after its appearance, when the infection has not yet had time to significantly damage the body and has not caused irreversible damage - in particular, in relation to the central nervous system - then you can expect a favorable outcome from the treatment.

Complex therapy with the use of modern antibacterial drugs and techniques, almost for all patients ends with full recovery, with laboratory confirmation of cure and prevention of late recurrences of the disease.

If the syphilitic rash was detected in a woman during pregnancy, the prognosis may be complicated depending on the gestational age and the intrauterine condition of the future child. If the pathology was detected in the first trimester, and the treatment was urgent and competent, the patient has every chance to bear and give birth to a healthy baby. If the infant is diagnosed with a congenital form of the disease, then a positive prognosis can be said only if adequate antisyphilitic therapy is prescribed under strict medical supervision.

Late stages of syphilis are more difficult to treat, as it is often possible only to suspend the disease process, without the possibility of restoring the condition and function of the affected organs.

The prognosis in this situation is comparable to any stepwise pathology: early diagnosis of the disease implies faster, easier treatment. Neglected cases are difficult to cure, with an increased likelihood of the development of unfavorable consequences. Secondary syphilis is the stage at which the syphilitic rash occurs - at this stage, the vast majority of patients manage to completely eliminate the disease.