What is congenital syphilis and how does it affect babies. How common is congenital syphilis in the United States. Why should pregnant women get tested for syphilis. How can congenital syphilis be prevented and treated.

Understanding Congenital Syphilis: A Growing Concern

Congenital syphilis (CS) is a serious condition that occurs when a mother with syphilis passes the infection to her baby during pregnancy. This disease can have devastating consequences for the unborn child, ranging from miscarriage and stillbirth to severe health problems after birth.

The incidence of CS has risen alarmingly in recent years, with over 2,000 cases reported in 2021 alone – the highest number since 1994. This surge has raised significant concerns among public health professionals, highlighting the critical need for awareness and prevention strategies.

How does congenital syphilis impact babies?

The effects of CS on a baby’s health can vary depending on the duration of the mother’s infection and whether she received treatment. Some potential consequences include:

• Miscarriage or stillbirth
• Premature birth
• Low birth weight
• Neonatal death
• Bone deformities
• Severe anemia
• Enlarged liver and spleen
• Jaundice
• Neurological problems (blindness, deafness)
• Meningitis
• Skin rashes

It’s important to note that not all babies born with CS show immediate symptoms. Without treatment, however, they may develop serious health issues weeks, months, or even years after birth.

Syphilis Testing During Pregnancy: A Crucial Step

Given the potential severity of CS, all pregnant women should undergo syphilis testing at their first prenatal visit. This simple blood test can detect the presence of syphilis even in asymptomatic individuals.

When should pregnant women get tested for syphilis?

While initial testing should occur at the first prenatal appointment, some women may require additional screenings:

1. At the beginning of the third trimester
2. At the time of delivery

The frequency of testing may depend on factors such as local syphilis prevalence and individual risk factors. Women should discuss their specific needs with their healthcare provider.

Treatment Options for Syphilis During Pregnancy

Fortunately, syphilis can be effectively treated and cured with antibiotics, even during pregnancy. Prompt treatment is essential to reduce the risk of transmitting the infection to the baby.

How is syphilis treated in pregnant women?

The primary treatment for syphilis in pregnant women is penicillin. The specific regimen may vary based on the stage of the infection and individual factors. After treatment, follow-up testing is crucial to ensure its effectiveness.

Diagnosing and Treating Congenital Syphilis in Newborns

Diagnosing CS in newborns involves considering multiple factors, including maternal syphilis test results, treatment history, and the baby’s physical examination.

What tests are used to diagnose congenital syphilis in babies?

Diagnostic procedures for CS may include:

• Blood tests
• Physical examination
• Spinal tap
• X-rays

If CS is confirmed, treatment should begin immediately to prevent or mitigate potential health complications.

How is congenital syphilis treated in newborns?

Treatment for CS typically involves intravenous antibiotics administered in a hospital setting. The duration of treatment can range from a single injection to a 10-day course, depending on the severity of the infection and other factors. Follow-up care is essential to ensure the treatment’s success.

Preventing Congenital Syphilis: Strategies for Expectant Mothers

Preventing CS begins with protecting oneself from syphilis infection before and during pregnancy. Here are some key strategies:

• Practice safe sex
• Get regular STD screenings
• Ensure all sexual partners are tested and treated if necessary
• Attend all prenatal appointments
• Communicate openly with healthcare providers about sexual history and potential risks

By implementing these preventive measures, expectant mothers can significantly reduce the risk of CS and protect their unborn children.

The Role of Healthcare Providers in Combating Congenital Syphilis

Healthcare providers play a crucial role in the prevention and management of CS. Their responsibilities include:

• Offering routine syphilis screening to all pregnant women
• Providing timely and appropriate treatment for infected individuals
• Educating patients about syphilis and its potential consequences
• Conducting thorough evaluations of infants born to mothers with syphilis
• Ensuring proper follow-up care for both mothers and infants

By adhering to established guidelines and maintaining open communication with patients, healthcare providers can contribute significantly to reducing CS rates.

Public Health Initiatives to Address the Rising Congenital Syphilis Rates

The recent surge in CS cases has prompted various public health initiatives aimed at curbing this trend. These efforts include:

• Increased funding for STD prevention and control programs
• Enhanced surveillance and reporting systems
• Targeted outreach to high-risk populations
• Collaboration between healthcare providers, public health departments, and community organizations
• Development of educational materials and awareness campaigns

These initiatives seek to address the root causes of CS and improve overall maternal and infant health outcomes.

Are there any innovative approaches being developed to combat congenital syphilis?

Researchers and public health experts are exploring several innovative approaches to address the CS epidemic:

• Rapid point-of-care syphilis testing
• Integration of syphilis screening with other prenatal tests
• Mobile health technologies for patient education and follow-up
• Improved partner notification and treatment strategies
• Novel antibiotic formulations for more effective treatment

These advancements hold promise for enhancing CS prevention and management in the future.

Long-term Consequences of Congenital Syphilis: Beyond Infancy

While the immediate effects of CS are well-documented, it’s crucial to consider the potential long-term consequences for affected individuals. Children who survive CS may face ongoing health challenges throughout their lives.

What are the potential long-term effects of congenital syphilis?

Some possible long-term consequences of CS include:

• Developmental delays
• Cognitive impairments
• Hearing and vision problems
• Bone and teeth abnormalities
• Neurological disorders
• Learning disabilities
• Increased susceptibility to other infections

These long-term effects underscore the importance of prevention and early intervention in cases of CS.

The Global Perspective: Congenital Syphilis as a Worldwide Health Issue

While the recent surge in CS cases in the United States is alarming, it’s important to recognize that this is a global health concern. Many countries, particularly in low- and middle-income regions, continue to grapple with high rates of CS.

How does the prevalence of congenital syphilis vary across different regions?

The prevalence of CS varies significantly across different parts of the world:

• Sub-Saharan Africa: Highest rates globally, with some countries reporting over 1,000 cases per 100,000 live births
• Southeast Asia: Second-highest prevalence, with significant variations between countries
• Latin America and the Caribbean: Moderate to high rates, with some countries making substantial progress in recent years
• Eastern Europe and Central Asia: Lower rates compared to other regions, but still a significant public health concern
• Western Europe and North America: Generally low rates, but with recent increases in some areas

These disparities highlight the need for tailored, context-specific interventions to address CS on a global scale.

The Economic Burden of Congenital Syphilis: Healthcare Costs and Societal Impact

Beyond the human toll, CS imposes a significant economic burden on healthcare systems and society at large. Understanding these costs can help emphasize the importance of prevention and early intervention.

What are the economic implications of congenital syphilis?

The economic impact of CS extends to various areas:

• Direct medical costs: Hospitalization, long-term care, and ongoing medical treatments
• Indirect costs: Lost productivity of affected individuals and their caregivers
• Social services: Additional support and interventions for affected children
• Public health expenditures: Screening programs, awareness campaigns, and prevention initiatives

Studies have shown that investing in CS prevention can result in substantial cost savings for healthcare systems and society as a whole.

Ethical Considerations in Congenital Syphilis Prevention and Management

The prevention and management of CS raise several ethical considerations that healthcare providers, policymakers, and society must grapple with.

What are some ethical challenges related to congenital syphilis?

Key ethical issues surrounding CS include:

• Balancing maternal autonomy with fetal protection
• Ensuring equitable access to testing and treatment
• Addressing stigma associated with STDs
• Protecting patient confidentiality while promoting partner notification
• Allocating resources for CS prevention versus other public health priorities

Addressing these ethical challenges requires careful consideration and ongoing dialogue among stakeholders.

The Role of Community Engagement in Congenital Syphilis Prevention

Effective CS prevention requires more than just medical interventions; it necessitates active community engagement and support. By involving communities in prevention efforts, we can create more sustainable and culturally appropriate solutions.

How can communities contribute to congenital syphilis prevention?

Community-based approaches to CS prevention may include:

• Peer education programs
• Community health worker initiatives
• Faith-based outreach
• School-based sexual health education
• Local advocacy campaigns
• Support groups for affected families

These grassroots efforts can complement and enhance traditional healthcare-based interventions, leading to more comprehensive CS prevention strategies.

Future Directions in Congenital Syphilis Research and Prevention

As we continue to grapple with the challenges posed by CS, ongoing research and innovation are crucial for developing more effective prevention and treatment strategies.

What are some promising areas of research in congenital syphilis?

Current and future research directions in CS include:

• Development of a syphilis vaccine
• Improved diagnostic techniques for early detection
• Novel antibiotic formulations for more effective treatment
• Implementation science to enhance the uptake of existing interventions
• Genetic studies to understand susceptibility and disease progression
• Behavioral research to identify effective prevention strategies

These research efforts hold promise for significantly reducing the burden of CS in the coming years.

As we conclude our exploration of congenital syphilis, it’s clear that this preventable condition continues to pose significant challenges to maternal and child health worldwide. By raising awareness, promoting testing and treatment, and addressing the underlying social and economic factors that contribute to its spread, we can work towards a future where no child is born with this devastating infection. The fight against congenital syphilis requires a concerted effort from healthcare providers, policymakers, researchers, and communities alike. Together, we can turn the tide on this resurgent public health threat and ensure a healthier future for generations to come.

STD Facts – Congenital Syphilis

What is congenital syphilis (CS)?

Congenital syphilis (CS) is a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy. Learn more about syphilis.

How can CS affect my baby?

CS can have major health impacts on your baby. How CS affects your baby’s health depends on how long you had syphilis and if — or when — you got treatment for the infection.

CS can cause:

• Miscarriage (losing the baby during pregnancy),
• Stillbirth (a baby born dead),
• Prematurity (a baby born early),
• Low birth weight, or
• Death shortly after birth.

Babies born to women with untreated syphilis may be stillborn, or die from the infection as a newborn.

For babies born with CS, CS can cause:

• Deformed bones,
• Severe anemia (low blood count),
• Enlarged liver and spleen,
• Jaundice (yellowing of the skin or eyes),
• Brain and nerve problems, like blindness or deafness,
• Meningitis, and
• Skin rashes.

Do all babies born with CS have signs or symptoms?

No. It is possible that a baby with CS won’t have any symptoms at birth. But without treatment, the baby may develop serious problems. Usually, these health problems develop in the first few weeks after birth, but they can also happen years later.

Babies who do not get treatment for CS and develop symptoms later on can die from the infection. They may also be developmentally delayed or have seizures.

How common is CS?

CS cases have more than tripled in recent years, with more than 2,000 cases reported in 2021 alone. This is the highest number reported in one year since 1994.

Public health professionals across the country are very concerned about the growing number of congenital syphilis cases in the United States. It is important to make sure you get tested for syphilis during your pregnancy.

I’m pregnant. Do I need to get tested for syphilis?

Yes. All pregnant women should be tested for syphilis at the first prenatal visit (the first time you see your doctor for health care during pregnancy). If you don’t get tested at your first visit, make sure to ask your doctor about getting tested during a future checkup. Some women should be tested more than once during pregnancy. Talk with your doctor about the number of syphilis cases in your area and your risk for syphilis to determine if you should be tested again at the beginning of the third trimester, and again when your baby is born.

Keep in mind that you can have syphilis and not know it. Many people with syphilis do not have any symptoms. Also, syphilis symptoms may be very mild, or be similar to signs of other health problems. The only way to know for sure if you have syphilis is to get tested.

Is there treatment for syphilis?

Yes. Syphilis can be treated and cured with antibiotics. If you test positive for syphilis during pregnancy, be sure to get treatment right away.

If you are diagnosed with and treated for syphilis, your doctor should do follow-up testing for at least one year to make sure that your treatment is working.

How will my doctor know if my baby has CS?

Your doctor must consider several factors to determine if your baby has CS. These factors will include the results of your syphilis blood test and, if you were diagnosed with syphilis, whether you received treatment for syphilis during your pregnancy. Your doctor may also want to test your baby’s blood, perform a physical exam of your baby, or do other tests, such as a spinal tap or an x-ray, to determine if your baby has CS.

CDC has specific recommendations for your healthcare provider on how to evaluate babies born to women who have positive syphilis tests during pregnancy.

My baby was born with CS. Is there a way to treat the infection?

Yes. There is treatment for CS. Babies who have CS need to be treated right away — or they can develop serious health problems. Depending on the results of your baby’s medical evaluation, he/she may need antibiotics in a hospital for 10 days. In some cases, only one injection of antibiotic is needed.

It’s also important that babies treated for CS get follow-up care to make sure that the treatment worked.

How can I reduce the risk of my baby getting CS or having health problems associated with CS?

Your baby will not get CS if you do not have syphilis. There are two important things you can do to protect your baby from getting CS and the health problems associated with the infection:

• Get a syphilis test at your first prenatal visit.
• Reduce your risk of getting syphilis before and during your pregnancy.

Talk with your doctor about your risk for syphilis. Have an open and honest conversation about your sexual history and STD testing. Your doctor can give you the best advice on any testing and treatment that you may need.

Get a syphilis test at your first prenatal visit

If you are pregnant, and have syphilis, you can still reduce the risk of CS in your baby. Getting tested and treated for syphilis can prevent serious health complications in both mother and baby.

Prenatal care is essential to the overall health and wellness of you and your unborn child. The sooner you begin receiving medical care during pregnancy, the better the health outcomes will be for you and your unborn baby.

At your first prenatal visit, ask your doctor about getting tested for syphilis. It is important that you have an open and honest conversation with your doctor at this time. Discuss any new or unusual physical symptoms you may be experiencing, as well as any drugs/medicines you are using, and whether you have new or multiple sex partners. This information will allow your doctor to make the appropriate testing recommendations. Even if you have been tested for syphilis in the past, you should be tested again when you become pregnant.

If you test positive for syphilis, you will need to be treated right away. Do not wait for your next prenatal visit. It is also important that your sex partner(s) receive treatment. Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be reinfected. For this reason you must continue to take actions that will reduce your risk of getting a new infection.

Reduce your risk of getting syphilis before and during your pregnancy

Preventing syphilis in women and their sex partners is the best way to prevent CS.

If you are sexually active, the following things can lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis.
• Using latex condoms the right way every time you have sex. Although condoms can prevent transmission of syphilis by preventing contact with a sore, you should know that sometimes syphilis sores occur in areas not covered by a condom, and contact with these sores can still transmit syphilis.

Also, talk with your doctor about your risk for syphilis. Have an open and honest conversation with your doctor about your sexual history and about STD testing. Your doctor can give you the best advice on any testing and treatment that you may need.

Remember that it’s possible to get syphilis and not know it, because sometimes the infection causes no symptoms, only very mild symptoms, or symptoms that mimic other illnesses.

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Pictures: Syphilis – All stages [Warning: Strong Images]

By: Pedro Pinheiro, MD

1 comment

Estimated reading time: 4 minutes.

What is syphilis?

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum.

The hallmark symptom of syphilis, typically seen in the initial stage, is a painless ulcer, known as a chancre, predominantly appearing in the genital region. The most significant risk of transmission comes from individuals in the primary or secondary stages of the disease, particularly when active lesions are present on their sexual organs.

Before showing the pictures, here’s a succinct overview of the three distinct stages of syphilis.

Stages of Syphilis

The initial or primary stage of syphilis is perhaps the most recognizable, marked by the presence of a genital sore, known as a chancre. This lesion, persisting for 3 to 6 weeks, may resolve itself without any intervention, which can misleadingly suggest self-resolution of the disease.

Following the disappearance of the chancre, after a period of weeks or months, syphilis reemerges in its secondary stage. This phase may present with skin lesions and mucous membrane involvement. If untreated, these symptoms may temporarily subside, only to resurface years later in the form of tertiary syphilis. This is the most severe stage of the disease, posing a high risk of producing disfiguring lesions.

The photo gallery below offers a visual journey through the primary, secondary, and tertiary stages of syphilis. The highly disfiguring lesions of tertiary syphilis displayed are infrequent in today’s medical landscape due to timely and effective treatments. However, such manifestations were relatively common in the era preceding antibiotics.

If you want to read more about syphilis, we recommend the following article: Syphilis: Symptoms, Tests, Transmission, Treatment, and Cure.

Caution: The following gallery contains graphic images depicting the primary, secondary, and tertiary stages of syphilis. These images consist of visually intense and disfiguring lesions or representations of sexual organs. We encourage discretion and recommend that you refrain from accessing this gallery if your current environment is not conducive to the viewing of such content.

Images and photos

Primary syphilis –

Syphilitic chancre

Genital ulcer – Primary syphilisTongue ulcer – Primary syphilis acquired by oral sexSyphilitic chancre Syphilitic chancre on the vulva Syphilitic chancre on the penis

Secondary syphilis

Photos of the syphilis rashes on the soles, palms, body, and oral cavity.

Secondary syphilis – rashes on the palmsSecondary syphilis – Rash on the backSecondary syphilis palmar lesionsSecondary syphilis – Reddish purple spots on the palmsSecondary syphilis – Eruptions on the palms and solesSevere secondary syphilis (malignant syphilis) with lesions all over the bodySecondary syphilis – Lesions on the hard palateRash on the sole of the footSecondary syphilis lesions on the tonguePustular secondary syphilis – rare and aggressive form

Tertiary syphilis – Syphilitic Gumma

Syphilitic gumma on the hand – Tertiary syphilisSyphilitic gumma on the face – Tertiary syphilisDisfiguring tertiary syphilis – Common findings before the antibiotic eraEffects of tertiary syphilis on a patient’s skullDestruction of nasal cartilage due to tertiary syphilis

Credits

• Shutterstock. com
• Multiple skin ulcers from malignant syphilis – The Lancet
• Secondary Syphilis in Cali, Colombia: New Concepts in Disease Pathogenesis – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Palmar-and-plantar-rash-of-secondary-syphilis-Typical-palmar-and-plantar-rash-of_fig8_44630365 [accessed 26 Apr, 2023]
• Morais, Lima & Melo, Thayná & Kitakawa, Dárcio & Da, Felipe & Peralta, Felipe & Gonzales, Sabrina & Carvalho, Luis Felipe & Carvalho, Silva. (2022). Secondary syphilis in oral cavity: Case report and literature review. International Journal of Case Reports and Images. 13. 226-229. 10.5348/101366Z01TM2022CR.
• Tertiary syphilitic ulceration of the scalp – St Bartholomew’s Hospital Archives & Museum.
• An Alaskan Inuit skull, showing the effects of syphilis. Photograph by Ales Hrdlicka, ca. 1910.
• A man suffering from syphilis, displaying pustular syphiloderm lesions on his scalp and torso. Process print after a photograph, ca. 1905.
• Face of a woman with a typical ‘syphilitic nose’. Picture: St Bartholomew’s Hospital Archives & Museum.

Pedro Pinheiro holds a medical degree from the Federal University of Rio de Janeiro (UFRJ) and is a specialist in Internal Medicine and Nephrology, certified by the State University of Rio de Janeiro (UERJ) and the Brazilian Society of Nephrology (SBN). He is currently based in Lisbon, Portugal, with his credentials recognized by the University of Porto and the Portuguese Nephrology Specialty College.

Categories Infectious disease, Urology

what a hard and pale syphilitic chancre looks like, treatment

Types of chancre

Chancre is an ulcer that occurs 3-90 (average – 21) days from the moment of infection with syphilis, more often – in the zone of penetration of the pathogen into the patient’s body. First, a pink spot (inflammation) forms on the skin, then a dense nodule appears at this place, after 7-10 days it becomes necrotic and turns into an ulcer or erosion. If the formed chancre is not accompanied by itching or pain, then it is called syphiloma.

Syphiloma has a regular round or oval shape and clear borders that protrude above the skin. The edges are dense, rolled. The bottom of the syphiloma is red, less often meat-colored, it can be red-brown, and the chancre itself looks varnished, due to the characteristics of the wound.

Syphilomas vary in size from 5 to 30 mm, but larger or smaller ulcers are found. The main sign of a hard chancre is a cartilaginous seal at the base of the ulcer, which is palpable on palpation. When pressed, the chancre is painless. The skin around the ulcer is clean, without signs of inflammation.

A chancre is formed due to the penetration of pale treponema (spirochete) into the body. The temperature of the human body is suitable for reproduction, and after entering the body, it actively forms syphilomas. Chancres themselves can be of different types, shapes and sizes.

Classification

Quantitatively

Solitary – chancre in the form of a separate neoplasm, or multiple, which looks like several ulcers.

Origin

Twin chancres – occur with simultaneous infection – when the pathogen enters the patient’s body not in one, but in several “places”. That is, instead of one chancre, two or more can be found.

Chancre formed due to infection at different times. Appear one after another, approximately in the same place.

The so-called “kissing” chancre that occurs on contact surfaces.

Comorbidities may contribute to the formation of multiple syphilomas:

• scabies
• acne
• skin injuries

By depth of tissue penetration

Syphilomas have different depths of tissue damage.

Ulcers affect the deeper layers of the skin. They can pass through the dermis – up to the subcutaneous tissue. I have a rough bottom covered with a purulent coating. Erosions are located closer to the surface. The bottom is smooth, shiny, shaped like a saucer.

Size

In addition to standard sizes from 5 to 10 mm, there are giant and pygmy chancres.

Giant chancres are extremely rare and can be up to 20 cm in diameter. They are localized mainly in areas of accumulation of fatty tissue: on the abdomen, thighs, pubis. Dwarfs are called syphilomas the size of a poppy seed – 1-2 mm, they can only be seen through a magnifying glass. Rarely seen.

Location

Chancre can be located on different parts of the body:

• genital syphilomas are located on the genitals
• extragenital – on any other parts of the body outside the genitals (Fig. 1)
• bipolar syphilomas occur simultaneously on the genitals and outside the perineum.

Figure 1. Chancre on the index finger of the left hand and in the region of the inner corner of the left eye. Source: CC0 Public Domain

Form

In addition to the classic rounded shape, the chancre may have a different appearance.

Slit-like syphilomas look like cracks. They can form in the corners of the mouth, on the tongue, near the anus. Rarely seen. Located in the corners of the mouth, they can be perceived by the owner as harmless “jams”.

The crusting chancre is not like the usual syphilomas, it is not concave and covered with a crust. It usually forms on ulcers that are located in places where their contents easily dry out: the surface of the nose, face, corners of the mouth.

Diphtheritic chancre covered with an ash-gray film similar to diphtheria. Occurs quite often. Can be localized in any area.

The burn chancre rapidly increases in diameter, while its borders lose their regular shape and clear outlines, and the bottom becomes red-granular from smooth (Fig. 2). Usually primary syphilomas do not tend to grow. This is an exception.

Figure 2. Burn syphiloma. Source: CC0 Public DomainCaption

Erosive chancre includes many erosions, ulcers may coalesce. It is formed exclusively on the mucous membranes of the genitals.

Chancre herpetiformis is named for its resemblance to genital herpes. This is an erosive formation, in the field of which there are many small ulcers with clearly defined edges. It looks like Folman’s balanitis, but in this case the sores do not merge.

Localization

Since syphilis is transmitted mainly through sexual contact, chancre is most often localized on the genitals. However, clinical practice shows that syphilomas are almost as often found in the mouth and in the anus.

This means that the chancre can appear anywhere, its location can be:

• penis and scrotum
• labia and clitoris
• posterior commissure and anus
• pubis
• oral cavity: lips, gums, tongue and throat
• inner thighs
• chest and abdomen
• person
• rare – eyelids, conjunctiva of the eyes

The chancre can be located inside the genitals, for example, on the walls of the vagina or cervix, then it is difficult to detect syphiloma.

Stages of development

Incubation period

The incubation period – from the moment of infection to the onset of symptoms of the disease – lasts on average from 2 weeks to 2 months, although observations of a longer duration are known. It all depends on the state of immunity at the time of infection. Long asymptomatic periods usually occur in people who were taking antibiotics at the time of infection to treat other conditions.

During the incubation period, treponema pallidum proliferates in the lymphatic system until it reaches its maximum concentration. Then they enter the bloodstream and spread throughout the body. At this time, the disease does not manifest itself in any way and is not determined in blood tests, but the person is already infected. Without realizing it, he or she endangers a sexual partner if they have unprotected sex.

Important! Treponema pallidum can multiply in a small temperature range, around 37 °C. Therefore, for the treatment of syphilis, the method of pyrotherapy is practiced – an increase in body temperature. The patient is injected with drugs that increase body temperature, as a result of which treponema is deprived of the opportunity to multiply. This method is considered the most effective in the nonspecific treatment of syphilis.

Chancre formation

Figure 3. Development of syphiloma. Source: CC0 Public Domain

Once in soft tissues, treponema begins to multiply actively. During this period, a slight increase in temperature, an increase in nearby lymph nodes that can be palpated is not excluded. Inflammation develops at the site of infection – this is how immune cells try to destroy the enemy.

From the outside, the focus of inflammation looks like a bright pink patch of skin. Then a characteristic dense nodule forms on the skin – the germ of the future chancre (Fig. 3). It increases, thickens and ulcerates in a week and a half.

If the ulcer is covered with a crust, then the chancre is also called -crustal. If you press on it, a yellowish liquid will come out, in which there is a high concentration of treponema. Such syphiloma is called “weeping chancre”.

Discharge from chancre is contagious and can transmit infection if touched. This danger is especially high when there is a hard chancre in the mouth – there is a high risk of infecting a partner with syphilis even through a kiss.

The formation of a chancre indicates the end of the incubation period and the onset of the primary stage of syphilis. The chancre does not disturb the wearer with any itching or pain, which is bad – a person can simply not pay attention to it and waste time.

The primary stage is the most favorable for the destruction of the pathogen. In this period, a complete and rapid recovery is possible with the timely appointment of antibiotic therapy. In the future, it will become more and more difficult to cope with the disease.

Chancre healing

Ulcerated chancre lasts 6-7 weeks, then healing begins. Erosion can pass without a trace, but sometimes leaves a dark pigment spot. When the ulcer heals, a scar remains. A few days before the disappearance of the chancre, profuse itchy rashes may appear on the body.

At this stage, syphilis enters the secondary stage.

Important! Healing of a chancre is often mistaken for a cure. This is wrong. In fact, the disease continues to develop, spreading throughout the body.

What is the difference between soft chancre and hard chancre

There is a soft chancre (chancroid) that looks like a hard one. It is also, like syphilis, sexually transmitted, but it occurs as a result of infection not with pale treponema, but with bacteria of the genus Haemophilus.

Chancroid differs from hard chancre in the following features:

• there is no hard cartilaginous base (which is why chancroid is called “soft”)
• the edges of the ulcer are not hard, but soft, spreading
• profuse discharge of pus is characteristic
• painful
• hot pink, red

Diagnosis

Several basic techniques are used to detect syphilis:

• Detection of pale treponema with a microscope in a scraping taken from a chancre.
• Serological method (Wassermann reaction) – when specific proteins are determined that the immune system produces in response to the appearance of treponema in the body, it is not effective in primary syphilis.
• Microprecipitation reaction – express diagnostics, also based on the production of antibodies by the body.
• Specific tests RIF, RIT, RPGA, etc. – difficult to set up, laborious and expensive. It is used to detect latent syphilis, in complex atypical cases, in differential diagnosis and for the diagnosis of late syphilis.

If treponema is detected immediately by microscopy, no further testing is required to prove infection. Upon detection of treponema, treatment is prescribed immediately.

Sometimes it is necessary to carry out a whole range of diagnostic measures in order to establish an accurate diagnosis, so it is impossible to diagnose the disease on your own, you must consult a doctor.

Treatment

It should be noted: in advanced cases, when it is not possible to get rid of the chancre, as well as with extensive tissue necrosis, they resort to surgical removal of syphiloma.

In all other cases, the chancre itself is not treated and there is no specific treatment for uncomplicated chancre. In secondary and combined infections, topical antibacterial drugs can be prescribed: baths with benzylpenicillin and dimexide, applications with mercury or mercury-bismuth ointment. When the chancre is located in the oral cavity, rinsing is recommended: a solution of furacilin, boric acid (2%), or gramicidin (2%).

The main task is to get rid of syphilis as quickly as possible and with minimal losses. Therefore, for the treatment of syphilis, antibiotics of the penicillin series are used – short and prolonged (durant) penicillins: Bicillin-1, Bicillin-5, Oxacillin, Ampicillin (semi-synthetic penicillin). The drug of choice for the treatment of syphilis is benzylpenicillin.

Reserve preparations for penicillin intolerance: tetracyclines (doxycycline), macrolides (azithromycin, erythromycin), cephalosporins (ceftriaxone).

Administration of drugs by injection – intravenous or intramuscular.

Source: CC0 Public Domain

The treatment regimen depends on the stage of the disease, location, degree of damage, etc. In any case, the dose of the drug and the number of courses of treatment is calculated by the doctor individually.

Control tests are carried out during treatment to confirm the effectiveness of the drugs.

Treatment of syphilis at an early stage is the most effective and creates all the prerequisites for a complete cure without consequences and complications.

Recommendations for the period of treatment

During the period of treatment it is necessary to stop sexual intercourse. When localizing the chancre on the fingers, it is recommended to wear protective gloves. If syphiloma is found in the mouth, it is necessary to separate personal items from common items – dishes, toothbrushes, etc.

If there are chancres on the body, the use of bed linen, towels, washcloths should be individual. Through public places (toilet, etc.) syphilis is not transmitted.

The sexual partners of the sick persons receive preventive treatment without fail, including pregnant and lactating women.

Important! Be sure to complete the full course of treatment! Under no circumstances will syphilis disappear spontaneously. Untreated syphilis will move to the next stage, increasing the risk of complications and persistent deterioration of the patient’s condition.

Clinical serological control (CSC)

All family members of the sick person, both adults and children, should receive preventive treatment after sexual or close household contact with patients with early forms of syphilis. 3 months after the end of preventive treatment, a single clinical and serological examination is performed.

Clinical and serological control (CSC) after the end of the specific treatment of the patient is carried out 1 time in 3 months during the first year of observation. Then 1 time in 6 months in subsequent years with the setting of non-treponemal (simple serological) tests, 1 time per year with the setting of the corresponding treponemal test (a complex test to detect possible latent forms of syphilis), which was used in the diagnosis of the disease. The duration of CSC is determined individually depending on the results of treatment.

Children born to seropositive mothers who have not had congenital syphilis, regardless of whether they received prophylactic treatment or not, are subject to observation for 1 year. Children receiving specific treatment are on CSC for 3 years.

Prevention

Since the way of transmission of the disease is mainly sexual, preventive measures consist in observing the fidelity of sexual partners – this is the most effective prevention of sexually transmitted diseases. When having sexual intercourse with an unverified person, you should always use a condom.

Barrier contraception (condom) provides almost 100% protection against syphilis.

In any case, after accidental contact, it is necessary to independently treat the genital area with antiseptic agents: miramistin or chlorhexidine.

If an unplanned contact occurred without protective equipment, or the integrity of the condom was broken in the process, doctors recommend visiting the ACU as soon as possible and making a prophylactic injection, which will almost 100% prevent the development of syphilis.

Conclusion

A chancre is the main symptom of the primary stage of syphilis. If you consult a doctor in time, you can quickly recover without consequences for the body. If a suspicious sore is found, you should not wait until it heals, it is better to see a specialist and pass the necessary tests. This will help to exclude, and, if necessary, neutralize a severe infection, which, having developed, will lead to damage to the whole organism.

Sources

1. Federal clinical guidelines for the management of patients with syphilis
2. Atlas of Dermatology prof. Sergeeva Yu.V.

Hard chancre: diagnosis and treatment in St. Petersburg

Hard chancre (primary sclerosis, primary syphiloma, primary erosion) is the first clinical sign of syphilis, a venereal disease caused by treponema pallidum (spirochete). A hard chancre appears at the site where the infection entered the body. The French say that in case of syphilis, the first place to be punished is the place with which the sin was committed. From the moment a hard chancre appears, the primary period of syphilis begins, which continues until multiple syphilitic rashes appear on the patient’s skin.

1. Service prices
2. Diagnostics
3. Treatment

FACT: Hard chancre can appear in any place where there was contact with a patient with syphilis: on the genitals, on the skin of the pubis, thighs, scrotum, abdomen, in the mouth or on the lips, in the anal area, on the skin of the hands. Therefore, a condom often does not save from infection with syphilis.

Prices for services

Initial appointment with a urologist FOR MEN

Initial appointment – an appointment with a doctor of a particular specialty for the first time.
Includes a conversation with the patient, initial examination, history taking, if necessary, rectal digital examination.

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900 ₽

Repeated appointment with a urologist

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700 ₽

Symptoms and diagnosis

Hard chancre most often looks like an even erosion of a rounded or oval red color with a smooth shiny bottom. The size of erosion can vary from 1-3 mm to 2-4 cm. 8-14 days after the onset of a hard chancre, the lymph nodes closest to it begin to increase. Sometimes in the primary period of syphilis, towards the end, before the appearance of rashes, patients with syphilis experience malaise, insomnia, headache, loss of appetite, increased irritability, pain in the bones and joints, fever. Possible indurative edema of the genitals.

There are also atypical forms of hard chancre. So, in about 15% of patients with syphilis, a hard chancre has the character of not a superficial erosion, but a deep ulcer. Ulcerative chancre at diagnosis is important to distinguish from soft chancre: an ulcer that can accompany some dermatological and venereal diseases. One of the atypical forms of hard chancre is also edema in the area of ​​the foreskin in men and labia in women, the edematous organ greatly increases in size, becomes very dense to the touch, but painless. Development periods

The primary period of syphilis is divided into primary seronegative syphilis, when blood reactions (Wassermann reaction) are still negative (the first 3-4 weeks from the onset of hard chancre) and primary seropositive syphilis, when blood reactions become positive.