Visceral syphilis is the result of damage to internal organs by Treponema pallidum. Syphilitic changes are divided into early and late. The visceral form of the disease can develop at any time after infection. The most dangerous are considered to be late pathological changes caused by a tertiary infection and the disorders are irreversible. If in the past visceral syphilis was diagnosed extremely rarely, now it is found in every fifth infected person. This is explained by several reasons.

A person often does not pay attention and does not begin treatment on time. Patients who have already been diagnosed with the disease prefer to undergo therapy in private clinics. Unscrupulous doctors may prescribe drugs incorrectly. In both cases, ideal conditions are created for the penetration of Treponema pallidum into the internal organs. Pathogenic microorganisms spread both hematogenously and lymphogenously. Since blood vessels are present in all parts of the body, treponemes can affect any tissue. Most often, syphilitic changes are observed in organs that have increased blood supply:

• liver;
• digestive system;
• lungs;
• kidneys.

It has the most severe course.

Cardiovascular form

The cardiovascular system includes the heart muscle, large and small arteries and veins. The largest vessel is the aorta, which extends from the heart. Cardiovascular syphilis is a lesion of the main parts of the circulatory system. The disease significantly reduces the patient's quality of life and can lead to death.

Early syphilitic changes include:

If the inflammatory process begins in the part of the aorta closest to the heart, it can spread to the valves. The disease is dangerous due to the absence of signs indicating the syphilitic origin of the pathological changes. The first symptoms are similar to those of most heart problems. The patient experiences:

• shortness of breath;
• tachycardia;
• malfunctions of the organ.

During the examination, doctors reveal only general signs of cardiac pathologies, while syphilis continues to spread in the body.

The tertiary form of the disease has even more dangerous consequences. Late syphilis affects the middle sections of the walls of large arteries, contributing to their destruction.

Aortic aneurysm is a protrusion of any part of the vessel that occurs against the background of replacement of normal tissues with scar tissue. The most common complication of cardiovascular syphilis is coronary artery stenosis. If the blood supply to the heart muscle is disrupted, the functioning of the organ is disrupted. Symptoms of mesaortitis can be confused with manifestations of angina pectoris. A person complains of pain and heaviness in the chest, which intensifies with physical activity.

With an aneurysm, sharp pain appears behind the sternum or in the epigastric region. The disease has a dangerously high risk of aortic rupture. In this case, massive internal bleeding occurs, in which death occurs within a few minutes.

How does syphilitic damage to the digestive system manifest?

The liver is responsible for filtering the blood and removing toxins from the body. In addition, the organ stores and synthesizes vitamins, nutrients and bile. Syphilitic hepatitis is an inflammation in the liver tissues that can occur at different stages of the disease. Most often it is found in its secondary and tertiary forms. In the initial stages, syphilitic hepatitis does not have pronounced symptoms. Only slight hepatomegaly is detected. Jaundice with inflammatory changes caused by treponema rarely occurs. Late syphilitic changes in liver tissue appear 5–10 years after infection. Observed:

During the examination, inflammatory foci of various sizes are detected. If left untreated, syphilitic hepatitis is complicated by cirrhosis and ends in death.

Damage to the stomach and intestines can occur at any stage of the infection. In the early stages, pathological changes are easily eliminated and do not lead to dangerous complications. With primary syphilis, inflammatory foci are found in the tissues of the esophagus and stomach - infectious esophagitis and gastritis. In this case, nagging pain in the epigastric region, nausea and vomiting, and a feeling of heaviness in the abdomen appear. The disturbances are mild in nature and practically do not worsen the patient’s quality of life.

In tertiary syphilis, the inflammatory foci are large. Symptoms may be similar to other gastroenterological diseases. Patients report acute pain in the stomach, nausea, lack of appetite, and sudden weight loss. Exhaustion of the body occurs due to malabsorption of nutrients.

What is neurosyphilis

This term refers to damage to the tissues and blood vessels of the brain. The disease can begin with both secondary and tertiary syphilis. The main symptoms of meningovascular lesions:

• headaches;
• sensory disturbance;
• decreased vision;
• tinnitus.

Problems with speech, gait and memory may occur. The symptoms of neurosyphilis are similar to those of stroke, hypertension and acute cerebrovascular accident. Suspicions of syphilis of internal organs arise when similar symptoms appear in young people, because the problems listed above are characteristic of the elderly. The diagnosis is confirmed by positive results.

Damage to internal organs due to syphilis can impair the functioning of the excretory and respiratory systems. However, these types of pathology are rarely found. The inflammatory process in the kidneys begins immediately after infection and continues until the disease is completely cured. The severity of pathological changes varies - from minor dysfunction to acute renal failure.

Against the background of syphilis, atypical pneumonia most often develops, in which the tissues of the alveoli become inflamed. Observed:

• frequent coughing attacks;
• chest pain;
• dyspnea.

Sputum is not separated, but examination may reveal tumor-like inclusions. has a severe course. Gummas form in the lungs, tissues are destroyed and replaced by scars. Vision with syphilis may be impaired due to insufficient blood supply to the retina or optic nerve, as well as inflammation of the eye tissue.

Methods for eliminating visceral syphilis

A unified therapeutic regimen has not been developed, since each patient has different lesions of internal organs. Treatment of visceral syphilis involves the use of antibacterial drugs of the penicillin and cephalosporin group.

Symptomatic therapy is also indicated, eliminating the main manifestations of syphilis in internal organs. You can get rid of the disease only with the correct administration of antibiotics in the maximum permissible doses. The therapeutic course cannot be interrupted or terminated prematurely. The latent course of syphilis contributes to the development of dangerous complications.

Complete recovery occurs only with early pathological changes. In such cases, it is enough to destroy the treponema and eliminate the inflammatory processes caused by it.

After the death of the bacteria, the tissues are gradually restored, and the general condition of the body returns to normal. In advanced forms of syphilis, pathological changes are irreversible. After antibiotic therapy, maintenance therapy is prescribed. In this case, it is impossible to cure visceropathy completely.

Late syphilitic visceropathies

Thanks to successful treatment and preventive measures, in patients with various forms of syphilis, pronounced and clearly defined lesions of internal organs have become rare. The most important of these are late visceropathies.

Changes in internal organs in patients with tertiary syphilis are based on endo-, meso- and perivasculitis characteristic of syphilitic infection, up to complete obliteration of blood vessels. Specific pathology is especially intense in the tissues of the heart, blood vessels, gastrointestinal tract, liver and lungs. Syphilitic damage to the heart and blood vessels often manifests itself as specific gummous myocarditis and syphilitic mesaortitis. Gummy myocardial proliferations can be isolated (like solitary gummas of the skin) or have the appearance of diffuse gummous infiltration. Often these processes are combined. The symptoms of the lesions have no specific features. Myocardial hypertrophy is observed with an increase in the size of the heart, weakening of heart sounds, and widespread pain. Diagnosis is based more clearly on ECG data and serological reactions; The RIF and RIBT indicators are especially important. The aorta is affected more often than the myocardium - specific mesaortitis occurs in patients with tertiary syphilis with a disease duration of more than 10 years. In the initial phase of infiltration and slight compaction of the intima and median membrane, the ascending part of the aortic arch thickens, which is clearly recorded on radiographs; subjective symptoms may be absent. Further stages of the formation of mesaortitis depend on the degree of allergic reactivity of the test organ and the intensity of the syphilitic lesion. With hyperergy, necrotic destructive changes develop, up to complete destruction of the aortic wall, ending in death. With low allergic tension, the process ends with proliferative compactions, foci of fibrous degeneration and calcification, which is more favorable for the prognosis for life and therapeutic effect. The transition of the process to the aortic valves leads to aortic insufficiency, which is manifested by pulsation of the cervical vessels, shortness of breath, nausea, increased fatigue, and the release of rusty sputum. Large main arteries and veins of the brain, upper and lower extremities can also be affected. They contain separately located small gummas with subsequent fibrous compaction or diffuse impregnation like sclerotic lesions, without destruction and necrosis.

Syphilitic aortitis - the most common form of visceral syphilis; characterized by a difference in pulse on both arms, a peculiar “ringing” accent of the second tone on the aorta, identification of the Sirotinin-Kukoverov phenomenon - a systolic murmur heard above the sternum when raising the arms as a result of displacement of the great vessels during aortitis (Myasnikov A.L., 1981), x-ray detectable expansion of the shadow of the ascending aortic arch. Syphilitic aortic aneurysm during fluoroscopy is detected as sac-like, less often fusiform, expansions with a clear pulsation (Dashtayants G.A., Frishman M.P., 1976). It is necessary to exclude syphilitic aortic aneurysm in patients with superior vena cava syndrome, which occurs with compression of it, as well as the trachea and bronchi. X-ray examination reveals a large, relatively homogeneous, petrific-free shadow in the anterior mediastinum. To exclude the malignant neoplasm that often causes this syndrome, aortic angiography, tomography, and serological testing are performed.

Late syphilis of the gastrointestinal tract characterized by the same specific infiltrative foci of a tubercular-gummous nature, reflecting the intensity of immunoallergic reactivity. Individual, focally located tubercles or gummas can be found in the esophagus, stomach, small and large intestine. Due to the more pronounced traumatic effect of food and the enzymatic action of gastric contents, gummous-infiltrative processes occur more often in the esophagus and stomach. Separate, solitary, gummas and diffuse gummous infiltration are formed in combination with each other or separately. In the case of a single gumma of the esophagus or stomach, the process remains unrecognized for a long time due to the weak severity of subjective and objective symptoms. Diffuse gummous infiltration is more often detected in the stomach. Superficial infiltrative damage to the mucous membrane initially manifests itself as symptoms of gastritis with severe dyspeptic disorders, a hypacid or anacid state. Deep infiltrative changes in the esophagus and stomach cause severe dysphagia and digestive disorders, similar to the symptoms of tumors of these organs.

When the intestine is damaged, syphilitic gummous-infiltrative elements are localized, as a rule, in the jejunum. The symptoms of syphilitic enteritis are very nonspecific. Diffuse proliferations, thickening the wall of the small intestine, give less symptoms than focused gummas, changing natural peristaltic movements and accompanied by obstruction phenomena (with significant infiltrate). Ulcerations of gummas or gummous infiltration aggravate the process with bleeding and peritoneal symptoms. The rectum is rarely affected in the tertiary period of syphilis. V. Ya. Arutyunov (1972) described gummous infiltration and isolated small gummas, circularly covering the lower part of the rectum. During the period of infiltration, defecation disorders are observed, and with ulceration and scarring, the symptoms are similar to severe proctitis, differing in less severe pain and an unusually small amount of purulent discharge. Diagnosis of syphilitic gastrointestinal processes is complicated by false-positive CSR for tumors, as well as difficulties in interpreting the results of x-ray examination. And yet, data from RIBT, RIF, anamnesis, and the results of trial antisyphilitic treatment usually make it possible to make a correct diagnosis.

Syphilitic liver damage observed in various variants, due to the localization of the proliferative process and its nodular or diffuse nature. In accordance with the classification of A. L. Myasnikov (1981), the following clinical varieties are distinguished among chronic syphilitic hepatitis: syphilitic chronic epithelial hepatitis, chronic interstitial hepatitis, miliary gummous hepatitis and limited gummous hepatitis. The earliest changes in liver function that occur in the secondary period of syphilis can manifest as icterus, skin itching and other symptoms of acute syphilitic hepatitis (Zlatkina A. R., 1966). As a result of rational antisyphilitic treatment or even without it, the latter resolves, leaving altered cellular reactivity. In the tertiary period of syphilis, when the phenomena of hyperergic reactivity increase, chronic epithelial hepatitis occurs secondarily or spontaneously, since it is the epithelium that is most reactive in infectious and allergic processes (AdoAD, 1976). Symptoms of the disease are nonspecific: general malaise, pain and heaviness in the liver area, anorexia, nausea, vomiting, severe itching. The liver is slightly enlarged, protrudes 4-5 cm from under the edge of the costal arch, rather dense, but painless.

Chronic syphilitic interstitial hepatitis develops as a result of diffuse proliferative damage to interstitial tissue cells. Just like epithelial hepatitis, it can form in the secondary period as a result of direct penetration of Treponema pallidum. However, interstitial hepatitis can also be infectious and allergic in nature. Even a small number of Treponema pallidum, but over a long period of time, dramatically changes the reactivity of interstitial tissue cells, and in the tertiary period, interstitial hepatitis of a productive-infiltrative nature is formed for the second time, accompanied by phenomena of necrosis. This clinical variety is characterized by intense pain in the liver area, its enlargement, density on palpation, but jaundice is absent in the early stages of the disease. In the later period, when syphilitic cirrhosis of the liver develops, jaundice and severe itching of the skin occur.

Miliary gummous and limited gummous hepatitis are characterized by the formation of nodular infiltrates. Liver hypertrophy in gummous hepatitis is characterized by unevenness, tuberosity, and lobulation. Miliary gummas are smaller in size, located around blood vessels and affect the liver tissue less. Therefore, miliary gummous hepatitis is manifested by pain in the liver area, its uniform enlargement with a smooth surface. The functional activity of liver cells is maintained for a long time, and jaundice is usually absent.

Limited gummous hepatitis, due to the formation of large nodes involving secretory and interstitial areas, is accompanied by severe pain, fever, and chills. Icterus of the sclera and skin, other liver function disorders are mild; in the initial stages of the disease, jaundice occurs only as a result of mechanical obstruction of the bile ducts. A zone of perifocal nonspecific inflammation forms around the gumma. At the final stages, pronounced sclero-gummous atrophic, deforming scars are observed.

Diagnosis of syphilitic liver damage is based on medical history, the presence of other manifestations of syphilitic infection, and the results of a serological study. It should be emphasized that false-positive CSR results in hepatocholecystitis, liver tumors, and alcoholic cirrhosis are observed in 15-20% of cases (Myasnikov A.L., 1981). Therefore, decisive importance is attached to the data of RIF, RIBT and the results of trial treatment.

Syphilitic kidney damage It is rare and occurs chronically. In the secondary period of syphilis, reactive inflammatory changes in the glomerular vessels spontaneously regress. In the tertiary period, as a result of the hyperergic reaction of the endothelium of the glomerular vessels, miliary or large gummas appear, as well as diffuse infiltration. Gummy lesion due to the focal nature of inflammation (nodular infiltrates) is similar in its main symptoms - albuminuria, pyuria and hematuria - to the blastomatous process. Syphilitic nephrosis with amyloid or lipoid degeneration ends in nephrosclerosis. Since amyloidosis and lipoid degeneration of the renal parenchyma are also characteristic of other chronic infections, the differential diagnosis of syphilitic kidney damage requires a careful analysis of anamnestic information, CSR, RIF and RIBT data, and examination results from related specialists (in order to detect or exclude a syphilitic process of another localization). Trial treatment for kidney damage is not recommended since bismuth preparations are contraindicated in such patients, and penicillin therapy does not always resolve diagnostic difficulties.

Syphilis of the bronchi and lungs manifests itself with extremely varied symptoms due to the peculiar localization of gummous and productive-infiltrative foci. Gummous compactions, both single and multiple (miliary gummas), are most often located in the lower or middle lobe of the lung. The process manifests itself with shortness of breath, a feeling of tightness in the chest, and vague pain. Compaction of lung tissue with syphilis is focal, as with a tumor, more often it is asymmetrical. Gummas of the lungs are differentiated from the tuberculosis process on the basis of the well-being of the patients. With syphilis, as a rule, there is no fever, asthenia, and Mycobacterium tuberculosis is absent in the sputum. Diffuse productive-infiltrative inflammation of syphilitic etiology is most often localized in the area of ​​tracheal bifurcation or in peribronchial tissue. Gumma of the lung and diffuse gummatous infiltration can occur with ulceration, purulent sputum, and even bleeding (Myasnikov A.L., 1981). But a more common outcome is fibrous compaction with the development of pneumosclerosis and bronchiectasis. In the diagnosis of syphilitic lung damage, the history data, the presence of a syphilitic process on the skin, mucous membranes or bones, the results of a serological study, and sometimes trial treatment are of decisive importance.

N. Schibli and I. Harms (1981) report tumor-like lesions of the lungs in tertiary and even secondary syphilis. Chest x-ray reveals round retrocardial opacities at the root of the lung. Sometimes patients with these types of lesions simulating a tumor undergo thoracotomy. The syphilitic nature of lung lesions is established by excluding other etiologies and the positive effect of antisyphilitic therapy. However, the simultaneous existence of syphilis and tuberculosis, gumma and lung tumor is also possible.

Syphilitic damage to the endocrine glands in the tertiary period it is manifested by the formation of gummous foci or diffuse productive inflammation. In men, gummatous orchitis and gummatous epididymitis seem to be the most frequently reported. The testicle and its epididymis increase in size, acquire pronounced density and a lumpy surface. Unlike orchitis and epididymitis of tuberculous etiology, there is no pain, no temperature reaction, serological reactions to syphilis are positive, and Pirquet and Mantoux tests are negative. Resolution of the process occurs with scarring phenomena. With testicular gumma, ulceration is possible, followed by the formation of a deforming scar. In women, the pancreas is more often affected, which is manifested by dysfunction of the islet apparatus and the formation of syphilitic diabetes. Syphilitic thyroiditis is observed in 25% of patients with early forms of syphilis. E.V. Bush (1913) divided thyroid diseases in tertiary syphilis into 3 groups: enlargement of the thyroid gland without changes in function, syphilitic thyroiditis with hyperfunction, and hypofunction of the thyroid gland after cicatricial resolution of syphilitic thyroiditis. V.M. Kogan-Yasny (1939) divided syphilitic thyroiditis into early and late forms. In the secondary period of syphilis, diffuse enlargement of the thyroid gland with hyperfunction is observed. In the tertiary period, a gummous or interstitial lesion develops, followed by scarring. As an example of a specific lesion of the thyroid gland, we present an observation. Complete restoration of the structure of any endocrine gland does not occur after treatment, and therefore syphilitic endocrinopathies are not accompanied by restoration of the functional activity of the gland.

Prevention of visceral syphilis.

Prevention of visceral syphilis involves timely diagnosis and early, comprehensive treatment, since visceral forms are a consequence of inadequate treatment of active forms of syphilis or its complete absence.

Since there are no strictly pathognomonic signs characteristic of syphilitic visceral lesions, diagnosis should be guided by a set of clinical and laboratory data, the dynamics of clinical changes under the influence of specific therapy, widely using a complex of serological reactions: RIT, RIF, RPGA, ELISA.PCR.

It is advisable to carry out research in therapeutic, surgical, obstetric-gynecological, and neurological hospitals with serological tests. A comprehensive examination of persons with syphilis at the end of treatment and upon deregistration serves to prevent visceral syphilis. It consists of an in-depth clinical examination with X-ray, cerebrospinal fluid, and ECG studies if indicated in order to assess the usefulness of the treatment. Targeted therapeutic examination is also indicated for patients with neurosyphilis, who often have specific lesions of internal organs.

For the timely diagnosis of visceral syphilis, it is very important to actively identify latent forms of syphilis, which in 50-70% of cases entail the possibility of late specific lesions of internal organs. In order to timely identify early forms of visceral syphilis, a 100% examination of patients in therapeutic, neurological, psychoneurological, surgical hospitals, ENT departments with RV is used. According to M.V. Milich, V.A. Blokhin (1985), positive serological reactions are found in 0.01% of subjects examined in somatic hospitals, and late forms of syphilis are more common in them: latent late - in 31%, latent unspecified - in 11.5%, late neurosyphilis - in 3.6%, late visceral - in 0.7%.

References:

1 .Rodionov A.N. Syphilis 2nd edition . Published: 2000, St. Petersburg

2 .Rodionov A.N. Handbook of skin and venereal diseases. 2nd ed.

Published: 2000, St. Petersburg

3 .Martin J. Isselbacher K. Braunwald E., Wilson J., Fauci A., Kasper D.,

Harrison's Handbook of Internal Medicine 1st ed. 2001, St. Petersburg.

Late syphilitic visceropathies

Thanks to successful treatment and preventive measures in patients with
various forms of syphilis have become rare and pronounced
lesions of internal organs outlined by clinical symptoms.
The most important of these are late visceropathies.

Changes in internal organs in patients with tertiary syphilis have
inherently characteristic of syphilitic infection are endo-, meso- and
perivasculitis, up to complete obliteration of blood vessels. Particularly intense
specific pathology manifests itself in the tissues of the heart, blood vessels,
gastrointestinal tract, liver and lungs. Syphilitic lesion
heart and blood vessels often manifests as specific gummous myocarditis
and syphilitic mesaortitis. Gummous myocardial proliferations can be
isolated (like solitary skin gummas) or have the appearance of diffuse
gummous infiltration. Often these processes are combined. Symptoms
lesions have no specific features. Hypertrophy is observed
myocardium with an increase in heart size, weakening of heart sounds,
widespread pain. Diagnostics are more clearly data-driven
ECG and serological reactions; The RIF and RIBT indicators are especially important.
The aorta is affected more often than the myocardium - specific mesaortitis occurs
in patients with tertiary syphilis with a disease duration of more than 10 years. IN
the initial phase of infiltration and slight compaction of the intima and
the median membrane of the ascending part of the aortic arch thickens, which clearly
recorded on radiographs; subjective symptoms may
absent. Further stages of mesaortitis formation depend on
degree of allergic reactivity of the test organ and intensity
syphilitic lesion. With hyperergy, necrotic lesions develop
destructive changes, up to complete destruction of the aortic wall,
ending in death. For low allergic
tension, the process ends with proliferative compactions,
foci of fibrous degeneration and calcification, which is more favorable for
prognosis for life and therapeutic effect. Transition process
on the aortic valves leads to aortic insufficiency, which
manifested by pulsation of the cervical vessels, shortness of breath, nausea, increased
fatigue, secretion of rusty sputum. May also be affected
large main arteries and veins of the brain, upper and lower
limbs. They contain separately located small gummas with
their subsequent fibrous compaction or diffuse impregnation according to the type
sclerotic lesions, without destruction and necrosis.

Syphilitic aortitis is the most common form of visceral syphilis;
characterized by a difference in the pulse on both hands, a kind of “ringing”
accent of the II tone on the aorta, identification of the phenomenon of Sirotinin - Kukoverov -
systolic murmur heard above the sternum when raising the arms in
as a result of displacement of the great vessels during aortitis (Myasnikov A.L.,
1981), radiographically detectable expansion of the ascending shadow
parts of the aortic arch. Syphilitic aortic aneurysm on fluoroscopy
is found as saccular, less often fusiform, extensions with
clear pulsation (Dashtayants G.A., Frishman M.P., 1976). Necessary
exclude syphilitic aortic aneurysm in patients with upper
vena cava, flowing with compression of it, as well as the trachea and bronchi. At
X-rays reveal a large,
relatively homogeneous, without petrification, shade. To exclude often
causing the specified syndrome of malignant neoplasm
perform aortic angiography, tomography, serological
study.

Late syphilis of the gastrointestinal tract is characterized by the same
specific infiltrative foci of a tubercular-gummous nature,
reflecting the intensity of immunoallergic reactivity. Separate,
focally located tubercles or gummas can be found in the esophagus,
stomach, small and large intestine. Due to more pronounced
traumatic influence of food and enzymatic action of the gastric
contents, gummous-infiltrative processes occur more often in the esophagus
and stomach. Isolated, solitary, gumma and diffuse gumma
infiltration are formed in combination with each other or separately. In case
the occurrence of a single gumma of the esophagus or stomach is a long-term process
remains unrecognized due to the weak expression of subjective and
objective symptoms. Diffuse gummous infiltration is more often detected
in the stomach. Superficial infiltrative lesion of the mucous membrane
initially manifests itself as symptoms of gastritis with severe dyspeptic symptoms
disorders, hypacid or anacid state. Deep
infiltrative changes in the esophagus and stomach cause severe
dysphagia, digestive disorders similar to the symptoms of a tumor of these
organs.

With intestinal damage, syphilitic gummous-infiltrative elements
are localized, as a rule, in the jejunum. Symptoms of syphilitic
enteritis is very nonspecific. Diffuse proliferations that thicken the wall
small intestine, give less symptoms than focused gummas,
changing natural peristaltic movements and accompanied
obstruction phenomena (with significant infiltration). Ulcerations of gums or
gummous infiltration aggravate the process with bleeding and
peritoneal symptoms. The rectum is rarely affected in tertiary
period of syphilis. V. Ya. Arutyunov (1972) described gummous infiltration and
isolated small gummas, circularly covering the lower part of the rectum
intestines. During the period of infiltration, defecation disorders are observed, and during
ulceration and scarring, symptoms similar to severe proctitis,
characterized by less severe pain and an unusually small amount
purulent discharge. Diagnosis of syphilitic gastrointestinal
processes are complicated by false-positive CSR in tumors, as well as
difficulties in interpreting the results of x-ray examination. AND
nevertheless, the data of RIBT, RIF, anamnesis, test results
antisyphilitic treatment usually makes it possible to
correct diagnosis.

Syphilitic liver damage is observed in various forms,
caused by the localization of the proliferative process and its nodular or
diffuse in nature. In accordance with the classification of A. L. Myasnikov
(1981) among chronic syphilitic hepatitis the following are distinguished:
clinical varieties: syphilitic chronic epithelial
hepatitis, chronic interstitial hepatitis, miliary gummous
hepatitis and limited gummous hepatitis. Earliest changes
liver functions that occur in the secondary period of syphilis may
manifest as icterus, skin itching and other symptoms of acute
syphilitic hepatitis (Zlatkina A. R., 1966). As a result
rational antisyphilitic treatment or even without it, the latter
resolves, leaving altered cellular reactivity. In tertiary
the period of syphilis, when the phenomena of hyperergic reactivity increase,
Chronic epithelial hepatitis occurs secondarily or spontaneously, so
how exactly the epithelium is most reactive in infectious-allergic diseases
processes (AdoA.D., 1976). Symptoms of the disease are nonspecific: general
malaise, pain and heaviness in the liver area, anorexia, nausea, vomiting,
severe skin itching. The liver is slightly enlarged, protruding by 4-5 cm
from under the edge of the costal arch, rather dense, but painless.

Chronic syphilitic interstitial hepatitis develops
due to diffuse proliferative damage to interstitial tissue cells.
Just like epithelial hepatitis, it can form even during
secondary period as a result of direct penetration of pale
Treponem. However, interstitial hepatitis can also have
infectious-allergic nature. Even a small number of pale
Treponema, but over a long period of time, dramatically changes reactivity
cells of the interstitial tissue, and in the tertiary period it is already formed for the second time
interstitial hepatitis of a productive-infiltrative nature,
accompanied by symptoms of necrosis. For this clinical variety
characterized by intense pain in the liver area, its enlargement, density
upon palpation, but jaundice is absent in the early stages of the disease. IN
in the late period, when syphilitic cirrhosis of the liver develops,
jaundice and severe itching of the skin are added.

There is pain in the liver area, its uniform enlargement with smooth
surface. Long-term functional activity of liver cells
persists and jaundice is usually absent.

Limited gummous hepatitis, due to the formation of large nodes with
involvement of secretory and interstitial areas, accompanied
severe pain, fever, chills. Icterus of sclera and skin, others
liver function disorders are mild; in the initial stages
disease, jaundice occurs only as a result of mechanical obstruction of the bile
ducts A perifocal nonspecific zone is formed around the gumma.
inflammation. At the final stages, pronounced sclero-gummous lesions are observed.
atrophic, deforming scars.

Diagnosis of syphilitic liver damage is based on data
medical history, presence of other manifestations of syphilitic infection, results
serological research. It should be emphasized that
false positive DCS results for hepatocholecystitis, tumors
liver, alcoholic cirrhosis are observed in 15-20% of cases (Myasnikov
A.L., 1981). Therefore, crucial importance is attached to the data of RIF, RIBT and
results of trial treatment.

Syphilitic kidney damage is rare and occurs chronically.
In the secondary period of syphilis, reactive inflammatory changes
glomerular vessels spontaneously regress. In the tertiary period
as a result of the hyperergic reaction of the glomerular vascular endothelium,
miliary or large gummas, as well as diffuse infiltration. Gummoznoe
damage due to the focal nature of inflammation (nodular
infiltrates) according to the main symptoms - albuminuria, pyuria and hematuria
- similar to the blastomatous process. Syphilitic nephrosis with amyloid
or lipoid degeneration ends with nephrosclerosis. Because
amyloidosis and lipoid degeneration of the renal parenchyma are also characteristic
other chronic infections, differential diagnosis of syphilitic
kidney damage requires a careful analysis of anamnestic information,
data from the CSR, RIF and RIBT, examination results from related specialists
(for the purpose of detecting or excluding the syphilitic process, other
localization). Trial treatment for kidney damage is not recommended
since bismuth preparations are contraindicated for such patients, and
Penicillin therapy does not always resolve diagnostic difficulties.

Syphilis of the bronchi and lungs manifests itself in extremely diverse
symptoms due to the peculiar localization of gummous and
productive-infiltrative foci. Gummous seals, as single,
and multiple (miliary gummas), located more often in the lower or
middle lobe of the lung. The process manifests itself as shortness of breath, a feeling of tightness
in the chest, vague pain. Thickening of lung tissue due to syphilis
has a focal character, as with a tumor, more often it is asymmetrical. From
tuberculosis process of lung gumma is differentiated based on
well-being of patients. With syphilis, as a rule, no
febrile state, asthenia, no mycobacteria in sputum
tuberculosis. Diffuse productive-infiltrative inflammation
syphilitic etiology is often localized in the area of ​​tracheal bifurcation
or in peribronchial tissue. Lung gumma and diffuse gumma
infiltration may occur with ulceration and purulent sputum
and even bleeding (Myasnikov A.L., 1981). But a more common outcome
is fibrous compaction with the development of pneumosclerosis and
bronchiectasis. In the diagnosis of syphilitic lung lesions, the decisive factor is
What is important is the history data, the presence of a syphilitic process on
skin, mucous membranes or bones, serological results
research and sometimes trial treatment.

N. Schibli and I. Harms (1981) report tumor-like lesions
lungs with tertiary and even secondary syphilis. With radiography
chest organs reveal round retrocardial opacities
at the root of the lung. Sometimes patients with this kind of lesions simulating
tumor, undergo thoracotomy. Syphilitic nature of the lesions
lungs is established by excluding other etiologies and
positive effects of antisyphilitic therapy. However, it is also possible
simultaneous existence of syphilis and tuberculosis, gumma and tumor
lung

Syphilitic damage to the endocrine glands in the tertiary period
manifested by the formation of gummous foci or diffuse productive
inflammation. In men, gummatous disease appears to be most frequently recorded.
orchitis and gummatous epididymitis. The testicle and its epididymis enlarge
sizes, acquire a pronounced density and lumpy surface. IN
difference from orchitis and epididymitis of tuberculous etiology of pain
absent, no temperature reaction, serological reactions to
syphilis is positive, and the Pirquet and Mantoux tests are negative. Permission
process occurs with scarring phenomena. With testicular gumma it is possible
ulceration followed by the formation of a deforming scar. In women
The pancreas is more often affected, which manifests itself as dysfunction
islet apparatus and the formation of syphilitic diabetes.
Syphilitic thyroiditis is observed in 25% of patients with early forms
syphilis. E.V. Bush (1913) divided thyroid diseases into
tertiary syphilis into 3 groups: enlarged thyroid gland without
changes in function, syphilitic thyroiditis with hyperfunction and
hypofunction of the thyroid gland after cicatricial resolution of syphilitic
thyroiditis. V.M. Kogan-Yasny (1939) divided syphilitic thyroiditis
into early and late forms. In the secondary period of syphilis there is
diffuse enlargement of the thyroid gland with hyperfunction. In tertiary
period, a gummous or interstitial lesion develops with
subsequent scarring. As an example of a specific lesion
We present an observation of the thyroid gland. Complete restoration of the structure
any endocrine gland does not occur after treatment, and therefore
syphilitic endocrinopathies are not accompanied by recovery
functional activity of the gland.

Prevention of visceral syphilis.

Prevention of visceral syphilis involves its timely
diagnosis and early comprehensive treatment, since visceral forms
are a consequence of inadequate treatment of active forms of syphilis or
its complete absence.

Since strictly pathognomonic signs characteristic of syphilitic
There are no visceral lesions; diagnosis should be guided by
complex of clinical and laboratory data, dynamics of clinical changes
under the influence of specific therapy, widely using the complex
serological reactions: RIT, RIF, RPGA, ELISA.PCR.

Research in therapeutic, surgical,
obstetric-gynecological, neurological profile is appropriate
carry out with serological reactions. Comprehensive examination
persons with syphilis at the end of treatment and upon deregistration
serves to prevent visceral syphilis. It consists of
in-depth clinical examination with
X-ray, according to indications of cerebrospinal fluid and ECG studies
in order to assess the usefulness of the treatment. Targeted
Therapeutic examination is also indicated for patients with neurosyphilis, in
which often reveal specific lesions of internal organs.

For timely diagnosis of visceral syphilis it is very important
active detection of latent forms of syphilis, which in 50-70% of cases
entail the possibility of late specific lesions of internal
organs. In order to timely identify early forms of visceral
syphilis is used 100% examination of patients in therapeutic,
neurological, psychoneurological, surgical hospitals,
ENT departments with RV staging. Submitted by M. V. Milich, V. A. Blokhin
(1985), positive serological reactions are found in 0.01%
examined in somatic hospitals, and they are more likely to have
late forms of syphilis: late late - in 31%, unspecified latent -
in 11.5%, late neurosyphilis - in 3.6%, late visceral - in 0.7%.

References:

1.Rodionov A.N. Syphilis 2nd ed. Published: 2000, St. Petersburg

2.Rodionov A.N. Handbook of skin and sexually transmitted diseases.2
ed.

Published: 2000, St. Petersburg

Harrison's Handbook of Internal Medicine 1st ed. 2001, St. Petersburg.

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16 Oct 2010

Visceral syphilis

Lesions with syphilis can develop in any organs and systems of the patient. These
changes are inflammatory or dystrophic in nature, may be asymptomatic or
manifest themselves in various functional disorders. Any specific clinical picture
There are no syphilitic lesions of internal organs. The diagnosis is made based on
positive serological reactions, as well as in the presence of syphilitic rashes on the skin and mucous membranes
shells.

Early visceral syphilis

Lesions of internal organs that occur with secondary, early latent, less often with
Primary syphilis usually proceeds favorably and responds well to specific treatment.

Damages of the cardiovascular system. Syphilitic myocarditis Maybe
be asymptomatic and detected only on an electrocardiogram or manifest as pronounced
functional disorders. In a significant proportion of patients, the electrocardiogram shows
nonspecific changes in the P, Q waves and ST segment. Patients complain of fatigue, general
weakness, shortness of breath, dizziness, body temperature may rise. Blood pressure
moderately reduced, the borders of the heart may shift to the left, sounds are muffled, and arrhythmia appears.
An objective sign of cardiac damage is a systolic murmur at the apex. Possible development
pericarditis and endocarditis.

Syphilitic aortitis is asymptomatic. When localizing the process at the beginning
In the ascending aorta, aortic and mitral valve insufficiency often develops.
Specific compaction of the ascending aorta can develop very early, already in the primary
period.

Damage to the digestive tract. Liver damage is early
a symptom of visceral syphilis. Clinically, this can manifest itself as functional liver disorders,
an increase in its size, yellowness of the sclera. In anicteric forms of syphilitic hepatitis, clinical
the only sign is an enlargement and hardening of the liver, often with simultaneous enlargement of the spleen.
It is quite rare to observe a picture of acute hepatitis with jaundice, reminiscent of infectious
hepatitis. The liver is enlarged, painful, and its function is impaired. Often it also increases
spleen, the level of bilirubin increases in the blood, and bile pigments and urobilin in the urine. Often
high body temperature and headaches are noted.

Unlike infectious hepatitis, patients have no or mild
preicteric dyspeptic disorders. Serological reactions in the blood of these patients, as a rule,
sharply positive, which, along with other symptoms of syphilis, makes it possible to determine the etiology of hepatitis.
Most authors note that acute syphilitic hepatitis develops after 6-8 months. after
infection. It is favored by alcohol abuse, poor nutrition, and concomitant
diseases.

Stomach damage occurs both in secondary fresh and recurrent
syphilis. The main clinical manifestations of specific gastric damage are transient
gastropathy, acute gastritis and syphilitic gastric ulcer. Syphilitic gastritis is caused by
the occurrence of foci of specific inflammation on the gastric mucosa, which, when
Fluoroscopy can simulate a peptic ulcer or gastric neoplasm. With functional
stomach disorders, patients complain of periodic pain in the epigastric region, nausea,
belching, loss of appetite, weight loss, feeling of fullness in the stomach after eating. Syphilitic gastritis
characterized by a decrease in the acidity of gastric juice, an increase in ESR, a positive reaction to
occult blood in the stool. The diagnosis is established on the basis of a comprehensive examination of patients,
including serological, radiological, fibrogastroscopic and histological methods.

Kidney damage is detected most often at the beginning of the secondary period of syphilis. It
may manifest as asymptomatic renal dysfunction, benign proteinuria,
specific lipoid nephrosis and glomerulonephritis. The only symptom of benign
Proteinuria is the presence of protein in the urine (0.1-0.3 g/l). Specific lipoid nephrosis occurs in two
types: acute and chronic. During the course of the disease, the urine is cloudy, is excreted in small quantities, and has
high density (up to 1.040 and higher), protein content in urine exceeds 2-3 g/l. The sediment contains cylinders,
leukocytes, epithelium, erythrocytes are rare and in small quantities. Blood pressure is not
increases, no changes are noted in the fundus. Latent nephrosis develops slowly,
manifested by moderate albuminuria and minor edema. Syphilitic nephritis in the clinic
resembles infectious glomerulonephritis. Kidney damage is based on primary damage to small
vessels, gradual death of the glomeruli and progressive shrinkage of the kidney.

Respiratory damage with secondary syphilis it is observed very rarely. They can
Acute bronchopneumonia, interstitial pneumonia, dry bronchitis may occur. Diagnosis of interstitial
pneumonia is diagnosed radiographically. The infiltrate in the lungs can have different sizes,
sometimes be massive, resembling a tumor. Clinical diagnosis of early pulmonary syphilis is very
difficult. Often the diagnosis is made retrospectively, especially in the absence of manifestations of syphilis on
skin.

Late visceral syphilis

Most often, with late visceral syphilis, the cardiovascular system is affected.
system (90-94%), less often the liver (4-6%) and other organs.

Damage to the cardiovascular system. Most often in late forms of syphilis
the aorta is affected, less often the myocardium, and their simultaneous damage is possible.

Syphilitic aortitis may be uncomplicated or accompanied by narrowing
coronary artery ostia, aortic valve insufficiency and aortic aneurysm. It is believed that
pathological changes occur mainly in its middle part and the process is diagnosed as
mesaortitis. The foci of specific infection that arise in it are subsequently replaced by connective tissue.
tissue, which leads to deformation of the inner shell. The ascending aorta is most often affected, others less frequently
its departments.

Syphilitic aortitis is the most common form of visceral syphilis. Syphilitic
uncomplicated aortitis (the so-called Dele-Geller disease) proceeds for a long time without
subjective feelings. One of the early and characteristic signs is chest pain, which
occurs in paroxysms and radiates like angina or persists for a long time, without reaching a major
intensity. Pressing or burning pain appears mainly at night.
Objectively, expansion of the ascending aorta, determined by percussion, auscultation and
radiographically. With syphilitic aortitis, in most cases the orifice is affected
both coronary arteries - syphilitic aortitis, complicated by stenosis of the mouths of the coronary arteries.
The process develops slowly, varies from slight narrowing to complete obliteration of one or two
ostia, resulting in a decrease in coronary blood flow, which, in turn, entails a violation
blood supply to the myocardium. In addition to the pain symptom in aortitis complicated by stenosis of the coronary orifices
arteries, angina syndrome is observed, initially - angina pectoris, later -
peace. Symptoms of progressive heart failure gradually develop, which is associated with
development of dystrophic and sclerotic changes in the heart muscle due to progressive
narrowing of the coronary arteries.

Syphilitic insufficiency of the aortic valves resulting from
expansion of the affected aorta, in the early stages it is asymptomatic. The most characteristic sign
This defect is aortalgia and true angina. Low diastolic pressure is noted.
Shortness of breath develops. Other symptoms may also occur, such as symptomatic hypertension,
hypertrophy and dilatation of the left ventricle with pronounced pulsation.

Aortic aneurysm is one of the outcomes of untreated or poorly treated
syphilitic aortitis. Due to the destruction of muscle or elastic fibers, mainly in
ascending part and arch of the aorta, an aneurysm develops. It has either a diffuse spindle-shaped shape,
or forms a sac-like protrusion, connecting to the aorta with a narrow opening. Often an aneurysm
grows, compressing the mediastinal organs, and eventually ruptures.

Clinical manifestations depend on the dysfunction of the organs being compressed
aneurysm. With pressure on the mediastinum, shortness of breath and a rough cough appear. When compressing the return
nerve, paralysis of one or another vocal fold and aphonia may occur. Compression of the trachea or bronchus leads to
to the development of stenotic breathing. Pressure of the sympathetic nerve causes anisocoria and retraction of the eye
apple Vein dilatation, cyanosis and swelling of the upper body are observed when the superior vena cava is compressed
veins. Pressure on the esophagus causes dysphagia.

An early symptom is pain in different places of the chest, depending on
location of the aneurysm, however, there are cases of asymptomatic disease. Pulse on the radial
artery appears to be different in both arms in terms of filling and time of appearance. Arterial
the pressure does not increase. The diagnosis of an aneurysm is confirmed by x-ray.

Syphilitic myocarditis It is rare and can occur independently
manifestation of late visceral syphilis or as a complication of aortitis. The disease manifests itself
the formation of gummas or chronic interstitial (gummy) myocarditis.

Liver damage usually develops 5-20 years after infection. Distinguish
four forms of late syphilitic hepatitis: focal gummous, miliary gummous and
chronic epithelial. All forms are characterized by a long process with gradual
the development of sclerogummous changes leading to cirrhosis and liver deformation. Syphilitic
hepatitis often occurs with an increase in body temperature, which can be low-grade, sometimes
remitting and even intermittent. Rise in temperature is combined with severe chills. For a long time
During the course of syphilitic hepatitis, a decrease and shrinkage of the liver is observed, ascites appears,
Collateral veins are formed (atrophic Laennecian cirrhosis of the liver). The patient's well-being
worsens, anemia, malnutrition appear, and cachexia develops. Syphilitic chronic
epithelial hepatitis is characterized by general malaise, pain and heaviness in the liver area,
anorexia, nausea, vomiting, severe skin itching. The liver is slightly enlarged, protruding by 4-5 cm
from under the edge of the costal arch, rather dense, painless. Jaundice is an early symptom of epithelial
hepatitis. Syphilitic chronic interstitial hepatitis is characterized by intense
pain in the liver area, its enlargement, density on palpation, absence of jaundice in the early stages
diseases. Subsequently, when syphilitic cirrhosis of the liver develops, jaundice and
severe itching of the skin. Miliary gummous and limited gummous hepatitis is characterized by the formation
nodular infiltrates. Liver hypertrophy in gummous hepatitis is uneven,
tuberosity, lobulation. Miliary gummas are smaller in size than with limited gummous
hepatitis, are located around blood vessels and affect liver tissue less. Miliary gummous hepatitis
manifested by pain in the liver area, its uniform enlargement with a smooth surface. Functional
Liver cell activity persists for a long time, and jaundice is usually absent. Limited
gummous hepatitis, due to the formation of large nodes involving secretory and interstitial
areas, accompanied by severe pain, fever, chills. The icterus of the sclera and skin is pronounced
insignificant.

Antibiotic therapy gives a beneficial effect in the early stages of syphilitic
hepatitis. In advanced cases, the process ends in cirrhosis of the liver.

Kidney damage may be in the form of amyloid nephrosis, nephrosclerosis and gummous
processes (limited nodes or diffuse gummous infiltration). The first two forms are clinically
are no different from similar lesions of other etiologies. The diagnosis is established only on
based on other manifestations of syphilis, medical history and positive serological reactions. Most
Rarely isolated gummas or diffuse gummatous infiltrate penetrating the renal
textile. In this case, protein and casts appear in the urine, sometimes the disease is accompanied by
paroxysmal pain in the lower back. The sclerotic process in the kidney leads to increased
blood pressure, hypertrophy of the left ventricle of the heart, impaired water metabolism and increased
residual nitrogen.

Lung damage expressed in the formation of individual gummas or peribronchial
gummous infiltration. They may dissolve or disintegrate to form cavities. Lung gummas,
ranging in size from a pea to a hazelnut or more, are located mainly in the middle and lower parts, which
distinguishes syphilis from tuberculosis. In addition, one should take into account the relatively good general
condition of patients with syphilis, negative results of tests for tuberculosis, positive
serological reactions.

VISCERAL SYPHILIS The clinical picture of diseases of internal organs affected by a syphilitic infection does not manifest any specific symptoms characteristic only of syphilis. The diagnosis is established based on the detection of lesions of the skin and mucous membranes and positive serological reactions in the blood. In the vast majority of cases, visceral syphilis responds well to antisyphilitic therapy.

Early visceral syphilis Lesions of the cardiovascular system Lesions of the digestive tract. Stomach damage Kidney damage Respiratory system damage Syphilis damage to the thyroid gland

Damages of the cardiovascular system Syphilitic myocarditis is one of the most common forms of early cardiovascular syphilis. It can be either asymptomatic and detected only electrocardiographically, or with severe functional disorders. Patients complain of easy fatigue, general weakness, shortness of breath, dizziness, and body temperature may rise. An objective sign of cardiac damage is a systolic murmur at the apex.

Syphilitic aortitis. v. Specific thickening of the ascending aorta can develop very early, already in the primary period of syphilis. v Clinically, the disease is asymptomatic. v When syphilitic aortitis is localized in the initial part of the ascending aorta, aortic valve insufficiency often develops, then the mitral valve is affected. v. A rare manifestation of early visceral syphilis is obliterating endarteritis of the coronary arteries, which can cause myocardial infarction.

LESIONS TO THE DIGESTIVE TRACT ORGANS. Liver damage is an early symptom of visceral syphilis and usually occurs at the onset of the disease as a manifestation of syphilitic septicemia. Clinically, liver syphilis can manifest itself as a violation of its function, an increase in size, and yellowness of the sclera; in anicteric forms, only enlargement and hardening of the liver with simultaneous enlargement of the spleen. Very rarely, acute syphilitic hepatitis with jaundice, reminiscent of Botkin's disease, is observed. Most often it develops 6–8 months after infection. the occurrence is facilitated by poor nutrition, alcohol abuse, and concomitant diseases (malaria, influenza, etc.). The pathological process is concentrated in the epithelial tissue of the liver.

LESIONS TO THE DIGESTIVE TRACT ORGANS Syphilitic hepatitis differs from Botkin's disease in less severe severity. The liver is enlarged and painful, and the spleen is often enlarged. The content of bilirubin in the blood is increased, the amount of bile pigments in the urine; liver functions (antitoxic, carbohydrate, etc.) are impaired. The course of syphilitic jaundice is favorable. It responds well to specific therapy and resolves after 2–3 weeks. Acute yellow liver dystrophy is practically never encountered at present.

Stomach damage Stomach damage occurs in both secondary fresh and secondary recurrent syphilis. The main clinical manifestations of specific damage to the stomach are transient gastropathy, acute gastritis and syphilitic gastric ulcer. Syphilis can aggravate the course of concomitant nonspecific gastric disease. In some cases, syphilitic lesions simulate a malignant tumor of the stomach. Transient gastropathy is characterized by transient functional disorders, accompanied by nausea, belching, loss of appetite, and decreased acidity of gastric juice.

Damage to the stomach Syphilitic gastritis (“early gastrosyphilis”) is manifested by more pronounced dyspeptic disorders, loss of appetite and body weight, weakness Visceral syphilis of hydrochloric acid in the gastric contents, increased ESR, a positive reaction to occult blood in the feces, an admixture of fresh blood in the vomit. Syphilitic gastritis is caused by the occurrence of foci of specific inflammation on the gastric mucosa, which, with fluoroscopy, can sometimes simulate a peptic ulcer or gastric neoplasm. Syphilitic gastric ulcer is characterized by night pain against the background of hypo and anacid gastritis, frequent vomiting of unchanged blood. In some cases, the clinical picture of gastric syphilis is combined: a mixed symptom complex of gastritis, peptic ulcer and tumor process is observed.

Kidney damage is detected, as a rule, at the beginning of secondary fresh syphilis. It can be observed in the form of asymptomatic renal dysfunction, determined by the results of radionuclide renography; benign proteinuria, syphilitic lipoid nephrosis and glomerulonephritis. The only symptom of benign proteinuria is the presence of protein in the urine (0.1–0.3 g/l). Syphilitic lipoid nephrosis is observed in two variants: acute and latent. In acute lipoid nephrosis, the patient's skin appears pale and swollen. Urine is cloudy, excreted in small quantities, has a high relative density (up to 1,040 or more); the amount of protein in urine usually exceeds 2–3 g/l. The sediment contains casts, leukocytes, epithelium, and fat droplets; red blood cells are rare in small numbers. Blood pressure is not elevated, the fundus is normal. Latent nephrosis develops slowly, sometimes a considerable time after infection, and is manifested by moderate albuminuria and minor edema. Specific nephritis is diagnosed as membranous tubulopathy and infectious glomerulonephritis. Kidney damage is based on primary damage to small vessels, gradual death of the glomeruli and progressive shrinkage of the kidney.

Lung damage ØDamage to the respiratory system in early syphilis is extremely rare. Ø Acute bronchopneumonia, interstitial pneumonia, dry syphilitic bronchitis may occur. Ø Syphilis of the respiratory system develops slowly. Ø Symptoms of bronchitis occur, a cough with sputum appears, sometimes low-grade body temperature and progressive shortness of breath. ØAcute bronchopneumonia of syphilitic etiology is similar in its onset to the same forms of tuberculous and nonspecific pneumonia. Acute syphilitic bronchopneumonia can acquire a subacute course with the formation of persistent pathological changes in the lung parenchyma and bronchial tree. ØThe diagnosis of interstitial pneumonia is established radiologically. ØInfiltrate in the lungs can have different sizes, sometimes be massive. Ø In such cases, it must be differentiated from a tumor. ØClinical diagnosis of early pulmonary syphilis is very difficult. ØThe diagnosis is often made retrospectively, especially in the absence of manifestations of syphilis on the skin and mucous membranes. ØThe main diagnostic criteria are the results of serological studies over time, the general satisfactory condition of the patient, the rapid therapeutic effect of antisyphilitic drugs

Damage to the thyroid gland Syphilis damage to the thyroid gland is rare and is characterized by tachycardia and the appearance of low-grade body temperature. Cases of diabetes insipidus of syphilitic etiology have been described.

Late visceral syphilis In the tertiary period of syphilis, limited gummas or gummous infiltrations may occur in all internal organs, and various degenerative processes and metabolic disorders are observed. Most often, late syphilis affects the cardiovascular system (90-94%), less often the liver (4-6%) and other organs - lungs, kidneys, stomach, intestines, testicles (1-2%).

Late syphilis of the cardiovascular system v. With late syphilis, the aorta is most often affected, less often the myocardium, and simultaneous damage to the aorta and myocardium is possible. v. Welch first described an aortic aneurysm in patients with syphilis in 1875, and in 1905 Reuter discovered a pale treponema in the aortic wall of an aneurysm. v. In untreated patients with syphilis observed in the clinic of Professor C. Boeck, late syphilis of the cardiovascular system developed in 10% of cases: aortic insufficiency in 5.3%, aortic aneurysm in 2.5%, aortic stenosis in 0.5% . v. In 0.3% of patients, uncomplicated syphilitic aortitis was discovered after death. Cardiovascular syphilis develops almost exclusively in patients with acquired syphilis 15–30 years after infection. v Uncomplicated syphilitic aortitis is complicated by aortic insufficiency and aortic aneurysm within 3–5 years. v. Aortic aneurysm occurs 6 times more often in men

Syphilitic aortitis (mesaortitis) is the most common manifestation of late cardiovascular syphilis. It can be uncomplicated (aortitis symplex) or accompanied by narrowing of the coronary artery ostia, aortic valve insufficiency and aortic aneurysm. The medial layer of the aorta is primarily affected. The foci of specific infection that arise in it are subsequently replaced by connective tissue, which leads to deformation of the inner shell, acquiring a shagreen appearance. The ascending aorta is most often affected. The mouths of the coronary vessels of the heart that open here are often affected by the syphilitic process, which only very rarely spreads throughout the vessel. The gradual destruction of the muscle and elastic fibers of the medial tunic of the aorta leads to its diffuse or saccular expansion.

Clinical picture. Clinical picture. For a long period of time, the patient may not experience any discomfort. The first symptom that makes you seek help is pain. It has a different character, it either occurs in paroxysms and radiates, like angina, or lasts for a long time, without reaching great intensity. Angina-type pain indicates damage to the mouths of the coronary vessels; constant pain (“aortalgia”) appears to be a consequence of syphilitic neuritis. An objective examination by percussion and especially by radiography reveals expansion, more often of the ascending part, less often of the arch, and even less often of the descending part of the aorta. During auscultation on the aorta, as a rule, a systolic murmur and an accent of the second tone with a metallic tint are heard. Pulse - no change. Further development of the clinical picture depends on the preferential localization of the process. If damage to the coronary vessels of the heart predominates, then, along with attacks of angina pectoris, attacks of cardiac asthma appear, occurring against the background of ever-increasing cardiovascular insufficiency. If the process is concentrated in the area of ​​the aortic valve apparatus, then a picture of aortic valve insufficiency gradually develops. Syphilitic aortic valve insufficiency is never combined with stenosis of the aortic mouth and, as a rule, has an unfavorable course (often decompensated) and is accompanied by pain. Subsequently, mesaortitis can lead to the development of an aortic aneurysm, which differs from aortitis only in the degree of expansion of the aorta

Aortic aneurysm Aortic aneurysm is one of the outcomes of untreated or poorly treated syphilitic aortitis. The aortic wall, devoid of a significant amount of muscle and elastic fibers of the tunica media, is stretched under the influence of blood pressure. Due to this, an aneurysm develops mainly in the ascending part and arch of the aorta. The aneurysm either has a diffuse fusiform shape or forms a sac-like protrusion connected to the aorta by a narrow opening. Growing in all directions, the aneurysm gradually loses the structure of the aortic wall and turns into a connective tissue sac, often filled with thrombotic masses. Blood clots can be a source of embolism; in rare cases, organizing and turning into a dense mass, they can lead to neglect of the aneurysmal cavity and spontaneous healing of the aneurysm. More often, an aneurysm grows, compresses the mediastinal organs, leads to the destruction of cartilage and bones, and eventually ruptures.

Clinical picture v. The clinical picture depends on the dysfunction of the organs compressed by the aneurysm. v. With pressure on the mediastinum, shortness of breath and a rough cough appear. v When the recurrent nerve is compressed, paralysis of one or another vocal fold and aphonia may occur. v. Compression of the trachea or bronchus leads to the development of stenotic breathing. Pressure of the sympathetic nerve causes anisocoria and retraction of the eyeball. v. Vein dilatation, cyanosis and swelling of the upper body are observed when the superior vena cava is compressed. Pressure on the esophagus causes dysphagia. v An early symptom is pain in different places of the chest, depending on the direction of growth of the aneurysm. v. There are, however, cases of asymptomatic aneurysm that reaches large sizes, destroying the sternum and ribs. When examining the chest, a pulsating tumor and the development of a vein in the chest along the line of attachment of the diaphragm are sometimes detected. v. The pulse on the radial artery, depending on the location of the aneurysm, is different in both arms in terms of filling and time of appearance. v. Blood pressure is not increased. v. The diagnosis of aneurysm is confirmed by x-ray. v. Syphilitic aneurysms differentiate from chest tumors, and the results of a serological examination of the patient for syphilis help.

Syphilitic myocarditis can occur as an independent manifestation of visceral syphilis or as a complication of aortitis. They are manifested by the formation of gummas or chronic interstitial myocarditis (gummy myocarditis). Heart gummas are extremely rare and can be asymptomatic. The most common clinical signs of gummous myocarditis are shortness of breath, general weakness, fatigue, and sometimes heart pain. Blueness of the skin, dilatation of the heart, and rhythm disturbances are noted. Syphilitic gummous myocarditis is usually accompanied by positive serological reactions. Gummy endo and pericarditis are extremely rare.

Kidney damage Kidney damage can be in the form of amyloid nephrosis, nephrosclerosis and gummous processes (limited nodes or diffuse gummous infiltration). The first two forms are clinically no different from similar lesions of other etiologies; the diagnosis is established only on the basis of concomitant manifestations of syphilis, medical history and positive serological reactions. Limited gummous nodes occur under the guise of tumors and are difficult to recognize. In this case, swelling appears, blood, protein, and casts are found in the urine. The disease is sometimes accompanied by paroxysmal pain in the lower back. When the gumma disintegrates and the contents rupture into the pelvis, thick, turbid, brown urine with a copious sediment of red blood cells, leukocytes, and cellular detritus is released. The sclerotic process in the kidney leads to increased blood pressure and hypertrophy of the left ventricle of the heart.

Lung damage v. Lung damage is expressed in the formation of either individual gummous nodes simulating tumors, or diffuse gummous peribronchial infiltration followed by fibrosis, as well as in the form of scattered small gummous foci. v The process is usually localized in the lower and middle lobes of the right lung, which distinguishes syphilis from pulmonary tuberculosis. v. In addition, in the differential diagnosis of syphilis and tuberculosis, one should take into account the general good condition of patients with syphilis, the absence of Mycobacterium tuberculosis in the sputum and positive serological reactions in the blood. v. It is more difficult to distinguish a limited gumma from a lung tumor. v. A correct diagnosis can sometimes only be made after a trial of treatment. Gummas of the bifurcation of the trachea and large bronchi can lead to the development of stenosis with a fatal outcome.

Lesions of the stomach and intestines 1. Lesions of the stomach and intestines are characterized by diffuse gummous infiltration of the wall or the formation of limited gummous nodes. 2. Clinical symptoms resemble a stomach tumor. 3. With syphilis of the stomach, severe dyspeptic disorders, loss of body weight are noted, and an X-ray examination reveals a filling defect or a “niche” symptom (with the disintegration of single gummous nodes). 4. In patients with gastric syphilis, as well as cancer, gastric secretion is reduced. The disintegration of gumma is similar to the disintegration of a tumor and can lead to deformations of the stomach (two-cavity, multi-cavity stomach) or diffuse fibrous wrinkling. 5. The following signs to a certain extent speak against cancer and indicate gastric syphilis: a higher location of the tumor, diffuse infiltration of the stomach walls and a relatively good general condition of the patient with a large filling defect.

Isolated syphilis of the spleen Lesions of the esophagus and intestines are rare. Both diffuse and limited processes develop. Intestinal syphilis in the initial period has symptoms of enteritis. As gummous nodes resolve, scars form, which lead to stenosis of the esophagus and intestines.

Isolated syphilis of the spleen is extremely rare in the form of limited gummous or diffuse interstitial splenitis.

Testicular damage is characterized by the appearance of limited gummous nodes or diffuse infiltration in the parenchyma of the organ. ü The affected testicle enlarges, becomes dense and heavy. ü With a limited form, the surface of the testicle is lumpy, ü with a diffuse form - smooth, even. üPalpation is painless. üThe feeling of heaviness as a result of stretching of the spermatic cord is disturbing. Limited gummas can be opened through the skin of the scrotum. üResolution of diffuse gummous infiltrate leads to testicular atrophy

Diagnosis of late visceral syphilis is very difficult. Patients usually experience damage to several organs and the nervous system. Syphilitic damage to one organ often entails a pathogenetically associated disorder in the function of other organs. These secondary diseases can hide the syphilitic nature of the main process. Diagnosis is made difficult by the absence in the medical history of 75–80% of patients of indications of syphilis in the past. Standard serological blood tests are positive in 50–80% of patients, RIT and RIF - in 94–100%. In addition, in patients with active visceral syphilis, serological reactions, including. RIT and RIF may be negative. In doubtful cases, trial therapy (therapy ex juvantibus) should be used as a diagnostic technique.

Literature Rodionov A. N. Syphilis 2nd ed. Published: 2000, Peter. , Rodionov A.N. Handbook of skin and sexually transmitted diseases, 2nd ed. Published: 2000, Peter. , Martin J. Isselbacher K, Braunwald E, Wilson J, Fauci A, Kasper D. Harrison's Handbook of Internal Medicine 1st ed. 2001, St. Petersburg, “Clinical course and methods of diagnosis of urogenital chlamydia” Recommended literature: E. G. Bochkarev, M. A. Bashmakova, A. M. Savicheva. “Chlamydia. Modern approaches to diagnosis and treatment. A manual for doctors." Moscow, 2000. , Batkaev E. A., Lipova E. V. “Treatment of genital herpes and urogenital chlamydia. Training manual". M.: Publishing house RMAPO Ministry of Health of the Russian Federation. -1999, -22 p. , Kisina V.I., Bednova V.N., Pogorelskaya L.V., Vasiliev M.M. et al. “Tactics of examination and treatment of patients with infectious urogenital diseases complicated by dysbacteriosis. A manual for doctors." – M.: -1996. , Serov V.N., Krasnopolsky V.I., Delectorsky V.V. et al. “Chlamydia. Clinic, diagnosis, treatment. Methodological recommendations". –M. : -1997. , -23 s.