≡× MENU

• Water supply
• Pumps
• Water purification
• Wells
• Filters

Syphilis. Syphilitic papules: varieties, symptoms and features Secondary fresh syphilis is characterized by the appearance

Secondary syphilis develops after a period of primary syphilis due to the spread of the pathogen through the circulatory system to various parts of the body. Spirochetes spread through the vessels, settle in various organs and tissues. The first signs of hematogenous spread of treponema can be detected on the skin and mucous membranes within 1.5-2 months after the onset of a hard chancre (primary syphiloma). Often, simultaneously with the first signs of secondary syphilis, you can see pigmentation or a scar at the site of the chancre and signs of complications of primary syphilis (phimosis, paraphimosis, and others).

General signs of secondary syphilis

The beginning of secondary syphilis is the appearance on the skin and mucous membranes of various specific rashes. The elements are diverse, but you can identify a pattern in the appearance of a rash and its general properties:

1. the rash spreads everywhere, dissemination of the process is characteristic of secondary syphilis;
2. benign course: the rash gradually disappears without destruction of the skin and mucous membranes;
3. no increase in body temperature;
4. the rash appears on healthy skin and is clearly demarcated from it;
5. elements are not accompanied by subjective sensations (itching, pain, paresthesia);
6. red shades of the rash (cherry, copper-red, cyanotic and others);
7. difference in the shape and size of the rash;
8. high contagiousness of erosive and ulcerative elements, that is, the ability to infect other people;
9. independent disappearance of foci of rash;
10. positive serological reactions (Wassermann reaction).

The course of the disease is undulating, there are three periods of secondary syphilis: fresh (early), recurrent (relapse), latent period. In the absence of therapy, the rashes disappear in 2-10 weeks, and after a while they reappear. With the progression of the process, subsequent waves of rashes have characteristic features:

1. the number of rashes decreases with each new episode;
2. an increase in the size of the elements with each relapse;
3. elements of the rash are grouped with the formation of various figures;
4. the rash is localized mainly in places of friction and pressure.

Elements of secondary syphilis of the skin and mucous membranes are called secondary syphilides and are divided into groups: papular, spotty (roseolous) and pustular. In addition, with secondary syphilis, there is a violation of pigmentation and.

Roseolas are rounded vascular formations up to 1 cm in diameter and spread along the lateral surface of the body. The border of the spots is indistinct, they are flat, do not rise above the surface of the skin. The color of the elements varies from bright red in the first episode to pale pink in subsequent waves of rashes. The spots become brighter with friction, taking vasodilators, and disappear with pressure. If roseolas exist for more than 3 weeks, hemosiderin is deposited in them, and they darken, become brownish, cease to disappear when pressed.

In addition to the classic version of the roseolous rash, the following rare varieties are distinguished:

1. Elevated (exudative, elevating, urticarial) roseola is characteristic of the first episode of secondary syphilis. The spots rise above the surface of the skin and resemble an allergic rash with hives. But roseola, unlike allergic elements, is not accompanied by itching.
2. Peeling roseola differs from the classic one by the presence of foci of peeling on the surface.
3. Follicular (dotted, granular) roseola is characterized by the appearance of small red nodules on the surface at the mouths of the hair follicles.
4. Confluent roseola appears when there is a profuse rash during the first episode of secondary syphilis. The elements of the rash coalesce to form large erythematous patches.

Papular rash

Papular rash with marginal peeling ("Biette's collar")

Papules in secondary syphilis are characterized by a dense texture, slightly rise above the surface of the skin. The size varies from small, miliary papules (1-2 mm) to nummular (1-3 cm in diameter) and plaque-like (more than 3 cm) elements. The papular rash also differs in color: from pink-red to cyanotic. At the beginning, the surface of the rash is smooth, as it develops, peeling appears in the focus. Hyperkeratosis in the center of the rash element gradually disappears, and peeling is localized only on the periphery of the plaque. This is how a sign characteristic of secondary syphilis is formed - "Biett's collar". With the spread of papules in the marginal zone of hair growth on the head, another well-known symptom of secondary syphilis is formed - the “crown of Venus”. A papular rash spreads to any part of the body, with the first wave of secondary syphilis, the foci do not merge or group.
There are also atypical forms of papular rash:

1. Seborrheic papules are characterized by the appearance of yellowish crusts on the surface of the foci, and the elements themselves are localized on the “seborrheic” areas of the skin: on the cheeks, in the frontal region, on the nose and chin. Rashes tend to merge and form large affected areas.
2. Psoriatic papules are similar to psoriatic plaques due to large whitish scales. The lesions do not merge and are not prone to peripheral growth.
3. Cockade papular syphilis is characterized by the appearance of a large papule, around which small child elements appear.
4. A blasting syphilis is formed when small papules are randomly scattered around a large focus.
5. Macerated (erosive) papules are usually localized in large folds of the skin, in the perianal region and between the fingers. These lesions often merge, forming large defects with scalloped edges.
6. Wide (vegetative) warts are formed at the site of erosive papules. These are foci with an uneven surface, prone to peripheral growth.
7. Palmar-plantar syphilis is distinguished by the localization of groups of papules on the palms and feet.

Often, secondary syphilis is manifested by a mixed roseolous-papular rash.

Pustular rash

This type of rash today occurs only with significant violations of the body's immune defenses (with HIV infection) and accompanies the severe course of syphilis. Rash elements can exist without changes for more than 3 months.

There are several types of pustular rash in secondary syphilis:

1. Impetigious syphilide is formed on the scalp, facial and pubic areas. On the surface of dark red or copper-colored papules, pustules with a thin cover appear within 3-4 days, along the periphery of which an infiltration rim remains. Pustules are opened, purulent erosions remain in their place.
2. Smallpox syphilide is hemispherical elements up to 1 cm in size with an umbilical depression in the center and a rim of hyperemia. As the syphilide ages, a purulent crust forms on its surface, which persists for 1.5 months.
3. Syphilitic ecthyma - the formation of an infiltrate occurs against the background of symptoms of general intoxication and an increase in body temperature, which is not typical for classical secondary syphilis. In the center of the infiltrate, a focus of tissue breakdown is formed with bloody clots, which transform into brown crusts. Ecthyma tends to grow peripherally and spread deep into the skin; as it heals, it is replaced by scar tissue.
4. The syphilitic rupee is a severe form of syphilitic ecthyma. The lesion is prone to rapid growth and spread into the deeper layers of the skin. After the process is resolved, pigmented scars remain.

Pigmentation disorders

Syphilitic leucoderma is called foci of lack of pigmentation on the skin. The spots are located on the back of the neck, forming the "necklace of Venus".

The disappearance of the pigment is temporary, the foci can remain on the skin for about six months. The reason for the decrease in skin pigmentation is the possible effect of treponema on the nerve plexus of the neck, the elements of which are responsible for the regulation of melanin formation.

Syphilitic alopecia

With syphilis, there are two types: small-focal and diffuse. The cause of small-focal baldness is considered to be the influence of toxins from the causative agent of syphilis on the hair follicles. With this type of alopecia, the hair on the head and eyebrows falls out in rare tufts, resembling "moth-eaten fur." A characteristic sign of syphilis is the loss of eyelashes - a sign of Pinkus, in which eyelashes of normal length alternate with short ones.

The cause of diffuse alopecia is the toxic effect of treponema on the hypothalamus, the autonomic nervous and endocrine systems responsible for hair nutrition. In this case, the patient loses all hair on any part of the body. There is also a mixed type of alopecia, in which both forms of alopecia are observed.

Under the influence of therapy, the hairline is restored within 2 months.

Mucosal damage

Rashes on the mucous membranes in secondary syphilis are important for the diagnosis of the disease. In addition, the elements of the rash, localized on the oral mucosa, contribute to the rapid transmission of the pathogen from one person to another when kissing, using common cutlery and hygiene products.

Treponema attacks the palatine tonsils (syphilitic angina), the larynx, the surface of the tongue and the inner surface of the cheeks. In this case, there may be hoarseness of the voice, swelling of the palatine tonsils without pain when swallowing.

Damage to internal organs

Hematogenous distribution of treponema leads to inflammatory reactions in all internal organs: to gastritis, hepatitis, nephritis, unexpressed inflammation of the meningeal membranes and other diseases. In secondary syphilis, these reactions are rarely accompanied by clinical symptoms, and organ damage is detected only during post-mortem examination.

Following the primary period of syphilis, which is characterized by a disseminated rash with a large polymorphism of elements (roseola, papules, vesicles, pustules), lesions of the somatic organs, musculoskeletal system, nervous system and generalized lymphadenitis. Diagnosis of secondary syphilis is carried out by detecting pale treponema in the discharge of skin elements, punctate of lymph nodes and cerebrospinal fluid; setting serological reactions. Treatment includes penicillin therapy and symptomatic therapy for lesions of internal organs.

General information

The period of secondary syphilis begins 2-3 months after the penetration of pale treponema into the body and is associated with their entry into the blood and lymph. Through the blood and lymphatic vessels, the causative agents of syphilis are carried to the internal organs, lymph nodes and nervous system, causing their damage. Under the influence of the body's immune response, pale treponema can form spores and cysts in which it remains in a non-virulent form, causing the development of a latent period of secondary syphilis. With a decrease in the activity of immune mechanisms, the pathogen is able to transform again into a pathogenic mobile form, causing a recurrence of secondary syphilis.

Classification of secondary syphilis

Fresh secondary syphilis - develops after primary syphilis and manifests itself as an abundant disseminated small polymorphic rash, the presence of a hard chancre in the resolution stage and polyadenitis. Duration 2-4 months.

Latent secondary syphilis - is characterized by the disappearance of clinical symptoms and is detected only by positive results of serological studies. Lasts up to 3 months or more.

Recurrent secondary syphilis - there is an alternation of relapses of syphilis with latent periods. During relapses, the rash reappears. However, unlike fresh secondary syphilis, it is less abundant, larger and located in groups, forming arcs, rings, garlands and half rings.

Symptoms of secondary syphilis

The development of secondary syphilis often begins with general symptoms similar to those of SARS or influenza. This malaise, fever, chills, headache. A distinctive feature of secondary syphilis is arthralgia and myalgia, aggravated at night. Skin manifestations of secondary syphilis occur only a week after the onset of these prodromal symptoms.

Rashes of secondary syphilis - secondary syphilis - are distinguished by significant polymorphism. At the same time, they have a number of similar characteristics: a benign course without peripheral growth and destruction of surrounding tissues, a rounded shape and a clear delimitation from the surrounding skin, the absence of subjective symptoms (sometimes there is slight itching) and acute inflammatory signs, healing without scarring. Secondary syphilides contain a high concentration of pale treponema and cause a high infectious danger of a patient with secondary syphilis.

The most common form of rash in secondary syphilis is syphilitic roseola or spotted syphilide, manifested by rounded pale pink spots up to 10 mm in diameter. Usually they are localized on the skin of the limbs and trunk, but can be on the face, feet and hands. Roseola with secondary syphilis appear gradually, 10-12 pieces per day for a week. Typical disappearance of roseola when pressed on it. Rarer forms of roseola rash in secondary syphilis include scaly and ascending roseola. The first has a slight depression in the center and is covered with lamellar scales, the second rises above the general level of the skin, which makes it look like a blister.

In second place in terms of prevalence in secondary syphilis is papular syphilis. Its most typical form is lenticular, having the appearance of densely elastic papules with a diameter of 3-5 mm of pink or copper-red color. Over time, peeling begins in the center of the papule of secondary syphilis, which spreads to the periphery. Characterized by "Biett's collar" - peeling along the edge of the papule while in the center it has already ended. The resolution of papules ends with the formation of long-term hyperpigmentation. Rarer forms of papular syphilis include seborrheic, coin-shaped, psoriasiform, weeping syphilis, papular syphilis of the palms and soles, as well as wide warts.

A rare form of rashes of secondary syphilis is pustular syphilis. Its appearance is usually observed in debilitated patients (tuberculosis patients, drug addicts, alcoholics) and indicates a more severe course of secondary syphilis. Pustular syphilide is characterized by the presence of purulent exudate, which dries up with the formation of a yellowish crust. The clinical picture resembles manifestations of pyoderma. Pustular syphilis of secondary syphilis can have the following forms: impetiginous, acne-like, ecthymatous, pox-like, rupoid.

With recurrent secondary syphilis, there may be pigmented syphilis(syphilitic leukoderma), appearing on the side and back of the neck in the form of rounded whitish spots, called the "necklace of Venus".

Skin manifestations of secondary syphilis are accompanied by a generalized enlargement of the lymph nodes (lymphadenitis). Enlarged cervical, axillary, femoral, inguinal lymph nodes remain painless and are not soldered to the surrounding tissues. Malnutrition of the hair roots in secondary syphilis leads to hair loss with the development of diffuse or focal alopecia. Often there are lesions of the mucous membranes of the oral cavity (syphilis of the oral cavity) and the larynx. The latter cause the characteristic hoarseness of the voice in patients with secondary syphilis.

On the part of the somatic organs, mainly functional changes are observed, which quickly disappear during treatment and are absent during periods of latent secondary syphilis. Liver damage is manifested by its soreness and enlargement, violation of liver tests. Gastritis and gastrointestinal dyskinesia are often observed. On the part of the kidneys, proteinuria and the occurrence of lipoid nephrosis are possible. Damage to the nervous system is manifested by irritability and sleep disturbance. Some patients with secondary syphilis have syphilitic meningitis that is easily treatable. It is possible to damage the skeletal system with the development of osteoperiostitis and periostitis, manifested by night pains mainly in the bones of the limbs and occurring without bone deformities. In some cases of secondary syphilis, otitis media, dry pleurisy, retinitis, neurosyphilis can be observed.

Diagnosis of secondary syphilis

The diverse clinical picture of secondary syphilis dictates the need to test for syphilis in every patient with a diffuse rash associated with polyadenopathy. First of all, this is a study of the detachable skin elements for the presence of pale treponema and an RPR test. Treponema pallidum can also be detected in the material taken from a puncture biopsy of a lymph node. The study of cerebrospinal fluid obtained by lumbar puncture during the period of fresh secondary syphilis or relapse also often reveals the presence of the pathogen.

With secondary syphilis, most patients have positive serological reactions (RIBT, RIF, RPHA). The exception is only 1-2% of cases of false-negative reactions due to too high an antibody titer, which can be lowered by diluting the serum.

Clinical manifestations of the internal organs may require additional consultation with a gastroenterologist,

Secondary syphilis is the next stage in the development of the disease. The activation of the presented stage occurs 2-5 months after infection. With the development of pathology, the bacteria of pale treponema, the main pathogen, spread. With secondary syphilis, the symptoms are extremely diverse, which complicates the diagnostic measures.

The reasons

The reasons that result in a secondary lesion are associated with the pathological activity of the bacterium pale treponema. Such microorganisms can persist for a long time, while being protected from antibiotics and antibodies of the patient. This is due to the conclusion of the bacterium in phagosomes, which has very unpleasant consequences. In addition to receiving such protection, the phagosome keeps the treponema from spreading throughout the body. As a result, the disease proceeds in a latent phase.

The sensitivity of a bacterium increases if it is outside the body. As a result, treponema is sensitive to desiccation, direct sunlight, chemicals, and heat treatment. The virulence of the bacterium is also preserved on household items, but until the named organism is completely dry. Low temperatures do not lead to the death of treponema.

The secondary nature of the pathology indicates the further development of the disease, since the pathogen is already in the patient's body. Pathogenic microorganisms spread throughout the patient's body, penetrating into the lymphatic and blood vessels. As a result, lymphadenopathy, diffuse and localized lesions of the skin and internal organs appear.

Symptoms

The defeat of the mucous membranes and integuments of the skin has its own characteristics in each case. There are several types of the disease, which determine the nature of the symptoms. The first form on this list is secondary fresh syphilis. It begins to develop after the primary type of pathology. The illness can last for several months. With the development of the patient, a small rash appears on the skin.

In addition, secondary recurrent syphilis is isolated, in which relapses are formed. At the presented stage, there is an alternation of latent and open phases of the disease, in which syphilis manifests itself and fades away. After the completion of the presented stage, manifestations arise again. The situation is complicated by the presence of a latent form of secondary syphilis. In most cases, patients take manifestations of this type as signs of a primary form that has not been completely eliminated.

Symptoms of secondary syphilis have the following features:

1. There is no peeling of the skin.
2. There is no itching and soreness of the affected areas.
3. Manifestations can disappear on their own and without scarring.
4. The elements are scattered, and the shape of the rashes is round.
5. The rash has a red tint. In rare cases, a dark or purple color.
6. The elements of the rashes are dense.

signs

Signs of secondary syphilis include rashes on the skin. These elements are characterized by great diversity. Skin rash and other symptoms are represented by the following manifestations:

1. Erythematous angina.
2. Syphilitic leukoderma.
3. Anal warts.
4. The palmar-plantar character of syphilis.
5. papular syphilis.
6. Roseolous syphilis.
7. Baldness of a syphilitic nature.

The secondary period of syphilis is often represented by roseolous syphilis. Such a sign indicates the active spread of the pale spirochete throughout the body of an infected person. Roseola is characterized by a small spot indicating the development of an inflammatory reaction. The spot has a pale pink or pink tint, the shape is often oval or round, but the contours are indistinct. The diameter of such a formation does not exceed 1.5 cm. The occurrence of roseola is observed due to a malfunction in the circulatory system.

For the recurrence of the pathology, rashes on the skin in the form of papular syphilide are characteristic. The neoplasm is represented by a nodule, which has a round shape. The papule is characterized by an elastic consistency in combination with density. Education at the beginning of development has a smooth surface, but after a while roughness appears. Such peeling leads to the appearance of Biette's collar - the appearance at the edges of the border.

A papule appears anywhere, but more often it is found on the surface of the palms or on the skin of the genitals. The appearance of the presented type of syphilide occurs in waves, in which the formation disappears and reappears.

The rash in secondary syphilis is represented by a variety of papular syphilis - the palmar-plantar form. There are nodules similar to corns, which have different shades: brown, purple or bright red. The surface can also be different - smooth or rough. At the initial stage, the formation is characterized by integrity, but in the process of development it cracks or begins to peel off. For this reason, the papule is often not noticed by patients, since such a manifestation makes it look like a corn.

Sometimes a vegetative papule appears in the anus, which can combine with other neoplasms. Such papules are characterized by a white coating and a stratum corneum. In most cases, it is the symptom presented that contributes to the definition of secondary syphilis.

When infected with syphilis and the development of the next stage, a necklace of Venus appears - syphilitic leukoderma. The onset of the symptom occurs 4-6 months after infection. As a result, discolored spots appear on the neck. Painful sensations and discomfort are absent, however, rashes can persist on the surface for several years.

Roseola can occur on the mucous membranes of the oral cavity, which indicates the development of syphilitic tonsillitis. The patient's pharynx acquires a red tint, and roseolas have a clear outline. At the relapse stage, such manifestations may be the only signs indicating the development of syphilis in a patient. Sometimes patients experience hoarseness, there is damage to the vocal cords, which leads to a change in the timbre of the voice.

Hair loss is also common. The pattern of prolapse is represented by local changes or lesions affecting large areas. A striking manifestation of the pathology is small-focal alopecia. Diagnosing such a symptom is quite easy. As for diffuse alopecia, the analysis of this condition is extremely difficult, since the symptom is characteristic of many diseases.

Diagnostics

Secondary syphilis must be detected in a timely manner. To detect pathology, laboratory tests are carried out and a variety of methods are used. During the diagnosis, the following methods of detecting pathology are used:

1. The reaction of passive hemagglutination.
2. Immunofluorescence reaction.
3. Precipitation microreaction.
4. Research in the dark field.
5. Wasserman reaction.
6. Linked immunosorbent assay.

For research in a dark field, a microscope is used, which allows doctors to observe living microorganisms. With the help of precipitation microreaction, it is possible to detect antibodies that are produced by the patient's body to combat the development and penetration of pale treponema into other parts of the body.

To exclude false positive results of diagnostics aimed at detecting syphilis, an immunofluorescence reaction is used. You can fix syphilis using a passive hemagglutination reaction. The analysis allows you to determine the stages of pathology.

Determination of genital infections is possible using enzyme immunoassay. There are a large number of modifications of such a study, which allows you to get an accurate result. As for the Wasserman reaction, such a study is gradually being replaced by newer methods.

If secondary syphilis has external manifestations, then differential diagnosis is used. Such tactics can be used in cases where the patient has the following diseases and manifestations:

1. Lichen.
2. Measles.
3. Rubella.
4. Spotted toxicoderma.
5. Bite spots.
6. Pink deprive.
7. Venus necklace.

Treatment

Treatment of secondary syphilis is a set of measures and techniques aimed at a comprehensive impact. In addition, the patient needs to be seen by a specialist. During therapy, antibacterial agents are used, the appointment of which occurs in a course. The duration of the use of such drugs can be up to 3 weeks.

Treatment is also carried out with the help of antibiotic preparations of the penicillin series. This is due to the susceptibility of the pathogen to the named category of drugs. It is possible to eliminate secondary syphilis, but for this you need to strictly follow the doctor's instructions and be observed often by a specialist.

During therapy, injections are used, which are administered intramuscularly every 3 hours. In some cases, home therapy may be prescribed, but most situations require treatment in a hospital setting.

In addition to these remedies, the doctor may prescribe treatment with ultraviolet radiation, biogenic stimulants and immunostimulants. For the period of treatment, a specialist can prescribe vitamins. Patients need to pay attention that self-treatment is completely prohibited, as this will lead to a deterioration in the condition and further development of the disease. Therapy performed with a single injection is gaining popularity. The secondary type of pathology cannot be eliminated so quickly, since treatment is a long and laborious process.

Especially pathology is dangerous for women who are in an interesting position. The disease can be transmitted to a child with a 100% probability, since studies have shown that the birth of a healthy baby in the presence of secondary syphilis in the mother is almost impossible. The disease will greatly affect the course of pregnancy, as there is a high probability of interruption. Therefore, it is required to be observed by a specialist more often, follow his instructions.

Prevention of the secondary form consists in the timely detection and treatment of the primary type of disease. You need to pay a lot of attention to your own health and take care of the body's defense mechanisms. It is possible to avoid the appearance and development of syphilis if you do not have casual sexual contacts, protect yourself and eliminate the diseases that have arisen in a timely manner. It is easier to prevent the appearance of a pathology than to deal with the elimination of the disease later, since this will require a lot of time and effort.

Thus, the secondary nature of syphilis is the next stage in the development of pathology.

If signs of illness appear, you should immediately seek medical help.

Otherwise, the pathology will move to the next stage of development, which is more dangerous for the health and life of the patient. It is forbidden to treat syphilis on your own, as this leads to a worsening of the course of the disease, the development of protection against antibiotics by pathogenic bacteria and a decrease in the chances of recovery.

The secondary period of syphilis often begins with prodromal phenomena that usually occur 7-10 days before the appearance of secondary syphilis. More often they are observed in women or debilitated patients and coincide in time with the massive spread of pale treponema in the patient's body by the hematogenous route. There are weakness, decreased performance, weakness, headache, pain in muscles, bones, joints (aggravated at night, which is typical for syphilis), fever (up to average numbers, less often up to 39-40 ° C). Often this condition is regarded by patients and doctors as flu-like, which delays the timely diagnosis of syphilis. During this period, leukocytosis and anemia can be observed in the blood. As a rule, with the appearance of clinical symptoms of the secondary period of syphilis, prodromal phenomena, which are far from all patients, disappear.

Secondary syphilis is characterized by a variety of morphological elements that are located on the skin and visible mucous membranes, as well as (to a lesser extent) changes in internal organs, the nervous system, the locomotor apparatus, etc. Secondary syphilis develops after 2-2.5, less often 3 months. after infection. Without treatment, relapses can recur several times over several years or more. In the intervals between rashes, a diagnosis of secondary latent syphilis is established.

Syphilides in secondary syphilis have common features:

all elements are benign, they usually do not destroy tissues, do not leave scars, except for rare cases of malignant syphilis, accompanied by ulceration, spontaneously disappear after 2-3 months, usually not accompanied by a violation of the general condition;

rashes are not accompanied, as a rule, by subjective sensations. Only in the presence of a rash on the scalp and in large folds of the skin, some patients complain of a slight itch;

there are no signs of acute inflammation in the elements, they have a copper-red, stagnant or brownish tint, and then their color becomes faded, “boring”, the latter reflects not only the tone of the color, but also the very course of the rash of secondary syphilis;

rashes have a rounded shape, they are sharply demarcated from healthy skin, are not prone to peripheral growth and fusion, and therefore are located focally, remaining delimited from each other;

expulsions are characterized by polymorphism, since secondary syphilis is often characterized by the simultaneous rash of various syphilides, which causes true polymorphism, and the paroxysmal appearance of syphilides causes evolutionary or false polymorphism;

syphilides quickly resolve under the influence of antisyphilitic treatment;

serological blood tests (RSK, RW) and sediment tests are sharply positive in almost 100% of cases with secondary fresh syphilis (with a high titer of reagins - 1:160, 1:320) and in 96-98% of patients with secondary recurrent syphilis (with a lower reagin titer). In almost 100% of cases, a sharply positive result is noted when examining the blood of patients using RIF. Treponema pallidum immobilization test (RIBT) gives a positive result in almost half of patients with secondary fresh syphilis (60-80% of immobilization) and in 80-100% of patients with secondary recurrent syphilis (90-100% of immobilization). Up to 50% of cases of secondary recurrent syphilis are accompanied by pathological changes in the cerebrospinal fluid in the absence of a clinical picture of meningitis (the so-called latent, latent syphilitic meningitis).

Syphilides consist of vascular spots (roseola), nodules (papules) and much less often vesicles (vesicles), pustules (pustules). In addition, secondary syphilis includes pigmentary syphilis (syphilitic leukoderma) and syphilitic hair loss (alopecia).

With secondary fresh syphilis, syphilis are smaller, more abundant, brighter in color, located symmetrically mainly on the skin of the body, do not tend to group and merge, as a rule, do not peel off. In most patients, remnants of a hard chancre and pronounced regional lymphadenitis can be detected (in 22-30% of patients). In addition, polyscleradenitis is better expressed (enlarged, densely elastic consistency, mobile, painless lymph nodes in the armpit, submandibular, cervical, cubital, etc.). Polyadenitis occurs in 88-90% of patients with secondary fresh syphilis.

In secondary recurrent syphilis, the elements of the rash are larger, less abundant, often asymmetrical, prone to grouping (formation of figures, garlands, arcs), paler in color, with frequent localization in the perineum, inguinal folds, on the mucous membranes of the genital organs, mouth, etc. e. in places subject to irritation. If with secondary fresh syphilis in 55-60% of patients a monomorphic roseolous rash is observed, then with secondary recurrent syphilis it is less common (in about 25% of patients), a monomorphic papular rash is more often observed (up to 22% of cases).

Spotted syphilis (syphilitic roseola) - the most common form of skin lesions in secondary fresh syphilis.

Roseola is first pink, and then pale pink, with blurred outlines, rounded, up to 1 cm in diameter, non-merging spots with a smooth surface that do not have peripheral growth and do not rise above the surrounding skin. Roseola appears gradually, 10-12 elements per day and reaches full development in 7-10 days, which explains the different intensity of its color. When pressure is applied to the roseola, it temporarily disappears or turns pale, but after the cessation of pressure, it reappears. Only when pressing on a long-existing roseola, a yellowish color remains in place of the pink one, due to the breakdown of erythrocytes and the deposition of hemosiderin. Long-standing roseola acquires a yellowish-brown color. Roseola is located mainly on the trunk and limbs. The skin of the face, hands and feet is rarely affected. Roseola is not accompanied by subjective sensations. After surviving an average of 3-4 weeks without treatment, roseola gradually disappears.

In secondary fresh syphilis, roseola is located randomly, but symmetrically and focally. Roseola in secondary recurrent syphilis occurs in a smaller amount than in secondary fresh syphilis, usually localized only in certain areas of the skin, often grouped with the formation of figures in the form of arcs, rings, semi-arcs, while leaving the focus of its location. At the same time, the size of recurrent roseola is slightly larger than the size of fresh roseola, and their color has a cyanotic hue. In patients with secondary fresh syphilis, after the first injections of penicillin, an exacerbation reaction usually occurs (the Herxheimer-Yarish-Lukashevich reaction), accompanied by an increase in body temperature and increased inflammation in the area of ​​syphilitic eruptions. In this regard, roseola, acquiring a more saturated pink-red color, is clearly visible. In addition, during an exacerbation reaction, roseola may appear in places where it was not before the start of treatment.

In addition to the typical roseola, the following varieties are distinguished, which are extremely rare:

flaky roseola - lamellar scales appear on the surface of the spotty elements, resembling crumpled tissue paper, and the center of the element appears to be somewhat sunken;

ascending roseola (elevating roseola) - in the presence of perivascular edema, it rises slightly above the level of normal surrounding skin, resembling a blister, but is not accompanied by itching.

differential diagnosis. Diagnosis of syphilitic roseola, especially with fresh secondary syphilis, is usually not difficult. When making a differential diagnosis of spotted syphilis, it should be borne in mind spotted rashes that occur with some acute infections (rubella, measles, typhoid and typhus), toxidermia, pink lichen, pityriasis versicolor, patch bite spots. However, rashes in acute infections are always accompanied by a rather high body temperature and general symptoms. In patients with measles, a profuse, large, merging, bright rash first appears on the face, neck, trunk, limbs, including the back of the hands and feet; when the rash regresses, the rash flakes off. Point whitish spots of Filatov-Koplik appear on the mucous membrane of the cheeks, sometimes on the lips, gums. In patients with rubella, the rash first appears on the face, then the neck and spreads to the trunk. Rashes are pale pink in color, up to lentils in size, have a round or oval shape, without a tendency to merge, often stand somewhat above the level of the skin, exist for 2-3 days and disappear without a trace; at the same time, similar rashes occur on the mucous membrane of the pharynx; sometimes worried about itching.

Rashes in typhoid and typhus are always accompanied by severe general phenomena, roseola in typhoid is not so abundant, often takes on a petechial character; in addition, in these cases there are no primary sclerosis, scleradenitis, polyadenitis.

In cases where the appearance of syphilitic roseola is preceded by prodromal phenomena with fever, the latter is not as high as in typhoid fever, and disappears in the very first days after the appearance of roseolous rashes.

Spotted rashes with toxidermia that occur when taking medications or poor-quality food are distinguished by an acute onset and course, bright color, rapid addition of peeling, a tendency to peripheral growth and fusion, they are often accompanied by burning and itching.

In patients with pink lichen of Zhiber, in contrast to syphilitic roseola, at first the so-called maternal plaque appears more often in the region of the lateral surface of the body, which is an oval, pink-red spot about 1.5x3 cm in size or more with a thin lamellar yellowish scale, wrinkled, like crumpled cigarette paper. After 1-2 weeks. a large number of similar elements appear, but of a smaller size, which are located along the metameres with their long diameter.

With pityriasis (varicolored) lichen, in contrast to syphilitic roseola, non-inflammatory, cafe-au-lait colors, scaly, spots prone to fusion occur, more often in the upper torso. When lubricating such spots with iodine tincture, they turn darker in comparison with the surrounding skin.

Spots from bites of flatheads differ from syphilitic roseola in a grayish-violet color, the presence in the center of some spots of a barely noticeable hemorrhagic point from a bite of pubic lice; these spots do not disappear with pressure.

When conducting a differential diagnosis of syphilitic roseola with the above diseases, the absence of other clinical symptoms of secondary syphilis, as well as the results of a serological examination of patients, are of great diagnostic importance.

Papular syphilis - the same frequent manifestation of secondary syphilis, as well as roseola. But if roseola is the most common manifestation of secondary fresh syphilis, then papular syphilis is secondary recurrent syphilis. Large-papular, or lenticular, and small-papular, or miliary, syphilides are distinguished by size.

Lenticular papular syphilis is the most common type of syphilitic papules, which have a dense elastic consistency, rounded, sharply limited outlines, hemispherical shape, ranging in size from lentil to pea (0.3-0.5 cm in diameter). They are not prone to peripheral growth and fusion. The color of the papules is initially pink, later becoming copper-red or bluish-red (ham). The surface of the papules in the first days is smooth, shiny, then begins to peel off. Peeling of papules begins in the center and ends earlier than on the periphery, which leads to the appearance of marginal peeling of papules in the form of Biett's "collar". Pressure on the center of the nodule with a blunt probe causes severe pain (Yadasson's symptom). Papular syphilides do not appear on the skin immediately, they appear jerkily, reaching full development in 10-14 days, after which they hold firm for 6-8 weeks, so papules in different stages of development can be seen in the same patient. After the resolution of the papules, pigmentation exists in their place for a long time.

With secondary fresh syphilis, papules are symmetrically, randomly scattered on the skin of the trunk and extremities, often on the face, scalp. In patients with secondary recurrent syphilis, papules are few in number, they tend to group in the form of rings, garlands, arcs, semi-arcs and localization in favorite places (genitals, anal region, oral mucosa, palms, soles, etc.).

There are the following clinical varieties of secondary papular syphilides: psoriasiform, nummular, seborrheic, palms and soles, weeping, wide warts, etc.

seborrheic papular syphilis localized in areas of the skin rich in sebaceous glands, mainly in persons suffering from oily seborrhea on the face, especially in the forehead at the border with the scalp (crown of Venus), in the nasolabial, nasolabial and chin folds, on the scalp.

Papules are covered with yellowish or greyish-yellow oily scales.

Psoriasiform papular syphilis It is characterized by the presence on the surface of the papules of a large number of silvery-white lamellar scales, due to which these elements become similar to psoriatic rashes.

Coin-shaped (nummular) papular syphilis It is represented by rounded papules with a diameter of 2 ruble coins and more with a somewhat flattened ilu-spherical surface, brownish or red. Occurs mainly with recurrent syphilis. In this case, single rashes are noted, which are usually grouped.

Papular syphilis of the palms and soles has a distinctive look. Papules at first almost do not rise above the level of the surrounding skin and look like sharply limited reddish-violet or yellowish spots with dense infiltration at the base. Subsequently, dense, difficult-to-remove flakes form on the surface of such elements. The peripheral part of the element remains free from scales.

After some time, the stratum corneum in the central part of the papule cracks and the papule begins to peel off, gradually forming Biett's "collar".

Such papules in the palms and soles can occur with fresh, but much more often with recurrent secondary syphilis. At the same time, the older the syphilis, the more pronounced the asymmetry of the location of the rashes, including on the palms and soles, their grouping into rings, arcs and merging into large plaques with scalloped outlines, sometimes pronounced peeling, cracks, which is typical for late recurrent syphilis.

Sometimes the keratinization of the surface of the papules on the palms and soles reaches a significant degree, corn-like thickenings are formed. However, they are always surrounded by a sharply limited, stagnant red, dull rim.

Weeping papular syphilis is formed when lenticular papules are localized in places with increased sweating and constantly exposed to friction (genital organs, anal region, inguinal-femoral, intergluteal, axillary folds, interdigital folds of the feet, under the mammary glands in women, etc.). In this case, maceration and rejection of the stratum corneum from the surface of the papule occur, resulting in a properly rounded weeping erosion. In the serous discharge of erosive papules, there is a large number of pale treponemas. Under the influence of prolonged irritation by friction, weeping papules can increase in size and merge into plaques with large scalloped edges. Under the influence of prolonged irritation and the addition of a secondary infection, an erosive papule may ulcerate. The sharp detachment of each element from the surrounding healthy skin, the elevation of erosion above the surface surrounding it, and mild subjective sensations (itching, burning) make it possible to establish a diagnosis. Broad condylomas (vegetative papules) arise from erosive papules located in the region of the labia majora and on the skin adjacent to them, in the anal region, intergluteal and inguinal-femoral folds, armpits, interdigital folds of the feet, the navel, scrotum, inguinal-scrotal folds, at the root of the penis. These papules, under the influence of prolonged irritation, can vegetate, their surface becomes bumpy, uneven, covered with a serous or grayish sticky coating containing a large number of pale treponemas.

Vegetative papules, or broad warts, tend to increase and sometimes reach large sizes. Wide condylomas are mainly characteristic of secondary recurrent syphilis and at a certain stage may be the only manifestation of the late period of the disease.

Miliary papular syphilis is extremely rare. Mostly on the skin of the trunk appear grouped brownish-reddish or copper-red, conical, the size of poppy or millet grains, dense papules. Grouping, the rashes form rings, arcs, plaques with jagged edges and a fine-grained surface. The nodules are located around the mouths of the sebaceous hair follicles. On the surface of individual papules there are scales or horny spines. Sometimes miliary papules are so pale and small that miliary syphilis can resemble the so-called goose bumps.

Abundant miliary syphilis indicates a severe course of syphilis.

differential diagnosis. Lenticular syphilis may bear a strong resemblance to lichen planus, parapsoriasis, and lichen squamous. However, with lichen planus, in contrast to papular syphilis, flat, shiny, polygonal livid colors appear, with an umbilical depression in the center of the papule. Due to uneven granulosis, a grayish-white mesh (Wickham mesh) is determined on the surface of the papules. Usually the process is accompanied by severe itching.

Clinically, the drop-shaped form of parapsoriasis can be very difficult to distinguish from syphilitic papules, however, with parapsoriasis there is a triad of symptoms characteristic only of this disease: latent peeling, detected when the rash is scraped; a symptom of a "wafer" (L.N. Mashkilleyson), i.e., peeling detected by scraping has the form of a colloidal film; and hemorrhages around the papule, arising from the scraping of the latter. In addition, rashes in parapsoriasis are accompanied by a smaller infiltrate compared to syphilitic nodules and extremely rarely appear on the oral mucosa.

Lichen squamous differs from psoriasiform papular syphilis in the presence of stearin stain, psoriatic film and pinpoint bleeding phenomena characteristic of psoriasis, peripheral growth and a tendency to merge with the formation of plaques, a chronic course with frequent relapses. In addition, psoriatic rashes are characterized by a pink color.

Wide warts may resemble genital warts, and when located in the anus, with hemorrhoids.

Genital warts differ from broad warts in their lobed structure, resembling cauliflower, and the presence of a thin stalk. Genital warts have a soft texture, including in the base of their legs, different sizes, sometimes reaching the size of a cherry or more, the color of normal skin or pinkish-red, they often bleed easily.

Due to the fact that genital warts are localized in the genital area and the anal region, their surface can be macerated and eroded.

As for hemorrhoids, in contrast to wide condylomas, which are located on the skin with their entire base, in the hemorrhoid, at least one of its surfaces is covered with the mucous membrane of the rectum. In addition, the hemorrhoid has a soft texture, often bleeds, and does not have a dense elastic infiltrate. The chronic nature of the course of hemorrhoids should be taken into account, as well as the possibility of syphilitic eruptions on hemorrhoids.

Miliary syphilide is similar to lichenoid tuberculosis of the skin, which, unlike syphilitic papules, is characterized by a soft texture, yellowish-red color, a tendency to cluster, the formation of tender scales on the surface of the rash, the onset of the process mainly in childhood, positive tuberculin reactions, and the absence of other signs syphilis and negative serological tests for syphilis. All these signs allow you to make the correct diagnosis.

When conducting a differential diagnosis of papular syphilis, serological examination of patients for syphilis is of paramount importance.

Pustular (pustular) syphilis is a relatively rare manifestation of secondary syphilis. Its presence usually indicates a severe, malignant course of the disease. The appearance of pustular syphilis is often accompanied by fever and general symptoms. It occurs, as a rule, in weakened, malnourished patients suffering from alcoholism, tuberculosis, drug addiction, hypovitaminosis, etc.

There are the following clinical varieties of pustular syphilis: acne, smallpox, impetiginous, ecthymatous (syphilitic ecthyma), rupioid (syphilitic rupee).

Superficial pustular syphilides, such as acne, smallpox and impetiginous, often occur in patients with secondary fresh syphilis, and deep pustular syphilides (ecthymatous and rupioid) - mainly during relapses of the disease. Pustular syphilides are ordinary syphilitic papules, the infiltrate of which is saturated with serous-polynuclear exudate, disintegrates, after which a yellowish-brown crust is formed, similar to pyoderma. At the same time, the varieties of pustular syphilides are determined by the localization, size and degree of their decay.

Acne-like (acneiform) pustular syphilis It is a follicular papules sharply demarcated from healthy skin, on top of which there is a cone-shaped pustule 0.2-0.3 cm in diameter. The purulent exudate quickly dries up into a yellowish-brownish crust, after which barely noticeable depressed pigmented scars are revealed. Acneiform syphilis is usually combined with other manifestations of the secondary period of syphilis.

differential diagnosis. Acne syphilide should be differentiated from acne vulgaris, papulonecrotic tuberculosis and iodine or bromide acne. Acne vulgaris differs from acne syphilis in the acute nature of inflammation, soreness, the presence of severe seborrhea and comedones, the age of patients, and a chronic course with frequent relapses of rashes. Papulonecrotic tuberculosis of the skin, localized on the extensor surfaces of the extremities, proceeds for a long time, the elements develop torpidly, and in place of nodular rashes that undergo necrosis of the central part, “stamped” scars remain, which never happen with syphilis. In the diagnosis of iodine and bromine acne, in contrast to syphilis, the presence of large pustules, an acute inflammatory corolla along the periphery of acne-like elements, matters; the absence of a dense infiltrate at the base, the rapid resolution of rashes after stopping the intake of iodine or bromine preparations.

Smallpox pustular syphilis is a hemispherical pustules the size of a lentil or pea, surrounded by a sharply demarcated copper-red infiltrate with an umbilical depression in the center. After 5-7 days, the content of the pustule shrinks into a crust located on an infiltrated base, and in this form the element lasts for a long time. After rejection of the crust, brown pigmentation and often a scar remain. Smallpox syphilis can appear in any quantity, but more often up to 15-20 elements usually occur on the flexor surfaces of the limbs, torso, face.

differential diagnosis. Smallpox syphilis should be distinguished from natural and chicken pox. An acute onset with a high body temperature, a severe general condition of the patient, the absence of a dense infiltrate at the base of the pustules, the appearance of rashes first on the face, negative serological reactions make it possible to reject the diagnosis of smallpox syphilis.

Impetiginous pustular syphilis begins with the formation on the skin of the face, flexor surface of the upper limbs, chest, back papules of a dark red color of a dense consistency, often up to 1 cm in diameter, less often - more. After a few days, thin-walled pustules form at the top of the papules, which quickly shrink to form massive raised, flaky, yellowish-brown crusts surrounded by a dark red, infiltrated corolla. When the crusts are forcibly removed, a dark red, easily bleeding ulcer is exposed.

differential diagnosis. Vulgar impetigo differs from syphilitic acute onset, rapid spread, the formation of flicken at first without compaction at the base, the presence of golden or dirty gray crusts, which, when removed, expose a smooth, moist, bright red erosive surface, “screenings” along the periphery and the merging of rashes into large foci wrong outlines. Mostly children get sick.

Ecthymatous pustular syphilis is a severe malignant form of pustular syphilis and usually occurs after 5-6 months. after infection. An important feature of ecthyma is the tendency of the element to decay both in depth and in breadth. A delimited dark red infiltrate appears, in the center of which a pustule quickly forms, drying into a dense, as if depressed, grayish-brown, almost black crust, surrounded by a copper-red infiltrate. Ecthyma gradually increases due to peripheral growth, reaching the size of a 5-ruble coin or more. After removing the crust, more or less is exposed. A deep ulcer with steep edges and a smooth bottom, covered with yellowish-gray necrotic masses with purulent discharge. The ulcer is surrounded by a dense, sharply demarcated, dark red infiltrated ridge. After the ecthyma heals, a pigmented scar remains.

Pale treponema, which is the causative agent, can cause quite a lot of inconvenience to an infected person. Not only does the disease lead to serious consequences, but also the social reaction is not very attractive - they tend to avoid such a patient, considering him one of the lumpen, that is, a representative of the lower strata of society. Moreover, like many other diseases, syphilis has several stages. Let's figure out what it is - a secondary form of an insidious disease (it is also called repeated syphilis).

Primary syphilis, that is, its initial stage, sometimes proceeds secretly, but most often the symptoms are clearly visible. The secondary stage is characterized by a deeper penetration of the infection into the body, which leads to somatic lesions of the internal organs, especially the nervous system and the musculoskeletal system. This happens about 2-3 months after the main infection.

Over time, pale treponema enters the patient's lymphatic system and spreads very quickly throughout the body. At the same time, the ability of the immune system to resist infectious diseases decreases. But before the body's defenses are defeated, the virus begins to form spores, which leads to the absence of symptoms characteristic of the primary form of syphilis. However, over time, the symptoms return, albeit in a slightly different form.

Periods

Depending on the behavior of treponema in the body and the timing of the development of the disease, doctors distinguish two main periods of development of the secondary form of syphilis:

• Latent (hidden) syphilis. It is impossible to identify the disease in this period by external signs - all clinical manifestations disappear for about 2-4 months. It is possible to detect an illness only through tests, but not all people go to hospitals: there are no symptoms - there is no disease. This is a big mistake.
• Recurrent syphilis. If we are talking about a fresh secondary form (the so-called fresh syphilis), that is, one that occurs immediately after the end of the primary stage, then the clinical symptoms persist - there are hard chancres, rashes, ulcers. But with the onset of the latent period, the signs disappear, appearing again only with recurrent exacerbations.

Note that the signs that occur during the recurrent period of syphilis are less abundant than during fresh syphilis and its primary form. All ulcers and spots are quite large, they form arcs, half rings, garlands and other shapes.

The reasons

Suppose that a certain patient was able to detect syphilis at an early stage, underwent an examination and a course of treatment. The symptoms are all gone, the person considers himself completely healthy. But somewhere in the depths of his body, undestroyed pale treponemas lurked. They have suffered greatly from antibiotics and restored immunity, but they do not want to leave the body. As soon as favorable conditions are created, the microorganisms will immediately begin to multiply again, which leads to re-infection and the second stage of syphilis.

These provoking factors include:

• penetration into the body of new treponemas;
• severe stress;
• oncological disease;
• any other infectious disease not properly treated.

This is if the patient was treated. If left untreated, syphilis begins to penetrate even deeper, affecting various organs and systems. At this stage, the bacteria change somewhat, the symptoms of the disease temporarily disappear, and the person feels well.

Thus, the causes of secondary syphilis include:

1. "weak" treatment in the early stages;
2. the development of infection in the complete absence of therapeutic measures.

Symptoms

At the stage of secondary syphilis, pale treponema reaches its peak of development. For some time after the transition of the disease to this form, the symptoms disappear, but soon return again (unless we are talking about a latent disease). Signs can be identified as follows:

• widespread rashes on the skin;
• the rash becomes burgundy;
• all formations are dense, have clear boundaries;
• over time, the rashes disappear on their own, without leaving scars and other “reminders” on the skin;
• muscle aches;
• weakness;
• insomnia;
• headache.

Also, some patients experience an increase in temperature, and both rise and fall, it suddenly and without outside intervention.

Diagnostics

Based on the history and analysis of skin rashes, the doctor can only draw preliminary conclusions; an accurate diagnosis cannot be made in this way. The fact is that such neoplasms, in combination with other signs (headaches, weakness, etc.), are inherent in some other diseases, including sexually transmitted diseases. Thus, the final diagnosis can only be made by conducting tests. All tests used by specialists are serological. Others will not be able to show the correct result.

Skin scrapings (in the area of ​​rashes) are used as a biomaterial. Conventionally, all studies of the obtained “product” can be divided into non-treponemal (microorganism substitutes are used) and treponemal, that is, using a real causative agent of syphilis. The first category includes:

The methods are quite simple, often giving false readings. Another group of studies include:

• RPGA;

These tests are expensive, but the result is more than accurate.

It is almost impossible to detect syphilis in a fetus in the womb.. One can only draw some conclusions in accordance with the state of health of a pregnant woman. But here you can diagnose syphilis in a newborn baby:

1. At the age of 3 months, the baby is examined by highly specialized specialists, and if signs of syphilis are found, then treatment begins.
2. Re-study of biomaterials in such a situation is carried out at the age of six months. If syphilis was not detected, then a second visit to the doctor will take place only at 9 months.

Treatment

Therapy of the disease is carried out only with antibacterial drugs. Pale treponema is most sensitive to penicillin and its derivatives. Usually, doctors prescribe injections of bicillin 5 (it costs no more than 100 rubles). But it happens that the patient has intolerance to penicillin derivatives. The situation is difficult, but not critical, there are substitutes:

• erythromycin (price about 150 rubles);
• doxycycline (costs around 20 rubles);
• tetracycline (the price usually does not exceed 100 rubles).

In addition to these antibiotics, doctors prescribe vitamin complexes and immunomodulators. This is necessary to maintain the body's defenses, which can be of great help in the fight against secondary syphilis.

Consequences and prevention

Syphilis refers to such diseases that do not go away for a person without a trace. People who are faced with its secondary form subsequently “get” the following complications:

• non-healing scars on the skin;
• baldness;
• infertility;
• chronic digestive disorders;
• kidney and liver problems.

In rare cases, pale treponema affects vision and hearing, as well as the heart muscle. In addition, some of those who have had syphilis suffer from dementia, because the disease affects the central nervous system.

You can avoid these consequences. But syphilis is easier to prevent than to completely cure. For prevention, you should:

1. exclude unprotected sexual contacts with casual partners;
2. observe the rules of personal hygiene;
3. monitor the state of your immunity;
4. diversify the diet with protein and plant foods;
5. regularly undergo preventive examinations.

Be sure to tell your children about these simple rules. Remember that you can get sick not only after casual sex, but at home. These measures will reduce the risk of disease and give you peace of mind and good mood!

You can watch this video, where the specialist will talk about secondary syphilis, what are the main signs of this disease, and you will also learn more about the consequences.