Syphilis treatment

Treatment of syphilis is a system of medical measures and manipulations designed to suppress the infectious agent, eliminate the disease itself, and correct the harm it causes to the body. Syphilis occurs as a result of infection with pale treponema, and is a sexually transmitted disease, as the main source of transmission of the pathogen is sex, especially unprotected. However, the sexual route of infection is not the only one characteristic of this disease. The transmission of syphilis is possible in everyday life, with blood transfusions, during surgical operations.

How successful the treatment of this disease can be, if it is detected on time and is engaged in adequate treatment, so the disease can be dangerous if you do not follow the recommendations of the doctor or do not seek medical help.

Syphilis in history: how to fight the disease before

The first cases of syphilis are known to historians since ancient times. A mass epidemic of infection shook the European continent for the first time at the end of the 15th century — then about 15% of its entire population was infected throughout Europe. The outbreak quickly spread across the mainland, and lasted about 50 years. The origin of the disease, “wiped out” of the population in number along with the plague, historians and other scientists attribute to Columbus’s earlier journey to South America. The sailors who returned on his ships were partially infected with syphilis, which had previously been transmitted to them from women in the West Indies.

Massive spread of infection contributed to the beginning of the Italian Wars, when the French army invaded the territory of Italy. Among the French soldiers were those who were already affected by the disease. Syphilis spread throughout Europe in about 1 year. After a year or two, defeat cases were recorded in Turkey, China, and North Africa.

The study of the disease in order to determine its nature and methods of treatment began in the Renaissance - before this period, syphilis was generally considered a disease of unknown origin. In the 15th and 16th centuries, many scientists and physicians compared syphilis with gonorrhea, considering that it is one and the same disease. This direction in medicine was called unitarism - it attributed the signs of all the venereal diseases at that time to syphilis. The founder and chief representative of this idea was the English physician Genter, who experienced and studied the development of syphilis and gonorrhea on himself. In 1767, he introduced himself to the body pus from the body of a patient with a chancroid. After some time, he developed the characteristic signs of syphilis, namely, hard chancre, which was then considered a sign of all venereal diseases.

Only 70 years later this event was able to be studied more thoroughly and interpreted in the right way. However, for this, one more experiment had to be carried out, in this case already connected with the infection of a large number of prisoners sentenced to death, without their consent, without providing them with medical assistance. In this way, the French physician Ricore managed to establish the differences between gonorrhea, syphilis and other venereal diseases, which were previously confused, dispelling doubts that all their manifestations belong to the same disease. Of course, the humanity of such a method of research is out of the question - in order to be able to treat patients with syphilis in the future, almost 1,400 people were infected with syphilis or gonorrhea. The results of the experiment became the basis of the science of syphilidology.

One of the first venereological scientists who began to study syphilis was Frenchman Jean Astruc. In 1736, under his editorship, a guide on venereal diseases was published - the first fundamental work on this topic, most of which was devoted to syphilis.

Treatment of the disease during the Middle Ages was very primitive, and was based on the introduction into the body of mercury preparations in the form of ointments or vapors. The urethra of patients was instilled with plantain juice, milk, gum, lead white - all these substances had an anti-inflammatory effect on the affected genital organs, and were thought to help cure syphilitic gum. For the procedure used catheters from the skin of various animals.

In those days, the appearance of syphilis in a person was associated with sexual promiscuity, and against the background of mass ignorance of the population, and general religiousness, was considered “God's punishment,” and treatment was carried out as a punishment. Relatively mild remedies were also used - diuretic and diaphoretic, for example, honey syrup with vinegar, pink honey syrups, aloe decoctions. However, the main method of treatment - mercury - in this context was very similar to mockery. First, the patient was subjected to cruel scourging, ostensibly to atone for his sin. Then for several days the patient received a laxative, and at the end of this preparation, he was placed in a special barrel, and twice daily he was covered with mercury ointment.

At that time, the poisonous properties of mercury vapors did not yet have a concrete idea, and against the background that in some cases recovery was still occurring, the method of treating mercury was the only way to salvation for patients with syphilis. Approximately 80% of patients who underwent such treatment died during treatment, and the rest died within the next 5-10 years.

In Russia, in the 16-18 centuries, to get rid of syphilis, doctors used “mercury” - mercury ointment, which was rubbed into the skin of the affected. In remote areas of Siberia, where, until 1861, there were no medical facilities, syphilis was treated with mercury, silver, vitriol, mercuric chloride, bearish and wolf bile, deer blood, and most patients generally resorted to the “services” of healers and shamans.

Until the beginning of the 19th century, only such methods were used in the treatment of lesions, mostly with mercury, until doctors of that time suggested the use of iodine chloride preparations for the treatment of syphilis - iodine was used to destroy the causative agent. In the 18th century, a surgical method of treating the disease was also proposed, although it was more related to its external manifestations - surgeons suggested to excise the chancre formed. Naturally, this technique did not give effect, since the infection itself remained in the body.

The use of drugs of mercury, silver, bismuth was fatal for patients, since these substances introduced into the body are toxic to it. Even if syphilis retreated, the person suffered from metal poisoning and damage to internal organs.

In the second half of the 19th century, the Odessa physician Rosenblyum began to successfully treat progressive paralysis in patients by applying to them typhoid fever, although it is officially considered that this method was developed by the Austrian Wagner-Yaren in 1914. In 1858, physician Y. Lukomsky wrote a scientific paper on the treatment of syphilis by inoculating poisons of cowpox.

Treatment of syphilis by grafting malaria is another method of “treating” the infected with a sadistic bias, which was practiced until the 20th century. This method was called pyrotherapy, and was based on the fact that the causative agent of the disease is able to exist and multiply in the human body in a rather narrow temperature range. The causative agents of the disease - Plasmodia - enter the body through the bite of an anopheles mosquito. They enter the bloodstream and enter the liver, which they begin to gradually destroy. When a pathogen enters the bloodstream, a toxin is formed in it, due to which the body temperature rises sharply. In this case, treponema in the body dies due to high temperature.

In 1909 a breakthrough was made in the treatment of the disease. The German scientist and Dr. Ehrlich suggested using a derivative of arsenic, salvarsan and neosalvarsan, for the treatment of syphilis. The drugs had sufficient clinical efficacy, higher than mercury drugs, but their side effects were similar to those with mercury.

Since 1921, drug therapy began to include bismuth preparations:

  • Bioquinol;
  • Bismoverol;
  • Pentabmol.

Since about the 1930s, agents with bismuth gradually began to force out mercury and iodine preparations in the treatment of syphilis. In their favor testified somewhat fewer side effects, although against the background of lower efficiency. The use of these tools in clinical practice was actively noted until the 90s of the last century. It should be noted that bismuth is also used in modern medicine as an element of a complex treatment regimen for chronic syphilis.

In 1943, American scientists Arnold, Harris and Magoneu revolutionized medical science — they discovered Penicillin. Treponema pallidum is highly sensitive to penicillin preparations, and they do not cause such harm to the body as mercury vapor or iodine compounds.

Salts of bismuth and arsenic, today, are practically not used in the treatment of syphilis because of their toxicity - they treat the disease only in cases when antibiotics do not help because of their resistance to the pathogen.

Modern methods of treatment of syphilis: general characteristics

It is known that, over time, bacteria and microorganisms have learned to produce a certain level of resistance to existing antibiotics, which have been affected by them for a long time. The group of penicillin antibiotics refers specifically to such drugs - today they are little used for the treatment of infectious diseases, since many groups of bacteria have already developed resistance to them. However, treponema pallidum is one of the few microorganisms that actively respond to Penicillin and respond well to treatment without protection mechanisms against penicillin exposure.

If the patient is allergic to the substance and its derivatives, or if the treponema strain that caused the disease is resistant to penicillin, the patient is given another type of treatment using macrolide drugs such as Erythromycin, Tetracycline derivatives, or cephalosporins.

The use of aminoglycosides has the property of suppressing the activity of treponema only in large doses, which are quite dangerous for the patient's body. As an element of monotherapy, aminoglycosides are not used.

If a patient is diagnosed with neurosyphilis, penicillin preparations are administered not only intramuscularly and orally, but also endoplumbally. In addition, pyrotherapy is prescribed to such a patient to increase the permeability of the blood-brain barrier. It should be noted that, for example, in Russia the endoplumbal method of administering penicillin-type drugs is practically not practiced because of the lack of personnel in hospitals and KVD who have experience in conducting such a procedure.

In addition to antibacterial drug treatment, the patient with syphilis is shown the appointment of immunostimulating agents. Immunostimulants are administered intramuscularly, and in addition, vitamin therapy and fortifying agents are prescribed to enhance the body's natural defenses. A special diet for syphilis is not provided, but adhere to the general principles of healthy eating does not hurt.

The tertiary period of syphilis in good condition of the patient, and in the presence of treponema resistance to antibacterial agents, is cured with a combination of antibiotics with a course of bismuth or arsenic derivatives. These drugs can not be bought in pharmacies - because of their toxicity, they are available only in special medical institutions.

The principles of modern treatment for syphilis imply not only the effect on the patient himself, and the need to treat his sexual partners in the last three months, if primary syphilis is diagnosed, and in the case of secondary syphilis - in the last year.

The purpose of the treatment regimen can only be carried out by a qualified venereologist, based on the results of the examination, patient interview, clinical examinations and tests. Self-treatment is unacceptable.

How long can syphilis treatment last, and is it curable? The process of therapy aimed at effectively getting rid of the disease can last from several months to several years, for example, if the patient is diagnosed with the primary form, he is waited for by continuous drug therapy of at least two months duration. With secondary, tertiary, late syphilis, treatment may take 4-5 years.

Depending on the condition of the patient, therapy can be carried out both on an outpatient basis and with placement in a hospital. Patients with syphilis in the framework of clinical examinations are taken for compulsory registration in the KVD - skin and venereal clinics.

The most effective therapy is water-soluble penicillins, administered through injections every 3 hours for 24 days, but it can only be carried out in the hospital, under the supervision of a physician.

The most commonly used drugs that are relevant for syphilis
TradenameActive substancePharmaceutical Group
AzithromycinAzithromycinMacrolide antimicrobials
AmoxiclavAmoxicillin (clavulanic acid)Antibacterial drugs for systemic use
AmoxicillinAmoxicillin as trihydrateBroad spectrum penicillins, antibacterial system drugs
AmpicillinAmpicillinBeta-lactam antibiotics of the penicillin group
BenzylpenicillinSodium salt of benzylpenicillinBeta-lactam antibiotics. Beta-lactamase sensitive penicillins
Bicillin 3A mixture of benzathine benzylpenicillin sterile, sodium and procaine benzylpenicillin saltsAntibacterial agents. Beta-lactamase sensitive penicillin combinations
Bicillin 5A mixture of sterile benzylpenicillin benzathine and benzylpenicillin novocaine saltAntibacterial agents. Beta-lactamase sensitive penicillin combinations
VilprafenJosamycinSystemic macrolides, antibacterial drugs
DoxycyclineDoxycyclineTetracycline antibiotics, antibacterial system agents
MiramistinMiramistinAntiseptic disinfectants
PenicillinPenicillinAntibacterial agents
RetarpenBenzathine, benzinpenicillinBeta-lactam antibiotics of the penicillin group
RocephinCeftriaxoneThird generation cephalosporins, antibacterial agents
SumamedAzithromycinMacrolides, linkosamides, streptogramins
TetracyclineTetracycline hydrochlorideLocal antibiotics
CefazolinSodium cefazolinFirst generation cephalosporins
CeftriaxoneCeftriaxoneThird generation cephalosporins
ExtensillinBenzatine benzylpenicillinAntibacterial agents of the penicillin group
ErythromycinErythromycinMacrolide antibacterial drugs
UnidoxDoxycillinTetracycline antibacterial agents

Early Syphilis Therapy

It is possible to identify a lesion during the incubation period, which precedes the appearance of the first symptoms, only if special serological tests are taken, which is why the disease is extremely rare in this period.When the affected person develops a characteristic chancre and lymphadenopathy, when visiting a venereologist, andrologist, infectious disease specialist or gynecologist, a specialist may already suspect syphilis in a person. Often it is detected at an early stage during preventive examinations. In such cases, you need to take emergency measures to influence the pathogen in the body.

Standards for the treatment of the initial stage of the disease require completely abandoning sex at the time of therapy. In addition, the doctor will require you to stop taking alcoholic beverages. The whole system of treatment is based on the use of penicillin antibiotics and antimicrobial drugs, which already create a load on the liver.

In addition, the doctor will offer to send to the survey all sexual partners of the infected, with whom he has had contacts lately.

Penicillin antibiotics form the basis of treatment, and in addition to the course of drugs like Ampicillin, Bicillin, Retarpen, the patient is prescribed a course of supporting drugs, vitamins, immunomodulators.

Therapy with tetracycline antibiotics, macrolides and cephalosporins is slightly less effective, however, it is indicated for those who are allergic to penicillin.

Is it necessary to hospitalize a patient with the initial stages of syphilis? If we are talking about the primary form, it is allowed to carry out treatment at home, however, it is necessary to ensure the possibility of a course of antibiotic injections under the scheme. If the patient is diagnosed with secondary syphilis, he is likely to be placed in the hospital.

After the end of treatment of the primary seronegative type of the disease, the patient is registered and under the supervision of a venereologist for the next year. Those who have been diagnosed with seropositive syphilis are observed by a doctor for another 3 years after receiving negative results of control tests.

Delivery of tests for control after the end of treatment is carried out every 2-3 months for the first 6 months, and then once every six months.

Treatment of pregnant women with primary syphilis can be carried out only by those drugs that do not harm the fetus - penicillin antibiotics and ceftriaxone. In order to prevent the onset of serious consequences for the child and the mother, a pregnant woman is given two compulsory courses of treatment - the main one, which is carried out in the hospital, and the preventive one, which is allowed for and outpatient.

In the first and second trimester of pregnancy, the expectant mother is also prescribed a double course of treatment - first with a diagnosis, and then with a term of 20-24 weeks.

Primary syphilis in children is treated in a similar pattern as in adult men and women. Antibiotics are administered by injection for 10-14 days to the patient, and immunostimulants are prescribed in the form of tablets, suppositories or injections. Secondary syphilis, including congenital, requires repeated courses of penicillin therapy until the pathogen disappears from the body. For newborns, macrolide drugs are provided.

Preventive treatment is prescribed to those people who have had contact with patients with syphilis, both intimate and household, if after contact no more than 2 months have passed. On an outpatient basis, the patient is prescribed a course of 4 injections of Bicillin-1, Bicillin-3 or Bicillin-5. It is allowed to use reperpene or extensillin in a single dose of 2.4 million units.

In the hospital, preventive treatment measures involve the administration of penicillin sodium or potassium preparations at a dosage of 400 thousand units every three hours for two weeks.

For patients who have become infected after blood transfusion with the causative agents of syphilis, a treatment regimen is provided that is similar to that intended for patients with primary or secondary fresh syphilis.

How late stage syphilis is treated

The latent, late, and chronic types of the disease are the worst treated. At this stage, the body has already been severely affected by the infection, so the patient develops various associated lesions and diseases affecting all internal organs and systems.

Therefore, treatment is based on the principle of complexity - the attending physician must choose not only the basic therapy for the elimination of the infection, but also a set of concomitant drugs for the correction of disturbances in the systems, tissues, organs.

Manifestations of tertiary syphilis are exposed to drugs with the active ingredient benzylpenicillin. For patients with allergic reactions to penicillin drugs, desensitization therapy is prescribed, as well as tetracycline drugs, cephalosporins, polysynthetic penicillins.

If the patient has an intolerance to any antibiotics, macrolide drugs are prescribed.

Treatment for patients with the absence of concomitant damage to internal organs is as follows: water-soluble penicillin is administered 1 million units 4 times a day, the total daily dose is 4 million units. Course duration - 28 days. Then a break of 14 days is made, after which a similar therapy lasting for 28 days is repeated again. The use of penicillin novocaine salt is also allowed, twice a day in a dosage of 600 thousand units. If procaine-penicillin is prescribed, it is administered by injection of 1.2 million units once a day for 10 days. Penicillin novocaine salt is introduced in a similar concentration, it is applied 28 days. At the end of the course, a 14-day break is observed, and the two-week scheme of injections begins again.

If a patient has internal lesions caused by syphilis, the treatment is carried out using another system. The general scheme is determined by the dermatovenerologist together with the therapist, and in difficult cases other, narrower specialists are involved.

The first requirement of such treatment is the implementation of preparatory therapy. 0.5 g of tetracycline or erythromycin, 4 times a day, are administered daily to the patient for 14 days. When the preparation is over, the patient is transferred to the 28-day course of Penicillin - injections should be made 8 times a day, every three hours. The dosage of the substance is 400 thousand in one step. At the end of this period, you need to wait two weeks off, after which a similar course of treatment is carried out again, but within 14-20 days.

Procaine-penicillin is administered to the patient in doses of 1.2 million units, once a day, for 42 days. After a two-week pause, the therapy is repeated for 14 days.

Treatment of neurosyphilis requires a slightly different approach. In the process of drawing up the method of treatment, not only the venereologist and therapist are involved, but also a neurologist with an ophthalmologist.

The effective remedy in this case is the sodium salt of benzylpenicillin. It is administered to the patient in a dosage of 10 million units and a half hour dropper. The procedure is carried out twice a day for two weeks. In addition, penicillin solution is administered intravenously 6 times a day.

Monitoring treatment of tertiary syphilis implies a mandatory chemical examination of the cerebrospinal fluid 6 months after completion of therapy.

Late neurosyphilis is treated according to a similar pattern, but antibiotic therapy is performed twice.

When gummy nodes are found in the spinal cord or brain, the patient is also shown a two-week intake of Prednisolone.

Such schemes have been successfully used to treat adults, pregnant women, the elderly.

As for children, tertiary and advanced syphilis is treated in them by Bicillin-3, Bicillin-5, Penicillin. Preparatory therapy is made by Biohequinol.

Concomitant methods of treating syphilis in later and neglected cases are most relevant - patients are prescribed immunomodulators, pyrotherapy, and hormonal drugs.

After all the medical measures taken, the patient must pass the control serological tests, and over the next five years the tests must be taken every half a year. All this time, people who have been ill with advanced syphilis have been registered in the KVD.

Additional preventive measures and surgery after completion of treatment

Syphilis is a very insidious disease, since in its course there is a characteristic variety of symptoms, which is sometimes replaced by hidden periods. Therefore, even if the patient in the test results notes the disappearance of the disease, it is still put on clinical control and registration of the venereologist. In order for a doctor to periodically check for the presence of antibodies in the blood, a person must periodically undergo appropriate tests. The presence of syphilis pathogens in the blood after the treatment is a warning sign that suggests that penicillin therapy should be continued.

In cases where the activity of pale treponema is suppressed in the body, but the negativity of serological processes in the blood is too slow, the patient may develop seroresistant or latent syphilis - this occurs in about 5-6% of cases of treatment. Seroresistance is due to substantial changes in humoral and cellular immunity, while the patient has reduced the number of T and B lymphocytes, as well as class M immunoglobulins. Therapeutic plasma exchange increases the level of specific antibodies in 1, -5 times. Due to such prevention of recurrence of syphilis, in 60% of patients after the procedure, seropositive reactions should disappear.

A more solid method of intervention after the end of syphilis treatment is surgical. Syphilis becomes the reason for the appointment of surgery in such cases:

  • with the deformation of the stomach;
  • with stenosis;
  • if the syphilis lesion is combined with cancer;
  • if there are gummy ulcers with infiltration in the cavities of internal organs or in the mouth;
  • with curvature of the bones, syphilitic lesions of the joints;
  • with the appearance of deformities of the maxillofacial part of the skull, the confluence of the nose, the destruction of the tissues of the lips.

Traditional medicine against syphilis

Can syphilis be treated alone at home? The clear answer is no. This disease, with many symptoms, can periodically become chronic. In addition, the effects of syphilis can not only disfigure the patient, but also make him disabled, or even lead to death. Such a disease requires constant clinical monitoring, observation of a qualified venereologist and accurate implementation of all medical prescriptions, otherwise there is a high probability of the formation of new lesions of the body tissues, as well as the reappearance of the disease after the latent period. At the same time, recipes of traditional medicine can be used only as additional measures for general strengthening of the body, and only in consultation with the doctor.

For example, common recipes are garlic and wine products. To prepare a remedy, you need to mix 200 grams of strawberry jam with 100 milliliters of water. The mixture is brought to a boil, then 400 grams of warm red wine and apple juice are added to it. The product is stirred, cooled, and then 7-8 crushed garlic cloves are put into it and left to infuse for 3 hours. Having strained, drink drink daily on 100 grams.

The treatment of burdock root consists in the use of a special broth. To make it, take 200 milliliters of water, add 1 tablespoon of chopped burdock root to it. After boiling the mixture for 20 minutes, it is filtered, and then the agent is taken daily in 1 tablespoon.

There are also methods of treatment of lesions with hops, various collections of herbs, sandy sedge roots.

How can all these remedies affect the progress of recovery? Basically, they have only a general stimulating and strengthening effect. Regarding the effects on the causative agent of syphilis, physicians and specialists in their responses convince patients not to rely on him, but to immediately consult a doctor to develop adequate treatment.

What to do if signs of syphilis develop

Having found the first symptoms of a lesion (solid chancre, inflammation of the lymph nodes, feverish state, characteristic rash on the body), one should immediately seek medical help.

What doctor should I go to see? A primary examination may be conducted by a therapist. Next, he must refer the patient to a venereologist, urologist, infectious disease specialist, and gynecologist.

Treatment of syphilis, first of all, should be systemic and complex. Of great importance is not just the ingress of the active substances of the prescribed drugs into the diseased organism, but also strict adherence to the dosage and drug administration scheme, otherwise the treatment will be ineffective. In addition, an element of the treatment is the constant laboratory quality control of the conducted clinical activities. Self-treatment of such a complex and dangerous disease is categorically not acceptable.

Watch the video: Mayo Clinic Minute: Signs and symptoms of syphilis (February 2020).