Syphilis rash. How to determine the stage of the disease based on skin manifestations

STD

Skin rashes are a sign of syphilis infection.

Syphilis is a severe infectious disease of an inflammatory nature caused by the pathogenic bacterium Treponema pallidum. First of all, it affects the skin and mucous membranes of the body, manifesting itself in various rashes, erosions and ulcers.

Syphilis is divided into three stages, each of which has its own manifestations, therefore, what a syphilis rash looks like will depend on the stage of development of the disease.

• Infection and incubation period Incubation period and its manifestations

Syphilis: what are we dealing with?

Many people believe that syphilis is a disease that is exclusively sexually transmitted. But in fact, this opinion is wrong. You can also become infected with this disease at home if the infection gets directly into the blood, for example, through scratches or abrasions. You can also become infected if you use a towel or washcloth that an infected person has previously washed with.

Infection can also occur in a hospital when a patient is given a transfusion of infected blood. There is also a congenital form. The first symptom is a rash on the body. But what kind of syphilis rash indicates the initial stage? When do you need to sound the alarm and urgently contact a venereologist? After all, this specialist will be able to help.

Purulent wounds on the face

Purulent rashes are often confused with an allergic reaction or skin fungus, especially when they are found on the body of a newborn baby. Watery boils on the face occur in older people. Doctors strictly prohibit opening them with a needle or trying to press, since there is a high risk of infection in an open wound.

Purulent formations are eliminated not only with the help of antibiotics, local drugs are also used to alleviate the patient’s condition. The formation of a purulent abscess obliges a person to consult a doctor as soon as possible, since it can lead to deep damage to the skin.

Symptoms of syphilis

In the classic version, signs of syphilis occur in very rare cases. Most often, the manifestations are hidden, so it is not always possible to detect them as early as possible. But there are still a number of symptoms by which you can independently diagnose the disease. They directly depend on the period of illness. Doctors distinguish four main periods of pathology:

• incubation;
• primary;
• secondary;
• tertiary.

The incubation period lasts from 20 to 40 days, during which time no clinical signs are noticeable. But in other periods, manifestations may be different, it all depends on which systems are affected by the disease and how seriously.

The first symptoms appear in the form of chancre and the lymph nodes become greatly enlarged. A chancre is an ulcer that does not cause any discomfort or pain; it has a round shape and a dense base.

Where does the syphilis rash appear first? And in the place where the pathogen was introduced. And with this pathology, it is treponema pallidum. If transmission occurs sexually, then in men the chancre appears on the foreskin of the male genital organ, but in women it can appear on the labia or in the cervix.

It can also be found on the vaginal mucosa, oral cavity or in the anal area. If it is not detected immediately, then after a couple of months the chancre will heal on its own. This makes a person think that everything is back to normal, all fears can be left behind. But this is only the beginning, the most serious and terrible things are yet to come.

Chancre on the oral mucosa appears after oral sexual contact. It is very difficult to identify it in the mouth on your own. After a while, the ulcer goes away, after which the submandibular lymph nodes become inflamed. These are all the signs that can appear after infection; it is very difficult to identify the disease from them. Only after a rash appears on the body due to syphilis, the patient consults a doctor and an accurate diagnosis is made.

Primary period

In the primary period, a single or syphilitic ulcer, or a hard ulcer or, as it is also called, a hard chancre, most often forms. They are most likely to appear in the mouth area, on the mucous membrane of the lips, often on their border or in the corner.

Hard chancre on the lip

Chancres are purulent, erosive or ulcerative in nature and over time become covered with a crust, a gray coating and cause pain when cracked. With syphilis, of course, there are also lesions on other parts of the face, but they are still single and more rare. Especially in the area of ​​the nose, where simple redness and the formation of some kind of compaction on the septum or wings of the nose are typical.

Often a hard chancre on the skin of the face festers, has a bright red color and hardened edges. Such primary chancres are called syphilomas.

Purulent chancre

Course of syphilis

In fact, the manifestations of syphilis are varied. At each stage of the disease they are different. Due to the fact that today it is not difficult to buy antibiotics at a pharmacy, a patient with a minor illness immediately begins to take them, thereby masking the symptoms. That is why most often the initial stage of the disease is asymptomatic and pathology can be detected already when a rash appears in secondary syphilis.

The incubation period can last quite a long time, it begins from the moment of infection until the first clinical manifestations. On average, the duration is about a month. It may not be as long, but only in people with immunodeficiency, or, conversely, it can be longer if the patient is taking antibacterial drugs.

The incubation period is dangerous because it does not manifest itself in any way, but the person is contagious and can transmit the infection to others. It is at this time that the pathogen multiplies intensively in the body and, together with blood flow and lymph, spreads to all organs.

The initial rash of syphilis can last up to two months. It begins with a hard chancre and lasts until multiple rashes appear on the body. During this period there are no other symptoms. By the end of the first stage of the disease, symptoms very similar to the flu may appear: high fever, general malaise and acute pain in the head. If you do not take any measures during this period and do not start taking medications, then the primary form becomes secondary. What does the rash look like with this form of syphilis? Primary rashes with syphilis are characterized by the following features:

• multiple rashes that can be localized on any part of the body;
• juiciness;
• brightness and disorderly arrangement.

The rash with syphilis may go away on its own, but after a while it will make itself felt again. The secondary type of the disease can last up to four years.

Smallpox syphilide

Initially, a red spot appears on the skin.

It has an average diameter of half a centimeter.

A pustular element is formed in the center of the spotty formation.

Exudate accumulates inside and thickens within a few days.

Then the covering of the pustule collapses and it transforms into a crust.

At this stage, syphilis strongly resembles chickenpox in its clinical manifestations.

The skin affected by the pathological process gradually thickens.

Then the crust is torn off.

Acne leaves behind atrophic scars.

The peculiarity is their gradual appearance.

There are not many pimples - 1-2 dozen morphological elements are formed.

They exist for 2 months.

The elements of the rash are located separately, not in groups, and never merge.

Favorite areas of the body:

• forehead;
• the front surface of the hands;
• back of the legs;
• face;
• torso.

Smallpox syphilide may be the first manifestation of secondary syphilis.

Often this form of pathology is accompanied by systemic clinical manifestations.

Low-grade body temperature is noted.

Patients complain of feeling unwell.

Along with the appearance of acne, inflammation of the eyes is possible.

In particular, the iris is involved in the process.

There is a deficiency of hemoglobin in the blood.

One of the types of smallpox syphilide is considered to be syphilitic pemphigus.

It develops rarely and is characterized by a more severe clinical course.

Often observed against the background:

• HIV;
• other immunodeficiencies;
• alcoholism;
• severe or long-term chronic diseases.

Round blisters appear on the skin.

They are filled with a clear liquid that may contain blood.

After a few days, pus appears inside.

When the elements resolve, crusts form, under which ulcers are located.

Most often, such elements appear on the soles and palms.

Types of rash with syphilis

Currently, syphilis is no longer considered a disease that ends in death. There are a lot of different drugs, thanks to which you can completely recover from the disease. The main thing is to remember that you need to approach treatment thoroughly and under no circumstances let the situation take its course. If the disease is detected at an early stage, it is very easily treated and after a couple of weeks the patient can completely forget about this shame.

But if you suddenly allow the disease to progress in the body for a long period of time, then the infection will spread to all organs and affect the nervous system.

Today, doctors distinguish several types of rash on you with syphilis:

• At the initial stage of the disease, a primary rash appears. This type of symptom appears a month after the patient was infected. The primary rash with syphilis, photos confirm this, appears in the form of small red spots, and later they turn into ulcers. The rash goes away after one to two weeks. But after a while it appears again and remains on the body for more than one year.

• The second stage is manifested by small tubercles throughout the body, which are colored soft pink. Purulent spots of a rich blue or brown color may also appear. In most cases, a doctor examining a patient discovers several types of rashes on the body. It is during this period that the patient becomes a carrier and distributor of the disease.
• At the third stage, the rash of syphilis appears in the form of bluish-purple bumps. Such manifestations can occur either singly or multiple times. After healing, a scar remains at the site of the rash.

Skin manifestations of tertiary syphilis

During the third stage, skin lesions are more pathological and irreversible.

As such, there is no rash and skin lesions appear:

1. Tuberous syphilide is a formation deep in the skin in the form of a node and with a diameter of up to 7 mm. At the moment of appearance, redness of the tissue is noted, then the node increases in size and begins to protrude above the skin. During the process of maturation, it turns into an open ulcer and an ulcer that does not heal for several months. It leaves behind deep scar tissue.
2. Syphilitic gumma is a formation in the subcutaneous tissue. At the beginning of the manifestation it is mobile, but gradually fusion with the surrounding tissue occurs and mobility disappears. In the process of maturation it turns into an ulcer with purulent contents. The danger of syphilitic gumma is damage not only to the skin, but also to bone, cartilage tissue and internal organs.

The photo shows tubercular syphilide and scar tissue after its healing.

Important. Tertiary syphilis occurs 7-10 years after infection. Its distinctive feature is the alternation of exacerbations and a latent period, which sometimes drags on for years.

Characteristic signs of rashes with syphilis

Most often, the rash appears on the head in the place where the hair grows, around the genitals, and in women under the breasts. There are several basic signs that will help the patient distinguish a syphilitic rash from any other rash. The presence of syphilis in the body can be recognized by the following signs:

• chaotic rashes, without any clear localization and systematicity;
• The patient does not feel any discomfort during the rash, for example, pain or itching, and there is no peeling;
• the rash has a round shape and its texture is very dense;

• individual areas of rashes are not prone to coalescence;
• the color of the syphilis rash can be red, burgundy or bluish;
• it goes away on its own after a couple of weeks.

In rare cases, the appearance of a rash occurs against a background of high body temperature. The person may appear to have a cold or flu.

Differences between vulgar impetigo and sycosis from syphilitic

In the process of differential diagnosis, the doctor tries, even at the stage of clinical examination, to distinguish syphilitic impetigo from vulgar impetigo.

This pathology is characterized by the formation of conflicts.

Their appearance is caused by streptococcal skin infection.

As with syphilitic impetigo, the characteristic localization remains the beard growth area.

Main differences:

• absence of infiltration in the area where conflicts occur;
• open quickly - within a few hours after pimples form;
• there are subjective sensations (mostly itching).

Sycosis can be very similar in clinical course and manifestations.

This is another type of bacterial skin infection.

It is caused by staphylococci.

Deep damage to the hair follicles occurs with the appearance of characteristic pimples in the hair growth area on the face.

The disease differs primarily in that it can last for years.

In addition, it progresses gradually.

Pimples appear in one place or another.

Their number and location change.

Long-term exudation with layering of crusts does not occur.

The pustules break open, crust over, and then heal, sometimes with scar formation.

How long does it take for a syphilitic rash to appear?

No one can answer exactly when a syphilis rash will appear, but in most cases it begins to appear towards the end of the primary period. This period is about 2-3 months after infection or one and a half to two months after the appearance of chancre.

It all starts with small bright spots or compactions that are located symmetrically throughout the body. If a relapse occurs, the rashes appear in smaller numbers, they are located in separate areas and grouped into rings or garlands.

Syphilitic rupee

This is one of the types of ecthyma.

The disease becomes even more severe.

It is often complicated by inflammation of the periosteum, eyes, and the formation of extensive ulcers in the oral cavity.

In general, the rupee resembles ecthyma.

The differences are as follows:

• under the crust the ulcer continues to grow in depth and breadth;
• a large multilayer crust is formed, reaching 3 cm in height and 8 cm in diameter;
• Significant destructive processes occur in tissues.

The clinical course is sluggish.

Syphilide develops slowly, but progresses steadily over several months.

Rupees do not appear in large quantities.

Basically, these are one or more elements located on the torso and limbs.

In terms of time, this is one of the latest types of rashes.

Sometimes the rupee appears even later than the tertiary elements of syphilis (tubercles and gummas).

What does the rash look like with secondary syphilis?

If you carefully examine the manifestations of syphilis on the skin, you can say for sure that they cannot be described in a few words. There are several classes, thanks to which some rashes can be classified into separate types. If we describe their main features, they look like this:

• Rosewood is one of the popular species. Appears after the pale spirochete has spread to all organs and systems of the body. They look like spots - roseola, which are not inflammatory in nature. Their outlines are not sharp, the color is not particularly pronounced, the shape is oval or circle. Most often, such spots have a diameter of 1.5 cm, the affected surface is smooth. Roseolas do not appear in groups and do not rise above the skin, which is why they are often called simply spots. A similar rash with syphilis, the photo confirms this, appears without any symptoms. But it is impossible to say for sure that it is caused by this particular infection, because allergies can manifest themselves in the same way.

• Papules indicate a relapse of the secondary stage. They look like round nodules. They are very dense and elastic, similar to a hemisphere and the size of a pea. Such lesions are not the same; at different times they may look different: at first they are smooth and shiny, and then peeling may appear. It is impossible to say for sure that a syphilis rash will appear on the face or any other part of the body.
• Palmoplantar papules. These rashes can be dangerous, because in appearance they resemble calluses, and few people would think that they are caused by the presence of an infection in the body. But they still have a distinctive feature: they stand out sharply above the surface of the skin, their color can be purple, but otherwise they are no different from calluses.
• Condylomas. These manifestations are much more common. Condylomas are a fusion of weeping papules that manifest as infiltration. Such signs are usually more hypertrophied than the rash on the palms of syphilis, and the rashes themselves look swollen, and a white coating is visible on top of them. Serous discharge may also be seen. The localization of such signs is the perianal area. If such a rash appears, it is better not to delay going to the doctor, because only he will be able to determine the cause of its appearance and prescribe timely and effective treatment.
• Leucoderma. These manifestations of syphilis are quite rare, unlike rashes, spots and other signs. Just a few years ago, this particular sign was considered one of the most specific, which indicated the presence of a sexually transmitted pathology in a patient. It looks like light and oval or round spots, while the skin underneath them becomes darker. Leucoderma most often affects the skin of the neck, but sometimes it can affect other parts such as the chest, armpits and legs.
• Baldness. In rare cases, you can see a person with bald patches on his head, but they are not found on the top of the head, but over the entire surface of the head; one gets the feeling that moths have worked thoroughly here. Such lesions may indicate that the human body is affected by syphilis. The areas of baldness are not extensive, and their totality looks exactly like fur that has been affected by moths.

Regardless of what kind of syphilis rash appears in the secondary form of a sexually transmitted disease, it is very important to know exactly what it looks like, and if there is even the slightest doubt, it is better to immediately seek qualified help, because it is very important to identify the infection in time and urgently take everything measures to kill her.

Roseola rash

Roseola is observed in 70% of people suffering from syphilis. The rashes are round spots with jagged edges. The color of roseolas varies from pale pink to crimson. Doctors point out to patients that spots of different colors can occur even on one area of ​​the body. When you press on the roseola, the stain completely disappears.

Roseolas do not merge with each other and do not peel off during the progression of syphilis. In terms of their relief and consistency, the spots should merge with the skin. The diameter of roseola does not exceed 2 cm. The rashes change color during cool weather, they become more saturated in color.

The rash can be located on the stomach, back, chest and mouth. Without drug treatment, the rash persists for 3 weeks. In the mouth, the rash will be clearly visible as it takes on a blue tint. The appearance of the oral cavity can be confused with a sore throat if the other symptoms of syphilis are not taken into account. Simultaneously with roseola, ulcers appear in the mouth; they are located on the vocal cords and larynx, causing the patient to lose his voice.

Recurrence of roseola rash occurs within 3 years after infection with a venereal disease.

What diagnostic methods will help identify syphilis?

How to determine what causes a rash on your back? Whether syphilis is to blame or what other disease is causing this, only a doctor can answer after conducting a series of studies. If you have any kind of rash, you should immediately consult a dermatologist. In most cases, the diagnosis can already be made after a visual examination.

But to accurately confirm the diagnosis, the doctor may prescribe the following studies:

• detection of treponema in what is released from chancre or erosion;
• conducting non-treponemal tests (microprecipitation reaction or rapid reaction with plasma);
• treponemal tests, test for immunofluorescence or immobilization of treponemes;
• enzyme immunoassay.

Laboratory research is carried out using a very complex technique. It will be difficult to read what is written in the analysis results on your own, so it is better to entrust this to an experienced specialist.

Frequently asked questions to the doctor

Real experiences

Hello. A week ago I had unprotected intercourse, and a couple of days later I noticed a red rash on my partner’s body. Could this be a sign of syphilis, and should I get tested now?

Good day. During syphilis, certain periods are distinguished. The initial one is called primary syphilis. At the stage of primary syphilis, there is a certain period of time, namely the first 3-4 weeks after infection, when test results do not reveal the disease. This period is called primary seronegative syphilis.

In this case, I recommend that you wait a few more weeks and only then get tested. In addition, if there is cause for concern, you and your partner should visit a venereologist.

How to properly treat a syphilitic rash?

Under no circumstances should you prescribe treatment for yourself, even if you read about it on the Internet or were advised by friends. The course of the pathology is different for each person, and the characteristics of the body are different, so the selection of medications is individual. It will be difficult to cure syphilis simply with ointment. A rash on the arm or other part of the body should be treated in a comprehensive manner. An antibiotic should be prescribed first. Most often, a penicillin drug with different durations of action is prescribed. If these antibiotics are not suitable, then they can be replaced with macrolides or Tetracycline.

To prevent allergies when taking antibiotics, the doctor recommends starting to take antihistamines, such as Claritin.

The rash also needs to be treated locally, in this case “Synthomycin emulsion”, “Levomekol” ointment or powder with talcum powder will help. It is not necessary to treat ulcers and rashes with an antiseptic.

If you start therapy in a timely manner and strictly adhere to all the doctor’s recommendations, then in this case you can avoid the serious consequences of this pathology, and in particular the appearance of scars on the skin. It is best, of course, to take all measures to avoid contracting this disease, and for this you need to take a more serious approach to choosing sexual partners and lead a healthy lifestyle.

Ulcers

Ulcerative formations form on mobile areas of the skin. They appear in the absence of drug therapy or incorrectly selected medications. A chancre forms on the surface of the ulcer. Over time it will grow and change its appearance.

During primary infection, ulcers rarely appear on the surface of the skin.

They occur against the background of worsening pathological course of the disease. Ulcerations cause pain and discomfort because the skin in this area becomes susceptible to any mechanical stress.

Severe skin lesions

With each new relapse, the manifestations of the disease become less pronounced. In other words, the number of spots decreases and changes occur in their shape and size. Moreover, the fact that the rash with secondary syphilis becomes relatively scarce does not mean an improvement in the patient’s condition.

In most cases, a decrease in the concentration of the rash indicates that syphilis is developing, leading to damage to internal organs.

At the same time, the rashes themselves over time take on the appearance of tubercles, group together and leave behind scars.