Dermatovenerology Faculty – of foreign students Course – 4 Practical classes for distancial education

Ways of the course of syphilis: 
1. hidden with the transition to late neurosyphilis; 
2. manifest 
3. with a transfusion route of infection, the development of secondary syphilis 
immediately. 
The traditional scheme of the course of syphilis includes: 
 Incubation period; 
 Primary seronegative syphilis (Lues premaria seronegativa); 
 Primary seropositive syphilis (Lues premaria seropositiva); 
 Secondary fresh syphilis; 
 Secondary latent syphilis; 
 Secondary recurrent syphilis; 

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 Tertiary syphilis. 
Syphilis infection conditions A sufficient amount of virulent pale treponemas 
(2-3). Damage to the skin or mucous membranes. Shells are the entrance gate. 
The incubation period is the time from the moment of infection to the appearance 
of primary syphilema (chancre). 
When Treponema pallidum enters the body, syphilis becomes a common 
disease - a disease of the whole organism. It is proved that after a few hours (6-8-
10) Treponema pallidum penetrates the lymphatic system, then into the blood and 
brain tissue. From this moment begins the immune restructuring of the body. 
 Clinical manifestations of the disease are absent for a relatively long time. 
Currently, the incubation period of syphilis is an average of 4-5 weeks. In general, 
the period can vary from 10-15 days to 3-6 months. Despite the absence of clinical 
symptoms in the incubation period, there is an intensive dissemination of 
Treponema pallidum from the site of introduction along the lymphatic, perineural 
and hematogenous pathways, which ends with the formation of primary syphilema 
(chancre), concomitant lymphangitis and regional sclerodenitis. 
From the moment hard chancre appears, the initial period of syphilis begins, which 
continues until multiple syphilitic rashes appear on the skin and mucous 
membranes. This period lasts 7-8 weeks.
The primary period of syphilis is divided into: 
1. primary seronegative syphilis, when standard serological reactions are negative; 
2. primary seropositive syphilis, when standard serological reactions become 
positive, which occurs on average 3-4 weeks after the occurrence of primary 
syphilis. 

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If untreated, the course of the initial period of syphilis ends with general 
febrile symptoms, malaise, pain in bones, joints and polyadenitis. These symptoms 
are due to generalization of the infection and dissemination of Treponema palidum 
to organs and tissues. This period of the course of infection is called the secondary 
period of syphilis and occurs 10-12 weeks after infection. Clinically, the secondary 
period of syphilis is characterized by the appearance of roseous, papular and 
pustular rashes on the skin and mucous membranes. In this period, the internal 
organs, nervous and bone systems are also affected. Rashes, having existed for 
several weeks, pass independently and a latent (latent) period of the disease occurs. 
After some time, a relapse of the disease is observed. On the skin and mucous 
membranes, rashes characteristic of the secondary period of syphilis again appear, 
after which a latent period of the disease can again occur. The secondary period of 
syphilis without treatment can last 2-5 years (during this time, an alternation of 
secondary latent and secondary recurrent syphilis can be observed).
The secondary period of syphilis is divided into: 
-Secondary fresh syphilis, when abundant and bright rashes first appear on the skin 
and mucous membranes in the presence of solid chancre or its residues. 9 -10 
weeks after infection. 
-Secondary latent syphilis is a period of syphilis without active manifestations on 
the skin and mucous membranes. 
-Secondary recurrent syphilis is the period of subsequent repeated rashes. After 4-6 
months from the moment of infection. 
After 2-5 years, if the patient has not been treated or was not sufficiently 
treated, a tertiary period of syphilis sets in. This period is characterized by the 
formation of tubercles and gum. Bumps occur on the skin and mucous membranes, 
and gum - in the subcutaneous fat, bones, internal organs and nervous system. The 
course of syphilis in this period is also wave-like - the phases of active 
manifestations are replaced by phases of a hidden pathological process.
The tertiary period of syphilis is divided into: 
Tertiary active syphilis. 

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 Tertiary latent syphilis. 
The tertiary period of syphilis can last for many years. In some patients without 
treatment or with its insufficiency 10-15 years or more after infection, late forms of 
syphilis may occur: 
1. neurosyphilis (spinal cord, progressive paralysis or tabo-paralysis); 
2. viscerosyphilis: mesortitis, aortic aneurysm, damage to the liver, stomach and 
other organs. 
The classic standard course of syphilis appears in 95-98% of patients. However, in 
the last 3-5 years, patients with a long asymptomatic latent course of the disease, 
which is diagnosed only serologically, have increasingly been identified.