Syphilitic Vaginitis: Symptoms, Diagnosis, Treatment
Table of Contents
Syphilis is a systemic human disease caused by Treponema pallidum. Syphilitic vaginitis is a manifestation of early primary genital syphilis.
Incubation period: 10-90 days between infection and appearance of the chancre.
Clinical picture
During gynecologic examination in mirrors, the chancre is usually superficial, solitary, painless with a clean base, with a clear discharge. Chancre may be accompanied by regional lymphadenopathy. Atypical chancres in appearance can be multiple, painful, deep and indistinguishable from a herpetic ulcer. Any anogenital ulcer should be considered syphilitic until proven otherwise.
Diagnosis of syphilitic vaginitis
Direct and indirect (serologic) diagnostic methods are used to confirm syphilitic vaginitis.
1. Direct methods (detection of the causative agent)
These methods are aimed at detecting Treponema pallidum in material from lesions:
- Darkfield microscopy – visualization of motile treponemes in exudate from chancres or erosions.
- Molecular tests (PCR) – detection of T. pallidum DNA in tissues or secretions.
- Immunohistochemistry (used less frequently) – detection of treponemes in mucosal biopsy specimens using antibodies.
Direct methods are most effective in the early stages (primary syphilis) when serologic tests may still be negative.
2. Serologic diagnostics (main method)
Two types of tests are necessarily used to confirm syphilis:
| Type of test | Examples of methods | Characterization |
|---|---|---|
| Nontreponemal (screening) tests | VDRL, RPR, TRUST, USR | Detect antibodies to lipids, appear 1-4 weeks after chancre formation. May give false positive results (in autoimmune diseases, pregnancy, etc.). |
| Treponemal (confirmatory) | ELISA, RPGA, RIF, immunoblotting, IHL, PBT | Detects specific antibodies to T. pallidum. Remains positive even after treatment |
Important:
- Only the combination of the two tests (nontreponemal + treponemal) allows for an accurate diagnosis.
- Using only one type of test can lead to:
- False negatives (early stage).
- False positives (due to cross-reactivity or past syphilis).
Treatment syphilitic vaginitis
Penicillin G
Parenterally administered penicillin G is the preferred treatment for patients at all stages of syphilis. The starting dose in adults and adolescents with early syphilis according to the WHO STI guidelines is benzathine benzylpenicillin 2.4 million units once intramuscularly.
It is possible to change the drug, dosage and duration of therapy depending on the stage of the disease and clinical picture. To achieve therapeutic effect, it is necessary to ensure treponemicidal level of antimicrobials in serum.
Characteristics of treponemicidal concentration:
| Parameter | Significance |
|---|---|
| Minimum treponemicidal level | > 0.018 mg/l |
| Effective concentration in vitro | 0.36 mg/l |
| Recommended duration of therapy | At least 7-10 days |
Longer treatment is necessary when the infection is of long duration, especially in the late stages of syphilis. This is due to the slower division of treponemes, which reduces the effectiveness of short courses and increases the risk of relapses.
Alternatives for penicillin allergies
- Desensitization to penicillin followed by first-line therapy.
- Utilization of alternative medications:
- Ceftriaxone;
- Doxycycline (oral).
Monitoring the effectiveness of treatment
Quantitative VDRL or RPR serologic tests are used to monitor disease progression and evaluate the effect of treatment. The quantitative titer should be recorded on the first day of treatment as a baseline.
Recommended Observation Pattern:
- 1 month after the start of therapy;
- Three months later;
- Every 6 months thereafter.
It is important to use the same test in the same laboratory for comparability of results. Monitoring continues until the test becomes negative or a stable low titer is established (1:1-1:4 for 1 year if there is no risk of re-infection).
Patients with persistently high titers should be under long-term follow-up.
Treatment of syphilitic vaginitis in pregnancy
Pregnant women with untreated early syphilis have a 70-100% risk of intrauterine infection of the fetus. Up to one third of cases may end in stillbirth.
Infection of the fetus most often occurs at the end of pregnancy (after 28 weeks). Treatment before this time prevents congenital lesions in most cases.
Parenteral penicillin G is the only drug with proven efficacy in the treatment of syphilis in pregnancy.
FAQ
1. How does syphilitic vaginitis differ from other sexually transmitted infections?
2. Can syphilitic chancre be painful?
3. Why is the combination of two serologic tests important in diagnosis?
4. Can syphilis be treated during pregnancy?
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