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Сифилис на анусе
Сифилитическая инфекция может поражать область заднего прохода и прямую кишку.
Причем на всех стадиях её развития.
Анус может быть входными воротами для инфекции у некоторых женщин и гомосексуалистов.
Кроме того, в этой области могут появиться элементы сыпи во вторичном и третичном периоде заболевания.
Можно ли подхватить сифилис при анальном сексе?
Заразиться сифилитической инфекцией можно при любом виде телесного контакта.
Это даже не обязательно должны быть половой акт.
Инфекция передается даже при бытовом контакте.
Но во время секса передача инфекции наиболее вероятна.
А потому чаще всего очаги первичной сифилитической инфекции располагаются на половых органах.
Реже можно увидеть сифилис на анусе, во рту или на других участках тела.
Для сифилитической инфекции нет разницы, каким способом и откуда внедряться в организм.
Бледная спирохета может вызвать появление первичной сифиломы везде, при создании необходимых условий.
А именно:
- наличие бактериовыделения у источника инфекции;
- наличие микротрещин или явных повреждений кожи и слизистой у реципиента;
- попадание даже нескольких бактериальных клеток на эти микроповреждения.
Сифилис – очень контагиозная инфекция.
Вероятность заражения даже при однократном анальном сексе очень высокая.
Инфицируются по понятным причинам чаще всего женщины.
Из мужчин таким способом заражаются только гомосексуалисты.
Оптимальные условия для инфицирования:
- на пенисе источника инфекции располагаются элементы сифилитических высыпаний;
- происходит эякуляция внутрь ануса (через сперму возможна передача инфекции даже при отсутствии видимых её клинических проявлений);
- не используется презерватив;
- грубый или длительный половой акт, повышающий вероятность травматизации слизистой;
- отсутствие туалета аногенитальной зоны непосредственно после секса.
Теоретически возможно инфицирование и при других видах половой активности.
Например, при анилингусе.
Но подобные случаи встречаются очень редко.
Причин тому несколько.
Анилингус редко бывает единственным видом половой активности между партнерами.
Обычно это лишь один из элементов секса, может использоваться в качестве прелюдии.
К тому же, обязательным условием для заражения является наличие высыпаний во рту или на губах.
Если сперма содержит бледные трепонемы практически всегда, то в слюне их нет.
В неё бактерии могут попадать только из ротовой полости, уже после выделения.
Можно ли заразиться сифилисом ануса у проктолога?
Теоретически это возможно.
Но чтобы подобное случилось в реальной жизни, а не в фантазии, должно случиться невероятное.
Нужно, чтобы проктолог обследовал человека с анальным сифилисом.
А затем, не сменив перчатки, полез в анус другому пациенту.
Случается это крайне редко.
Во-первых, проктологи используют только одноразовые перчатки.
Во-вторых, к ним редко заходят пациенты, страдающие сифилитической инфекцией.
В основном ими занимаются венерологи.
Таким образом, отказываться от услуг проктолога или любого другого врача из-за боязни заразиться сифилисом с вашей стороны было бы неразумно.
Инфицирование этой патологией в медицинском учреждении практически исключено.
Очень редко происходят случаи парентеральной передачи заболевания.
Но всю донорскую кровь тщательно проверяют, так что инфицирование таким способом крайне маловероятно.
Что же касается инфицирования в условиях клиники через анус, то это вообще нереально.
Шанкр в анусе
Итак, чаще всего первичное попадание возбудителя сифилиса в задний проход обусловлено анальным сексом.
В этом случае бледные спирохеты проникают на поврежденную слизистую.
Это обязательное условие инфицирования.
Почти всегда оно соблюдается.
Так как при анальном сексе как минимум микротрещины ануса появляются всегда.
Около 1 месяца никаких симптомов нет.
Затем появляется первичная сифилома.
Она обнаруживается не всегда.
Во-первых, потому что может образоваться в форме небольшой безболезненной эрозии.
Зону ануса весьма специфичная.
Она отличается тем, что в повседневной жизни не демонстрируется окружающим.
Сам пациент её тоже не видит из-за особенностей расположения.
Вот и выходит, что те симптомы, которые проявляются исключительно визуально, в анусе попросту не обнаруживаются.
Пациент способен заподозрить неладное, только когда есть субъективные проявления заболевания.
Например, если ощущается боль, зуд и т.д.
А также если первичная сифилома определяется пальпаторно.
Например, во время дефекации или гигиенических процедур.
Особенности первичного сифилиса ануса
Классическая сифилома, если она появляется на половых органах, выглядит как эрозия.
Она круглая, красная, безболезненная, сопровождается увеличением паховых лимфоузлов, которые легко пальпируются.
Но в анусе шанкр выглядит и ощущается пациентом по-другому.
Он почти всегда болезненный.
Причем даже в тех случаях, когда нет присоединения вторичной бактериальной микрофлоры.
При осмотре обнаруживается чаще всего в зоне анальных складок.
Значительно реже – внутри прямой кишки, на её слизистой.
На вид это может быть классический эрозивный шанкр.
Но достаточно часто встречаются атипичные формы.
При расположении в зоне внутреннего сфинктера сифилома становится овальной.
Если располагается в анальных складках, может быть ракетообразной.
Иногда сифилома и вовсе выглядит как анальная трещина.
Из-за этого пациент идет жаловаться не к венерологу, а к проктологу.
Тот не всегда способен заподозрить сифилис, так как не имеет соответствующей настороженности.
Он лечит пациента от анальной трещины.
Та, естественно, проходит, ведь первичная сифилома не может существовать вечно.
Она исчезает через несколько недель, и других симптомов в течение длительного периода нет.
В результате пациент покидает лечебное учреждение с невыявленным и непролеченным сифилисом.
Болезнь переходит во вторую стадию.
Пациенту же грозят многочисленные осложнения, а его партнеры подвергаются риску заражения.
К тому же признаки расположенной в анусе первичной сифиломы часто напоминают проктит.
Слизистая отекает, кровоточит и болит.
Дифференциальная диагностика проводится и с другими заболеваниями:
При расположении шанкра в глубине прямой кишки выявить его можно только при помощи инструментальных исследований.
Для этого выполняется ректоскопия.
Ещё одной особенностью анального расположения первичной сифиломы является отсутствие у многих пациентов увеличенных лимфоузлов.
В иных случаях лимфаденит развивается в тех зонах, которые не доступны для осмотра и пальпации.
Вторичный сифилис ануса
Если у человека не была обнаружена сифилитическая инфекция, он не получает лечение.
Тогда заболевание переходит в следующую стадию.
Постепенно первичная сифилома в анусе исчезает.
Пациент может ошибочно принять исчезновение симптомов за выздоровление.
Но в действительности это не так.
Наступает скрытый период сифилиса, который может продолжаться несколько недель, а иногда и несколько месяцев.
Затем возникают симптомы вторичного периода.
Его проявления весьма разнообразны.
Они затрагивают в первую очередь кожу и слизистые различных участков организма.
В том числе проявления возникают и в зоне ануса.
Папулезный сифилид в анусе
Разновидностей папулезного сифилида есть достаточно много.
Некоторые могут появляться в анусе.
Изначально появляются единичные небольшие папулы.
Это бесполостные элементы, которые возвышаются над поверхностью кожи.
Они могут сливаться в бляшки.
Из них впоследствии формируется мокнущий папулезный сифилид.
В зоне анальных складок это происходит достаточно часто.
Потому что причиной мокнутия становится воздействие таких факторов:
Риск выше при недостаточной гигиене анальной области.
В складках создаются условия с высокой температурой, влажностью.
В результате кожа размягчается.
Бляшка становится рыхлой, набухшей.
Из неё выделяется большое количество жидкости, содержащей бледные трепонемы.
В дальнейшем под действием трения на месте мокнущей бляшки формируется эрозия.
Как правило, она круглой формы.
Четко отграничена от окружающих здоровых тканей.
По периметру есть красный ободок, слегка возвышающийся над кожей.
Пациенты почти не имеют субъективных ощущений.
Изредка отмечается зуд.
При дальнейшем развитии возможно образование в анальных складках язвенного сифилида.
Часто он выглядит как трещина.
Такой сифилид называют рагадиформным.
Такой вторичный сифилид может быть очень болезненным.
Особенно если трещина глубокая.
Заживает она с образованием рубца.
В иных случаях язвенный сифилид представляет собой глубокий язвенный дефект круглой формы.
Он покрыт серым налетом.
Широкие кондиломы в анусе
Одна из частых локализаций широких кондилом – задний проход.
Это разновидность папулезного сифилида.
Другое название: вегетирующие папулы.
Образуются в результате длительного, но слабого раздражения лентикулярных или нумулярных папул.
В его результате повреждаются, а затем гипертрофируются сосочки кожи.
В результате папула растет как по площади, так и в высоту.
Появляются бородавчатоподобные разрастания.
Они возвышаются над кожей до 2 см.
Множество широких кондилом сливаются, образуя единое образование.
Оно с виду напоминает доброкачественную опухоль.
Такую форму сифилиса ануса можно перепутать с проявлениями папилломавирусной инфекции.
Поверхность часто:
- покрывается серым налетом, который легко снимается;
- изъязвляется;
- размягчается;
- выделяет экссудат.
Из-за особенностей расположения очень часто широкие кондиломы служат фактором передачи инфекции.
В выделяемой ими жидкости и содержащемся на поверхности налёте присутствует множество бактерий.
Другие особенности вторичного сифилида:
- часто рецидивируют;
- появляются на том же месте;
- могут возникать изолированно, без других элементов сыпи на теле;
- длительно сохраняются без лечения.
Дифференциальная диагностика проводится в первую очередь с остроконечными кондиломами.
Это результат инфицирования папилломавирусной инфекцией.
Она, как и сифилис ануса, передается половым путем.
Главное отличие в том, что вирусные кондиломы располагаются на тонкой ножке, а при сифилисе они имеют широкое основание.
Дифференциальная диагностика проводится с помощью лабораторных анализов.
Всех пациентов с кондиломами проверяют на сифилис.
Третичный сифилис ануса
В третичном периоде в области ануса могут появляться бугорки и гуммы.
Особенности этих элементов:
- деструктивный рост – разрушают окружающие органы и ткани;
- медленное формирование;
- отсутствие выраженных болевых ощущений;
- нет признаков воспалительного процесса;
- изолированное расположение.
В благоприятных случаях существующие узлы рассасываются.
Иногда они вскрываются с вытеканием клейкой жидкости.
Иногда рубцуются, в них откладываются соли кальция.
Расположенные в прямой кишке гуммы могут приводить к стриктурам (сужениям).
Иногда развиваются осложнения, требующие хирургического лечения.
Диагностика сифилиса ануса
При появлении любых симптомов в зоне ануса, будь то папулезные высыпания, бородавчатые разрастания или эрозии, врач всегда должен назначить анализы.
Как минимум ставятся отборочные реакции на сифилис.
В случае отрицательного результата человек может быть спокоен, что у него нет этой инфекции.
Если же результат положительный, назначают подтверждающий тест.
Для установления диагноза требуется 2 серологических исследования.
Часто это RPR и ИФА.
Но могут применяться и другие тесты: РПГА, реакция Вассермана, РИФ.
При наличии высыпаний в зоне ануса возможно и прямое обнаружение бледных спирохет.
Для этого применяется микроскопия или ПЦР.
С ануса берут мазок.
Изначально элементы сыпи раздражают, чтобы из них выделилась жидкость.
Затем производят забор биоматериала.
Его могут исследовать под микроскопом, в тёмном поле.
Но более чувствительным тестом является ПЦР.
Методика позволяет обнаруживать ДНК бледной спирохеты.
Выявление микроорганизмов возможно даже при их незначительном количестве во взятом материале.
Прямое обнаружение бледной трепонемы, вне зависимости от используемого метода, является безусловным доказательством сифилитической инфекции.
Поэтому после их проведения дополнительных подтверждающих тестов не требуется.
Лечение сифилиса ануса
Какое лечение будет назначено, зависит от того, на какой стадии обнаружена сифилитическая инфекция.
В анусе могут выявляться первичная сифилома, вторичные сифилиды или гуммы третичного периода.
Во всех ситуациях терапия будет разной.
Основу лечения в любом случае составляет этиотропная терапия.
То есть, комплекс мероприятий, направленных на уничтожение бактерии, являющейся возбудителем сифилиса.
После её элиминации (выведения) из организма большинство симптомов уходят.
Некоторые исчезают в течение нескольких недель, другие – нескольких месяцев.
В запущенных стадиях возможны остаточные явления.
Например, при вовлечении в патологический процесс центральной нервной системы.
При локализации твердого шанкра в анусе назначают курс пенициллинов.
Часто используются препараты длительного действия.
Они вводятся 1 раз в 5-7 дней.
Всего несколько инъекций позволяют избавиться от сифилитической инфекции.
Во вторичном периоде препараты вводят 1 раз в день.
Используют чаще всего прокаин бензилпенициллин.
Курс лечения длится 2-3 недели.
В третичном периоде может потребоваться 2-3 курса продолжительностью несколько недель.
Лечение проходит в условиях стационара.
Это лишь ориентировочные сведения о принципах терапии заболевания.
Схема подбирается врачом индивидуально под каждого конкретного пациента.
Потому что у всех заболевание имеет свои особенности течения.
Поражается зачастую не только анус, но также кожа различных участков тела, ЦНС и внутренние органы.
В терапевтическом процессе часто принимают участие не только венерологи, но и представители других врачебных специализаций.
Это могут быть неврологи, отоларингологи, офтальмологи, кардиологи и т.д.
Лечить сифилис необходимо как можно раньше.
Запущенные формы инфекции лечатся тяжело и долго.
После прохождения терапии могут остаться необратимые последствия перенесенного заболевания, в том числе со стороны нервной системы.
В то время как на ранних стадиях сифилис можно излечить быстро, безопасно, в амбулаторных условиях (без госпитализации в стационар).
Куда обратиться при подозрении на сифилис?
Обратитесь в нашу клинику, если вы:
- имели анальный половой контакт с потенциальным или установленным источником сифилитической инфекции;
- обнаружили в зоне ануса подозрительное образование, напоминающее округлую язву или трещину;
- выявили любые другие симптомы через 1-2 месяца после анального секса.
Иногда первые признаки сифилиса ануса обнаруживаются только через несколько лет после заражения.
Это может быть эрозивный или язвенный папулезный сифилид, широкие кондиломы.
Поэтому в каждом случае при подозрении на сифилитическое поражение ануса стоит провериться.
В нашей клинике проводится экспресс-анализ на сифилис за 20 минут.
Вы можете быстро провериться на это венерическое заболевание.
В случае подтверждения диагноза вы можете пройти у нас лечение.
Опытный венеролог подберет индивидуальную схему антибиотикотерапии.
При появлении симптомов сифилиса на анусе обращайтесь к автору этой статьи – венерологу в Москве с многолетним опытом работы.
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