Syphilis

by: Andrew S. Jamolin Liza May C. Ellaga Syphilis is an acute and chronic infectious disease caused by the spirochete Treponema pallidum. It can be Acquired or Congenital.

Mode of Transmission
Direct Contact
Contact with an infectious, moist lesion Sexual intercourse Skin abrasions Transplacental transmission

Stages and Accompanying Signs and Symptoms Primary Stage of Syphilis

Begins with the entry of the Treponema pallidum spirochete through the skin or mucous membranes. Between 3 and 90 days later, a papule develops at the site of entry, then sloughs off, leaving a painless, red, ulcerated area called a chancre. The disease is highly contagious at this stage.

Chancre formation is generally the only symptom of this stage of syphilis. It eventually heals, but the spirochete remains active in the infected individual. The chancre usually heals within 3 to 12 weeks, with or without treatment.

Secondary Stage of Syphilis

Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. Secondary syphilis generally occurs about 2 to 8 weeks after the chancre formation. Rash appears that involves the trunk and the extremities including the palms and the soles

Generalized signs of infection:

lymphadenopathy arthritis meningitis hair loss fever malaise weight loss

Period of Latency
Infected person has no signs or symptoms of syphilis and may progress to tertiary syphilis. But in 25% to 50% latency period may last a lifetime. Persons can be infective during the first 1 to 2 years of latency.

Tertiary Stage of Syphilis

Tertiary syphilis is a delayed response of the untreated disease. It can occur as long as 20 years after the initial infection.

When syphilis does progress to the symptomatic tertiary stage, it commonly takes one of three forms: development of localized destructive lesions called gummas development of cardiovascular lesions (Cardiovascular Syphilis) development of central nervous system lesions (Neurosyphilis)

Syphilitic gumma is a peculiar, rubbery, necrotic lesion that is caused by noninflammatory tissue necrosis. Central nervous system lesions can produce dementia, blindness, or injury to the spinal cord, ataxia syphilitic meningitis, paralysis. Cardiovascular manifestations result from scarring of the medial layer of the thoracic aorta with aneurysm formation. These aneurysms produce enlargement of the aortic valve ring with aortic valve insufficiency. Assessment and Diagnostic Findings The conclusive diagnosis of syphilis can be made by direct identification of the spirochete obtained from the chancre lesions of primary syphilis. Serologic tests used in the diagnosis of secondary and tertiary syphilis require clinical correlation in interpretation.

Serologic Tests
Nontreponemal or Reagin Test Venereal Disease Research Laboratory (VDRL) Example: Rapid plasma reagin circle card test (RPR-CT) Used for screening and diagnosis. After adequate therapy, the test result is expected to decrease quantitatively until it is read as negative, usually about 2 years after therapy is completed.

 Treponemal tests Fluorescent treponemal antibody absorption test (FTA-ABS) Microhemagglutination test (MHA-TP) Used to verify that the screening test did not represent a false-positive result. Treponemal enzyme-linked immunosorbent assay (ELISA) Polymerase chain reaction (PCR) tests for treponemal DNA are some newer methods that reduce the risk of false results.

Medical Management Treatment of all stages of syphilis is administration of antibiotics. Penicillin G benzathine is the medication of choice for early syphilis or latent syphilis of less than 1 years duration. Patients who are allergic to penicillin are usually treated with doxycycline.

Nursing Management Establish a sexual history, including the number of sexual partners and whether the patient was protected by a condom. Question the patient about intravenous (IV) drug use and previous STIs. Establish a history of fever, headaches, nausea, anorexia, weight loss, sore throat, mild fever, hair loss, or rashes, symptoms of the primary and secondary stages. Determine if the patient has experienced paresis, seizures, arm and leg weakness, alterations in judgment, or personality changes, all of which are symptoms of late-stage syphilis. Carefully inspect the patients genitalia, anus, mouth, breasts, eyelids, tonsils, or hands for a primary lesion. With female patients, be sure to determine if chancres have developed on internal structures such as the cervix or the vaginal wall. Also inspect the scalp, skin, and mucous membranes for hair loss, rashes, or mucoid lesions, which are characteristic of the secondary stage. Assure the patient that her or his privacy and confidentiality will be maintained during examination, diagnosis, and treatment, although all sexual partners need to be notified so that they can be examined and treated as needed.

 Medical treatment for syphilis infection at any stage consists of antibiotic therapy to destroy the infecting bacteria. After treatment, patients are instructed to refrain from sexual contact for at least 2 weeks or until lesions heal and to return for serology testing in 1 month and then every 3 months for 1 year. Carefully question patients about penicillin sensitivity before treatment. Instruct the patient to rest, drink fluids, and take antipyretics. Provide care for the patients lesions. Keep them clean and dry. Properly dispose of contaminated materials from draining lesions. Use universal precautions when you come in direct contact with the patient, when collecting specimens, and when caring for the lesions. Focus on prevention. Educate patients about the course of the disease and the need to return for follow-up treatment or blood tests. Teach patients how to reduce risk factors to prevent future infections by limiting the number of sexual partners and practicing safer sex. Patients need ongoing emotional support to make lifestyle changes. Explain the need for regular laboratory testing (VDRL) every 3 months for 2 years to detect a relapse. Urge patients in the latent or late stages to have blood tests every 6 months for 2 years.