SYPHILIS
insights as to how T. pallidum functions.
I. SYNONYM
1. AIDS (Acquired immune deficiency syndrome)
2. HIV
3. SIDA
4. STD
5. VD
6. Chancroid
7. Chlamydia
8. Clap
9. Crab louse, crabs
10. Genital herpes
11. Genital warts
12. Gonorrhea
13. Herpes, herpes simplex
14. Scabies, social disease
15. Tabes, dorsalis
16. Venereal disease
II. DEFINITION
Syphilis- is a sexually transmitted disease caused
by the spirochetal bacteria Treponema
pallidum subspecies pallidum. The primary route
of transmission of syphilis is through sexual
contact however it may also be transmitted from
mother to fetus during pregnancy or at birth
resulting in congenital syphilis.
III. ETIOLOGICAL AGENT
Treponema pallidum is a novel pathogen whose
physical properties allow it to be highly invasive
and evade host defense mechanisms. T.
pallidum is a gram-negative spirochete, helical
shaped bacteria that cannot be cultured on
artificial media and must be grown in rabbit
testicles. This is one of the main reasons for why
little is known anout this pathogen. Recently, its
genome of 1.14 Mb was sequenced and analysis
of this sequence has given researchers new
IV. MODE OF TRANSMISSION
Treponema pallidum is transmitted from one
infected person to another. It is usually spread
through sexual contact. However, transmission
can occur anytime the infected ulcer comes in
contact with mucous membranes or other broken
skin. It cannot, however, be transmitted by toilet
seats, door handles, swimming pools, bath tubs,
shared clothing, or eating utensils. A pregnant
woman can also pass the bacterium on to her child
possibly resulting in mental or physical problems,
or even still born birth.
Sexual contact, but in rare cases blood transfusion
V. INCUBATION PERIOD
Syphilis has an incubation period of between 9
days and 3 months. Syphilis is almost always a
result of unprotected sex with an infected person.
The incubation period is around 10-90 days with
an average of 21 days.
VI. SIGNS AND SYMPTOMS
The signs and symptoms of syphilis vary
depending on which of the four stages it presents
in (primary, secondary, latent, and tertiary). The
primary stage typically presents with a single
chancre, secondary syphilis with a diffuse rash,
latent with little to no symptoms, and tertiary
with gummas, neurological, or cardiac symptoms.
Diagnosis is usually via blood tests. It can be
effectively treated with antibiotics, specifically
intramuscular penicillin G.
Syphilis is believed to have infected 12 million
people worldwide in 1999 with greater than 90%
of cases in the developing world. Rates of
infection have increased during the 2000s in many
countries.
Syphilis can present in one of four different
stages: primary, secondary, latent, and tertiary. It
may also occur congenitally. It has been referred
to as the “great imitator of skin diseases" due to
its varied presentations.
PRIMARY
Primary syphilis is typically acquired via direct
sexual contact with the infectious lesions of
another person. Approximately 3–90 days after
the initial exposure (average 21 days) a skin
lesion appears at the point of contact called
a chancre. This is classically (40% of the time) a
single firm, painless, non itchy skin ulceration
with a clean base and sharp borders between 0.3
and 3 cm in size. Occasionally multiple lesions
maybe present. Lesions outside of the genitals
may be painful. Lymph node enlargement
frequently (80%) occurs around the area of
infection.The lesion may persist for 3 to 6 weeks
without treatment.
SECONDARY
Secondary syphilis occurs approximately 4 to
10 weeks after the primary infection. There are
many different manifestations of secondary
disease. There may be a symmetrical reddish-pink
non-itchy rash on the trunk and extremities
including the palms and soles the rash may
become maculopapular or pustular. On mucous
membranes it may form flat, broad, whitish, wart-
like lesions known as condyloma latum.All of
these lesions are infectious harboring bacteria.
Other symptoms may include fever, sore
throat, malaise, weight loss, hair loss, and
headache. Rare manifestations
include hepatitis, kidney disease, arthritis, periosti
tis, optic neuritis, uveitis, and interstitial keratitis.
The acute symptoms usually resolve after 3 to
6 weeks.
LATENT
Latent syphilis is defined as having serologic
proof of infection without signs or symptoms of
disease. It is further described as either early (less
than 1 yr after secondary syphilis) or late (more
than 1 year after secondary syphilis). Early latent
syphilis may have relapses of symptoms. Late
latent syphilis is asymptomatic and not as
contagious as early latent syphilis.
TERTIARY
Tertiary syphilis may occur approximately 3 to 15
years after the initial infection and may be divided
into three different forms: late neurosyphilis
(6.5%), cardiovascular syphilis (10%) and
gummatous syphilis (15%). Without treatment a
third of people develop tertiary disease.[5]People
with tertiary syphilis are not infectious.[1]
Gummatous
Gummatous syphilis or late benign syphilis
usually occurs 1–46 years after the initial
infection, with an average of 15 years.[1] This
stage is characterized by the formation of
chronic gummas, which are soft, tumor-like balls
of inflammation which may vary considerably in
size. They typically affect the skin, bone, and
liver, but can occur anywhere.
Late neurosyphilis
Neurosyphilis refers to an infection involving
the central nervous system. It may occur early
being either asymptomatic or in the form of
syphilitic meningitis or late as meningovascular
syphilis, general or tabes dorsalis.[1] Late
neurosyphilis typically occurs 4 to 25 years after
the initial infection. Meningovascular syphilis
typically presents with apathy and seizure, general
paresis with dementia and tabes dorsalis is
associated with poor balance and lightening pains
in the lower extremities.
CARDIOVASCULAR
Cardiovascular syphilis usually occurs 10–
30 years after the initial infection. The most
common complications is syphilitic aortitis which
may result in aneurysm formation.
CONGENITAL
Congenital syphilis may occur during pregnancy
or during the birth process. Most infants (2/3) are
born without symptoms. Common symptoms that
then develop over the first couple years of life
include: hepatosplenomegaly (70%), rash (70%),
fever (40%), neurosyphylis
(20%), pneumonitis (20%). If untreated late
congenital syphilis may occur in 40%
including: saddle
nose deformation, Higoumenakis sign,saber shin,
or Clutton's joints among others.
VII. PATHOGOMONIC SIGN
Syphilis — painless chancre or ulceration.
VIII. DIAGNOSTIC TEST
The list of diagnostic tests mentioned in various
sources as used in the diagnosis
of Syphilis includes:
1. Swab of chancre - in primary and
secondary syphilis phases
2. Swab/scraping test
3. Syphilis blood tests
4. VDRL (Venereal Disease Research
Laboratory)
5. RPR (rapid plasma reagin) test
6. Syphilis antibody tests
7. .Fluorescent treponemal antibody-
absorption (FTA-ABS) test
8. Treponema pallidum hemagglutination
assay (TPHA)
9. Lumbar puncture (spinal tap) - to test CSF
for syphilis exposure
10. CSF syphilis tests
11. Repetition of blood tests - some blood
tests take up to 3 months to be positive
after infection.
Syphilis may be confirmed
Either via blood tests or direct visualization
using microscopy.
Typical diagnosis is with blood tests using
nontreponemal and/or treponemal tests.
Nontreponemal test are used initially and
include venereal disease research
laboratory (VDRL) and rapid plasma
reaginhowever as these test occasionally are
falsely positive confirmation is required with a
treponemal test such as treponemal pallidum
particle agglutination (TPHA) or fluorescent
treponemal antibody absorption test (FTA-Abs).
False positives on the nontreponemal tests can
occur with some viral infections such as
(varicella and measles), as well as
with lymphoma, tuberculosis, malaria,endocarditi
s, connective tissue disease, pregnancy.
Neurosyphilis is diagnosed by finding high
numbers
of leukocytes (predominate lymphocytes) and
high protein levels in the fluid in the setting of a
known syphilis infection.
1. Antibody screening tests (nontreponemal)
o Rapid plasma reagin (RPR)
o Venereal Disease Research
Laboratory (VDRL)
o Unheated serum reagin (USR)
o Reagin screen test (RST)
 2. Antibody confirmatory tests (treponemal)
o Fluorescent treponemal antibody
absorption (FTA-ABS)
o Fluorescent treponemal antibody
absorption double staining (FTA-
ABS DS)
o Microhemagglutination assay for
antibody to T. pallidum (MHA-TP)
o Hemagglutination treponemal test
for syphilis (HATTS)
o Bio-enzaBead Test (ELISA)
3. Direct examination of lesion or tissue
o Darkfield microscopy
o Direct fluorescent antibody test for
T. pallidum (DFA-TP)
o Silver stains (modified Steiner)
o Hematoxylin and eosin (H & E)
stains
Experimental Tests
4. FTA-ABS immunoglobulin (IgM)
5. FTA-ABS 19S IgM
6. IgM capture ELISA
IX. DRUG OF CHOICE
Parenteral penicillin continues to be the drug of
choice for treatment of all stages of syphilis
X. IMMUNIZATION
As of 2010 there is no vaccine effective for
Syphilis.
XI. PREVENTION AND CONTROL
Abstinence from intimate physical contact with an
infected person is effective at reducing the
transmission of syphilis, as is the proper use of
a latex condom. Condom use, however, does not
completely eliminate the risk. Syphilis cannot be
contracted through toilet seats, daily activities, hot
tubs, or sharing eating utensils or clothing
Control
The control of early infectious syphilis is essential
for the control of congenital syphilis. When the
prevalence of infectious syphilis substantially
increases among reproductive-age women, cases
of congenital syphilis very likely will follow.
Increased prevalence has been observed in several
areas of the United States in recent years. To
prevent future cases of congenital syphilis, STD
control programs need to place more emphasis on
early syphilis control, especially in areas with a
high incidence.
Prevention of Congenital Syphilis
1. Ensure that official public health statutes
and/or regulations mandate STS on all
pregnant women at the time of the initial
prenatal visit and early in the third
trimester.
2. Monitor public and private laboratories
regularly to ensure the prompt and
thorough reporting of reactive STS.
3. Assess the pregnancy status of women
with diagnosed syphilis and of women
who are the sex partners of men with
diagnosed syphilis.
4. Ask early infectious syphilis patients or
their unexamined sex partners who reside
in neighborhoods with a high incidence of
syphilis to identify women in the area who
may be pregnant. Refer all identified
women for serologic testing and prenatal
care.
5. Inform every woman of reproductive age
who is seen in an STD clinic (for any
reason) about the need for prenatal care
and STS in future pregnancies.
6. Encourage prenatal screening for syphilis
wherever pregnant women are seen for
health care, including women, infants, and
 children (WIC) programs, methadone
maintenance clinics, detention facilities,
and prenatal care facilities; whenever
possible, review existing clinic protocols
and suggest specific amendments to the
clinic medical director.
7. Conduct selective serologic screening of
women of childbearing age in groups with
an increased risk of infection, e.g., women
residing in neighborhoods that have a
particularly high incidence of syphilis.
8. Deliver educational messages to the
medical community about laboratory tests,
diagnostic criteria, treatment, and follow-
up of patients who are at risk of infection
and who may be pregnant.
9. Develop and disseminate public service
educational messages to women who share
demographic characteristics with the
women most often diagnosed with early
syphilis. In many areas of the United
States, these women are young, single,
members of a minority group, and
residents of a central city neighborhood.
Brief, well-targeted radio announcements
in the language and vernacular of the
audience may be particularly effective.
XII. NURSING MANAGEMENT
1. Administer IM injection of benzathine
penicillin G as ordered,and document.
2. Discuss the importance of abstaining from
sexual activity until he and his partners are
cured, and of using condoms to prevent re-
infection.
3. Explain the need to return for follow-up
testing in 3 months and again at 6 months.
Provide a copy of the STI prevention
checklist, and document that reminders
need to be sent at 3- and 6-month
intervals.
4. Notify sexual partners that they need to
come to the clinic for testing.
5. Refer to a social worker for counseling
about the impact of the disease on their
relationship.
6. Teach the couple about the importance of
treatment to the health of their infant.
7. Instruct the patient to refrain from sexual
contact for at least 2 weeks or until lesions
heal and return for serology testing in 1
month and then every three months for 1
years.
8. Tell the patient that the disease should be
reported to the local health authority and
that the confidentiality will be maintained.
9. Identifying and treating the sexual partners
of the infected patient is an important
intervention.
10. Provide care for the patient’s lesions, keep
them clean and dry.
11. Dispose the contaminated material from
draining lesions properly.
12. Focus on prevention.
13. Educated patients about the course of the
disease and need to return for a follow up
treatment or blood tests.
14. Patients need to understand that although
their lesions may heal, the infection may
not be gone.
15. Teach patients how to reduce the risk
factors on how to prevent future infections
by limiting the number of sexual partners
and practising SAFER SEX.
16. Advise patients to use condoms with
spermicides and inspecting partners for
any rashes or lesions may reduce exposure
to disease.
17. Patients also need an ongoing emotional
support to make lifestyle changes.
18. Explain the need for a regular laboratory
testing.
19. Explain the relationship between human
immunodeficiency virus (HIV) and
syphilis and perform HIV TESTING of
the patient wishes.
20. Instruct the patient given oral tetracycline
to take the medication 1 hour before or 2
hours after meals and to avoid dairy
products, antacids, iron, and sunlight while
taking the drug.
XIII. POSSIBLE NURSING DIAGNOSIS

1.acute pain
2.impaired skin/tissue integrity
3.delayed growth and development
4.deficient knowledge regarding pathophysiology
of condition,transmissibility,therapy
needs.expected outcomes,and potential
complications

Submitted by:
Ace A. San Joaquin
BSN III-F
Group # 24

Submitted to:
Mr. Armando A. De los Santos, RN,MAN
Clinical Instructor