IN T R O D U C T I O N
“Abstinence is the only completely effective method of preventing STDs and HIV. If you choose to be sexually active, practice safer sex, along with maintaining open communications with your partner. Practicing safer sex doesn't mean eliminating sex from your life. Safer sex means being smart and staying healthy. It means showing love, concern, and respect for partners and for self. Safer sex means enjoying sex to the fullest without transmitting, or acquiring, sexually related infections.”
Syphilis acquired person.
(siff-ill-iss) sexual can lead be to
is an infection that is usually through Syphilis it can contact with another infected frightening because if it goes untreated, serious health problems and increase a person’s risk for HIV that causes AIDS. A syphilis infection can be treated at the early stages with antibiotics and can be prevented by avoiding any sexual contacts with an infected person or a person with an unknown health history. The discovery of penicillin in the 1940s and its use in treating syphilis led to a dramatic decline in the incidence of the disease. However in the late 1980s and 1990s, the incidence of syphilis began to rise along with the incidence of HIV/AIDS.
The incidence of syphilis is highest among young adults. Rates have remained relatively steady for women yet syphilis is on the rise in men, particularly those who have sex with other men. Many people affected with syphilis do not have signs and symptoms for years, yet remain at risk for later complications if they are not treated. It’s important to know the symptoms of syphilis early on. Pregnant women should be screened for syphilis and treated so they don’t pass the infection on to their babies. Sexually active teens should understand the importance of avoiding any behavior like unprotected sex that might put them at risk for syphilis or other sexually transmitted diseases.
Syphilis is a sexually transmitted disease (STD), often called “the great imitator” because of its so many signs and symptoms that are distinguishable from those of other diseases. Syphilis affects the genitals, skin and mucous membranes, but it may also involve other parts of the body, including the brain and the heart. It is caused by the bacterium Treponema Pallidum is
extremely sensitive to light, air and changes in the temperature. Because of this, the disease is difficult to transmit except by intimate contact. You can’t contract syphilis using the same toilet, bathtub, clothing or tablewear as an infected person.
Syphilis is capable of destroying tissue in almost any organ of the body. Typically, syphilis first appears as a sore area. The signs and symptoms of syphilis may occur in stages and can spread during the first two stages of the disease. 1. Incubation Period No symptoms or lesions and Spirochetemia is present; patient’s blood is infective. 2. Primary Stage Most infectious stage which may occur 10 days to 3 months after exposure and lasts for 1-6 weeks.
Manifestations: Chancre – a small, painless sore with heaped-up firm edges which appears on the site where the treponema entered the body. The sore can appear on the vulva, vagina, cervix, oral cavity or other parts of the body; generally related to the pattern of one’s sexual behavior Enlarged lymph nodes on the groin – Spirochetes appear in the local lymph nodes producing a swelling of the
regional lymph nodes (BUBO), entering the blood and is now carried to every organ in the body. Sore heals with or without treatment but underlying disease and remains will progress to the next stage if untreated. 3. Secondary Stage Starts 3-8 weeks after the sore appears and it involves any cutaneous or mucosal surface of the body as well as any organ. Manifestations: Dermatitis – generalized maculopapular rash, polymorphous and bilaterally symmetrical in distribution a) Macular – spots with a faint flush, rose-colored b) Papular – hard & wartlike under breasts or the genitals c) Syphilides – when found on palms
Mucuous Patches – on the mouth, throat and cervix; they are yellow to white in color and covered with exudates and are highly infectious Alopecia – patchy baldness or hair loss on scalp including the eyebrows
Headache and muscle aches Fever, tiredness and weight loss 4. Latent Stage The next stage is called the latent or hidden stage. This stage can start from 2 years to over 30 years after initial infection. There are no symptoms present because symptoms tend to recede without treatment. Signs and symptoms may never return or the disease may progress to the tertiary stage. 5. Late Stage Without treatment, syphilis bacteria may spread, leading to serious internal organ damage and death, years after the initial original infection.
Gummas – appearance of lesions on external and internal surfaces which are ulcerous and abscess-like Granulomatous lesions – appear in skin, bones, liver, cardiovascular system and the central nervous system
Neurologic problems. These may include stroke; infection and inflammation of
the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination, numbness; paralysis; deafness or visual problems; personality changes and dementia. Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve stenosis.
Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period. The bacterial organism that causes Syphilis, Treponema Pallidum, enters your body through minor cuts or abrasions in your skin or music membranes: 1. Sexual Intercourse – most common route of transmission 2. Blood Transfusion of infected blood 3. Direct unprotected close contact with an active lesion 4. Pregnancy - through an uninfected to her unborn child Risk Factors. High-risk sexual activity puts you at risk of syphilis and other STDs. Men who have unprotected sex with other men are at greater risk. Young adults between the ages of 15-25 years appear to be at higher risk. However, anyone who has unprotected sex is at risk for developing syphilis.
Pregnant women can pass syphilis to their babies during pregnancy and childbirth. It can cause miscarriage, stillbirth or death soon after birth. An infected baby may be born without signs of the disease others may manifest the following symptoms:
Skin sores and rashes Fever Jaundice Anemia Swollen liver and spleen Saddle nose – depressed nose bridge Bone abnormalities & pain, swollen joints Hutchinson’s teeth – disfigured, screwdriver-shaped teeth Snuffles or chronic coryza often noticed at birth or soon after and usually precedes the appearance of a variety of rashes, mucocutaneous lesions. Interstitial Keratitis – characterized by photophobia, increased lacrimation and vascularization of the cornea with exudation. All pregnant women should be tested for syphilis. Those found out to be positive should be treated right away with Penicillin.
Antibiotic therapy. Penicillin is the drug of choice to treat syphilis at all stages. The dose and length of treatment depends on the stage and symptoms of the disease.
Newborn 1. Benzathine Penicillin G Dosage: 100,000 units/kg Route: single IM dose 2. Erthyromycin – for Pts allergic to penicillin Dosage: 15 mg/kg for 12-15days Route: IM Adult 1. Benzathine Penicillin G Dosage: 2.4 million units total Route: IM at a single dose/session 2. Tetracycline HC l– for Pts allergic to penicillin Dosage: 500 mg Route: PO, 4 times a day for 14 days
On the first day of treatment, one may experience what’s known as the Jarisch-Heixheimer reaction. Signs and symptoms of this reaction include fever, chills, nausea, achy pain and headache. This reaction may probably be caused by many bacteria dying at once at the beginning of the antibiotioc therapy. Other Medical Treatments include: Topical corticosteroids – applied every 2 hours and indicated in interstitial Keratitis Opthalmologists should be consulted for severe ocular lesions Adequate necessary Patients with syphilis of more than 1 year’s duration are treated with a different regimen Post-treatment follow-up is essential for treatment failures do occur and may require re-treatment nutrition and blood transfusion for anemia are
Abstinence. The best way to prevent syphilis or any STD is to abstain from sex – vaginal’ oral or anal Mutual monogamous relationship. Have a sexual relationship with one partner who is not infected and be faithful to each other. Use Condoms. Honesty. Talk frankly with sex partners, doctors or nurse about any STDs you or partner have or had or any sores in the genital area. Being honest could save lives. Have regular pelvic exams.
1. Case Finding – tactful and careful taking and recording of history of exposure and observation. 2. Health teaching and guidance on preventive measures. 3. Proper direction to patient and family on how to use available services of community health facilities. 4. Assisting physician in the interpretation of the diagnosis and its implication on the prescribed treatment.
5. Assistance and encouragement on the prescribed follow-up visits to attain a complete cure. 6. Keeping oneself in pace with the changes on the different aspects of the Veneral Disease control program through attendance and participation in reviews, research and other in-service education aimed to improve VD services. 7. Develop ways and means to help patient and family, remember follow-up dates when due as well as continue the treatment prescribed. 8. Discuss clearly with the patient the need for medical examination of patient’s contacts. Encourage his participation to bring about this most needed examination.
We would like to acknowledge our Heavenly Father, for the blessings He has given us and for allowing us this learning experiences in the community. To our parents, for all their help and support in our goal to finish our nursing course. To our school, Our Lady of Fatima University, College of Nursing, for having a program that allows student nurses like us to learn and be of service to their community. And of course the members of Group 47-E who shared their knowledge, time, research and resources to complete this project. Mostly our thanks to our professor in Community Care
Management, Sir Domingo J. Buncan III, for his patience, support, teachings and guidance.
COMMUNITY CARE MANAGEMENT
Our Lady of Fatima University College of Nursing
Quiroz, Catherine G. Ramirez, Melodee Grace P. Ramos, Ernesto S. Reynado, Jay-Ar Rivera, Robert Santiniaman, Brian Sebastian, Alicia V. Suarez, Mervin William Tan Torres, Robert Patricio Tumaliuan, Myrna
February 23, 2007 S.Y. 2006-2007
Diagnosis of Syphilis depends on the clinical manifestations and laboratory examinations. A. Non-Specific Laboratory Tests VDRL “Venereal Disease Research Laboratory test” and RPR “Rapid Plasma Reagin” VDRL and RPR is a screening test for syphilis that measures antibodies called reagins that can be produced by Treponema pallidum, the bacteria which causes syphilis. However, the body does not always produce reagin specifically in response to the syphilis bacteria, so the test is not always accurate. The value of a negative test depends on the stage of syphilis that is suspected and additional testing may be needed prior to ruling out syphilis. A positive test result may mean you have syphilis. If the test is positive, the next step is to confirm the results with an FTA-ABS test, which is a more specific syphilis test. B. Specific Laboratory Tests 1. Dark Field Examination of Chancre Fluid Dark-field examination is done daily for 3 consecutive days. The field appears dark so as to prevent entrance of any rays of light and the spirochete will be numerous and readily recognizable by their characteristic morphology and motility.
2. FTA-ABS “Flourescent Treponemal Antibody Absorption test”
This test is used routinely to confirm whether a positive screening test for syphilis (either VDRL or RPR ) reflects true infection with syphilis. It may also be done when either primary or tertiary syphilis are suspected and the initial screening tests are negative, because screening tests during these stages of syphilis may be falsely negative. A negative or non-reactive result indicates no current or past infection with syphilis. A positive FTA-ABS usually indicates infection with syphilis. This test will remain positive for life even if an individual has received appropriate treatment. 3. TPI “Treponema Pallidum Immobilization test” TPHA “Treponema Pallidum Hemagglutination Test”
REFERENCES: San Lazaro. , Compilation of Communicable Diseases in Nursing www.mayoclinic.com www.nlm.nih.gov/medlineplus www.kidshealth.org/parent/infections/std/syphilis.html www.hkmj.org.hk/skin/syphilis.htm www.phototakeusa.com www.istockphoto.com