Medical

Syphilis

Syphilis is a chronic systemic infection caused by the spirochete Treponema pallidum. Syphilis is spread through sexual contact and initially appears as a painless sore, usually found on genitals, rectum or mouth. Syphilis occurs in 4 stages.

Causes:

The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through physical contact with an infected person’s sore during sexually related activity. The bacteria enter the body through minor cuts or abrasions in the skin or through mucous membranes.

Diagnosis:

It is diagnosed serologically.

Signs & Symptoms:

> The first stage is when a sore appears at the location where the bacteria entered the body. This sore is called a chance. Most people infected with syphilis have 1 chance with the exception of a few people having more than 1. Chancres appear 3 weeks after initial contact and are painless which is why most people are unaware they have it. Chancres heal on their own within 3-6 weeks.

> The second stage is when a rash appears on the person’s trunk and eventually covers the person’s body. The rash is generally not itchy but it can be accompanied by wart-like sores in the mouth and genital area. Some people have been known to experience hair loss, muscle aches, fever, sore throat, and swollen lymph nodes. These symptoms can either disappear in a few weeks or they recur and disappear repeatedly for a year.

> The third stage is the latency stage where there will be no clinical manifestation found present in the body. Untreated latent syphilis progresses to late syphilis in 30% of reported syphilis cases but it may persist throughout the infected person’s lifetime, which means the symptoms don’t return ever again. However, syphilis rarely resolves without treatment.

> The last and final stage of syphilis, the disease will move on to damage the person’s brain and this leads to neurosyphilis, damage the person’s heart and blood vessels which leads to cardiovascular syphilis and damage the person’s bones, mouth, and liver which leads to gummas.

Treatment:

For primary, secondary or early latent stage of syphilis à For non-penicillin allergic patients, Penicillin G benzathine (single dose of 2.4 million units injected intramuscularly, 1.2 million units in each buttock). For penicillin-allergic patients, Tetracycline hydrochloride (500mg oral dose 4 times a day) or Doxycycline (100mg oral dose 2 times a day) for 2 weeks.

For late latent, cardiovascular or benign tertiary stage of syphilis à For non-penicillin allergic patients & normal CSF, Penicillin G benzathine (2.4 million units injected intramuscularly weekly for 3 weeks). For non-penicillin allergic patients & abnormal CSF, treat as neurosyphilis. For penicillin-allergic patients & normal CSF, Tetracycline hydrochloride (500mg oral dose 4 times a day) or Doxycycline (100mg oral dose 2 times a day) for 4 weeks. For penicillin-allergic patients & abnormal CSF, treat as neurosyphilis.

For neurosyphilis (asymptomatic or symptomatic) à For non-penicillin allergic patients, Aqueous Penicillin G (12-24 million units/day injected intravenously to be given in divided doses every 4 hours) or Aqueous Penicillin G procaine (2.4 million units/day injected intramuscularly) plus oral probenecid acid (500mg 4 times a day) both for 10-14 days. For penicillin-allergic patients, desensitization, and treatment with penicillin if allergy to penicillin is confirmed by skin testing.

For syphilis in pregnancy à For non-penicillin allergic patients, give medicine according to the stage. For penicillin-allergic patients, desensitization, and treatment with penicillin if an allergy is confirmed by skin testing.

Prevention:

There are no vaccines for syphilis so the best way to prevent syphilis is to abstain from sex or only have a monogamous sexual relationship, use a latex condom and avoid the use of recreational drugs.

 

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