Syphilis (chronic systemic infectious disease).
Syphilis
Define syphilis : Syphilis is a chronic systemic infectious disease caused by Treponema pallidum, usually transmitted by close sexual contact.
We have described :
Classification of Syphilis
Clinical features of Syphilis
Treatment of Syphilis
Prevention of Syphilis
Classification of Syphilis :
A. Acquired syphilis :
1. Early :
- primary syphilis.
- Secondary syphilis.
- Latent syphilis.
2. Late:
- Latent syphilis
- Benign tertiary.
- Quaternary.
B. Congenital syphilis :
1. Early :
- Clinical syphilis
- Latent syphilis.
2. Late :
- Clinical syphilis
- Latent syphilis
- Stigmata syphilis.
Clinical features of syphilis :
1. Early stages :
A. Primary syphilis :
- History of exposure usually 2-4 weeks back.
- Chancre develops at the site of infection, usually on the genitals, anus and rectum.
- Regional lymph nodes : Moderately enlarged, mobile, discrete, rubbery, painless and tender.
- The primary chancre heals without treatment.
B. Secondary syphilis :
- Develops 6-8 weeks after the appearance of primary chancre.
- Mucosal ulceration.
- Rash
- Lymphadenopathy.
- Condylomata – lata.
2. Late stages :
A. Latent syphilis : May persists for many years.
B. Tertiary syphilis :
- Usually develops within 3 to 10 years of infection.
- The mainly affect skin and subcutaneous tissues, mucous membrane.
C. Quartentary syphilis : Cardiovascular and neurosyphilis take longer to develop and may lead to the patient death.
Investigation of Syphilis :
A. Microscopic examination :
- Dark ground illumination test.
- Immunofluorescent test.
B. Serological test :
1. Non specific or lipoid antigen test :
- VDRL (Venereal disease research laboratory) test.
- RPR ( Rapid plasma regain).
2. Specific antibody tests :
- TPHA ( Treponema pallidum haemagglutination test).
- FTA – abs (Flurescent treponemal antigen absorbent test).
- ELISA (Treponemal enzyme linked immune sorbent assay).
Treatment of Syphilis :
Treatment : ( CDC recommendation – 1998) :
A. Early syphilis (Primary, secondary and early latent syphilis of less than 1 year of duration) :
- Benzathine penicillin G 2.4 million units IM, single dose, half to each buttock.
- IN penicillin hypersensitive cases : Tetracycline or Erythromycin 500 mg 4 times daily orally for 14 days.
B. Late syphilis :
- Benzathine penicillin G 2.4 million units IM, weekly for 3 weeks.
- Alternative regimen : Doxycycline 100 mg orally twice daily or Tetracycline 500 mg 4 times daily orally for 4 weeks.
Treatment of syphilis in pregnancy :
- The treatment is the same as above.
- The women who is allergic to penicillin should be treated with Certriaxone.
- The baby should be assessed at birth and at 6 weeks and 3 months after birth.
Complication of syphilis in Pregnancy :
- Miscarriage.
- Premature birth.
- Fetal growth restriction ( also called growth- restricted, small for gestational age or small for date) and low birth weight.
- Problems with the placenta and the umbilical cord.
- Stillbirth.
Prevention of Syphilis :
- People should be educated about dangers of syphilis.
- Advice regarding nutrition, sanitation and personal hygiene.
- Use of condom, diaphragm, intravaginal jellies and cream.
- Genital wash after intercourse.
- Provision of decent living condition.
- Marriage counseling and pre-marital examination.
- Motivation of sexual behaviour.
- Education to rise the responsibility that his or her partner should attend the venereal disease clinic.
- Education informing the importance of completing treatment and follows up.
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