(SOLVED) Sexually Transmitted Infections(Syphilis)
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Academic Level: Undergrad. (yrs 1-2)
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SEXUALLY TRANSMITTED INFECTIONS
Treponema pallidum, a bacterium, causes syphilis, a sexually transmitted ailment and can be transmitted through sexual contact with an infected person, contact with blood from an infected person, and mother to baby during labor, delivery, or nursing. Syphilis primary stage involves a painless sore at the point where the infection entered an individual’s body, for example, mouth, anus, or rectum, and the genitals and the sores will disappear with time (Forrestel et al., 2020). The second phase involves the rashes, which also disappear, then a dormant phase before the final stage sets in that is fatal and can cause blindness, brain damage, and heart problems, among others (Kimberlin, 2018). This presentation will discuss the pathophysiology of syphilis, the etiology of syphilis, the clinical manifestation of syphilis, and the treatment for syphilis.
Pathophysiology of Syphilis
- Causes of Syphilis
- Stages of syphilis
- Clinical manifestations in every stage
- Incubation period
The Treponema pallidum invades or penetrates mucous membranes or dermal abrasions, and in a few hours, it enters the blood and lymphatic system and spreads to the entire body. It takes 2-3 weeks before the presentation of the primary clinical manifestation, including a painless papule which later ulcerates to chancres at the point of infection like the mouth, genitalia, or rectum and can spontaneously heal without treatment (Kimberlin, 2018). The sores or chancres can be single or multiple, and if the primary syphilis is not treated, it progresses to secondary syphilis (Ghanem et al., 2020). The secondary clinical manifestation includes symptoms like hepatitis, condyloma lata, headache, diffuse lymphadenopathy, alopecia, and malaise, which, like the primary manifestations, can go away without treatment but, if not treated, move to the latent stage. The latent stage involves a phase where the infection can only be detected using a serology test because there are no symptoms in the primary and secondary stages. Without treatment, some individuals move to the tertiary phase, including cases like neuropathy and cardiovascular syphilis. The incubation period of syphilis is between 20 and 90 days.
Etiology of syphilis
- The agent that causes syphilis
- The host of the agent
- Diagnosis of infection
- Modes of infection and transmission
Syphilis is an STI caused by an infection with Treponema pallidum, a spiral-shaped bacteria with a slow metabolizing rate and can take up to 30 hours to multiply. The host of the Treponema pallidum bacteria in humans. Primarily syphilis is transmitted through sexual contact, which can be anal, vaginal, or oral sex between an infected person and an uninfected person. The early symptoms occur 2-3 weeks after infection (Kimberlin, 2018). Other transmissions and infection methods include contact with the sores of an infected person, blood transfusion, especially infected blood, kissing when having lesions on the mouth, mother to baby during labor, childbirth, or nursing (Hicks & Clement, 2017). The infection can rarely occur through skin contact with an infected person unless both people have sores or chancres on their skin. Additionally, it is rare in blood transfusions if the blood is stored for some time before transfusion because Treponema pallidum cannot survive past 24 or 48 hours.
Clinical Manifestation of Syphilis
- Primary clinical manifestations
- Secondary clinical manifestations
- Latent clinical manifestations
- Tertiary clinical manifestation
Clinical manifestation of syphilis depends on the stage of syphilis and includes the following:
v Primary stage clinical manifestations-the early clinical manifestation occurs after a 2 to 3 weeks incubation period. Usually, it involves a painless papule that occurs at the point where the infection entered the body, for example, in the genitalia, rectum, or mouth. The papule may take around three months to ulcerate, maybe due to previous syphilis infection or inoculation load. The papule then ulcerates to create a sore or chancre that is 1-2 centimeters raised and a non-exudative base with mild to moderate regional, bilateral lymphadenopathy. The chancres usually heal spontaneously after 2 to 8 weeks. Spirochetes spread during the primary stage of syphilis infection (Forrestel et al., 2020).
v Secondary clinical manifestations- this stage includes the development of an illness due to untreated syphilis in the primary stage and is usually suffered by 30% of patients. Syphilis at this stage is characterized by patchy alopecia, diffuse lymphadenopathy, fever, malaise, weight loss, condylomata lata, nephropathy, hepatitis, neurologic abnormalities, headache, enlarged lymph nodes, and scaly maculopapular rash, among others. Secondary clinical manifestations can occur for up to five years if untreated, and they heal spontaneously, just like in the primary manifestations.
v Latent and tertiary clinical manifestations- this stage can occur after a year or up to even 30 years after infection, and patients have an infection but no symptoms. The infection can only be identified through serologic testing. It is categorized into early latent with the reoccurrence of secondary stage infection and late latent, where transmission is not going on, and there are no clinical symptoms (Forrestel et al., 2020).
Treatment for Syphilis
- Treatment in the primary stage
- Treatment in the secondary stage
- Treatment in the latent stage
- Prevention treatment
- Treatment in the tertiary stage
Syphilis treatment differs and always depend on the stage of syphilis for instant;
v Syphilis is treated with one dose of Benzathine penicillin G 2.4 million units administered intramuscularly (IM) in the main and secondary phases. At the primary and secondary stages, therapy is not necessary. If necessary, alternate therapy comprise intramuscular (IM) or intravenously (IV) injection of ceftriaxone 1 to 2 gm a day for 10 to 14 days, or tetracycline 100 mg PO 4 times for 14 days, or doxycycline 100 mg PO twice a day for 14 days (Cooper & Sanchez, 2018).
v In the latent phase, the treatment depends on the existing documentation about the past. For instance, a single dose of Benzathine penicillin G is given to patients using the IM route if there is a report showing non-reactive syphilis serology in the past year or a report that there has been a chancre or seropositivity within the past year. However, if there is no record of the chancre, seropositivity, and non-reactive syphilis serology in the past year, the treatment of latent syphilis will be unknown. Patients will be given three doses of Benzathine penicillin G 2.4 million units once weekly for three weeks or more. Alternative therapies in the latent stage include tetracycline 100 mg PO four times daily for 28 days or doxycycline 100 mg PO twice daily for 28 days (Cooper & Sanchez, 2018).
v In the tertiary stage, using IM, syphilis is treated with Benzathine penicillin G 2.4 million units once a week for three weeks. For patients with Neurosyphilis are treated with Penicillin G aqueous 18-24 units daily for 10 to 14 days.
v To prevent patients who have been exposed to syphilis through sex or blood contact, a single dose of Benzathine penicillin is administered.
Individuals should be keen and check out any symptoms of syphilis as early as in the primary stage to avoid more fatal infections associated with the infection. If one suspects they have contracted syphilis, they should get medical attention immediately. People should ensure they practice protected sex and avoid sharing needles and sharp objects to prevent infection between infected and uninfected persons. Mothers should consult their healthcare providers to be assisted in ways they can stop transmission of syphilis to their babies if they think they are infected with syphilis.
Cooper, J. M., & Sánchez, P. J. (2018, April). Congenital syphilis. In Seminars in perinatology (Vol. 42, No. 3, pp. 176-184). WB Saunders. https://doi.org/10.1053/j.semperi.2018.02.005
Forrestel, A. K., Kovarik, C. L., & Katz, K. A. (2020). Sexually acquired syphilis: historical aspects, microbiology, epidemiology, and clinical manifestations. Journal of the American Academy of Dermatology, 82(1), 1-14. https://doi.org/10.1016/j.jaad.2019.02.073
Ghanem, K. G., Ram, S., & Rice, P. A. (2020). The modern epidemic of syphilis. New England Journal of Medicine, 382(9), 845-854. DOI: 10.1056/NEJMra1901593
Hicks, C. B., & Clement, M. (2017). Syphilis: screening and diagnostic testing. UpToDate.
Kimberlin, D. W. (2018). Red Book: 2018-2021 report of the committee on infectious diseases (No. Ed. 32). American academy of pediatrics. ISBN 9781610025218
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