SYPHILIS (Lues Venereal/Morbus Gallicus) DEFINITION: - A chronic, infectious, sexually transmitted disease that usually begins in the mucous

membrane and quickly becomes systematic. - Is caused by a spirochete and is acquired through sexual contact - May also be congenital in nature ETIOLOGIC AGENT: Treponema pallidum SOURCES OF INFECTION: 1. Discharges from obvious/concealed lesions of the skin 2. Semen, blood, tears and urine of infected persons 3. Mucous discharges from the nose, eyes, genital tract or bowels 4. Surface lesions INCUBATION PERIOD: 10-90 days (Average of 3 weeks) PERIOD OF COMMUNICABILITY: variable and indefinite MODE OF TRANSMISSION: Direct transmission Indirect transmission Congenital transmission CLINICAL MANIFESTATION: 1. Primary Syphilis - One or more chancres in genitalia, anus, nipples, tonsils or eyelids - Painless chancres that disappear after 3 6 weeks 2. Secondary Syphilis - Mucocutaneous lesions and generalized lymphadenopathy - Rash (macular, popular, pustular or nodular)

- alopecia - brittle, pitted nails 3. Latent Syphilis - no clinical symptoms 4. Late Syphilis - destructive but non-infectious stage a. Late, benign syphilis - 1 to 10 years after the infection - gumma lesion (chronic, superficial nodule or deep granulomatous lesion that is solitary, asymmetric, painless and endurated) found in skin, bones, mucous membranes, upper respiratory tract, liver or stomach b. The Late Syphilis - involves liver - epigastric pain, tenderness, enlarged spleen, anemia c. Cardiovascular Syphilis - about 10 years after the initial infection - asymptomatic 5. Congenital Syphilis - Once the treponeme enters fetal circulation, dissemination to all tissues occurs. Treponeme multiplies and infects many organs - Fetus may be infected and may die. CLINICAL MANIFESTATION: a. Early congenital syphilis - Lesions of skin and mucous membrane - Enlargement of liver and spleen b. Late congenital syphilis - Interstitial keratitis COMPLICATIONS: 1. Severe damage to several organs and the nervous system 2. Heart disease, insanity and brain damage

3. Severe illness or death in newborn DIAGNOSTIC PROCEDURES: 1. Dark filled illumination test 2. Fluorescent treponemal antibody absorption test 3. VDRL slide test and rapid plasma reagent test 4. CSF analysis TREATMENT MODALITIES: 1. Penicillin G benzathine IM 2. Oral tetracycline or doxycycline for 15 days (early syphilis) and for 30 days (late infections) - for allergic to penicillin NURSING MANAGEMENT: 1. Stress to the client the importance of completing the treatment even after the symptoms subside. 2. Instruct infected individuals to inform their partner that they should be tested and if necessary, treated. 3. Practice universal precaution. 4. In secondary syphilis, keep the lesions dry as much as possible. If they are draining, dispose of contaminated materials properly. 5. In cardiovascular syphilis, check for signs of decreased cardiac output and pulmonary congestion 6. In neurosyphilis, regularly check the level of consciousness, mood and coherence. Watch for signs of ataxia. 7. Encourage the patient to undergo VDRL testing after 3,6,12 and 24 months to detect any possible relapse. 8. Be sure to report all cases of syphilis to local public health authorities. Refer the patient and his/her sexual partner for HIV testing. PREVENTION AND CONTROL: 1. Report cases to the Department of Health 2. Control prostitution. 3. Require sex workers to have regular check-ups. 4. Proper sex education should be given in early life at home, in schools and in the community. 5. Look for cases of syphilis infection

6. Contact tracing.