What is Syphilis Fara dilla binti Mohd Razali

What is Syphilis? Fara dilla binti Mohd Razali Nurul Ain binti Razali

Syphilis • Syphilis is a sexually transmitted disease (STD) or sexually transmitted infection (STI) that, when left untreated, can progress to a late stage that causes serious health problems. • The infection alternates with periods of being active and inactive (latent). • When the infection is active, symptoms occur. But when the infection is latent, no symptoms appear even though you still have syphilis. • Anyone who comes into close physical contact with a person who has syphilis can develop syphilis. You don't have to have sexual intercourse to get syphilis because exposure can result from close contact with an infected person's genitals, mouth or rectum.

Statistic of occurrence ! Year Incident Rate 1997 6. 08 1998 11. 09 1999 11. 70 2000 7. 70 2001 5. 98 2002 4. 36 2003 4. 27 2004 3. 84 2005 3. 44 2006 3. 06 2007 3. 19

Incident rate/100 000 population (in comparison with other communicable diseases) 14 12 10 8 6 Incident rate (%) 4 2 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Infectious syphilis by five year age group and sex

Causes • Bacteria called Treponema pallidum. Commonly transmitted through: • Contact with an infected person's sore during sexual activity. • Through minor cuts or abrasions in skin or mucous membranes. Less commonly spread through: • Transfusion of infected blood • Direct unprotected close contact with an active lesion (kissing) • Infected mother to her baby during pregnancy or childbirth (congenital syphilis).

However, • You won't get syphilis from using the same toilet, bathtub, clothing or eating utensils as an infected person, or from doorknobs, swimming pools or hot tubs. Because Treponema pallidum is sensitive to light, air and changes in temperature.

Symptoms • Primary stage • Secondary stage • Latent stage • Tertiary stage

~ Primary Stage ~ Symptoms : During this stage of syphilis, a firm, painless open sore (skin ulceration) called a chancre develops. Rarely, there may be multiple lesions present although typically one lesion is seen. Because syphilis is usually passed from person to person through sexual activities, chancres are often found in the genital area, anus, or mouth, but they may also be found wherever the bacteria entered the body.

• This commonly occurs within 3 weeks of exposure but can range from 10 to 90 days. • In men, a chancre often appears in the genital area, usually (but not always) on the penis. • In women, chancres can develop on the outer genitals or on the inner part of the vagina. A chancre may go unnoticed if it occurs inside the vagina or at the opening to the uterus (cervix). • Swelling of the lymph nodes may occur near the area of the chancre. • The chancre lasts for 28 to 42 days, heals without treatment, and may leave a thin scar. But just because the chancre has healed does not mean the syphilis is cured or that a person cannot pass the infection to others.

Secondary Stages Symptoms : A skin rash and other symptoms occur during the secondary stage, which begins 4 to 10 weeks after the initial infection. Secondary syphilis is highly contagious through direct contact with the mucous membranes or other surfaces affected by the skin rash. Other symptoms common include fever, sore throat, weight loss, headache, meningismus, and enlarged lymph nodes.

• A rash often develops over the body and commonly includes the palms of the hands and the soles of the feet. • The rash usually consists of reddish brown, small, solid, flat or raised skin sores that are less than 2 cm (0. 8 in. ) across. But the rash may look like other more common skin problems. • Small, open sores may be present on mucous membranes. The sores may contain pus, or moist sores that look like warts. • In moist areas of the body, the rash becomes flat broad whitish lesions known as condylomata lata • In dark-skinned people the sores may be a lighter colour than the surrounding skin. • The skin rash usually heals in 2 to 12 weeks on its own, without scarring. After healing, skin discoloration may develop.

Latent Stage • have no symptoms. The latent stage can last for years. Latent syphilis can be described as either early or late. EARLY LATENT SYPHILIS • 2 years or less from initial infection, • > 2 years but w/o clinical w/o signs or symptoms of diseases evidence of diseases • Treated with single intramuscular • Requires 3 weekly injections injection of penicillin • 50% of those infected with latent syphilis will progress into late stage syphilis, 25% will stay in the latent stage, and 25% will make a full recovery.

Tertiary Syphilis • Occurs 1 -10 years after the initial infection Characterized by : • formation of gummas soft, tumor-like balls of inflammation known as granulomas represent an inability of the immune system to completely clear the organism. They may appear almost anywhere in the body including in the skeleton. • neuropathic joint disease, which is a degeneration of joint surfaces resulting from loss of sensation and fine position sense (proprioception). • The more severe manifestations include neurosyphilis and cardiovascular syphilis.

Tertiary Syphilis

In a study of untreated syphilis, 10% of patients developed cardiovascular syphilis, 16% had gumma formation, and 7% had neurosyphilis. Cardiovascular complications • include syphilitic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation. • Syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur. The course can be insidious, and heart failure may be the presenting sign after years of disease. • The infection can also occur in the coronary arteries and cause narrowing of the vessels.

Neurological complications • In some patients, manifestations include generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes, and Argyll-Robertson pupil A diagnostic sign in which the pupils constrict in response to focusing the eyes on near objects[accomondate], but not to light [not react to light]. • Tabes dorsalis, also known as locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait.

Neurosyphilis • Neurosyphilis is a slowly progressive and destructive infection of the brain or spinal cord life-threatening complication. • There are 4 different forms of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis. • Asymptomatic neurosyphilis precedes symptomatic syphilis and is present in 15% of those with latent (hidden) syphilis. In this case, abnormalities may be present in the cerebrospinal fluid, but no symptoms are present. • In meningovascular neurosyphilis, cranial nerve palsies and pupil abnormalities may be among a wide variety of symptoms. This may also cause damage to blood vessels resulting in stroke.

Neurosyphilis • In tabes dorsalis, progressive degeneration of the spinal cord occurs causing an inability to walk. • In general paresis, paralysis, tremors, seizures, and mental decline occur as a result of damage to brain cells. Gummas (inflammatory lesions) may occur anywhere in the brain or spinal cord and can cause a wide variety of neurologic deficits. • Syphilitic aseptic meningitis occurs as a chronic infection and may involve headaches, cognitive changes and cranial nerve abnormalities.

Diagnostic Tests Microscopy of fluid from the primary or secondary lesion using darkfield illumination can diagnose treponemal disease with high accuracy. (to see whether syphilis bacteria are present or not) Rapid Plasma Reagin (RPR) Venereal Disease Research Laboratory (VDRL)

Treponema pallidum hemagglutination assay (TPHA) Fluorescent Treponemal Antibody Absorption (FTA-ABS) Enzyme-Linked Immuno. Sorbent Assay (ELISA)

TREATMENTS AND DRUGS • All stages penicillin kill the bacteria. • One dose of penicillin is sufficient for early syphilis [less than a year]. If longer than a year, additional doses needed. • Allergic reactions to penicillin (eg: anaphylaxis) may be treated with oral tetracycline or doxycycline. Other altenative : Ceftriaxone , Azithromycin. • Penicillin treatment for pregnant women with syphilis. All pregnant women with syphilis should be desensitized and treated with penicillin. Follow-up treatment. • Penicillin standard treatment for infants and children with congenital syphilis. • 24 hour after treatment Jarisch-Herxheimer reaction. Symptoms include fever, chills, nausea and headache. This reaction usually doesn't last more than 1 day.

TREATMENTS After you're treated for syphilis, doctor will ask you to: • Follow-up tests for 6 months and 12 months [maybe more! ] after treatment – periodic blood tests needed to make sure you're responding to the usual dosage of penicillin. • Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured. • Notify your sex partners so that they can be tested and get treatment if necessary. • Be tested for HIV infection.

PREVENTION • Abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. • Avoiding alcohol and drug use may lead to risky sexual behavior. • If you are sexually active, practice safe sex and always use condoms. Correct and consistent use of latex condoms can reduce the risk of syphilis when the infected area or site of potential exposure is protected. Condoms lubricated with spermicides (Nonoxynol-9 or N -9) protecting against the transmission of STDs. • Do not have sex with someone who has an open sore on his or her sex organs or whom you know to be infected. • All pregnant women should be screened for syphilis.

SOURCES • http: //www. mayoclinic. com/health/syphilis/DS 003 74 • http: //www. herpes-coldsores. com/std/syphilis. htm • http: //en. wikipedia. org/wiki/Syphilis#Latent_syphi lis • http: //www. healthscout. com/ency/1/000703. html