Syphilis And Nursing care Plan NCP


• Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponemapallidum.



Order: Spirochaetales

Family: Spirochaetaceae

Genus: Treponema


Spirochaetales Associated Human Diseases





pallidum ssp. pallidum

pallidum ssp. endemicum

pallidum ssp. pertenue









Many species

Lyme disease (borreliosis)

Epidemic relapsing fever

Endemic relapsing fever




(Weil’s Disease)


Gram-negative spirochetes

  • Extremely thin and can be very long
  • Tightly coiled helical cells with tapered ends
  • Motile by periplasmic flagella (a.k.a., axial fibrils or endoflagella)
  • Outer sheath encloses axial fibrils wrapped around protoplasmic cylinder
  • Differering numbers of endoflagella according to genus & species


Gram-negative spirochetes


Darkfield Microscopy of Treponema pallidum

Treponema pallidum



  • Penis, anus, vagina, mouth, breasts
  • Chancre 3 weeks, red bump
  • Bump breaks, depression heals, no pain
    • Rash on body, feet and palms, painless
    • 3-40 years
    • Heart failure, liver damage, blindness
    • Ruptured blood vessels


    Venereal Treponemal Disease

    • Syphilis
    • Primarily sexually transmitted disease (STD)
    • May be transmitted congenitally


    General Characteristics of Treponema pallidum

    • Too thin to be seen with light microscopy in specimens stained with Gram stain or Giemsa stain
    • Motile spirochetes can be seen with darkfield micoscopy
    • Staining with anti-treponemal antibodies labeled with fluorescent dyes
  • Intracellular pathogen
  • Cannot be grown in cell-free cultures in vitro
  • Do not survive well outside of host

    Epidemiology of T. pallidum

    • Transmitted from direct sexual contact or from mother to fetus
    • Not highly contagious (~30% chance of acquiring disease after single exposure to infected partner) but transmission rate dependent upon stage of disease
    • Long incubation period during which time host is non-infectious


    Pathogenesis of T. pallidum

    • Tissue destruction and lesions are primarily a consequence of patient’s immune response
    • Syphilis is a disease of blood vessels and of the perivascular areas
    • In spite of a vigorous host immune response the organisms are capable of persisting for decades
    • Infection is neither fully controlled nor eradicated
    • In early stages, there is an inhibition of cell-mediated immunity


    Virulence Factors of T. pallidum

    • Outer membrane proteins promote adherence
    • Hyaluronidase may facilitate perivascular infiltration
    • Antiphagocytic coating of fibronectin
    • Tissue destruction and lesions are primarily result of host’s immune response (immunopathology)


    Primary Syphilis

    • Primary disease process involves invasion of mucus membranes, rapid multiplication & wide dissemination through perivascular lymphatics and systemic circulation
    • Occurs prior to development of the primary lesion
  • 10-90 days (usually 3-4 weeks) after initial contact the host mounts an inflammatory response at the site of inoculation resulting in the hallmark syphilitic lesion, called the chancre (usually painless)
    • Chancre changes from hard to ulcerative with profuse shedding of spirochetes
    • Swelling of capillary walls & regional lymph nodes w/ draining
  • Syphilitic chancres are indurated (= hard chancre)
  • They are highly infectious
  • They may occur anywhere on the body
  • They are painless
  • Chancres will heal in 3-6 weeks.
  • Regional lymphadenopathy adjacent to the chancre may develop during primary syphilis.
  • Facial Chancre


    Multiple Chancres


    Primary Chancre - Labial


    Chancre of the Tongue


    Chancre of Hard Palate


    Chancre of the Lip


    Digital Chancre


    Secondary Syphilis

    • Secondary disease 2-10 weeks after primary lesion
    • Widely disseminated mucocutaneous rash
    • Secondary lesions of the skin and mucus membranes are highly contagious
    • Generalized immunological response

    Generalized Mucocutaneous Rash of Secondary Syphilis

    Generalized Mucocutaneous Rash of Secondary Syphilis


    Latent Stage Syphilis

    • Following secondary disease, host enters latent period
    • First 4 years = early latent
    • Subsequent period = late latent
  • About 40% of late latent patients progress to late tertiary syphilitic disease

    Tertiary Syphilis

    • Tertiary syphilis characterized by localized granulomatous dermal lesions (gummas) in which few organisms are present
    • Late neurosyphilis develops in about 1/6 untreated cases, usually more than 5 years after initial infection
    • Central nervous system and spinal cord involvement
    • Dementia, seizures, wasting, etc.
  • Cardiovascular involvement appears 10-40 years after initial infection with resulting myocardial insufficiency and death

    Progression of Untreated Syphilis

    Progression of Untreated Syphilis


    Congenital Syphilis

    • Congenital syphilis results from transplacental infection
    • T. pallidum septicemia in the developing fetus and widespread dissemination
    • Abortion, neonatal mortality, and late mental or physical problems





    Prevention & Treatment of Syphilis

    • Penicillin remains drug of choice
    • WHO monitors treatment recommendations
    • 7-10 days continuously for early stage
    • At least 21 days continuously beyond the early stage
  • Prevention with barrier methods (e.g., condoms)
  • Prophylactic treatment of contacts identified through epidemiological tracing

    Diagnostic Tests for Syphilis


    NOTE: Treponemal antigen tests indicate experience with a treponemal infection, but cross-react with antigens other than T. pallidum ssp. pallidum.


    Sensitivity & Specificity of Serologic Tests for Syphillis


    Conditions Associated with False Positive Serological Tests for Syphillis



    Nursing Care Plan and Management of Syphilis

    • Medical Management using antibiotic medications to kill the bacteria.
    • After finishing the treatment patient should be educated to not to have any secual relation at least for 2 weeks
    • Bencilin sensitivity test before the treatment
    • Taking care of patients lesions , including cleaning , drying
    • disposing contaminated leasions
    • follow universal precautions when you come in direct contact with the patient or in  collecting specimens.
    • Patient education , to promote prevention.

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