Syphilis And Nursing care Plan NCP

Syphilis

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

 

Taxonomy

Order: Spirochaetales

Family: Spirochaetaceae

Genus: Treponema

 

Spirochaetales Associated Human Diseases

Genus

Species

Disease

Treponema

pallidum ssp. pallidum

pallidum ssp. endemicum

pallidum ssp. pertenue

carateum

Syphilis

Bejel

Yaws

Pinta

Borrelia

burgdorferi

recurrentis

Many species

Lyme disease (borreliosis)

Epidemic relapsing fever

Endemic relapsing fever

Leptospira

interrogans

Leptospirosis

(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

 

Syphilis

  • Penis, anus, vagina, mouth, breasts
  • PRIMARY SPHYHILIS
  • Chancre 3 weeks, red bump
  • Bump breaks, depression heals, no pain
  • SECONDARY SYPHILIS
    • Rash on body, feet and palms, painless
  • TERTIARY SYPHILIS
    • 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

     

    Gummas

     

     

    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

    image

    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

    image

    Conditions Associated with False Positive Serological Tests for Syphillis

    image

     

    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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