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Sunday, September 21, 2008

Syphilis


Also known as
Primary syphilis, secondary syphilis, or the great imitator

Description
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. The infection is usually transmitted person to person through minor cuts in the skin or mucous membranes (genitals or mouth) during sexual intercourse. Syphilis has three stages: Primary, Secondary, and Tertiary.




Symptoms

* Primary Syphilis:
* Genital ulcer-usually painless with firm, indented borders
* Swollen lymph glands in the groin
* Secondary Syphilis:
* A rash is usually composed of red lesions that can either be small or large. The rash is also present on the palms and soles of the feet (only a few conditions have a rash in these places)
* Condylomata Lata-sweeping skin lesions in the moist areas of skin and mucous membranes
* Silvery ulcer patches on the mucous membranes (mouth or vagina)
* Diffuse lymph node swelling in the body
* Yellow skin or eyes (occasionally)
* Low-grade fever
* Lack of energy
* Loss of appetite
* Joint and muscle aches
* Headaches
* Neck stiffness (rare-a sign of meningitis)
* Eye inflammation

Diagnosis

* VDRL or RPR are screening tests
* FTA-ABS (antibody test for syphilis) confirms the diagnosis
* Microscopic exam-dark field microscopy techniques show Treponema pallidum from material that has been aspirated from lesions of the affected regional lymph nodes

Similar Conditions

* Gonorrhea
* Chlamydia
* Chancroid
* Herpes
* HIV

Treatment

* Penicillin by injection is the treatment of choice
* Alternatives include Tetracycline, Doxycycline, or Azithromycin
* There is no need for local treatment of lesions
* Jarisch-Hersheimer reaction, the sudden killing of the Treponema pallidum bacteria that results in the release toxic products, may occur. This causes fever and a worsening of the current symptoms.
* Treatment should not be stopped unless the symptoms are severe. Antipyretics (fever reducing medications such as Tylenol or aspirin) and corticosteroids can be used to prevent or modify this reaction.
* The Jarisch-Hersheimer reaction generally resolves itself in 24 hours.

Prevention

* Safe sex practices. Abstinence is ideal until the syphilis is properly treated.
* Condoms are only effective in the covered areas
* Exposed parts should be washed with soap and water after sex (both males and females) if couples do not refrain from engaging in sexual relations.
* Persons exposed to syphilis in the preceding 3 months should be treated for presumed syphilis, as blood tests may initially be negative.




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