IN T R O D U C T I O N

“Abstinence is the only completely effective method of preventing

STDs and HIV. If you choose to be sexually active, practice safer sex,
along with maintaining open communications with your partner.

Practicing safer sex doesn't mean eliminating sex from your life.
Safer sex means being smart and staying healthy.
It means showing love, concern, and respect for partners and for self.
Safer sex means enjoying sex to the fullest without transmitting,
or acquiring, sexually related infections.”

Syphilis (siff-ill-iss)
is an infection that is usually
acquired through sexual
contact with another infected
person. Syphilis can be
frightening because if it goes
untreated, it can lead to
serious health problems and
increase a person’s risk for
HIV that causes AIDS.

A syphilis infection can be treated at the early stages with

antibiotics and can be prevented by avoiding any sexual contacts with
an infected person or a person with an unknown health history.

The discovery of penicillin in the 1940s and its use in treating

syphilis led to a dramatic decline in the incidence of the disease.
However in the late 1980s and 1990s, the incidence of syphilis began
to rise along with the incidence of HIV/AIDS.
 The incidence of syphilis is highest among young adults. Rates
have remained relatively steady for women yet syphilis is on the rise in
men, particularly those who have sex with other men.

Many people affected with syphilis do not have signs and

symptoms for years, yet remain at risk for later complications if they
are not treated.

It’s important to know the symptoms of syphilis early on.

Pregnant women should be screened for syphilis and treated so they
don’t pass the infection on to their babies. Sexually active teens should
understand the importance of avoiding any behavior like unprotected
sex that might put them at risk for syphilis or other sexually
transmitted diseases.
SYPHILIS

Syphilis is a sexually transmitted disease (STD), often called

“the great imitator” because of its so many signs and symptoms that
are distinguishable from those of other diseases. Syphilis affects the
genitals, skin and mucous membranes, but it may also involve other
parts of the body, including the brain and the heart.

It is caused by the bacterium Treponema Pallidum is

extremely sensitive to light, air and changes in the temperature.
Because of this, the disease is difficult to transmit except by intimate
contact. You can’t contract syphilis using the same toilet, bathtub,
clothing or tablewear as an infected person.

SIGNS AND SYMPTOMS

 Syphilis is capable of destroying tissue in almost any organ of the
body. Typically, syphilis first appears as a sore area. The signs and
symptoms of syphilis may occur in stages and can spread during the
first two stages of the disease.

1. Incubation Period
No symptoms or lesions and Spirochetemia is present;
patient’s blood is infective.

2. Primary Stage
Most infectious stage which may occur 10 days to 3 months
after exposure and lasts for 1-6 weeks.

Manifestations:

 Chancre – a small, painless sore with heaped-up firm

edges which appears on the site where the treponema
entered the body. The sore can appear on the vulva, vagina,
cervix, oral cavity or other parts of the body; generally
related to the pattern of one’s sexual behavior

 Enlarged lymph nodes on the groin – Spirochetes

appear in the local lymph nodes producing a swelling of the
 regional lymph nodes (BUBO), entering the blood and is now
carried to every organ in the body.

Sore heals with or without treatment but underlying disease and

remains will progress to the next stage if untreated.

3. Secondary Stage

Starts 3-8 weeks after the sore appears and it involves any
cutaneous or mucosal surface of the body as well as any organ.

Manifestations:

 Dermatitis – generalized maculopapular rash,

polymorphous and bilaterally symmetrical in distribution
a) Macular – spots with a faint flush, rose-colored
b) Papular – hard & wartlike under breasts or the genitals
c) Syphilides – when found on palms

 Mucuous Patches – on the mouth, throat and cervix;

they are yellow to white in color and covered with
exudates and are highly infectious

 Alopecia – patchy baldness or hair loss on scalp including

the eyebrows
  Headache and muscle aches

 Fever, tiredness and weight loss

4. Latent Stage

The next stage is called the latent or hidden stage. This

stage can start from 2 years to over 30 years after initial
infection. There are no symptoms present because symptoms
tend to recede without treatment. Signs and symptoms may
never return or the disease may progress to the tertiary stage.

5. Late Stage

Without treatment, syphilis bacteria may spread, leading

to serious internal organ damage and death, years after the initial
original infection.

 Gummas – appearance of lesions on

external and internal surfaces which are
ulcerous and abscess-like

 Granulomatous lesions – appear in

skin, bones, liver, cardiovascular system
and the central nervous system
  Neurologic problems.
These may include stroke; infection and inflammation of
the membranes and fluid surrounding the brain and spinal cord
(meningitis); poor muscle coordination, numbness; paralysis;
deafness or visual problems; personality changes and dementia.

 Cardiovascular problems.
These may include bulging (aneurysm) and inflammation
of the aorta and of other blood vessels. Syphilis may also cause
valvular heart disease, such as aortic valve stenosis.

MODE OF TRANSMISSION
 Syphilis is contagious during its primary and secondary stages,
and sometimes in the early latent period. The bacterial organism that
causes Syphilis, Treponema Pallidum, enters your body through minor
cuts or abrasions in your skin or music membranes:

1. Sexual Intercourse – most common route of transmission

2. Blood Transfusion of infected blood

3. Direct unprotected close contact with an active lesion

4. Pregnancy - through an uninfected to her unborn child

Risk Factors. High-risk sexual activity puts you at risk of syphilis and
other STDs. Men who have unprotected sex with other men are at
greater risk.

Young adults between the ages of 15-25 years appear to be at

higher risk. However, anyone who has unprotected sex is at risk for
developing syphilis.

COMPLICATIONS
 Pregnant women can pass syphilis to their babies during
pregnancy and childbirth. It can cause miscarriage, stillbirth or death
soon after birth.

An infected baby may be born without signs of the disease others

may manifest the following symptoms:

 Skin sores and rashes

 Fever

 Jaundice

 Anemia

 Swollen liver and spleen

 Saddle nose – depressed nose bridge

 Bone abnormalities & pain, swollen joints

 Hutchinson’s teeth – disfigured, screwdriver-shaped teeth

 Snuffles or chronic coryza often noticed at birth or soon after

and usually precedes the appearance of a variety of rashes,
mucocutaneous lesions.
 Interstitial Keratitis – characterized by photophobia, increased
lacrimation and vascularization of the cornea with exudation.

All pregnant women should be tested for syphilis. Those found out
to be positive should be treated right away with Penicillin.

MEDICAL TREATMENT
 Antibiotic therapy. Penicillin is the drug of choice to treat
syphilis at all stages. The dose and length of treatment depends on the
stage and symptoms of the disease.

 Newborn
1. Benzathine Penicillin G
Dosage: 100,000 units/kg
Route: single IM dose

2. Erthyromycin – for Pts allergic to penicillin

Dosage: 15 mg/kg for 12-15days
Route: IM

 Adult
1. Benzathine Penicillin G
Dosage: 2.4 million units total
Route: IM at a single dose/session

2. Tetracycline HC l– for Pts allergic to penicillin

Dosage: 500 mg
Route: PO, 4 times a day for 14 days
 On the first day of treatment, one may experience what’s known
as the Jarisch-Heixheimer reaction. Signs and symptoms of this
reaction include fever, chills, nausea, achy pain and headache. This
reaction may probably be caused by many bacteria dying at once at
the beginning of the antibiotioc therapy.

Other Medical Treatments include:

 Topical corticosteroids – applied every 2 hours and indicated in

interstitial Keratitis

 Opthalmologists should be consulted for severe ocular lesions

 Adequate nutrition and blood transfusion for anemia are

necessary

 Patients with syphilis of more than 1 year’s duration are treated

with a different regimen

 Post-treatment follow-up is essential for treatment failures do

occur and may require re-treatment

PREVENTION
  Abstinence. The best way to prevent syphilis or any STD is to
abstain from sex – vaginal’ oral or anal

 Mutual monogamous relationship. Have a sexual relationship

with one partner who is not infected and be faithful to each
other.

 Use Condoms.

 Honesty. Talk frankly with sex partners, doctors or nurse about

any STDs you or partner have or had or any sores in the genital
area. Being honest could save lives.

 Have regular pelvic exams.

ROLES OF THE PHN NURSE

1. Case Finding – tactful and careful taking and
recording of history of exposure and observation.

2. Health teaching and guidance on preventive

measures.

3. Proper direction to patient and family on how to use

available services of community health facilities.

4. Assisting physician in the interpretation of the diagnosis and its

implication on the prescribed treatment.

5. Assistance and encouragement on the prescribed follow-up visits to

attain a complete cure.

6. Keeping oneself in pace with the changes on the different aspects of

the Veneral Disease control program through attendance and
participation in reviews, research and other in-service education
aimed to improve VD services.

7. Develop ways and means to help patient and family, remember

follow-up dates when due as well as continue the treatment
prescribed.

8. Discuss clearly with the patient the need for medical examination of
patient’s contacts. Encourage his participation to bring about this
most needed examination.

A CKNOWLEDGEMENT
 We would like to acknowledge our Heavenly Father, for the
blessings He has given us and for allowing us this learning experiences
in the community.

To our parents, for all their help and support in our goal to finish
our nursing course.

To our school, Our Lady of Fatima University, College of Nursing,

for having a program that allows student nurses like us to learn and be
of service to their community.

And of course the members of Group 47-E who shared their

knowledge, time, research and resources to complete this project.

Mostly our thanks to our professor in Community Care

Management, Sir Domingo J. Buncan III, for his patience, support,
teachings and guidance.
COMMUNITY CARE MANAGEMENT
Our Lady of Fatima University
College of Nursing

Submitted to:
Boncan, R.N.
Professor

Submitted by:
GROUP 47-E
Quiroz, Catherine G.
Ramirez, Melodee Grace P.
Ramos, Ernesto S.
Reynado, Jay-Ar
Rivera, Robert
Santiniaman, Brian
Sebastian, Alicia V.
Suarez, Mervin William
Tan Torres, Robert Patricio
Tumaliuan, Myrna

February 23, 2007

S.Y. 2006-2007
DIAGNOSTIC PROCEDURES
Diagnosis of Syphilis depends on the clinical manifestations and
laboratory examinations.

A. Non-Specific Laboratory Tests

VDRL “Venereal Disease Research Laboratory test” and
RPR “Rapid Plasma Reagin”

VDRL and RPR is a screening test for syphilis that

measures antibodies called reagins that can be produced by
Treponema pallidum, the bacteria which causes syphilis.
However, the body does not always produce reagin specifically in
response to the syphilis bacteria, so the test is not always
accurate.
The value of a negative test depends on the stage of
syphilis that is suspected and additional testing may be needed
prior to ruling out syphilis.
A positive test result may mean you have syphilis. If the
test is positive, the next step is to confirm the results with an
FTA-ABS test, which is a more specific syphilis test.

B. Specific Laboratory Tests

1. Dark Field Examination of Chancre Fluid

Dark-field examination is done daily for 3 consecutive
days. The field appears dark so as to prevent entrance of any
rays of light and the spirochete will be numerous and readily
recognizable by their characteristic morphology and motility.
2. FTA-ABS “Flourescent Treponemal Antibody Absorption test”
This test is used routinely to confirm whether a positive
screening test for syphilis (either VDRL or RPR ) reflects true
infection with syphilis. It may also be done when either primary
or tertiary syphilis are suspected and the initial screening tests
are negative, because screening tests during these stages of
syphilis may be falsely negative.
A negative or non-reactive result indicates no current or
past infection with syphilis.
A positive FTA-ABS usually indicates infection with syphilis.
This test will remain positive for life even if an individual has
received appropriate treatment.

3. TPI “Treponema Pallidum Immobilization test”

TPHA “Treponema Pallidum Hemagglutination Test”
REFERENCES:

San Lazaro. , Compilation of Communicable Diseases in Nursing

www.mayoclinic.com
www.nlm.nih.gov/medlineplus
www.kidshealth.org/parent/infections/std/syphilis.html

www.hkmj.org.hk/skin/syphilis.htm

www.phototakeusa.com
www.istockphoto.com