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Syphilis

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by

Brice Butterfield

on 24 September 2013

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Transcript of Syphilis

What is Syphilis?

Syphilis is an acute and chronic condition caused by the spirochete Treponema pallidum. It has a long clinical course that begins with an incubation period followed by primary, secondary, and tertiary infection.


Syphilis
Syphilis:Maternal Infection
Congenital Syphilis
- Pregnant mother infected with syphilis passes the disease to the child in utero or at birth
Education, Prevention, and Treatment are important aspects when dealing with congenital syphilis.
Pathophysiologic Process
Organism:
Treponema pallidumi (T. pallidum)
PREVENTION
Pharmacologic Interventions
Some studies show an additional dose, given to pregnant women 1 week after the first, can be therapeutic for primary, secondary, or early latent syphilis.
Nursing Diagnosis
Nurse's Role in Assessment of Client
Infection spreads to baby
Brice, Emily, Jenny, and Kiera
Seek prenatal care immediately
Practice safer sex
Get tested
Take newborn to all checkups
A client visiting a family planning clinic is suspected of having an STD. The most diagnostic test for all stages of treponema pallidum (syphilis) is the:


A. Venereal Disease Research Lab (VDRL)
B. Rapid plasma reagin (RPR)
C. Florescent treponemal antibody (FTA-Abs)
D. Thayer-Martin culture (TMC)


NCLEX-RN
Answer and Rational:
Answer
C
is correct
.
The FTA-Abs is the most sensitive to all stages of syphilis.
VDRL and RPR are screening tests done for syphilis, so answers A and B are incorrect.
The Thayer-Martin culture is done for gonorrhea, so answer D is incorrect.
Benzathine penicillin G:
2.4 million units IM, single dose.


Tetracycline and Doxycycline: rarely used during pregnancy.

Erythromycin and Azithromycin: Lack of evidence to prove either are effective for maternal infection or treat the fetus.

Rocephin: insufficient data.


PCN Allergy:
There are no alternative medications during
pregnancy. Desensitize and treat.
TESTS
for DIAGNOSES
• Fluorescent Treponemal Antibody Absorption (
FTA-ABS
) Test
SCREENS for Syphilis
• Venereal Disease Research Laboratory (
VDRL
) Test
• Treponema Pallidum Particle Agglutination Assay (
TPPA
)
• Darkfield Microscopy
• Microhemagglutination Assay (
MHA-TP
)
While the TPPA gives fewer false positive test results, the FTA-ABS is the most sensitive to all stages of syphilis.
*
Depending on the test, a collection of blood, drainage from a sore, skin sample from an area with a rash, or spinal fluid may be needed.
DIAGNOSTIC
TESTS
• Rapid plasma reagin (
RPR
) titers
• Enzyme Immunoassay (
EIA
) Test

*All detect antibodies produced by those infected with syphilis or specific syphilis antibodies*
*
TREATMENT MANAGEMENT
Health Teaching
How infection spreads
Encourage proper use of antibiotics
Drug Therapy
Antibiotic
Provide Support and Assurance of Confidentiality
Sexually transmitted Disease
Through blood and placenta
Through vaginal birth and contact with genital lesions


Infection crosses placenta early in gestation
Congenital syphilis can result in significant health problems to the infant including skin lesions, systemic infection leading to enlarged liver and spleen, infection in the brain and even death.
The Stage of syphilis contraction the mother is at affects the chances of the fetus becoming infected
A mother with a primary infection has nearly 100% chance of passing along the disease
Make sure mother has been tested for syphilis
Assess Newborn
Symptoms In Newborns:
Failure to gain weight
Fever
Irritability
No bridge to nose
Rash of mouth, genitals, and anus
Watery fluid released from the nose
Stages of Syphilis
Fetal Involvement
Transmission
Works Cited:
Brian Euerle, Jan 6, 2012. Syphilis Differential Diagnoses. Medscape: Drugs, Diseases & Procedures. Sept 18, 2013.

http://emedicine.medscape.com/article/229461-differential

Centers for Disease Control and Prevention. 2010. Syphilis section of Sexually transmitted diseases treatment guidelines. Sept 17 2013. MMWR, (pg. 1-110).
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm?s_cid=rr5912a1_w

Centers for Disease Control and Prevention (CDC). August 30, 2013. Syphilis Treatment and Care. CDC Sexually Transmitted Diseases. Sept 20, 2013.

http://www.cdc.gov/std/syphilis/treatment.htm

Cure Byte. Dec 04, 2012. Clinical Trials and Related Photos for Syphilis in Women. Sept 17, 2013.
http://trialx.com/curebyte/2012/12/04/clinical-trials-and-related-photos-for-syphilis-in-women/

Ignatavivius. Workman. 2013. Medical-Surgical Nursing: Patient-Centered Collaborative Care-7th Edition. (pg. 1654-1656).

Medline Plus. 22 March 2013. Congenital Syphilis. ADAM. Sept 17, 2013.

http://www.nlm.nih.gov/medlineplus/ency/article/001344.htm

MicrobeWiki. 2009. Syphilis in Sub-Saharan Africa. Sept 17, 2013.
http://microbewiki.kenyon.edu/index.php/Syphilis_in_Sub-Saharan_Africa

U.S. Preventive Services Task Force.19 May 2009. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation
statement. Annals of Internal Medicine, 150(10): 705-709.
http://annals.org/article.aspx?articleid=744501

Ward and Hisley. 2009. Maternal-Child Nursing Care: Optimizing Outcomes for Mothers, Children, & Families. F.A Davis Company. (pg. 182, 317, 232, 260)

Web Md. Syphilis. Sept 29, 2011. Tests.Healthwise. Sept 15th, 2013.
http://www.webmd.com/sexual-conditions/syphilis-tests

Related to:
Psychological distress
Expression of deficient cognitive readiness for parenthood and decreased maternal confidence
Evidenced by:
Unpleasant symptoms of pregnancy that are not reported managed
Verbalization of inappropriate prenatal, intrapartum, and postpartum care and lifestyle (nutrition, elimination, sleep, bodily movement, exercise, personal hygiene, etc.)
Ineffective childbearing process
Risk for injury
Related to:
Impaired skin integrity
Lifestyle
Evidenced by:
Change in skin appearance or integrity
Unsafe behavior
(
blood
or
spinal fluid
)
(
blood
)
(
blood
)
(
fluid or tissue from an open sore (chancre)
)
(
blood
)
(
blood
or
CSF
)
+
Positive results should be confirmed with either the VDRL or TPPA test.
*
Molecular testing, Polymerase Chain Reaction (
PCR
)
(
sore
,
blood
, or
CSF
)
Full transcript