• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Sexually transmitted infections. Part II
 

Sexually transmitted infections. Part II

on

  • 2,118 views

Includes Sexually transmitted infections that is characterized by ulcers: chancroid, herpes, donovanosis, lymphogranuloma venereum, syphilis

Includes Sexually transmitted infections that is characterized by ulcers: chancroid, herpes, donovanosis, lymphogranuloma venereum, syphilis

Statistics

Views

Total Views
2,118
Views on SlideShare
2,118
Embed Views
0

Actions

Likes
1
Downloads
156
Comments
1

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel

11 of 1 previous next

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
  • I just want everyone to know never to give up believing there is someone out there for you even though you have std! We are very happy with each other and that www.Hmeet.net made it possible for us to find each other. Don't pass a good thing, you never know what it may evolve into.Good luck on your search and wish you the best:)
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Sexually transmitted infections. Part II Sexually transmitted infections. Part II Presentation Transcript

    • Sexually Transmitted Infections By: Maria Carmela L. Domocmat, RN, MSN Nurse Instructor Northern Luzon Adventist College
    • Diseases Characterized by Diseases Characterized by Ulcerations Vaginal Discharge Chancroid Bacterial Vaginosis Trichomoniasis Genital HSV Infections Vulvovaginal Candidiasis Granuloma Inguinale (Donovanosis) Human Papillomavirus (HPV) Infection Lymphogranuloma Venereum Genital Warts Syphilis Hepatitis A, B, C Diseases Characterized by Sexually transmitted enteric Urethritis or Cervicitis infections Chlamydial Infections Proctitis, Proctocolitis, and Gonococcal Infections Enteritis Ectoparasitic Infections Scabies Pediculosis PubisOverview Maria Carmela L.Domocmat, RN, MSN
    • › Chancroid› Genital HSV Infections› Granuloma Inguinale (Donovanosis),› Lymphogranuloma Venereum› Syphilis Maria Carmela L.Domocmat, RN, MSN
    • CHANCROID
    • http://www.webmd.com/sexual-conditions/slideshow-std-pictures-and-http://www.webmd.com/sexual-conditions/slideshow-std-pictures-and-facts Maria Carmela L.Domocmat, RN, MSN
    • Chancroid is caused by Haemophilusducreyi a, a small, gram-negative,facultative anaerobic bacillus.It produces a cytocidal distending toxinthat appears to be responsible for its toxiceffects.Cofactor of HIV transmission, syphilis andHSV Maria Carmela L.Domocmat, RN, MSN
    • usually from 3 to 5 days may extend up to 2 weeksIncubation period Maria Carmela L.Domocmat, RN, MSN
    • transmitted sexually by direct contactwith purulent lesionsby autoinoculation to nonsexual sites suchas the eye and skin.can be transmitted as long as the originalsore or oozing lymph node remainsinfected with the bacteria.MOT Maria Carmela L.Domocmat, RN, MSN
    • Initially papules or pustules Multiple painful, irregular, deep genital ulcers Inguinal lymphadenopathy or buboes (swelling of the lymph nodes)s/s Maria Carmela L.Domocmat, RN, MSN
    • Culture of H. ducreyi The differential diagnosis proved to be chancroid, caused by Haemophilus ducreyi, and not syphilis.. Dx Maria Carmela L.Domocmat, RN, MSN
    • Chancroid of the Penis Chancroid of the Labia Maria Carmela L.Domocmat, RN, MSN
    • IM, single dose Oral azithromycin Ceftriaxone Oral Ciprofloxacin Erythromycin Sexual partners within 10 days before onset of s/s should also be treated Chancroid ulcers typically improve within 3 to 7 days after institution of therapy and healing is usually complete in 2 weeks. http://www.ncbi.nlm.nih.gov/books/NBK25605/Treatment Maria Carmela L.Domocmat, RN, MSN
    • Drain fluctuant lymph nodes by eitherneedle aspiration or incision. Maria Carmela L.Domocmat, RN, MSN
    • Syphilis, herpes simplex virus (HSV), andHIV testing and counseling are essentialto diagnose those patients who arecoinfected with this disease. Maria Carmela L.Domocmat, RN, MSN
    • Rupture of buboes, with subsequent scarring and/or chronic sinus tract drainage Phimosis (the foreskin cannot be fully retracted over the glans penis) and balanoposthitis (or balanitis is an inflammation of the foreskin and head of the penis)Complications Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • GENITAL HERPES
    • At least 50 million persons in the UnitedStates have genital HSV infectionestimated that 1.6 million new casesoccur each year.Most persons infected with HSV-2 havenot been diagnosed. Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • Two types of a viral infection characterized by periodic outbreaks of painful sores. Stress, sunburn, and certain foods are the primary causes of a herpes outbreak.Herpes simplex Maria Carmela L.Domocmat, RN, MSN
    • Both herpes simplex virus-1 and virus-2may be transmitted through sex, or bykissing or touching any affected area.Possible by fomites (e.g., towels)Newborn vaginal deliveryMOT Maria Carmela L.Domocmat, RN, MSN
    • Fetal demise due to HSV Maria Carmela L.Domocmat, RN, MSN
    • Genital Herpes Organism: Herpes simplex II (90% of cases) & Herpes simplex I, viruses Maria Carmela L.Domocmat, RN, MSN
    • from five to twenty daysIncubation Period Maria Carmela L.Domocmat, RN, MSN
    • Herpes simplex virus-1 usually shows up as cold sores or blisters. Herpes simplex virus-2 some are asymptomatic Early symptoms can include burning sensation in the genitals, low back pain, dysuria, and flu-like symptoms.Symptoms: Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • A short while later, small red bumps may appear around the genitals or on the mouth; later these bumps become painful blisters which then crust over, form a scab, and heal. symptoms go away but reappear since the virus stays in the bodySymptoms: Maria Carmela L.Domocmat, RN, MSN
    • Herpes genitalis Maria Carmela L.Domocmat, RN, MSN
    • Genital HerpesMaculopapular herpetic rash on the penile shaft and corona of the Maria Carmela L.Domocmat, RN, MSNglans penis.
    • Herpes simplex keratitis is a serious viral infection. It may cause repeated attacks that are triggered by stress, esposure to sunlight, or any condition that impairs the immune system.Herpes simplex keratitis Maria Carmela L.Domocmat, RN, MSN
    • Infectivity: Washing with soap people can infect and water readily others when they inactivates HSV; have symptoms & therefore fomite some times when transmission is they do not unlikely. Maria Carmela L.Domocmat, RN, MSN
    • Visual – lesions Viral culture Confirm the dx Most accurate if specimens are obtained within 48 hrs of 1st outbreak of blisters Direct immunofluorescence staining Antigen detection testing of vesicualar exudate Pap smearDx Maria Carmela L.Domocmat, RN, MSN
    • Decrease discomfort Promote healing without secondary infection Decrease viral shedding Prevent infection transmissionGoals of treatment Maria Carmela L.Domocmat, RN, MSN
    • TreatmentNo cureDrugs help decrease severity ofsymptoms, promote healing, anddecrease recurrent outbreaks Maria Carmela L.Domocmat, RN, MSN
    • Genital Herpes: Acyclovir 200-400mg TID x 10 days Famciclovir (Famvir) Valacyclovir (Valtex) Herpes prophylaxis: Acyclovir 200-400mg BID Herpes zoster (shingles): Acyclovir 800mg 5 times a day for 10 days use Betadine on lesions to dry & prevent secondary infectionsTreatment Maria Carmela L.Domocmat, RN, MSN
    • Oral analgesics Local anesthetic sprays Ice packs or warm compress to lesions Sitz bath – 3-4x/day Increase fluid intake Frequent urination Pour water over genitalia while voiding, or encourage voiding while sitting in tub of water or standing in shower Catheterize as necessary Wear loose-fitting nonsynthetic undergarmentsReduce pain Maria Carmela L.Domocmat, RN, MSN
    • When vesicles rupture release highly contagious exudate Wash hands thoroughly after contact with lesion Genital hygiene Keep skin clean and dry Wear gloves when applying ointment Avoid touching eyes Avoid sex when (+) with lesion Use latex or polyurethane condoms Launder towels that have direct contact with lesion; separate towels and other personal items of clientPrevent reinfection Maria Carmela L.Domocmat, RN, MSN
    • Emphasize risk of fetal infection to both male and female clients A condom can prevent herpes transmission during vaginal or anal sex, but oral contact with genitals or open sores anywhere can spread the disease.Health educ Maria Carmela L.Domocmat, RN, MSN
    • While herpes is not life-threatening, and not all people who have it suffer from outbreaks disseminated infections Meningitis Transverse myelitis Risk for spontaneous abortion Predispose carcinoma of cervixComplications Maria Carmela L.Domocmat, RN, MSN
    • HSV Vesicles Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • GRANULOMA INGUINALE
    • Aka: donovanosis Incubation period initially described 1 to 12 weeks by Donovan over a century agoGranuloma Inguinale Maria Carmela L.Domocmat, RN, MSN
    • bacterium was classified in 1913as Calymmatobacterium granulomatis.the molecular structure of the causativeorganism was similar to Klebsiella speciesand reclassified the gram-negativepleomorphic bacillus as Klebsiellagranulomatis. Maria Carmela L.Domocmat, RN, MSN
    • About half of infected men and women have sores in the anal area. Small, beefy-red bumps appear on the genitals or around the anus. The skin gradually wears away, and the bumps turn into raised, beefy-red, velvety nodules called granulation tissue. usually painless, but they bleed easily if injured. without lymphadenopathy S/Shttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001660/ Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • The disease slowly spreads and destroys genital tissue. Tissue damage may spread to the area where the legs meet the torso. This area is called the inguinal folds. The genitals and the skin around them lose skin color. In its early stages, it may be hard to tell the difference between donovanosis and chancroid In the later stages, donovanosis may look like advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis S/Shttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001660/ Maria Carmela L.Domocmat, RN, MSN
    • causative organism - difficult to culture, diagnosis requires visualization of dark- staining Donovan bodies on tissue crush preparation or biopsy Culture of tissue sample (hard to do and not routinely available) Scrapings or punch biopsy of lesion Microscopic identification of Donovan’s bodies from edge scraping of lesionsDx Maria Carmela L.Domocmat, RN, MSN
    • sexual contact; however, it ishypothesized to have low infectiouscapabilities because repeated exposure isnecessary for clinical infection to occur.may also be obtained through the fecalrouteor by passage through an infected birthcanal.MOT Maria Carmela L.Domocmat, RN, MSN
    • Donovanosisor granuloma inguinale Maria Carmela L.Domocmat, RN, MSN
    • Antibiotics are used to treat donovanosis. To cure the condition requires long-term treatment. Most treatment courses run 3 weeks or until the sores have completely healed. A follow-up examination is important because the disease can reappear after it seems to be cured.Treatment Maria Carmela L.Domocmat, RN, MSN
    • Doxycycline 100 mg orally BID for at least 3 weeks and until all lesions have completely healedRecommended Regimen Maria Carmela L.Domocmat, RN, MSN
    • Azithromycin 1 g orally once per week for at least 3 weeks and until all lesions have completely healedOR Ciprofloxacin 750 mg orally BID for at least 3 weeks and until all lesions have completely healedOR Erythromycin base 500 mg orally four times a day for at least 3 weeks and until all lesions have completely healedOR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed The addition of an aminoglycoside (e.g., gentamicin 1 mg/kg IV every 8 hours) to these regimens can be considered if improvement is not evident within the first few days of therapy.Alternative Regimens Maria Carmela L.Domocmat, RN, MSN
    • Genital damage and scarring Loss of skin color in genital area Permanent genital swelling due to scarringComplications Maria Carmela L.Domocmat, RN, MSN
    • Treat partners within 60 days before dx.Health educ Maria Carmela L.Domocmat, RN, MSN
    • LYMPHOGRANULOMAVENERUEM (LGV)
    • AKA: lymphopahia venerea tropical bubo, climatic bubo, strumous bubo, poradenitis inguinales, Durand-Nicolas- Favre disease, lymphogranuloma inguinaleLymphogranuloma venereum Maria Carmela L.Domocmat, RN, MSN
    • is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacterium Chlamydia trachomatis. serovars L1, L2, or L3 not caused by the same bacteria that cause genital chlamydia more common in men than women. The main risk factor is being HIV-positive.Causes, incidence, and risk factors Maria Carmela L.Domocmat, RN, MSN
    • 3 to 30 daysIncubation period Maria Carmela L.Domocmat, RN, MSN
    • Tender, enlarged, inflamed inguinal and/or femoral lymphadenopathy -typically unilateral. Both sides – “groove sign” Can drain, ulcerate and scar Or recede self-limited genital ulcer or papule sometimes occurs at the site of inoculation. However, by the time patients seek care, the lesions have often disappeared. Marked external genital deformitySymptoms Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • Rectal exposure in women or MSM can result in proctocolitis, including mucoid and/or hemorrhagic rectal discharge, anal pain, constipation, fever, and/or tenesmus (painful bowel movements)Symptoms Maria Carmela L.Domocmat, RN, MSN
    • Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers. C. trachomatis testing also should be conducted, if available. Genital and lymph node specimens (i.e., lesion swab or bubo aspirate) can be tested for C. trachomatis by culture, direct immunofluorescence, or nucleic acid detection. Chlamydia serologyDx tests Maria Carmela L.Domocmat, RN, MSN
    • Treatment cures infection and prevents ongoing tissue damage, although tissue reaction to the infection can result in scarring. Buboes aspiration through intact skin or incision and drainage to prevent the formation of inguinal/femoral ulcerations. Doxycycline is the preferred treatmentTreatment Maria Carmela L.Domocmat, RN, MSN
    • Recommended Regimen Doxycycline 100 mg orally twice a day for 21 days Alternative Regimen Erythromycin , 500 mg orally 4x/day for 21 days Although clinical data are lacking, Azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.Treatment Maria Carmela L.Domocmat, RN, MSN
    • Management of Sex Partners Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined, tested for urethral or cervical chlamydial infection, and treated with a chlamydia regimen (azithromycin 1 gm orally single dose or doxycycline 100 mg orally twice a day for 7 days).Treatment Maria Carmela L.Domocmat, RN, MSN
    • Pregnancy Pregnant and lactating women should be treated with erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.Special Considerations Maria Carmela L.Domocmat, RN, MSN
    • HIV Infection Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.Special Considerations Maria Carmela L.Domocmat, RN, MSN
    • Abnormal connections between the rectum and vagina Brain inflammation (very rare) Infections in the joints, eyes, heart, or liver Long-term inflammation and swelling of the genitals Scarring and narrowing of the rectum Complications can occur many years after you are first infected.Complications Maria Carmela L.Domocmat, RN, MSN
    • LGV is an invasive, systemic infection If not treated early LGV proctocolitis can lead to chronic, colorectal fistulas and strictures. Genital and colorectal LGV lesions can also develop secondary bacterial infection or can be coinfected with other sexually and nonsexually transmitted pathogens.Complications Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • SYPHILIS
    • Treponema pallidum bacterium.Secondary syphilis is the most contagious of allthe stages, and is characterized by a systemicspread of the Maria Carmela L.Domocmat, RN, MSN
    • Stages Maria Carmela L.Domocmat, RN, MSN
    • Genital chancre Chancre – an oval ulcer with a raised firm border that does not bleed readily and is painless unless infected Develop at site of inoculation (i.e., genitalia, anus, mouth) Occurs abt 4 wks after initial infection If untreated – heals spontaneously in 4 to 6 wks Leave thin, atrophic scarPrimary syphilis Maria Carmela L.Domocmat, RN, MSN
    • Syphilitic Ulcer Maria Carmela L.Domocmat, RN, MSN
    • Lymphadenopathy near the chancre Nodes – painless, firm, discrete Maria Carmela L.Domocmat, RN, MSN
    • Develops when primary is untreated 6 to 8 wks after infection Generalized rash – maculopapular and nonpruritic rash Usually on palm, sole Infectious Generalized nontender, discrete Lymphadenopathy Mucous patches Gray, superficial patches on mucous membranes in mouthSecondary syphilis Maria Carmela L.Domocmat, RN, MSN
    • Secondary Syphilis: includes multiplelesions located on the penis and scrotum. The secondary maculopapular rash usually causes no itching, and can appear as the chancre, or chancres found during the primary stage of syphilis are healing, or several weeks after the chancres have Maria Carmela L.Domocmat, RN, MSN healed.
    • syphilis can causepainless ulcers(know as chancres)to appear on thepenis, or at theplace where thesyphilis bacteriaentered thebody.(Credit: MRein/CDC)Syphilis chancre Maria Carmela L.Domocmat, RN, MSN
    • can cause painless ulcers (known as chancres) to appear on the vagina, or at the place where the syphilis bacteria entered the body.(Credit: CDC)Syphilis Maria Carmela L.Domocmat, RN, MSN
    • Condylomata lata Broad-based flat papules Develop in warm, moist body areas (i.e., labia, anus corners of mouth) Highly contagious General flu-like manifestations Patchy hair loss from eyebrows and scalp (alopecia) Usually disappear after 2 to 6 wksSecondary syphilis Maria Carmela L.Domocmat, RN, MSN
    • Condylomata lata Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • secondary stage syphilis caninclude flat, warty-lookinggrowths on the vulva andaround the anus.(Credit: CDC) Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • Client is seroreactive but shows no evidence of disease non infectious except transplacental spread or BT Not sexually transmitted this time Occurs 1 to 2 yrs after primary lesion, can last as long as 50 yrs More than half remain at this stageLatent syphilis Maria Carmela L.Domocmat, RN, MSN
    • Occurs 1 to 35 yrs after primary infection Devastating, irreversible complications Chronic bone and joint inflammation Cardiovascular problems (e.g., aneurysms, valvular involvement) Granulomatous lesions (gummas) on any part of the body Ophthalmic, auditory, CNS problems Noninfectious Terminal if untreatedTertiary Maria Carmela L.Domocmat, RN, MSN
    • Tertiary neurosyphilis presents with symptoms of meningitis or with focal deficits consistent with stroke. The mnemonic device "PARESIS" is an aid to recall the following types of symptoms: Personality Affect Reflexes (e.g., hyperactive) Eye (e.g., Argyll Robertson pupils) Sensorium (e.g., illusions, delusions, hallucinations) Intellect (e.g., decreased recent memory, orientation, judgment, insight) Speech abnormalitiesTertiary Maria Carmela L.Domocmat, RN, MSN
    • gummas observed in tertiarysyphilis Maria Carmela L.Domocmat, RN, MSN
    • oral, anal, or vaginal sex, or via intimatetouching or kissing.Mothers can pass it to their babies bytouching syphilis sores (chancres) andthen touching the baby.MOT Maria Carmela L.Domocmat, RN, MSN
    • One week to three monthsIncubation Period Maria Carmela L.Domocmat, RN, MSN
    • Dark-filed microscopy (DFA) Lesions scraped and causative organism identified Serologic tests Indirect test that detect antibodies Venereal disease research laboratory (VDRL) Rapid plasma reagin (RPR) Fluorescent treponemal antibody absorptions (FTA-ABS) test Treponema pallidum particle agglutination (TP- PA)Dx tests Maria Carmela L.Domocmat, RN, MSN
    • Dark-filed microscopy (DFA) Lesions scraped and causative organism identifiedDiagnostic tests Maria Carmela L.Domocmat, RN, MSN
    • T. pallidum cannot be Advantages of viewed by normal darkfield microscopy: light microscopy. Definitive immediate Darkfield microscopy diagnosis (useful in primary and secondary can identify T. disease). pallidum with its Rapid results. spiral shape, 10-14 coils, corkscrew motion, and a total length of 6-20 micrometers.Darkfield microscopy Maria Carmela L.Domocmat, RN, MSN
    • An experienced microscopist and specialized equipment (often not available outside of a specialized clinic) are required. Confusion with other pathogenic or nonpathogenic spirochetes may occur. Generally not recommended on oral lesions because of specificity problem with nonpathogenic spirochetes in the oral cavity. It must be performed immediately because motility is important to identification. The sensitivity of darkfield microscopy decreases as the lesion heals. Possibility of false-negatives increases with use of topical substances such as soap and water, antibiotic ointments, etc.Disadvantages of darkfieldmicroscopy: Maria Carmela L.Domocmat, RN, MSN
    • Serologic tests Indirect test that detect antibodies Note: antibodies are not present in serum until 4 wks after the appearance of chancreDiagnostic tests Maria Carmela L.Domocmat, RN, MSN
    • Venereal disease research laboratory (VDRL) Rapid plasma reagin (RPR) Uses antigen to detect the antibody relatively specific for Treponema pallidumDiagnostic tests: Serologic tests Maria Carmela L.Domocmat, RN, MSN
    • Fluorescent treponemal antibody absorptions (FTA-ABS) test Treponema pallidum particle agglutination (TP-PA)Diagnostic tests: Serologic tests Maria Carmela L.Domocmat, RN, MSN
    • Direct fluorescent antibody - T. pallidum (DFA-TP) identifies T. pallidum on direct lesion smear by immunofluorescence using polyclonal antiserum or monoclonal antibody.Direct fluorescent antibody Maria Carmela L.Domocmat, RN, MSN
    • Maria Carmela L.Domocmat, RN, MSN
    • Primary, secondary, Primary, secondary tertiary syphilis syphilis Benzathine Abstain from penicillin G 2.4 sexual contact at mU, IM, one dose least 1 month Doxycycline or after treatment tetracycline 100 mg, PO, 2-3 times a day for 14 days.Treatment Maria Carmela L.Domocmat, RN, MSN
    • Latent syphilis Three weekly penicillin injections Neurosyphilis – IV aqueous crystalline penicillin GTreatment: Maria Carmela L.Domocmat, RN, MSN
    • AdultsPrimary, secondary, and early latentsyphilis without neurologic involvement:Benzathine penicillin G, IM, 2.4 millionunits in a single dose If penicillin allergic (one of thefollowing): Doxycycline 100 mg orally twicedaily for 2 weeks Tetracycline 500 mg orally 4 timesdaily for 2 weeks Maria Carmela L.Domocmat, RN, MSN
    • AdultsLate latent or latent syphilis of unknownduration without neurologic involvement:•Benzathine penicillin G 7.2 million unitstotal, administered as 3 doses of 2.4million units IM each at 1-week intervalsIf penicillin allergic (one of the following): Doxycycline 100 mg orally twicedaily for 28 days Tetracycline 500 mg orally 4 timesdaily for 28 days Maria Carmela L.Domocmat, RN, MSN
    • AdultsTertiary (late) syphilis without neurologicinvolvement:Benzathine penicillin G 7.2 million units total,administered as three doses of 2.4 million units IMeach at 1-week intervals If penicillin allergic: Treat according to treatment for late latentsyphilis.Neurosyphilis:Aqueous crystalline penicillin G 18-24 million unitsper day, administered as 3-4 million units IV every 4hours or continuous infusion for 10-14 days IV Maria Carmela L.Domocmat, RN, MSN
    • Alternative regimen (if compliance can be ensured): Procaine penicillin 2.4 million units IM once daily PLUSProbenecid 500 mg orally 4 times a day, both for 10-14 days Maria Carmela L.Domocmat, RN, MSN
    • is a self-limited reaction to anti- treponemal therapy. characterized by fever, malaise, nausea, and vomiting. may be associated with chills and exacerbation of secondary rash. This reaction occurs within 24 hours after therapy and usually resolves within 24 hours.Jarisch-Jarisch-Herxheimer Reaction Maria Carmela L.Domocmat, RN, MSN
    • Patients should be warned that it is not an allergic reaction to penicillin and that it can be treated with symptomatic support. It occurs more frequently after treatment with penicillin and treatment of early syphilis, especially at the secondary stage. Pregnant women should be informed that treatment for syphilis may precipitate early labor and that they should notify an obstetrician if problems develop.Jarisch-Jarisch-Herxheimer Reaction Maria Carmela L.Domocmat, RN, MSN
    • serious damage to A fetus is at the brain and the particular risk if the nervous system; mother doesnt mental seek treatment; deterioration; the chances for a loss of balance, stillbirth and serious vision, and birth defects, sensation; including blindness, leg pain; and are very high. heart disease.Complications: Untreated syphiliscan lead to Maria Carmela L.Domocmat, RN, MSN
    • Irreversible blindness Mental illness Paralysis Heart disease deathComplications Maria Carmela L.Domocmat, RN, MSN
    • caused by transplacental transmission of spirochetes; the transmission rate approaches 100%. Perinatal death may result from congenital infection in more than 40% of affected, untreated pregnancies.Congenital syphilis Maria Carmela L.Domocmat, RN, MSN
    • Among survivors, manifestations have traditionally been divided into early and late stages. Manifestations are defined as early if they appear in the first 2 years of life and late if they develop after age 2 years.Congenital syphilis Maria Carmela L.Domocmat, RN, MSN
    • Syphilis in pregnancy can lead to spontaneous abortion, stillbirth, premature delivery, or perinatal death. It can also cause significant morbidity during infancy, childhood, and adolescence. A very strict follow-up of pregnant women before delivery and an active approach to identify and treat exposed neonates born to infected mothers are strongly recommended. A study in Nigeria has demonstrated the usefulness of syphilis screening during pregnancy and recommended that syphilis screening should be continued as part of routine antenatal testingSyphilis in pregnancy Maria Carmela L.Domocmat, RN, MSN
    • Hutchinsons teeth notched,narrow-edged permanent incisors,sometimes but not always a sign ofcongenital syphilis. Maria Carmela L.Domocmat, RN, MSN
    • Early manifestations of congenital infection vary and involve multiple organ systems. The most striking lesions affect the mucocutaneous tissues and bones. Mucous patches, rhinitis, and condylomatous lesions are highly characteristic features of mucous membrane involvement in congenital syphilis.Early onset congenital syphilis Maria Carmela L.Domocmat, RN, MSN
    • Nasal fluid is highly infectious. Snuffles are followed quickly by a diffuse maculopapular desquamative rash that involves extensive sloughing of the epithelium, particularly on the palms and soles and around the mouth and anus. In contrast to acquired syphilis, a vesicular rash and bullae may develop. These lesions are highly infectious. Hepatomegaly is reported in almost 100% of cases, and biochemical evidence of liver dysfunction is usually observed.Early onset congenital syphilis Maria Carmela L.Domocmat, RN, MSN
    • syphilisScarring from the early systemic disease causes late manifestations of congenital syphilis. Manifestations include neurosyphilis and involvement of the teeth, bones, eyes, and the eighth cranial nerve.Late-Late-onset congenital Maria Carmela L.Domocmat, RN, MSN
    • http://www.nzma.org.nz/journal/120-1250/2448/content01.jpgCongenital syphilis Maria Carmela L.Domocmat, RN, MSN
    • HIV infected persons with early stage syphilis should receive a single IM dose of 2.4mu of benzathine penicillin Some specialists suggest that HIV-infected persons with primary or secondary syphilis receive additional treatments (e.g., benzathine penicillin G administered at 1- week intervals for 3 weeks, as recommended for late syphilis). However, the benefit of this approach remain unprovenSyphilis and HIV/Other STDs Maria Carmela L.Domocmat, RN, MSN
    • All patients who have syphilis should be tested for HIV infection. Persons with primary or secondary syphilis who live in areas with a high prevalence of HIV should be retested for HIV after 3 months if the first HIV test result was negative. Consider screening persons with syphilis for other STDs.Syphilis and HIV/Other STDs Maria Carmela L.Domocmat, RN, MSN