Analysis of Syphilis: Pathophysiology, Assessment, and Management

This report provides a comprehensive overview of syphilis, a sexually transmitted infection caused by Treponema pallidum. It details the pathophysiology of the disease, outlining its stages (primary, secondary, latent, and tertiary) and modes of transmission. The report further examines the assessment and management of syphilis, including diagnostic methods like dark-field microscopy and nontreponemal tests, along with the recommended treatment using penicillin G and alternative therapies. Ethical and legal issues related to patient safety, informed consent, confidentiality, and equity are discussed, emphasizing the roles of sexual health teams in patient care, treatment planning, clinical management, self-management support, and follow-up. The report also highlights the educational needs for preventing syphilis, emphasizing transmission, symptoms, prevention measures like safe sex and condom use, and the importance of regular STI testing. References from various sources support the information provided.

Running Head: SEXUALLY TRANSMITTED INFECTIONS: SYPHILIS
Sexually Transmitted Infections: Syphilis
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SEXUALLY TRANSMITTED INFECTIONS: SYPHILIS
Pathophysiology of Syphilis
Syphilis is a venereal disease caused by Treponema pallidum. It is an infectious disease
that is transmitted through sexual contact with infectious lesions (Chow et al, 2017). It can be
transmitted from the mother to the fetus in the uterus, through blood transfusion and through
contact of a broken skin with an infectious lesion. The first sign of the infection is appearance of
a small, painless sore on the sexual organs, the rectum or in the mouth. This sore is commonly
known as a chancre (Uslu et al, 2017). Syphilis is classified in 4 stages if not treated. The first
two stages are considered to be the most infectious stages. They include the primary stage, the
secondary stage, the latent stage and the tertiary stage. T. pallidum penetrates the mucous
membrane in acquired syphilis and enters the lymphatics and becomes a systemic infection. The
average incubation period from the time of exposure to development of lesions is 3 weeks.
The primary stage involves the development of painless chancre after incubation at the
site of transmission commonly on the external genitalia (Tuddenham & Ghanem, 2015). This
stage occurs between the third and the fourth week of infection by the bacteria. The secondary
stage occurs 4-10 weeks after the primary stage. The spirochetes spread throughout the body
with variable manifestations of the lesions. When systemic, the manifestations include fever,
malaise, lymphadenopathy, rash, weight loss, hair loss, and aching joints (Taylor et al, 2017).
Histologically, the reaction from the inflammation is similar to the primary chancre but less
intense. These symptoms usually go away with or without treatment though the treatment will
still be present without treatment.
Another stage is the latent syphilis where the secondary features have resolved. The
infectious skin lesions recur from the secondary stage (Handsfield, 2015). If untreated, the latent
syphilis develops to tertiary syphilis after many years of infection. The final stage is tertiary

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syphilis which when it occurs, it affects the cardiovascular and the central nervous systems
damaging the tissues. This stage can be life threatening and can cause outcomes such as
blindness, mental illness, memory loss, destruction of soft tissue and bone, deafness,
neurological disorders such as meningitis, heart disease and neuro-syphilis (Kenyon et al, 2017).
Congenital syphilis occurs when the treponemes cross the placenta and infect the fetus which
causes spontaneous abortion and stillbirth.
Assessment and Management of Syphilis
Syphilis, in most cases, poses a challenge in its diagnosis as one may be infected and
show no symptoms for quite some time, even years. Blood and urine samples are collected to run
tests and also a thorough physical examination is conducted (Navale et al, 2014). Syphilis
diagnosis is mostly done by dark-field microscopy when an active chancre is present. The lesion
is cleansed and abraded with a gauze pad. On appearance of serous exudates, it is placed on a
glass slide and examined under a microscope with a dark-field condenser. The spirochete is
characterized by a corkscrew appearance. For a lesion for T.pallidum to be considered negative,
negative examinations are necessary on three different days (Klausner, 2017). The screening of
syphilis widely uses qualitative nontreponemal tests. Their usefulness is however limited by
decreased sensitivity of primary stages of syphilis and the latent stage. Nontreponemal tests
become nonreactive after proper treatment of syphilis. Treponemal-specific tests are also used to
detect antibodies produced on the onset of T. pallidum antigens. This test is used on patients
whose nontreponemal test is reactive.
Treatment
The center for disease and prevention (CDC) recommends penicillin G that is
parenterally administered for all stages of syphilis. A single intramuscular injection of

SEXUALLY TRANSMITTED INFECTIONS: SYPHILIS
Benzathine penicillin G of 2.4 million is ministered to cure syphilis (Klausner, 2017). Treatment
by penicillin kills the bacteria but does not repair the damage done on the skin. Doxycycline is
considered is one the best alternatives in treating early and latent syphilis (Lithgow et al, 2017).
Patients under treatment should abstain from sexual contacts until the sores are fully healed. In
any stage of treatment of syphilis, acquiring other STIs should be taken into account. In the
initial evaluation, HIV testing is necessary for all syphilitic patients (Müller, 2011). Screening
for other diseases like hepatitis B and C, chlamydial infection and gonorrhea should also be
considered. After administration of proper treatment, follow up with quantitative nontreponemal
test titers in order to establish treatment response. When syphilis remains untreated it can cause
damage to important organs in the body like the heart and the brain thus the need for early
treatment.
Ethical and Legal Issues
Ethical and legal issues with regard to STIs have been raised by therapists.
The first issue raised is patient safety which requires that a patient must be thoroughly examined
before prescribing medication to ensure that the right infection is being treated and to avoid any
allergic reactions (Lago, 2016). Examination also allows the patient to inquire more about the
infection, treatment and also present relevant medical history. Secondly, informed consent is
mandatory. The patient has the right to get information on the symptoms, complications,
disbursement of treatment and the risks that come with the treatment so that he/she is able to
make informed decisions concerning the management of the disease (Klausner, 2017). Another
important aspect is the need for confidentiality. In this regard, information on a patient’s
condition should be kept private and confidential and only revealed with the consent of the
patient and can only be breached when the infection is of public health concern (Lithgow et al,

SEXUALLY TRANSMITTED INFECTIONS: SYPHILIS
2017). Therefore, confidentiality of a patient’s health details is protected by the law because
disclosure can cause harm to the patient. Lastly is equity which requires that health care
resources be distributed according to people’s difference in need, worth and ability to pay. Laws
have been made to ensure there is no discrimination based on one’s health status. For example,
discriminating one in employment based on his/her health status.
Role of Sexual Health Teams
To effectively manage syphilis interventions, a multidisciplinary care team is
recommended. The sexual health team would include nurses, pharmacists and doctors with
behavioral skills. They play the various roles in the management of Syphilis (Lago, 2016). The
first role of the team includes patient based care. This involves planning and delivering care to
the patient. It starts with protocols that define the assessment and treatment that are of quality
care. The required steps for the delivery of the interventions are delegated to the team members
according to their specified duties (Klausner, 2017). The treatment plan should come second.
The treatment team knows and should provide the most preferred treatment required by the
patient with regard to the disease and the medical history of the patient.
Thirdly there is need for clinical management. This would be best done by nurses who
would monitor the progress of the patient as he takes on the treatment. They should be able to
monitor any effect of the treatment on the patient. Another role performed is to provide self
management support. Educational interventions often support patients to change risky behaviors
or help them became better self-managers (Handsfield, H. (2015). This helps reduce the risk of
re-infection and possible transmission to others. It is therefore advantageous to have a nurse
trained on behavioral counseling since most doctors neither have the skills nor the time to do

SEXUALLY TRANSMITTED INFECTIONS: SYPHILIS
counseling on behavior change. Lastly, there is need for sustained follow up. Close follow up is
necessary in the management of syphilis so as to monitor problems in compliance, inability to
respond to treatment, detect adverse effects of the treatment (Müller, 2011). Telephone follow up
is commonly done by nurses. Therefore, to manage syphilis, various groups have to work
together as a team to merge the different skills such as counseling, pharmacology, diagnostic
skills and patient care.
Education needs to prevent further STIs
The education needs for individuals at risk of contracting or those already with the
condition are based on the basis that the STI is a very contagious disease which spreads majorly
through sexual activities. Thus one of the needs includes information on the pathophysiology and
how the disease is transmitted from an infected person to another. From research, it is spread
from sores and lesions on the skin of infected person to another when they come in contact
during unprotected sexual intercourse (Callander et al, 2013). Secondly, there is need for
education on the symptoms and signs of the condition for people to seek early medical attention.
There is need to however emphasize that a lot of infected persons are always not aware of being
infected and therefore, they easily unknowingly pass the infection to their sexual partners.
Thirdly, educational approaches should focus on prevention measures against syphilis.
Among them is that the STI can be prevented majorly through self care. This helps in lowering
the chances of getting infected or re-infected with not just syphilis but other sexually transmitted
infections. Practicing safe sex is one of the ways of preventing syphilis (Ahmed-Jushuf, 2010).
Limiting oneself to one sexual partner and ensuring that your partner does not get involved in
risky sexual behaviors. Another preventive measure is the use of condoms during sexual
intercourse (Handsfield, 2015). Condoms reduce the risk of contracting STIs but only if it covers

SEXUALLY TRANSMITTED INFECTIONS: SYPHILIS
the lesions and sores. Educational and coaching approach should also focus on emphasizing the
need to avoid drug abuse. Abuse of alcohol and other hard drugs may cloud one’s judgment
which may lead one to unsafe sexual practices (Taylor et al, 2017). Abstinence from sex as a
preventive measure should be emphasized as an educational need, since it is considered to be the
surest ways of avoiding any STIs. Syphilis has no vaccine and is transmitted through sexual
contact with an infected person. It is also important to regularly get tested for STIs as a way of
keeping oneself healthy. A further important educational need includes the diagnosis,
management and treatment of syphilis. Individuals should be taught on these particular issues to
ensure that they seek medical attention early enough before the progression of the disease gets
worse. According to Ahmed-Jushuf (2010), health promotion to individuals at the risk of
contracting such STIs as syphilis should focus on addressing poor health-seeking behavior so as
to enlighten the community on the need for attention to healthcare.

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Callander, D., Baker, D., Chen, M., & Guy, R. (2013). Including Syphilis Testing as Part of
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Chow, E., Callander, D., Fairley, C., Zhang, L., Donovan, B., & Guy, R. et al. (2017). Increased
Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic
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Handsfield, H. (2015). Sexually Transmitted Diseases, Infections, and Disorders. Sexually
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Uslu, U., Heppt, F., & Sticherling, M. (2017). Secondary syphilis infection under treatment with
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