COMMUNICABLE DISEASES IN NURSING

NAME: AZORES, Mae Ann A. September 17, 2010

SECTION: BSN 4A1-4 Dr. Alfredo Ed Talosig, RN
SYPHILLIS

“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.

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”

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.
CASE:
Mr. X, age 22, works as a bellman at a large hotel. For the past year, he has shared a small apartment with Ms. Y,
who is 5 months pregnant with his child. Although he intends to marry Ms. Y before the baby is born, he has
continued a previous relationship with a woman named Ms. Z. His sexual activities with Ms. Z have
increased in frequency as Ms. Y’s pregnancy has advanced. Recently Mr. X has noticed a swelling in his groin and
a sore on his penis.

ASSESSMENT:
When Mr. X comes to the community clinic the nurse takes a thorough and document medical and sexual history,
including questions about drug use, allergies, difficulty with urination, urinary frequency, itching or discharge
from the penis, recent sexual activities, precautions taken against infection, history of STIs, and sexual
function. She determines that Mr. X has been having unprotected sex with both Ms. Y and Ms. Z. He believes
that Ms. Y is not having sex with anyone except him, but he is not sure. Physical assessment reveals a classic
syphilitic chancre on the shaft of the penis and regional lymphadenopathy. A specimen the nurse discusses with Mr. X
the likelihood that he has syphilis and the need to tell both Ms. Y and Ms. Z so that they can be tested and, if
necessary, treated. The nurse also suggests that Mr. X be tested for HIV since he has been having unprotected sex
with two women, at least one of whom may be sexually active with other partners. He agrees, and blood is drawn for
an ELISA test. Darkfield analysis of the chancre exudate confirms the diagnosis of syphilis; the ELISA results are
negative for HIV.

DIAGNOSES:
• Risk for injury to the client,his partners,and the infant,related to the disease process
• Ineffective health maintenance, related to a lack of knowledge about the disease process, its transmission,
and the need for treatment
• Interrupted family processes, related to the effects of the diagnosis of syphilis on the couple’s relationship
• Anxiety, related to the effects of the infection on the unborn child.

EXPECTED OUTCOMES
• Prompt treatment will cure the syphilis
• Will verbalize understanding for the need to abstain from sexual contact during treatment, complete all
medications, return for follow-up visits, and use condoms to prevent reinfection.
• Will verbalize decreased anxiety following education and treatment.

PLANNING AND IMPLEMENTATION

• Administer IM injection of benzathine penicillin G as ordered,
• Discuss the importance of abstaining from sexual activity until he and his partners are cured, and of using condoms
to prevent reinfection.
• Explain the need to return for follow-up testing in 3 months and again at 6 months. Provide a copy of the STI
prevention checklist, and document that reminders need to be sent at 3- and 6-month intervals.
• Notify sexual partners that they need to come to the clinic for a specimen testing.
• Refer to a social worker for counseling about the impact of disease on their relationship.
• Teach the couple about the importance of treatment to the health of their infant.

EVALUATION
At the 3-month follow-up visit, the chancre on Mr. X‘s penis has healed, and he reports that he is using a condom any
time he has sex. Ms. Y has also tested positive for syphilis and negative for HIV, so she, too, is given benzathine
penicillin G, and verbal and written follow-up instructions, including follow-up until the infant is born. The couple
is meeting every other week with the social worker and says that their relationship is improving.
Ms. Z has received similar test results and is given a prescription for doxycycline because she is allergic to penicillin.

Critical Thinking in the Nursing Process

1. What signs and symptoms might a client with early syphilis experience?
ANSWER: During the incubation period, the client may have absence of signs of spirochetemia but the blood is
already infective. During the primary stage, the client may have manifestations of 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.)
and enlarged inguinal lymph nodes which may appear on the10th day to 3 rd week after exposure and may remain
from 1-6 months.

2. What is the etiologic cause of infection?

ANSWER: 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.

3. Is Mr. X recommended to be isolated in a private room?

ANSWER: Isolation in a private room is unlikely to be required unless other highly communicable disease is occurring.
Lesions of primary and secondary syphilis MAYBE HIGLY INFECTIVE but gloves are just worn when direct contact with
the lesions is likely, and hand hygiene is performed after gloves are removed.

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
 OUR LADY OF FATIMA UNIVERSITY-QC
COMMUNICABLE DISEASES IN NURSING
NCM 104-BSN 4A1-4

CASE STUDIES ON:

SYPHILLIS
DENGUE FEVER

SUBMITTED BY:
AZORES, MAE ANN A.
 SUBMITTED TO:
MR. ALFFREDO ED TALOSIG,RN,MD