Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It is primarily transmitted in two ways: through sexual contact and from mother to baby during pregnancy or delivery.
- Sexual Transmission: The infection is spread when a person comes into direct contact with painless ulcers, known as chancres, which can appear on the genitals, anus, mouth, or mucous membranes.
- Mother-to-Baby Transmission: Syphilis can also be passed from a mother to her baby via the bloodstream. The bacterium enters the bloodstream and can be transmitted through the placenta or during delivery, when the baby may come into contact with the chancres.
Stages of Syphilis
Syphilis progresses in four distinct stages. These are not only important to remember for your nursing exams, but they are also important to know so that you can recognize the signs and symptoms of each stage to provide timely treatment.
1. Primary Stage
The primary stage of syphilis occurs about three weeks after exposure to the bacterium. During this stage, a painless ulcer, or chancre, appears at the site of infection, such as the genital area, anus, mouth, or mucous membranes. The chancre is highly contagious and can spread the infection to others. This stage typically lasts between three to six weeks and resolves on its own. However, if left untreated, the infection remains in the body, progressing to the next stage.
2. Secondary Stage
The secondary stage begins six to twelve weeks after the initial infection. In this stage, the patient typically develops a full-body rash, which is typically not itchy. The rash usually starts on the trunk but can spread to other areas, including the palms of the hands and soles of the feet. Flu-like symptoms may also occur, including low-grade fever, swollen lymph nodes, and muscle aches. The infection remains contagious at this stage, and the symptoms may go away on their own, but without treatment, the infection remains present and progresses to the next stage.
3. Latent Stage
The latent stage can last for years without symptoms. This stage is divided into two phases:
- Early Latent Stage: In this phase, the patient may relapse and experience signs and symptoms again, making them contagious.
- Late Latent Stage: In this phase, the patient typically has no symptoms and is no longer contagious. However, the syphilis bacterium can still be present in the bloodstream, which can pose a risk during pregnancy, as the infection can be transmitted to the baby.
4. Tertiary Stage
The tertiary stage occurs about 10 to 30 years after the initial infection if syphilis is left untreated. Not all individuals with syphilis will reach this stage. It can cause severe damage to the brain, nerves, heart, and other organs. The formation of gummas (growths) in organs like the liver, skin, eyes, and bones is a hallmark of this stage. At this point, the infection is generally not contagious.
Complications of Syphilis
If syphilis is transmitted to a baby, it can cause serious complications such as stillbirth, death at birth, or congenital syphilis. Congenital syphilis can manifest in the baby as deafness, blindness, birth deformities, or neurological damage.
Nurse’s Role in Syphilis Care
As a nurse, it is crucial to understand the screening and treatment protocols for syphilis, especially in pregnant patients.
Screening Recommendations:
The American College of Obstetricians and Gynecologists recommends that all pregnant patients be screened for syphilis, not just high-risk individuals. The screenings should occur at three points during pregnancy:
- First prenatal visit
- Third trimester (around 28 weeks)
- At delivery
This is especially important due to the rise in cases of congenital syphilis. The tests typically involve blood tests such as the Rapid Plasma Reagin (RPR) test or the Venereal Disease Research Laboratory (VDRL) test.
Treatment of Syphilis:
The CDC recommends Penicillin G as the first-line treatment for all stages of syphilis. It is typically given intramuscularly but may also be administered intravenously if the patient has neurosyphilis (a form of syphilis affecting the central nervous system) or congenital syphilis. Penicillin G is the only recommended treatment for pregnant patients, as other antibiotics like doxycycline and tetracycline are unsafe during pregnancy.
If a patient is allergic to penicillin, a process called penicillin desensitization can be performed. This involves administering small doses of penicillin over time while closely monitoring the patient, gradually increasing the dose until the required therapeutic level is reached.
Patient Education and Follow-Up Care
After treatment, patients must be educated on the following points:
- No sexual activity until the treatment is complete and signs and symptoms have subsided.
- Use latex condoms during sexual activity to reduce the risk of transmission.
- Inform sexual partners about the infection and encourage them to get tested and treated to prevent reinfection.
- Follow-up testing is important to ensure the infection has been effectively treated and to monitor for reinfection. Typically, follow-up testing occurs at 3, 6, and 12 months after treatment.
By recognizing the symptoms of syphilis at each stage and ensuring timely treatment, healthcare providers can help prevent complications and stop the transmission of this infection.
Test your knowledge of syphilis by taking our syphilis nclex review quiz.
Sources:
American College of Obstetricians and Gynecologists. (2024, April). Screening for syphilis in pregnancy. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2024/04/screening-for-syphilis-in-pregnancy
Centers for Disease Control and Prevention. (2023, August 16). Syphilis – CDC Fact Sheet (Detailed). U.S. Department of Health and Human Services. https://www.cdc.gov/syphilis/about/index.html
Centers for Disease Control and Prevention. (2021, July 27). Syphilis treatment guidelines. U.S. Department of Health and Human Services. https://www.cdc.gov/std/treatment-guidelines/syphilis.htm