Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum subspecies pallidum . The signs and symptoms of syphilis vary depending on which of the four stages are presented (primary, secondary, latent, and tertiary). The main stages are classically present with a single chancre (a hard, painless, non-itchy skin ulceration) but there may be multiple injuries. In secondary syphilis occurs diffuse rash, which often involves the palms of the hands and soles of the feet. There may also be wound in the mouth or vagina. In latent syphilis, which may last for years, there are few or no symptoms. In tertiary syphilis there is gumma (non-cancerous growth soft), neurologic, or cardiac symptoms. Syphilis has been known as a "mastermind" because it can cause symptoms similar to many other diseases.
Syphilis most often spreads through sexual activity. It can also be transmitted from mother to baby during pregnancy or at birth, resulting in congenital syphilis. Other human diseases caused by bacteria Treponema include frambusia (subspecies
The risk of sexual syphilis transmission can be reduced by using latex condoms. Syphilis can be effectively treated with antibiotics. The preferred antibiotic for most cases is benzathine benzylpenicillin injected into the muscle. In those with severe penicillin allergies, doxycycline or tetracycline may be used. In those with neurosyphilis, an intravenous benzylpenicillin or ceftriaxone is required. During treatment, one can experience fever, headache, and muscle aches, a reaction known as Jarisch-Herxheimer.
By 2015, about 45.4 million people are infected with syphilis, with 6 million new cases. During 2015, it caused about 107,000 deaths, down from 202,000 in 1990. After declining dramatically with the availability of penicillin in the 1940s, rates of infection have increased since the turn of the millennium in many countries, often combined with human immunodeficiency virus (HIV). This is believed in part due to increased promiscuity, prostitution, decreased condom use, and unsafe sexual practices among men who have sex with men. In 2015, Cuba became the world's first country to eliminate mother-to-child transmission of syphilis.
Video Syphilis
Signs and symptoms
Syphilis may be present in one of four stages: primary, secondary, latent, and tertiary, and may also occur congenitally. This is called a "master copy" by Sir William Osler because of his varied presentation.
Primary
Primary syphilis is usually obtained by direct sexual contact with infectious lesions in others. About 3 to 90 days after initial exposure (average 21 days) skin lesions, called chancre, appear at the point of contact. This is a classic (40% of the time), single, strong, painless, non-itchy, skinless ulceration with a net basis and a sharp limit of 0.3-3.0 cm. Lesions can occur in almost any form. In the classical form, it evolved from the macula to the papules and eventually became erosion or ulcers. Occasionally, multiple lesions may be present (~ 40%), with multiple lesions more common when coinfected with HIV. Lesions may be painful or tender (30%), and may occur in places other than genital (2-7%). The most common sites in women are cervix (44%), penis in heterosexual men (99%), and are relatively orally and rectally common in men who have sex with men (34%). Lymph node enlargement often (80%) occurs around the area of ​​infection, occurring seven to 10 days after the formation of chancre. Lesions can last for three to six weeks without treatment.
Secondary
Secondary syphilis occurs about four to ten weeks after primary infection. While secondary disease is known for many different ways it can manifest, most symptoms often involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical rash, redness-pink, no itching on the stem and extremities, including the palms and soles of the feet. The rash may become maculopapular or pustular. It can form flat, wide, vaginal lesions, such as warts known as the condyloma of the mucosal membrane. All of these lesions contain bacteria and are infectious. Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headaches. Rare manifestations include liver inflammation, renal disease, joint inflammation, periostitis, optic nerve inflammation, uveitis, and interstitial keratitis. The acute symptoms usually heal after three to six weeks; about 25% of people may appear with recurrent secondary symptoms. Many people who come with secondary syphilis (40-85% women, 20-65% of men) do not report previously after having a classic primary syphilis chancre.
Latent
Latent syphilis is defined as having serological evidence of asymptomatic infection of the disease. This is further described as early (less than 1 year after secondary syphilis) or late (more than 1 year after secondary syphilis) in the United States. The United Kingdom uses a two-year cut-off for early and late latent syphilis. Early latent syphilis may have a symptom relapse. Latent late syphilis is asymptomatic, and is not contagious as early latent syphilis.
Tertiary
Tertiary syphilis can occur about 3 to 15 years after the initial infection, and can be divided into three forms: gummatous syphilis (15%), advanced neurosyphilis (6.5%), and cardiovascular syphilis (10%). Without treatment, one-third of infected people develop tertiary disease. People with tertiary syphilis are not contagious.
Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic gumma, which is soft, balls like inflammatory tumors that can vary in size. They usually affect the skin, bones, and liver, but can occur anywhere.
Neurosyphilis refers to an infection involving the central nervous system. This may occur earlier, either asymptomatic or in the form of syphilis meningitis, or delayed as meningovascular syphilis, generalized paresis, or dorsal tabes, associated with poor balance and lightning pain in the lower extremities. The end of neurosyphilis usually occurs 4 to 25 years after the initial infection. Meningovascular syphilis usually presents with apathy and seizures, and a generalized paresis with dementia and dementia. Also, there may be a student of Argyll Robertson, who is a small, bilateral pupil that narrows as the person focuses on near objects but does not narrow when exposed to bright light.
Cardiovascular syphilis usually occurs 10-30 years after the initial infection. The most common complication is syphilis aortitis, which can lead to the formation of aneurysms.
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Congenital syphilis is transmitted during pregnancy or during birth. Two-thirds of syphilis babies are born asymptomatic. Common symptoms developed during the first few years of life include enlarged liver and spleen (70%), rash (70%), fever (40%), neurosyphilis (20%), and lung inflammation (20%). If left untreated, late congenital syphilis may occur in 40%, including saddle nose deformation, Higoumenakis marks, saber shin, or Clutton joints among others. Infection during pregnancy is also associated with miscarriage.
Maps Syphilis
Cause
Bacteriology
Treponema pallidum subspecies pallidum is a spiral, Gram-negative, very mobile bacteria. The other three human diseases are caused by the related subspecies of Treponema pallidum, including frambusia (subspecies Transmission
Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her fetus; the spirochete is capable of passing through intact mucous membranes or disturbed skin. Thus it can be transmitted through a kiss near the lesion, as well as oral, vaginal, and anal sex. Approximately 30% to 60% of those exposed to primary or secondary syphilis will develop the disease. The infectivity is exemplified by the fact that individuals inoculated with only 57 organisms have a 50% chance of being infected. Most (60%) of new cases in the United States occur in men who have sex with men. Syphilis can be transmitted by blood products, but the risk is low because of blood tests in many countries. The risk of transmission from needle sharing seems limited.
It is generally not possible to have syphilis through toilet seats, daily activities, hot tubs, or sharing of cutlery or clothing. This is mainly because the bacteria die very quickly outside the body, making the transmission by objects very difficult.
Diagnosis
Syphilis is difficult to diagnose clinically from the beginning of presentation. Confirmation is done through a blood test or direct visual inspection using a microscopy. Blood tests are more commonly used, because they are easier to do. Diagnostic tests can not distinguish between stages of disease.
Blood tests
Blood tests are divided into nontreponemal and treponemal tests.
Nontreponemal testing was used initially, and included laboratory tests of venereal disease (VDRL) and rapid reagent plasma (RPR) tests. False positives on nontreponemal tests can occur with some viral infections, such as varicella (chicken pox) and measles. False positives can also occur with lymphoma, tuberculosis, malaria, endocarditis, connective tissue diseases, and pregnancy.
Because of the possibility of false positives with nontreponemal testing, confirmation is required with treponemal tests, such as treponemal pallidum particle agglutination (TPHA) or fluorescence treponemal absorption (FTA-Abs) antibody test. The treponemal antibody test usually becomes positive two to five weeks after the initial infection. Neurosyphilis is diagnosed by finding a high leukocyte count (dominated by lymphocytes) and high levels of protein in cerebrospinal fluid in the regulation of known syphilis infections.
Live test
The dark soil microscopy of serous fluid from the chancre can be used to make an immediate diagnosis. Hospitals do not always have equipment or experienced staff members, and testing should be done within 10 minutes of sampling. Sensitivity has been reported to be almost 80%; therefore tests can only be used to confirm the diagnosis, but not to rule out one. Two other tests can be performed on samples from chancre: direct fluorescent antibody tests and nucleic acid amplification tests. Direct fluorescent testing uses antibodies characterized by fluorescein, which is attached to certain syphilis proteins, while nucleic acid amplification techniques use techniques, such as polymerase chain reactions, to detect the presence of specific syphilis genes. This test is not time sensitive, as they do not require live bacteria to make the diagnosis.
Prevention
Vaccines
By 2018, there is no effective vaccine for prevention. Some vaccines based on treponemal protein reduce the development of lesions in animal models and research continues.
Sex
Condom use reduces the likelihood of transmission during sex, but does not completely eliminate the risk. The Center for Disease Control and Prevention (CDC) states, "The consistent and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or potential exposure site is protected.However, sick syphilis outside the area covered by latex condoms still allows transmission, so need to be careful even when using condoms. "
Abstinence from intimate physical contact with an infected person effectively reduces the transmission of syphilis. The CDC states, "The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or be in a long-term monogamous relationship with a partner who has been tested and known to be uninfected."
Default disease
Congenital congenital syphilis in newborns can be prevented by maternal screening during early pregnancy and treating those who are infected. The United States Prevention Task Force (USPSTF) strongly recommends universal screening for all pregnant women, while the World Health Organization recommends all women to be tested on their first antenatal visit and again in the third trimester. If they are positive, advised their partners are also treated. Congenital syphilis is still common in developing countries, as many women do not receive antenatal care at all, and antenatal care received by others does not include screening. This is sometimes still the case in developed countries, as they are most likely to get syphilis (through drug use, etc.) Most unlikely to receive treatment during pregnancy. Some steps to improve access to tests appear to be effective in reducing the rate of congenital syphilis in low- and middle-income countries. The treatment point test for detecting syphilis seems to be good although more research is needed to assess its effectiveness and in improving outcomes in mothers and infants.
Screening
CDC recommends that sexually active men who have sex with men are tested at least annually. The USPSTF also recommends screening among those at high risk.
Syphilis is a disease that is reported in many countries, including Canada, the European Union, and the United States. This means that healthcare providers are required to notify public health authorities, who then ideally will notify the partner of the person. Doctors can also encourage patients to send their partner to seek treatment. Several strategies have been found to improve follow-up for IMS testing, including email and text messaging as appointment reminders.
Treatment
Early infection
The first choice treatment for uncomplicated syphilis remains a single dose of benzathpillilin intramuscular benzathine. Doxycycline and tetracycline are an alternative choice for those allergic to penicillin; because of the risk of birth defects, this is not recommended for pregnant women. Resistance to macrolides, rifampicin, and clindamycin are common. Ceftriaxone, a third generation cephalosporin antibiotic, may be as effective as penicillin-based treatment. It is recommended that the treated person avoid sex until the wound healed.
Advanced infection
For neurosyphilis, due to poor penetration of benzylpenicillin into the central nervous system, those affected are advised to be given large doses of intravenous penicillin for at least 10 days. If a person is allergic, ceftriaxone may be used or desensitization of penicillin is attempted. Other advanced presentations may be treated with intramuscular benzylpenicillin once a week for three weeks. If allergies, as in the case of early disease, doxycycline or tetracycline may be used, albeit for longer duration. Treatment at this stage limits further development but has little effect on the damage that has occurred.
Reaction of Jarisch-Herxheimer
One potential side effect of treatment is the Jarisch-Herxheimer reaction. It often starts in an hour and lasts for 24 hours, with symptoms of fever, muscle aches, headaches, and rapid heartbeat. This is due to the cytokines released by the immune system in response to lipoproteins that are detached from the broken syphilis bacteria.
Pregnancy
Penicillin is an effective treatment for syphilis in pregnancy but there is no agreement on the most effective dose or delivery method. More research is needed on how many antibiotics should be given and when they are given.
Epidemiology
In 2012, about 0.5% of adults are infected with syphilis, with 6 million new cases. In 1999 it was believed to have infected an additional 12 million people, with over 90% of cases in developing countries. It affects between 700,000 and 1.6 million pregnancies a year, resulting in spontaneous abortion, stillbirth, and congenital syphilis. During 2010, it caused about 113,000 deaths, down from 202,000 in 1990. In sub-Saharan Africa, syphilis accounts for about 20% of perinatal deaths. The proportionate rate is higher among injecting drug users, those who are HIV-infected, and men who have sex with men. In the United States, the rate of syphilis in 2007 was six times greater in men than in women; they were almost the same in 1997. African Americans accounted for nearly half of all cases by 2010. In 2014, syphilis infection continues to increase in the United States.
Syphilis was very common in Europe during the 18th and 19th centuries. Flaubert considered it universal among Egyptian prostitutes of the 19th century. In developed countries in the early 20th century, infections declined rapidly with the widespread use of antibiotics, until the 1980s and 1990s. Since 2000, rates of syphilis have increased in the United States, Canada, Britain, Australia and Europe, especially among men who have sex with men. The rate of syphilis among American women has remained stable during this time, while rates among British women have increased, but to a lesser degree than men. Increased levels among heterosexuals have occurred in China and Russia since the 1990s. It has been linked to unsafe sexual practices, such as sexual intercourse, prostitution, and reducing the use of barrier protection.
Untreated, it has an 8% to 58% mortality rate, with a higher mortality rate in men. Symptoms of syphilis have become less severe during the 19th and 20th centuries, in part because of the wide availability of treatment, and partly because of spirochaete virulence. With early treatment, several complications occur. Syphilis increases the risk of HIV transmission by two to five times, and coinfection is common (30-60% in some urban centers). In 2015, Cuba became the world's first country to combat mother-to-child transmission of syphilis.
History
The exact origins of syphilis are debated. Syphilis is clearly present in America before European contact, and may have been brought from America to Europe by a crew returning from Christopher Columbus's voyage to America; or may have been in Europe before, but not recognized until shortly after Columbus returned. These are referred to as Columbian and pre-Columbus hypotheses, respectively.
The Columbian hypothesis is best supported by the available evidence. The first written record of a syphilis outbreak in Europe occurred in 1494 or 1495 in Naples, Italy, during the French invasion (Italian War 1494-98). Because it was claimed to have been propagated by French troops, it was originally known as "French disease" by the people of Naples. In 1530, the pastoral name "syphilis" (character name) was first used by Italian physicians and poet Girolamo Fracastoro as the title of his Latin poetry in a dactylic hexameter describing the damage caused by the disease in Italy. It's also known historically as "Great Pox".
In the 16th to 19th centuries, syphilis was one of the largest public health burdens in terms of prevalence, symptoms and disability, although records of actual prevalence were not generally stored because of the alarming and disgusting status of sexually transmitted diseases in those centuries.. No one knows exactly how the cause (ie, biological or chemical details), but most people know that it is sexually transmitted and often from infected mothers to children. His relationship to sex, especially sexual intercourse and being a john or prostitute who make a living from johns, makes it an object of fear and disgust and taboo topics for polite conversation. The magnitude of morbidity and mortality in these centuries reflects that, unlike today, there is no adequate understanding of its pathogenesis and no truly effective treatment. The damage was caused not so much by major illness or death at the beginning of the journey but rather by the horrific effects of decades later as neurosyphilis with the dorsal tabes finally developed.
The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905. The first effective treatment for syphilis was Salvarsan, developed in 1910 by Paul Ehrlich. The effectiveness of treatment with penicillin was confirmed in trials in 1943.
Prior to the discovery and use of antibiotics in the mid-twentieth century, mercury and isolation were commonly used, with treatments that are often worse than disease. During the 20th century, as microbiology and pharmacology were so advanced, syphilis, like so many other infectious diseases, became more manageable than a frightening and destructive mystery, at least in developed countries among people who were able to pay for a timely diagnosis. and treatment.
Many famous historical figures, including Franz Schubert, Arthur Schopenhauer, Manard, Charles Baudelaire, and Guy de Maupassant are believed to have the disease. Friedrich Nietzche has long been believed to have gone crazy due to tertiary syphilis, but the diagnosis was recently questioned.
Art and literature
The earliest known portrayal of an individual with syphilis is Albrecht DÃÆ'¼rer's Syphilitic Man , a piece of wood believed to represent a Landsknecht, a Northern European mercenary. The myths of the 19th-century femme fatale or "female poison" are believed to originate from the destruction of syphilis, with classic examples in literature including John Keats' La Belle Dame sans Merci
Artist Jan van der Straet painted the scene of a rich man who received treatment for syphilis with tropical wood guaiacum circa 1580. The title of the work is "Preparation and Use of Guayaco to Treat Syphilis". That the artist chooses to include this picture in a series of works celebrating the New World shows how important treatment, however ineffective, is for syphilis for European elites at that time. The rich and detailed work depicts the four waiters preparing the potion while a doctor sees, hiding something behind his back while the unfortunate patient drinks.
Tuskegee and Guatemala learn
One of the most famous cases in the United States of questionable medical ethics in the 20th century is the Tuskegee syphilis study. The research took place in Tuskegee, Alabama, and supported by the US Public Health Service (PHS) in partnership with Tuskegee Institute. The study began in 1932, when syphilis was a widespread problem and there was no safe and effective treatment. This study was designed to measure the development of untreated syphilis. In 1947, penicillin has proven to be an effective drug for early syphilis and has been widely used to treat illness. Its use in syphilis is still unclear. The study director went on to study and did not offer the treatment participants with penicillin. This is disputed, and some have found that penicillin is given to many subjects.
In the 1960s, Peter Buxtun sent a letter to the CDC, which controlled the research, expressed concerns about the ethics of letting hundreds of blacks die of curable diseases. The CDC insists that it is necessary to continue the study until all the men have died. In 1972, Buxton went to the mainstream press, causing public outrage. As a result, the program was terminated, the US Government resolved a class action lawsuit on behalf of study participants and their offspring in the amount of $ 10 million ($ 49.6 million in 2017) and agreed to provide free medical care to survivors and surviving family members infected as a consequence of the research, and Congress makes an empowered commission for writing the rules to prevent such abuse from happening in the future.
On May 16, 1997, thanks to the efforts of the Tuskegee Syphilis Estimation Committee established in 1994, survivors of the study were invited to the White House to be present when President Bill Clinton apologized on behalf of the US government for the study.
Syphilis trials were also conducted in Guatemala from 1946 to 1948. They were a US-sponsored human experiment, conducted during the reign of Juan José © doro with the cooperation of several health ministries and Guatemalan officials. Doctors infect soldiers, prisoners, and mental patients with syphilis and other sexually transmitted diseases, without the subject's consent, and then treat them with antibiotics. In October 2010, the US officially apologized to Guatemala for conducting this experiment.
References
External links
- "Syphilis - CDC Fact Sheet" Disease Control and Prevention (CDC)
- HIV Knowledge Base INSITE UCSF Chapter: Syphilis and HIV
Source of the article : Wikipedia
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