Syphilis
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CLINICAL DESCRIPTION
Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.
CLINICAL FEATURESSIGNS AND SYMPTOMS
- Rash is usually not itchy
- Wartlike sores in your mouth or genital area
- Some people also experience hair loss
- muscle aches
- Fever
- Sore throat
- Swollen lymph nodes
INVESTIGATION
- The VDRL test is a screening test for syphilis
TREATMENT
- Use this regime for patients with syphilis confirmed by laboratory testing.
- In treatment of secondary syphilis, a Herxheimer reaction (malaise, fever, headache, rigors) may sometimes occur within 6-12 hours of initial treatment. This is treated with Aspirin 600mg 6 hourly.
EARLY SYPHILIS
CLINICAL DESCRIPTION
Primary (ulcer), secondary (generalized skin rashes, condylomatalata) or latent syphilis of not more than 2 years’ duration.
INVESTIGATION
- The VDRL test is a screening test for syphilis
Note: Treat as late syphilis all patients with a positive RPR or VDRL and no documented syphilis serology in the last 2 years.
TREATMENTPHARMACOLOGICAL
- Benzathine Penicillin one dose of 2.4 MU IM
- Divide as 1.2 MU into each buttock
- Alternatively, if allergic to penicillin:
- Doxycycline 100mg 12 hourly for 14 days
Note: In pregnancy/lactation, substitute Doxycycline with Erythromycin 500mg every 6hrs for 15 days.
LATE SYPHILIS
CLINICAL DESCRIPTION
Late syphilis: benign, cardiovascular and latent syphilis of more than 2 years; syphilis of indeterminate duration congenital syphilis in children.
TREATMENT
PHARMACOLOGICAL
- Benzathine Penicillin 3 doses of 2.4 MU IM at weekly intervals
- Divide each weekly dose 1.2 MU into each buttock: total (3 doses) is 7.2 MU
Alternatively, if allergic to penicillin:
- Doxycycline 100mg PO 12 hourly for 30 days
Note: In pregnancy/lactation, substitute Doxycycline with Erythromycin 500 mg 6 hourly 30 days
Notes for pregnant patients
- Any history of penicillin hypersensitivity (e.g fever, erythema, hives, rash, SOB, wheezy, red eyes, runny nose) must be reliable as these patients are put at serious disadvantage because they cannot be given tetracycline’s
- The child must be treated for congenital syphilis at birth as Erythromycin does not readily cross the placenta
CONGENITAL SYPHILIS IN CHILDREN
SIGNS AND SYMPTOMS
- Thoroughly examine for congenital syphilis all infants born to women with reactive serologic tests: look for ascites, oedema, jaundice, hepatosplenomegaly, rhinitis, nasal discharge, hoarse cry, skin rash, and/or pseudoparalysis of any extremity.
TREATMENT
PHARMACOLOGICAL
- Treat with a single dose of Benzathine penicillin 50 000 IU/kg IM in all infants born to syphilis sero-positive mothers whether or not the mothers were treated during pregnancy (with or without penicillin) unless they have features of congenital syphilis.
- Treat infants with these symptoms as early congenital syphilis:
- Give Benzylpenicillin 50 000 IU/kg/dose IV 12 hourly, during the first 7 days of life and 8 hourly thereafter for a total of 10 days,
- Children with late congenital syphilis (more than 2 years) are treated as follows:
- Give Benzylpenicillin 50 000 IU/kg/doses 4 hourly – 6 hourly 10 to 14 days,
Alternatively, in penicillin allergic children
- Give Erythromycin syrup 5mg 6 hourly for 30 days.
Note: The risk of penicillin hypersensitivity in the 1st month of life can be safely discount