Syphilis

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.

Signs 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

Investigations

• The VDRL test is a screening test for syphilis

Pharmacological

• 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.

19.1.9 ALL SYPHILIS EXCEPT NEUROSYPHILIS 17.1.9.1. EARLY SYPHILIS

Clinical Description

Primary (ulcer), secondary (generalized skin rashes, condylomatalata) or latent syphilis of not more than 2 years’ duration.

Investigations

• 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.

Pharmacological

• 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: Inpregnancy/lactation, substitute Doxycycline with Erythromycin 500mg every 6hrs for 15 days.

17.1.9.1.2 LATE SYPHILIS

Clinical Description

Late syphilis: benign, cardiovascular and latent syphilis of more than 2 years; syphilis of indeterminate duration congenital syphilis in children.

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 17.1.9.1.2 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.

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 8n 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 12.5mg 6 hourly for 30 days.

Note: The risk of penicillin hypersensitivity in the 1 st month of life can be safely discount