05.03 Nursing Care and Pathophysiology for Syphilis (STI)

Hey there, it's Meg again. Today we're going to talk about syphilis, another sexually transmitted infection. Let's go ahead and get started.

So what is syphilis? Let's hit the high points first. Syphilis is spread most often through sexual contact, but it can also be spread through contact with infected blood. This can include IV drug use if people are sharing dirty needles as well as blood transfusion. Syphilis is one of the things that can be transmitted through a contaminated blood transfusion. The likelihood of this is very, very low, but it is still possible and that is something that we educate patients on when they're signing their consent for a blood transfusion. We're going to be talking about syphilis mostly in the context of being spread through sexual contact today because that is where it is found most often. So, syphilis goes through four stages of infection and it is curable if it's treated within those first two stages. So we're going to focus on really catching it early and treating it early. And then finally, the reason that we want to treat it early is because it can be truly debilitating if caught in later stages at that point, and it is not curable, although we can sometimes halt some of the progression of the disease.

So let's jump into the stages of syphilis first because this is really going to enhance your understanding of why preventing it is so important. So primary syphilis, this is when people have symptoms that people are most familiar with. So this is going to be those chancre sores you can see on this patient's penis. It is going to occur 10 to 90 days after infection, and that is a very broad window. One of the reasons that syphilis is spread is because it can take up to three months to appear. So, people could have had multiple sexual partners during that time before they even knew that they had syphilis.
Again, this is when we want to treat, this is the opportune time. Primary syphilis is the symptom that people notice and recognize most readily, so catching it now gives us our best chance at treating to cure.

After primary infection, we're going to have secondary infection. This is one of the two phases that patients often miss. It happens about a month or two after patients have had their chancre sores. They get this diffuse sort of rash on their torso, their back, and even sometimes their hands. I do want to highlight that the rash is not always this pronounced and that is one of the reasons that it's often missed. It is really the last chance to treat with the objective of curing, but because this phase gets missed, that's why I say primary is really the ideal time to catch to treat.

And then we have latent infection. Now, this can last up to 25 years. During this time period, the patient is going to be asymptomatic. Earlier on in the latency period, patients are still very much contagious, but as time goes by they become less contagious. However, regardless of the amount of time that the patient has been in latent infection, they can still spread in utero because the infection is still in the mother's bloodstream. So, this is what we're talking about when we say congenital syphilis and you can see there not only are there some deformities here but the little baby has our trademark sniffles that is associated with congenital syphilis, as well as these lesions around the mouth that sort of resemble those chancres that we saw on the primary syphilis slide. We'll talk a little bit more about congenital syphilis and prevention here in a moment.

For now we're going to move on to tertiary syphilis infection. This is the stage we are hoping to avoid altogether with early treatment and identification. This can cause any type of organ damage, but neuro and cardio deficits are going to be the most common. Now, tertiary syphilis was actually historically linked with insanity, which we now understand to be early onset dementia. Back in the day though, patients with tertiary syphilis were considered outcasts because they were young and they had this early onset dementia. It can also cause seizures as well as aortic aneurysms. I want to highlight seizures because neurologic syphilis is actually very dangerous; it can be deadly. So if we have a patient coming in with new onset seizures, they often are going to get a lumbar puncture and that is going to be looking for, of course, any type of meningitis. But, syphilis is actually one of the things they rule out whenever someone has unexplained seizures. This is going to be the only phase where patients are not contagious. However, they're dealing with all of these deficits over here, so tertiary syphilis is still very much something that we want to avoid.

So, let's dive a little bit deeper into congenital syphilis, which we talked about just a few moments ago. Early screening and treatment during pregnancy is going to help us to prevent congenital syphilis. Like we said, it causes deformities and can cause cognitive issues in the infant-- and it can also be life limiting. This you can see to the right on this slide is a grown man, who we now believe probably had congenital syphilis. So, they do live to adulthood, but they have these deformities on their face that made them outcasts historically. It also causes the sniffles that we talked about, which is rhinitis or a runny nose, as well as lesions around the mouth. And you can see that pronounced as well on this individual. If an infant is born with congenital syphilis, it is treatable, but much like trying to treat tertiary syphilis, we cannot cure the symptoms that they've already acquired. Catching congenital syphilis early means catching syphilis in the pregnant mother. Some places now include that in routine screening for all pregnant mothers, but the CDC recommendation is actually only to screen high risk mothers for syphilis in pregnancy. Really getting a full sexual history on any pregnant woman is key to catching this early and preventing harm to the infant.

So, I've talked at length about early treatment, but what exactly does that treatment look like? Penicillin is our drug of choice across the board. A single dose of penicillin might do the trick for primary and secondary syphilis, so let's highlight that-- a single dose can help to cure syphilis. In tertiary infection, however, the patient will need infusions over at least a week to halt progression, which is incredibly expensive and not only does it not cure, it only limits the progression of syphilis. Any sort of cardiac or neurological deficits they have, those are not reversible. We are only limiting the progression or the worsening of those symptoms.

So how can we best educate our patients so that they come to see us for early treatment? Annual checkups are a great time to assess for sexual activity, so let's highlight that. Annual exams-- and that is not only for females-- that is also for males. It is not a question to breeze over. When we're talking about sexual activity, we need to be asking them and identifying any potentially high risk behaviors. So this is just like asking about smoking or alcohol use-- we need to ask the question without judgment, but very firmly and emphasize that we just want to help our patients rule out any other dangerous disorders or diseases.We also need to let our patients know that syphilis is a reportable disease in the US, so that means we have to tell the CDC as well as the health department. They're going to notify sexual partners of that individual. Now, the doctor is also going to strongly encourage the patient to notify these sexual partners personally just because that's a much better way to find out that you might be infected with a sexually transmitted infection. We need to make sure that we're educating our patients about the chance of transmitting to a baby. Most doctors, like I said, are going to test for syphilis early to help prevent infection. But because of that, prenatal care is a necessity because that is the only way that we can prevent congenital syphilis is by having routine prenatal care.

Okay, so let's touch base on some of our priority nursing concepts. Infection control is key to preventing the spread and treating early in the disease process. Reproduction and sexuality are of course also impacted because it can cause birth defects and it also seriously alters your patient's sexuality to get a diagnosis of syphilis.

Let's wrap this up with some key points. Remember there are four stages of infection and each of them vary in level of curability and also how contagious the patient is. Remember, it can be transmitted from mom to baby in pregnancy, so detection early on in pregnancy is going to help us prevent complications for the infant. Also, remember that we can cure syphilis if we catch it early on, but if our patients don't come in to see us, they can have lifelong complications. Really taking an honest sexual history during annual examinations and any time we encounter a patient is key to preventing those lifelong deficits.
All right, folks, that is it for our lesson on syphilis. Catch it early and your patients will thank you. Now, go out and be your best self today and as always, happy nursing.