Sexually Transmitted Disease - Research Paper Example

? Syphilis This paper uses five different references to research about a sexually transmitted disease (STD), syphilis and its various clinical features and treatment therapies. The different factors influencing the increasing rate of syphilis like low income, lack of education, age and ethnicity have been discussed. The various statistical variations of syphilis in United States have been highlighted. The clinical course of the infection has been discussed in the form of four stages which are primary, secondary, latent and tertiary stages. The various organs affected in all the stages and the common sites of occurrence of the ulcers and their characteristics have been brought forward. Neurosyphilis, ocular syphilis and other visceral syphilis are mentioned. Co-infection with HIV is a significant feature in United States and it has been discussed in relation to the syphilitic infection. The treponemal and nontreponemal tests are two diagnostic tests used for the detection of syphilis in individuals. The antibiotic treatment, penicillin benzathione G, is an established treatment for syphilis and its different formulations, dosage and administration methods in various stages have been highlighted. Syphilis Syphilis is a sexually transmitted disease and can also spread from the mother to the newborn during birth, known as vertical transmission (Gross 2011). Syphilis spreads more commonly in relation to other Sexually Transmitted Diseases (STDs) like AIDS, gonorrhea and chlamydial infections. It is also common in immune-compromised patients who are vulnerable to syphilitic infections. According to the statistics, the incidence and prevalence of syphilis has decreased due to preventative and management strategies in the recent years (Shmaefsky et al 2010). This paper describes about the clinical features and general pathology of the disease. Moreover, it examines the current statistics of the positive cases of syphilis in the United States and the current available treatments. The incidence of syphilis was on the rise until the 1950s. However after the introduction of antibiotics in 1950s, the syphilis infections were controlled dramatically. The WHO health programs and general public education played an important role in the decline of syphilis incidence. The prevalence of syphilis in USA has shown major variations through the course of history. In 1940s the maximum rate of syphilis positive cases was observed but public health services and preventive strategies led to a decline (Gross 2011). From 1980 to 2002 the annual number of syphilis cases declined. But from 1997 to 2002 an increase in the annual cases was seen. According to studies, in 2002, it was established that every year 70,000 new cases will be recognized. When compared with other countries of the world, Canada shows lesser number of cases while United Kingdom and Australia show an increasing prevalence of syphilis (Shmaefsky et al 2010). Since 2001, an increase in the rates of syphilis infections has been observed. From an incidence of 2.1 in the year of 2000 it was exceeded to an incidence rate of 2.4 in 2004. Hence, an increasing rate of 12% per 100,000 has been estimated (Gross 2011). According to a research study carried out on the 1978 National Health and Nutrition Examination Survey, it was established that prevalence of syphilis positive cases is affected by the age, marital status, income and education of the person. Gender plays a very insignificant role. It increases with increasing age, low socioeconomic status, lack of college education and low income. The Blacks were found to have a greater prevalence estimate of 3.05% while the Whites had a 0.53 % value (Hahn et al 1989). Another important characteristic noted was co-infection with HIV in United States. It has been estimated that 16% of patients positive with syphilis and 28% of the syphilitic males also test positive for the HIV infection, establishing a strong basis for co-infection. Therefore, co-infection of HIV and syphilis requires significant attention and research in United States (Gross 2011). An increase of syphilis infection observed in the men as compared to the females has been indicated owing to the rise of syphilis in homosexual men (Zetola et al 2007). Syphilis is a sexually transmitted disease (STD) and it has been observed that it is spread by heterosexual sex in young population. In developed countries, female drug addicts develop this infection from prostitution or other sexual activities for attaining drugs. Male homosexuals are another major contributing factor to this infection. In developing nations, unawareness about safe sex and exceeding prostitution activities account for the major syphilis infections (Shmaefsky et al 2010). Syphilis is caused by Treponema pallidum and the clinical course is described by alternating periods of symptomatic stages and latent stages of syphilis infection. With the first exposure to the causative agent, Treponema pallidum, an ulcer is formed after a period of two to six weeks. This ulcer is round in appearance, firm in consistency, painless and non-purulent and is termed chancre. This chancre formation is associated with lymphadenopathy which is localized to the area of infection (Gross 2011). The common sites in heterosexual men are the glans, prepuce (inner surface) shaft of penis and the coronal sulcus. In homosexual men, it is found commonly in the anal canal or in mouth. In women, vulva, labia and cervix are the common sites for the ulcer formation. Apart from the genital ulcers, extra-genital locations are also common which include the lips, mouth, buttocks and lymph nodes (Warrell et al 2003). This is the primary stage of syphilis; other stages include secondary, latent and tertiary stages. Genital ulcers are highly vulnerable to HIV infections because of inflammatory changes and destruction of epidermal layers (Gross 2011). Secondary syphilis is the next stage which is caused by the hematogenous spread of the disease from the ulcer. This occurs four to ten weeks after the primary stage (Gross 2011). This stage affects various systems of the body and is represented with milder symptoms of malaise, headache, and low-grade fever of nocturnal nature. The macular rash distributes along the proximal limbs, trunk, palms, soles and face. If associated with headache and positive CSF findings, it is a sign of low-grade meningitis. Liver inflammatory changes can also take place which result in syphilitic hepatitis. Nephrotic syndrome can occur if immune-complex bodies are deposited in the glomerulus of the nephrons. Bones can also be affected, resulting in periostitis which manifests with bone and joint pain. Ocular involvement presents as uveitis which is also seen in the tertiary stage of the infection (Warrell et al 2003). Alopecia results in case of scalp involvement. In HIV-co-infected patients, malignant syphilis, a form of secondary syphilis is seen which manifests as rapidly growing ulcerations on the face and lower limbs (Gross 2011). Latent syphilis is described as asymptomatic stage but the patient gives a positive serological result. Further it is classified into early and late latent stages; early latent duration is less than 2 years and late latent duration is more than 2 years. Around 60% of patients go into the latent phase; however the infective period does not end over here. A latent syphilitic mother can spread the infection to her child at the time of birth (Warrell et al 2003). The late syphilis or tertiary syphilis is a chronic stage which presents with granulomatous lesions and involves various viscera, the central nervous system and the cardiovascular system, mainly the aorta. Osteoperiostitis of the tibia and fibula are painful and mostly worsen at night. Liver involvement in late syphilis is not very common and remains asymptomatic for a long time. Uveitis, optic atrophy and chondoretinits are the major manifestations of the ocular involvement in late syphilis. Involvement of stomach, testes and lungs has also been observed but is quite rare (Warrell et al 2003). Cardiovascular syphilis is another presentation of the late syphilis. It is asymptomatic aortitis of the ascending aorta which causes aneurysms, stenosis and regurgitation. However, with the introduction of penicillin treatment it has declined. Neurosyphilis results from the invasion of the cerebrospinal fluid (CSF) of the brain by the T.Pallidum. The meninges and blood vessels are affected initially in the early stages while the spinal cord and brain are affected in the later stages. This invasion leads to stroke, seizures, myelopathy, dementia, sensory ataxia, general paresis and bowel/bladder dysfunction. It manifests earlier in HIV-infected patients. The increased rate of ocular involvement, visceral invasion and the severe progression of the stages are also observed more commonly in patients with co-infection of HIV (Gross 2011). Clinical diagnosis of the disease depends on a detailed history and physical examination. Confirmation by the dark field microscopy and direct fluorescent antibody is done. Biopsy of the lesions can also be done for immunological staining which is more specific and sensitive for the syphilitic infections. Currently serological testing is considered as a gold standard for syphilis diagnosis. Both non treponemal and treponemal testing is used. VDRL and Rapid Plasma Reagin (RPR) tests are the routine tests which come under the category of nontreponemal tests. The antigens of T.Pallidum are used for diagnostic purposes in the treponemal tests for syphilis (Zetola et al 2007). Penicillin G benzathine is an antibiotic and is indicated as a first-line treatment strategy for all the clinical stages of syphilitic infection. Three formulations of penicillin are available in United States which include; Bicillin L-A which contains 2.4 million units of penicillin, Bicillin C-R that consists of a combination of 1.2 million units of procaine penicillin and 1.2 million units of penicillin and the third form available is Bicillin C-R. However, the highly recommended drug for syphilis is Bicillin L-A because of its maximum therapeutic outcomes (Zetola et al 2007). Single dose is indicated in most cases but some specialists indicate doses for 3 weeks with one week interval. This is highly recommended for those who have neurosyphilis. Patients who are at a latent stage should be tested after every 6 months for the decline of the titers. Moreover, the CSF should also be examined for any abnormality. 7.2 million Units of penicillin benzathine, in a single dose, are indicated in patients that do not manifest with neurosyphilis. The treatment plan indicated for neurosyphilis is a total amount of 18-24 million units of penicillin G in aqueous crystalline form, per day every four hours in amounts of 3- million units. The normalization of CSF findings and VDRL tests results should be confirmed within 2 years (Gross 2011). In cases of allergic reaction to penicillin, patients can be treated with doxycycline 100mg twice a day for two weeks. Ceftriaxone is also an alternative for penicillin. Pregnant women allergic to penicillin should be immediately hospitalized and desensitized for penicillin. The treatments for HIV-infected and non-infected syphilitic patients are almost similar to each other (Zetola et al 2007). Syphilis is a notable STD because of its common occurrence and increasing rates worldwide. Although the incidence of the disease has been controlled in the United States because of health interventions, public awareness about safe sex, sexual partners and risk factors is crucial. The vertical transmission of the disease also is a major cause towards the congenital syphilis among the newborns. HIV co-infection is an important feature in US and the systemic involvement and treatment strategies are of significance. Penicillin is currently the major treatment strategy and provides satisfactory and effectual therapeutic results. References Gross, G. (2011). Sexually transmitted infections and sexually transmitted diseases. Berlin: Springer. Hahn, R. A., Magder, L. S., Aral, S. O., Johnson, R. E., & Larsen, S. A. (January 01, 1989). Race and the prevalence of syphilis seroreactivity in the United States population: a national sero-epidemiologic study. American Journal of Public Health, 79, 4, 467-70. Top of Form Bottom of Form Shmaefsky, B. R., Babcock, H., & Heymann, D. L. (2010).Syphilis. New York: Infobase Pub. Warrell, D. A., Cox, T. M., & Firth, J. D. (2003). Oxford textbook of medicine: Vol. 1.. Oxford University Press Zetola, N. M., Engelman, J., Jensen, T. P., & Klausner, J. D. (January 01, 2007). Syphilis in the United States: an update for clinicians with an emphasis on HIV coinfection.Mayo Clinic Proceedings. Mayo Clinic, 82, 9, 1091-102. Read More