Syphilis

- sexually transmitted illness caused by the bacteria Treponema Pallidum

- mostly affects the skin and mucous membrane (external genitalia; mouth)

Treponema Pallidum
- gram negative bacteria
- obligatory parasite: cannot exist on its own outside of a live organism
- part of the class of bacteria known as spirochetes (long, thin, and include
endoflagella - a band of spiraling protein filaments that gives the spirochetes the
spiral form)
- by spinning or twisting, the endoflagella aid in the spirochetes’ mobility as well
- has three main antigens: Species-Specific Antigens (Exclusive to T. Pallidum),
Group-Specific Antigens (Found in all treponemes), and Lipid Antigen
Cardiolipin (In both cells and spirochetes)

Pathophysiology of Syphilis
Treponema Pallidum is the causative agent of the disease syphilis. Endo flagella mediated
twisting motion can help spirochaetes to move through thick mucus and attach to cells.
Generally, they are acquired by close sexual contact during sexual activity. They enter
the host via breaches in squamous or columnar epithelium. If there is a small breach in
your skin and there is contact with the fluid that contains Treponema, it can enter your
body.

Transmission
1. Acquired syphilis: treponema pallidum entering the body through BODILY
FLUIDS
● Sexual Intercourse: oral, anal, and vaginal
● Wounds/Tears in the skin or mucous membranes: mouth and external genitalia
● Contaminated Needles
● Close contact with an infected person’s skin lesions
2. Congenital Syphilis: occurs when a pregnant woman has the disease; treponema
pallidum infects the unborn child either inside the uterus or as it emerges from
the vagina
Acquired Syphilis - 3 stages
1. Primary (Early Localized)
- begins one to three weeks after T. Pallidum attaches itself to the skin or mucous
membrane
- syphilitic chancres: destroying the epidermis and soft tissues - lesion that
present first as a papule [raised lesion] and then progresses into painless ulcer
with raised, firm border + bilateral lymphadenopathy (regional: inguinal)
- normally, some of syphilitic chancre resolve on their own within a few months
- primary chancre: external genitalia through sexual contact or on the
hands/another body part through personal contact with the lesion
- lymphadenopathy (swelling of the lymph nodes): some spirochetes infect nearby
lymph node, they enter the lymph and finally the blood
- median incubation period: 21 days
- heals within 2 or 3 to 6 weeks with or without treatment (patient may not know if
they have this lesion and have it go away even before it becomes detected and
they can have syphilis without realizing it)

2. Secondary (Disseminated Stage)

- happens six to twelve weeks after the initial infection
- spirochetemia: entry of spirochetes into the bloodstream, results in generalized
lymphadenopathy
- the spirochetes prefer to attach to and infect endothelial cells in small capillaries
close to the skin, which leads to a non-itchy maculopapular rash - small, raised
or flat - that begins on the trunk that moves to the arms and legs, then the palms,
soles, genitalia, and other mucous membrane
- papulosquamous: extremely scaly and hard
- pustular: filled with white fluid pus
- condyloma lata: smooth, white, painless lesions resembling wart that develop on
moist places such as the armpits, genitalia and the area surrounding the anal
region.
- spirochetes are abundant in the lesions, that can appear anywhere in the body,
and the MOST CONTAGIOUS STAGE
- rashes often go away in a few weeks to months
 3. Latent Syphilis (Enters dormancy or lack of symptoms)
- spirochetes are mostly found in the tiny capillaries of various body organs and
tissues.
Early Phase: within a year (12 months) of infection
- during this period, spirochetes can re-enter the bloodstream, which implies that
spirochetes can still be detected circulating in significant quantities in the
bloodstream, resulting in secondary symptoms.
Late Phase: spirochetes often remain within the microscopic capillaries of different
human organs and tissues
- occurs after a year (12 months)

4. Tertiary syphilis
- happens when the spirochetes trigger the immune response
- there are few spirochetes in the capillaries of tissues and organs, but when they
do, the body mounts a very strong immune reaction that severely damages the
cells within
- a type IV hypersensitivity reaction, indicating a T-cell-driven immune response
that recruits macrophages and other phagocytes and release proinflammatory
cytokines such IL-1, IL-6, and tumor necrosis factor that results in systemic
symptoms (fever, localized redness, warmth, and swelling or edema.
- by generating antibody against this antigens, plasma cell prefer to participate in
the immunological response

Granulomatous Lesions: Gumma

- in certain circumstances, the immune cells start to huddle together and create a
granulomatous lesion called a gumma, and this contains many of various types of
immune cells that get surrounded by an outermost layer of fibroblasts.
- spirochetes are frequently completely absent from these lesions; instead, it
appears as though the immune cells are over excited and constricting for no
apparent reason. coagulation necrosis can occur when there is insufficient
oxygen in the gumma’s central tissue.
Organs that are affected by tertiary syphilis:
1. Cardiovascular syphilis: endarteritis - inflammation of the small arteries (vasa
vasorum) as a consequence, the aorta becomes inflamed (aortitis) and this can
lead to the development of aortic aneurysms.
2. Neurosyphilis: the spirochetes take up camp in the capillaries feeding the
posterior or rear section of the spinal cord, and this can result in something
called tabes dorsalis, which literally translates as wasting or loss of the back of
the spinal cord. the protective sheath which covers the nerve running along the
back of the spinal cord is damaged, and this results in a loss of vibration
sensation, and a loss of proprioception, which is the sense of position of the
joints and other body parts, like the hands and the feet. that is what happens
when the syphilis damages the posterior spinal cord.
occasionally, spirochetes can also invade the capillaries supplying the anterior or
front of the spinal cord, causing condition known as general paresis, which
primarily affects the legs and causes loss of sensation, weakness, and sometimes
even paralysis.
spirochetes can cause memory loss, changed behavior slurred speech, difficulties
coordinating muscular movements, and paralysis (if they enter the capillaries that
supply the brain)
Argyll Roberston Pupil: the pupil loses its ability to react to light, but retains its
ability to constrict when an object is close by and does nothing in very bright
light
3. Liver
4. Joints
5. Testes

Neurosyphilis, Ocular Syphilis, and Otosyphilis

At any stage of infection, syphilis can invade the:
- nervous system (neurosyphilis)
- visual system (ocular syphilis)
- auditory and/or vestibular syphilis (otosyphilis)

Signs and symptoms of neurosyphilis can include:

● severe headache
 ● trouble with muscle movements
● muscle weakness or paralysis (not able to move certain parts of the body)
● numbness
● changes in mental status (trouble focusing, confusion, personality change) and/or
dementia (problems with memory, thinking, and/or making decision)

Signs and symptoms of ocular syphilis can include:

● eye pain or redness
● floating spots in the field of vision (floaters)
● sensitivity to light
● changes in vision (blurry vision or even blindness)

Signs and symptoms of otosyphilis may include:

● hearing loss
● ringing, buzzing, roaring, or hissing in the ears (tinnitus)
● balance difficulties
● dizziness and vertigo

Congenital Syphilis
Early Disease (first 2 years)
- the outcome can vary from a stillbirth or death in the womb to the classic
features of a maculopapular rash on palms and soles of the feets and snuffles -
a condition when the nose becomes blocked due to increased secretions
containing spirochetes.
- infants may also have damage to their liver, spleen or both, leading to
hepatosplenomegaly, as well as eye problems such as optic neuritis
Late Disease (> 2 years)
- hearing loss, saddle nose - a bony destruction of the nose, saber shins - a bowed
tibia, and hutchinson teeth - tiny notches in the teeth
Simplified Version of Diagnosis
[Blood] Serologic Testing: Non-treponemal (RPR, VDRL, and TRUST)
- traditionally used as inital screening test (easy to perform and affordable), it
detects antibodies to cardiolipin-cholesterol-lecitin antigen
- non-specific, which can be false positive (lupus, acute febrile illness like
endocarditis, and others)
- quantitative in nature and reported as titer (1:32) and can be used to monitor
response to therapy

[Blood] Serologic Testing: Treponemal (FTA-ABS, MHA-TP, TPPA, TP-EIA, and CIA)
- detects antibodies to specific treponemal antigens
- tend to be more specific than non-treponemal tests
- once positive, it usually remains positive for life even when the patient has
already received treatment for syphilis

[Biopsy] Non-serologic Testing: Darkfield Microscopy

- spirochete is too small to be seen using ordinary microscopy; needs dark field
illumunation

[Biopsy] Non-serologic Testing: Direct Fluorescent Antibody (DFA)

- fluorescent antibody binds to treponemal antigen, giving them a bright green
appearance

Traditional Screen
Non-treponemal -> Treponemal
- if non-treponemal test is positive, it will move into treponemal test to confirm
whether or not a person had syphilis, but there is also a reverse screen that can be
done where you start with a treponemal test and then move into non-treponemal
test
 - diagnosing requires that two serologic tests be positive, because both test,
wheteher you are talking about the treponemal or non-treponemal are not perfect
as they both can have false negatives and false positives

Diagnosis
- serologic diagnosis of syphilis requires the detection of 2 types of antibodies
(non-treponemal and treponemal antibodies)
Needs to consider:
- presence of absence of clinical disease
- prior history of syphilis

Case 1: Negative non-treponemal or negative treponemal

● absence of syphilis
● very early syphilis before seroconversion: both treponemal and non treponemal
tests take about 2-4 weeks to seroconvert to give a positive result in the setting of
a new infection
- caveat to consider: if the patient had a recent unprotected sexual encounter
within the last few weeks, it’s possible that there is actually syphilis but it just
has not yet been detected on the tests; if it is really concerning, the patient can be
retested after a few weeks

Case 2: Positive non-treponemal and positive treponemal

● active infection
● recently treated syphilis with titers that have not yet decreased (the treponemal is
usually going to remain positive for life, but the non-treponemal test titers will
decrease over time)
● inadequate treatment/failure to respond to treatment
> successful treatment: 4-fold decrease in titers (1:32 to 1:8)
Case 3: Positive treponemal and negative non-treponemal (reverse testing); less common
● history of syphilis that was treated
 ● untreated syphilis: (1) if no h/o syphilis, check second treponemal test that targets
a different treponemal antigen (2) if positive, treat
● false-positive treponemal test
Case 4: Positive non-treponemal and negative treponemal
● false positive non-treponemal test: (1) if no possible recent exposure to syphilis,
(2) evaluate for cause of false-positive test result (ruling out other underlying
conditions like lupus)

Non-Treponemal Treponemal

Fluorescent treponemal antibody

absorption (FTA-ABS)

Rapid plasma reagin (RPR); most common Microhemagglutination test for anibodies
to T. pallidum (MHA-TP)

Venereal Disease Research Laboratory T. pallidum particle agglutination assay

(VDRL); most common (TP-PA)

Toluidine Red Unheated Serum Test T. pallidum enzyme immunoassay

(TRUST) (TP-EIA)

Chemiluminescence immunoassay (CIA)

Syphilis is a systemic disease caused by Treponema Pallidum. The disease has been
divided into stages on the basis of clinical findings, which guide treatment and
follow-up. Persons who have syphilis might seek treatment for signs or symptoms.

Primary syphilis classically presents as a single painless ulcer or chancre at the site of
infection but can also present with multiple, atypical, or painful lesions. Secondary
syphilis manifestations can include skin rash, mucocutaneous lesions, and
lymphadenopathy. Tertiary syphilis can present with cardiac involvement, gummatous
lesions, tabes dorsalis, and general paresis. Latent infections (i.e., those lacking clinical
manifestations) are detected by serologic testing. Latent syphilis acquired within the
preceding year is referred to as early latent syphilis; all other cases of latent syphilis are
classified as late latent syphilis or latent syphilis of unknown duration.

T. pallidum can infect the CNS, which can occur at any stage of syphilis and result in
neurosyphilis. Early neurologic clinical manifestations or syphilitic meningitis (e.g.,
cranial nerve dysfunction, meningitis, meningovascular syphilis, stroke, and acute
altered mental status) are usually present within the first few months or years of
infection. Late neurologic manifestations (e.g., tabes dorsalis and general paresis) occur
10 to > 30 years after infection.

Infection of the visual system (ocular syphilis) or auditory system (otosyphilis) can
occur at any stage of syphilis but is commonly identified during the early stages and can
present with or without additional CNS involvement. Ocular syphilis often presents as
panuveitis but can involve structures in both the anterior and posterior segment of the
eye, including conjunctivitis, anterior uveitis, posterior interstitial keratitis, optic
neuropathy, and retinal vasculitis. Ocular syphilis can result in permanent vision loss.
Otosyphilis typically presents with cochleo-vestibular symptoms, including tinnitus,
vertigo, and sensorineural hearing loss. Hearing loss can be unilateral or bilateral, have
a sudden onset, and progress rapidly. Otosyphilis can result in permanent hearing loss.

Diagnostic Considerations

Darkfield examinations and molecular tests for detecting T. pallidum directly from
lesion exudate or tissue are the definitive methods for diagnosing early syphilis and
congenital syphilis. Although no T. pallidum direct-detection molecular NAATs are
commercially available, certain laboratories provide locally developed and validated
PCR tests for detecting T. pallidum DNA. A presumptive diagnosis of syphilis requires
use of two laboratory serologic tests: a nontreponemal test (i.e., Venereal Disease
Research Laboratory [VDRL] or rapid plasma reagin [RPR] test) and a treponemal test
(i.e., the T. pallidum passive particle agglutination [TP-PA] assay, various EIAs,
chemiluminescence immunoassays [CIAs] and immunoblots, or rapid treponemal
assays). At least 18 treponemal-specific tests are cleared for use in the United States.
Use of only one type of serologic test (nontreponemal or treponemal) is insufficient for
diagnosis and can result in false-negative results among persons tested during primary
syphilis and false-positive results among persons without syphilis or previously treated
syphilis.

Nontreponemal Tests and Traditional Algorithm

False-positive nontreponemal test results can be associated with multiple medical

conditions and factors unrelated to syphilis, including other infections (e.g., HIV),
autoimmune conditions, vaccinations, injecting drug use, pregnancy, and older age.
Therefore, persons with a reactive nontreponemal test should always receive a
treponemal test to confirm the syphilis diagnosis (i.e., traditional algorithm).
Nontreponemal test antibody titers might correlate with disease activity and are used
for monitoring treatment response. Serum should be diluted to identify the highest titer,
and results should be reported quantitatively. A fourfold change in titer, equivalent to a
change of two dilutions (e.g., from 1:16 to 1:4 or from 1:8 to 1:32), is considered necessary
for demonstrating a clinically significant difference between two nontreponemal test
results obtained by using the same serologic test, preferably from the same
manufacturer to avoid variation in results. Sequential serologic tests for a patient should
be performed using the same testing method (VDRL or RPR), preferably by the same
laboratory. VDRL and RPR are equally valid assays; however, quantitative results from
the two tests cannot be compared directly with each other because the methods are
different, and RPR titers frequently are slightly higher than VDRL titers.

Nontreponemal test titers usually decrease after treatment and might become
nonreactive with time. However, for certain persons, nontreponemal antibodies might
decrease less than fourfold after treatment (i.e., inadequate serologic response) or might
decline appropriately but fail to serorevert and persist for a long period. Atypical
nontreponemal serologic test results (e.g., unusually high, unusually low, or fluctuating
titers) might occur regardless of HIV status. When serologic tests do not correspond
with clinical findings indicative of primary, secondary, or latent syphilis, presumptive
treatment is recommended for persons with risk factors for syphilis, and use of other
tests (e.g., biopsy for histology and immunostaining and PCR of lesion) should be
considered. For the majority of persons with HIV infection, serologic tests are accurate
and reliable for diagnosing syphilis and evaluating response to treatment.

Treponemal Tests and Reverse Sequence Algorithm

The majority of patients who have reactive treponemal tests will have reactive tests for
the remainder of their lives, regardless of adequate treatment or disease activity.
However, 15%–25% of patients treated during the primary stage revert to being
serologically nonreactive after 2–3 years. Treponemal antibody titers do not predict
treatment response and therefore should not be used for this purpose.

Clinical laboratories sometimes screen syphilis serologic samples by using automated

treponemal immunoassays, typically by EIA or CIA. This reverse sequence algorithm
for syphilis testing can identify persons previously treated for syphilis, those with
untreated or incompletely treated syphilis, and those with false-positive results that can
occur with a low likelihood of infection. Persons with a positive treponemal screening
test should have a standard quantitative nontreponemal test with titer performed
reflexively by the laboratory to guide patient management decisions. If the
nontreponemal test is negative, the laboratory should perform a treponemal test
different from the one used for initial testing, preferably TP-PA or treponemal assay
based on different antigens than the original test, to adjudicate the results of the initial
test.

If a second treponemal test is positive (e.g., EIA reactive, RPR nonreactive, TP-PA
reactive), persons with a history of previous treatment will require no further
management unless sexual history indicates a reexposure. In this instance, a repeat
nontreponemal test 2–4 weeks after a confirmed medical history and physical
examination is recommended to evaluate for early infection. Those without a history of
treatment for syphilis should be offered treatment. Unless a medical history or results of
a physical examination indicate a recent infection, previously untreated persons should
be treated for syphilis of unknown duration or late latent syphilis.
If the second treponemal test is negative (e.g., EIA reactive, RPR nonreactive, TP-PA
nonreactive) and the epidemiologic risk and clinical probability for syphilis are low,
further evaluation or treatment is not indicated.

Multiple studies demonstrate that high quantitative index values or high

signal-to-cutoff ratio from treponemal EIA or CIA tests correlate with TP-PA positivity,
which might eliminate the need for additional confirmatory testing; however, the range
of index values varies among different treponemal immunoassays, and the values that
correspond to high levels of reactivity with confirmatory testing might differ by
immunoassay.

Cerebrospinal Fluid Evaluation

Further testing with CSF evaluation is warranted for persons with clinical signs of
neurosyphilis (e.g., cranial nerve dysfunction, meningitis, stroke, acute or chronic
altered mental status, or loss of vibration sense). All patients with ocular symptoms and
reactive syphilis serology need a full ocular examination, including cranial nerve
evaluation. If cranial nerve dysfunction is present, a CSF evaluation is needed. Among
persons with isolated ocular symptoms (i.e., no cranial nerve dysfunction or other
neurologic abnormalities), confirmed ocular abnormalities on examination, and reactive
syphilis serology, a CSF examination is unnecessary before treatment. CSF analysis can
be helpful in evaluating persons with ocular symptoms and reactive syphilis serology
who do not have ocular findings or cranial nerve dysfunction on examination. Among
patients with isolated auditory abnormalities and reactive syphilis serology, CSF
evaluation is likely to be normal and is unnecessary before treatment.

Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no

single test can be used to diagnose neurosyphilis in all instances. Diagnosis of
neurosyphilis depends on a combination of CSF tests (e.g., CSF cell count, protein, or
reactive CSF-VDRL) in the presence of reactive serologic test (nontreponemal and
treponemal) results and neurologic signs and symptoms. CSF laboratory abnormalities
are common for persons with early syphilis and are of unknown medical significance in
the absence of neurologic signs or symptoms. CSF-VDRL is highly specific but
insensitive. For a person with neurologic signs or symptoms, a reactive CSF-VDRL (in
the absence of blood contamination) is considered diagnostic of neurosyphilis.
When CSF-VDRL is negative despite clinical signs of neurosyphilis, reactive serologic
tests results, lymphocytic pleocytosis, or protein, neurosyphilis should be considered. In
that instance, additional evaluation by using fluorescent treponemal-antibody
absorption (FTA-ABS) or TP-PA testing on CSF might be warranted. The CSF FTA-ABS
test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive. Fewer
data are available regarding CSF TP-PA; however, the sensitivity and specificity appear
similar to the CSF FTA-ABS. Neurosyphilis is highly unlikely with a negative CSF
FTA-ABS or TP-PA test, especially among persons with nonspecific neurologic signs
and symptoms.

Among persons with HIV infection, CSF leukocyte count can be elevated (>5
3
WBCs/mm ); the association with CSF leukocyte count and plasma HIV viral
3
suppression has not been well characterized. Using a higher cutoff (>20 WBCs/mm )
might improve the specificity of neurosyphilis diagnosis among this population.

Treatment

Penicillin G, administered parenterally, is the preferred drug for treating patients in all
stages of syphilis. The preparation used (i.e., benzathine, aqueous procaine, or aqueous
crystalline), dosage, and length of treatment depend on the stage and clinical
manifestations of the disease. Treatment for late latent syphilis (>1 years’ duration) and
tertiary syphilis requires a longer duration of therapy because organisms theoretically
might be dividing more slowly (the validity of this rationale has not been assessed).
Longer treatment duration is required for persons with latent syphilis of unknown
duration to ensure that those who did not acquire syphilis within the preceding year are
adequately treated.
Selection of the appropriate penicillin preparation is important because T. pallidum can
reside in sequestered sites (e.g., the CNS and aqueous humor) that are poorly accessed
by certain forms of penicillin. Combinations of benzathine penicillin, procaine
penicillin, and oral penicillin preparations are not considered appropriate for syphilis
treatment. Reports have indicated that practitioners have inadvertently prescribed
combination long- and short-acting benzathine-procaine penicillin (Bicillin C-R)
instead of the standard benzathine penicillin product (Bicillin L-A) recommended in the
United States for treating primary, secondary, and latent syphilis. Practitioners,
pharmacists, and purchasing agents should be aware of the similar names of these two
products to avoid using the incorrect combination therapy agent for treating syphilis.

The recommended treatment for adults and adolescents with primary, secondary, or
early latent syphilis is:
● Benzathine penicillin G 2.4 million units administered intramuscularly in a
single dose

The treatment recommendation for adults and adolescents with late latent syphilis or
latent syphilis of unknown duration is:
● Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4
million units administered intramuscularly each at weekly intervals

The treatment recommendation for neurosyphilis, ocular syphilis, or otosyphilis is:

● Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4
million units intravenously every 4 hours or continuous infusion, for 10-14 days

The treatment will prevent progression, but it might not repair damage already done.

Penicillin’s effectiveness for treating syphilis was well established through clinical
experience even before the value of randomized controlled clinical trials was
recognized. Therefore, approximately all recommendations for treating syphilis are
based not only on clinical trials and observational studies, but on many decades of
clinical experience.

Special Considerations

Pregnancy
Parenteral penicillin G is the only therapy with documented efficacy for syphilis during
pregnancy. Pregnant women with syphilis at any stage who report penicillin allergy
should be desensitized and treated with penicillin.

Jarisch-Herxheimer Reaction
- the spirochete rupture and release a large number of antigens at once,
stimulating the immune system to overreacts (sudden fevers, sweating, muscle
and joint pains that may last for a few hours to a few days)
The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by
headache, myalgia, and fever that can occur within the first 24 hours after the initiation
of any syphilis therapy; it is a reaction to treatment and not an allergic reaction to
penicillin. Patients should be informed about this possible adverse reaction and how to
manage it if it occurs. The Jarisch-Herxheimer reaction occurs most frequently among
persons who have early syphilis, presumably because bacterial loads are higher during
these stages. Antipyretics can be used to manage symptoms; however, they have not
been proven to prevent this reaction. The Jarisch-Herxheimer reaction might induce
early labor or cause fetal distress in pregnant women; however, this should not prevent
or delay therapy.

Management of Sex Partners

Sexual transmission of T. pallidum is thought to occur only when mucocutaneous

syphilitic lesions are present. Such manifestations are uncommon after the first year of
infection. Persons exposed through sexual contact with a person who has primary,
secondary, or early latent syphilis should be evaluated clinically and serologically and
treated according to the following recommendations:
● Persons who have had sexual contact with a person who receives a diagnosis of
primary, secondary, or early latent syphilis < 90 days before the diagnosis should
be treated presumptively for early syphilis, even if serologic test results are
negative.
● Persons who have had sexual contact with a person who receives a diagnosis of
primary, secondary, or early latent syphilis > 90 days before the diagnosis should
be treated presumptively for early syphilis if serologic test results are not
immediately available and the opportunity for follow-up is uncertain. If serologic
tests are negative, no treatment is needed. If serologic tests are positive,
treatment should be based on clinical and serologic evaluation and syphilis stage.
● In certain areas or among populations with high syphilis infection rates, health
departments recommend notification and presumptive treatment of sex partners
of persons with syphilis of unknown duration who have high nontreponemal
serologic test titers (i.e., > 1:32) because high titers might be indicative of early
syphilis. These partners should be managed as if the index patient had early
syphilis.
● Long-term sex partners of persons who have late latent syphilis should be
evaluated clinically and serologically for syphilis and treated on the basis of the
evaluation’s findings.
● The following sex partners of persons with syphilis are considered at risk for
infection and should be confidentially notified of the exposure and need for
evaluation: partners who have had sexual contact within 3 months plus the
duration of symptoms for persons who receive a diagnosis of primary syphilis,
within 6 months plus duration of symptoms for those with secondary syphilis,
and within 1 year for persons with early latent syphilis.
Health Teaching
● Take all the prescribed medications exactly as directed by the healthcare
provider; it is crucial to complete the full course of treatment for curing syphilis,
even if symptoms improve or disappear before the treatment is completed.
● Make sure to attend the follow-up appointments for early detection and get
tested for syphilis regularly, especially if the client is engaged in high-risk
behaviors.
● Encourage the client to be honest with their partner, inform them about the
diagnosis so they can get tested and treated as well if necessary. This is crucial to
prevent the spread of syphilis and other associated STIs.
● Instruct the client for optimal protection if sexual activity cannot be prevented.
Practice safe sex by consistently and correctly using condoms to reduce the risk
of transmitting syphilis to others or acquiring other STIs.
● Adhere with the Doctor’s guidance, advice and recommendation; they can
provide valuable support and resources to help the client manage syphilis
diagnosis effectively.
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untreated or of the the syphilis complications treatment and
inadequately importance of infection and associated with adhering to
managed seeking timely detect any untreated or prescribed
syphilis medical complications inadequately therapy for
infection. treatment and early. managed syphilis
adhering to syphilis. infection.
prescribed
therapy for Monitoring the This helps
syphilis client’s reinforce the
infection. treatment rationale
adherence. behind
prescribed
therapy and its
role in
preventing
complications.

Promote the This fosters

client’s collaborative
engagement patient-provide
with regular r relationship,
follow-up enhancing
appointments. effectiveness of
care and
promoting
positive health
outcomes.