Nursing Diagnoses

Risk for injury to patient and others related to the disease process.

If not properly treated, the patient will be at risk of the syphilis progressing into the other phases, which can have serious consequences for the individual. The patient is also at risk of transmitting the infection to others if not properly being treated and/or if not using safe sex practices to protect any sexual partners.

Interrupted family processes related to the effects of the diagnosis on a couple.

Receiving a diagnosis of syphilis can cause some strain and tension within a relationship especially if it agreed to be a closed relationship and neither partner originally had syphilis. Open and casual relationships can also be affected. Patient education should include talking to any sex partners the patient may have to let them know so they can get checked as well to see if they have the infection as well.

Anxiety related to the diagnosis.

Discovering you have a sexually transmitted infection, like syphilis, can create a lot of anxiety for an individual. The person may become anxious about how long he/she has had it, who it was contracted from, and how many people the person may have transmitted it to. Having to tell sex partners you have syphilis can induce anxiety. If a woman is pregnant she may worry about what effect the infection may have on the fetus.

Nursing Care

Patient education

Patient education for a patient with syphilis is critical for the individual to recover and prevent the spread of the infection. The patient needs to understand that syphilis is caused by a bacteria and therefore will be treated by using antibiotics. It is imperative that the patient understands he/she needs to finish the entire course of antibiotics even if the symptoms are resolved before the treatment is complete. 

It is important to explain to the patient that he/she should refrain from any sexual activities during the treatment as the infection can still be transmitted to others. Counseling and testing for HIV infection is also encouraged as well as discussing safe sex practices.

The patient will need to be informed that he/she will need to come in for repeat testing in six and twelve months to verify the infection has been cleared.

References

Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Sexually Transmitted Infections. In Medical-Surgical Nursing: Assessment and Management of Clinical Problems (9th ed., pp. 1264-1265). St. Louis, Missouri: El Sevier.

Treatment

The first choice of treatment for syphilis is the long-acting benzathine penicillin G given through an intramuscular (IM) injection. For individuals who have penicillin allergies there are other antibiotics that can be used to treat the infection such as doxycycline and tetracycline. The chart below explains the recommended treatment based on which phase of syphilis the patient is in. For more information on the treatment of syphilis in different phases and for the treatment of other sexually transmitted infections check out this article.

Phase	Treatment	Treatment outcomes
Primary	One-time IM injection of long-acting benzathine penicillin G, 2.4 million units	Treat T. pallidum infection before progresses to other phases
Secondary	One-time IM injection of long-acting benzathine penicillin G, 2.4 million units	Treat T. pallidum infection before progresses to other phases; will not repair damage already done
Early Latent	One-time IM injection of long-acting benzathine penicillin G, 2.4 million units	Treat T. pallidum infection before progresses to tertiary phase; will not repair damage already done
Late Latent/Latent of unknown duration	Three IM injections of long-acting benzathine penicillin G, 7.2 million units total, given at weekly intervals	Treat T. pallidum infection before progresses to tertiary phase; will not repair damage already done
Tertiary	Three IM injections of long-acting benzathine penicillin G, 7.2 million units total, given at weekly intervals	Treat T. pallidum infection; will not repair damage already done

References:

1:  Syphilis Treatment and Care. (2015, April 17). Retrieved May 6, 2015, from http://www.cdc.gov/std/syphilis/treatment.htm

2:  Diseases Characterized by Genital, Anal, or Perianal Ulcers. (2014, August 15). Retrieved May 6, 2015, from http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm

Uh oh! What's that?

Signs and symptoms

As mentioned in previous posts, syphilis is broken up into four different stages: primary, secondary, latent, and tertiary syphilis. Each stage has it's own unique signs and symptoms.

Primary Syphilis

Primary syphilis is characterized by swollen nodes and the presence of a sore where the bacteria entered the body that appears generally a few weeks after the transmission occurred. This sore is known as a chancre and is not painless and may go unnoticed depending on location. In addition to it being painless, the sore will resolve itself in three to six weeks with or without treatment. If the individual infected does not seek treatment, the sore will heal, but the bacteria will continue to multiply within the body, which then leads to the second phase of syphilis.1,2

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Secondary Syphilis

Secondary syphilis may present immediately after the chancre is healed, or it may present several weeks after. This second phase is characterized by a rash that appears on various areas of the body including in the mouth, vagina, and anus. Very commonly the rash appears on the palm of the hands and the torso of the body. Other characteristics of secondary syphilis that appear in concurrence with the rash are symptoms of the flu like swollen lymph nodes, muscles aches, sore throat and fatigue. During this phase the bacteria is still in the body and can be treated.1

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Latent Phase

The latent phase of syphilis is just what it sounds like - the absence of any signs or symptoms - even though the person is still infected. The latent phase can last for several years to several decades, and many will remain indefinitely in the latent phase without advancing to the final phase.1

Tertiary Syphilis

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The final phase of syphilis is characterized by the presence of a gumma, or a soft growth similar to a granuloma made of dead and swollen fibrous tissue. The gumma most often will form on the liver, but can also form on the brain, skin, heart, and even the eyes.3 Of course having a tumor-like growth on an organ will inhibit or alter the function of the given organ resulting in problematic symptoms depending on the location of the gumma. Symptoms can include numbness in parts of the body, blindness, dementia, decreased muscle coordination, and paralysis.1


References:

1:  Syphilis - CDC Fact Sheet. (2014, July 8). Retrieved May 4, 2015, from http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

2:  Syphilis - primary: MedlinePlus Medical Encyclopedia. Retrieved May 4, 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/000861.htm

3:  Gumma. Retrieved May 4, 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/000859.htm

4: Andrade, P., Mariano, A., & Figueiredo, A. (2010). Solitary frontal ulcer: A syphilitic gumma. Dermatology Online Journal 16(9). Retrieved from: https://escholarship.org/uc/item/5gs4q6wz