Untreated syphilis progresses to a third or tertiary stage in about 35-40% of patients. Std test near Mcbh Kaneohe Bay. Patients with tertiary syphilis cannot infect others with the disease. It is thought that the symptoms of this stage are a delayed hypersensitivity reaction to the spirochetes. Some patients develop so-called benign late syphilis, which begins between three and 10 years after infection and is characterized by the development of gummas. Gummas are rubbery tumor-like growths that are most likely to involve the skin or long bones but may also develop in the eyes, mucous membranes, throat, liver, or stomach lining. Gummas are increasingly uncommon since the introduction of antibiotics for treating syphilis. Benign late syphilis is usually rapid in onset and responds well to treatment.
HIV PATIENTS. Syphilis has been closely associated with HIV infection since the late 1980s. Syphilis sometimes mimics the symptoms of AIDS. Conversely, AIDS appears to increase the severity of syphilis in patients suffering from both diseases, and to speed up the development or appearance of neurosyphilis. Patients with HIV are also more likely to develop lues maligna, a skin disease that sometimes occurs in secondary syphilis. Lues maligna is characterized by areas of ulcerated and dying tissue. In addition, HIV patients have a higher rate of treatment failure with penicillin than patients without HIV. Mcbh Kaneohe Bay HI Std Test.
The diagnosis of syphilis is often delayed because of the variety of early symptoms, the varying length of the incubation period, and the possibility of not noticing the initial chancre. Patients do not always connect their symptoms with recent sexual contact. They may go to a dermatologist when they develop the skin rash of secondary syphilis rather than to their primary care doctor. Women may be diagnosed in the course of a gynecological checkup. Because of the long-term risks of untreated syphilis, certain groups of people are now routinely screened for the disease:
NONTREPONEMAL ANTIGEN TESTS. Nontreponemal antigen tests are used as screeners. They measure the presence of reagin, which is an antibody formed in reaction to syphilis. In the venereal disease research laboratory (VDRL) test, a sample of the patient's blood is mixed with cardiolipin and cholesterol. If the mixture forms clumps or masses of matter, the test is considered reactive or positive. Mcbh Kaneohe Bay, Hawaii Std Test. The serum sample can be diluted several times to determine the concentration of reagin in the patient's blood.
Nontreponemal antigen tests require a doctor's interpretation and sometimes further testing. They can yield both false-negative and false-positive results. False-positive results can be caused by other infectious diseases, including mononucleosis, malaria , leprosy, rheumatoid arthritis, and lupus. HIV patients have a particularly high rate (4%, compared to 0.8% of HIV-negative patients) of false-positive results on reagin tests. False-negatives can occur when patients are tested too soon after exposure to syphilis; it takes about 14-21 days after infection for the blood to become reactive.
TREPONEMAL ANTIBODY TESTS. Treponemal antibody tests are used to rule out false-positive results on reagin tests. They measure the presence of antibodies that are specific for T. pallidum. The most commonly used tests are the microhemagglutination-T. pallidum (MHA-TP) and the fluorescent treponemal antibody absorption (FTA-ABS) tests. In the FTA-ABS, the patient's blood serum is mixed with a preparation that prevents interference from antibodies to other treponemal infections. The test serum is added to a slide containing T. pallidum. In a positive reaction, syphilitic antibodies in the blood coat the spirochetes on the slide. Std test in Mcbh Kaneohe Bay. The slide is then stained with fluorescein, which causes the coated spirochetes to fluoresce when the slide is viewed under ultraviolet (UV) light. In the MHA-TP test, red blood cells from sheep are coated with T. pallidum antigen. The cells will clump if the patient's blood contains antibodies for syphilis.
SPINAL FLUID TESTS. Testing of cerebrospinal fluid (CSF) is an important part of patient monitoring as well as a diagnostic test. The VDRL and FTA-ABS tests can be performed on CSF as well as on blood. An abnormally high white cell count and elevated protein levels in the CSF, together with positive VDRL results, suggest a possible diagnosis of neurosyphilis. CSF testing is not used for routine screening. It is used most frequently for infants with congenital syphilis, HIV-positive patients, and patients of any age who are not responding to penicillin treatment.
Syphilis is treated with antibiotics given either intramuscularly (benzathine penicillin G or ceftriaxone) or orally (doxycycline, minocycline, tetracycline, or azithromycin). Neurosyphilis is treated with a combination of aqueous crystalline penicillin G, benzathine penicillin G, or doxycycline. Std Test near me Mcbh Kaneohe Bay. It is important to keep the levels of penicillin in the patient's tissues at sufficiently high levels over a period of days or weeks because the spirochetes have a relatively long reproduction time. Penicillin is more effective in treating the early stages of syphilis than the later stages.
The Jarisch-Herxheimer reaction, first described in 1895, is a reaction to penicillin treatment that may occur during the late primary, secondary, or early latent stages. The patient develops chills, fever, headache , and muscle pains within two to six hours after the penicillin is injected. The chancre or rash gets temporarily worse. The Jarisch-Herxheimer reaction, which lasts about a day, is thought to be an allergic reaction to toxins released when the penicillin kills massive numbers of spirochetes.
Homeopathic practitioners are forbidden by law in the United States to claim that homeopathic treatment can cure syphilis. Given the high rate of syphilis in HIV-positive patients, however, some alternative practitioners who are treating AIDS patients with homeopathic remedies maintain that they are beneficial for syphilis as well. The remedies suggested most frequently are Medorrhinum, Syphilinum, Mercurius vivus, and Aurum. The historical link between homeopathy and syphilis is Hahnemann's theory of miasms. He thought that the syphilitic miasm was the second oldest cause of constitutional weakness in humans.
The prognosis is good for the early stages of syphilis if the patient is treated promptly and given sufficiently large doses of antibiotics. Treatment failures can occur and patients can be reinfected. There are no definite criteria for cure for patients with primary and secondary syphilis, although patients who are symptom-free and have had negative blood tests for two years after treatment are usually considered cured. Patients should be followed up with blood tests at one, three, six, and 12 months after treatment, or until the results are negative. CSF should be examined after one year. Patients with recurrences during the latency period should be tested for reinfection.
Diagnosis. Testing for syphilis is usually by a serologic test for syphilis , of which there are two types: (1) the nontreponemal antigen tests detect antibodies to substance (reagin) derived from host tissues; they originated with the wassermann test and are now represented by the vdrl and rapid plasma reagin tests ; (2) the treponemal antigen tests detect specific antitreponemal antibodies; they originated with the Treponema pallidum immobilization test and are now represented by tests such as the microhemagglutination assay-T. Std Test near Mcbh Kaneohe Bay, HI. pallidum (MHA-TP), and assays using enzyme-linked immunosorbent assay (ELISA) methods. The term serologic tests for syphilis” is occasionally used with reference only to nontreponemal antigen tests.
A positive test for syphilis should be repeated. A false positive result can be due to other diseases such as malaria, leprosy, and advanced pulmonary tuberculosis, and therefore should not be ignored. A false negative serological test can occur when the infection is too recent to have triggered the production of antibodies. A negative result can also occur if the disease is late symptomatic syphilis or if the patient's immune system is not functioning normally. If treatment of syphilis had been started before the test, the patient's blood could be temporarily nonreactive. Since alcohol interferes with and decreases the intensity of a reaction, it should be considered as a possible cause of a negative result. Std Test in Mcbh Kaneohe Bay, Hawaii. Once treatment has been started, patients with early syphilis should have repeated testing every three months for one full year.
Primary Syphilis. Within a few hours after the spirochetes penetrate the skin or a mucous membrane, they enter the bloodstream, and usually in about a week they spread throughout the body. The first sign is a painless sore, called a chancre, that appears 9 days to 3 months (usually about 3 weeks) after infection. Usually firm or hard, the chancre may resemble a blister, pimple, or ulcerated open sore. In men, it appears usually on or near the head of the penis. In women, the chancre is commonly found on the labia, but it may be concealed inside the vagina, where it may not be felt or seen. Chancres sometimes develop elsewhere, such as on the lips of the mouth, a breast, or a finger. They also may appear in the anal region. The nearby lymph nodes become hard and swollen.
Secondary Syphilis. Two to six months after the primary sore disappears, the secondary stage of syphilis begins; it may last up to 2 years. A rash is usually one of the first symptoms. It may cover any part of the body and often spreads over the entire skin surface, including the palms and soles. It does not itch and may resemble the rash of measles as well as of many other diseases. It can be identified positively as a symptom of syphilis only by a blood test. During secondary syphilis, thin white sores may appear on the mucosa of the mouth and throat and around the genitalia and rectum. Headache, fever, and a general feeling of illness are common. Hair may fall out in patches, bones and joints may be painful, and anemia may develop. Sometimes the eyes are affected. Syphilis is highly contagious in this stage and of great danger to others. If mouth sores are present, the disease may be spread by kissing.
If late syphilis attacks the heart, aorta, or aortic valve, death may result from rupture of the weakened aorta or from heart failure. When it attacks the central nervous system, general paresis, a severe disease of the brain, may result; if not treated promptly, it will cause insanity and death. Another serious disorder of the nervous system caused by late syphilis is tabes dorsalis , in which there is pain and loss of position sense. Blindness may result if the infection involves the eyes. Other possible effects are deep ulcers on the legs or elsewhere, chronic inflammation of the bones, which is especially painful at night, and perforation of the soft palate.
Mcbh Kaneohe Bay HI Std Test. Congenital Syphilis. Congenital syphilis is transmitted from a diseased mother to her unborn child through the placenta; this often results in spontaneous abortion or stillbirth. Std test in Hawaii. Infants with congenital syphilis who are born alive may have a nasal discharge called snuffles , caused by inflammation of the nose, and may be generally weak and sickly. Syphilitic rashes, especially in the genital area, may occur when the baby is 3 to 8 weeks old. Many are born with deformities or later develop any of a wide variety of impairments and disabilities.
nonvenereal syphilis a chronic treponemal infection mainly seen in children, occurring in many areas of the world, caused by an organism indistinguishable from Treponema pallidum, and transmitted directly by nonsexual contact and indirectly by common use of table and drinking utensils. The first lesions are usually oral mucous patches; subsequent lesions are concentrated in the axillae, inguinal region, and rectum. Then, after a latent period, there develop destructive lesions of the skin and bones. Researchers have hypothesized that venereal syphilis mutated from one of the nonvenereal forms.
An acute and chronic infectious disease caused by the bacterium Treponema pallidum and transmitted by direct contact, usually through sexual intercourse. Std Test nearby Mcbh Kaneohe Bay, Hawaii. After an incubation period of 12-30 days, the first symptom is a chancre, followed by slight fever and other constitutional symptoms (primary syphilis), followed by a skin eruption of various appearances with mucous patches and generalized lymphadenopathy (secondary syphilis), and subsequently by the formation of gummas, cellular infiltration, and functional abnormalities usually resulting from cardiovascular and central nervous system lesions (tertiary syphilis).
observations The first stage (primary syphilis) is marked by the appearance of a small, painless red pustule on the skin or mucous membrane between 10 and 90 days after exposure. The lesion may appear anywhere on the body where contact with a lesion on an infected person has occurred, but it is seen most often in the anogenital region. It quickly erodes, forming a painless, bloodless ulcer, called a chancre, exuding a fluid that swarms with spirochetes. The chancre may not be noticed by the patient, and many people may become infected. Std Test closest to HI, United States. It heals spontaneously within 10 to 40 days, often creating the mistaken impression that it was not a serious symptom. The second stage (secondary syphilis) occurs about 2 months later, after the spirochetes have increased in number and spread throughout the body. This stage is characterized by general malaise; anorexia; nausea; fever; headache; alopecia; bone and joint pain; and the appearance of a morbilliform rash that does not itch, flat white sores in the mouth and throat, or condylomata lata papules on the moist areas of the skin. The disease remains highly contagious at this stage and can be spread by kissing. The symptoms usually continue from 3 weeks to 3 months but may recur over a period of 2 years. The third stage (tertiary syphilis) may not develop for 3 to 15 or more years. It is characterized by the appearance of soft rubbery tumors, called gummas, that ulcerate and heal by scarring. Gummas may develop anywhere on the surface of the body and in the eye, liver, lungs, stomach, or reproductive organs. Tertiary syphilis may be painless, unnoticed except for gummas, or it may be accompanied by deep, burrowing pain. The ulceration of the gummas may result in punched-out areas of the palate, nasal septum, or larynx. Various tissues and structures of the body, including the central nervous system, myocardium, and valves of the heart, may be damaged or destroyed, leading to mental or physical disability and premature death. Congenital syphilis resulting from prenatal infection may result in the birth of a deformed or blind infant or stillborn child. In some cases, the infant appears to be well until, at several weeks of age, snuffles, sometimes with a blood-stained or mucopurulent discharge, and skin lesions, particularly on the palms and soles or in the genital region, are observed. Such children also may have visual or hearing defects, and progeria and poor health may develop. Diagnosis of syphilis is made by dark field microscopy of fluid from primary or secondary stage lesions, by bacteriological study of blood samples, and by an examination of cerebrospinal fluid. Because of the slow development of the disease during the early stages, the various serological tests, including the obsolete Wassermann, may not produce accurate findings until months after exposure. Repeated tests and cross-checking with more than one test may be required in some cases. The report by a person that exposure to syphilis has occurred is often the only evidence available to the clinician.
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