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SYPHILIS - PRIMARY
Syphilis is a vertically or sexually transmitted infection caused by Treponema pallidum subspecies pallidum.
In the primary stage of acquired syphilis, there is an appearance of a painless ulcer (chancre). Then in the secondary stage, there are skin rashes and sores on mucous membranes.
In the latent stage, it is asymptomatic and not communicable. It is in the tertiary or late stage that it is symptomatic but not communicable; it usually appears 10-20 years after 1st infection.

Patient Education

  • Patient needs to be informed about the nature of the infection, importance of taking the full course of medication,and possible side effects especially in pregnant patients in whom fetal distress or preterm labor may ensue
  • Counsel patients on possible complications of sexually transmitted infection (STI)

Advise patients on how to lower their risk of acquiring sexually transmitted infections (STIs)

  • Tailor counseling to the patient’s specific risk factors
  • Abstinence, condom use
  • Careful selection of sex partners

Reactions to Treatment

  • Jarisch-Herxheimer reaction
    • An acute febrile reaction associated with headache, myalgia, or chills that occurs within 2 hours after any treatment for syphilis, especially with penicillin, which resolves within 24 hours
    • Can be prevented by giving Prednisolone for 3 days and starting the anti-treponemal treatment 24 hours after Prednisolone was started
  • Procaine reaction (Procaine psychosis or mania)
    • Secondary to inadvertent intravenous (IV) injection of Procaine penicillin that lasts for 20 minutes
    • May cause hallucinations, convulsions or fear of imminent death
    • May be decreased by “aspiration technique of injection”; may give Diazepam if seizure occurs
  • Anaphylactic shock
    • Penicillin is one of the most common causes of anaphylaxis and should be managed with Epinephrine

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