Syphilis

oh my God, whats a matter with this picture? there is something on gland? yes that is wound, like ulcus. Mbah Dukun will explain what that is. it's called syphillis
 1. Definition
2. Etiology
3. Symptoms
4. Therapy and Treatment
5. Mbah dukun's advices 






 
Definition
Syphilis is a chronic infectious disease caused by the spirochaete Treponema pallidum. It progresses in stages. Syphilis is easy to cure in its early stages. But without treatment, it can hurt your body’s organs, leading to severe illness and even death.

Etiology

Syphilis caused by Treponema pallidum.  Treponema pallidum including Spirochaeta group which is shaped like a spiral with a length between 50-20 microns wide and 0.1 to 0.2 microns, easily visible with dark field microscope looks like a spiral that can perform movements such as rotation.  These organisms are easily killed by soap anaerobic, oxygen, sapranin, even by aquades.  In donor blood stored in the refrigerator Treponema pallidum will die within three days but can be transmitted through transfusion using fresh blood.

How is syphilis spread?
Syphilis is usually transmitted by sexual contact or from mother to infant, although endemic syphilis is transmitted by non-sexual contact in communities living under poor hygiene conditions. T. pallidum can also be transmitted by blood transfusion. In spite of provoking a strong humoral and cell-mediated immune response, T. pallidum is able to survive in the human host for several decades.After an incubation period of about 21 days, an ulcer (the primary chancre) appears at the site of inoculation. This resolves spontaneously and 6–8 weeks later is followed by the secondary stage, at which time the organism has disseminated via the blood stream and any organ can be affected.
Tertiary syphilis, which can affect the skin, bones or central nervous and cardiovascular systems, can occur many years later1. In pregnant women, syphilis can lead to stillbirth or congenital infection of the neonate, resulting in neonatal death or late sequelae.Parenteral penicillin remains the treatment of choice, and resistance to it has not been described.As T. pallidum divides slowly, a long-acting preparation is recommended.

Symptoms and signs
A. Primary syphilis
In the early stages of syphilis a sore can appear on the penis or in the rectum or, in women, on the cervix. In people co-infected with HIV, multiple sores can appear. Because the sores appear in hidden locations, early-stage syphilis might go unnoticed in both men and women. Lymph nodes in the groin may become swollen, usually within a week of the appearance of the syphilitic sore. Although the sore, sometimes called a chancre, can heal within four to six weeks, lymph nodes may remain swollen for several months.
Still, early-stage syphilis can have minimal symptoms and may go unnoticed by affected people. Troublingly, treponemes have been found in the spinal fluid of people with primary syphilis, regardless of HIV infection.

  

                             

B. Secondary syphilis
In this stage, generally two to 12 weeks after the appearance of the chancre, symptoms of a widespread T. pallidum infection occur. Symptoms can vary considerably but the following can be common:
• skin rash;
• low-grade fever;
• lack of energy;
• sore throat;
• lack of appetite.
The skin rash can begin on the trunk but may also appear anywhere else, including on the palms of the hands and soles of the feet. If the rash affects a hairy area, temporary patchy hair loss can occur. For instance, thinning of the eyebrows, beard or parts of the head can be a feature of syphilitic rash. Painless lesions called mucous patches can appear on the wet tissues of the genitals, mouth, throat and tonsils. These lesions are teeming with treponemes and are highly infectious.
In up to 40% of people with secondary syphilis, the brain and spinal cord (CNS—central nervous system) can become infected, with or without symptoms. In some cases, symptoms such as the following may appear:
• ringing in the ears;
• decrease in the ability to hear clearly;
• difficulty seeing clearly;
• headache.
If left untreated, neurosyphilis can develop, leading to severe complications. The germs that cause syphilis can also infect the liver, causing liver damage or hepatitis, which can be detected by increased levels of liver enzymes in the blood.
Secondary syphilis can also turn into latent syphilis. At this stage, no symptoms are present and the infection is only detectable with blood tests. However, despite the lack of symptoms, the disease is still eating away at the body.

C. Late syphilis (tertiary syphilis)
In this stage of illness, any organ of the body may become slowly inflamed and affected by T. pallidum. Generally, late syphilis can affect the nervous system (neurosyphilis), the heart and blood vessels (cardiovascular syphilis) and just
about any organ/system where a syphilitic lesion can appear. These lesions, which are usually solitary, are called gummas.
If left untreated, late-stage syphilis can eventually lead to unpleasant and dreadful complications, including the following:
• difficulty falling asleep;
• peripheral neuropathy;
• problems getting and maintaining an erection;
• changes in personality;
• poor memory;
• decreased capacity for insight and good
judgment;
• meningitis;
• poor control of muscles;
• damaged joints;
• seizures;
• stroke.
Given all of these, regular blood tests for syphilis (and other STIs) are important for sexually active people who wish to remain healthy.

Treatment and Teraphy
Unlike the case with many other diseases, one syphilis expert, writing in an infectious disease textbook, noted that “there have not been many well-controlled, carefully planned, prospective studies to determine [the best dose or length] of therapy.” Current recommendations for treatment of syphilis are based on extrapolations of older data. Despite these drawbacks, an antibiotic called benzathine penicillin G is considered the gold standard of anti-syphilis therapy.

Drug levels
Ideally, maintaining high levels of penicillin in the blood should keep T. pallidum from reproducing and still higher levels can help kill these germs. So, for treating early syphilis, high levels of penicillin G are needed for at least seven days. The most convenient way to achieve this while avoiding the issue of patient adherence is an injection of benzathine G penicillin into muscle. However, it is important to note that this dose is inadequate for neurosyphilis; indeed, levels of penicillin that can kill treponemes in the CNS are not reliably achieved with a single injection of benzathine penicillin G 2.4 million units. Yet, in cases of early diagnosis, where, in theory, there are fewer treponemes, the evidence shows that treatment with a single injection of penicillin is sufficient therapy for the average person with primary syphilis.
Other antibiotics
Antibiotics such as doxycycline impair the growth of treponemes and are sometimes used in patients who are allergic to penicillin. Bear in mind that unlike penicillin, doxycycline does not kill treponemes and may be less effective in people with severely weakened immune systems.
In cases of penicillin allergy, some experts prefer to desensitize their patients to penicillin—a course of action suggested by PHAC (Public Health Agency of Canada). Penicillin desensitization is also recommended for cases of syphilis in pregnant women.
Another potential treatment is the antibiotic azithromycin (Zithromax). However, reports have emerged of cases of syphilis resistant to azithromycin in the United States, Ireland and, recently, in the province of British Columbia. All of the BC cases of azithromycin-resistant syphilis were in MSM. PHAC does not  recommend the use of this antibiotic for the routine treatment of syphilis.


Mbah Dukun's Advice For You
There are steps you can take to lower your risk of getting syphilis:
• Don’t have sex. The surest way to keep from getting syphilis is to prac¬tice abstinence. This means not hav¬ing vaginal, oral, or anal sex.
• Be faithful. Having a sexual rela¬tionship with one partner who has been tested for syphilis and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.
• Use condoms. Syphilis sores can occur in places that are covered by a condom, as well as areas that are not covered. So, using a condom the right way and every time you have vaginal, anal, or oral sex might lower your risk. For vaginal sex, use a latex male condom or a female polyure¬thane condom. For anal sex, use a latex male condom. For oral sex use a male latex condom. A dental dam might offer some protection during oral sex (mouth to vagina/anus).
• Know that some methods of birth control, like birth control pills, shots, implants, or dia¬phragms, will not protect you from STIs, including syphilis. If you use one of these methods, be sure to also use a latex condom every time you have sex.
• Talk with your sex partner(s) about STIs and using condoms. It’s up to you to make sure you are protected. Remember, it’s your body! For more information, call the Centers for Disease Control and Prevention at (800) 232-4636.
• Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all health problems. Also, being open with your partners can help you protect your health and the health of others.
• Have a yearly pelvic exam. Ask your doctor if you should be tested for syphilis or other STIs, and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The soon¬er syphilis is found, the more likely it can be cured quickly and easily.
• Avoid using drugs or drinking too much alcohol. These activi¬ties may lead to risky sexual behavior such as not wearing a condom.

refferences
1. http://www.womenshealth.gov/faq/syphilis.pdf
2. http://www.catie.ca/pdf/facts/syphilis.pdf
3. http://www.gov.mb.ca/health/publichealth/cdc/protocol/syphilis.pdf
4. http://www.hpa.org.uk/cdph/issues/CDPHvol3/No3/guidelines.pdf
5. http://www2a.cdc.gov