Pathophysiology

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Disordersofthegenitourinarysystem

Thelma H. Walker

Rasmussen College

NUR2063: Essentials of Pathophysiology

Instructor Desautels

November 08, 2020

Syphilis is an STI infection caused by treponema pallidum, which is a spirochete. It is transmitted through sexual contact with an infected person; it is transmitted from the mother to her child in the uterus or giving birth through the birth canal. It can also be transmitted through blood and plod product transfusion and skin to skin contact. It goes through 4 stages if left untreated, which include the primary location is the initial stage, followed by secondary stage, latent stage, and finally tertiary stage. Syphilis is associated with commercial sex workers and people with HIV/AIDS. It is more common in low-income countries.

Pathophysiology

Pathophysiology is described in how the disease progresses. T. pallidum is an aerophilic bacterium and has flagella for motility. The bacterium is transmitted to the body through sexual contact, blood transfusion, mother to child, and skin contact. When the bacterium enters the body, it stimulates responses of the body. The reactions include immune response, protective immunity, a cell-mediated response, and humoral response.

The immune response is provoked when the bacterium enters the body. Antibodies are formed against these bacteria, which are the antigens. However, in the presence of this immune response, the bacterium can survive in the body for an extended period and damage organs. In the cell-mediated response, the bacterium is terminated by macrophages, lymphocytes, and other plasma cells.

Syphilis pathophysiology is described through four stages, which have been described above. In the primary step, a chancre or a sore is produced in the site through which the bacteria went through into the body. This occurs in the first three weeks of infection. In this stage, the patient is highly infectious. The secondary stage is described by a generalized rash that develops between 2-8 weeks after the sore. This shows that the infection has spread throughout the whole body. In this stage, the patient becomes highly contagious. These rashes are commonly seen in the palms, feet, and sole. If untreated, the infection will progress to a latent stage, which is asymptomatic, the rash will fade, and the chancre heals. The patient becomes highly contagious in the early part of this stage. After this stage, many patients have a relapse of the secondary phase, and others undergo the tertiary stage described as the destructive stage. This stage begins one year after the initial infection and is defined by the complications of the disease.

Etiology of syphilis

A bacterium treponema pallidum causes syphilis from an infected person to a healthy person. The routes of transmission include direct contact of a healthy person to an infected person. This contact comes through sexual contact, skin contact through cuts and abrasions in mucous membranes, or the skin. Another way of transmission is in contact through kissing. Mother to child transmission is common during pregnancy and childbirth as the baby passes through the birth canal. Blood transfusion and intravenous drug use are associated with transmission. Other forms believed to aid transmission of the bacterium are not valid. These include; bathtub, toilet, utensils, clothing, swimming pools, and doorknobs.

Risk factors for the transmission of the infection include; unprotected sex, men who have sex with men, people with HIV/AIDS, multiple sexual partners, and intravenous drug users (Cooper et al., 2018).

Clinical manifestations

The symptoms of syphilis are described according to the stages, and these vary in each stage. A chancre characterizes the primary step at the site of entry. It usually occurs 2-3 weeks after infection. The sore is always painless and may be hidden in the rectum or vagina. In the secondary stage, the main clinical feature, the chancre, heals, and a rash develops, which begins at the body trunk, and later it spreads to the entire body. They are non-itchy and accompanied by sores, water like in the genital area and the mouth. Other symptoms include sore throat, fever, and swollen lymph nodes. If not treated in this stage, it progresses to a latent stage, which has no signs and later to tertiary, the destructive stage characterized by damage to blood vessels, nerves, heart, bones, eyes, and joints. It is also characterized by neurosyphilis and congenital syphilis.

Treatment of syphilis

The treatment of syphilis is antibiotics where benzathine penicillin G is the drug of choice. This drug is given intramuscularly as a single dose of 2.4 million units. Three doses are also recommended for people with latent syphilis, presented at an interval of one week for three weeks. Prevention is done through abstinence, avoid multiple sexual partners, use condoms, and avoid recreational drug use. Pregnant mothers should also be screened and partner notification and counseling (Oliver et al., 2016).

References

Cooper, J. M., & Sánchez, P. J. (2018, April). Congenital syphilis. In Seminars in perinatology (Vol. 42, No. 3, pp. 176-184). WB Saunders.

Oliver, S. E., Aubin, M., Atwell, L., Matthias, J., Cope, A., Mobley, V., ... & Hennessy, R. R. (2016). Ocular syphilis—eight jurisdictions, United States, 2014–2015. Morbidity and Mortality Weekly Report, 65(43), 1185-1188.