Pharmacotherapy of Syphilis

PST 06106

Basic Pharmacotherapy

Session 15: Pharmacotherapy of Syphilis

Learning Task

By the end of this session students are expected to be able to:

Define syphilis

Explain the clinical presentation of syphilis

Outline diagnosis of syphilis

Describe pharmacological treatment of syphilis

Describe the monitoring of syphilis

therapy

.

Activity: Buzzing

is syphilis??

Definition of Syphilis

Syphilis

Syphilis is an infectious venereal disease caused by the spirochete

Treponema pallidum

.

Syphilis is transmissible by sexual contact with infectious lesions, from mother to fetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions.

If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary

Clinical Presentation

Primary Syphilis

The primary stage, characterized by the appearance of a chancre on cutaneous or mucocutaneous tissue exposed to the organism, is highly infectious.

Even without treatment, chancres persist only for 1 to 8 weeks before healing spontaneously. Because syphilitic chancres can be confused with other infectious etiologies, appropriate diagnostic testing is important

.

Clinical

Presentation

Cont

…

Secondary Syphilis

The secondary stage of syphilis is characterized by a variety of mucocutaneous eruptions resulting from widespread

hematogenous

and lymphatic spread of

T. pallidum

.

Skin lesions can be either generalized or localized to a small portion of the body and, with the exception of follicular lesions, are

nonpruritic

.

Generalized lymphadenopathy also is seen in the majority of patients, as are nonspecific symptoms such as mild and transitory malaise, fever, pharyngitis, headache, anorexia, and arthralgia.

If untreated, secondary syphilis disappears in 4 to 10 weeks; however, lesions can recur at any time within 4 years.

Clinical Presentation

Cont

…

Latent Syphilis

These are persons with a positive serologic test for syphilis but with no other evidence of disease.

Latent syphilis is further divided into early and late latency.

During early latency, the patient is considered potentially infectious.

Early latency is

defined as 1 year from the onset of infection, up to 2 to 4 years.

Late latency is considered noninfectious, although the patient remains a host.

Most untreated patients with late latent syphilis have no further sequelae; however, approximately 25% to 30% progress either to neurosyphilis or to late syphilis with clinical manifestations other than neurosyphilis.

Treatment of all patients with latent syphilis is essential because there is no way to predict which patients will have progression of their disease

Clinical Presentation

Cont

…

Tertiary Syphilis and

Neurosyphilis

If

left untreated, syphilis can slowly produce an inflammatory reaction in virtually any organ in the body.

Manifestations of this disease progression are referred to as

tertiary syphilis.

These clinical manifestations are differentiated into two subgroups based on the presence or absence of central nervous system (CNS) involvement which are neurosyphilis or tertiary syphilis (i.e., gumma and cardiovascular syphilis).

The gumma, a nonspecific granulomatous lesion, is the classic lesion of late syphilis and develops in 50% of patients with disease progression.

These chronic, destructive lesions characteristically infiltrate the skin, bone, soft tissue, and liver but can be found in any organ or tissue.

Gummas of critical organs, such as the heart or brain, can be fatal

Clinical Presentation Of Syphilis

Diagnosis Of Syphilis

Syphilis diagnosis is based on the;

patient’s history,

physical examination,

laboratory testing and

Radiology

Diagnosis of

Sphilis

Cont

…

The available laboratory tests for diagnosis of syphilis include

D

irect

detection methods (i.e.

dark field

microscopy, direct fluorescent antibody test and nucleic acid amplification test),

S

erology

tests such as;

Treponemal tests which include the Treponema pallidum

haem- agglutination

assay (TPHA), the Treponema pallidum particle agglutination assay (TPPA) and the fluorescent treponemal antibody absorbed (FTA-ABS) tests

Non-treponemal tests (the microscopic Venereal Diseases Research Laboratory -VDRL and the macroscopic rapid plasma

reagin

–RPR tests),

Examination of cerebrospinal fluids

Rapid diagnostic tests (RDTs) for treponemal antibodies in syphilis infection

Activity

: Small Group Discussion

is the

treatment

of

Syphilis

?

Pharmacological Treatment

Parenteral penicillin G is the treatment of choice for all stages of syphilis.

Because

T. pallidum

multiplies slowly, single doses of short- or intermediate-acting penicillins do not provide the prolonged, low-level exposure to penicillin required for eradication of the

treponeme

.

A result, benzathine penicillin G is the only penicillin effective for single-dose therapy.

The recommended treatment for syphilis of less than 1 year’s duration is benzathine penicillin G 2.4 million units as a single dose.

Units can be administered once a week for 2 consecutive weeks.

In patients with syphilis of longer than 1 year’s duration and normal CSF examination, benzathine penicillin G is administered weekly for three successive doses

Monitoring Of Syphilis Therapy

Non treponemal tests should be performed at 6 and 12 months in all patients

treated

for

primary and secondary syphilis and at 6, 12, and 24 months for early and late latent disease.

More frequent monitoring of HIV-infected individuals (i.e., 3, 6, 9, 12, and 24 months after therapy) should be done

In general, the time to reach seronegativity is proportional to the duration of the

disease.

Despite adequate therapy, some patients can remain seropositive based on

non- treponemal

test results.

In these cases, stabilization of low antibody titers is indicative of adequate therapy.

For women treated during pregnancy, monthly quantitative

non-treponemal

tests are recommended in those at high risk of reinfection.

Key Points

Syphilis

is a systemic disease from the outset and is caused by the

spirochaete

,

Treponema

pallidum (T. pallidum)

The infection can be classified as congenital (transmitted from mother to child in utero) or acquired (through sex or blood transfusion)

Acquired syphilis is divided into early and late syphilis

Early syphilis comprises the primary, secondary and early latent stages while late syphilis refers to late latent syphilis,

gummatous

, neurological and cardiovascular syphilis

Long-acting benzathine

benzylpenicillin

provides optimal

treponemicidal

penicillinaemia

and is recommended for syphilis treatment

Evaluation

What

is Syphilis?

What are the signs and symptoms of syphilis?

What is the treatment of Syphilis?

How will you monitor patient on syphilis therapy

References

Wells

BG,

DiPiro

J,

Schwinghammer

T (2013),

Pharmacotherapy Handbook

(6

th

Ed). New York, NY: McGraw-Hill.

DiPiro

JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):

Pharmacotherapy: A Pathophysiologic Approach

(7

th

ed

): New York, NY: McGraw-Hill.

Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)

Principles & Practice Study Guide: A Case-Based Care Plan Approach

: New York, NY: McGraw-Hill.

Schwinghammer

TL, Koehler JM (2009)

Pharmacotherapy Casebook: A Patient-Focused Approach

(7

th

ed

): New York, NY: McGraw-Hill.

Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP