Adequate Treatment Plan, Follow Up, Prevention And The Social Measures Of Syphilis Infection
Treating Syphilis With Penicillin
Treatment Of Syphilis
The principal aims of therapy are to make the patient non-infectious within the shortest time and to achiever cure. Benzyl penicillin is very effective in killing, T. Pallidum, but prolonged exposure to the drug is required for satisfactory results. Long standing preparations of penicillin are employed.
Primary state: Most of the cases respond to procaine penicillin 600,000 units a day given intramuscularly for 10 days. If daily injections are not practical, the long acting preparation benzathine penicillin may be given intramuscularly in a total dose of 2.4 mega units, 1.2 mega units each is given in both gluteal regions at the same time and the patient is reviewed two weeks later. Subjects who are allergic to penicillin may be treated with erythromycin, 500 mg given 6-hourly for 15 days or tetracycline 500 mg given 6-hourly for 2 weeks.
Early and late latent syphilis and tertiary syphilis: Aqueous procaine penicillin G, 600,000 units per day, intramuscularly is given for 14 days of benzathine penicillin 2.4 mega units is given intramuscularly every week for 3 weeks (total 7.2 mega units).
Cardiovascular and neurosyphilis: The patients should be preferably hospitalized and put to rest. Heavy exertion should be avoid. Procaine penicillin is given intramuscularly 600,000 units a day for 14 to 21 days. The course may have to be repeated at intervals depending on the progress of the case and titer of antibodies. For neurosyphilis administration, 1 to 2 mega units given on alternate days to reach a total dose of 20 mega units has been found to be more satisfactory.
Adverse effects of penicillin: In addition to all the adverse side effects of penicillin, syphilitic subjects receiving the drug may develop acute Herxheimer reaction caused by rapid destruction of spirochetes. It may develop in up to 50% of cases of secondary syphilis and in a smaller proportion of late syphilis. It is characterized by fever, general malaise, headache, rigor and transient exacerbation of the local lesions. The reaction subsides within a few hours with symptomatic management. However, in patients with general paresis or high CSF cell counts, further neurological damage may develop and lead to extension of paralysis. The lesions of syphilitic aortitis may extend and lead to coronary occlusion which can be fatal. Administration of 20 mg prednisolones starting 24 hours prior to penicillin injections and continued for two days prevents Herxheimer reaction. If Herxheimer reaction occurs, management is the same as for anaphylactic shock.
Careful Monitoring For Total Disappearance Of The Disease
Follow Up After Treatment
All patients should be seen once in three months for two years. The cerebrospinal fluid should be examined at the end of one year. The patient may be considered as cured if he remains clinically and serologically negative at the end of two years.
Further treatment is indicated if the serologic result remains positive or the titers increase after one year of completing therapy. Relapse is uncommon. If it occurs, a course of penicillin is repeated, this time using twice the dose given during the initial treatment.
Congenital Syphilis: For early congenital syphilis, the baby is given benzathine penicillin intramuscularly in a dose of 50,000 units/Kg as single or divided injections. An alternate regimen is to give acqueous procaine penicillin 10,000 units/Kg/day for twn days. The CSF should be examined in all cases of late congenital syphilis before starting treatment. If it is abnormal, the treatment is the same as for latent syphilis.
When congenital syphilis is detected, the mother also should be investigated serologically. Surveillance plan is the same as for late syphilis. The baby should be followed up late into adult life. Interstitial keratitis should be treated with local cortico-steroids and atropine drops in addition.
Avoidance Of Careless And Rampant Sexual Intercourse
Prevention And Social Measures Of Syphilis
Prevention: Congenital syphilis is preventable if the mother is treated before the fourth month of pregnancy. Treatment administered later in pregnancy usually cures both the mother and the fetus, though residual stigmata may be seen in the baby. If syphilits is detected in the pregnant woman, the course of treatment is the same as for primary syphilis. Tetracycline should be avoided in pregnancy.
Social measures: When primary or latent syphilis is detected, all sexual contacts in the near past should be traced out and examined. Since a social stigma has been attached to the sexually transmitted diseases (in some parts of the world), patients tend to conceal the infection and do not come up for treatment. Hence great care is required to avoid psychological trauma to the patient and his contacts. Proper instruction on healthy sexual practices, avoidance of direct contact by the use of condoms and periodic examination of prostitutes and other personnel engaged in similar practices help in limiting to some extent the incidence of sexually transmitted diseases.
© 2014 Funom Theophilus Makama