Today, around 40 million new cases are noti?ed annually in the world, and this is probably an underestimate. In the UK the annual incidence of new cases of syphilis diagnosed in NHS genito-urinary medicine clinics has risen from 8.8 to 9.7 per million of male population between 1991 and 1999; among women the ?gures were 4.0 to 4.5 per million. The infection is most common in homosexual men (see HOMOSEXUALITY).
Causes The causative organism is the Treponema pallidum, a long, thread-like wavy organism with pointed tapering ends. It is found in large numbers in the sores in the primary stage of the disease and in the skin lesions in the secondary stage.
Syphilis may be acquired from people already suffering from the disease, or it may be congenital. The acquired form is usually got by sexual intercourse, kissing or other intimate bodily contact. The epithelium covering the general surface of the skin seems to be an e?cient protection, but the infective material penetrates mucous membranes. The acquired form of the disease is infectious from contact with sores, both in its primary and secondary stages; infants suffering from the congenital form are also highly infectious. Accordingly, anyone frequently handling such an infant is at risk of infection, although the mother may handle the baby with impunity.
Symptoms The acquired form of the disease is commonly divided into three stages – primary, secondary, and tertiary (although the latter is much less common than it was 50 years ago). The clinical manifestations are varied and are sometimes confused with those of other diseases. There are several laboratory tests for con?rming the diagnosis.
The incubation period ranges from ten to 90 days, although most frequently it is around four weeks. Then, a small persistent ULCER appears at the site of infection, which is accompanied by a typical cartilaginous hardness of the tissues immediately around and beneath it. This, which is known as the primary sore (or chancre), may be very much in?amed, or it may be so small as to pass almost or quite unnoticed. A few days later, the lymphatic glands in its neighbourhood, and then those all over the body, become swollen and hard. This condition lasts for several weeks before the sore slowly heals and the glands subside. After a variable period – usually about two months from the date of infection – the secondary symptoms appear and resemble the symptoms of an ordinary FEVER, with pyrexia, loss of appetite, vague pains through the body, and a faint red rash seen best upon the front of the chest. People with syphilis are infectious in the primary and secondary stages but not in the latent or tertiary stages.
In untreated or inadequately treated cases, manifestations of the tertiary stage develop after the lapse of some months or even years: this is known as the latent period. These consist in the growth, at various sites throughout the body, of masses of granulation tissue known as gummas. These gummas may appear as hard nodules in the skin, or form tumour-like masses in the muscles, or produce thickening of bones. They may develop in the brain and spinal cord, where their presence causes very serious symptoms. Gummas yield readily, as a rule, to appropriate treatment, and generally disappear speedily.
Still later, effects are apt to follow, such as disease of the arteries, leading to ANEURYSM (see also ARTERIES, DISEASES OF), to STROKE, and to mental deterioration (see MENTAL ILLNESS); also certain nervous diseases, of which tabes dorsalis and general paralysis are the chief.
The congenital form of syphilis, now rare, may affect the child before birth, leading then as a rule to miscarriage or to a stillbirth if born at full time. Alternatively he (or she) may show the ?rst symptoms a few weeks after birth, the appearances then corresponding to the secondary manifestations of the acquired form.
Laboratory con?rmation of a clinical diagnosis is done by identifying active spirochaetes (see SPIROCHAETE) in a smear taken at the site of the initial chancre, and by blood tests such as the treponomal antibody absorption tests. These tests are strongly positive at the secondary stage, and in patients with neurosyphilis the tests may have to be done on CEREBROSPINAL FLUID.
Treatment Any person with syphilis is a source of infection, and should take precautions not to spread it. PENICILLIN is the drug of choice in the disease in all its stages, but resistant strains of the Treponema pallidum have emerged and are causing problems, especially in developing countries. Treatment must be instituted as soon as possible after infection is acquired: (1) a full course of treatment is essential in every case, no matter how mild the disease may appear to be; (2) periodic blood examinations must be carried out on every patient for at least two years after he or she has been apparently cured.
Prevention is important and promiscuous hetero- or homosexual intercourse involves a risk of infection. Condoms provide some, but not complete protection. Infection can be avoided by maintaining a monogamous relationship.... syphilis
Symptoms. Mild fever, temperature rising to 101°F (38°C), headache, drowsiness, runny nose, sore throat, swelling of glands side of neck and behind ears; itchy rash of small pink spots spreads from face downwards to whole of the body, lasting 3 days.
Complication: inflammation of the brain (rare).
If patient is pregnant professional care is necessary as congenital defects, stillbirth or abortion may follow in early pregnancy. There is evidence of a link between the virus and juvenile joint disease and arthritis later in life.
Treatment. Bedrest. Plenty of fluids (herb teas, fruit juices). Should not be suppressed by drugs. Alternatives:– Teas. Any one. Balm, Chamomile flowers, Elderflowers and Peppermint, Hyssop, Wild Thyme, Marigold. Sage, Peppermint. Combination: equal parts, Marigold flowers, Elderflowers, Yarrow. Prepare: 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely.
Tablets/capsules. Echinacea.
Tinctures. Echinacea: 5-30 drops in water every 2 hours. OR: Combine, equal parts Echinacea and Wild Indigo with few drops Tincture Capsicum; 5-30 drops every 2 hours.
Absence of urine: add 1 part Pleurisy root.
For swollen glands: add 1 part Clivers.
For nervousness: add 1 part Skullcap.
For sore throat: Cinnamon.
Diet. Commence 3-day fast with no solid food. Abundant Vitamin C drinks, fruit juices, etc.
To be treated by or in liaison with a qualified medical practitioner. ... german measles
Lupus erythematosis – accounts for a significant number of unexplained miscarriages. Some lupus sufferers may have ten or more miscarriages (Swedish study). In lupus there is a sluggish blood supply – microscopic blood vessels between baby and the mother may silt up, the nutrient supply cut off and the baby dies. Agents with blood-thinning properties (anti-coagulants) can keep blood flowing smoothly to the baby. Some women with severe lupus symptoms may require the stronger anti-coagulants of general medicine (heparin).
Pregnancy. Should be carefully monitored with one-month scans to make sure the baby is alive. All women who miscarry should be tested to see if they are carrying lupus antibodies, and have a lupus test after their first miscarriage.
Influenza. Epidemiologists found that women whose pregnancies were more likely to have had flu-like illness during pregnancy can miscarry. Evidence of a link between influenzal infection during pregnancy and miscarriage or stillbirth has been uncovered. Such infection during pregnancy may also cause schizophrenia in offspring.
Information. Miscarriage Association, C/O Clayton Hospital, Northgate, Wakefield, West Yorks WF1 3JS, UK. Send SAE. ... miscarriage
Insomnia, malaise, agitation, and tearfulness are also common. Gradually, but usually within 2 years, the bereaved person adjusts to the loss.
Family and friends can often provide support. Outside help may be required and may be given by a social worker, health visitor, member of the clergy, or self-help group. For some people, when depression, apathy, and lethargy impede any chance of recovery, specialized counselling or psychotherapy is necessary. (See also stillbirth.)... bereavement
A blood test early in pregnancy enables the detection of antibodies in the mother’s blood and the adoption of various precautions for the infant’s safety, including Doppler measurement of the fetal cerebral vessels (MCA Doppler; see Doppler ultrasound) to detect fetal anaemia, which may require intrauterine transfusion. The incidence of the disease has been greatly reduced by preventing the formation of antibodies in a Rh-negative mother (see anti-D immunoglobulin).... haemolytic disease of the newborn
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