Discussion Paper: Syphilis
Diseases affect populations differently. They are also caused by different microorganisms and modes of transmission. People are affected by various social determinants of health, each with varying effects on a specific population. Health promotion interventions aim to empower communities to control their determinants of health and enhance their health.
This essay analyses the epidemiology of syphilis, including signs and symptoms and social determinants of health, and also explores the nurse practitioner’s role in managing and controlling syphilis.
Epidemiology of Syphilis
Syphilis is a bacterial infection caused by Treponema pallidum. Syphilis is transmitted primarily through unprotected sex with infected individuals. Other modes of transmission are transfusion from an infected person and mother-to-child transfer during pregnancy or labor. It begins as a painless sore, which is self-limiting. Syphilis develops through four stages, each with different clinical manifestations.
The first stage presents with a painless sore on the genitals, which often disappears after about two weeks (Tudor et al., 2022). The individual then develops a rash that disappears, with or without treatment. The individuals then undergo a latent phase, showing no signs or symptoms.
The fourth stage involves a marked invasion of vital organs and subsequent symptoms. Signs include dementia, numbness, syphilitic gummers, and vision loss-unhealing lesions are common in the late stage of syphilis. Before this stage, individuals can experience second-stage relapse rashes on the palms and soles of feet that take about 2-6 weeks to heal (Tudor et al., 2022).
Syphilis has fatal effects if not well treated and leads to complications such as renal failure, brain damage, stillbirths, intrauterine growth retardation, paralysis, and death. Syphilis is treatable using antibiotics. Amoxicillin, for a prolonged period of 21 days, leads to remission from the disease. Alternatively, Benzathine penicillin G 2.4Munits IM can be used for primary, secondary, and early latent syphilis (Tudor et al., 2022).
Syphilis affects all genders, with a higher prevalence in males than females. The primary risk factor is inconsistent condom use Individuals of reproductive age are most affected, with individuals aged 15-24 having the highest prevalence of syphilis. Cases are also higher among the males who have sex with other males (11.8%) (Tsuboi et al., 2021).
Syphilis prevalence is lowest among children, and most children contract the disease from their mothers during delivery. Syphilis mortality varies depending on severity and access to medications. The mortality rate ranges from 8% -58%, but the rate has decreased dramatically following the knowledge and development of effective medications (Petermann & Kidd, 2019). Syphilis affects up to 1.6million pregnancies each year and is responsible for over 20% of perinatal deaths in sub-Saharan Africa (Hussen & Tadesse, 2019). HIV and syphilis are co-infections diagnosed together in antenatal mothers.
Determinants of Health and Syphilis
Social determinants of health are the conditions in which people are born, live, and work. These social determinants of health include income level, social status, level of education, access to healthcare services, childhood experiences, gender, and health behaviors. Johnson et al. (2022) note that one of the objectives of the HP2020 was to reduce the rate of transmission of syphilis, with the metric being reducing the number of individuals testing for syphilis to 1.4 per 100000 individuals. Engaging in unhealthy behaviors such as IV drug users, multiple sex partners, and avoidance of screening are the leading causes of syphilis (Johnson et al., 2022). These behaviors predispose one to the disease.
Poverty can cause individuals to indulge in unsafe commercial sex and drug abuse. Social stigma is prevalent in most societies, and individuals fear seeking healthcare services. Individuals fail to seek healthcare services and only seek healthcare during advanced stages of the diseases hence higher mortality and morbidity. Poor access to healthcare services is also a contributing factor.
Most of these individuals affected are youths, and most hospitals do not offer youth-friendly services. Most youths fear seeking healthcare services; hence the disease develops more severe symptoms with increased morbidity and mortality (Johnson et al., 2022). Healthcare providers should address these social determinants of health to help manage the problem.
Syphilis Epidemiologic Triad
Syphilis infections begin with the entry of Treponema pallidum through an abrasion during sexual intercourse or blood-blood contact. At the point of entry, the bacteria multiplies in the epithelial, causing chancres-painless sores on the skin. The bacterium produced are mature and are capable of infecting any individual. The bacteria then enter the circulatory system and diffuse to the major organ systems.
The bacteria is found in body fluids such as blood and semen and can be transmitted to other persons. The immune system responds, leading to a rash and minor symptoms in stage two syphilis. The infection then spreads silents in latent syphilis between 3-15 years (Forrestel et al., 2020).
Forrestel et al. (2020) note that in the last stage, the bacteria invade multiple organ systems, leading to compromised health, cardiovascular conditions, mental health disorders, renal failure, blindness, and bone disorders. Treponema pallidum depends on the host for about half of the metabolic needs and can bypass host defense mechanisms to cause diffuse infections in seemingly healthy individuals.
The bacteria specifically affect human beings; the bacteria cannot survive outside the host, and transmission is through direct contact (Tudor et al., 2022). Thus, the disease does not require a vector. The bacteria only enter the host through broken skin, such as abrasions, cuts, bruises, and pricks. Thus, the rates of syphilis are highest in sexually active groups with the most sexual partners. In addition, transmission rates are higher in dry and hot climates hence the high rates in areas such as sub-Saharan Africa.
The Role of the Nurse Practitioner in Syphilis
Nurse practitioners play vital roles in preventing, managing, and rehabilitating syphilis victims. The nurses’ roles in syphilis revolve around the health belief model. The model focuses on increasing people’s health behavior. The nurse practitioner’s scope of practice is regulated by the nursing practice act, the organizational policies and regulations, and the field of practice of the nurse practitioner.
The model explains health constructs, such as perceived severity, benefits, barriers, and self-efficacy (Green et al., 2020). The nurse practitioner’s roles revolve around the four constructs to promote health and syphilis management.
As identified earlier, youth-friendly services are required for the management of syphilis. Nurse practitioners play essential roles in policy development and can pioneer the development of youth-friendly clinics and hospitals that improve access to healthcare services (Rowe et al., 2018). Nurse practitioners also develop and implement education programs targeting risk populations.
They also explain the risk factors for syphilis and help individuals stop risky behavior such as multiple sex partners and drug abuse (Rowe et al., 2018). They also participate in community screening and referral to help infected patients to get the medical attention they need. The nurse practitioner can also counsel victims to help them avoid the stigma associated with the disease and increase their access to healthcare services.
In addition, nurse practitioners should participate in the management and reporting of syphilis as per the guidelines set forth by the government to enhance government efforts in managing and controlling the disease.
Conclusion
Syphilis is a dangerous bacterial infection primarily transmitted through sexual intercourse. Syphilis develops in stages and does not require a vector to be transmitted. The disease is more prevalent in youths aged 15-25 who are more sexually active. Social determinants of health such as income level and level of education predispose one to the disease; risky behaviors such as sharing injection drugs and multiple sex partners also predispose one to the disease. The nurse practitioner plays a vital role in breaking the disease cycle and mitigating social determinants of health. Nurse practitioners can utilize models such as the HBF to promote health and mitigate the effects of syphilis.
References
Forrestel, A. K., Kovarik, C. L., & Katz, K. A. (2020). Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations. Journal of the American Academy of Dermatology, 82(1), 1-14. https://doi.org/10.1016/j.jaad.2019.02.073
Green, E. C., Murphy, E. M., & Gryboski, K. (2020). The health belief model. The Wiley Encyclopedia Of Health Psychology, 211-214. https://doi.org/10.1002/9781119057840.ch68
Hussen, S., & Tadesse, B. T. (2019). Prevalence of syphilis among pregnant women in sub-Saharan Africa: a systematic review and meta-analysis. BioMed Research International, 2019. https://doi.org/10.1155/2019/4562385
Johnson, K. A., Snyder, R. E., Tang, E. C., de Guzman, N. S., Plotzker, R. E., Murphy, R., & Jacobson, K. (2022). Geospatial Social Determinants of Health Correlate with Disparities in Syphilis and Congenital Syphilis Cases in California. Pathogens, 11(5), 547. https://doi.org/10.3390/pathogens11050547
Peterman, T. A., & Kidd, S. E. (2019). Trends in Deaths due to Syphilis, United States, 1968—2015. Sexually Transmitted Diseases, 46(1), 37. https://doi.org/10.1097/OLQ.0000000000000899
Rowe, C. R., Newberry, D. M., & Jnah, A. J. (2018). Congenital syphilis: a discussion of epidemiology, diagnosis, management, and nurses’ role in early identification and treatment. Advances in Neonatal Care, 18(6), 438-445. https://doi.org/10.1097/ANC.0000000000000534
Schmidt, R., Carson, P. J., & Jansen, R. J. (2019). Resurgence of syphilis in the United States: an assessment of contributing factors. Infectious Diseases: Research and Treatment, 12, 1178633719883282. https://doi.org/10.1177/1178633719883282
Tsuboi, M., Evans, J., Davies, E. P., Rowley, J., Korenromp, E. L., Clayton, T., Tylor, M. M., Mabey, D., & Chico, R. M. (2021). Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000–20. The Lancet Global Health, 9(8), e1110-e1118. https://doi.org/10.1016/S2214-109X(21)00221-7
Tudor, M. E., Al Aboud, A. M., & Gossman, W. (2022). Syphilis. StatPearls publishing. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534780/
Assignment Description:
Based on what you have learned so far in this course, create a PowerPoint presentation for high school-aged students discussing normative aging changes, sexuality, STDs, and prevention. Be sure to address each of the following points/questions. Be sure to completely answer all the questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least two (2) sources throughout your presentation. Make sure to reference the citations using the APA writing style for the presentation. Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Review the rubric criteria for this assignment.
Address the following:
- Discuss normal body changes that occur through puberty into young adulthood
- Discuss specific STDs, causes, symptoms, complications, and treatment. You should include a slide or two for each of the following:
- Gonorrhea
- Chlamydia
- Herpes
- Hepatitis B
- HIV
- Syphilis
- HPV
- Discuss pregnancy and prevention
The assignment should be submitted in PowerPoint format, with at least 10 content slides (in addition to a title slide and reference slide) and include at least two (2) scholarly sources other than provided materials.