Infectious Disease: Syphilis Discussion Paper

Infectious Disease: Syphilis Discussion Paper

Infectious Disease: Syphilis Discussion Paper

An infectious disease is a communicable condition transmitted from one person to another. Humans are themselves a common source of infections from an infected person or a carrier. An infection occurs when there is lodgment and multiplication of a microorganism in the tissues of a host. The purpose of this paper is to discuss syphilis, including its determinants of health, epidemiological triad, and the NP’s role concerning the disease.

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Introduction to Syphilis

Syphilis is primarily a sexually transmitted disease (STD) caused by Treponema pallidum. It may also be transmitted congenitally from mother to fetus. Syphilis is not highly contagious, and one has a 30% chance of contracting the disease after a single exposure to an infected partner. However, the transmission rate is dependent upon the stage of the disease. Syphilis has a long incubation period during which the host is non-infectious (Keçici, 2018). It has four stages of clinical presentation primary, secondary, latent, and tertiary. The primary stage is characterized by a local lesion at the site of entry, which ulcerates to form an ulcer. The classic ulcer, known as a chancre, is usually single, painless, and relatively clean and can go unnoticed by the patient (Keçici, 2018). In the secondary stage, the T.pallidum spreads widely throughout the body roughly 3-6 weeks after the appearance of the chancre. Common symptoms include skin rashes, itching primarily at the palms and soles, mucosal ulceration, and generalized lymphadenopathy.

The latent stage is asymptomatic and occurs after the resolution of the clinical manifestations in secondary syphilis. Nonetheless, a patient has a positive syphilis serology test. The tertiary stage can affect multiple different organs in the body, including the heart, blood vessels, eyes (ocular syphilis), and brain (neurosyphilis) (Keçici, 2018). Patients who develop neurosyphilis have difficulty coordinating muscular movements, severe headaches, numbness, paralysis, and mental disorders. Ocular syphilis causes changes in vision and blindness. Penicillin remains the drug of choice in treating syphilis (Kojima & Klausner, 2018). Treatment in the early stage includes 7-10 days of penicillin, while beyond the early stage is at least 21 days.

Syphilis is prevalent in most developing countries and some areas of Asia, North America, and Europe, particularly Eastern Europe. The highest syphilis infection rates are in South and Southeast Asia, followed closely by sub-Saharan Africa (Kojima & Klausner, 2018). Latin America and the Caribbean have the third highest rates. Furthermore, syphilis is most prevalent during peak sexual activity age of 20-29 years. Males have higher infection rates of primary and secondary syphilis than females.

Determinants of Health

Syphilis is attributed to social determinants of health (SDOH) comprising the personal, economic, social, and environmental factors influencing health. Johnson et al. (2022) explain that syphilis is associated with SDOH, like living in poverty, homelessness or unstable housing, limited or no healthcare access, incarceration, and illicit drug use. Furthermore, belonging to particular racial/ethnic and gender-identity groups is associated with syphilis owing to discrimination, stigma, and structural racism. Socioeconomic status (SES) is one of the most important SDOH of sexual health. At the macro level, unemployment and poverty are connected with residential segregation, instability, and migration (Johnson et al., 2022). Due to racism and segregation, minority groups have experienced disproportionate poverty and access to less employment and educational opportunities. Residential instability, often caused by poverty, is a key contributor to rising STD rates in minority groups in the US, especially Blacks.

Individuals with low incomes and reduced access to health insurance have a higher risk of contracting syphilis. The availability and access to relevant health care are vital to STD treatment and prevention. Public STD services gather from people who are underemployed, disproportionately poor, uninsured, and members of minority racial/ethnic groups. Lack of insurance reduces access to preventive care and has been associated with syphilis infection (Johnson et al., 2022). Besides, living in neighborhoods with a high housing density, crime rates, and transportation barriers adversely compounds the risk of infection in these populations. Prostitution for drugs or money to purchase drugs remains a central epidemiologic aspect of transmission.

Epidemiological Triad

1. pallidum is the responsible microorganism for syphilis. It is a fragile spiral bacterium and an intracellular pathogen. It survives only briefly outside of the body, and therefore transmission usually requires direct contact with the infectious lesions. The incubation time from exposure to the appearance of primary lesions at the primary site of inoculation takes about three weeks but can range from 10 to 90 days (Keçici, 2018). Despite the stage of syphilis and location of lesions, the histopathologic hallmarks of syphilis are endarteritis, and a plasma cell-rich infiltrate. The virulence factors of T. Pallidum include outer membrane proteins, which promote adherence. The agent has hyaluronidase, which facilitates perivascular infiltration and antiphagocytic coating of fibronectin. The host humoral and cellular immune responses can prevent the formation of a primary lesion on successive infections with T pallidum (Keçici, 2018). However, they are inadequate to clear the organism. This is because the outer sheath of the spirochete lacks immunogenic molecules or the down-regulation of helper T cells. Tissue destruction and lesions primarily result from the host’s immune response.

Role of the NP

The AANP outlines the scope of practice for nurse practitioners (NPs). It defines the following NP roles: taking patient history, performing physical assessment, ordering, conducting, and interpreting lab tests, diagnosing, managing pharmacologic and non-pharmacologic treatments; care coordination; counseling, and providing health education (Peterson, 2018). Therefore, the NP has the role of assessing patients with STD symptoms, diagnosing syphilis, developing treatment, and educating individuals on prevention and control interventions for syphilis. The NP also has a role in educating the community on syphilis prevention using barrier methods like condoms (Kojima & Klausner, 2018). In addition, the NP has the role of conducting epidemiological tracing and providing prophylactic treatment to contacts. The NP is also tasked with following up on patients with syphilis by monitoring clinically and with laboratory testing to ensure they are responding appropriately to treatment.

Conclusion

Syphilis is caused by T.Pallidum, which is contracted through sexual contact and congenitally. It occurs in four stages: primary, secondary, latent, and tertiary. Complications of syphilis are evident in the tertiary stage. SDOH that increases a person’s risk of syphilis includes economic hardship and unhealthy neighborhood conditions. Social disorganization in segregated communities decreases health care access to preventive and treatment services for syphilis. Virulence factors of T.Pallidum include outer membrane proteins, hyaluronidase, and antiphagocytic coating. The NP has the role of assessing, diagnosing, and treating patients with syphilis and providing health education to patients and the community on preventing syphilis.

References

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

Keçici, A. S. (2018). Syphilis. Fundamentals of Sexually Transmitted Infections. https://doi.org/10.5772/intechopen.70282 

Kojima, N., & Klausner, J. D. (2018). An Update on the Global Epidemiology of Syphilis. Current epidemiology reports, 5(1), 24–38. https://doi.org/10.1007/s40471-018-0138-z

Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

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Purpose
Infectious disease occurs worldwide and must be addressed just as chronic disease is approached. This assignment will present the learner an opportunity to explore a communicable disease, to apply the epidemiological triad, and to discern the demographic and at-risk background data for a specific infectious disease agent . Apply the concepts of population health and epidemiology to the topic.

Synthesize Course content from Weeks 1-5 according to the following sections:
Introduction: Analysis of the communicable disease Syphilis (causes, symptoms, mode of transmission, complications, treatment) to include demographic break down that includes age, gender, race, or other at-risk indicators (da ta per demographics should include mortality, morbidity, incidence, and prevalence).
Determinants of Health: Define, identify and synthesize the determinants of health as related to the development of the infection. Utilize HP2020.
Epidemiological Triad: Identify and describe all elements of the epidemiological triad: Host factors, agent factors (presence or absence), and environmental factors. Utilize the demographic break down to further describe the triad.
Role of the NP: Succinctly define the role of the nurse practitioner according to a national nurse practitioner organization ( National Board of Nursing or AANP, for example) and synthesize the role to the management of infectious diseases (surveillance, primary/secondary/tertiary interventions, reporting, data collecting, data analysis, and follow-up). This includes the integration of a model of practice which supports the implementation of an evidence-based practice. Refer to your course textbook for models of practice examples.
Preparing the paper
Submission Requirements

Application: Use Microsoft Word to create the written assessment.
Length: The paper (excluding the title page and reference page) should be limited to a maximum of four (4) pages. Papers not adhering to the page length may be returned to you for editing to meet the length guidelines .
A minimum of three (3) scholarly research/literature references must be used. CDC or other web sources may be utilized but are not counted towards the three minimum references required. Your course text may be used as an additional resource but is not included in the three minimum scholarly references.
APA format current edition.
Include scholarly in-text references and a reference list.
Adhere to the Chamberlain College of Nursing academic policy on integrity as it pertains to the submission of student created original work for assignments .
Do not write in the first person (such as I and me).
Best Practices in Preparing the Project

The following are best practices in preparing this project:

Review directions and rubric thoroughly.
Follow submission requirements.
Make sure all elements on the grading rubric are included. Organize the paper using the rubric sections and appropriate headings to match the sections.
Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.
Title page, running head, body of paper, and reference page must follow APA guidelines as found in the current edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.
Ideas and information that come from scholarly literature must be cited and referenced correctly.
A minimum of three (3) scholarly literature references must be used. **See above section on Preparing the Paper.