Syphilis Review for Nurses: Causes, Symptoms, and Treatment


Hi everyone, it’s Nurse Sarah! In this review, we’ll dive into syphilis, a common sexually transmitted infection (STI). I’ll cover how it spreads, its stages, and the nurse’s role in treatment and patient education. Let’s get started!


What is Syphilis?

Syphilis is caused by the bacterium Treponema pallidum. It spreads in two main ways:

  1. Sexual Transmission
    • Syphilis is transmitted through direct contact with painless sores called chancres.
    • These sores can appear on the genitals, anus, mouth, or mucous membranes.
  2. Mother-to-Baby Transmission
    • The bacterium can pass from mother to baby during pregnancy or delivery.
    • It crosses the placenta through the bloodstream or can be transmitted during birth if the baby comes into contact with chancres.

Stages of Syphilis and Their Symptoms

Syphilis progresses through four stages, each with distinct symptoms. Remember these stages and their key signs, as they’re commonly tested on nursing exams!

1. Primary Stage

  • Timeline: About 3 weeks after exposure
  • Symptoms:
    • Painless chancres at the site of infection (genitals, mouth, anus, etc.)
    • Highly contagious during this stage
  • Duration: 3 to 6 weeks
  • Important:
    • Chancres may heal without treatment, but the infection remains.
    • Without treatment, syphilis progresses to the next stage.

2. Secondary Stage

  • Timeline: 6 to 12 weeks after the primary stage
  • Symptoms:
    • A non-itchy, full-body rash (often starting on the trunk and spreading to the palms and soles)
    • Flu-like symptoms: low-grade fever, swollen lymph nodes, and muscle aches
  • Contagious: Yes
  • Important:
    • Symptoms may resolve on their own, but the infection still remains without treatment.
    • Early treatment prevents progression to later stages.

3. Latent Stage

  • Timeline: Can last for years
  • Phases:
    • Early Latent Stage:
      • Symptoms may relapse, and the patient remains contagious.
    • Late Latent Stage:
      • No symptoms and typically not contagious.
  • Important:
    • Even without symptoms, syphilis can be transmitted from a pregnant person to their baby via the placenta.
    • Regular screening during pregnancy is critical to prevent congenital syphilis.

4. Tertiary Stage

  • Timeline: 10 to 30 years after initial infection
  • Symptoms:
    • Severe damage to the brain, nerves, heart, and other organs
    • Formation of gummas (growths in the liver, skin, eyes, and bones)
  • Contagious: No
  • Important:
    • Not everyone progresses to this stage, but when they do, the damage can be life-threatening.

Syphilis and Pregnancy Risks

If untreated, syphilis can cause severe complications during pregnancy, such as:

  • Stillbirth or death at birth
  • Congenital syphilis, leading to:
    • Deafness or blindness
    • Birth deformities
    • Neurological damage

The Nurse's Role in Syphilis Screening and Treatment

Screening Recommendations

The American College of Obstetricians and Gynecologists recommends screening all pregnant patients, not just high-risk ones. Testing should occur at:

  1. The first prenatal visit
  2. The third trimester (around 28 weeks)
  3. Delivery

This is crucial due to the rising rates of congenital syphilis.

Diagnostic Tests

  • Blood Tests:
    • Rapid Plasma Reagin (RPR)
    • Venereal Disease Research Laboratory test (VDRL)

Treatment for Syphilis

First-Line Treatment

  • Penicillin G is the CDC-recommended treatment for all stages of syphilis.
    • Intramuscular injection is typical, but intravenous administration is used for:
      • Neurosyphilis (affecting the central nervous system)
      • Congenital syphilis

Treatment During Pregnancy

  • Penicillin G is the only safe option for pregnant patients.
  • Alternatives like doxycycline or tetracycline are not safe during pregnancy.

Penicillin Allergy Management

  • If a patient has a penicillin allergy, the CDC still recommends penicillin after a process called penicillin desensitization.
    • This involves giving small doses of penicillin while closely monitoring the patient.
    • The goal is to build tolerance and reduce the risk of an allergic reaction.

Patient Education Post-Treatment

After treatment, it’s important to educate patients on the following:

  • Abstain from sexual activity until a healthcare provider confirms the infection is fully treated.
  • Follow-up testing is essential to ensure the infection is cured.
  • Notify sexual partners so they can get tested and treated if necessary.

Final Thoughts

Syphilis is a serious but treatable infection. Early detection, proper treatment, and patient education are key to preventing complications, especially during pregnancy. As nurses, understanding the stages of syphilis and the importance of screening can make a significant difference in patient outcomes.

Thanks for joining me in this review, and I hope it helps you in your nursing journey!

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