care personnel who examine potentially infectious
Syphilis is a treponemal disease that may be
acute, or chronic. Symptoms appear in stages as
the untreated disease progresses through primary
lesion, a rash of the skin and mucous membranes,
a long period of latency, and finally lesions of the
cardiovascular system, central nervous system,
viscera, bone, and skin. The first symptom, a
papule, appears within 3 weeks at the site of the
direct exposure contact and often erodes to form
an indurated painless ulcer (chancre). This is
primary syphilis. After 4 to 6 weeks the chancre
heals and the rash appears. This rash is flat, red-
dish, and patchy, affects the trunk and ex-
tremities, but characteristically is seen on the
palms and soles. This rash typifies secondary
syphilis. Within a few weeks or up to 12 months,
the rash disappears and is followed by a latency
period that may last from weeks to several years.
Sometimes latency continues through life and
recovery may occur. In many instances, after 5
to 20 years of untreated disease, lesions of ter-
tiary syphilis can invade and destroy tissue in the
skin, bone, central nervous system, heart and
The diagnosis for primary and secondary
syphilis is confirmed by a dark field microscopic
examination of material from genital lesions or
aspirates from lymph nodes, as well as the
serologic test for syphilis in blood or cerebrospinal
The infectious agent is Treponema pallidum,
a spirochete. The reservoir is man. The incuba-
tion period is usually 3 weeks and ranges from
10 days to 10 weeks. Transmission is by direct con-
tact with exudates of moist lesions or body fluid
secretions from mucosal surfaces (e.g., vagina,
rectum, or pharynx) of infected persons during
sexual contact. It can also be transmitted by kiss-
ing or fondling involving infected surfaces/le-
sions. Transmission can also occur through blood
transfusion. Fetal infection can occur through
placental transfer. The period of communicability
is variable and indefinite. Adequate antibiotic
treatment usually ends communicability within 24
to 48 hours.
Specific treatment as directed by a medical of-
ficer is the parenteral long-acting penicillin G. It
may be given in a single large dose of 2.4 million
units. Increased dosages and longer periods are
indicated for the late stages of syphilis.
Preventive measures should emphasize the
control of patients in a transmissible stage and
should include a search for person with latent
syphilis to prevent relapse and disability. Con-
genital syphilis is prevented by performing
serologic examinations during early and late
pregnancy and ensuring treatment of positive
Measures that promote general good sexual
health are encouraged. This includes health and
sex education in preparation for marriage.
Syphilis serology tests should be included in the
workup of all cases of sexually transmitted
diseases and as a part of prenatal examinations.
Sexual promiscuity and contacts with pro-
stitutes should be discouraged.
Provide good medical facilities for early
diagnosis and treatment of syphilis. Establish
case-finding programs that include interview of
patients and tracing of contacts.
Patients should avoid sexual contact until le-
sions clear with proper antibiotic treatment.
The most important aspect of syphilis control
is the interview of patients to identify contacts.
Best results are obtained by trained interviewers.
The criteria for contact tracing depends on the
stage of the disease. For primary syphilis, inter-
view all sexual contacts for 3 months prior to the
onset of symptoms; for secondary syphilis, those
for the 6 preceding months; for early latent
syphilis, those for the preceding year if the time
of primary and secondary lesions cannot be
established; for late and late latent syphilis,
marital partners and children of infected mothers;
and for congenital syphilis, all members of the
immediate family. All identified contacts of con-
firmed cases of early syphilis should receive
Shigellosis (Bacillary dysentery)
Shigellosis is a bacterial infection of the in-
testines. Signs and symptoms are diarrhea, fever,
nausea, vomiting, and abdominal cramps. Usually
the stools contain blood with mucus and pus.
Watery diarrhea can also occur. The average case
lasts from 4 to 7 days.
The diagnosis is established by isolation of
Shigella from the stool or rectal swabs. Shigellosis
occurs worldwide with the majority of the cases
in children younger than 10 years of age.
The infectious agents are the four Shigella
species. Man is the only significant reservoir.
Shigellosis is transmitted through direct or indirect
fecal-oral transmission. The incubation period