care personnel who examine potentially infectious lesions.
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, reddish, and patchy, affects the trunk and extremities, 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 tertiary syphilis can invade and destroy tissue in the skin, bone, central nervous system, heart and aorta.
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 fluid.
The infectious agent is Treponema pallidum, a spirochete. The reservoir is man. The incubation period is usually 3 weeks and ranges from 10 days to 10 weeks. Transmission is by direct contact 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 kissing or fondling involving infected surfaces/lesions. 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 officer 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. Congenital syphilis is prevented by performing serologic examinations during early and late pregnancy and ensuring treatment of positive reactors.
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 prostitutes 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 lesions 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, interview 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 confirmed cases of early syphilis should receive therapy.
Shigellosis is a bacterial infection of the intestines. 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