Holistic approaches to syphilis diagnosis and treatment

Health

Syphilis -- viewed from the perspective of Traditional Chinese Medicine as a Public Health Issue

Syphilis is an infection due to the bacteria Treponema pallidum. Syphilis is a sexually-transmitted infectious disease. The bacteria causes it spread through broken skin or mucous membranes. Syphilis is widespread in the United States and mainly affects sexually active adults ages 20 to 29 (Syphilis, 2010).

Syphilis is a bacterium caused sexually transmitted disease. It contaminates the genital area, lips, mouth, or anus of both men and women. One usually gets syphilis from sexual contact with someone who has it. It can also be passed during pregnancy from mother to baby (Syphilis, 2010). The main symptoms are hard chancre and nearby lymphadenectasis. This occurs about 2-4 weeks after sexual intercourse and most commonly in the genital region, but also in the lips, throat, tongue, and breast and around the anus. The typical hard chancre is about 1-2 cm in diameter and round or ovary shaped. It has a distinctive border, and obvious infiltration. They are typically flat ulcerous sores, manifested by chondroid hardness with no pain and tenderness. They are called chancre sores in Chinese Medicine and are accompanied by nearby lymphadenectasis, namely syphilis bubo (Syphilis, n.d.).

Lesion of Dermal Mucosa in Phase ? can occur in 80-95% patients and usually subside automatically. It usually occurs 7-10 weeks after infection or 6 -- 8 weeks after appearance of a hard chancre. The early symptoms are influenza-like along with general lymphadenectasis.

Phase ? Mucocutaneous Syphilis consists of the following things. Nodular Syphilid occurs 5-10 years after infection. In most cases, subcutaneous nodes are listed in the cyclic, polycyclic or horseshoe forms. They are frequently seen on the face, four limbs, or scapula and between the scapulae, and can disappear naturally to leave atrophic macules, or superficial ulceration. Mter healing, scars can be left with new lesions on the border. Syphiloma Small hard nodes under the skin enlarges gradually and adheres to the skin to form infiltrative plaques and cause perforating ulceration after gradual softening in the center, mostly in the extension aspects of the four limbs, forehead, head, sternum region, legs and buttocks. Syphiloma in the upper palate and nasal septum can invade the bone to discharge the dead bone and to cause perforation in the upper palate and nasal septum and saddle nose (Syphilis, n.d.).

History

Syphilis first appeared prominently in Europe at the end of the fourteenth century, and by 1500 syphilis had spread to most of the continent. The explorer Vasco da Gama is thought to have carried it to Calcutta in 1498, and by 1520 syphilis had reached Africa and China. It was considered the sexual plague of the sixteenth century. Syphilis remained a major part of the infectious disease landscape throughout Europe, Asia, and Africa for centuries. The disease was thought to have come to the United States with the fifteenth- and sixteenth-century explorers (Syphilis: A Sexual Scourge with a Long History, 2009).

Epidemiology

Reporting of syphilis cases in the U.S. began in 1941; since that time, the incidence of syphilis has varied greatly. The occurrence of primary and secondary syphilis continues to cycle with peaks and troughs and reached an all-time low in 2000, with 2.1 cases per 100,000 persons. During 1999, the Centers for Disease Control and Prevention (CDC) launched the National Plan to Eliminate Syphilis from the U.S. Unfortunately, syphilis rates again began to rise, reaching 2.7 cases per 100,000 persons in 2004. The increase in both primary and secondary syphilis is thought to be due to an increased incidence among men. Today, more than 60% of new cases of syphilis occur in men who have sex with men and these cases are often associated with HIV co-infection and high-risk sexual behavior. HIV co-infection rates have been reported to be as high as 60% in Los Angeles, 51% in Chicago, 60% in San Francisco, and 34% in Houston. While the rates of primary and secondary syphilis in the U.S. have increased among men in recent years, they have remained stable among women. In addition, rates of primary and secondary syphilis among women and rates of congenital syphilis have shown an average yearly decrease of 19.8% and 17%, respectively, from 1991 to 2004. The racial difference among African-Americans and non-Hispanic whites peaked in 1992 with a ratio of 62:1 and has been declining ever since with a ratio of 5.6:1 in 2004 (Kent and Romanelli, 2008).

Groups at Risk

Any person is at risk for syphilis during sexual contact with an infected person or a person whose syphilis status is not known. Babies born to infected women are also at risk (Syphilis, n.d.). Those that have an increased risk for syphilis are those who have had multiple sex partners, have sexual relations with an infected partner, have been infected in the past with another STD and do not use condoms (Syphilis, 2008).

Risk Factors

One has an increased risk of acquiring syphilis if they engage in high-risk sexual activity, including unprotected sex, sex with multiple partners, having sex with a new partner, or having sex under the influence of drugs or alcohol, are a man who has sex with men or are infected with the human immunodeficiency virus (HIV). The more sexual partners that one has, the more likely they are to get syphilis or another sexually transmitted disease (STD). Even if one has had syphilis and been treated for it previously, they can get it again (Risk factors, 2008).

Management

Traditional Chinese Medicine (TCM) uses a unique system in order to diagnose and cure illness. The TCM philosophy is fundamentally different from that of Western medicine. In TCM, the perceptive of the human body is based on the holistic understanding of the universe as described in Daoism, and the treatment of illness is based primarily on the diagnosis and differentiation of syndromes (Introduction to TCM, n.d.).

TCM treats zang-fu organs as the center of the human body. Tissue and organs are linked through a network of channels and blood vessels inside the body. Qi (or Chi) acts as a transporter of information that is expressed externally through jingluo system. A dysfunction of the zang-fu organs is often reflected on the body surface through the network, and diseases of body surface tissues may also affect their related zang or fu organs. Affected zang or fu organs may also affect each other through internal connections. Treatment with Traditional Chinese medicine starts with the analysis of the entire system, and then focuses on the correction of pathological changes through readjusting the functions of the zang-fu organs (Introduction to TCM, n.d.).

Accumulated Toxin of Bayberry Sore refers to phase ? syphilis, mainly manifested by the typical symptoms of nodular skin rashes or mucosal and skeletal Syphiloma. Infantile Remnant Toxin refers to placental syphilis. It is believed in Chinese medicine that Bayberry Sore is mainly caused by infection of essence transformation, in which the toxin takes the advantage of deficiency of the liver and kidney to invade the interior during ejaculation in sexual contact with the patient with syphilis, or by infection of qi transformation, in which the toxin transmits inwards via the lung and spleen meridians in contact with the dirty toxin, or by infection of toxin in the fetus due to transmission of the toxin from the body of the mother. Once infected by pathogenic factors, the toxins can be accumulated in the internal organs and manifested externally on the skin to cause this disease (Introduction to TCM, n.d.).

Syphilis is a general disease and should be treated generally. At present, the treatment is given in accordance with syphilis therapeutic draft stipulated by the epidemic prevention bureau of the health ministry of China. Chinese medical treatment can be used as an auxiliary therapeutic measure (Syphilis, n.d.).

Primary Level

Sexual overstrain refers to exhaustion due to overindulgence in a sexual life. Abstinence from sexual overstrain is not only the important measure to preserve health and prevent diseases, but also the objective requirement at the stage of recovery. Sexual behavior is the human instinct and the important component part of life. From the viewpoint of medicine, moderate sexual life is the physiological and psychological needs of the human body, while celibacy and asceticism are by no means beneficial to health and longevity. But this does not mean overindulgence in sexual life, but temperance should be exercised. Intemperance in sexual life inevitably consumes renal essence, impairs primordial qi and injures the human health (Syphilis, n.d.).

The patient should set aside his worries and have a good rest due to deficiency of essence and qi to supplement qi and restore health. Overindulgence in sexual life without temperance consumes his essence even more seriously to result in the development of the disease into an incurable one. Patients with pulmonary tuberculosis suffer from deficiency of yin and essence. Their yin and essence should be nourished. If indulging in sexual life frequently, they are extremely susceptible to the deterioration of the disease. Take the renal disease, hypertension and coronary heart disease for examples. These diseases may be aggravated or deteriorated because of indulgence in sexual life as well. In severe cases, indulgence in sexual life even may cause vital crises such as cerebral bleeding and myocardiac infarction. Accordingly, sexual life should be moderated during the daily health care and rehabilitation. In severe cases, sexual life should be stopped for the time being (Syphilis, n.d.).

There are several tests that can be used to for Syphilis. These include: Syphilis Serum Test, the venereal diseases research laboratory test (VDRL test), unheated serum reagin test (USR test), rapid plasma reagin card test (RPR test), and cardiophospholipid is used as an antigen to examine the anti-cardiophospholipid antibody in serum. This test is used for screening examination. In spirochete antigen test, such as fluorescent treponemal antibody-absorption test (FTA-ABS test), Treponema pallidum hemagglutination test (TPHA), usually the diagnosis of syphilis can be confirmed by positive result in the spirochete antigen test (Syphilis, n.d.).

Secondary Level

Treatment is based on syndrome differentiation. The first syndrome is that of Syndrome of Dampness and Heat in the Liver Meridian. Main Symptoms include single hard papule in the external genitalia and anus or breast, surrounding swelling, burning sensation in the infected area, white and hard mass in size of apricot kernel or egg in the inguinal groove, bayberry eruption, bayberry nodes or bayberry plaque in the chest, abdomen, lumbus, flexion aspects of the four limbs and neck, accompanied by bitter taste in the mouth, poor appetite, scanty and brown urine, constipation, yellowish and greasy tongue coating, wiry and rapid pulse. The therapeutic method used for this syndrome includes clearing the liver, dissolving toxins, removing dampness and alleviating plaque (Syphilis, n.d.).

A second syndrome is that of the Syndrome of Mixture of Phlegm and Blood Stasis. The main symptoms include purple red chancre sores with hard and protruded border, or tough bubo, or purple nodular bayberry sores, or belly as hard as a brick, hepatosplenomegaly, slightly purple tongue or dark tongue, greasy or moist coating, slippery or thready and hesitant pulse. The therapeutic methods used for this syndrome include expelling stasis, to dissolve toxins, to dissipate phlegm and disperse accumulation (Syphilis, n.d.).

A third syndrome is that of the Syndrome of Dampness Accumulation due to Spleen Deficiency. The main symptoms of this include ruptured chancre sores, slight moisture on the surface, or extensive ulceration, dark brown skin color, or dermal boils with discharge of yellowish fluid, or falling putrid flesh, without healing for a long time, accompanied by soreness and pain in the tendons and bones, stuffy chest, poor appetite, loose stool, fatigue in the limbs and heavy sensation in the body, flabby and moist tongue, greasy coating, slippery or soft pulse. The therapeutic methods that are used include strengthening the spleen, removing dampness, dissolving toxins and dissipating turbidity (Syphilis, n.d.).