TREATMENT AND DRUGS

MECHANISM OF ACTION
SECONDARY SYPHILLIS
M. ZHAFRAN DARWIS (C111 11 146)
MAGHFIRAH MAHMUDDIN (C111 11 310)
NURFADILLAH (c111 10 310)

What is Syphillis
A disease caused by the
spirochete Treponema
pallidum subspecies pallidum
that is usually sexually
transmitted.

Syphiliis Stages
Syphilis passes through four distinct clinical phases:
1. Primary stage, characterized by a chancre.
2. Secondary stage, characterized typically by skin
eruption(s) with or without lymphadenopathy and
organ disease.
3. A latent period of varied duration, characterized
by the absence of signs or symptoms of disease,
with only reactive serologic tests as evidence of
infection.
4. Tertiary stage, with cutaneous, neurologic, or
cardiovascular manifestations.

Secondary syphillis
Secondary syphilis is the stage when
generalized manifestations occur on the skin
and mucous membranes. Serological tests are
always positive in immunocompetent persons.
Rashes in secondary syphilis have three
common features:
1 they do not itch
2 they are coppery red
3 the lesions are symmetrically distributed

Treatment of Syphillis

CDC recommendation

Follow up syphillis
Follow-up for clinical and serological

assessment should be done at 3, 6 and 12

months after the completion of treatment in
early syphilis.
Non-treponemal antibody test titres correlate
with disease activity and will usually become
negative with time after successful treatment.
In some patients
Treatment failure is suggested by a fourfold
increase in titres

titer for each person diagnosed with syphilis

must be obtained on the day-of-treatment

In persons treated for secondary syphilis, the
tests usually become nonreactive 1224
months after treatment.

The JarischHerxheimer reaction

The JarischHerxheimer reaction is a self-limited
clinical syndrome consisting of
Fever
headache
flare of mucocutaneous lesions
tender lymphadenopathy, pharyngitis, malaise,
myalgias, and leukocytosis.
It occurs within 12 hours of initiating therapy and
resolves within 2436 hours.
The pathogenesis of the JarischHerxheimer reaction
is unknown, but is thought to result from cytokine
release mediated by the release of lipoproteins from
dying T. pallidum organisms

Penicilin
Penicillins are members of the -lactam
family.All penicillins have a nucleus composed
of a thiazolidine ring and -lactam ring, which
is required for antibiotic activity

Penicilin
poorly absorbed and unstable at low Ph
Penicillins are widely distributed in body fluids

and tissues
Natural penicillins can interact with amines
(such as procaine and benzathine) to form
salts with relatively low solubility;
administered intramuscularly, penicillin is
released more slowly, prolonging drug
delivery

bind to specific penicillin binding proteins

(PNBs)
inhibit cell-wall peptidoglycan synthesis

inactivate an inhibitor of autolytic enzymes

present on bacterial cell walls.

Tetracycline
Tetracycline is incompletely absorbed

primarily in the stomach and small intestine

Doxycycline is excreted in the feces and no
adjustments for renal or hepatic failure are
necessary

Tetracycline
Tetracyclines inhibit bacterial protein
synthesis by binding to the 30s
ribosomal subunit and blocking
transfer RNA binding to the mRNAribosome complex