Contemporary society faces the problem of sexually transmitted diseases and syphilis as one of such diseases. The Healthy People 2010 is the agenda designed by the national organization that provide the population with health care services and establishes effective strategies. This agenda includes sexually transmitted diseases and other areas of concern that can be used to promote a healthy lifestyle among people of different generations.
In this respect, the Healthy People 2010 national agenda contains strategies and practices aimed at prevention of illness and promotion of health that were introduced in 2000 to enable the health care organizations to provide appropriate health care services to the population of the United states for the period of 2000-2010 (Centers for Disease Control and Prevention, 2009a, n. p.).
Syphilis is one of the sexually transmitted diseases that causes ulcerating chancre spread to all body tissues. Demographic peculiarities of people that live on the territory of the United States are also taken into consideration while creating this national agenda on health care.
Healthy People 2010 Goals and Its Relation to Syphilis
As the national agenda Healthy People 2010 is aimed at solving a number of health care problems and those related to the health of the population, it is necessary to indicate the key concepts that should be analyzed in terms of syphilis as a sexually transmitted disease. The main problem is that the problem of syphilis is a burning issue for different generations.
As such, those young adults or even students at school who start their sexual life know little, if any, about sex and sexually transmitted diseases. In this respect, education of such people and prevention of illness are important strategies in solving this problem.
So, the Healthy People national agenda includes different areas of concern that are related to syphilis as a sexually transmitted disease. For instance, access to quality health services as well as educational and community-based programs (Centers for Disease Control and Prevention, 2009b, n. p.) should be viewed as ways for promoting healthy lifestyle with regard to syphilis.
Though the aspect of immunization and infectious diseases (Centers for Disease Control and Prevention, 2009b, n. p.) has little relation to syphilis, family planning issues are affected by the problem of syphilis because each parent should be concerned about the health of a future baby and potential threat of danger imposed by syphilis and other sexually transmitted diseases.
At the same time, such issues as injury and violence prevention and maternal, infant, and child health (Centers for Disease Control and Prevention, 2009b, n. p.) as well as public health infrastructure should be taken into account while developing strategies for preventing syphilis because people suffer from violence when they are infected with syphilis due to violent actions.
Besides, substance abuse can be considered one of the reasons for being infected with syphilis when people are ready for anything only to receive a dose of a drug.
Syphilis in Leading Health Indicators
As syphilis as a sexually transmitted disease is one of the leading health indicators (Centers for Disease Control and Prevention, 2009c, n. p.), it is necessary to find solution to the problem of ineffective education of people about the danger of sexually transmitted diseases, symptoms, and ways of treatment. In this respect, the national agenda should include cooperation with educational institutions to propagate safe sex and prevent syphilis.
Reference List
Centers for Disease Control and Prevention. (2009a). Healthy People 2010. Web.
Centers for Disease Control and Prevention. (2009b). Healthy People 2010. Web.
Centers for Disease Control and Prevention. (2009c). Healthy People 2010. Web.
Describe the facts surrounding the Tuskegee Syphilis study
The Tuskegee syphilis study is the most controversial research ever performed on the black race. It was carried out in a small town of Tuskegee in Alabama. The participants of the study were completely ignorant of the experiment. The hope of treatment for the participants of the experiment was not in sight. In addition, these people died in their numbers for something they never understood.
The Tuskegee syphilis study was a complete disaster. There was a time when doctors in the United States believed that black American’s resistance to the effects of syphilis was not high when compared to the whites. This theory motivated the racial study of blacks in the United States. With the high rate of syphilis in Alabama, the government felt it was time to use these black folks as a pawn for their medical research.
The government of Alabama decided to conduct medical research on black Negroes who had syphilis. The victims of the Tuskegee syphilis study were told that they were treated on a free term. The study generated ethical questions on public health (Heintzelman, 1997).
There are some notable facts about the Tuskegee syphilis study:
The government of the United States of America abused the constitutional rights of the victims of the Tuskegee study.
The authorities of the Tuskegee study did not treat the patients who had syphilis.
These victims did not give their consent before the study.
The objective of the Tuskegee syphilis study was racially motivated.
Although the research was a comprehensive one, there were no regulations during the study.
There should be proper documentation of the research study and the progress of the study must be published on an annual basis.
Explain why the Tuskegee Syphilis study is considered an important milestone in the history of public health research
The Tuskegee experiment has changed the world in many ways. Research on humans has been re-examined. After the exposure of the Tuskegee study, medical research board raised various ethical questions as it regards the use of humans as research subjects. An ethical code of conduct for health practitioners was formulated and it was called the Nuremberg Code, it consists of 10 fundamental points of research. However, this ethical code did not prevent the doctors that performed an unethical study on the Tuskegee subjects.
One notable milestone achieved was based on the information given to the participants of the experiment. There were suggestions that all participants should have the right to know the reason for the experiment, the risks, and hazards associated with the experiment. Each participant has the right to accept or refuse to be part of the experiment. The use of deceit to lure a participant into a research program was termed unprofessional and unethical. The Tuskegee syphilis study became the pivot for much debate on the rights of human subjects used for experiments. The Nuremberg code of 1947 had loopholes and did not get international acceptance.
Although this code was passed in 1947, it did not stop the doctors in Alabama from performing their atrocities on the black race in Tuskegee (Heintzelman, 1997). The Tuskegee experiment came at a time when the economic situation for the black people in the States was below average. While doctors used the situation to give monetary tokens to the victims of the syphilis study. The major effect of the Tuskegee study was on the black race. After the failed experiment, black Americans are yet to come to terms with their loss. In addition, they oppose any form of treatment that includes vaccination.
Describe the need for ethical guidelines to govern health research
Guidelines are necessary for the success of any research. It is upon this set of rules that any research may be probed for its failures or success. The Nuremberg code of 1947 fell short of medical standards. Article 5 of the Nuremberg code had its own flaws; it states that an experiment can be done on an individual provided the medical investigator is ready to risk his/her life. You cannot take another person’s life because you are ready to lose yours.
For example, if a man is drunk with alcohol, should he be allowed to drive other people to their death, because he is ready to risk his own life? This is a major loophole in the Nuremberg code of 1947. Article 10 stated that the medical investigator might stop the research if he sees any danger. There was no definite rule on when to stop, but a decision that lies solely with the investigator’s willingness to terminate the experiment if he wishes. This is another flaw in the 1947 Nuremberg code. By law, an experimental study on humans should be terminated if it is a risk to the life of the subject.
In order to safeguard the lives of people, health guidelines must be followed. In addition, there is a need for ethical guidelines to govern health research. The storyline in Miss Evers Boys portrayed the loopholes in the ethical guidelines that govern health research. The movie showed to the entire world the rot in the medical research field. The fact that experimental studies are meant for the good of the people, does not entail that lives should be lost in the study. There is no justification for causing the death of an individual used for an experiment.
The case of the Tuskegee syphilis was an example of misguided research. There was no proper documentation for the participants used for the experiment. Those who lost their lives in the experiment were not accounted for, neither were their names complied. The Tuskegee experiment lasted for 40 years and there was not a single journal that was published on the findings of the research.
This is a major setback for any meaningful research. Ethical guidelines limit the use of science to cause harm or take the life of a person. In 1974, the National Investigation Human Board was established and was in response to the Tuskegee syphilis saga. Alongside was the Tuskegee Health Benefit Program, it was set aside to help the victims of the Tuskegee experimental research.
What are the recognizable key Hypothesis that underlined contemporary research impacting the Tuskegee Syphilis study on health research
The hypothesis for any research should not be controversial or made on assumptions. The effect of using assumptions could affect the quality of the study. Unlike contemporary research guidelines, the key to a productive study rests on the tests of the hypothesis. In addition, it must be fruitful, unbiased, and will not be used to take lives. In conclusion, the Tuskegee syphilis study, which was performed in Miss Ever Boys’ film, will not be forgotten by the black community. Moreover, still raises questions about the ethical standards and guidelines used by researchers.
Reference
Heintzelman, C. (1997). The Tuskegee Syphilis Study and Its Implications for the 21st Century.
Syphilis has been known to be one of the world’s feared chronic venereal diseases and Tuskegee syphilis is not exceptional. The study of the disease dates back to the 1910s. When there was research on guinea pigs and ever since this failed due to poor treatment administration and lack of advanced research, the focus was turned on man. Oslo clinical observations had revealed pathological manifestations in the white men observed thus need for scientific research on the disease pathology, clinical signs, disease cause, and fatalism, epidemiology and find convenient treatment with preventive measures. The kind of study that they did was retrospective and there was a need for a progressive study. Oslo also got a big blow upon the downfall of the stock market hence the lack of funding to continue with the research. It is to this call that in 1932, the longest nontherapeutic experiment was established by the Tuskegee Institute in collaboration with the Public health service. They got 399 infected persons for their subjects and 201 healthy persons as control. These people were taken from the poor illiterate African Americans at Macon country, Alabama.
This research was concealed from the public as the physicians undertaking it knew that this was morally wrong and the highest order of racism in medicine with abuse of humanity. The government was at the forefront of supporting the research where the poor people were given some compensation for unknowingly participating in this fatal and unethical study. They were told that they were been treated for bad blood which could signify syphilis anemia or fatigue. Among the compensations were: free medical examinations, meals, burial money, and transportation to and fro their homes and clinical centers. In exchange, they have subjected Salvarsan, mercury-based, and bismuth drugs which were toxic with advanced side effects yet ineffective. In 1934 when penicillin was found to be a more effective drug with fewer side effects and fur much less toxicity, there was a national campaign for treatment of Tuskegee syphilis with specific clinics set up for treatment but, the men under experiment were not allowed to access medication. They were subjected to unproductive treatment to provide room for the assessment of the fatal progression of the disease. Once any of them died a post mo term examination was carried out to analyze the effect of the virus on the cells and tissues this was also the determinant factor to accord funeral benefits.
The task involved several physicians key among them was, Dr. Oliver C. Weger who did the first developmental analysis setting down the protocols to be observed in the research. The site director Dr. Kario Von Pereira had to do the initial examinations to detect the presence of the virus as well as give down the ways to be followed in the treatment. Dr. Raymond H. Vondelehr gave policies to be followed and urged that the subject’s consent be sort when conducting the neurological spiral taps text in the advanced levels of the disease. After the groundwork and base were laid, Dr. John R. Heller carried out the progressive phase during which the administration of drugs was done. He was an outspoken person defending the unethical study in his argument that the people involved were lab materials called subjects but, not sick patients as thought by society. He, therefore, saw no need for ethical debate. Another key person in the study was an African American nurse named Eunice Rivers, she was in the entire process from the beginning to the end. She was the contact person between the physicians and the community. Treatment, transportation, accommodation of very weak subjects, organization of the clinic days, the free meals and the continuity of the study were all under her care.
It was not until 1966 that Dr. Peter Buxtun(director for the division of venereal diseases), stood up to question the morality of the study. The government and the physicians involved ignored his questioning and so he set up to leak the information to the public through the press where he wrote a report concerning the study in 1970 (Hitner pp 1177). The report was also sent to the National Medical Association and the American Medical Association. He was called at a congress held by Senator Ted Kennedy to present his report. After which the National Medical Association filed a lawsuit against the study. So the Tuskegee Syphilis Study Committee was formed to investigate the matter. They dug deep into the origin, progress, feelings of the physicians, effects of the study to the African Americans, the political impact, legal aspects involved and did an analysis of participants’ anthropology.
It is from their findings and recommendations that the study came to an end in 1972 after 40 years of its existence. At this point; of the 399 persons infected, 28 had died from the disease, 100 died from complications by drugs administered and secondary infections, 40 wives were infected and 19 children contracted the disease through congenital aspects. At this time only 74 persons had survived although with very poor chances of full recovery. The effect of this study led to the establishment of the National Research Act and so the affected families were compensated with $ 9 million, free medication to the survivors and their infected family members. This was finally marked with an apology speech by President Clinton in 1997 at the white house where the Tuskegee Study Committee members and the 5 survivors remaining attended. (Jones pp 72).
Mr. Clinton’s apology was quite genuine as he clearly admitted that there was no reverse nor adequate compensation to the loss, pain, and damage caused by the study. He also highlighted that the matter could not be ignored nor the issues pertaining to the study overlooked. The way out was to face the victims and admit that he and the government were sorry. Such abuse of human ethics was not to be kept silent now or ever.
His apology was, however, not received by some African Americans as genuine since they held back to their belief that they were still discriminated against. The civil rights movement had capitalized on this study in their protests. An African American preacher Mr. Jeremiah Wright criticized the act as the highest form and degree of racism. The study developed a very negative impact on the African American approach to medical trust thus shunning treatment activities, preventive measures of some diseases, and transplantation of organs together with their donations.
In conclusion; this was the most unethical conduct in the medic cycles. It had a very strong sense of racism. The fact that the true information was withheld from the subjects and the public makes it even worse. Their denial to access medication is criminal in nature as it is murder. The government supposed to protect the citizens were in fact exploiting them. Although President Clinton’s apology was genuine the compensations given were not sufficient. The law on National research was a very positive move and more moves should be made. Animal scientists are already campaigning for the welfare of animals in terms of their use in medical research and so it is my opinion that the use of fellow human beings should be unheard of. If it is vitally important to use man in research, let it not be for a longer course than half a year. The persons should be fully aware of what is to be done and the repercussions thus, enroll on a voluntary basis.
Works cited
Hitner, S. “Tuskegee Syphilis Study under review” Christ century 90 (43); (1973) pp 1174-1176.
Jones, James H. Bad blood: The Tuskegee Syphilis exercise. New York, Free press.(1981) pp 1-85.
Olansky S; Lsimpson et al. Environmental factors in the Tuskegee study of the untreated syphilis. A public health report 69(7); (1954) pp 691-698.
It should be stated that complaints of painless bumps on genitalia can signify many conditions, the diagnostics of which requires gathering more detailed information from the patient. Based on the subjective data given by AB and objective findings, it is impossible to make a final diagnosis, which means that more information should be gathered from this woman. The primary diagnosis of a chancre cannot be rejected, though it cannot be accepted unless supported with results of diagnostics. Differential diagnoses identified include sexually transmitted diseases, such as genital herpes (Simplex II), asymptomatic genital herpes with Chlamydia, and syphilis. However, additional tests should be performed in order to make a conclusive diagnosis.
Additional Information
Additional subjective information should be gathered from the patient by the health care professional. It is not known if the patient has noticed bumps in the past or this is for the first time. The description of painless bumps is rather broad and insufficient. The patient does not specify where the bumps are localized. She should be asked what recent illnesses she had and if she noticed bumps on any other part of her body and whether there are internal bumps.
Considering that AB had Chlamydia two years ago, she should be asked if she had any similar symptoms at that time. Currently, AB states that the bumps are painless, but it should be clarified if she felt any itching before she noticed them and whether she feels any discomfort now.
To determine a diagnosis, AB should be asked if the bumps weep or become crusty and whether they change over time. Additionally, more detailed past medical history should be obtained to learn if she had other STIs. In order to reject the diagnosis of contact dermatitis, it should be clarified which food and topical allergies the patient has. Finally, considering that AB has had an STI, a medical professional should ask what protection she currently uses, with whom she lives, and how many people share the bathroom.
Objective data also seems to be incomplete, as other body parts should be checked. In particular, it is important to assess her throat for redness and other signs of HSV and her neck for any apparent goiters or nodules. The cervix needs to be inspected for uterine size and presentation (Sullivan, 2019). Bartholin and Skene glands should be palpated for Bartholin’s and Sebaceous cysts.
Diagnostics
It is impossible to make a diagnosis without performing appropriate diagnostics. Tzanck smear can be used to confirm the diagnosis of herpes infection (Dains, Baumann, & Scheibel, 2016). Nucleic acid amplification tests can be used to identify Gonorrhea and Chlamydia. Syphilis Serology should be used for the screening of syphilis and positive results should be confirmed using treponemal tests such as TPPA or FTA-ABS (Morshed & Singh, 2014). Scrapings from the ulcer can be taken to identify spirochetes (Dains et al., 2016). The acetic acid test can be used for examination of cervical lesions.
Differential Diagnoses
AB may have syphilis with painless bumps being its first signs. This is supported by the fact that the patient has had STIs and is sexually active. Since the ulcer appears on the external labia, it can be in contact with a syphilis sore. This condition can be confirmed with serology or nontreponemal and treponemal tests. The second differential diagnosis to be considered is genital herpes (Simplex II). The condition has an erythematous base and is located in the genital region. The ulcer can be painful, but it does not itch or burn (Ball, Dains, Flynn, Solomon, & Stewart, 2015). The third possible diagnosis is asymptomatic genital herpes with Chlamydia.
AB can have Chlamydia and Herpes due to her prior history of Chlamydia and sexual habits. In some cases, genital herpes can be asymptomatic, which may explain why AB does not feel itching or burning in her genitalia (Dains et al., 2016). NAATs with vaginal self-swabs are recommended for diagnostics of asymptomatic Chlamydia (Westhoff, Jones, & Guiahi, 2011). However, the lack of data does not make it possible to make a conclusive diagnosis.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Morshed, M. G., & Singh, A. E. (2014). Recent trends in the serologic diagnosis of syphilis. Clinical and Vaccine Immunology, 22(2), 137-147. Web.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5-10. Web.
Syphilis is a sexually transmitted disease (STD) caused by a bacterium known as the spirochetal bacterium. This bacterium initially causes genital ulcers and can be treated using antibiotics. If not treated early it may cause serious infections such as blindness, heart damage, damage to the bones or nerve damage. This paper seeks to find the major causes, the signs and symptoms of syphilis and why it is prevalent among the black people living in America.
Causes of syphilis
It is mainly caused through sexual transmission although is can be passed on from mother to child. If a pregnant woman is affected with syphilis, the bacterium can affect the child in the uterus. The infections the baby will get depend on the stage of syphilis that the woman is at. Women who have been infected for along period of time are at high risks of giving birth to dead babies or babies who dies after a short time (Bruess & Greenberg, 2008).
Signs and symptoms
The signs and symptoms of syphilis manifest themselves at different stages of the disease. In most cases majority of the infected do not show any signs or symptoms for many years though they continue being at risk of complications, which may occur latter if not treated. In babies born with the disease, some may show symptoms and others may show no sign but if not treated the baby may develop serious problems.
Primary syphilis
Primary syphilis is normally gotten through direct sexual contact with an infected person. After 10-90 days (from the day of infection) sores or lesion begin to appear on the skin. This skin lesion is normally painless and causes firm ulcers at that point of initial exposure to the bacterium which can be the penis, vagina, and rectum (Bruess & Greenberg, 2008). After about 4 to 7 weeks, the lesion grows impulsively.
Secondary syphilis
On an approximate of one to six months after primary infection, the secondary infection appears. Initially symmetrical reddish-pink rashes which are not itchy appear on the trunk and farther points. Such rashes can appear on the palm of hands and soles of feet. It can also appear in places of the body which are moist for example the vulva or scrotum where the rash becomes even, large, whitish, wart-like lesion. In the mouth or the genitals mucous patches may appear (Winter, 2006). A person suffering from secondary syphilis may experience weight loss, fever, sole throat, headache, meningitis, arthritis, among other infections. Secondary syphilis is more contagious than primary syphilis.
Latent syphilis
This is a condition where by one has the disease but shows no signs or symptoms. In early latent syphilis one can have the disease for less than two years since the day of infection but experiences no signs or symptoms of the disease while as in late latent syphilis one can have the disease for more than two years since the day of infection with no any medical proof of the disease. In order to treat late latent syphilis one requires a continuous 3 weeks injection although it is not as contagious as early latent.
Diagnosis of syphilis
Syphilis can be diagnosed by an examination of some materials from an infected sore. This examination is done using a microscope known as a “dark-field microscope” bacterium will be seen through the microscope. Another popular method is by use of blood test. After one is infected by the bacterium, syphilis antibiotics are produced by the body which can be detected by a simple blood test (Winter, 2006).
Syphilis in United States
Although it is an ancient disease, it is still of major concern today especially in the United States. In the period 1990 to 2000 the number of infection declined by approximately 90% but rose again in the period 2000 to 2006 from 5,979 to 9,756. This increase was particularly high in year 2005 to 2006 where it rose by approximately 12%. The increase was associated with changes in the groups that were affected most. Primary and secondary syphilis in men increased by almost 54% during the period 2002 – 2006. The number of men infected increases by 11.8% in 2005 to 2006 especially among homosexuals while that of women increased by almost 11.4% during the same period (Anon, 2006).
In 2006 the health officials recorded 36,000 syphilis cases 9756 of that number being primary and secondary syphilis. Majority of the infected were persons between the age of 20 and 39 years. In women majority were from 20 to 24 years while in men majority were from 35 to 39 years of age. Cases of syphilis transmitted from mother to child during birth also increased in 2006 (Anon, 2006).
Black men were the most vulnerable to this disease. According to data collected in years 2003 and 2004 it revealed that there was a difference in the number of people infected by the disease between the blacks and the whites. The number of black men infected had increases drastically since 1993 to 2003 as compared to the whites. In 2000 to 2003 the incidence among the blacks had initially decreased but rose again in 2004. This was the only year since the year 1993 that there was an increase the difference between the white and black people of the incidences of primary and secondary syphilis infections. Among the black men, syphilis was common among the homosexuals.
Environmental factors
Some of the factors that contribute to the spread of syphilis are biological factors, public health, sexual behaviors, access to health care, and changes in population. Majority of men infected are low income earners both in the rural areas and urban settings. The number of sex partners that one has affects the spread of syphilis and also some sociophysical factors such as availability of treatment. The spread of syphilis among the black men was wider due to lack of proper diagnosis and treatment.
Treatment of syphilis
If detected during its initial stages, it’s easily treated than on its advanced stages. A person infected with syphilis can be treated using a single “intramuscular injection of penicillin” for a person who has been infected for more than one year it will require more doses to treat. Individuals who have been exposed sexually to a person who have been diagnosed with either primary, secondary or latent syphilis is assumed infected and should be treated.
Penicillin G has remained as the only effective therapy even for pregnant mothers. However non pregnant people with allergic reactions can be treated using oral tetracycline or doxycycline although they are not as effective as penicillin G. Another dose that has been used as an alternative is Azithromycin. Azithromycin has been found to be sensitive it has resistance is some areas thus not effective.
Majority of the black people infected with syphilis were not treated for many years. Most of them were not that they were infected which was a major cause of mental illness or even death. Medical officials in United States promised them free treatment for what was termed as “bad blood” but they were never treated for the disease even after the discovery of penicillin. This facilitated the spreading of the disease because even those who were infected were not given proper diagnosis and they continued spreading the disease. This contributed to the drastic increase of the disease especially in 2004 among the black men.
Prevention and control of syphilis
The prevention of syphilis and its control is conducted in health departments and the state. These departments receive grants and personnel assistance from the center for disease control and prevention (CDC). CDC is aimed at ensuring that health providers are equipped with the necessary skills that will help in prevention of the spread of STDs. CDC has started centers for training of health providers in almost 10 public health schools where they offer special training in STD prevention and control (Bruess & Greenberg, 2008).
Proper use of latex condom can be used as a form of prevention against syphilis. This may not be relied on completely because other parts that are non genital can also be affected and the condom will not prevent such areas from infections.
Social and cultural factors
In cases where syphilis is diagnosed and treated at its initial stages, its spread becomes limited. There are communities where STDs is publicly addressed and people are advised on how to go about them if they become infected. In other communities people die in silence because it’s seen as a taboo and hence people shun from talking about it. In the United States, the blacks were discriminated against and were not given any form of awareness concerning the disease that could have prevented them from spreading syphilis among themselves.
Conclusion
Syphilis is an STD caused by a bacterium. This bacterium is passed on during sexual intercourse or by a pregnant mother to the baby. The signs and symptoms of syphilis manifest themselves at different stages of the disease. In most cases majority of the infected do not show any signs or symptoms for many years though they remain at risk of developing complications which may occur latter if not treated. Primary syphilis is normally gotten through direct sexual contact with an infected person. After a period of about 10 to 90 days painless and firm sores begin to appear on the skin. If this is not treated, the infection proceeds to secondary stage. In secondary syphilis, initially symmetrical reddish-pink rashes which are not itchy appear on the trunk and extremities. Such rashes can appear on the palm of hands and soles of the feet. Latent syphilis is the stage whereby one lives with the disease but shows no signs or symptoms.
Syphilis is more common among the black people in the United States. Black men were the most vulnerable to this disease. According to data collected in years 2003 and 2004 it revealed that there was a disparity in the number of people infected by the disease between the blacks and the whites. The number of black men infected had increased drastically since 1993 to 2003 as compared to the white. Most of the black were discriminated against in terms of treatment. They were not properly diagnosed but were told that they were suffering from bad blood and received treatment for that.
Reference
Anon. (2006). Primary and Secondary Syphilis -United States, 2003—200. Web.
Bruess C., E., & Greenberg J., S., (2008). Sexuality Education: Theory and Practice. New York: Jones & Bartlett Publishers.
Winter, A. (2006). Syphilis The library of sexual health. The Rosen Publishing Group.
HPI: A 26-year-old Hispanic female presents with a complaint of watery fish-smelling vaginal discharge. The symptoms started about a month ago, and attempts to get rid of the odour have not been successful. AM tried taking showers frequently, but no relief was noticed. She is sexually active and has one partner of the male gender.
Location: vagina
Onset: 30 days ago
Character: watery discharge with a very unpleasant odour
Associated signs and symptoms: occasional skin irritation in the vagina
Timing: all day round
Exacerbating/ relieving factors: when hydrocortisone topical (ointment) is applied, the itching becomes less severe, but the smell still does not disappear
Severity: 9/10 pain scale
Current Medications: hydrocortisone topical (ointment), several times a day for the past two weeks
Soc Hx: AM is a hotel manager, and she spends much time at work. In her free time, the patient enjoys doing sports and going places. AM is not married, but she has been in a serious relationship for the past three years. The patients used to smoke when she was a teen, but she quit nine years ago. AM can occasionally have a few glasses of wine, but she is very self-cautious and always controls the consumption. The patient has three years of driving experience; she always fastens her seat-belt and makes her passengers do the same. AM’s apartment is situated in a clean district, not far from her parents’ home. The family is friendly, and AM can always rely on them. Her mother even accompanied her to the appointment in case the patient would not be able to drive back home.
Fam Hx: AM’s maternal grandmother died of ovary cancer. AM’s mother has been treated for cervical dysplasia, and she suffers from menstrual disorders.
ROS
GENERAL: AM has lost one pound over the past month; she does not experience fatigue or any health changes.
HEENT: Eyes: normal vision. Ears, Nose, Throat: normal hearing, no throat pain, no abnormal nose discharge.
SKIN: no itching or rash.
CARDIOVASCULAR: no pain in chest; no oedema or palpitations.
GASTROINTESTINAL: loss of appetite; no vomiting, or diarrhoea, nausea, or anorexia. No abdominal pain or blood.
GENITOURINARY: Last menstrual period: 1/20/2019. No pregnancies, abortions, or miscarriages.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCTINOLOGIC: No polydipsia or polyuria. No heat or cold intolerance.
Objective Data
Physical exam
Vital signs: Height 5’7”; Weight 134 lbs; BP 125/65; T 97 F°; P 73 bpm.
General: The patient appears neat, clean, and well-nourished. She answers all questions easily and seems alert.
HEENT: Head normocephalic; eyes clear, no difficulty focusing; ears clean; no pain in the neck; throat clear.
Genital: External genitalia pink, no oedema, cervix intact, thin foul yellowish-greyish discharge in the vaginal canal.
Skin: warm, soft, dry to touch.
Diagnostic results: obtaining secretions from posterior fornix with the help of a Q-tip (a wet mount test); microscopic examination to check the pH of the vaginal secretions; a whiff test to assess the odour.
Assessment
Differential Diagnoses
Bacterial vaginosis (BV) is the most typical reason for vaginal discharge in women at reproductive age. This condition can cause several negative reproductive health outcomes, the severest one being the acquisition of HIV-1 (Mitchell & Marrazzo, 2014). BV is characterised by the loss of normal lactobacilli and vaginal colonisation with anaerobic bacterial species. The clinical presentation of BV does not necessarily include swelling or redness, but it frequently includes odorous discharge (Mitchell & Marrazzo, 2014). A wet mount test is the most reliable way of diagnosing BV. This diagnosis is the most likely for the patient, taking into consideration her past history of chlamydia.
Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infections (STIs) (Yeung et al., 2017). Chlamydiae are gram-negative obligate intracellular bacteria which can lead to genital infections, including infertility and pelvic inflammatory disease. The cervix is one of the organs most frequently affected by chlamydia. A swab test and a urine test can be employed to diagnose this STI. The patient has past history of chlamydia, and she is at reproductive age, which makes it necessary to check this diagnosis.
Urinary tract infections are often associated with gynaecologic health issues (Gillmor-Kahn, 2017; Sheng & Miller, 2017). When a woman’s organism has a susceptible host and an active pathogen, the likelihood of such an infection is increased (Gillmor-Kahn, 2017). A urine test or cystoscopy can be used for diagnosis. Problems with urinary tract may cause serious physical, social, or emotional discomfort (Tharpe, Farley, & Jordan, 2017). Thus, it is crucial to diagnose the infection as soon as possible and start treatment immediately.
Plan
Treatment Plan
If the diagnosis of bacterial vaginosis is confirmed by the wet mount test, it is necessary to start treatment. The most typical treatment plan includes the following options:
500 mg metronidazole two times a day;
2% vaginal clindamycin cream once a day for a week;
oral clindamycin 300 mg two times a day for a week;
metronidazole 0.75% vaginal gel once a day for five days;
“the stat regimens of 2 g of metronidazole or tinidazole in a single dose” (Donders, Zodzika, & Rezeberga, 2014, p. 647).
Alternative treatment includes probiotic supplementation, which has been proven to prevent BV recurrence (Parma, Stella Vanni, Bertini, & Candiani, 2014).
Health Promotion
During treatment, the patient should abstain from consuming alcoholic drinks. Also, she should avoid intercourse in order to eliminate the risk of passing the infection to her partner.
Disease Prevention
To prevent the recurrence of BV, the patient should use condoms during intercourse and avoid douching too frequently. Also, she should not use daily pads since they can irritate skin.
Reflection
The experience has increased my knowledge about STIs, as well as the difficulty of their diagnosis and treatment. In particular, I realised how similar symptoms of some illnesses could be. Without the correct diagnosis, a healthcare provider risks selecting wrong medicines, which can lead to the complication of the patient’s condition. Therefore, the most important lesson from the experience was acknowledging the need for a very thorough examination of patients with genitourinary system problems. I understood that my patient’s health and future reproductive life depended on the correctness of the diagnosis. However, the responsibility did not affect me in a negative way: I did not feel anxious and instead, decided to do everything possible to obtain the necessary test results.
In the future, I would probably approach a similar patient evaluation a little differently. In particular, I would pay more attention to the lymphatic system during examination because it is closely related to women’s reproductive system. Also, I would recommend the patient not to seek an appointment after a month since she first noticed the symptoms. I would assert the need for regular examinations and invite the patient to pass the text for BV in two or three weeks. In general, I was satisfied with the results that I managed to obtain during examination and tests.
References
Donders, G. G. G., Zodzika, J., & Rezeberga, D. (2014). Treatment of bacterial vaginosis: What we have and what we miss. Expert Opinion of Pharmacotherapy, 15(5), 645-657.
Gillmor-Kahn, M. (2017). Urinary tract infections. In K. D. Schuilig & F. E. Likis (Eds.), Women’s gynecologic health (3rd ed.) (pp. 513-524). Burlington, MA: Jones & Bartlett Learning.
Mitchell, C., & Marrazzo, J. (2014). Bacterial vaginosis and the cervicovascular immune response. American Journal of Reproductive Immunology, 71(6), 555-563.
Parma, M., Stella Vanni, V., Bertini, M., & Candiani, M. (2014). Probiotics in the prevention of recurrences of bacterial vaginosis. Alternative Therapies in Health and Medicine, 20(1), 52-57.
Sheng, Y., & Miller, J. M. (2017). Urinary inconsistence. In K. D. Schuilig & F. E. Likis (Eds.), Women’s gynecologic health (3rd ed.) (pp. 525-548). Burlington, MA: Jones & Bartlett Learning.
Tharpe, N. L., Farley, C. L., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Learning.
Yeung, A. T. Y., Hale, C., Lee, A. H., Gill, E. E., Bushell, W., Parry-Smith, D.,… Hancock, R. E. W. (2017). Exploiting induced pluripotent stem cell-derived macrophages to unravel host factors influencing chlamydia trachomatis pathogenesis. Nature Communications, 8, 15013.
Access to medical care often determines people’s health-related decisions and dictates their choices in seeking help. In the United States, large populations of people in underserved neighborhoods cannot afford a doctor visit or a diagnostic test, often relying on home-prepared remedies and simple over-the-counter medication (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis, & Escamilla-Cejudo, 2016). Moreover, the lack of awareness about specific issues and practices leaves these individuals at risk of contracting infectious conditions or developing severe chronic problems (Tharpe, Farley, & Jordan, 2017). In the considered case, the patient comes into the office with an issue that has been bothering her for several years. However, without sufficient funds or insurance, she could not attend to her health in time. The patient’s examination points to the primary diagnosis of genital herpes with differential diagnoses, including syphilis, human papillomavirus (HPV), and chancroid.
General Patient Information
The patient is 23 years old; she identified herself as Hispanic. The patient is currently single; she does not have a stable romantic relationship or a long-term sexual partner.
Current Health Status
The patient comes to the clinic with a complaint of lesions in the vaginal and perianal regions. The lesions resemble blisters and are painful. They first started appearing about two years ago and have been disappearing and reoccurring periodically. The latest outbreak began four days ago, and the patient felt discomfort and pain and decided to get medical advice since she was now able to do that. The patient reports that the blisters usually recur for about a week. She did not consider using any pharmacological or nonpharmacologic solutions to alleviate the discomfort. There are also no apparent factors that exacerbate the condition. The patient rates her discomfort as a 3/10 on a pain scale.
The patient’s last menstrual period (LMP) was on 9/20/19. She is sexually active, and she uses condoms occasionally when engaging in sexual activity with men. She does not use any other types of barrier prevention. The patient is bisexual – she states that she has had sexual relationships with several male and female partners in the past years. She seems to be somewhat dissatisfied with her sexual relations, especially in the past year, since the blisters started appearing. According to the patient, she always mentions blisters to her partners before sexual activity.
Contraception Method
The patient reports that she does not use any long-term contraception method as she was unable to access proper medical care for years, and she states that, without support, all options are expensive. She also says that she has used condoms in the past, but only with some of the male partners. She did not attempt to use any protective methods with female sex partners. The patient admits to having minimal knowledge about different ways of birth control and sexual hygiene.
Patient History
There are no significant pertinent events in the patient’s medical history. The patient does not report having any problems with mental health. Currently, the patient does not take any medications or home remedies since she only recently got access to Medicaid. She has no known food, drug, animal, or environmental allergies. The patient had her first and only Pap test at 21 at a free clinic. Her vaccinations are incomplete – the patient did not receive an HPV vaccine in time to be eligible for financial support, but she had an MMR, hepatitis B, and DTaP in 2015.
The patient’s family does not have any conditions that are relevant to her issue. Her mother is 45 years old and alive; she has type 2 diabetes. Her father is 47 years old and alive; he does not have any diagnoses. The patient has two siblings, brothers (20 and 25 years old), both healthy. She also has three young children – two daughters (2 and 3 years old) and a son (5 years old). She is single, so the fathers’ health data is unavailable.
The gynecologic history shows a multipara, as the woman has three children. She does not have an account of sexually transmitted infections (STIs), although this lack of evidence may be to her restricted access to healthcare. The patient reports her menstrual patterns to be healthy, 4-5 days of menarche between 28 days. She is a G3 P2-1-0-3. The patient’s first child was born preterm (36 weeks) and underweight.
The patient lives in an underserved neighborhood with limited access to proper medical care. She currently works as a cashier at Dollar Tree. The patient does not have higher education and is in a difficult economic position, being a single mother of three young children and working a low-wage job. She does not report any incidences of forced sex, although stating that she had some negative experiences with her past partners involving physical and financial abuse. The job of a cashier is stressful and demanding; the patient does not have much time to rest or sit down.
Her home environment is taxing as well – she has to look after her three children, work, and maintain the household, although she received some help from her family with babysitting. The patient denies the use of illicit drugs and tobacco, but she admits to occasionally drinking alcohol – the results of CAGE screening are negative (0 points). She does not exercise due to the lack of time, but she often walks to her job instead of using public transport. Her diet appears to be limited due to available funds, and there is a lack of fresh produce and a surplus of processed foods; the patient often skips meals. She does not report any problems sleeping, but she sometimes gets less than 6 hours of sleep. She drinks coffee almost every morning and, rarely, during the day on weekdays instead of lunch.
Review of Systems (ROS)
The patient appears in good health; she denies fatigue or fever. Her vision is acute, and she does not wear glasses or contact lenses. The patient has no difficulty hearing and no pain in the ears. Her sinus is not congested, there is no discharge or nasal pain, and the patient denies having a sore throat. The patient has no complaints about her cardiovascular system – no palpitations, chest pain or discomfort, or edema. She has no difficulty breathing and denies wheezing or cough. The patient has no history of reflux; she denies abdominal pain, nausea, vomiting, diarrhea, or constipation.
The patient states that she did not notice any abnormal vaginal discharge. She does not have dysuria, and her bowel and bladder function as usual. The patient denies back, joint, or muscle pain or stiffness or any difficulties in movements. She does not have headaches, syncope, memory problems, or weakness; her mood is stable, and she does not have depression or anxiety. The patient does not have thyroid problems, polyuria, polyphagia, or polydipsia. She denies any unusual bruises, bleeding, anemia, also stating that she never noticed any allergic reactions.
Physical Exam
The patient is alert and oriented; she seems calm and nourished. Her temperature is 98 F, blood pressure 123/70, and pulse 86 bpm. The patient’s height is 5’5”, while her weight is 149lbs, making her BMI equal to 24.8. The pupillary test shows centered equal round pupils reacting to light, darkness, and accommodation. The sclera is white, and the conjunctiva is pink; the vision is 20/20. The patient’s oral and nasal mucosa are pink and moist; there is no nasal discharge, erythema, or inflammation in the throat. Her heart beats at a regular rate with S1 and S2 and no murmurs or gallops. The respiratory system is clear to auscultation without wheezes or rales. The abdomen is soft, non-tender, not distended, without masses; normal bowel sounds are present. The bladder is not tender on palpation; there is no distention noted.
The external genitalia has several blister-like lesions filled with fluid; some are ruptured and ulcerated. The sores are tender and painful to touch; some are located on the vulva, while others appear on the perineum. There is some edema present with the vulva inflamed and reddish, but the inflammation is not intense. The inguinal lymph nodes are not tender, and there is no visible vaginal discharge. The rest of the patient’s skin is soft, warm, and dry to touch, with no irritation or rash. The patient has a normal gait and good reflexes; her cranial nerves II-XII are intact, and she answers questions clearly and appropriately without any problems.
Labs, Tests, and Other Diagnostics
Several tests should be performed since the symptoms can be connected to a variety of conditions. Syphilis serology, a polymerase chain reaction (PCR) test for HSV and HSV antibody serology, is among the first diagnostics to complete (Jin, 2016). Moreover, a biopsy of the blisters’ fluid can give a more reliable result about their origin (Tharpe et al., 2017). Tests for other STIs, such as gonorrhea, are advised since some infections can coexist. Finally, an HIV (human immunodeficiency virus) test is required to confirm that the patient does not have it (Schuiling & Likis, 2017). Additionally, if these tests do not show any conclusive results, a check for Haemophilus ducreyi is necessary to eliminate the possibility of chancroid (Lautenschlager, Kemp, Christensen, Mayans, & Moi, 2017). This number of diagnostics is the basis of removing possible differential diagnoses, but the patient may need other tests if the results are negative.
Differential Diagnoses
The first differential diagnosis is genital herpes caused by HSV. This type of herpes is known as HSV-2, which is transmitted during sexual contact (Gnann & Whitley, 2016). The condition is mostly asymptomatic, similar to other STIs, but its main sign is the appearance of sores that look like blisters, which occur on one’s genitalia, buttocks, thighs, anus, and sometimes mouth. This infection is widespread in the US, and its recurrences may happen for years since herpes never leaves the body completely (Ramchandani et al., 2018). In some cases, lesions reappear multiple times per year, being less painful than the original outbreak. The central risk factor for genital herpes is unprotected sexual activity with multiple partners (Gnann & Whitley, 2016). This diagnosis is strongly considered due to the patient’s physical examination and medical history.
The second possible condition is syphilis, an STI caused by the bacteria Treponema pallidum. It develops in stages, starting with small painless sores called chancres (Park et al., 2018). Later, a rash may appear on other parts of the body, and such signs as fever and muscle pain are common (Park et al., 2018). Then, syphilis can be completely asymptomatic while also severely damaging one’s body systems. The patient’s blisters do not have a strong resemblance to the lesions developing during syphilis. Nonetheless, a test is necessary to make sure that the patient does not have it to avoid serious consequences.
Genital warts caused by the human papillomavirus (HPV) are the third differential diagnosis. HPV presents with warts on different parts of the boy, including one’s genitalia. These warts can put one at risk of cancer and should be checked out to lower this possibility (Park, Introcaso, & Dunne, 2015). The patient’s blisters may be an atypical presentation of HPV and, since the patient is not vaccinated, present a real danger to her health.
The final differential diagnosis is chancroid, an infection that, similar to other STIs, increases the risk of HIV. Its prevalence has dramatically decreased in the US, but some cases are still possible. Chancroid is caused by Haemophilus ducreyi and is characterized by painful genital ulcers and lymphadenopathy (Lautenschlager et al., 2017). The patient’s symptoms are close to the presentation of this infection. If she does not have signs of syphilis, herpes, or other described conditions, this diagnosis has to be considered.
Management Plan
The primary diagnosis is genital herpes due to the recurring nature of the condition, the patient’s examination, and the PCR test. Herpes cannot be cured completely, and the blisters will likely continue to appear. The treatment, thus, focuses on the alleviation of symptoms, protection from transmission, and reduction of lesions’ frequency and severity. First of all, the patient can take Acyclovir 400 mg orally three times a day for five days during outbreaks and Acyclovir 400 mg orally twice a day to suppress the infection during other periods (Schuiling & Likis, 2017, p. 505). Topical solutions are inadvisable since the membranes of the genitalia are extremely sensitive. Some alternative and nonpharmacologic therapies include warm baths with baking soda, well-fitting underwear made from cotton and comfortable clothing, and keeping the area dry with soft towels.
Essential parts of patient education are genital hygiene and sexual activity awareness. It is vital to explain to the patient that genital cleaning should be gentle and non-invasive as not to disturb the natural balance of the internal genitalia. The patient should communicate with partners about her conditions and aim to minimize the risk of infection. For example, she should be aware that periods when lesions form and shed are the most infectious, but the lack of symptoms does not lower the risk substantially (Groves, 2016). Thus, during outbreaks, all sexual activity is highly discouraged, and at other times, protection is essential. Latex condoms and dental dams are to be used during sex, and water-based lubrication will protect the genitals from irritation. Follow-up care involves missed vaccination, Pap test in the following year, nutrition advice, and subsequent STI tests to maintain the patient’s health.
Summary
In the discussed case, a young Hispanic female is concerned about recurring blisters on her genitalia. The physical examination and previous medical history point to the primary diagnosis of genital herpes caused by HSV. The patient’s difficult financial situation and lack of access to care explain her inability to treat the condition sooner. The management plan includes symptom alleviation since herpes is an incurable infection. Acyclovir is the primary medication that can decrease the rate and severity of recurrence. Patient education should focus on protection and awareness during sexual activity.
References
Gnann Jr, J. W., & Whitley, R. J. (2016). Genital herpes. New England Journal of Medicine, 375(7), 666-674.
Groves, M. J. (2016). Genital herpes: A review. American Family Physician, 93(11), 928-934.
Jin, J. (2016). Screening for genital herpes. JAMA, 316(23), 2560-2560.
Lautenschlager, S., Kemp, M., Christensen, J. J., Mayans, M. V., & Moi, H. (2017). 2017 European guideline for the management of chancroid. International Journal of STD & AIDS, 28(4), 324-329.
Park, I. U., Fakile, Y. F., Chow, J. M., Gustafson, K. J., Jost, H., Schapiro, J. M.,… Bolan, G. (2018). Performance of treponemal tests for the diagnosis of syphilis. Clinical Infectious Diseases, 68(6), 913-918.
Park, I. U., Introcaso, C., & Dunne, E. F. (2015). Human papillomavirus and genital warts: A review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clinical Infectious Diseases, 61(suppl_8), S849-S855.
Ramchandani, M., Selke, S., Magaret, A., Barnum, G., Huang, M. L. W., Corey, L., & Wald, A. (2018). Prospective cohort study showing persistent HSV-2 shedding in women with genital herpes 2 years after acquisition. Sexually Transmitted Infections, 94(8), 568-570.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, J. A. (2016). Hispanic health in the USA: A scoping review of the literature. Public Health Reviews, 37(31), 1-27.
The study under analysis is called the Tuskegee Study of Untreated Syphilis in the Negro Male and it took place in Macon County, Alabama. The main purpose of the following study was “to record the natural history of syphilis in Blacks” (About the USPHS Syphilis Study, n.d., para. 1). However, at those times when the experiment started, there was no treatment for this disease and, moreover, people did not know that they suffer from it.
There were 600 participants, besides, all of them were black people. They were divided into two parts. The first one, which consisted of 399 people, became the experimental group. Moreover, every person in this group suffered from syphilis. The rest of the participants became control subjects. (About the USPHS Syphilis Study, n.d.). During the experiment, all black people lived under perfect conditions and had to accept all suggested procedures. However, there was no real treatment for them. Several years later the experiment was ended. However, there were several reasons for it.
First of all, it was called unethical as all participants were not informed about the conditions of the experiment and their illness. Moreover, a great number of patients died in the course of the experiment. The main purpose of this study was to analyze the aftermath of untreated syphilis, which is why patients were not informed about their disease. Their family members also suffered from it. However, this experiment became rather a controversial issue which led to some serious processes in society (LeNoir – NMA Pediatric Lecture Series, 2003). First of all, participants were promised to have free medical service. Moreover, the question of the moral side of different studies appeared. Tuskegee Syphilis Study Legacy Committee was created in order to improve the situation and try to change the current state of affairs.
Syphilis and poliomyelitis were severe problems for the United States of America in the mid-20th century. That is why many scientists and public officials did their best to protect the population from these illnesses. The attempts to cure syphilis and the campaign to wipe out polio implied both similarities and differences. Thus, the primary task of this paper is to comment on how the US managed to defeat these diseases.
To begin with, one should state that the similarities referred to the universal role of both syphilis and polio in society. As a result, curing these diseases was necessary to save the whole nation. That is why Warner and Tighe (2001) explain that it was required “to lessen the stigma” of syphilis (p. 449). Furthermore, Warner Brothers Studios released the film, Dr. Ehrlich’s Magic Bullet, about the scientist who introduced a vaccine against syphilis (Warner & Tighe, 2001). It was another step to emphasize the importance of curing the disease. In addition to that, the polio problem caused philanthropic efforts that resulted in the publicity of the illness (Warner & Tighe, 2001). As has been mentioned above, the differences were also present, and they referred to clinical trials. It relates to the fact that the development of the poliomyelitis vaccine was more ethical and did not imply scandals (National Museum of American History, n.d.).
In conclusion, American society invested much effort to cure syphilis and polio. Even though the strategies are considered successful, they implied both similarities and differences. It was a useful step to make the population understand that the diseases were their shared problem. At the same time, the difference in clinical trials denoted that the strategy to wipe out poliomyelitis was safer when it came to the health of the experiment participants.
References
National Museum of American History. (n.d.). Clinical trials. Web.
Warner, J. H., & Tighe, J. A. (2001). Major problems in the history of American medicine and public health: documents and essays. Houghton Mifflin.
Over the years, syphilis has always been a deadly ailment, killing numerous people due to poor intervention measures. India is among the many countries experiencing tremendous problems with this ruthless disease. The country has experienced an escalating trend of the disease especially in the period between 2002 and 2004. This noted increasing trend continues in current times thereby putting the Indian population at risk. The rapid spread of this disease is owed to a number of factors such as the incredible increase in population, cultural factors, and poor intervention measures among others (Kohn, 2008). However, according to statistical records, the number of the infected varies from one location to another, although at an average difference of 1% to 2%. The source also points out the most prone age group is people between 5-18 years. This document, therefore, is going to explore and analyze the impact of syphilis within the age group 5-18 years, in India.
Literature review
Several studies have been conducted to discover and assess various aspects of syphilis within India. These studies have been extremely comprehensive thus uncovering some of the crucial aspects of syphilis in India. They indicate an escalating trend of the disease after the year 2004. Sources indicate that this trend has always been increasing until recent years. Moreover, these sources further single out the age group 5-18 as the most prone to this deadly disease, following the nature of their vulnerability. Individuals under this age group are often at the adolescent stage. They are often sexually active thus engage in risky sexual activities, which make them vulnerable to sexually transmitted diseases such as Syphilis. Most of these adolescents tend to engage in sexual activities without thinking of the long-term consequences of their actions.
In addition to risky sexual activities, other factors also contribute to making this age group more prone to syphilis infection. For instance, most adolescents in India often fail to resist peer pressure hence may end up engaging in risky activities such as drug abuse, alcoholism and other risky sexual activities. This puts them in a vulnerable situation of being infected by the deadly disease.
Aside from peer pressure, this age group is also often vulnerable to sexual abuse such as sex trafficking and child prostitution. Most sex traffickers often target young people preferably within the age of 5-18, since they have a promising future for their business (Kristof, 2007). Additionally, most commercial sex businesspersons often target this age group due to their incredible sexual potential. This, therefore, makes the age group extremely vulnerable to sexually transmitted diseases, which include deadly syphilis. Moreover, it is currently approximated that over one million children (adolescents) engage in child prostitution in India. Sources also indicate 3,500 young victims of sex trafficking, the majority being below the age of 15.
Impacts of syphilis in India
After its discovery hundreds of years back, Syphilis found its way to India, in 1504 (Hendrick, 2011). Carried by sailors from Europe, the disease further spread to other non-European countries via sexual encounters (INDG India, 2011). Since then, the spread of the disease has always been on an increasing trend. However, after 1995, in India, there was a significant decline in the spread of the disease with only a few people being infected.
Since the disease found its way to India, many people have seriously been affected. The disease has significantly affected the normal lives of many individuals as well as the Indian economy. Due to the ruthless nature of the disease, many Indians have lost their relatives, friends, and families. The disease has left many Indians as orphans and others as widows. Such affected persons often feel the effects of the disease throughout their lifetime, since they often face difficulties in their daily activities. Orphan, for instance, often have problems in finding solutions to their daily needs, especially when left at a tender age. On the other hand, widows are often left with a massive burden to raise their families singlehandedly. Most of the widows often have to spend a better part of their lives making massive sacrifices just to ensure that their family lives happily.
Another impact on human daily lives is that promiscuity was reduced among young men and women. This is because they became afraid of being infected by the deadly disease. Therefore, most Indians decided to keep away from practices or activities that could lead to infections. Most of them avoided promiscuity and other immoral sexual behaviors.
Additionally, the disease has also significantly affected the economy of India in various capacities. Since most of the persons affected by this disease are young men and women, India has lost a significant energetic workforce needed for the country’s productivity. This has slowed the country’s growth and prosperity thus a negative turn, in the general economy. Additionally, left orphans and widows experience harsh living conditions due to the tremendously reduced living standards.
In addition to decreased productivity, the Indian government wasted a significant amount of cash trying to find a solution for curbing the disease. The Indian government spent a significant amount of cash in researching the best cure for the disease. It also wasted huge chunks on strategizing the various approaches to mitigate the effects of the disease. All these activities slowed down the economic progress of India since the resources needed for economic growth were diverted into finding intervention measures.
Intervention measures
The Indian government has taken several intervention measures against the spread of syphilis. For instance, the government has introduced various programs such as the education of sexually transmitted diseases (STI) in schools in a bid to curb the disease. This program helps in providing the adolescent with adequate information about STIs. Eventually, they will be able to understand how to prevent themselves from the disease.
In addition to STI education in schools, the Indian government also developed another program (The National Adolescents Educational Program), AEP, to help curb the disease (NACO, 2007). This program concentrates on implementing various prevention measures among the young population.
Despite these tremendous efforts, the fight against syphilis faces significant challenges. These challenges slow down the progress of mitigating the effects and spread of this deadly disease. Most students, for instance, missed the classes organized within the education program. This is a massive setback to the intervention measure since most of the students will never gain from the strategy. AEP, on the other hand, was criticized for failing to be culturally sensitive. However, despite these challenges, these programs have also helped in curbing the disease in various capacities.
Other challenges include cultural barriers whereby discussing sex topics is forbidden. This discourages the process of intervening in the disease. Moreover, Indians consider the maintenance of silence when facing problems as a virtue among women. Moreover, the Indian culture discourages the free movement of women, which limits their access to information (Jayaram, 2009). Such cultural barriers often limit the fight against syphilis.
Critical analysis of the challenges
Due to globalization and other contributing factors, many Indians are shying away from their cultural practices, which pose some significance to the future of syphilis. The effects of this trend pose both positive and negative effects. Among the positive effects, including the increase in promiscuity. Other cultures (western) will influence the Indians to engage in activities not supported in their culture. Eventually, this would lead to the increased spread of the disease. On the other hand, abandoning their culture would also mean the freedom of women. Thus, women would mean easily access the needed information about Syphilis. This, in turn, would reduce the spread of the disease, since most women will have the capacity to avoid practices that contribute to the spread of the disease.
Conclusion
Over years, syphilis has proven to be a serious disease, causing deaths and serious effects on families and the economy. This does not exclude India, since it also experienced the effects of this deadly disease. According to studies, the age group under threat is adolescents, an age group between 5-18 years. This is due to various factors, which include their sexual activeness and their vulnerability to sex abuses such as child prostitution and sex trafficking.
India has experienced both positive and negative effects of the disease. However, the negative has always dominated the positive ones. This has prompted the government to employ various intervention measures in a bid to intervene in the spread of the disease. However, these strategies face several setbacks thus making them inadequate. Therefore, one can project the future of the disease judging from the current situation.
References
Hendrick, R. (2011). Historic dispute: did syphilis originate in the new world, from which it was brought to Europe by Christopher Columbus and his crew? Science clarified. Web.
INDG India. (2011). Health: how do people get syphilis. IDNG India. Web.
Jayaram, V. (2009). The problem and status of women in Hindu society. Hindu Website. Web.
Kohn, G. (2008). Encyclopedia of plague and pestilence: from ancient times to the Present. New York, NY: InfoBase publishing.
Kristof, N. (2007). Sex trafficking in India. New York Times. Web.
NACO. (2007). Adolescents Education Program. Ministry of health and family welfare government of India. Web.