WEBVTT 00:00:02.840 --> 00:00:07.670 [Syphilis] 00:00:07.670 --> 00:00:19.920 [The United States Public Health Service] 00:00:19.920 --> 00:00:25.630 [The Diagnosis of Syphilis by the General Practitioner] 00:00:25.630 --> 00:00:34.450 [The Diagnosis of Early Syphilis, Primary Stage] 00:00:34.450 --> 00:00:45.940 [Primary Stage, The Diagnostic Maxims] 00:00:45.940 --> 00:00:59.440 [Narrator:] The typical chancre is raised, injurated, sharply circumscribed, frequently ulcerated, usually has satellite buboes and is not particularly painful unless there is secondary infection. 00:00:59.440 --> 00:01:06.890 Chancres frequently are not typical and may be multiple. Suspect any genital lesion. 00:01:06.890 --> 00:01:19.100 In every case of urethral discharge, palpate the urethra for possible intra-urethral chancre. Follow every case of gonorrhea with blood tests for four months to rule out syphilis. 00:01:19.100 --> 00:01:29.390 Look for cervical chancre. Some are atypical consisting merely of diffuse enlargement and injuration of the entire cervix. 00:01:29.390 --> 00:01:39.950 Extra-genitals chancres occur on the lip, tonsil, breast and elsewhere. Do dark fields on suspicion and blood tests routinely. 00:01:39.950 --> 00:01:51.950 Look for chancre of the finger in doctors and nurses. They are painful and often not as typical as this one. They frequently resemble an ordinary paronychia. 00:01:51.950 --> 00:02:03.030 This lesion and those following are not syphilitic. Dark field examinations should be performed on every genital lesion and on all suspected extra-genital lesions. 00:02:03.030 --> 00:02:19.870 If repeated dark fields are negative follow with blood tests for four months to rule out syphilis. Take a blood test at least once a week for the first two months and once a month for the next two months. 00:02:20.750 --> 00:02:39.730 Differential diagnosis of primary syphilis depends largely upon dark field examination. To prepare the lesion for obtaining a specimen, soak a piece of gauze in normal saline solution and rub hard to produce slight abrasion. 00:02:39.730 --> 00:02:58.650 After the surface of the lesion has been cleansed and abraded, blot it with a dry piece of gauze and wait a few seconds for serum to ooze from the surface. Now touch a clean dry slide to the serum and cover specimen with a clean, dry cover slip. 00:02:58.650 --> 00:03:06.350 The specimen is now ready to be placed under the dark field microscope for examination. 00:03:06.350 --> 00:03:17.900 Spirochete palladia resembles many non-pathogenic spirilla, therefore dark field examination should be undertaken only by one who is thoroughly experienced in this procedure. 00:03:17.900 --> 00:03:37.240 In localities where persons experienced in dark field technique are not available the delayed dark field is useful. The specimen of serum is drawn into a capillary tube, the ends sealed, and the tube mailed immediately. 00:03:37.240 --> 00:03:45.850 Most state health departments provide for examination of delayed dark field specimens. 00:03:45.850 --> 00:03:55.090 Do not use dark field examination for lesions inside the mouth unless the specimen is taken by aspiration rather than from the surface of the lesions. 00:03:55.090 --> 00:04:01.070 Some normal mouth spirochetes cannot be distinguished from spirochete palladia. 00:04:01.070 --> 00:04:12.410 If the lesion is on the outer surface of the lip, cleanse the surface carefully before taking the specimen. Specimens may also be obtained by aspiration of serum from the base of the lesion. 00:04:12.410 --> 00:04:21.390 One tenth cc of normal saline is injected and withdrawn. 00:04:21.390 --> 00:04:31.760 A single negative dark field examination does not exclude syphilis. Chancres are apt to be dark field negative if topical applications have been used... 00:04:31.760 --> 00:04:39.760 If the patient has received anti-syphilitic treatment of any kind, or if the lesion has been present more than a month or six weeks. 00:04:39.760 --> 00:04:48.090 At least three or four negative specimens should be obtained before a suspected lesion is considered dark field negative. 00:04:48.090 --> 00:04:56.960 On the other hand, a positive dark field establishes the diagnoses of syphilis even while the blood test is still negative. 00:04:58.690 --> 00:05:15.540 Time is of the essence in the diagnosis of syphilis. Let us assume an exposure to syphilis or gonorrhea or both at this point. In three to six days there may be evidence of gonorrhea. Both smears and cultures should be made. 00:05:15.540 --> 00:05:30.770 As early as ten days after exposure the chancre may appear. It usually develops in about 21 days, although its appearance may be delayed as long as three months. A dark field examination should be employed. 00:05:30.770 --> 00:05:41.860 A negative dark field of course does not exclude syphilis. From six to nine weeks after exposure, the blood test may be expected to assume diagnostic significance. 00:05:41.860 --> 00:05:53.750 Again, a single negative should not be relied upon. The case should be followed for at least four months before concluding that infection has not resulted from the exposure. 00:05:53.750 --> 00:06:08.210 The control of early syphilis and the prevention of congenital syphilis and late manifestations depends on careful and painstaking attention to the time element and on a high index of suspicion. 00:06:08.210 --> 00:06:21.140 During the secondary stage of syphilis the organism is disseminated throughout the body. This gives rise to a constitutional reaction with general malaise and aching of the bones and joints. 00:06:21.140 --> 00:06:38.510 Sore throat may be prominent. There is usually a generalized lymph adenopathy. Macular syphilids are salmon or rose-colored. 00:06:38.510 --> 00:07:06.560 If natural daylight cannot be used, the light from a blue bulb will often reveal a macular rash which would be invisible in light from an ordinary bulb. Involvement of the palms and soles is particularly suggestive. Secondary syphilids are often papular. 00:07:06.560 --> 00:07:16.620 Angular lesions should always suggest syphilis to the physician. They frequently coalesce and assume a serpiginous appearance. 00:07:16.620 --> 00:07:28.240 It is not uncommon for the hair to fall out in patches, giving it a moth-eaten appearance. Mucus patches occur in the mouth or nose or on the genitalia. 00:07:28.240 --> 00:07:37.100 They are usually about one half to two centimeters in diameter, sharply circumscribed, pink and slightly raised from the surrounding surface. 00:07:37.100 --> 00:07:52.140 Ordinarily they are not painful. Moist papules also known as condyloma lata occur on moist contiguous surfaces of the skin. They are raised from the surrounding surface and are round and flat on top. 00:07:52.140 --> 00:08:01.220 Venereal warts are not syphilitic lesions. They differ from moist papules in that they are flat on the sides rather than on top. 00:08:01.220 --> 00:08:11.620 The split papule shown here are large, but often they are so small as to be overlooked easily. Split papules may be the only sign of secondary syphilis. 00:08:11.620 --> 00:08:24.890 Dark field examination is positive. In cases of iritis the physician should think first of atropine and second of a blood test. Many cases are due to secondary syphilis. 00:08:24.890 --> 00:08:36.200 The symptoms and signs of early meningeal neurosyphilis are those of any acute meningitis. This condition is distinguished by the positive spinal fluid serologic test for syphilis. 00:08:36.200 --> 00:08:48.930 It often follows a lapse in treatment for early syphilis and in such cases is called neuro-recurrence. Dark field examination is useful in secondary syphilis as well as in primary syphilis. 00:08:48.930 --> 00:08:58.230 A diagnosis of primary or secondary syphilis should always be confirmed either by positive dark field or positive blood tests. 00:08:58.230 --> 00:09:09.850 To obtain a specimen for blood test a tourniquet is first applied to the upper arm. If the veins are not prominent, one is located by palpation. The overlying skin is cleansed with alcohol. 00:09:09.850 --> 00:09:50.960 The operator's left thumb draws the skin taut, and the needle is inserted through the skin at an acute angle and lowered until almost parallel with the vein. The vein is entered and blood withdrawn. 00:09:50.960 --> 00:10:01.300 The blood is placed in a clean, dry test tube. 00:10:01.300 --> 00:10:13.570 The tube is stoppered with a clean, dry cork, carefully labeled and prepared for mailing. Do not use soap to clean test tubes for this purpose. Any residual of soap will cause hemolysis of the blood. 00:10:13.570 --> 00:10:20.100 [Title of pamphlet reads, "Syphilis in Mother and Child." Part I: Syphilis in Pregnant Women. Part II: Congenital Syphilis.] 00:10:20.100 --> 00:10:32.000 Congenital syphilis is transmitted from mother to fetus in utero usually about the fifth month of pregnancy. Frequently the fetus dies and a miscarriage or stillbirth results. 00:10:32.000 --> 00:10:38.800 The infant with active early congenital syphilis is fretful and often has snuffles. 00:10:38.800 --> 00:10:55.050 Crusted lesions about the mouth and nose are frequently observed. There may be a generalized eruption and moist papules about the anus and genitalia. 00:10:55.050 --> 00:11:08.990 The diagnosis should be confirmed by dark field examination of the lesions or by blood tests or by both. Apparently well babies of both treated and untreated syphilitic mothers should be followed for at least 2 years. 00:11:08.990 --> 00:11:27.130 Perform blood tests at monthly intervals for six months and every six months thereafter. In the absence of other evidence a diagnosis of syphilis should not be made on the basis of positive blood tests taken when the child is less than two months old, unless quantitative tests reveal a rising titer. 00:11:27.130 --> 00:11:38.030 Congenital syphilis can be prevented by treating infected mothers, but first the infected mothers must be found. Take a blood test as soon as pregnancy is suspected. 00:11:38.030 --> 00:11:53.260 Repeat at least once later in pregnancy. Take a blood test as a routine part of physical examinations before marriage. More than half of the cases of syphilis so discovered will have been unsuspected. 00:11:53.260 --> 00:12:05.210 Blood tests before marriage are the particular responsibility of the private physician to whom most couples go. A blood test experienced impresses itself on the minds of young people. 00:12:05.210 --> 00:12:15.240 If it is accompanied by a physical examination and if the full significance of the procedure is brought home to the couple, an important relationship is established with the physician. 00:12:15.240 --> 00:12:25.440 Later when pregnancy occurs the physician is afforded the opportunity not only to meet the threat of congenital syphilis but also to provide general pre-natal care. 00:12:25.440 --> 00:12:40.930 Thus the private practitioner plays a vital and fundamental part in both medical and epidemiologic aspects of syphilis control. Personalized education by him vitalizes the mass program of the health department. 00:12:40.930 --> 00:12:54.590 Every case of syphilis comes from another case. To break this chain of infection all contact whether familial or non-familial should be examined by the physician or for him by the health department. 00:12:54.590 --> 00:13:11.080 Prostitution is another important link in the chain of infection. Physicians can help to break this link by demanding that law enforcement officers vigorously enforce all laws prohibiting prostitution, procurement, solicitation, and assignation. 00:13:11.080 --> 00:13:20.830 Periodic examination of prostitutes does not retard the spread of venereal diseases and it involves the physician as an accessory to the fact. 00:13:20.830 --> 00:13:40.750 Nothing short of total war on vice will break this link in the chain of infection. To keep abreast of current developments in the diagnosis, treatment, and public health aspects of syphilis, read Venereal Disease Information, one of the medical journals published by the United States Public Health Service. 00:13:41.130 --> 00:13:42.120 [ Music ] 00:13:42.120 --> 00:13:55.930 [This film is in three parts: I. Diagnosis of Early Syphilis. II. Diagnosis of Late and Latent Syphilis. III. The Management of Syphilis.] 00:13:57.070 --> 00:14:06.480 [A United States Public Health Service Production. Clinical Photography...Carroll T. Bowen, Passed Assistant Surgeon (R), Medical Direction...Glenn S. Usher, Passed Assistant Surgeon, General Direction...W. Allen Luey, Production...Howard Ennes, 00:14:06.480 --> 00:14:22.620 Medical Consultants Harold N. Cole, M. D., Cleveland, Ohio, Joseph E. Moore, M. D., Baltimore, Maryland, Paul A. O'Leary, M. D., Rochester, Minnesota, Thomas Parran, Surgeon General, U. S. Public Health Service, Washington, D. C., Francis E. Senear, M. D., Chicago, Illinois, John H. Stokes, M. D., Philadelphia, Pa., Lida J. Usilton, M. A., U. S. Public Health Service, Washington, D. C., Raymond A. Vonderlehr, Assistant Surgeon General, U. S. Public Health Service, Washington, D. C.] 00:14:23.660 --> 00:14:30.550 [Federal Security Agency Paul V. McNutt, Administrator. U. S. Public Health Service Thomas Parran, Surgeon General] 00:14:30.550 --> 00:14:36.970 [Seal of the U. S. Public Health Service, 1798] 00:14:36.970 --> 00:14:41.860 [The End]