Profile of Syphilis Compliance and Success of Therapy at Dermatology and Venereology Clinic RSUD Dr. Saiful Anwar Malang: A Descriptive Study
Syphilis is a chronic progressive sexually transmitted infection, that causes a life-threatening condition if left untreated. In lower-middle-income countries, the burden of disease might appear to be lower due to a lack of reports. This study aimed to report the epidemiological profile, the profile of compliance, and the success of therapy of syphilis at the Dermatology and Venereology Outpatient Clinic in RSUD dr. Saiful Anwar Malang, Indonesia. This study used a descriptive approach using secondary data from the medical records of newly diagnosed syphilis patients at Dermatology and Venereology Clinic RSUD dr. Saiful Anwar Malang from January 2021 - December 2021. Sample collection was using a total sampling technique. Eighteen medical records met the inclusion criteria. The majority of samples were men (77.8%), aged 17-25 years (44.4%) and 26-35 years (44.4%), had a high school education (55.6%), HIV positive (50%) and HIV negative (50%). All 18 patients got intramuscular injections of a single 2.4 million U or 7.2 million U Benzathine Penicillin G according to the syphilis stage. It was found that eight patients (44.4%) had a successful therapy, two patients (11.2%), experienced failure, and the remaining eight patients (44.4%) were unknown due to loss of follow-up. Several factors are associated with better patient compliance including older age, higher educational level, type of the disease, and lower complexity of treatment schedules. Overall, therapeutic compliance of syphilis patients is good, but monitoring compliance needs to be improved. Benzathine Penicillin G remains the drug of choice for syphilis and has a high success rate.
INTRODUCTION
Syphilis is a chronic progressive sexually transmitted infection caused by the bacteriumTreponema pallidum. Syphilis can be classified into active clinical spectrums (primary, secondary, tertiary) and an asymptomatic period called latency1,212. This disease will develop into various stages, causing life-threatening complications if left untreated33.
Although the incidence of syphilis declined significantly worldwide and managed to reach its lowest point five decades after the discovery of penicillin in the mid-1940s, the number of cases in the United States and Europe reported to the Centers for Disease Control and Prevention (CDC) increased by 81% from 2014 to 20184,545. In 2020, there were 7.1 million new cases of syphilis globally in people aged 15-49 years33. In Southeast Asia, the trend of syphilis is also increasing with a total of 350,000 cases22. According to the Indonesian Ministry of Health in 2021 there were 13,505 cases of early syphilis and 3,775 cases of stage syphilis66.
In lower-middle-income countries, the burden of disease might appear to be lower due to a lack of reports77. Therefore this study aimed to report the epidemiological profile, the level of compliance, and the success of therapy of syphilis at the Dermatology and Venereology Outpatient Clinic in RSUD dr. Saiful Anwar Malang, Indonesia from January 2021 to December 2021.
MATERIALS AND METHOD
This study used a descriptive approach to secondary data from the medical records of syphilis patients at the Dermatology and Venereology Clinic RSUD dr. Saiful Anwar Malang from January 2021 - December 2021. Sample collection was using a total sampling technique which included all patients who met the inclusion and exclusion criteria. The inclusion criteria were newly diagnosed syphilis patients at Dermatology and Venereology Clinic RSUD dr. Saiful Anwar Malang from January 2021 - December 2021. The diagnosis of syphilis was confirmed by laboratory examination; the finding ofT. pallidumin dark field examination or a reactive (nontreponemal & treponemal) syphilis serological test. The exclusion criteria were syphilis patients who received syphilis management outside the Dermatology and Venereology Clinic RSUD dr. Saiful Anwar Malang. The parameters studied were gender, age, education, occupation, syphilis stage, HIV infection status, CD4+ level, therapeutic modalities, therapeutic compliance, monitoring compliance, and success of therapy. Therapeutic compliance is the patient's behavior to seek treatment regularly according to a set time. Monitoring compliance is the patient's behavior to come for re-evaluation according to a set time. Successful treatment of syphilis was defined as a fourfold decrease in nontreponemal titer (VDRL) within 3–24 months of syphilis therapy, no persistence/recurrence of symptoms, nor a fourfold increase in titer for >2 weeks1,8. The data obtained were presented in numbers and percentages descriptively, and subjected to univariate analysis using the Statistical Package for the Social Sciences (SPSS ver. 21, IBM®) application. The research protocol has been approved by the Medical Research Ethics Committee of RSUD Dr. Saiful Anwar Malang (Approval number: 070/036/102.7/IKKK/09/2022, Date: September 28th, 2022 ).
RESULTS
There were 18 medical records of syphilis at the Dermatology and Venereology Clinic RSUD dr. Saiful Anwar Malang from January 2021 - December 2021 which met the inclusion and exclusion criteria.
According to Table 1, the majority of samples were men (77.8%), HIV positive (50%), aged 17-25 years (44.4%) and 26-35 years (44.4%), had a high school education (55.6%), and worked in the private sector (44.4%).
Parameters | HIV positive (n,%) | HIV negative (n,%) | Total |
Gender | |||
Male | 9 (100) | 5 (55.6) | 14 (77.8) |
Female | 0 (0) | 4 (44.4) | 4 (22.2) |
Age (years old) | |||
17 – 25 | 4 (44.4) | 4 (44.4) | 8 (44.4) |
26 – 35 | 5 (55.6) | 2 (22.2) | 8 (44.4) |
36 – 45 | 0 (0) | 3 (33.3) | 2 (11.2) |
Education | |||
Elementary School | 0 (0) | 1 (11.1) | 1 (5.6) |
Junior High School | 0 (0) | 0 (0) | 0 (0) |
Senior High School | 5 (55.6) | 5 (55.6) | 10 (55.6) |
Higher Education | 2 (22.2) | 1 (11.1) | 3 (16.7) |
Unknown | 2 (22.2) | 2 (22.2) | 4 (22.7) |
Occupation | |||
Student | 3 (33.3) | 3 (33.3) | 6 (33.3) |
Private Sector | 3 (33.3) | 5 (55.6) | 8 (44.4) |
Civil Servant | 1 (11.1) | 0 (0) | 1 (5.6) |
Entrepreneur | 0 (0) | 1 (11.1) | 1 (5.6) |
Unemployed | 2 (22.2) | 0 (0) | 2 (11.1) |
Table 2 shows that the majority of syphilis patients were diagnosed at the secondary stage (50%). All 18 patients got intramuscular Benzathine Penicillin G according to the stage. The level of CD4+ of those who were tested was mostly <200/µL (27.7%).
All 15 (100%) earlysyphilis patients underwent a Benzathine Penicillin G 2.4 million U single dose intramuscular injection and all three (100%) late syphilis (tertiary and late latent) patients underwent a complete series of IM Benzathine Penicillin G 2.4 million U once a week for three consecutive weeks (shown in Table 3).
Stage | Frequency(n) | Percentage (%) |
Primary | 3 | 16.7 |
Secondary | 9 | 50.0 |
Tertiary | 0 | 0 |
Early Latent | 3 | 16.7 |
Late Latent | 3 | 16.7 |
Total | 18 | 100 |
Therapeutic modalities | ||
IM Benzathine Penicillin G (2.4 million U) | 15 | 83.3 |
IM Benzathine Penicillin G (7.2 million U) | 3 | 16.7 |
PO Doxycycline (2 x 100 mg) | 0 | 0 |
Others | 0 | 0 |
Total | 18 | 100 |
CD4+ level | ||
< 200/µL | 5 | 27.7 |
200 – 349/µL | 1 | 5.6 |
350 – 499/µL | 0 | 0 |
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