Altered Mental Status- a surprise diagnosis

tyvin, BSN, RN · Oct 30, 2014

Very interesting...many people are not aware that a few states and Puerto Rico still require blood testing for a marriage license (it use to be all states). The required blood test is/was for syphilis and rubella. Apparently, in the 20' and 30's syphilis was quite common, especially in the big cities.

I think the reasoning was that instead of your partner giving you syphilis when you got married (back than many people didn't have sex until they were married, and living together wasn't as common as it is today) that the partner of the couple could be treated prior to marriage or during, or maybe both of them.

It is touted as having a huge effect on the fall of syphilis in America. I don't know why rubella was included but some states even test for other things these days as well.

Also, everyone knows that Al Capone died of complications from syphilis. It is also believed that George Washington, Cortes, Hitler, Mussolini, and Ivan the Terrible suffered from syphilis though, it can't be proven. :nailbiting:

SnowballDVM · Oct 30, 2014

Also, everyone knows that Al Capone died of complications from syphilis. It is also believed that George Washington, Cortes, Hitler, Mussolini, and Ivan the Terrible suffered from syphilis though, it can't be proven.

Don't forget Idi Amin Dada, one of the most brutal dictators and mass murderers in history. Some of his mental instability may have been due to untreated syphilis, although he was, at bottom, a truly evil human being.

Christy1019, ASN, RN · Oct 30, 2014

I thought once it reached the neuro stage it was untreatable? Then again, I am by no means an expert on syphilis lol.

tyvin, BSN, RN · Oct 30, 2014

Don't forget Idi Amin Dada, one of the most brutal dictators and mass murderers in history. Some of his mental instability may have been due to untreated syphilis, although he was, at bottom, a truly evil human being.

Oh yes; "The Butcher of Uganda" ... I studied him for a research paper and it blew my mind the things he did; but I did not know he had syphilis. Well, that explains the deranged actions that were increasing dare I say; exponentially. :nailbiting:

Every time I hear his name my mind pictures a brutal 6'4" naked monster, lurking around the palace, bored out of his deranged skull, trying to decide how to amuse himself. According to some of my sources when I was doing my paper, he loved to walk around the palace naked :specs: :angrybird3:

Geat post. Syphilis is still with us, but no where near the numbers it use to be. Thank goodness for Alexander Fleming. :yes:

ktwlpn, LPN · Oct 30, 2014

Very interesting...many people are not aware that a few states and Puerto Rico still require blood testing for a marriage license (it use to be all states). The required blood test is/was for syphilis and rubella. Apparently, in the 20' and 30's syphilis was quite common, especially in the big cities.
I:nailbiting:

Before my husband and I got married I had him believing he had to submit to a rectal exam along with the blood test.....

Dranger · Oct 31, 2014

Eh? We rule out syphilis pretty commonly with AMS and older patients. I am surprised it took a neurologist to figure that one out.

Stcroix, ASN, PhD, RN · Oct 31, 2014

I thought once it reached the neuro stage it was untreatable? Then again, I am by no means an expert on syphilis lol.

Ya, me too. Apparently it's got to do with the 'blood brain barrier' thing. But I learned that high doses over long periods will treat it and I sure saw a vast improvement in the guy.

bb007rn · Oct 31, 2014

It is touted as having a huge effect on the fall of syphilis in America. I don't know why rubella was included but some states even test for other things these days as well.

This is the info I found re: testing for rubella, remember this was back before the vaccination for it came about, so it would make sense to delay a marriage license in order to prevent a new wife from getting pregnant and possibly causing the following:

Rubella can cause congenital rubella syndrome in the newborn. The syndrome (CRS) follows intrauterine infection by the rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects. It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester. CRS is the main reason a vaccine for rubella was developed.

Many mothers who contract rubella within the first critical trimester either have a miscarriage or a still born baby. If the baby survives the infection, it can be born with severe heart disorders (Patent ductus arteriosis being the most common), blindness, deafness, or other life-threatening organ disorders. The skin manifestations are called "blueberry muffin lesions".

firstinfamily, RN · Oct 31, 2014

It use to be that every hospital admission was tested for syphyllis, there was an "admission panel" that was done on every single admission. Sometimes I feel we should still include this type of testing. It might eliminate some of the second guessing that is done for diagnosis and treatments.

twinkerrs · Oct 31, 2014

Had a 30 something year d patient at our psych hospital last month with mental status changes also had lesions that his pcp was telling him was eczema or something like that. Ended up being syphlis transferred him out for iv abx.

Christy1019, ASN, RN · Oct 31, 2014

It use to be that every hospital admission was tested for syphyllis, there was an "admission panel" that was done on every single admission. Sometimes I feel we should still include this type of testing. It might eliminate some of the second guessing that is done for diagnosis and treatments.

That would be lovely if our healthcare costs weren't so over inflated and that wouldn't cost an arm and a leg for all those tests.