Rising Syphilis Cases in Yellowstone County: Action Needed
The Infection Prevention Office at St. Vincent provided the following SBAR regarding syphilis cases:
SITUATION
We are continuing to see sustained high numbers of syphilis cases in Yellowstone County and our area. We are seeing unprecedented numbers of congenital syphilis due to women either contracting syphilis before or during pregnancy and not receiving adequate testing and treatment.
BACKGROUND
Syphilis is often asymptomatic and testing needs to be based on risk factors. However, many patients may not fully disclose their risk factors. It can be transmitted w/ oral, anal, or genital contact. Rarely, the rash of secondary syphilis (which involves the palms and soles of the feet) can transmit syphilis via skin contact. For those that test positive, determining proper treatment can be difficult, and ensuring short term and long term follow-up can also be challenging since the treatment regimens often require weekly dosing. Some patients need retreatment if their RPR markers do not normalize. Furthermore, pregnant women can pass syphilis on to their unborn child and it can lead to fetal demise and many severe birth defects. Finally, there is a nationwide shortage of bicillin, which is the mainstay treatment for syphilis. Luckily Intermountain has a good stockpile of it, but other facilities may have a shortage and could need alternative treatments such as doxycycline or ceftriaxone.
ASSESSMENT
There is likely inadequate recognition of patients needing to be screened for syphilis. There are also opportunities to improve treatment completion and also to ensure the RPR normalizes and that the patient doesn’t need further evaluation and treatment.
RECOMMENDATION
Please test any person in the following groups:
Any patient using drugs like meth, cocaine, narcotics, etc. could be at risk for having syphilis. Transactional sex is associated with these activities.
Any person w/ a partner who has tested positive for syphilis, multiple sex partners, or a victim of human trafficking.
Any person needing testing for other sexually transmitted infections (STIs).
Any pregnant patient
Ensure short-term follow-up is completed and that they receive their full regimen.
If unsure how long a patient has had syphilis, we recommend erring on the side of using a regimen for late latent syphilis.
Ensure long-term follow-up to trend the RPR levels and ensure it normalizes. If it does not, then consider repeating treatment for late latent syphilis or evaluating and treating for neurosyphilis.
References
https://dphhs.mt.gov/publichealth/hivstd/stdprevention/Syphilis
Syphilis - STI Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/syphilis.htm