Cuyahoga County Syphilis Surveillance Report, 2014 Executive Summary

Transcription

1 Cuyahoga County Syphilis Surveillance Report, 24 Executive Summary Demographics There were a total of 8 reported syphilis cases in Cuyahoga County in 24 A 9% increase in cases from 23 There were a total of 72 P&S (Primary and Secondary) Syphilis cases reported in Cuyahoga County in 24 An 48% increase from 24 The majority of 24 syphilis cases were male (92%) Most cases were reported from those who are 2-24 years of age 73% of the cases reported were African American Risk Factors for P&S Syphilis HIV Co-infection was reported in 6% of P&S syphilis cases. In MSM/bisexual males 76% report they are co-infected with HIV 64% of 24 P&S syphilis cases reported MSM/bisexual behaviors 4% reported a history of STD infection 9% of P&S syphilis cases reported marijuana use in the last 2 months. Out of 72 P&S cases, no one reported a injecting drugs within the past 2 months. Cocaine (3), crack () and heroine () use was also reported Having sex with anonymous partner was very common among syphilis cases with 38% of P&S cases reporting having sex (oral, anal or vaginal) with an anonymous partner in the past 2 months. Nearly half (22 of 46) of the MSM/bisexual cases reported having sex (oral, anal, vaginal) with an anonymous partner in the past 2 months. A total of 2 cases reported using the internet to find sexual partners, 9 of those 2 reported having MSM/bisexual behaviors A total of 6 people reported having sex with someone they knew was HIV positive all six reported MSM-bisexual behaviors. Condom usage was very rare, especially among MSM/bisexual males (refer to page 2 for table) Cleveland and Cuyahoga County Syphilis Surveillance Report

2 Cleveland Department of Public Health Office of Communicable Disease Surveillance and Epidemiology Cuyahoga County Syphilis Surveillance Report, 24 Cleveland Department of Public Health 75 Erieview Plaza Cleveland OH, 444 Phone: Fax: Cleveland and Cuyahoga County Syphilis Surveillance Report 2

3 Cuyahoga County Syphilis Surveillance Report, 24 Cleveland Department of Public Heath Office of Communicable Disease Surveillance and Epidemiology The Cleveland Department of Public Health would like to thank the following for their contributions to this report: Cleveland Department of Public Health Jacqulyn Tomer, MPH Disease Surveillance Specialist Vinothini Sundaram, MPH Office of Communicable Disease Surveillance and Epidemiology Alisha Cassady, MPH Candidate Epidemiology Intern Data prepared by Ohio Department of Public Health ODRS (Ohio Disease Reporting System). Surveillance performed in cooperation with the Cuyahoga County Board of Health Cleveland and Cuyahoga County Syphilis Surveillance Report 3

4 Table of Contents Introduction....4 Total Syphilis Cases for Cuyahoga County.6&7 Total Syphilis Cases for Cleveland..8 Syphilis Cases by City..9 Syphilis Case by County.. Risk Factors for P&S Syphilis Cases. Condom Use among Syphilis Cases 2 Stages of Syphilis.3 Testing Centers.4 Acknowledgments.5 Cleveland and Cuyahoga County Syphilis Surveillance Report 4

5 Introduction Syphilis is a sexually transmitted disease (STD) that is caused by the bacterium Treponema pallidum The time between being exposed and experiencing symptoms of the disease can be between 9 and 9 days Stages of Syphilis Primary and secondary (P&S) the most acute and infective stages Latent Syphilis asymptomatic, potentially infectious Tertiary syphilis late stage, non infectious, lesions on skin, bones and organs Congenital Syphilis when transferred from mother to infant, potentially fatal How is it transmitted? Intimate genital contact Unprotected vaginal, anal or oral sex Kissing an infected person From an infected pregnant mother to her baby Diagnosis and Treatment A blood test is used to confirm a syphilis infection Antibiotics treatment is very effective It is very important to inform any sexual partners so they may get tested/treatment An infected individual may still transmit the disease up to 2 weeks after treatment It is important to abstain from intercourse for at least 2 weeks after treatment Prevention Condoms can prevent the spread of syphilis if used correctly Statistics Nationally, in 24 there were 9,999 reported primary and secondary (P&S) syphilis cases with a rate of 6.3 per, it s the highest rate since 994 In Ohio, there were 56 P&S syphilis cases reported with a rate of 4.8 per, An outbreak of syphilis in Cuyahoga County began in 27, has since been decreasing Cleveland and Cuyahoga County Syphilis Surveillance Report 5

6 Cases Total Syphilis Cases for Cuyahoga County Total Syphilis Cases by Stage for Cuyahoga County, Cases Year Congenital Late Latent Early Latent P&S Beginning in 27, Cuyahoga County saw an outbreak of Syphilis. Since 2, Syphilis cases have been steadily decreasing until 24 where we have seen an 89.4% increase in cases compared to 23. Unfortunately, there was a case of congenital syphilis reported in 2, 22 and 23, respectively. Congenital cases are preventable. Total Syphilis Cases by Age and Stage for Cuyahoga County, Late Latent 4 3 Early Latent P&S Ages In 24, persons aged 2-24 had a total of 62 cases of syphilis that were reported, the highest of all the age groups by more than double. There were no reported cases of syphilis in persons aged under 5. Cleveland and Cuyahoga County Syphilis Surveillance Report 6

7 Cases Rate per, Total Syphilis Cases for Cuyahoga County Number of Cases and Rates of Primary and Secondary Stage Syphilis for Cuyahoga County, Year Cases Rate per, Primary and secondary cases are of great importance to public health officials as they are highly infectious. These stages of the disease occur within the first three to six months from initial exposure. The above figure shows the number of primary and secondary syphilis cases for Cuyahoga County as well as the rate of infection. In 23, the county saw a total of 29 cases and in 24 there were 72 cases, an increase of 48%. The P&S rate increased from 2.3 per, in 23 to 5.6 per, in 24. P&S Early Latent Late Latent White African American Hispanic 2 3 Bi-Racial 4 2 P&S Early Latent Late Latent Total Male Female (8%) In Cuyahoga County, 92% of reported syphilis cases were male with only 8% being female. The majority of cases were African American with 73% of the total cases and 2% of cases being white. Cleveland and Cuyahoga County Syphilis Surveillance Report 7

8 Total Syphilis Cases for Cleveland Number of Cases and Rates of Primary and Secondary Stage Syphilis 3 for Cleveland, Cases Late Latent Early Latent P&S Ages In Cleveland, persons aged 2-24 had a total of 24 cases of syphilis that were reported, the highest of all the age groups. There were no reported cases of syphilis in persons aged under 5. The majority of the cases were either primary or secondary stage within the cases who were 2-24 years old. P&S Early Latent Late Latent White African American Hispanic Bi-Racial 3 2 P&S Early Latent Late Latent Total Male (9%) Female (9%) In Cuyahoga County, 92% of reported syphilis cases were male with only 8% being female. The majority of cases were African American with 73% of the total cases and 2% of cases being white. Of the 28 African American P&S cases, 63% were MSM/Biracial. It is clear that the African American MSM population in Cleveland is at high risk for syphilis. Cleveland and Cuyahoga County Syphilis Surveillance Report 8

9 Rate per, Syphilis Cases by City Number of Cases and Rates of Primary and Secondary Stage Syphilis for Cleveland, Cases Cases Year Rate per, Rate per, In Cleveland, the rate for 24 syphilis cases was 9.6 per,. This is a rate is a 43% increase from 23 and the highest rate that Cleveland has seen since 2. Total Syphilis Rates for Selected Cities in Ohio, 2-24* Years Cleveland Akron Columbus Cincinnati Cincinnati continues to lead Ohio with the greatest syphilis rate of 95.8 cases per,. This is nearly three times the rate at which Cleveland is currently experiencing. *Rates per,; Data retrieved from 2-24 Ohio Infectious Disease Status Report: Total Syphilis Cleveland and Cuyahoga County Syphilis Surveillance Report 9

10 Syphilis Cases by County Total Syphilis Rates for Selected Counties in Ohio, 2-24* Cases Year Cuyahoga Franklin Hamilton Hamilton county is showing a decrease in syphilis cases despite having the most cases for Franklin County syphilis cases are continuously increasing while Cuyahoga county has stayed steady until a spike from 23 to 24. Primary/Secondary Syphilis by Municipality in Cuyahoga County: P&S Syphilis cases were reported in the following municipalities (with case counts): Bay Village(), Bedford (), Cleveland (38), Cleveland Heights (4), East Cleveland (4), Euclid (4), Garfield heights (3), Independence (), Lakewood (2), Maple Heights (2), North Olmstead (2), Parma (2), Parma Heights (2), Richmond Heights (2), Strongsville (), Warrensville Heights (), Westlake (2). Treponema pallidum spirochetes *Rates per,; Data retrieved from 2-24 Ohio Infectious Disease Status Report: Total Syphilis Cleveland and Cuyahoga County Syphilis Surveillance Report

11 Risk Factors for P&S Syphilis Cases in Cuyahoga County* HIV Co-infection: Syphilis co-infection with HIV continues to be a major public health problem in Cuyahoga county. Of those who were reported as primary and secondary syphilis cases, 43 of 72 (6%) reported being HIV positive as well. In males who reported sexual activity with another male (MSM) or being bisexual in the past 2 months, 35 of 46 (76%) reported being co-infected with HIV. Out of two P&S syphilis reports from females, one of two (5%) were HIV positive. Year % Co-infected with HIV MSM Coinfected HIV 22 58% 7% 23 4% 24 6% 76% Sexual Preference: 64% of Syphilis reports for 24 were MSM/bi-sexual males. The two females reported being heterosexual. 22% either refused to answer or had an unknown sexual preference. STD History: Out of all P&S cases, 4% reported a history of STD infection. In those who reported being MSM/bisexual, 46% reported having an STD in the past. Drug Use: 9% of P&S syphilis cases reported marijuana use in the last 2 months; the majority of those cases were MSM/bisexual with 26% reporting marijuana use in the last 2 months. Out of 72 P&S cases, no one reported a injecting drugs within the past 2 months. Cocaine (3), crack () and heroine () use was also reported. Alcohol Use: 7% of P&S cases reported having sex while intoxicated in the last 2 months while 22% of MSM/bisexual cases reported having sex while intoxicated in the last 2 months. Having sex with anonymous partner was very common among syphilis cases with 38% of P&S cases reporting having sex (oral, anal or vaginal) with an anonymous partner in the past 2 months. Nearly half (22 of 46) of the MSM/bisexual cases reported having sex (oral, anal, vaginal) with an anonymous partner in the past 2 months. Using the internet to find sexual partners was very common among the MSM/bisexual syphilis cases. Of those who reported using the internet to find sexual partners 9 out of the 2 reported being MSM/ bisexual. While 4% of MSM/bisexual cases reported using the internet to find sexual partners, only % of heterosexual males/females reported finding sex partners using the internet. HIV positive partners: In 24, a total of six persons reported having sex with someone they knew was HIV positive all six also reported having MSM/bisexual behaviors. *All risk factors are self-reported Cleveland and Cuyahoga County Syphilis Surveillance Report

12 Risk Factors for P&S Syphilis Cases in Cuyahoga County* Condom Use among P&S Syphilis Cases in Cuyahoga County, 24 Risk Behavior Condom Use for Anal Sex - always - sometimes - never MSM/Bisexual Males n (%) 4 (9%) 32 (7%) 8 (7%) Heterosexual Male/Female n (%) 4 (44%) Condom Use for Vaginal Sex - always - sometimes - never 2 (4%) 3 (7%) 2 (4%) 8 (89%) (%) Condom Use for Oral Sex - always - sometimes - never 8 (7%) 36 (78%) 8 (89%) The above table shows the use of condoms among syphilis cases by sexual preference for 24. Proper condom use can help prevent unwanted pregnancies and reduce the risk of contracting/spreading sexually transmitted diseases. Inconsistent use of condoms for anal sex in the MSM/Bisexual male community is a warning signs that safe sex prevention messages are not being followed. Condom use during oral sex for this population was also very rare. Condom use among heterosexual males and females was also largely underutilized. Cleveland and Cuyahoga County Syphilis Surveillance Report

13 Stages of Syphilis Syphilis is Preventable and Treatable. - - Get smart. Get checked. Get treated. Since syphilis symptoms can easily be mistaken for other illnesses, the only way to be sure you don t have syphilis is to get tested. Got a new partner? Got more than one partner? Then get checked for STDs at least every six months. And use condoms consistently for oral, anal and vaginal sex. First Signs of Syphilis Look for an open sore in the genital area (penis/testicles or vagina, and anus) or in the mouth that is painless. It can last for to 3 weeks and go away without medicine. The sore may be in the vagina or rectum and won t be noticeable. Second Signs of Syphilis Look for a rash that does not itch on the palms of the hands, the bottoms of your feet, or on your stomach or chest. The rash may spread across your body. Flat patches, small bumps or warts on your genitals. Sometimes these patches are reddish brown or red. Swollen glands in your neck, groin, or next to your armpits. Fever, sore throat, head and muscle aches, fatigue similar to a bad cold or flu. Hair may begin to fall out of your head. Even if these symptoms go away, you are still infective to others. Late and Latent Stages After the symptoms from primary and secondary stages occur, symptoms may not appear for years, but syphilis remains in the body. This stage may occur within the first 2 months after the initial infection (early latent syphilis) or may begin more than a year after. Major body systems, such as the brain and nervous system, heart and cardiovascular system, liver and hepatic system, and muscle systems can be severely damaged by syphilis. In as early as ten years, untreated syphilis can lead to neurosyphilis, a condition where dementia, loss of muscle coordination, numbness, blindness and even death can occur. In persons with HIV, neurosyphilis can occur as early as three years after the initial infection. Cleveland and Cuyahoga County Syphilis Surveillance Report

14 Testing Centers Your risk of getting HIV from an infected partner is much higher if you already have a STD. HIV positive persons put their partner at risk when safe sex practices aren t followed. Get smart. Get checked. Get treated. To find a testing center near you visit Local testing centers include: Cleveland Department of Public Health McCafferty Health Center Cuyahoga County Board of Health Health Center 4242 Lorain Ave 555 Venture Drive Cleveland, OH 443 Parma, OH 443 (26) (26) 2-2 J. Glen Smith Health Center Northeast Ohio Neighborhood St. Clair Ave Health Services (NEON) Cleveland, OH Hough Ave (26) Cleveland, OH ) Care Alliance Downtown Free Clinic of Greater Cleveland 22 Euclid Ave 53 St. Clair Ave Cleveland, OH 446 Cleveland, OH 444 (26) 72-4 (26) Cleveland and Cuyahoga County Syphilis Surveillance Report

15 Cuyahoga County Syphilis Surveillance Report, 24 Created by: CDPH Office of Communicable Disease Surveillance and Epidemiology (OCDSE) Data Source: Ohio Department of Health ODRS (Ohio Disease Reporting System) Date: May, 27, 26 Cleveland and Cuyahoga County Syphilis Surveillance Report