Syphilis Screening and Prevalence: Past, Present, Future

Transcription

1 Syphilis Screening and Prevalence: Past, Present, Future Allison Haynes, MD University of Kansas School of Medicine- Wichita Family Medicine Residency at Smoky Hill- Salina 1

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4 Objectives Outline the manifestations of syphilis infection, i.e. congenital, primary, tertiary Describe the impact of increasing syphilis rates on society List current recommended screening methodology Discuss future goals and plans for improved screening and increased levels of treatment 4

5 Manifestations Primary Syphilis: A (usually) single, painless lesion at the sight of inoculation Appears roughly 2-3 weeks after exposure Will resolve in 4-5 weeks if left untreated ilis&rank=3~150&source=see_link 5

6 Manifestations Secondary syphilis Classically a symmetrical, generalized macular/papular rash Multiple other organ systems can be affected Appears 4-8 weeks after the primary lesion Will resolve in 3-6 weeks (rarely will relapse) philis&rank=3~150&source=see_link lis&rank=3~150&source=see_link 6

7 Manifestations Tertiary (1-30 years) 3 main manifestations CNS General Paresis (dementia) Tabes Dorsalis Cardiovascular Aortic incompetence Coronary ostial stenosis Aortic medial necrosis Gummatous Locally destructive lesions 7

8 Manifestations Congenital Divided into early and late depending on whether presentation is before or after 2 years of age ikipedia/commons/thumb/f/f2 commons/thumb/5/5c enitalsyphilis 8

9 Rates In Society Worldwide: In 2012 the WHO estimated a prevalence of 18 million cases in adults and 5.6 million new cases Highest prevalence is in Africa, East Asia, and Western Pacific United States: Nationally notifiable disease since 1944 Number of cases hit an all time low in 2000, but have been increasing every year since 2001 In 2016 the overall number of early syphilis cases was 27,814 9

10 US Statistics Primary and Secondary syphilis rates are highest in the and age groups Has increased: Across all age groups ages 15 and over In every part of the nation Across all races and ethnicities In homosexual and heterosexual populations 10

11 Men in the US 11

12 Women in the US 12

13 Rates in Kansas 13

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16 Impact Increasing numbers in women Congenital syphilis Stillbirth HIV infection Left untreated infection can span decades 16

17 Screening Methods Screening tests are either treponemal or non-treponemal RPR, VDRL Confirmatory testing utilizes one to confirm the other Optimal screening interval is not well established 17

18 Who do we test? Anyone with signs or symptoms Sexually active patients with an undiagnosed genital ulcer, or a rash on their palms and soles Less specific signs or symptoms particularly if no alternate etiology is identified Patients with a sexual partner who has early syphilis (also should receive empiric tx) Men who have sex with men (annual) 18

19 Who do we test? HIV infected individuals (annually or more frequently depending on sexual behaviors) Individuals with hx of incarceration or commercial sex work Pregnant women Screening can be justified in areas where syphilis is very common 19

20 Where do we go from here? Prevention was, is, and will be key Improving sex education Increased awareness Possible vaccine development Cost effective Point-of-Care diagnostic testing Currently in development 20

21 Where do we go from here? Our role as Family Physicians Talk Treat Test 21

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23 References osyphilis&topicref=7584&anchor=h11&source=see_link#h11 Sex, Sin, and Science A History of Syphilis in America

24 Thank you. ANY QUESTIONS? 24