April is STD Awareness Month, and this year’s theme is Syphilis Strikes Back. This week’s post highlights the impact of syphilis on women and newborns, and strategies of local health departments to address syphilis among these populations.
As noted in the previous blog post, syphilis is a bacterial infection that is primarily spread through sexual contact, but can also be spread from mother to child during pregnancy. Rates of syphilis among women have increased in recent years: during 2014-2015, the rate of reported cases of primary and secondary (P&S) syphilis among women increased 27.3%. As rates of syphilis increase among women, so does the likelihood of the disease being passed from a mother with syphilis to her baby during pregnancy (congenital syphilis). In fact, the rate of congenital syphilis rose 36.3% from 2011 to 2015. Congenital syphilis can yield many negative health outcomes for babies, such as prematurity or low birth weight; skeletal deformity; brain and nerve issues such as blindness and deafness; anemia, meningitis, jaundice, and skin rashes; and death shortly after birth.
At the local level, important strategies to reduce the prevalence of congenital syphilis include educating providers on the need to test pregnant women for syphilis, understanding local epidemiological trends in syphilis among women and where women at risk for syphilis access healthcare and other services, and ensuring coordination among those key access points, providers, and disease intervention specialists (DIS) to allow for effective follow up with women of childbearing age who have tested positive for syphilis so treatment can be provided.
Below, Kim Toevs, MPH, Director of Adolescent Sexual Health Equity and STD/HIV/HCV Programs at Multnomah County Health Department (OR), recounts how Multnomah implemented some of these strategies.
Locally, our pregnant women with syphilis often have common challenges: active addiction, homelessness, short-term incarceration, and, sometimes, abusive partners. Rather than getting syphilis messaging out to all private obstetrics providers, we felt we needed a key set of providers to come to the same threshold of urgency about the obstetric emergency that is congenital syphilis, and better communicate, coordinate care, and implement clinical consultation pathways between the health department STD program, local jails, and addictions treatment facilities. To facilitate this process, we convened our Corrections Health Medical Director, the Medical Director of a large addictions treatment agency offering integrated prenatal care, our DIS team, and the health department STD clinicians to do a detailed root cause analysis of a congenital syphilis case.
We all left this meeting with agreements about how to shorten the length of time between various lab tests, diagnosis and treatment, and how to share medical records. We also identified staff to be key points of contact, and increased understanding of the assistance DIS and health department STD clinicians can offer in finding clients and providing clinical consultation. The meeting also served as a step in helping our Corrections Health partners move toward implementation of syphilis screening of inmates, which had been terminated previously when syphilis cases were very low and were almost exclusively among MSM.
From taking this approach, we learned that busy physician partners were willing to come to the table when we framed the process as a root cause analysis of a sentinel event. This framework was focused enough to fit within their realm of familiarity and represent a good use of their time, and we were able to use that framework and the providers’ engagement to identify and improve systems issues, instead of using a larger group planning approach. Now that our set of integrated addictions and prenatal care treatment providers has expanded, we are promoting the learnings and solutions to those providers who are also likely to see pregnant women with syphilis based on our local epidemiology.
Multnomah’s work to address syphilis among women of childbearing age illustrates the importance of establishing community partnerships and engaging stakeholders across local jurisdictions. It also shows how smaller-scale efforts to address systems-level issues can yield significant results, especially when those key stakeholders are all at the same table.
Next week’s post in the STD Awareness Month series will highlight a NACCHO project supported by CDC’s Division of STD Prevention that aims to assess optimal uses for rapid syphilis testing in nonclinical settings, including in DIS settings. The next post will be available on April 25, and as a reminder, throughout the month of April check out CDC’s resources on syphilis, participate in CDC’s Syphilis Strikes Back Thunderclap, and use sample STD Awareness Month tweets and Facebook posts on your social media accounts.