Syphilis Staging and Getting It Wrong - Trends Across the SEHD

Abstract

Background: Syphilis, an ancient sexually transmitted infection (STI) caused by the organism Treponema pallidum, develops in four stages: primary, secondary, non-primary non-secondary, and unknown duration or late syphilis. Untreated syphilis at any stage can cause serious health problems.

In addition to direct morbidity, syphilis increases individuals’ risk of HIV infection. Diagnosis and management of persons with syphilis is often challenging because of its varied symptoms and stages and difficulty in interpretation of serological tests as results may vary with the procedure, stage of disease, and treatment history.

To explore these issues, we will discuss and describe syphilis trends and partner services issues across the 16-county Southeast Health District (SEHD).

Methods: We examined SEHD’s STI incidence, field record dispositions, social locations, lab history, pregnancy status, and treatment history.

Results: Between 2013-2022, the SEHD received reports of over 900 cases of syphilis (excluding congenital syphilis). Of these, 9% were primary syphilis, 18.8% secondary syphilis, 22.7% non-primary non-secondary, and 49.5% unknown duration or late syphilis. We initiated 969 field investigations during this period in which 60.4% were considered infected and treated while 11% were considered infected, not treated. Throughout this time, 45 patients received inadequate treatment for their stage of syphilis. Additionally, we discovered an increase in syphilis screening tests reported without titers which complicates staging. Patients meeting partners through the internet and engaging in sexual activities in hotels/motels also increased.

Conclusions: If syphilis control and prevention is not as effective as it should be, is it because we are not doing the right things, or because we are not doing things right? Data suggests provider education related to ordering and interpreting syphilis lab tests is needed to correctly stage and treat infected patients. As these processes improve, we anticipate better health outcomes in positive syphilis patients.

Keywords

syphilis, stages, diagnosis and management, lab interpretation, partner services, rural Georgia

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Syphilis Staging and Getting It Wrong - Trends Across the SEHD

Background: Syphilis, an ancient sexually transmitted infection (STI) caused by the organism Treponema pallidum, develops in four stages: primary, secondary, non-primary non-secondary, and unknown duration or late syphilis. Untreated syphilis at any stage can cause serious health problems.

In addition to direct morbidity, syphilis increases individuals’ risk of HIV infection. Diagnosis and management of persons with syphilis is often challenging because of its varied symptoms and stages and difficulty in interpretation of serological tests as results may vary with the procedure, stage of disease, and treatment history.

To explore these issues, we will discuss and describe syphilis trends and partner services issues across the 16-county Southeast Health District (SEHD).

Methods: We examined SEHD’s STI incidence, field record dispositions, social locations, lab history, pregnancy status, and treatment history.

Results: Between 2013-2022, the SEHD received reports of over 900 cases of syphilis (excluding congenital syphilis). Of these, 9% were primary syphilis, 18.8% secondary syphilis, 22.7% non-primary non-secondary, and 49.5% unknown duration or late syphilis. We initiated 969 field investigations during this period in which 60.4% were considered infected and treated while 11% were considered infected, not treated. Throughout this time, 45 patients received inadequate treatment for their stage of syphilis. Additionally, we discovered an increase in syphilis screening tests reported without titers which complicates staging. Patients meeting partners through the internet and engaging in sexual activities in hotels/motels also increased.

Conclusions: If syphilis control and prevention is not as effective as it should be, is it because we are not doing the right things, or because we are not doing things right? Data suggests provider education related to ordering and interpreting syphilis lab tests is needed to correctly stage and treat infected patients. As these processes improve, we anticipate better health outcomes in positive syphilis patients.