Public Health Alert letter on syphilis outbreak to medical providers

Medical professionals, medical centers, clinics and prenatal care service organizations are asked to increase screening for syphilis.

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PUBLIC HEALTH ALERT-SYPHILIS

March 4, 2009 Dear Health Care Colleague, Cuyahoga County is i n the midst of a syphilis (Tre~onema a l l i d u m outbreak. The Cleveland ~ ) Department of Public Health (CDPH), the Cuyahoga County Board of Health (CCBH), and the Shaker Heights Health Department (SHHD) urge Greater Cleveland medical providers to screen all sexually active patients, particularly youth, for syphilis. This outbreak began i n June of 2007 and persists to the present. From January to November 2008, there have been 94 early (primary, secondary, and early latent) syphllis cases in the County, w h c h is a 135%increase from this time last year. On average, 10%were diagnosed with primary s y p f i s , 50% a s secondary and 40% a s early latent syphilis. The prevalence of syphilis has been low enough over the last several years that many providers have never seen symptomatic syphilis. These findings require t h a t all Cuyahoga County clinicians raise our index of clinical suspicion and our tendency to conduct primary screening. In those reporting symptoms, genital lesions were identified in 27%,a rash on palms or soles of feet in 30%, generalized rash in 21%,and condyloma lata (raised skin scaling) or mucous patches in 18%.Only 3%reported swollen nodes. Lesions were present i n nearly all primary and early latent cases. Recent cases are occurring in two populations: 1) African-American heterosexual males and females, and 2) men who have sex with men and bisexual men regardless of race or ethnicity. Youth, ages 14 to 24, are of particular concern, reflecting one in four new cases. There have been 16 new cases of syphdis among teens 14 to 19 from January through November 2008, a 300% increase since the same period for 2007. I n addition, Chlamydia and gonorrhea rates are highest among this age group. CDPH, CCBH,and SHHD urge medical providers to screen al sexually active patients for ayphilis l and to adhere to the Centers for Disease Control and Prevention STD Treatment Guidelines: Any patient presenting with a sexually transmitted disease (STD) should be screened for syphilis by obtaining a serum RPR. All HIV positive patients should have a n annual screening RPR. More frequent screening (every 3 to 6 months) is also recommended for those with high-risk behaviors such a s having multiple sex partners, engaging in any unprotected intercourse andlor illicit drug use. All pregnant women should have a screening RPR obtained a t fnst prenatal visit and again a t 28 weeks gestation, and during the third trimester if the patient has any hgh-risk behaviors. Any woman who delivers without prenatal care needs to have a n RPR drawn a t delivery. We require your pport i n order to help make Cuyahoga County a healther community. Please contact CDPF bP drtner Notification and Referral Services a t (216)664-7080 for further information ake a communicable disease referral.

andalakas, M.D., M.S., Medical Director County Board of Health