Syphilis Outbreak in Clark County

Syphilis Outbreak in Clark County

 

The Ohio Department of Health (ODH) and the Clark County Combined Health District (CCCHD) have reported an increase in syphilis cases over the last three months.  As of October 1, there were 50 cases of syphilis reported so far in Clark County in 2020, compared to a total of 36 in all of 2019.  ODH and CCCHD are asking healthcare providers to screen, diagnose, and treat all syphilis cases.

Background

Syphilis is a systemic disease caused by Treponema pallidum. The disease has been divided into stages based on clinical findings, helping to guide treatment and follow-up.  Persons who have syphilis might seek treatment for signs or symptoms of:

  • Primary syphilis infection (i.e., ulcers or chancre at the infection site)
  • Secondary syphilis (i.e., manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymphadenopathy),
  • Tertiary syphilis (i.e., cardiac, gummatous lesions, tabes dorsalis, and general paresis)
  • Early neurologic clinical manifestations (i.e., cranial nerve dysfunction, meningitis, stroke, acute altered mental status, and auditory or ophthalmic abnormalities), which are usually present within the first few months or years of infection.
  • Late neurologic manifestations (i.e., tabes dorsalis and general paresis), which occur 10–30 years after infection.

 

Latent infections (i.e., those lacking clinical manifestations) are detected by serologic testing. Latent syphilis acquired within the preceding year is referred to as early latent syphilis; all other cases of latent syphilis are late latent syphilis or syphilis of unknown duration. 

Those at risk for syphilis include:

  • Individuals who:
    • Have multiple sex partners (or a partner with multiple sex partners);
    • Have anonymous sex partners;
    • Engage in sex while using recreational drugs (e.g., methamphetamines);
    • Have had a recent STI diagnosis (e.g. chlamydia, gonorrhea, trichomoniasis) or present for care due to STI symptoms; and,
    • Exchange sex for money or drugs
  • Men who have sex with men
  • Transgender women
  • HIV positive individuals
  • Individuals taking HIV PrEP

Recommendations

ODH and CCCHD is asking healthcare providers to screen, diagnose, and treat syphilis in accordance with current CDC guidelines (https://www.cdc.gov/std/tg2015/syphilis.htm):

  • Early syphilis (primary or secondary syphilis): a single intramuscular (IM) injection of Penicillin G benzathine (Bicillin L-A®) 2.4 MU for HIV negative and HIV positive patients.
  • Late latent syphilis: Three weekly IM injections of Bicillin L-A® 2.4 MU for HIV negative and HIV positive patients.
  • Pregnant women should be screened for syphilis at least 3 times during pregnancy (intake, 28-32 weeks, and at delivery).  Penicillin is the only treatment recommended for syphilis treatment in pregnant women.
  • Neurosyphilis and ocular syphilis should be managed in collaboration with an ophthalmologist and according to the treatment and other recommendations for neurosyphilis.

Reporting

  • Syphilis is a Class B reportable condition which is required to be reported by the end of the next business day.
  • Health care providers and laboratories should report all syphilis infections and other notifiable STDs in accordance with Ohio’s infectious disease reporting requirements found here.

Attachments

  • Syphilis Disease Fact Sheet

Resources

If you are receiving this health advisory via fax, please visit the CCCHD website to view a digital copy with clickable links.  In the future, if you wish receive health alerts electronically, please contact apetroff@ccchd.com. 

Alert Details

Date: 11/4/20

Time Sensitivity: Moderate

To: Medical offices, Urgent Cares, Clinics, Hospitals, Laboratories and ICPs

Target Audience: Physicians, PA, NP, Nurses, Medical Staff, ICP staff, and Laboratorians

From: Clark County Combined Health District

Subject: Syphilis Outbreak in Clark County

Relevance to Public Health: High


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