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Syphilis Outbreak in Southwestern Idaho — 2002 – 2003

Syphilis Outbreak in Southwestern Idaho — 2002 – 2003. Jared Bartschi, MHE STD/HIV Epidemiologist Idaho Dept. of Health and Welfare. Introduction. U.S. P&S syphilis rates show an increase after a decade of decline U.S. syphilis rates increasing among men

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Syphilis Outbreak in Southwestern Idaho — 2002 – 2003

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  1. Syphilis Outbreak in Southwestern Idaho —2002 – 2003 Jared Bartschi, MHE STD/HIV Epidemiologist Idaho Dept. of Health and Welfare

  2. Introduction • U.S. P&S syphilis rates show an increase after a decade of decline • U.S. syphilis rates increasing among men • Recently reported outbreaks describe syphilis among MSMs • Idaho experiencing a syphilis outbreak • 22 in 2000-2001 • 64 in 2002-2003

  3. Objectives • Determine the extent of the outbreak • Describe characteristics of the affected population • Follow up with patients and partners • Discuss difficulties with outbreak investigation and get suggestions from peers

  4. Case-finding • Case-finding • Passive: laboratory and physician reporting • Active: contact tracing and testing • Laboratory testing • Nontreponemal (VDRL or RPR) • Treponemal (FTA-ABS or MHA-TP) • Dark-field microscopy NOT available • Interviews using CDC STD forms

  5. Case Definitions • Standard CSTE/CDC • Early syphilis • Primary syphilis (chancres) • Secondary syphilis (mucocutaneous lesions) • Early latent syphilis • Latent syphilis (no symptoms or signs) • Evidence of acquiring infection within previous12 months

  6. Early Syphilis Cases — 2002 – 2003

  7. Geography of Early Syphilis

  8. Patient Characteristics — Sex

  9. Patient Characteristics — Age

  10. Patient Characteristics — Ethnicity

  11. Patient Characteristics — Pregnant

  12. Patient Characteristics — Number of Partners • Reported number of opposite sex partners • Reported number same sex partners = 0

  13. Health Care Characteristics —Provider at Diagnosis

  14. Health Care Characteristics — Days Onset to Diagnosis

  15. Public Health Response • Raising awareness • Health Alerts to area physicians • Press releases • Informational handouts / posters • Radio announcements • Follow-up infants from positive mothers • Visit by CDC Project Officer

  16. Limitations — Individual • Withholding of partner information • Language barriers • Illiteracy in any language

  17. Limitations — Investigation • Lack of timely contact follow-up • Safety concerns • Travel time (large jurisdictions) • Incarcerated patients and partners • Out-of-jurisdiction and out-of-country partners

  18. Recommendations • Enhance syphilis screening during prenatal care for young Hispanics in SW ID • Syphilis screening for inmates upon intake at correctional facilities • Improve outreach to Hispanics in SW ID • Expand screening to social networks

  19. Future Needs • Spanish language services • Educational materials for illiterate persons • Interview training for syphilis investigation • Permanent bridge to Hispanic community • Change in cultural norms

  20. Acknowledgments Southwest District Health Department Pat Harris, Epidemiology Supervisor Craig Christiansen, Epidemiologist Jennifer Tripp, Epidemiologist Central District Health Department Gladys Goodman, Epidemiologist IDHW Office of Epidemiology and Food Protection Christine Hahn, State Epidemiologist Kris Carter, CDC EIS Officer Centers for Disease Control and Prevention Gail Gould, Public Health Advisor Mary Hayes, STD Project Advisor

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