Increase in Syphilis Cases among Homeless & Identification of Congenital Syphilis in King County and Washington State
Posted over 3 years ago by Nancy Lawton
Increase in Syphilis Cases among Heterosexual Individuals living Homeless & Identification of Congenital Syphilis in King County and Washington State January 25, 2021 - Washington State Department of Health and Public Health Seattle & King County (PHSKC) officials are jointly issuing the attached health advisory. We are calling on the health care community to test, treat, and report cases of syphilis to address the alarming rise of syphilis infection among heterosexual individuals, particularly those living homeless, and pregnant women.
Actions Requested:
• Treat all patients with signs or symptoms consistent with primary or secondary syphilis when they present for care. Clinicians should perform serological tests on patients with signs or symptoms of syphilis, but should not wait for the results of such tests to provide treatment, particularly among pregnant women, persons who are living homeless and other persons for whom medical follow-up is difficult to ensure.
• Know the symptoms of primary syphilis: A syphilitic chancre is usually a firm ulcer at the site of inoculation; it is usually painless and may be associated with localized lymphadenopathy.
• Know the many symptoms of secondary syphilis: Rash is the most common symptom and may present as a generalized maculopapular rash on the torso with or without palmar and plantar lesions, though the rash may also be pustular; other presentations of rash include condyloma lata, mucous patches, alopecia; other symptoms include generalized malaise, lymphadenopathy, sore throat and arthralgias.
• Test ALL PREGNANT women for syphilis at their first prenatal visit and AGAIN with routine 3rd trimester labs, typically at 24-28 weeks gestation.
• Pregnant women who present late for prenatal care or have fragmented care should be screened for syphilis (along with HIV, HBsAg and STI testing), whenever they present for care (e.g. emergency departments, jail, urgent care and labor and delivery).
• Refer non-contracepting women of childbearing potential diagnosed with syphilis for contraception if the diagnosed woman does not desire pregnancy.
• Medical providers should test sexually active persons experiencing homelessness, persons who exchange money or drugs for sex, and persons who use methamphetamine, heroin or cocaine for syphilis when they present for care, including in emergency rooms. Non-pregnant persons without signs or symptoms of syphilis, or a known exposure to syphilis do not require testing more than every 90 days.
• Treat any persons who reports sexual exposure to someone with syphilis, even in the absence of signs or symptoms of infection. Treatment is not dependent on the results of serological testing, which can be falsely negative early in infection. Test these individuals for syphilis but treatment should not be withheld awaiting test results.
• Know the treatment of early syphilis (primary, secondary and early latent): benzathine penicillin (bicillin) 2.4 million units intramuscularly once. Patients with late latent syphilis or syphilis of unknown duration require three injections spaced one week apart.
Syphilis related questions?
King County: Call Rolf Pederson 206.744.4376, Dr. Lindley Barbee 206.744.2595 or Dr. Matthew Golden 206.744.6829.
Outside of King County: Call your local health jurisdiction, or Department of health staff members Zandt Bryan 360.890.5816, Katrina Miller 360.236.3425, or Kari Haecker 360.890.6897 for assistance in locating public health staff who can assist you and your patient.
Cases should be reported to your local health department. Reporting information and forms for public health jurisdictions can be found on the DOH website.