USPSTF: All Pregnant Women Should Be Screened For Syphilis

MedicalResearch.com Interview with:

Melissa A. Simon, M.D., M.P.H. Member, U.S. Preventive Services Task Force George H. Gardner professor of clinical gynecology, Vice chair of clinical research Department of Obstetrics and Gynecology Professor of preventive medicine and medical social sciences Northwestern University Feinberg School of Medicine

Dr. Simon

Melissa A. Simon, M.D., M.P.H.
Member, U.S. Preventive Services Task Force
George H. Gardner professor of clinical gynecology, Vice chair of clinical research
Department of Obstetrics and Gynecology
Professor of preventive medicine and medical social sciences
Northwestern University Feinberg School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The number of babies born with syphilis is increasing, mirroring the recent increase of syphilis among women. Syphilis infection passed from a pregnant woman to her baby, also known as congenital syphilis, can lead to serious health complications for the baby including premature birth, low birthweight, birth defects, and even death. The Task Force recommends that all pregnant women be screened for syphilis as early in pregnancy as possible to prevent congenital syphilis.  Continue reading

Girls with PID Underscreened For Syphilis and HIV in ERs

MedicalResearch.com Interview with:

Monika K. Goyal, M.D., M.S.C.E., senior study author Assistant professor of Pediatrics and Emergency Medicine Children’s National Health System Washington, DC

Dr. Goyal

Monika K. Goyal, M.D., M.S.C.E., senior study author
Assistant professor of Pediatrics and Emergency Medicine
Children’s National Health System
Washington, DC 

MedicalResearch.com: What is the background for this study?

Response: Patients with pelvic inflammatory disease (PID) are at an increased risk for syphilis and HIV. We know that adolescents account for 20 percent of the 1 million cases of PID that are diagnosed each year. We also know that an estimated one in four sexually active adolescent females has a sexually transmitted infection (STI). While screening for syphilis and HIV is recommended when diagnosing PID, actual screening rates among adolescents have been understudied.

This multi-center study aimed to quantify rates of HIV and syphilis screening in young women diagnosed with . pelvic inflammatory disease in pediatric emergency departments and to explore patient- and hospital-specific characteristics associated with screening for these two sexually transmitted infections.

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Does HAART Treatment for HIV Contribute To Rapid Rise in Syphilis Infections?

MedicalResearch.com Interview with:

Michael Rekart, MD, DTM&H Clinical Professor, Medicine and Global Health The University of British Columbia .... On behalf of my co-authors

Dr. Michael Rekart

Michael Rekart, MD, DTM&H
Clinical Professor, Medicine and Global Health
The University of British Columbia
…. On behalf of my co-authors

MedicalResearch.com: What is the background for this study?

Response: The background for this study is the observation that new syphilis cases over the last decade in British Columbia, Canada, have been escalating more rapidly than anyone could have predicted and that syphilis incidence has outpaced the incidence of other sexually transmitted diseases (STDs), including gonorrhea and chlamydia. This unexpected increase in syphilis has been almost wholly concentrated in men who have sex with men (MSM). Most of these MSM are HIV-1 infected and many are taking highly active antiretroviral therapy (HAART). In fact, the expansion in HAART coverage in MSM parallels the growth in syphilis in the same population. In addition, my co-authors and I had serious doubts as to whether ‘treatment optimism’, the generally accepted explanation for this phenomenon, was robust enough to account for such a dramatic increase in new syphilis cases. Treatment optimism posits that HAART availability and effectiveness have led to the perception in both HIV-1-infected and HIV-1-uninfected individuals that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhea, chlamydia and syphilis.

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Syphilis Skyrockets Among MSM

MedicalResearch.com Interview with:

Alex de Voux, PhD, Epidemiologist Centers for Disease Control Division of STD Prevention

Dr. Alex de Voux

Alex de Voux, PhD, Epidemiologist
Centers for Disease Control
Division of STD Prevention

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Reported cases of primary and secondary syphilis have been increasing steadily in the United States since 2001, with men-who-have-sex-with-men (MSM) accounting for 83% of male primary and secondary syphilis cases with information on sex of sex partner in 2014.

However calculating the true disparity of primary and secondary syphilis cases relative to the MSM population size has been difficult because census data does not routinely collect information on sexual orientation or same-sex behavior. Through a recent collaboration with Emory University and CDC, Grey and colleagues developed refined estimates of the population size of MSM by state allowing us to calculate state-specific rates of primary and secondary syphilis for the first time. Looking at data from 44 states that had information on sex of sex partner for at least 70% of their male primary and secondary syphilis cases, the overall rate of syphilis was 309 per 100,000.

The state level data found syphilis rates among gay and bisexual men ranged widely among the 44 states, from 73.1 per 100,000 in Alaska to 748.3 per 100,000 in North Carolina. Some of the highest rates among MSM were in states in the Southeast and the West.

Comparing rates of syphilis among MSM to men reporting sex with women only (MSW), the overall rate for MSM was 107 times the rate for MSW. By state, the rate among MSM was at least 40 times the rate among MSW – and at most, 340 times the rate among MSW.

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Meta-analysis finds that pre-exposure chemoprophylaxis for prevention of HIV infection may be associated with an increase in STDs among MSM

MedicalResearch.com Interview with:
Noah Kojima

David Geffen School of Medicine
University of California
Los Angeles, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the most exciting new methods to prevent human immunodeficiency virus (HIV) type 1 infection is through the use of chemical pre-exposure prophylaxis (PrEP), which has been shown to be safe and effective in randomized-controlled trials and “real world” studies among men who have sex with men (MSM). However, reports of high incidence of sexually transmitted infections (STIs) and condomless sex in PrEP trials has led clinicians and public health advocates to be concerned that the use of PrEP for HIV might lead to higher STI incidence due to increased sexual risk behavior. We found that PrEP for HIV infection is associated with increased risk of STI acquisition among MSM in a meta-analysis of prior studies.

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Almost A Million Cases of Maternal Syphilis Globally Per year

MedicalResearch.com Interview with:

N. Saman Wijesooriya Public Health Advisor/Technical Advisor Centers for Disease Control and Prevention

N. Saman Wijesooriya

N. Saman Wijesooriya
Public Health Advisor/Technical Advisor
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The article Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modeling study by Wijesooriya, et al published in the August 2016 issue of The Lancet Global Health (Open source – http://dx.doi.org/10.1016/S2214-109X(16)30135-8) estimates the incidence and prevalence of maternal and congenital syphilis for both time periods and identifies gaps antenatal care access and syphilis testing and treatment services to assess progress in the global elimination of congenital syphilis, or mother-to-child transmission of syphilis, as a public health problem.

Untreated maternal syphilis is understood to be transmitted from mother-to-child in utero in 50% of cases resulting in tragic adverse pregnancy outcomes, or congenital syphilis infections, including early fetal death, stillbirth, preterm birth, low birthweight, neonatal death, and congenital infections in infants. Since most maternal syphilis infections are asymptomatic, it is recommended that screening for syphilis use a combination of serological tests for pregnant women and treatment of syphilis seropositive women with at least 2.4 million units of benzathine penicillin intramuscularly early in pregnancy to prevent most congenital syphilis infections.

In 2007, the World Health Organization responded to estimates indicating 2 million maternal and 1.5 congenital syphilis infections would occur annually without treatment and launched the global initiative for the Elimination of Congenital Syphilis (ECS). The strategy includes reducing the prevalence of syphilis in pregnant women and mother-to-child transmission of syphilis. The objective is for countries to achieve high performing antenatal care systems providing access to antenatal care to more than 95% of pregnant women, syphilis testing for more than 95% of pregnant women, and treatment for more than 95% of seropositive women to attain a congenital syphilis rate of 50 or fewer cases per 100,000 live births.

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Number of Babies Born With Syphilis Rises Sharply

MedicalResearch.com Interview with:
Dr. Virginia Bowen PhD
Epidemic Intelligence Service
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,CDC 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bowen: Congenital syphilis (CS) occurs when a mother infected with syphilis transmits the infection to her child during the course of pregnancy. Our study looked at recent trends in CS between 2008 and 2014. After four years of decline, Congenital syphilis rates increased by 38% from 2012 to 2014.

The findings from this report show we are missing opportunities to screen and treat pregnant women for STDs. Syphilis in pregnant women can cause miscarriages, premature births, stillbirths, or death of newborn babies. We have effective tests and treatment for syphilis – there’s no excuse for allowing it to resurge. Every case of CS is one too many.

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