According to the Center for Disease Control and Prevention’s (CDC) 2022 Sexually Transmitted Infections Surveillance Report, congenital syphilis has increased by 30.6% from 2021 to 2022 and increased by 183.4% from 2018 to 2022. Similarly, syphilis has increased by 17.1% from 2021 to 2022 and increased by 78.9% from 2018 to 2022.
Preventative care is key. There have been over 10 times as many babies born with syphilis in 2022 compared to 2012. It is estimated that timely testing and treatment during pregnancy may have prevented 9 in 10 cases (88%) based on data from 2022. Primary and secondary and congenital syphilis rates were highest among American Indian or Alaska Native (AI/AN) people, which are comparable to rates from the pre-penicillin era when syphilis was difficult to cure (1 case per 155 AI/AN births). The U.S. Department of Health and Human Services (HHS) recently announced their plan for slowing the syphilis epidemic.
Indian Health Service (IHS) National Clinical Recommendations:
- Annual syphilis testing for everyone ages 13 to 64 years old
- Enable annual electronic health record reminders
- Perform three-point syphilis testing (prenatal, third trimester, & delivery) for pregnant people
- Adopt a testing bundle that includes Human Immunodeficiency Virus (HIV), Hepatitis B and C, and sexually transmitted infections
- Implement STI testing without a full clinical exam, known as “Express STI Testing”
- Screen outside hospitals and clinics (i.e.- community health fairs)
- Provide field treatment for syphilis among high-risk adults and their partners
- Treat syphilis presumptively for patients with a known exposure
- Build awareness and encourage people to get tested and seek treatment
If you have any questions related to these recommendations, please contact Rick Haverkate, National HIV/HCV/STI Consultant, at richard.haverkate@ihs.gov. For questions related to field treatment, please contact Tina Tah, Public Health Nursing Consultant, tina.tah@ihs.gov or Melissa Wyaco, Navajo Area Nursing Consultant, at melissa.wyaco@ihs.gov.
Free AI/AN Educational Material:
Syphilis Resource Hub
Sample ToolKit for Express STI Resources
AI/AN Specific National Campaign Materials
Free Rapid Syphilis Tests
Diagnostic Direct is partnering with the National Coalition of STD Directors (NCSD) to aid in meeting the needs of Tribal communities. Rapid syphilis testing is an important tool in addressing the rising rates of congenital syphilis. The benefit of utilizing a rapid test is its ability to produce results quickly and to provide immediate treatment while the patient is still in clinic.
Diagnostics Direct is looking to donate rapid syphilis tests to Tribal and Urban Clinics and Health Departments within Indian Country. Due to ethics restrictions, IHS cannot directly receive donations of free tests. If you are interested in receiving test donations, please reach out to Cait Shea, Senior Manager of Clinical Programs, at cshea@ncsddc.org.
Treatment:
The best practice for syphilis treatment is benzathine penicillin whenever feasible. Field injection of benzathine penicillin by Public Health Nurses is the standard-of-care for difficult-to treat patients who are not engaged in care. This includes pregnant patients with syphilis. Penicillin should automatically be given to all partners of cases whose last sexual contact was within 90 days. Partners whose last contact was greater than 90 days can be tested and treated if positive or automatically given penicillin if follow-up cannot be ensured. IHS Guidance is linked here for a tier system based on periods of shortages.
In January 2024, the U.S. Food and Drug Administration (FDA) announced the availability of Extencilline in the United States to address the ongoing shortages of Bicillin L-A (benzathine penicillin). For differences between Extencilline and Bicillin L-A, please refer to the DHCP letter posted on the drug shortage website.
FDA Drug Shortages
CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR
Fall 2023 IHS STI Treatment Guidance
Funding Flexibilities and Guidance
Recipients funded under CDC Notice of Funding Opportunities may use their grant resources, including funds or staff, for STI activities that are conducted in conjunction with HIV prevention activities, such as PS20-2010 “Ending the HIV Epidemic” and others. For a full list and additional guidance, please see the following resources.
Funding Flexibilities and Guidance to Support Syphilis | Dear Colleague Letters | NCHHSTP | CDC
Flexibilities Guidance for Applicants and Recipients of Federal Financial Assistance (cdc.gov)
For additional information or for clinical guidance, please see the sources below. The USET epidemiology team is available to assist with any questions or concerns. Please do not hesitate to contact us at usetepi@usetinc.org.
All Sources
USET Programmatic Alert | USET Tribal Epidemiology Center (USET TEC) | Syphilis Epidemic Affecting American Indians and Alaska Natives Communities (mailerlite.com)
Fall 2023 IHS STI Treatment Guidance
The IHS Director writes to provide information regarding the syphilis epidemic affecting American Indian and Alaska Native communities.
CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR
HHS Announces Department Actions to Slow Surging Syphilis Epidemic | HHS.gov
Sexually Transmitted Infections Surveillance, 2022 (cdc.gov)
Syphilis in Babies Reflects Health System Failures | VitalSigns | CDC
FDA Drug Shortages
Funding Flexibilities and Guidance to Support Syphilis | Dear Colleague Letters | NCHHSTP | CDC
Flexibilities Guidance for Applicants and Recipients of Federal Financial Assistance (cdc.gov)
Expedited Partner Therapy (EPT) for infections due to Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis Guidance for Health Professionals in Minnesota - MN Dept. of Health (state.mn.us)
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