Multistate Syphilis Outbreak Among American Indians, 2013 to 2015

Abstract

This article summarizes a multi-state outbreak of heterosexual syphilis, including 134 cases of syphilis in adults and adolescents and at least two cases of congenital syphilis, which occurred on an American Indian reservation in the United States during 2013-2015. In addition to providing salient details about the outbreak, the article seeks to document the case-finding and treatment activities undertaken, their relative success or failure, and the lessons learned from a coordinated, multiagency response. Of 134 adult cases of syphilis, 40% were identified by enhanced, interagency contact tracing and partner services; 26% through symptomatic testing; and 16% through screening of asymptomatic individuals as the result of an electronic medical record (EMR) screening prompt. A smaller proportion of cases were identified by community screening events in high-morbidity communities; high risk venue-based screening events; other screening, including screening upon request; and prenatal screening at first trimester, third trimester, and day-of-delivery. Future heterosexual syphilis outbreak responders should act quickly to coordinate a package of high-yield case-finding and treatment activities-potentially including activities that seek to do the following: 1) increase prenatal screening, 2) improve community awareness and symptomatic test-seeking, 3) educate providers and improve general screening for syphilis; 4) implement EMR reminders for providers; 5) screen high-morbidity communities and at high-risk venues; and 6) form novel partnerships to accomplish partner services work when the context does not allow for traditional, DIS-only partner services.

Maternal and congenital syphilis in Indigenous Peoples: a scoping review of the worldwide literature

“…All studies showed an under-detection and under-reporting of cases. The studies indicated that the offer of massive rapid testing [ 16 , 23 ], the increase in general and gestational screening for syphilis [ 16 ], health staff training [ 20 , 30 ], intersectoral articulation, and coordinated response with community participation [ 24 , 25 , 29 ] are key points for the control of syphilis in these populations, particularly in remote areas [ 17 ].…”

Treatment Completion With Three-Dose Series of Benzathine Penicillin Among People Diagnosed With Late Latent and Unknown Duration Syphilis, Maricopa County, Arizona

“…18 We also propose making BPG more affordable by expanding 340B pricing to private practices and using mobile health clinics to delivery BPG to patients' homes. 19 In the interim, although BPG access is still limited, healthcare provider education is needed to know where patients can receive BPG. Finally, consideration should be given to expanding the time interval between therapies.…”

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review

“…Six references described an outbreak response for syphilis 4 and gonorrhoea. 2 STI testing and treatment within the Indian Health System are primarily provided in outpatient clinics and emergency departments 37,[73][74][75][76][77][78][79][80][81] and are delivered according to national guidelines. 73 Expedited partner therapy (EPT) is available in some clinical settings.…”

“…[76][77][78][79] In some situations, such as outbreaks or in review of local epidemiology, STI screening and clinical decision support can be expanded based on local policy and practice needs. 77,80,81 In comparison to non-Hispanic Whites, AI/AN men and women have been reported to more likely seek STI services. 85,86 Yet, in 2019, nationally recommended routine annual chlamydia screening coverage among women aged 16-25 years in IHS facilities was 35%, with a wide range of delivery across sites (0-54%) (A. Apostolou, pers.…”

“…Collaboration between Indian Health System clinics and state and county STI programs facilitate case investigation and the delivery of partner services (notification of exposure and referral to care) to persons diagnosed with STIs. 80,81,88,89 Tribal and federal Public Health Nurses (PHN) frequently serve in many roles to combat the spread of STIs in AI/AN communities; these include case-finding, therapeutic and preventive interventions. Per-patient referral and follow up, PHNs conduct home visits for STIs and other communicable disease investigation and can assess and treat patients according to established protocols, in consultation with their referral provider.…”