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P6.11 Stemming the tide of rising syphilis in the united states (U.S.)
  1. Melissa Habel,
  2. Karen Kroeger,
  3. Gail Bolan,
  4. Sevgi Aral
  1. Centres for Disease Control and Prevention, Atlanta, USA

Abstract

Introduction In the U.S., rates of primary and secondary (P and S) syphilis increased by 19% from 2014–2015. While rates have increased among both men and women, men account for more than 90% of all P and S cases; the majority (83%) among men who have sex with men (MSM). Likewise, increases in congenital syphilis (CS) have paralleled the national increase in P and S syphilis among women.

Methods On January 23–26, 2016, CDC held a consultation with 140 experts in the field of syphilis to discuss current issues, trends, and priority actions in response to increasing syphilis rates. Consultants included experts from academia, local and state health departments, and other federal agencies. The summit included five focus areas; 2 sessions concentrated on congenital and MSM syphilis. Strategies for a syphilis action plan were discussed. Meeting notes were taken during the summit, then independently reviewed, reconciled, and summarised.

Results Several cross-cutting themes emerged: clearer recommendations for better clinical management of syphilis; better diagnostics for detection of active Treponema pallidum infection with need for new testing technologies and strain surveillance; and the need to address CS and MSM (and transgender) data gaps through better coordination between epidemiology, surveillance, lab, and program. Specific to CS, strategies need to address penicillin G manufacturing and supply line shortages; healthcare providers need to test all pregnant women for syphilis at the prenatal visit, the beginning of the third trimester and at delivery, promptly treat and quickly report cases to health departments where all CS cases should be reviewed for missed opportunities in the CS prevention cascade to inform interventions. Strategies relevant to MSM include addressing payment and access barriers, developing a sexual healthcare model for men which could include standing orders for frequent syphilis screening for MSM seeking STD or HIV services along with other recommended STD screening, vaccinations and prevention interventions, monitoring adverse outcomes of syphilis in MSM such as neurosyphilis and ocular syphilis, and aligning HIV and syphilis surveillance systems and prevention messages.

Conclusion The prevention of CS and MSM syphilis depend on a successful call to action defining ways that healthcare providers, health departments, communities and policymakers can contribute to syphilis prevention and control.

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