by Kaci Nishimura, Abid Nader, Ruth Zuniga, Kaitlin Lowe Syphilis by Kaci Nishimura, Abid Nader, Ruth Zuniga, Kaitlin Lowe

PAY ATTENTION!! The game at the end of the presentation requires your full attention! Note the underlined terms in the following slides Keep these noted somewhere...you’ll need them!

Question #1 True or False? It is possible to get syphilis from sharing food or utensils, or from using tubs, pools, or toilets.

Question #2 Which is the best way to prevent syphilis? Condoms Regular testing with multiple partners Abstinence Taking a shower after sex A, B, and C only

Question #3 Which of the following categories is most likely to be infected with syphilis? Middle class heterosexual couples Homosexual males Lower income, female caucasians College students

Question #4 True or False? Infants only need to be tested for syphilis before birth. Kaci

What is it? Syphilis is a sexually transmitted disease Usually asymptomatic Can cause long term problems if not treated properly “The great imitator” Has the ability to look like many harmless bumps like zipper pinches 1 RUTH Syphilis - CDC Fact Sheet. (2014). Retrieved March 4, 2015, from http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm Syphilis. (2014). Retrieved March 4, 2015, from http://www.niaid.nih.gov/topics/syphilis/understanding/Pages/transmission.aspx

Extent of problem 18th and 19th century: More of a major threat to public health than it is now Effective treatment was medication found in the late 1940s: penicillin According to the CDC: 1990 it caused about 202,000 deaths 2010 it caused about 113,000 deaths New cases of syphilis doubled between 2005 and 2013 8,724 to 16,663 cases 2 RUTH Syphilis. (2014). Retrieved March 4, 2015, from http://www.niaid.nih.gov/topics/syphilis/understanding/Pages/transmission.aspx CDC. (2014, July 8). Syphilis - CDC Fact Sheet. Retrieved March 1, 2015, from http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm

Agent of disease Spirochete bacterium Treponema pallidum Primary method of transmission is through sexual contact May also be transmitted from mother to fetus during pregnancy or at birth Results in congenital syphilis 3 RUTH Syphilis - CDC Fact Sheet. (2014, July 8). Retrieved March 4, 2015, from http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

Symptoms Symptoms in adults are divided into 3 stages: Primary Secondary Late stage Primary: A single sore, but there may also be multiple sores. Usually firm, round, and painless STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis. (n.d.). Retrieved March 4, 2015, from http://www.cdc.gov/std/stats10/tables/trends-table.htm Syphilis Symptoms, Causes, and Diagnosis. (n.d.). Retrieved March 4, 2015, from http://www.webmd.com/sexual-conditions/guide/syphilis 4 RUTH

Symptoms (cont.) Secondary: Skin rashes or sores in the mouth, vagina, or other parts of the body Reddish brown spots on the palms of the hands or the bottom of the feet Fever Swollen lymph glands Sore throat Patchy hair loss Weight loss Muscle aches Headaches Fatigue Syphilis Symptoms, Causes, and Diagnosis. (n.d.). Retrieved March 4, 2015, from http://www.webmd.com/sexual-conditions/guide/syphilis Syphilis. (2014, October 28). Retrieved March 4, 2015, from http://www.niaid.nih.gov/topics/syphilis/understanding/Pages/transmission.aspx 4 RUTH

Symptoms (cont.) The late stage of syphilis symptoms are: Difficulty coordinating muscle movements, paralysis, numbness, blindness, dementia and other brain damage Very late stages: Damages the internal organs Can lead to death (Syphilis - CDC Fact Sheet, 2014) STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis. (n.d.). Retrieved March 4, 2015, from http://www.cdc.gov/std/stats10/tables/trends-table.htm Syphilis Symptoms, Causes, and Diagnosis. (n.d.). Retrieved March 4, 2015, from http://www.webmd.com/sexual-conditions/guide/syphilis 4 RUTH

(top left) Penile Syphilis, (top center) Vaginal Syphilis, (top right) Syphilis in a Newborn, (bottom left) Syphilis in the Mouth, (bottom right) Syphilis on the Hands 4 RUTH

Modes of transmission The major mode of transmission: sexual contact: genital area, lips, mouth, or anus Invasion depends upon an open wound or lesion An infected mother can transmit the disease to her fetus Stillbirth, death of the infant, congenital syphilis Not possible to get syphilis from sharing food or utensils, or from using tubs, pools, or toilets (NIH, 2014) 5 RUTH Syphilis. (2014). Retrieved March 4, 2015, from http://www.niaid.nih.gov/topics/syphilis/understanding/Pages/transmission.aspx

Control problem/spread of disease Abstinence Using protection i.e dental dams or condoms Frequent testing for STI’s When being active with new partners it is good to be tested at least once a year MSM are more at risk If you are pregnant taking preventative measures to ensure your baby's safety is crucial. Can cause problems in babies major organs 6 KAITLIN is primarily a sexually transmitted disease, but may be passed to a baby by an infected mother during pregnancy. Passing syphilis to a developing baby can lead to serious health problems. Syphilis has been linked to premature births, stillbirths and, in some cases, death shortly after birth7. Untreated infants that survive tend to develop problems in multiple organs, including the brain, eyes, ears, heart, skin, teeth, and bones. Screening for syphilis should be performed in all pregnant women during their first prenatal medical visit and repeated in the third trimester, if the patient is considered to be at high risk. http://aidsinfo.nih.gov/education-materials/fact-sheets/24/71/preventing-mother-to-child-transmission-of-hiv-after-birth CDC. "STD & HIV Screening Recommendations." Centers for Disease Control anda Prevention. Centers for Disease Control and Prevention, 16 Dec. 2014. Web. 2 May 2015. . http://www.cdc.gov/std/prevention/screeningreccs.htm Syphilis - CDC Fact Sheet. (2014, July 8). Retrieved May 4, 2015, from http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

2012 Syphilis Rates by State look up map to figure out the states with highest rates of Syphilis (both maps) Gopalakrishnan, L. (2012). File: Primary and Secondary Syphilis Rates by State. Retrieved May 1, 2015, from http://www.wikidoc.org/index.php/File:Primary_and_secondary_syphilis_rates_by_state.gif

2014 Syphilis Rates by State Gholipour, B. (2014). Hidden STD Epidemic: 110 Million Infections in the US. Retrieved May 1, 2015, from http://www.livescience.com/48100-sexually-transmitted-infections-50-states-map.html disease is spreading but highest ranks are lowering (like boot state)

69% Counties Report No Syphilis CDC. (2011). 2010 Sexually Transmitted Diseases Surveillance. Retrieved May 1, 2015, from http://www.cdc.gov/std/stats10/figures/38.htm

Host factors Heterosexual and homosexual are both vulnerable 75% are MSM (2013) Race affected in California (cases per 100,000 in population) African Americans 22.5 Native Hawaiian/Other Pacific Islanders 13.1 California has one of the highest number of cases in the U.S. Ages 20-29 are most vulnerable (2013) compared to 30-39 (1990) 7 KAITLIN CDC. (2015). Syphilis Profiles, 2013. Retrieved May 4, 2015, from http://www.cdc.gov/std/syphilis2013/default.htm CDC. (2014). Syphilis - CDC Fact Sheet. Retrieved May 4, 2015, from http://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm

Syphilis in the US per 100,000 CDC. (2009). Sexually Transmitted Disease Surveillance, 2009. Retrieved May 1, 2015, from http://www.cdc.gov/nchhstp/newsroom/images/syphilis-chart-4.jpg

Environmental factors Lower class populations have a higher risk of contracting the disease. Little exposure to clinics Little education offered about STDs Money (insurance and medical bills) Lower class women Lower class MSM CDC and public health partners are working to implement CDC’s Syphilis Elimination Plan 8 KAITLIN CDC. (2011, November 17). STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis. Retrieved May 4, 2015, from http://www.cdc.gov/std/stats10/trends.htm

Temporal variation Syphilis has been around since the 15th century Pandemic World wide issue It can cross international borders In 2010 it was said that syphilis was decreasing in women by 21 percent and only slightly increased in men by 1.3% Because of lack of screening, or people not associating certain symptoms as an sti, the number of people affected is generally going up. 9 KAITLIN STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis. (n.d.). Retrieved May 4, 2015, from http://www.cdc.gov/std/stats10/tables/trends-table.htm Friis, R., & Sellers, T. (2009). Epidemiology for public health practice (4th ed., pp. 18-21). Sudbury, Mass.: Jones and Bartlett.

Additional variables In a recent study analyzed by the CDC, during 2005 to 2013, there was a doubling in amounts of people infected. Especially in the Gay, Bisexual, and men who have sex with men group Present among all age, races, and ethnic groups Places of lower economics have higher rates In Females, there was an increase during 2005-2008, however, there was a decrease during 2009-2013 Variations in Socioeconomic class, race, ethnicities, and ages. Patton, M., & All, E. (2014). Primary and Secondary Syphilis — United States, 2005–2013. Retrieved March 4, 2015, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a4.htm 10 ABID

Hypotheses to explain distribution of problem For Men: Must look deeper into the Homosexual, Bisexual, and MSM groups Elevated rates of being promiscuous Lack of safe sex and sexual health For Women: Research their demographics Race/Ethnicity Socioeconomic class Other Social Determinants of Health 11 ABID Wendel Jr., G. (2014). Treatment of Syphilis in Pregnancy and Prevention of Congenital Syphilis. Retrieved March 4, 2015, from http://cid.oxfordjournals.org/content/35/Supplement_2/S200.long

2013 Reported Cases 17 KACI CDC. (2014). Figure 41. Primary and Secondary Syphilis — Reported Cases* by Sex, Sexual Behavior, and Race/Ethnicity, United States, 2013. Retrieved May 1, 2015, from http://www.cdc.gov/std/stats13/figures/41.htm

Gaps in knowledge Gaps Stigma behind an STD Symptoms are painless Pressing Issues CDC and WHO call on better diagnosis Syphilis Elimination Effort (SEE) trying educate healthcare workers Push for further research, proper diagnosis, and ultimately its prevention 12 ABID Wendel Jr., G. (2014). Treatment of Syphilis in Pregnancy and Prevention of Congenital Syphilis. Retrieved March 4, 2015, from http://cid.oxfordjournals.org/content/35/Supplement_2/S200.long

Existing and/or previous policies Syphilis Screenings (Enacted by the CDC) Test administered at 1st prenatal meeting Especially during times of higher Morbidity Again at the 3rd Trimester When baby is born Obama Care No more preexisting conditions Coverage for those with the disease Promotion of Education Patton, M., & All, E. (2014). Primary and Secondary Syphilis — United States, 2005–2013. Retrieved March 4, 2015, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a4.htm 13 ABID

Significance and implications Better informed decisions on child-birth in expectant mothers with syphilis: Testing before and after birth Can lead to stillbirth or congenital syphilis Shows signs long after infection Primary syphilis 10-90 days after exposure Secondary syphilis 6 wks.-6 mo. after exposure Tertiary syphilis 10-30 yrs. after exposure WebMD. (2013). Syphilis Symptoms in Women and Men. Retrieved May 1, 2015, from http://www.webmd.com/sexual-conditions/tc/syphilis-symptoms CDC. (2014). Syphilis - CDC Fact Sheet. Retrieved May 1, 2015, from http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm 14 KACI

Further Research Potential vaccine Vaccines potentially save a life time of treatments Outreach traveling clinics STI testing besides HIV/AIDS STI education 15 KACI

In Conclusion... Syphilis is on a slow decline since 18th and 19th century outbreaks after discovery of the medication penicillin Implementation of the following could be well on its way to elimination: Screening policies Tracking symptoms/severity Community outreach Target MSM (highest rates) population Sex education Self-checks Abstinence or condoms 16 KACI

Here are the answers to the opening questions! SO HOW’D YOU DO? Here are the answers to the opening questions!

Question #1 True or False? It is possible to get syphilis from sharing food or utensils, or from using tubs, pools, or toilets. FALSE! Mainly transmitted through sexual contact, pregnancy or birth.

Question #2 Which is the best way to prevent syphilis? Condoms Regular testing with multiple partners Abstinence Taking a shower after sex A, B, and C only E. A, B, and C only

Question #3 Which of the following categories is most likely to be infected with syphilis? Middle class, heterosexual couples Homosexual males Lower income, female caucasians College students B. Homosexual males

Question #4 True or False? Infants only need to be tested for syphilis before birth. FALSE! Infants are tested before AND IMMEDIATELY AFTER birth to check for congenital syphilis.

LET’S PLAY! Remember those underlined words we told you about? Find all 10 of those words in a word search! First 5 to finish win a prize!