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

2. 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!

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

4. 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

5. 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

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

7. 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
Syphilis. (2014). Retrieved March 4, 2015, from

8. 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
CDC. (2014, July 8). Syphilis - CDC Fact Sheet. Retrieved March 1, 2015, from

9. 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

10. 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
Syphilis Symptoms, Causes, and Diagnosis. (n.d.). Retrieved March 4, 2015, from
4 RUTH

11. 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
Syphilis. (2014, October 28). Retrieved March 4, 2015, from
4 RUTH

12. 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
Syphilis Symptoms, Causes, and Diagnosis. (n.d.). Retrieved March 4, 2015, from
4 RUTH

13. (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

14. 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

15. 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.
CDC. "STD & HIV Screening Recommendations." Centers for Disease Control anda Prevention. Centers for Disease Control and Prevention, 16 Dec Web. 2 May
Syphilis - CDC Fact Sheet. (2014, July 8). Retrieved May 4, 2015, from

16. 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

17. 2014 Syphilis Rates by State
Gholipour, B. (2014). Hidden STD Epidemic: 110 Million Infections in the US. Retrieved May 1, 2015, from
disease is spreading but highest ranks are lowering (like boot state)

18. 69% Counties Report No Syphilis
CDC. (2011) Sexually Transmitted Diseases Surveillance. Retrieved May 1, 2015, from

19. 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 are most vulnerable (2013) compared to (1990)
7 KAITLIN
CDC. (2015). Syphilis Profiles, Retrieved May 4, 2015, from
CDC. (2014). Syphilis - CDC Fact Sheet. Retrieved May 4, 2015, from

20. Syphilis in the US per 100,000
CDC. (2009). Sexually Transmitted Disease Surveillance, Retrieved May 1, 2015, from

21. 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

22. 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
Friis, R., & Sellers, T. (2009). Epidemiology for public health practice (4th ed., pp ). Sudbury, Mass.: Jones and Bartlett.

23. 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 , however, there was a decrease during
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
10 ABID

24. 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

25. 2013 Reported Cases
17 KACI
CDC. (2014). Figure 41. Primary and Secondary Syphilis — Reported Cases* by Sex, Sexual Behavior, and Race/Ethnicity, United States, Retrieved May 1, 2015, from

26. 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

27. 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
13 ABID

28. 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 days after exposure
Secondary syphilis 6 wks.-6 mo. after exposure
Tertiary syphilis yrs. after exposure
WebMD. (2013). Syphilis Symptoms in Women and Men. Retrieved May 1, 2015, from
CDC. (2014). Syphilis - CDC Fact Sheet. Retrieved May 1, 2015, from
14 KACI

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

30. 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

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

32. 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.

33. 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

34. 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

35. 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.

36. 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!