Rural Missouri - September 2022 - 36

ADVERTORIAL
PAID FOR BY MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES
Missouri Syphilis Cases on the Rise
hat is your name?
lary Reno MD PhD
Treat Yourself, with Respect
n you tell us a little about your work in STIs and HIV?
ave been the medical director of the St. Louis County Sexual Health Clinic since 2007. As an Associate Professor at Washington University in St. Lo
ecialize in Infectious Disease, specifically Sexually Transmitted Infections (STIs) and HIV prevention. I focus on research using large health care dat
describe and improve care for patients with STIs and HIV. I also am the PI for the St. Louis STI/ HIV Prevention Training Center, a CDC funded traini
nter that delivers clinical training in sexual health care for the Midwest region and works closely with state and local health departments. Some of
me is spent advising health departments on aspects of sexual health care including increasing services for public health threats such as congenita
philis and now, monkey pox.
hat is syphilis?
philis is a STI transmitted through sexual contact and caused by the bacterium Treponema pallidum. At the site of contact and transmission, a cha
r ulcer with a firm border) forms that is painless and can be missed by patients (primary syphilis). T. pallidum disseminates through the body with
fection and as the chancre heals, T. pallidum will then usually present as a rash (secondary syphilis) many weeks later. Hepatitis, alopecia, condylo
a, colitis are also seen with secondary syphilis.
pallidum can affect vision, called ocular syphilis, or hearing, called otic syphilis at any stage of syphilis. Syphilis is also transmitted during pregnanc
e fetus. Anyone with any stage of syphilis should be asked about vision or hearing problems as well as have a full neurological review of syphilis.
ould also be assessed for pregnancy.
ft untreated, syphilis can cause cardiac disease (aortitis), soft tissue or boney destruction (gummas), or neurological disease (confusion, loss of hig
nctions, meningitis, etc). Tertiary syphilis occurs years after T. pallidum infection and can leave people debilitated.
hy is syphilis an issue?
philis rates have been increasing in the US for the past 6-7 years. If diagnosed early, syphilis is curable and manageable. Tertiary syphilis can leave
eople debilitated even when treated but testing and treatment of syphilis is easy and accomplishable. The most devastating impact of syphilis is c
nital syphilis. Cases have been climbing in the US, including Missouri and every pregnant person should be screened for syphilis at the first prena
Combatting the Rise of Syphilis in Missouri
Syphilis rates have been increasing in the US for the past 6-7 years. And Missouri
has not been immune to this increase. This sexually transmitted infection (STI) is
tricky - the initial genital sores that present are often painless and easy to miss. But
given enough time to disseminate through the body, the infection can cause a rash,
then affect vision or hearing. And unfortunately, that only scratches the surface of
what harm syphilis is capable of. Left untreated, the infection can lead to cardiac
disease, soft tissue and bone destruction and even neurological diseases.
sit, 28 weeks gestation, and delivery.
hat are the risk factors for syphilis?
nyone who has sex can get syphilis. We know that syphilis has been more common in men who have sex with men in the past, however, rates in m
ho have sex with women and women are increasing. Syphilis is increasingly associated with drug use and is also associated with a history of incar
on. If you live in area with high syphilis rates, you are more likely to get syphilis.
ho should be getting tested?
These life-impacting effects can be devastating, but maybe the most pernicious thing
about syphilis is that it can also be transmitted through pregnancy to newborns,
causing yet further damage to these young innocent lives. Cases of congenital
syphilis - syphilis passed down from mother to child - have also been steadily
climbing over time, to the point that doctors and medical professionals suggest that
those who are pregnant get screened for syphilis at their first prenatal visit, at 28
weeks of gestation and once more at delivery.
nyone who is having sex should be tested for STIs including gonorrhea, chlamydia, HIV and syphilis. Anyone with signs or symptoms of syphilis sho
e tested. And pregnant people should be tested for syphilis per screening recommendations.
ow is it treated?
l stages of syphilis are treated with benzathine penicillin, either intramuscularly or via IV. If it has been over a year since the last syphilis test or som
ne has tertiary syphilis, then three weekly injection of benzathine penicillin is needed to treat. If someone is diagnosed with neurologic syphilis, oc
philis, or otic syphilis, IV penicillin is needed.
ople who are TRULY allergic to penicillin can be treated with another antibiotic, doxycycline, but treatment failures have occurred. Sometimes, pe
ll need to be desensitized to penicillin to be treated. Doxycycline is not an alternative treatment for syphilis but should only be used if a patients
perienced a TRUE allergy to penicillin.
nzathine penicillin is the only treatment that crosses the placenta to treat syphilis in pregnancy.
hat happens when syphilis goes untreated?
syphilis is not treated, symptoms resolve, and someone might think that they are healthy. T. pallidum is still in the body and can, over years, cause
tensive damage and symptoms to the neurological system, heart, or other organs. And if someone, later gets pregnant, can still result in congenit
philis.
here can people go to get tested and treated?
Anyone who has sex can get syphilis. While historically, syphilis has been more
common in men who have sex with men, that is rapidly changing, as rates of
heterosexual and woman/woman transmission continue to rise.
So, more and more people are getting and passing along syphilis. What can we do
to protect ourselves from it? The key is catching it early, when syphilis is at its most
manageable and most curable state. Any clinic can order syphilis testing, and STI/
sexual health clinics are specialized in non-stigmatizing and affirming sexual health
care to give you the help you need in a judgement-free zone. The CDC even has a
website listing places that offer testing: http://gettested.cdc.gov.
ny clinic can order syphilis testing. STI clinics/ Sexual Health clinics are specialized in nonstigmatizing and affirming sexual health care and some p
ay be more comfortable in that setting.
e CDC does have a website that lists sites that offer testing.
et Tested | National HIV, STD, and Hepatitis Testing (cdc.gov)
e St. Louis County Sexual Health Clinic has a website and map of testing locations in the St. Louis Region (being updated)
xual Health Resources - St. Louis County Website (stlouiscountymo.gov)
hy is it important for clinicians to conduct a detailed sexual history as a part of prevention and wellness?
most everyone has had sex. Sex is one aspect of being human and setting sexual health goals should be part of preventive health care and wellne
st as wearing a seat belt in a car or increasing vegetables in one's diet can improve quality of live and how we feel. Clinicians asking even simple qu
ons such as " Do you have questions or concerns about your sexual health? " normalizes that sexual health care is health care
Treat yourself, and your sexual partners, with respect by getting tested for syphilis.
It's the best way we have to combat these rising trends and protect our fellow
Missourians.

http://gettested.cdc.gov

Rural Missouri - September 2022

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