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Friday, January 12, 2007

Syphilis on Rise

State sees syphilis spike
THE ASSOCIATED PRESS
JACKSON - Cases of syphilis in Mississippi spiked in 2006, especially on the Gulf Coast.
Health officials issued a warning to doctors, but not the general public, about the increase in the potentially fatal, but easily curable sexually transmitted disease, said Craig Thompson, director of the Department of Health's Bureau of STD/HIV.
Figures released show reported syphilis cases jumped nearly 75 percent in the past year, more than doubling on the coast.
The increase in syphilis - often a harbinger of a rise in the spread of the virus that causes AIDS - comes as the Health Department already faces criticism for failing to warn the public about an increase in cases of West Nile virus before it reached a record level in Mississippi.
In a written response to questions, Thompson said no public warning has been issued "to allow additional epidemiological studies (e.g. greater targeted syphilis screening) to take place and to develop and train specific community partners."
The health department also has been criticized for failing to have enough health professionals assigned to stem the spread of sexually transmitted diseases.
On the Gulf Coast where the increase in syphilis is greatest, the department is down to two disease-intervention specialists to help track the spread of the sexually transmitted disease, including making contact with each infected person's sexual partners.
"That's outrageous," Patricia Kissinger, an epidemiologist at Tulane University, told The Clarion-Ledger newspaper in Jackson. "They are the primary tool for controlling that kind of epidemic."
Thompson had warned higher-ups in the Health Department nearly three years ago that the issue of STD/HIV workload "requires senior management attention," according to documents.
Two years later, the Health Department actually had fewer disease intervention specialists, and Thompson's office made similar staffing recommendations "to improve the quality of field work."
The department still has not increased staffing.
Last month State Health Officer Brian Amy narrowly survived a vote by the State Board of Health to oust him. But the state has added only one more person to STDs and HIV, bringing the total to 34.
Untreated, syphilis can lead to serious health problem and can be fatal, but it can be cured with a simple penicillin injection. More troubling is that the upsurge in syphilis cases across the state may presage a future increase in HIV infections.
HIV infection often follows closely behind syphilis because the broken skin caused by syphilis assists in the transmission of the deadly virus that causes AIDS
Syphilis is often called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. Many infected people do not have any symptoms for years, but they are at risk for late complications if they are not treated.
Transmission appears to occur from persons with sores who are in the primary or secondary stages of the disease, but many of these sores are unrecognized.

Facts about Syphyilis Taken From CDC FAQS
http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission appears to occur from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, most transmission is from persons who are unaware of their infection.

Primary Stage
The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and late stages of disease.

Late Stage
The latent (hidden) stage of syphilis begins when secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. In the late stages of syphilis, it may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

A blood test is a way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.

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