Download Early Syphilis

Responding to the changing epidemiology
of syphilis: Exploratory interviews of
women with early syphilis—Chicago, 2005
Heather Lindstrom1, Lora Branch2, Gus Conda2,
Cassandra Davis2, Thomas Peterman1, Irina Tabidze2,
William Wong2, Carol Ciesielski2
1Epidemiology
and Surveillance Branch
Division of STD Prevention
National Center for HIV, STD, TB Prevention
2Chicago
Department of Public Health
The findings and conclusions in this presentation have not been formally disseminated by the Centers for
Disease Control and Prevention and should not be construed to represent any agency determination or policy.
Syphilis
Sexually transmitted bacterial infection
(Treponema pallidum)
Curable
Stages of Untreated Syphilis
Exposure
(Incubation 2-6 wks)
Primary
Secondary
3
months
Early Latent
6
months
Infectious Period
“Early Syphilis”
12
months
Late Latent
1-30+ Years
Primary and secondary (P&S) syphilis
rates by sex: Chicago, 1999-2004
Rate per 100,000
25
20
Males
15
10
Females
5
0
1999
2000
2001
2002
Year
2003
2004
Women with P&S syphilis: Chicago,
2004
Median age 22 years
African-American, 87%
Low-risk
• No common social or sexual networks
• Fewer than 10%:
Used illegal drugs
– Exchanged of sex for money or drugs
– Had history of incarceration
–
Reasons for concern
Unexplained increases in P&S syphilis
among women in 2004
Continued reporting of P&S cases among
women in 2005
Cases occurred among young women
of reproductive age
Objectives
Describe context in which early syphilis
transmission occurred
Identify possible risk factors that could be
studied further if necessary
Generate ideas on future prevention
strategies
Methods
Identified 57 women with early syphilis
•
•
Reported to the CDPH from January through
October 10, 2005
Interviewed by disease intervention specialists
(DIS)
Data on reported cases was reviewed by CDPH
epidemiologists
•
Requested additional in-depth, exploratory
interviews
Exploratory interviews
Voluntary, no incentive provided
Conducted with assistance from CDPH Disease
Intervention Specialists (DIS)
30-60 minutes
At home, in the car, or by phone
Sexual behavior and prevention strategies
Hypothesis generating, not hypothesis testing
Sample
57 early syphilis cases
5 refused
2 not contacted
3 had non-working phone numbers
33 did not respond to requests for interviews
14 interviewed (25%)
Context: n=14 women interviewed
Stage of syphilis:
•
•
secondary syphilis, 8
early latent syphilis, 6
African-American 13, Hispanic 1
Median age 22.5 years, range 17 – 43 years
Pregnant at diagnosis, 5
High school graduates
Impoverished
Risk factors: n=14 women interviewed
Past sexually transmitted disease (STD), 6
Concurrent STD, 8
# of period sex partners: median = 2, range 1-6
Drug or alcohol abuse, 2
Exchanged sex for money or drugs, 0
History of incarceration, 0
Insights: sexual safety and prevention
Women felt they picked “safe” partners
•
•
•
•
Met within social network
Monogamous
Healthy appearance
STD tested
Strategies to prevent STDs
•
•
•
Condoms used early in relationships
STD testing
Trust
Insights: experience with syphilis
Emotional response to diagnosis
•
•
•
Shame
Stigma
Fear
Knowledge
•
•
Knew about other STDs
Limited knowledge of syphilis
How to identify risky partners
•
•
Incarceration history
“Travelers” or men who like to “party”
Insights: ideas on future prevention
Advice to other women
•
•
•
Always use condoms
No partner is a safe partner
Get tested together
Community interventions
•
•
•
Information pamphlets and posters
Radio or television spots
Community outreach: teen clubs, field houses
Limitations
Small number of interviews
Limited generalizability
Conclusions
Women were generally low risk
No major risk factors identified
Insights that could be used to inform
future prevention interventions
•
•
•
Educate women about syphilis
Encourage women to use condoms longer
in new relationships
Consider the possibility that “no partner is
a safe partner” in some settings
Acknowledgements
Chicago
Department of
Public Health
Illinois
Department of
Public Health
CDC Colleagues:
Stuart Berman
Fred Bloom
Dayne Collins
Office of
Workforce and
Career
Development
Age distribution of female P&S syphilis
cases: US, 2004 vs. Chicago, 2005
25
20
US (2004)
Chicago (2005)
15
10
5
Age Category
55
-6
4
45
-5
4
40
-4
4
35
-3
9
30
-3
4
25
-2
9
20
-2
4
0
15
-1
9
% of Reported Cases
30