Health Alert
SYPHILIS INCREASE IN AT-RISK POPULATION-
MEN WHO HAVE SEX WITH MEN (MSM)

The Delaware Division of Public Health alerts the Delaware medical community about an increase in syphilis cases among men who have sex with men (MSM) who engage in unsafe or unprotected sexual activities.

From Jan. to June of 2011, Delaware reported 12 cases of primary and secondary (P&S) syphilis compared to 3 cases for the same time period in 2010. Of these cases, 10 (83%) were reported in MSM. These MSM cases have been identified in Kent, Sussex and New Castle Counties.

According to the Centers for Disease Control and Prevention, over the past several years, increases in syphilis among MSM have been reported in various cities and areas, including Chicago, Seattle, San Francisco, Southern California, Miami, and New York City. In recent outbreaks, high rates of HIV co-infection were documented, ranging from 20 percent to 70 percent.

Syphilis is known as "the great imitator" because its early symptoms are similar to those of many other diseases. Those who have been tested and/or treated for other STDs, such as gonorrhea or chlamydia, should also be tested for syphilis.

All patients presenting with any of the following symptoms should be immediately tested for syphilis:

• A macular and/or papular rash on the palms of the hands or on the soles of the feet
• A generalized rash that may be macular, papular, or papulosquamous on the back, chest, or stomach
• A lesion in the genital, rectal, or oral area
• Moist papules in the anogenital region or the mouth
• Sudden “Moth-eaten” scalp alopecia with a typical onset at the back of the head
• Loss of eyelashes and the lateral third of the eyebrows
• Generalized lymphadenopathy
• Malaise

Physicians should consult the 2010 CDC Sexually Transmitted Disease Treatment Guidelines, which is available on the Internet at http://www.cdc.gov/std/treatment.

Treatment of Insured or Medicaid Clients

Physicians, without immediate access to Benzathine penicillin G, for the treatment of syphilis, may send their insured (Private or Medicaid) clients to a pharmacy (such as Walgreens or Rite Aid) with a prescription for the medication and directions for immediate return to the MD office for medication administration.

Treatment of Uninsured or Underinsured Clients

Physicians, without immediate access to Benzathine penicillin G, for the treatment of syphilis in uninsured or underinsured clients are advised to contact the Division of Public Health Medical Director at (302) 744-4702 for approval and coordination of treatment at one of the Division of Public Health Reproductive and Sexual Health Clinics.

For Additional Information about this or any other STD or to report a case, call the Delaware Division of Public Health, Sexually Transmitted Disease Program at (302) 744-1050 or visit our website:  http://www.dhss.delaware.gov/dhss/dph/dpc/stds.html

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