Week 7 - STD Healthy People 2020 Discussion.docx - STD...

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STD Standard STD-7: Reduce sustained domestic transmission of primary and secondary syphilis. Background of STD Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum , which is a spirochete, or spiral-shaped bacteria (Hollier, 2018; Klein, McLaud, & Rogers, 2015; CDC, 2018). Syphilis is transmitted through direct contact with an ulcerative lesion, or chancre which appears during the primary stage (most infectious) of syphilis (Klein et al., 2018). Chancres occur mainly on the external genitals, vagina, anus, or in the rectum, but can also occur on the lips and in the mouth (CDC, 2018). Transmission of the infection occurs during vaginal, anal, or oral sex; and because open lesions can serve as a portal of entry for other bacteria and viruses, primary syphilis has been linked to HIV infection and other STI’s (CDC, 2018). Screening or diagnosing syphilis is usually a 2-step process, which begins with a highly sensitive and treponeme-specific antibody test followed by the non-specific rapid plasma reagin (RPR) test and titer (Klein et al., 2015; Hollier, 2018; Cantor, Pappas, Daeges, & Nelson, 2016). If the RPR is negative, the test reflexes to another treponemal test, such as Microhemagglutination assay for antibody to Treponema pallidum (MHA-TP), Treponema pallidum particle agglutination (TP-PA) assay, or fluorescent treponemal antibody absorbed (FTA-ABS) tests for confirmation (Klein et al., 2015; Hollier, 2018; Cantor et al., 2016; Workowski & Bolan, (2015). The RPR titer is also useful for monitoring a patient’s response to treatment (Klein et al., 2015). In 2015, the United States had 23,872 reported cases of primary and secondary syphilis, yielding a rate of 7.5 per 100,000, the highest reported since 1994. While cases of syphilis continue to occur primarily among gay men, bisexual men, and other men who have sex with men (MSM) who are at the highest risk infection; cases among women have also increased (Klein et al., 2015; CDC, 2018). Other important risk factors include concomitant HIV infection or other STI, use of illicit drugs during sex, poverty, and trading sex for drugs or money (Klein et al., 2015). In 2017, a total of 30,644 cases of primary and secondary syphilis were reported in the United States, yielding a rate of 9.5 cases per 100,000 population (CDC, 2018). According to the CDC (2018), this rate signifies a 10.5% increase compared with 2016 (8.6 cases per 100,000 population), and a 72.7% increase compared with 2013 (5.5 cases per 100,000 population). Signs and Symptoms Primary syphilis is characterized by the presence of one or more chancres at the original site of infection with T palladium; begins as a small papule, then ulcerates with a hard edge and clean, yellow base; indurated and painless; usually located on genitalia, around the anus or in the rectum, or in or around the mouth; may be solitary or multiple; continues for 1-5 weeks, then heals spontaneously (Klein et al., 2015; Hollier, 2018). Most often the exposure site or chancre may go unnoticed, especially in women because the genial and anal regions are not easily visualized (Klein et al., 2015; Hollier, 2018).

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