The Role of State Public Health in Combatting Syphilis: A Conversation with CDC’s Gail Bolan

September 07, 2017|1:49 p.m.| ASTHO Staff

Gail Bolan, MDOnce on the brink of elimination, rates of syphilis are now on the rise in the United States. CDC data shows that in 2015, cases of primary and secondary syphilis—the earliest and most infectious stages of the disease—are higher than they have been in 20 years. To combat the resurgence of syphilis, CDC is working with federal agencies and key partners to raise awareness. In April, CDC released a call to action, which outlines specific steps that state and local health departments, healthcare providers, and other stakeholders can take to reverse this emerging public health threat.

ASTHO spoke with Gail Bolan, MD, director for the Division of STD Prevention in CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, to discuss the increasing rates of syphilis in the United States and what state health officials can do to disrupt the spread of this disease.

In a recent Medscape commentary, you refer to the “rising tide of syphilis.” What should health officials know about the challenge we are currently facing?

Health officials need to know that rates of primary and secondary syphilis are on the rise across the United States—in every region, across a majority of age groups, and among almost every race and ethnicity. Men in general—and gay, bisexual, and other men who have sex with men specifically—continue to face the greatest burden. But even women are now seeing increases, which has resulted in a surge of congenital syphilis.

The good news is: we’re dealing with a preventable and highly treatable infection. And with state and local health officials in our corner, we know that we can put this dangerous disease behind us, where it belongs.

We encourage health officials—along with STD, HIV, and maternal and child health program staff—to discuss trends in their jurisdiction and make concrete plans to combat syphilis.There are steps that we can all take to stem the tide for this disease and that’s what the call to action is all about.

What specific actions can health officials take to combat syphilis?

We’re asking public health departments to focus on reducing congenital syphilis and syphilis in men who have sex with men because that’s where we think we can have the most impact. To do that, one really important action will be improving surveillance. We need surveillance data to help understand the root causes of syphilis, such as behavioral health, lack of access to healthcare, health literacy, etc.

To get our arms around what’s happening with men who have sex with men, we need syphilis surveillance to capture data, including HIV serostatus, gender of sex partners, use of pre-exposure prophylaxis, ocular and neurological manifestations, as well as sexual and social network characteristics. We also need to eliminate data gaps in congenital syphilis surveillance, which we know can be challenging for a number of reasons. One solution is to partner with providers and labs to obtain pregnancy status along with epidemiologic and clinical data on female syphilis cases. This kind of information could really help to bridge the gaps that we’re seeing.

Two other incredibly important actions include conducting effective partner services for pregnant women and increasing the frequency of testing for at-risk men who have sex with men and pregnant women. Work with your STD program to prioritize partner services and screening among pregnant women and women of reproductive age, their sex partners, and men who have sex with women. We also encourage you to implement standing orders for a sexual health panel of laboratory tests for all men who have sex with men seeking clinical services.

What partners can health officials work with to make a big impact?

This is a great question. No one can take down syphilis alone. This an all-hands-on-deck situation that requires those of us in public health, healthcare providers, and private citizens to work together.

Cross-program health department partnerships can be very impactful. We suggest connecting your state’s STD program with the maternal and child health program to address congenital syphilis. For syphilis among men who have sex with men, you can support coordinated efforts between your state’s STD program and HIV prevention program. This is a very essential piece, since national data indicates that approximately half of men who have sex with men who have syphilis are also living with HIV. For those not living with HIV, their risk of acquiring HIV is significant and they can benefit from pre-exposure prophylaxis.

Healthcare provider partnerships are also crucial. The backlash after years of low syphilis rates is that many providers have little, if any, experience diagnosing and treating it. Work with your STD program to offer resources for them on how to properly test, interpret test results, diagnose, and treat syphilis. CDC’s new video, as well as their existing suite of resources for providers, can help. You can also work with the National Network of STD Clinical Prevention Training Centers to train and educate providers. Once clinical providers are equipped to rapidly detect and provide timely treatment, together you can address barriers to care and conduct targeted testing in various settings.

Health officials are also in a key position to engage community leaders and advocacy groups to develop and promote programs directed towards residents. The impact of patient advocacy group partnerships cannot be overstated. They can help leverage additional resources that we simply may not have through public health channels.

How is CDC working with the research community and industry partners to address the resurgence of syphilis?

CDC pledges to unite and strengthen new and old tools of prevention to protect the public from this dangerous disease. Of course, partnerships are one way to achieve this goal.

We are engaging universities and industry partners to improve diagnostic tools, develop new treatment options, and explore vaccine options. Electronic medical record developers and vendors are also key partners who can help ensure that electronic medical records support syphilis screening and treatment and capture a complete sexual history for each patient.

We are also taking steps to improve surveillance, as well as making a syphilis specimen repository available for technological developments.

Above all, we remain committed to STD prevention and to undoing these worsening syphilis trends.

State health officials are stepping up to answer CDC’s call to action to combat syphilis in the United States. Check out ASTHO’s Q&A with John Hellerstedt, MD, commissioner of the Texas Department of State Health Services, where he shares the steps Texas is taking to prevent and respond to congenital syphilis.

Gail Bolan, MD, was appointed director of CDC’s Division of Sexually Transmitted Disease Prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in December 2010. She began her public health career in 1982 as an epidemic intelligence service officer at CDC, and later served as director of the STD prevention and control program at the San Francisco Department of Public Health. Bolan earned her medical degree from the Dartmouth Medical School.