Potential for community-based screening, treatment, and antibiotic prophylaxis for syphilis prevention

BACKGROUND: The recent syphilis epidemic in Louisiana occurred predominantly among disadvantaged African Americans who may distrust public health agencies and prevention efforts. OBJECTIVES: To determine community perceptions regarding trust and use of public health clinics, to assess whether race of provider is important to persons at risk for syphilis, and to assess the willingness of persons to participate in syphilis screening, treatment, and antibiotic prophylaxis. STUDY DESIGN: Qualitative interviews were conducted with 18 community leaders and 38 community members who were at risk for syphilis. Quantitative surveys were completed by persons with primary or secondary syphilis (n = 92), their sexual contacts (n = 56), and with neighborhood controls (n = 143). Three possible programs for syphilis screening and antibiotic prophylaxis were proposed (1) bar setting; (2) home setting, and (3) mobile health-van setting in high-risk communities. RESULTS: In qualitative interviews, community leaders and community members reported a high degree of trust in the public sexually transmitted disease clinic. A majority of respondents felt that race was not a factor in choosing healthcare providers. Respondents favored the provision of services in a mobile health van over in a bar or in their homes. In quantitative interviews, more than 80% of community members surveyed reported that they would go to a mobile health van for syphilis testing. Nearly two thirds of respondents reported that they would be willing to take oral prophylaxis for syphilis, and more than half of respondents reported that they would accept an injection. CONCLUSIONS: Community members trust the public sexually transmitted disease (STD) clinic, are generally not concerned with the race of healthcare providers, and are supportive of community-based STD screening, treatment, and antibiotic prophylaxis provided from a mobile clinic.     

我国梅毒防治面临的挑战及对策

本文阐述了我国梅毒流行出现的新的挑战,提示了梅毒发病的现状,提出了胎传梅毒流行的新趋势,并就相关问题提出讨论和建议.     

梅毒防治中值得重视的几个问题

本文以循证医学的观点,阐述了梅毒等性病防治应以生物一心理一社会医学模式为基点。提示了临床流行病学在梅毒预防控制中的重要作用。     

Clindamycin for intraincisional antibiotic prophylaxis in dermatologic surgery

OBJECTIVE: To assess the efficacy of intraincisional clindamycin therapy as an alternative to nafcillin treatment in decreasing the risk of postoperative wound infections in dermatologic surgery. DESIGN: Prospective, double-blinded, randomized, placebo-controlled trial conducted over a 7-month period. SETTING: Three private practice Mohs micrographic surgery referral centers. PATIENTS: A total of 1030 consecutive patients who underwent Mohs micrographic surgery with subsequent reconstruction. INTERVENTIONS: Prior to reconstruction, patients were randomly assigned to receive either intraincisional buffered lidocaine with epinephrine containing clindamycin or buffered lidocaine with epinephrine without clindamycin. Nurses and physicians who scored the wound at follow-up were blinded to the treatment conditions. MAIN OUTCOME MEASURES: Surgical wounds evaluated at the time of suture removal were scored according to a standardized assessment based on erythema, edema, and the presence of purulent discharge. Wounds scored 4 or higher were considered to be infected. Bacterial cultures obtained when indicated were also compared. RESULTS: Of the 1172 surgical wounds included in the study, 29 had wound scores of 4 or higher, 6 in the study group and 23 in the control group (P =.001, Fisher exact test). Of these 29, 18 had culture-positive infections. Four of these occurred in the study group, and 14 occurred in the control group (P =.02, Fisher exact test). CONCLUSIONS: The results of this study further support the efficacy of single-dose preoperative intraincisional antibiotic treatment for dermatologic surgery. With the relatively high prevalence of patient-reported penicillin allergies, buffered lidocaine containing clindamycin offers an inexpensive, safe, convenient, and effective alternative.     

Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding

OBJECTIVES: To investigate the feasibility and acceptability of implementing community based syphilis screening using different sample collection techniques, and its effectiveness in screening at-risk populations and identifying new syphilis cases. METHODS: Two phases of syphilis screening were conducted in venues frequented by men who have sex with men (MSM). Phase 1 used venepuncture and phase 2 a validated saliva test. Evaluation used quantitative data from testers, venues and the local genitourinary medicine (GUM) clinic, and qualitative data from venue and programme staff. RESULTS: 1090 MSM were tested over 7 weeks. 62% of testers had not attended a GUM clinic in the past year. 64% of testers reported > or = 2 sexual contacts in the past 90 days and 11% reported > or = 10. Similar diagnosis rates were recorded for phase 1 (1.4%) and phase 2 (1.8%). There was greater uptake of testing with the saliva test in saunas during phase 2. CONCLUSIONS: Syphilis screening in gay venues is feasible and acceptable to at-risk MSM, and reaches a group not routinely accessing GUM services. The low case detection for syphilis suggest this approach, while unlikely to contain outbreaks, may be more useful if combined with screening for other sexually transmitted infections and effective health promotion strategies.     

妊娠合并梅毒的临床特点与预防方法分析

目的:分析妊娠合并梅毒的临床特点及预防方法。方法:选取2010年1月至2015年12月100例医院收诊行常规治疗措施的妊娠合并梅毒患者为观察组,再选取100例未采取治疗措施的妊娠合并梅毒患者为对照组,比较两组患者的妊娠结局以及围产儿预后等方面差异。结果:观察组100例患者中,2例流产、12例早产、2例死胎、84例足月产;对照组100例患者中,13例流产、42例早产、11例死胎、34例足月产,观察组妊娠结局显著优于对照组(P0.05)。观察组100例新生儿中,10例低体质量围产儿、4例新生儿死亡、13例先天性梅毒、6例宫内胎儿窘迫;对照组100例新生儿中,30例低体质量围产儿、24例新生儿死亡、43例先天性梅毒、22例宫内胎儿窘迫,观察组新生儿结局显著优于对照组(P0.05)。结论:妊娠合并梅毒严重影响了产妇及新生儿的健康安全,需要采取积极的治疗措施,改善妊娠结局和新生儿结局。     

先天梅毒4例分析与预防措施探讨

目的:探讨预防发生先天梅毒的有效措施,旨在降低先天梅毒的发生率。方法:通过总结临床所见的先天梅毒患儿的临床资料,分析发生先天梅毒的高危因素。结果:先天梅毒的发生,与父母的生活环境、从事的职业、受教育程度有一定的相关性。结论:加强性道德、性卫生的宣传教育及性病知识的普及教育,切实抓好健康教育工作及孕前检查,加强孕妇学校建设,做好孕期管理和监测;做好梅毒血清学阳性妇女的驱梅治疗,可以有效地预防和减少先天梅毒的发生。     

Missed opportunities for congenital syphilis prevention in an urban southeastern hospital

BACKGROUND: Despite recent declines in syphilis rates nationally, recent outbreaks suggest that prevention of congenital syphilis remains an ongoing public health problem. GOALS: To identify missed opportunities for congenital syphilis prevention during prenatal care. STUDY DESIGN: Retrospective medical record review of 157 live birth or stillbirth deliveries that involved cases of congenital syphilis from Grady Memorial Hospital (Atlanta, GA). RESULTS: The hospital congenital syphilis prevalence was 8.2 cases per 1,000 live births. Six percent of case patients were HIV positive. Opportunities for earlier maternal screening, treatment, or diagnosis were missed in 60% of case patients who received timely prenatal care. Congenital syphilis cases attributable to preventable missed opportunities were significantly more common among case patients with fewer prenatal visits (66% versus 28%, P = 0.01). CONCLUSION: Provider efforts to reduce congenital syphilis in high-risk populations receiving prenatal care should focus on (1) screening patients at the first opportunity, at both the first prenatal visit and during the third trimester (i.e., 28 weeks); (2) performing on-site testing and same-day treatment; (3) providing appropriate treatment to infected women with penicillin allergy; (4) referring sex partners for treatment to prevent reinfection; and (5) screening all pregnant women attending emergency clinics.     

Strategies for syphilis prevention: findings from surveys in a high-incidence area

BACKGROUND: The persistence of syphilis in the United States suggests that a better understanding is needed of the potential for various public health approaches to prevent the spread of the disease. STUDY DESIGN: The authors conducted surveys of 92 persons with early syphilis, 56 uninfected sexual contacts, and 143 neighborhood controls in the Baton Rouge, Louisiana area. The surveys collected information regarding sexual behavior, access to and use of healthcare services, encounters at sites at which serologic screening for syphilis could be done, and exposure to interventions designed to prevent HIV infection. RESULTS: All groups reported high-risk sexual behavior. Cases and contacts were more likely than controls to report two or more sex partners in the previous year, but the three groups were similar in the percentage reporting five or more sex partners. Cases had poor access to health care and by some measures this access was less than that of controls. The potential screening site visited most frequently by cases was the public hospital emergency room (40%). Cases were less likely to have been exposed to programs designed to prevent HIV infection than uninfected contacts and controls combined (odds ratios, 0.51-0.66). CONCLUSIONS: Persons with syphilis were not unlike others in their neighborhoods, suggesting that syphilis is a sentinel event that indicates an entire neighborhood is at risk. Improvements in access to health care for sexually transmitted disease-related symptoms, screening in sites such as public hospital emergency rooms, and emphasizing sexual risk-reduction interventions may limit the spread of syphilis in these neighborhoods. To prevent syphilis in the long term, public health programs should also try to better understand and change other community-level socioeconomic factors that influence sexual behavior.     

山东省预防与控制梅毒规划实施效果评价

目的：评价山东省预防与控制梅毒规划实施效果,为制定“十四五”规划提供依据。方法：（1）通过自上而下方式开展规划终期评估部署、指导、质控和培训。（2）按照工作任务分工,开展多部门协作收集资料。（3）保障措施情况、准确性核查、不同人群的知晓率等通过专项调查获得。专业技术人员知识掌握合格率通过携手医访APP现场考试获得。（4）通过自下而上方式开展规划自评、审核和验收。结果：16个评估指标中,在省级层面达标13个,基本达标3个。全省梅毒报告发病率自2014年后增长趋缓,年增长率2.15%。一期和二期梅毒报告发病率自2010-2014年呈上升趋势,2014年后呈下降趋势。三期梅毒报告发病率保持在较低发病水平,但呈缓慢上升趋势。胎传梅毒报告发病率于2012年前快速上升,2012年后快速下降。 隐性梅毒报告发病率呈增长趋势,但增长速度放缓。结论：山东省预防与控制梅毒规划实施取得显著效果,全省梅毒流行处于较低水平,增长趋势得到有效遏制。