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Syphilis Epidemic in Los Angeles County

S EXUALLY T RANSMITTED D ISEASE P ROGRAM. Syphilis Epidemic in Los Angeles County. April 2006. Primary and Secondary Syphilis Rates in the United States, 1981–2004*. Rate (per 100,000 population).

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Syphilis Epidemic in Los Angeles County

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  1. SEXUALLY TRANSMITTED DISEASE PROGRAM Syphilis Epidemic in Los Angeles County April 2006

  2. Primary and Secondary Syphilis Rates in the United States, 1981–2004* Rate (per 100,000 population) Source: Tom Peterman, Division of STD Prevention, National Center for HIV, STD, and TB Prevention. Centers for Disease Control and Prevention

  3. P&S Syphilis Rates by Sex in the United States, 1981–2004 Rate (per 100,000 population) Men Women Source: Tom Peterman, Division of STD Prevention, National Center for HIV, STD, and TB Prevention. Centers for Disease Control and Prevention

  4. P & S Syphilis: Rates by Race and Ethnicity, 1981–2003 Rate (per 100,000 population) Source: Tom Peterman, Division of STD Prevention, National Center for HIV, STD, and TB Prevention. Centers for Disease Control and Prevention

  5. P&S Syphilis Rates by Sex and Race, United States,1998-2004 Rate(per 100,000 population) Black men Black women White men White women Source: Tom Peterman, Division of STD Prevention, National Center for HIV, STD, and TB Prevention. Centers for Disease Control and Prevention

  6. National Plan to Eliminate Syphilis: Definitions • National Level: The absence of sustained transmission in the United States. • Healthy People 2010 Objective (per 100,000 population): • National Target = 0.2 • National (2004) = 2.7 • Local Level: The absence of transmission of new cases within the jurisdiction except within 90 days of report of an imported index case. Source: CDC Syphilis Elimination Executive Summary

  7. Syphilis Elimination • “It is anticipated that these definitions will translate to <1,000 cases (0.4/100,000 population) of primary and secondary (P&S) syphilis reported nationally each year. “The national goal, therefore, is to reduce Primary & Secondary syphilis cases to 1,000 or fewer and to increase the number of syphilis-free counties to 90% by 2005” Source: CDC Syphilis Elimination Executive Summary

  8. Cross Cutting Strategies • Enhanced surveillance : • includes complete, accurate, and timely reportingof positive syphilis tests; effective, timely, and regular data analyses; development of a framework for and implementation of syphilis surveillance; and ongoing evaluation of the amount of syphilis in a community by monitoring positive syphilis tests. • Strengthened community involvement and partnerships: • acknowledges and responds to the effects of racism, poverty, and other relevant social issues on the persistence of syphilis in the U.S.; develops and maintains partnerships to increase the availability of and accessibility to preventive and care services; and assures that affected communities are collaborative partners in developing, delivering, and evaluating syphilis elimination interventions. Source: CDC Syphilis Elimination Executive Summary

  9. Intervention Strategies • Rapid outbreak response : • includes both the development of an outbreak response plan and establishment of area-specific criteria that determine when the outbreak response plan should be implemented. • Expanded clinical and laboratory services: • provides accessible and timely client-centered counseling, screening, and treatment services in sites frequented by populations at risk for syphilis; and ensures high quality syphilis preventive and care services. • Enhanced health promotion: • includes implementation and evaluation of appropriate and effective health promotion interventions; and timely delivery of high quality, confidential, and comprehensive client-centered partner services to patients, partners, and other identified high-risk individuals. Source: CDC Syphilis Elimination Executive Summary

  10. National Plan to Eliminate Syphilis • While national in scope, the NPES focuses on two area categories: 1. areas with high syphilis morbidity; 2. those areas with potential for syphilis re-emergence. • High Morbidity Areas(HMAs): areas with continuing syphilis transmission; HMAs must address all five of the syphilis elimination strategies. Source: CDC Syphilis Elimination Executive Summary

  11. National Plan to Eliminate Syphilis • Potential re-emergence areas (PRAs): areas that currently experience little or no syphilis transmission but that are at significant risk for syphilis reintroduction because • 1. History f high syphilis rates in the 90s or more recently. • 2. A port or border jurisdiction or are located along migrant streams • 3. Located along drug corridors • 4. They include groups that are disproportionately affected by syphilis • PRAs should focus primarily on enhanced surveillance and rapid outbreak response, including the involvement of affected communities in implementing these strategies. Source: CDC Syphilis Elimination Executive Summary

  12. Reported Sexually Transmitted Diseases,Los Angeles County (n=51,759), 2004 Source: LAC DHS STD Program; N=51,749

  13. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  14. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  15. Reported Primary, Secondary and Early Latent Syphilis Cases, Los Angeles, California, United States, 2000-2005

  16. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  17. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  18. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  19. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  20. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  21. SPAs with less than 6% included in “Other” Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  22. Trends in Early Syphilis in Los Angeles County, Women • Female incidence has increased 97% between 2001 (69) and 2005 (136). • African American and Hispanic women each comprised 41% of 136 ES cases reported for women in 2005 • 17% of these cases were pregnant • 91% of pregnant cases were either African American or Hispanic • Nearly one-third of female ES cases in 2005 were from SPA 6, followed by SPA 4 at 18%, SPA 8 at 15%, and SPA 7 at 12%. • 1.5% syphilis cases were co-infected with HIV

  23. Source: LAC-DHS, Early Syphilis Surveillance Summary – as of December 31, 2005

  24. Trends in Early Syphilis in Los Angeles County, Men • The Syphilis epidemic has been concentrated in the Hollywood-Wilshire Health District (SPA 4, Metro) • Epidemic is centered around the MSM and MSM/W populations • Primarily amongst White and Latino MSM • Approximately 60% of MSM were co-infected with HIV

  25. Behavioral Risk Factors for MSM Syphilis Cases

  26. Sexual Encounter Venues Among MSM Early Syphilis Cases, Los Angeles County, 2001-2005 Internet (n=512) Bars/Clubs (n=846) CSVs (n=429) Source: Epidemiology Unit, STD Program, 2006.

  27. Sociodemographic Characteristics Associated with Behavioral Risk Factors, 2004 * p<0.05

  28. Commercial Sex Venues • Compared to those who did not, MSM diagnosed with syphilis that frequent commercial sex venues were: • Two times aslikely to be HIV infected • Five times as likely to report having sex with anonymous partners • One and half times as likely to use non-IV drugs • The most common drug used at commercial sex venues was methamphetamine (60%). • They were also: • more likely to report condom non-use, IV drugs use than those who do not. • less likely to have sexual encounters at other venues (bars/clubs, motels, parks, Internet, dancehalls, streets).

  29. MSM and the Internet • Overall 19% MSM who were diagnosed with early syphilis infection met their sexual partners through the Internet • 65% were HIV positive • MSM with early syphilis who do use the Internet to meet their sexual partners were: • 2.6times more likely to be White • 3.8times more likely to have anonymous sex • 2.6times more likely to use injection drugs • Independent predictors of meeting sexual partners via the Internet among MSM with early syphilis were: • White race • Having anonymous sex partners

  30. Conclusion • Despite national progress toward syphilis elimination syphilis remains an important problem in the South and in urban areas in other regions of the country. • In Los Angeles County syphilis rates amongst MSM populations have continued to rise since 2001. In this population, the epidemic has been characterized by high HIV-co-infection rates.

  31. Conclusions (cont’d) • In 2004, syphilis rates increased for men and women in almost all racial and ethnic groups. • In 2004, half of the total number of P&S syphilis cases in the US were reported from 19 counties and 1 city 1.Los Angeles County 2.San Francisco County, CA 3.Cook County, IL 4.New York County, NY 5.Fulton County, GA 6.Dade County, FL 7.Harris County, TX 8.Baltimore (City), MD 9.Dallas County, TX 10.Broward County, FL

  32. Syphilis Elimination Conclusions “Elimination of syphilis would have far-reaching public health implications because it would remove two devastating consequences of the disease –increased likelihood of HIV transmission and compromised ability to have healthy babies due to spontaneous abortions, stillbirths, and multi-system disorders caused by congenital syphilis acquired from mothers with syphilis. In addition, more than $996 million is spent annually as a result of syphilis. Eliminating syphilis in the United States would be a landmark achievement because it would remove these direct health burdens, and it would significantly decrease one of this Nation's most glaring racial disparities in health.” Source: CDC Syphilis Elimination Executive Summary

  33. SEXUALLY TRANSMITTED DISEASE PROGRAM Dante’ Tolbert, MPH Epidemiology Analyst, STD Program datolbert@ladhs.org (213) 744-5901

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