Flash Report
December 2015
In This Issue
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Syphilis Increase
in Oregon
Seasonal
Influenza
Public Health
Accreditation
Oregon CD
Summary
Subscription
A Brief Report of Public Health Activity Within Jackson County
Syphilis Increase in Oregon
Oregon is known for many things: natural beauty, coffee, beer and pinot noir, but did
you know that Oregon is also known for syphilis? Syphilis rates in Oregon have
increased more than 1,000% from 2007 to 2014. 1 Jackson County has seen a
significant increase in the syphilis cases since 2009. The graph below shows the
epidemiological trend of syphilis in Jackson County.
Contact Us
Communicable
Disease Reporting at
JCPH:
541-774-8045
After Hours:
541-618-4651
Jackson County
Health & Human
Services
Jim Shames
Medical Director
541-774-7885
shamesjg@jacksoncou
nty.org
Because of the significant increase in syphilis cases in Oregon and across the nation,
the Oregon Health Authority has
launched a syphilis awareness
public health information campaign
called SyphAware. This website is
used to convey information about
syphilis in an easy and interactive
way for the public and professionals
to use.
Providers can find more information on the Oregon Health Authority Sexually
Transmitted Disease website.
Who is At Risk?
Anyone who is sexually active and exposed to syphilis can get the infection. We know
that syphilis impacts some groups of people more than others. Among those most
impacted by syphilis are men who have sex with men (MSM), people living with HIV,
1
http://www.syphaware.org
Please print the
Reporting
Guidelines
and people who use drugs, along with sexual partners of these different groups. A few
years ago, syphilis cases were almost exclusively found in men. However, we are now
seeing a steady increase in cases among women. 1
Symptoms
Primary or First Stage of Syphilis: The appearance of a single chancre marks the
primary (first) stage of syphilis symptoms, but there may be multiple sores. The chancre
is usually firm, round, and painless. It appears at the location where syphilis entered
the body. These painless chancres can occur in locations that make them difficult to
find (e.g., the vagina or anus). The chancre lasts 3 to 6 weeks and heals regardless of
whether a person is treated or not. However, if the infected person does not receive
adequate treatment, the infection progresses to the secondary stage. 2
Look for the
January edition in
the first week of the
month!
Secondary Stage: Skin rashes and/or mucous membrane lesions (sores in the mouth,
vagina, or anus) mark the second stage of symptoms. This stage typically starts with
the development of a rash on one or more areas of the body. Rashes associated with
secondary syphilis can appear when the primary chancre is healing or several weeks
after the chancre has healed. The rash usually does not cause itching. The
characteristic rash of secondary syphilis may appear as rough, red, or reddish brown
spots both on the palms of the hands and the bottoms of the feet. However, rashes
with a different appearance may occur on other parts of the body, sometimes
resembling rashes caused by other diseases. Sometimes rashes associated with
secondary syphilis are so faint that they are not noticed. Large, raised, gray or white
lesions, known as condyloma lata, may develop in warm, moist areas such as the
mouth, underarm or groin region. In addition to rashes, symptoms of secondary syphilis
may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches,
weight loss, muscle aches, and fatigue. The symptoms of secondary syphilis will go
away with or without treatment, but without treatment, the infection will progress to the
latent and possibly late stages of disease. 2
Latent and Late Stages: The latent (hidden) stage of syphilis begins when primary and
secondary symptoms disappear. Without treatment, the infected person will continue
to have syphilis infection in their body even though there are no signs or symptoms.
Early latent syphilis is latent syphilis where infection occurred within the past 12
months. Late latent syphilis is latent syphilis where infection occurred more than 12
months ago. Latent syphilis can last for years. 2
http://jacksoncount
yor.org/hhs/PublicHealth
The late stages of syphilis can develop in about 15% of people who have not been
treated for syphilis, and can appear 10–20 years after infection was first acquired. In
the late stages of syphilis, the disease may damage the internal organs, including the
brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Symptoms of the late
stage of syphilis include difficulty coordinating muscle movements, paralysis,
numbness, gradual blindness, and dementia. This damage may be serious enough to
cause death. 2
Neurosyphilis: Syphilis can invade the nervous system at any stage of infection, and
causes a wide range of symptoms varying from no symptoms at all, to headache,
altered behavior, and movement problems that look like other neurologic diseases,
such as Parkinson’s or Huntington’s disease. Ocular syphilis, a clinical manifestation
of neurosyphilis, can involve almost any eye structure, but posterior uveitis and
2
http://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm
panuveitis are the most common. Ocular syphilis may lead to decreased visual acuity
including permanent blindness. Clinicians should be aware of ocular syphilis and
screen for visual complaints in any patient at risk for syphilis (e.g., MSM, HIV-infected
persons, others with risk factors and persons with multiple or anonymous partners).
Who Should be Screened for Syphilis?
If a client has never been screened for syphilis and present with any risk factors: MSM,
drug use, people living with HIV, or sexual partners of these different groups, they need
to be screened for syphilis.
MSM should be screened for syphilis every three months. People who are HIV
positive, people who are injection drug users, partners of high risk individuals, anyone
who has had a sexually transmitted disease within the last year, and anyone who
exchanges sex for drugs or money should be screened yearly.
New OB Screening Guidelines: syphilis screening should be done upon entry into
prenatal care, at the beginning of the third trimester, and at delivery.
Algorithm for Syphilis Screening
Below are the two methods for syphilis screening. It is important to check with the lab
that will be testing the specimen for syphilis to see if they have a preferred method.
You can also contact Jackson County Public Communicable Disease staff if you have
questions about either method.
Reporting Syphilis Cases to Jackson County Public Health
Syphilis is a reportable communicable disease and should be reported to Jackson
County Public Health within one working day. To report a communicable disease,
please call Jackson County Public Health Communicable Disease program at 541774-8045.
Seasonal Influenza Update
The current week’s FluBites data for week 45 (November 8- 14, 2015) is reporting that
Influenza-Like Illness (ILI) activity level is minimal and the activity geographic spread
is local. Oregon Public Health tracks hospital emergency department (ED) visits
throughout the state using the Oregon ESSENCE syndromic surveillance system. The
percent of ED visits for ILI was .98% during week 45 in Oregon and .179% in Jackson
County.
Public Health Accreditation
Jackson County Public Health is working towards improving and protecting the health
of the public by seeking voluntary national accreditation that will advance the quality
and performance of our public health department.
Public health accreditation is the measurement of health department performance
against a set of nationally recognized, practiced-focused and evidence-based
standards. It is the assurance of recognition of achievement of accreditation within a
specified time frame by a nationally recognized entity. And it is the continual
development, revision, and distribution of public health standards.
Currently, Clackamas County Public Health, Crook County Public Health, Deschutes
County Health Services, and Marion County Health Department are accredited health
departments in Oregon. Benton County and Oregon Health Authority Public Health
Division are in the process of becoming accredited.
Through the accreditation process Jackson County Public Health teamed up with
Jackson County Coordinated Care Organizations to develop the Jackson County
Community Health Assessment and the Community Health Improvement Plan.
Jackson County Public Health also developed a Strategic Improvement Plan. You can
view these documents on the Jackson County Public Health website.
Oregon CD Summary Subscription
The CD Summary is a fortnightly publication of the Oregon Health Authority, Public
Health Division. Its intended audience is licensed health care providers; public health
and health care agencies; media representatives; medical laboratories; hospitals; and
other individuals and institutions with an interest in epidemiology and public health
interests. Read the current CD Summary: Pulmonary NTM: The Other Acid-Fast
Bacteria
To request your subscription, copy the sample subscription request below, click on the
email link ([email protected]), paste the message into the email window, adjust
to taste, and send.
“The mission of Jackson County Health and Human Services is to plan, coordinate and
provide public services that protect and promote the health and well-being of county
residents.