Syphilis: Review and Synthesis of Current Literature
Liberty University
Master of Public Health
HLTH 625
Screening, Treatment, and Resolution of Syphilis Throughout the
Population: Article Review and Synthesis
Callahan Stevens
ID: Student ID as L123456789
November 30, 2023
Words: body of paper word-count as xxxx
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https://www.coursehero.com/file/221278535/Stevens-Journal-Review-2doc x/
Syphilis: Review and Synthesis of Current Literature
Introduction
The incidence of syphilis infections throughout the United States has increased
exponentially throughout the last two decades. In the article “Resurgence of syphilis in the
United States: an assessment of contributing factors,” Schmidt et al., identified the current
guidelines of syphilis screening within the United States1. The guidelines include screening
pregnant patients, men who have sex with men, and HIV positive patients but notes that
provider adherence to these guidelines varies between individual practices1. Although
medical guidelines are helpful to narrow down care plans and diagnostic testing for patients,
it is important to note that adherence by medical professionals is paramount to ensure
accurate data capturing, treatment, and monitoring of particularly contagious diseases, such
as syphilis. Integrating broader screening guidelines, more thorough patient education, and
relevant policy revision in the face of drastic case increases are important interventions to
utilize when attempting to eliminate the threat of venereal disease2. The purpose of this
article review is to summarize the current practices utilized within the United States as
methods of screening, treating, and preventing syphilis, understanding hypotheses
surrounding the evident syphilis crisis within the country, and to propose (with evidence-
based support) changes or additions to current guidelines to better serve the general
community and to improve current best practices. By analyzing current practices,
investigating the root cause of increased case incidence, and suggesting potential changes to
national guidelines, this review aims to provide a holistic understanding of the disease
process, and to implore the United States healthcare delivery systems to identify weaknesses
in their screening capabilities and adjust accordingly to meet current population needs.
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Syphilis: Review and Synthesis of Current Literature
Article Summary and Infectious Disease Epidemiological Background
Major Points of the Article
The main article of discussion by Schmidt et al., is a meta-analysis of current literature
and practice guidelines within the United States pertaining to the identification and treatment of
syphilis1. Beyond identification of the disease and pathology of illness, the article describes the
roles and responsibilities of care providers within the health care management team and how to
integrate appropriate community resources to maintain holistic care of the patient1. The authors
aim to promote the significant correlation between HIV status and the prevalence of syphilis
within specific populations, as well as the increased burden that both diseases have on both
individual and national healthcare efforts1. A review of social and behavioral patterns is conducted
within this article, with added recommendations for future strategies within the medical and
public health fields. Overall, the main article is an excellent source of information regarding the
historical, present day, and potential future significance of syphilis as a disease that continues to
plague citizens nationwide.
Epidemiology of the Infectious Disease and Disease Impact on Populations
It is imperative to this review to include a detailed description of the epidemiology of
syphilis as it is known as “the great imitator” among contagious diseases3. Syphilis is a sexually
transmitted infection (STI) that is spread by a bacteria called T. pallidum1. Though the three
stages of syphilis infections are distinct, the symptoms are far ranging from a painless bump on
the genitals (stage 1) to generalized fatigue, swelling of the lymph nodes, diffuse rash, and
fevers4. In the late stages of syphilis, those infected usually experience varying degrees of
neurological involvement and multi-organ dysfunction because of increased inflammatory
responses to the bacteria within the entire body4. Though death as a result of syphilis infection is
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Syphilis: Review and Synthesis of Current Literature
rare, neonates and individuals that are HIV positive are at a higher risk of experiencing more
severe reactions and potentially morbid side effects as a result of a maternally transmitted
(congenital) or intimate contact (acquired) syphilis infections3. Over the past twenty years, there
has been a documented 413% increase in primary and secondary syphilis infections1. Among
those infected, men who have sex with men are among the highest risk groups accounting for
approximately 80% of total male cases1. Among this population, about half of those infected are
also suffering from HIV infections1. Among the female population, a rise in syphilis infections
has caused a 153% increase in congenital syphilis infections between the years of 2013-20171.
Nationally, the risk of syphilis among the general population has grown significantly over the
past two decades, thus costing the US approximately $39 million per year in medical costs1.
Best Practices or Standard of Care
Each article chosen for this review has described the best practices for screening, treating,
and preventing syphilis infections within the United States. In terms of screening, serology tests
are the mainstay to evaluate an active infection versus a previously infected individual4. These
tests are often done at certain intervals during a woman’s pregnancy, if a patient presents with
active symptoms indicative of syphilis, or if there is a potential for syphilis infection based on
the patient’s sexual history4. Though there are a multitude of other diagnostic tests to determine
the presence of the bacteria responsible for syphilis, it is internationally recognized to perform
these serology studies as it is the most cost effective and specific tests available at this time.
Treatment for syphilis is completed with penicillin G as an intramuscular injection given at set
intervals over the course of two weeks4. Penicillin G is a medication with a short half-life, and
therefore becomes cost-ineffective for pharmacies to maintain continuous stock of this
medication for patients in need of treatment. Because of this financial factor, treatment for
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Syphilis: Review and Synthesis of Current Literature
syphilis within the US can become devastatingly unaffordable for many socioeconomic groups.
Prevention of this disease is achieved through thorough patient education prior to infection (such
as sexual health classes within schools, teaching patients at higher risk of infection, and patient
teaching during prenatal appointments). Depending on the site of the active infection, condoms
may help reduce the incidence of syphilis exposure for those that are sexually active.
Evaluation and Critique
Comparison and Contrast
While serology screening and education are imperative in supporting syphilis prevention
within the United States, more intervention is necessary to be able to combat the current rise in
case numbers throughout the general population, especially among vulnerable populations. Many
of the studies researched for this review agree that while these interventions have been
resoundingly beneficial for the general populations, that there are multiple factors contributing to
the resurgence of syphilis1,2,3. One of the most apparent reasons for the increase is the
introduction of PrEP, which is the combination of medications that assist In preventing exposure
to the HIV virus for those participating in unprotected sex with an infected individual. With
assumed safety from a once wholly feared virus, some individuals within the LGBTQ+
community (in general) are practicing unprotected sex at a higher rate than has been seen in
recent history1,2. This is supported by the drastic increase in cases within the men who have sex
with men community, and could be contributing to the congenital rise in syphilis infections if
these men also have sexual histories with women who then become infected with syphilis before
or during a pregnancy. All of the articles studied within this review present strong information
regarding the history and presentation of syphilis, as well as the clinical significance of the
disease in modern medicine. Approximately half of the articles stressed the importance of
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Syphilis: Review and Synthesis of Current Literature
screening and treating the disease during pregnancy, while the other articles stressed the
importance of universal screening for the general population, especially those with a history of
homosexual relationships, illicit drug use, or HIV coinfections1,2,3,4.
Evaluative Critique
As stated previously, the articles chosen for this review present strong, well supported
data regarding the epidemiology, case prevalence, current best practices, and potential future
strategies to help reduce the risk of syphilis among the general population. These articles have
shown no conflicts of interest or financial gain from third party stakeholders. It is worth noting
that one study in particular gave potential realistic goals to improve the screening processes and
treatments of syphilis within the lower socioeconomic groups of the United States2. The authors
sought to improve diagnosis and treatment within this community by generalizing the screening
process for all patients seen within hospital emergency departments or local urgent cares2. In
generalizing the screening process, medical providers are able to more accurately capture the
current cases of syphilis within their community, able to treat patients earlier and therefore offset
the potential medical costs that they may endure without more rigorous testing capabilities2. This
strategy could help to reduce cost, case incidence, and increase overall wellbeing of some of the
most vulnerable groups within the United States.
Conclusion
Schmidt et al., provides a generous overview of syphilis as a disease and a national
health care urgency. The article aims to provide specific insight into the mechanisms of the
disease, as well as the key roles that health care personnel play in reducing the incidence and
disease burden of syphilis among the general population. While supported by the comparison
articles in this review, one key factor missing is the hypothetical implementation given
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Syphilis: Review and Synthesis of Current Literature
References
1. 1. Schmidt R, Carson PJ, Jansen RJ. Resurgence of Syphilis in the United States: An
Assessment of Contributing Factors. Infectious Diseases: Research and Treatment.
2019;12:117863371988328. doi:10.1177/1178633719883282
2. Stanford K, Ridgway JP, Schneider JA. P740 Improving syphilis diagnosis and treatment in an
urban population through routine emergency department screening. Poster presentations.
doi:10.1136/sextrans-2019-sti.800
3. Keuning MW, Kamp GA, Schonenberg-Meinema D, Dorigo-Zetsma JW, van Zuiden JM,
Pajkrt D. Congenital syphilis, the great imitator—case report and review. The Lancet Infectious
Diseases . 2020;20(7):e173-e179. doi:10.1016/s1473-3099(20)30268-1
4. Cantisani C, Rega F, Ambrosio L, et al. Syphilis, the Great Imitator—Clinical and
Dermoscopic Features of a Rare Presentation of Secondary Syphilis. International Journal of
Environmental Research and Public Health. 2023;20(2):1339. doi:10.3390/ijerph20021339
5. Trivedi S, Taylor M, Kamb ML, Chou D. Evaluating coverage of maternal syphilis screening
and treatment within antenatal care to guide service improvements for prevention of congenital
syphilis in Countdown 2030 Countries. Journal of Global Health. 2020;10(1).
doi:10.7189/jogh.10.010504
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