INFECTIOUS DISEASES
Removing Barriers by Bringing Testing to the Community
By Timothy Southern , PhD , laboratory director , South Dakota Public Health Laboratory ; and Susan Trow , PhD , specialist , Infectious Diseases
After reaching historic lows in the early 2000s , syphilis transmission has steadily increased across the United States . 1 Outpacing this nationwide trend , South Dakota has experienced a staggering increase in syphilis . The South Dakota Department of Health ( SDDOH ) reported 1,504 adult cases in 2022 , a 2,493 % increase from the five-year median number of cases . 2 As of mid-December there were 1,229 cases for 2023 ( 1,496 % increase ). 3
Syphilis is a sexually transmitted bacterial infection that , left untreated , can progress to severe complications in adults . Simple treatment with antibiotics can clear early cases effectively , but the consequences of undetected maternal transmission during pregnancy can be extreme . Congenital syphilis can result in miscarriage , birth defects , stillbirth and illness or death after birth . As the infection has spread to unprecedented levels in women , this is cause for alarm . In 2022 , there were 40 cases of congenital syphilis and three syphilitic stillbirths in South Dakota , a 1,233 % increase from the five-year median . 2
Many factors fuel this uncontrolled spread . 4 The COVID-19 pandemic played a role , redirecting resources and deferring clinical services for sexual health . The syphilis outbreak has disproportionately affected Native American communities — around 75 % of South Dakota ’ s cases in 2022 were in Native Americans . 5 Outside of the state ’ s two most populous counties , the highest number of cases have occurred in Todd and Oglala Lakota counties , within the Rosebud and Pine Ridge reservations respectively . 5 Many of those affected live in rural communities with limited healthcare access ; geography and poverty present significant barriers to equitable testing and treatment across this vast Great Plains state . The stigma of sexually transmitted infection within these communities also can be high , preventing individuals from seeking health education or care . Finally , substance abuse is also a driver of infection . 4
Securing Testing Access for All
Slowing the surge in syphilis requires multipronged solutions to complex factors , but one clear challenge that begs solving is making testing accessible . Timothy Southern , PhD , director of the South Dakota Public Health Laboratory ( SDPHL ) worked with providers to examine syphilis testing algorithms in use but found the approaches were falling short for identifying infections and curbing spread .
“ They needed to take the test to the people rather than the people to the test ” said Southern . Already anticipating this need , SDDOH had begun considering rapid point-of-care ( POC ) options in 2017 , guided by SDPHL ’ s expertise . The earlier evaluation pre-pandemic had faltered , however , when acceptable performance was not achieved with the platform examined . As time passed , the need only continued to grow . Motivated to implement a solution , Southern and the team examined the ChemBio Diagnostics , Inc . Dual Path Platform ® ( DPP ) HIV-Syphilis rapid test , which they piloted in partnership with the Oyate Health Center in 2022 . The center is a tribally owned primary care clinic in Rapid City , managed by the Great Plains Tribal Leaders ’ Health Board . Initially , this test was evaluated under a research use only ( RUO ) designation and provided free of cost . Under piloting conditions , good performance was achieved .
Public Health Collaboration for Solutions
When the DPP HIV-Syphilis rapid test received FDA Clinical Laboratory Improvement Amendments ( CLIA ) - waived status in 2023 , SDPHL was able to work within its jurisdiction to utilize the test clinically . It is now in use at multiple clinic locations of Horizon Health Care , a federally qualified health center operating in rural , underserved areas . Southern and the SDPHL team worked with Indian Health Services , SDDOH Office of Disease Prevention and state epidemiologists to ensure positive rapid tests are actionable and correctly reported to the state .
The deployment of this test is not an instant solution to South Dakota ’ s challenges ; the epidemic of syphilis is ongoing . However , it provides a tool for expanding testing access to treat the populations hit hardest . Despite also facing a 2023 shortage of Bicillin ® L-A ( the injectable long-acting penicillin formulation used to treat syphilis ), SDDOH has worked to support providers in following priority actions and CDC guidance to ensure South Dakota patients still receive the treatment they need . 2 , 6 g
References :
1 . National Overview of STDs , 2021 [ Internet ]. 2023 [ cited 2023 Dec 18 ]. Available from : https :// www . cdc . gov / std / statistics / 2021 / overview . htm
2 . reducingsyphilis _ 2023 . pdf [ Internet ]. [ cited 2023 Dec 18 ]. Available from : https :// doh . sd . gov / media / gi1b4rwt / reducingsyphilis _ 2023 . pdf
3 . Infectious Disease Dashboard | South Dakota Department of Health [ Internet ]. [ cited 2023 Dec 18 ]. Available from : https :// doh . sd . gov / health-data-reports / data-dashboards / infectious-disease-dashboard /
4 . Landman K . Syphilis rates are soaring in South Dakota ’ s American Indian communities . What ’ s going on ? [ Internet ]. Vox . 2022 [ cited 2023 Dec 18 ]. Available from : https :// www . vox . com / science-and-health / 23460951 / syphilis-south-dakota-american-indian-native-congenital
5 . Sexually Transmitted Infections Surveillance , 2022 [ Internet ]. 2024 [ cited 2024 May 24 ]. Available from : https :// www . cdc . gov / std / statistics / 2022 / default . htm
6 . South Dakota syphilis outbreak continues despite testing and awareness [ Internet ]. SDPB . 2022 [ cited 2023 Dec 18 ]. Available from : https :// listen . sdpb . org / healthcare / 2022-07-22 / south-dakota-syphilis-outbreak-continues-despite-testing-and-awareness
7 . CDC - STD Treatment - Drug notices [ Internet ]. 2023 [ cited 2023 Dec 18 ]. Available from : https :// www . cdc . gov / std / treatment / drug-notices . htm
26 LAB MATTERS Summer 2024
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