1. Syphilis in North Carolina update for 2010 Evelyn M. Foust Head, Communicable Disease Branch Communicable Disease Surveillance Unit

2. NC Syphilis Rates 1999-2009 Communicable Disease Surveillance Unit

3. NC PSEL Syphilis Cases in Select Counties YTD Communicable Disease Surveillance Unit

5. PSEL Syphilis Rates by Gender, 2005-2009 Rate ratios: 2.4 2.6 3.0 3.6 3.6 84%↑ 88%↑ Communicable Disease Surveillance Unit

6. 2009 PSEL Race/Ethnicity Rates for Males and Females Males Whites 4.9/100,000 Blacks 57.5/100,000 11.7 times that of whites (9.6 in 2008) Hispanics 6.5/100,000 1.3 times that of whites (1.5 in 2008) Females Whites 1.7/100,000 Blacks 13.6/100,000 8 times that of whites (11 times in 2008) Hispanics 4.7/100,000 ~ 3 times that of whites (~ 4 times in 2008)

7. PSEL Syphilis Cases 2001-2009 (by Gender) Overall rates at lowest point Communicable Disease Surveillance Unit

8. Comorbidity (early syphilis & HIV) Communicable Disease Surveillance Unit

9. Current and Proposed Syphilis Elimination Activities North Carolina Response to Syphilis 2010/2011 The Communicable Disease Branch (CDB) has created an Epidemic Response Team (ERT). The Communicable Disease Director and State Epidemiologist will provide oversight as needed to this team. CDB has initiated a clinician education campaign to review the signs, symptoms and treatment for syphilis with frontline medical providers. The North Carolina MSM (men who have sex with men) Task Force, comprised of many thought leaders from around the state, has been established in order to foster dialogue and effective partnership with the MSM community, currently at highest risk for syphilis and/or new HIV infection. CDB testing efforts need to be streamlined and focused in order to reach the highest risk individuals in this epidemic. CDB Surveillance Team and the Field Services staff perform weekly, monthly and quarterly analysis of syphilis and HIV surveillance reports and case investigation reports. CDB is discussing opportunities to provide direct education and follow up of reported cased of G.C. in men within highly impacted areas. The Communicable Disease Branch is working with the CDC, receiving consultation and technical assistance on addressing the increase in syphilis.

10. Specific Guidance to Providers/Field Staff All syphilis cases must have an HIV test All HIV infected individuals must have syphilis testing and continue to be tested at 3-6 months intervals if possible Treat all suspected cases Treat all contacts who are within a 90 day window from early syphilis cases Field Staff should work associates/suspects/networks Notify local EDs of Syphilis epidemic and assure they have BZN PCN Look for opportunities to integrate testing Treat, treat, treat THINK SYNERGY and THINK SYDEMICALLY

11. Successes and Barriers Public Health must stay vigilant and be ready to respond quickly. If you take your eye off the ball it can hit you when you least expect it!!! Epidemic response must be flexible, quick and tailored. Know Thy Data There must be community involvement and buy in. People have to come first. Local health departments, community organizations, local providers are the frontline heroes. Available resources to respond and challenged. Don’t wait for help. Be the wind under the wings.