STD Awareness Month: I don’t think this is what they meant by ‘everything old is new again’

This month, Melanie Deal, MS, FNP-BC, WHNP-BC writes how WHNPs can teach and treat their patients for STDs. Melanie has worked as a nurse practitioner for over 20 years.  She received her Master of Science in Nursing at the University of California in San Francisco.  Melanie currently practices at UC Berkeley Health Center and is clinical faculty for the California STD Prevention Training Center.  She is a regular presenter at Contemporary Forum’s Contraceptive Technology conferences. She has served on the Board of Directors for the National Association of Nurse Practitioners in Women’s Health (NPWH). 

April is STD awareness month. We as women’s health nurse practitioners have been front and center in the fight to keep our patient’s safe from these all too common infections.

We know that:

Chlamydia and gonorrhea rates have continued to rise. We must seek all opportunities to screen our female patients < 26 years old at least on an annual basis.

Antibiotic-resistant gonorrhea remains a major concern. In the U.S., we have one remaining class of drugs that will adequately treat this infection, cephalosporins.  Around the globe, countries are reporting cases of gonorrhea with decreased susceptibility and resistance to cephalosporins.  We must be vigilant for potential antibiotic-resistant cases and know how to treat them.

But one STD has made a significant comeback in the past decade: syphilis.

I think back to a conversation I had with my mother-in-law over dinner many years ago.  We were having one of our girls’ nights.  At the time, I was directing a CDC STD program, so it was not surprising that our conversation drifted to the topic of STDs.  Cocktail in hand, she leaned in and said, “So, tell me about the herpes”.  She wanted to hear about what was new with STDs because in “my day, we only knew about syphilis.”

At the time of this conversation, syphilis was a waning concern, especially in women’s health.  Syphilis rates in the country were so low, the CDC launched a program called The Syphilis Elimination Project” through which they hoped they could rid the U.S. of syphilis completely.

Here we are 20 years later, and syphilis is once again a growing threat.  Rates of syphilis have increased 67% between 2011 and 20151; and increased another almost 18% since 20152.  While the greatest surge has been among men who have male sexual partners, rates are also increasing among heterosexual men and women.  “Rates have increased in every region, in a majority of age groups, and across almost every race/ethnicity.”3 The U.S. is also seeing a concerning growth in cases of congenital syphilis, which should be absolutely preventable.

As women’s health nurse practitioners we must prepare ourselves to address this growing epidemic in a way we have not needed to in many years.

In response, the CDC has developed many clinician resources.

To put it simply the CDC challenges us to: Talk. Test. Treat.4

Talk.

Take a complete sexual history. We as women’s health nurse practitioners are familiar with taking sexual histories.  We must redouble our efforts especially with our prenatal patients.

Test.

Screen all prenatal patients at their first visit, and for higher risk patients, rescreen in 3rd trimester and at delivery.

Treat.

Know how to identify the stage of syphilis for your patients in order to provide the appropriate treatment regimen.

Neurosyphilis can occur at any stage.  Screen all syphilis patients for signs of neurosyphilis, including ocular and otic syphilis.

Hopefully, with our vigilance, we can once again make syphilis seem like an old time disease; one for the history books.

References:

  1. CDC Call to Action: Let’s Work Together to Stem the Tide of Rising Syphilis in the United States
  2. CDC: The State of STDs
  3. The rising tide of syphilis: Coming to a patient near you
  4. Test. Treat.

Additional resources

  1. Syphilis: Pocket Guide for Clinicians
  2. Sexual Health and Your Patients: A provider’s guide
  3. Asking Essential Sexual Health Questions
  4. CDC STD Treatment Guidelines