DOH Sends Alert to Providers in Response to Significant Increase of Syphilis

On March 11, 2015, the Pennsylvania Department of Health (DOH) sent an alert to all Pennsylvania physicians subscribed to its PA Health Alert Network (PA HAN) in response to a significant increase in the annual rate of reported syphilis in the female population since 2010.

The alert said that:

  • Special testing precautions for all pregnant women are to be taken in the following counties: Delaware, Allegheny, York, Berks, Lycoming, Luzerne, Dauphin, Lancaster, Schuylkill, Fayette, Lackawanna, Lehigh, Erie, Blair, Franklin, Montgomery, Bucks, Beaver, and Butler.
  • DOH is recommending pregnant females in the impacted counties be offered a test for syphilis in any of the following situations:
    • At the third trimester of pregnancy
    • At the delivery of a child
    • At the delivery of a stillborn child
  • This is in addition to the statewide requirement for syphilis testing contained in 28 Pa Code SS 27.89 (a)(1)(i) that directs a physician who attends, treats, or examines a pregnant woman for conditions relating to pregnancy to offer the woman a test for syphilis at the time of first examination.
  • If a pregnant woman does not object, the test shall be performed in accordance with 28 Pa Code SS27.89. If a pregnant woman objects, the regulation requires the person attending the woman to explain to her the need for the test.
  • Physicians in all other counties not listed in the alert are still required to offer pregnant women a test for syphilis at the time of first examination for conditions related to pregnancy in accordance with 28 Pa Code SS 27.89 (a)(1)(i).
  • With respect to the woman who has given birth, information relating to the test or the objection to the test is to be recorded in both the woman’s medical record and in the record of the newborn, as regulation states.
  • All patients presenting with any of the following symptoms also should be immediately tested for syphilis:
    • A macular and/or papular rash on the palms of the hands or on the soles of the feet
    • A generalized rash that may be macular, papular, or papulosquamous on the back, chest, or stomach
    • A lesion in the genital, rectal, or oral area
    • Moist papules in the anogenital region or the mouth
    • Sudden “Moth-eaten” scalp alopecia with a typical onset at the back of the head
    • Loss of eyelashes and the lateral third of the eyebrows
    • Generalized lymphadenopathy
    • Malaise

Additional information on the treatment and follow up of syphilis also is available on the Centers for Control and Prevention’s website.