Syphilis in Detroit, Michigan - American Sexually Transmitted

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Syphilis in Detroit, Michigan - American Sexually Transmitted
Syphilis in Detroit, Michigan:
Population Dynamics
& Effective Interventions
Carla Merritt, MPH
March 10, 2004
Disease Trends
& Background
Number of Cases
P&S Syphilis by Region
1997-2003
600
500
400
300
200
100
0
1997
1998
1999
2000
2001
2002
2003
Michigan
153
211
249
330
428
486
249
Detroit City
101
152
189
274
351
384
179
52
59
60
56
77
102
70
Outstate
Source: MDCH
Quarterly Decline 2000-2003
140
Number of Cases
120
100
80
60
40
20
0
P&S
Q1- Q2- Q3- Q4- Q1- Q2- Q3- Q4- Q1- Q2- Q3- Q4- Q1- Q2- Q3- Q400
00
00
00
01
01
01
01
74
66
71
63
71
99
89
96
02
02
118 105
02
02
03
03
03
03
80
77
77
35
33
34
2003 Detroit
Reported Syphilis
Primary (62)
Secondary (123)
0%
5%
10%
Early Latent (91)
19%
Latent of Unknown
Duration (44)
Late Latent (279)
45%
14%
7%
Neurosyphilis (3)
Congenital Syphilis
(33)
Data includes: Detroit, Harper Woods, Highland Park, Hamtramck and the Grosse Pointes
Population
Profile
Who gets Syphilis in Detroit?
• Detroit’s Overall • Detroit’s Syphilis
Population
Population
•
•
•
•
•
76% Black
0.89:1
Male:Female Ratio
21% between the ages
of 15 and 29
52% between the ages
of 20 and 59
Average Age, =30.9
• Males, = 29.2
• Females, = 32.5
•
•
•
Disproportionately Black (92%)
Disproportionately Male (59%)
Heavily affect the middle ages
between 20 and 59 (95%)
• When people are most sexually
active
•
Older on Average, =37.0
• Male, =38.7
• Female, =34.4
Data Includes Detroit, Harper Woods, Hamtramck, Highland Park, and the Grosse Pointes
Source 2003 P&S Data: MDCH/DDHWP
Source Detroit Population Data: 2000 Census Figure
Risk Factor Profile
Percent of Cases
Core Group Characteristics
40
35
30
25
20
15
10
5
0
Core Group
Anonymous
Partners
Exchanged
Money or Drugs
for Sex
Hard Drug Use
Four or More
Partners
Sexual Orientation, P&S
1%
Syphilis
Detroit 2003
6% Cases,
1%
5%
Heterosexual
MSM
Bi-Sexual
93%
HIV/Syphilis Co-Infection
Significant Trends
• 60% of HIV/Syphilis co-infected cases were
diagnosed with HIV prior to acquiring syphilis
• 73% of HIV/ Early Syphilis co-infected cases
reported MSM activity while only 4% of early
syphilis cases did
• Among 2003 male early syphilis cases the
odds of HIV co-infection was 133 times
higher for those self-reporting MSM than
those self-reporting only heterosexual sex
(OR: 133.0, 95% CI: {15.1, 1168.9})
HIV/Syphilis Co-Infection
Implications for Program and Policy
•
•
•
Some HIV infected individuals continue high-risk
sexual behavior regardless of HIV status
HIV testing should be encouraged for all syphilis
cases but especially those self-reporting MSM
behavior
Education should be provided to clinicians
treating HIV positive patients on the recognition
of and screening for syphilis, as well as the
promotion of safer sex practices as HAART
extends and improves quality of life
Effective
Interventions
Emergency Room Visits
ER Case Detection Before and After Intervention
50%
Percent of Cases
45%
40%
35%
Intervention
October 2001
30%
25%
20%
15%
10%
5%
0%
m=.00461
moverall=.00546
m=.00006
J
F
M A M J
J A
S O N D
J
F
M A M J
J A
S O
N D
J
F
M A M J
J A
S O
N D
% 7% 16 14 17 5% 13 8% 20 12 9% 8% 10 24 13 20 17 20 24 33 38 23 24 5% 19 40 33 43 20 13 10 17 43 17 37 33 20
2001
2002
2003
Geographic Targeting
High Morbidity Regions and Risk Space Interventions
Acknowledgements
•
•
•
•
Dawn Jackson, Co-Author
Bruce Nowak, Co-Author
Kathryn Macomber, MPH
The Detroit Department of Health and
Wellness Promotion Sexually Transmitted
Disease Surveillance and Intervention
Program Staff
• The Michigan Department of Community
Health HIV/STD and Other Blood borne
Pathogens Division

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