The Illinois Department of Public Health has issued information on Syphilis Staging and Treatment. Please note that syphilis is the only STD where treatment is dependent upon the stage of the infection (please see the treatment table). Currently there is also a national shortage of Benzathine penicillin G (bicillin). This makes it critical to stage syphilis accurately and treat accordingly. Any non-pregnant patients should be considered for the alternative treatment with doxycycline.
Syphilis during pregnancy must be treated with the penicillin regimen appropriate to their stage of syphilis. If a pregnant woman is allergic to penicillin, she must be desensitized and treated with penicillin according to the stage at time of diagnosis. There is no alternative treatment for pregnant females. Benzathine penicillin G is the only known effective antimicrobial for prevention of maternal transmission of syphilis to the fetus.
Please click HERE for a full copy of the IDPH information, including treatment tables.
The Chicago Department of Public Health, in partnership with the Chicago Area HIV Integrated Services Council (CAHISC), has identified PrEP as one of the department's top priorities for investment. Along with HIV treatment, PrEP is an essential tool to reduce HIV transmission.
The Illinois Department of Public Health has launched the Illinois HIV Pre-exposure Prophylaxis (PrEP) Assistance Program. The Program provides information and financial assistance for current and future PrEP users in Illinois. PrEP users can apply for assistance with IDPH and, if approved, IDPH can help cover medication-related costs. Illinois is only the fourth state in the U.S. to offer financial support to PrEP users. On the program webpage interested persons can fill out an online application to get the process started.
PrEP is a daily dose of antiretroviral medication (tenofovir + emtricitabine; brand name Truvada®) that helps prevent HIV infection. When used consistently, studies show that PrEP is >90% effective at preventing transmission. Current Centers for Disease Control and Prevention guidelines say that PrEP should be considered for:
- Anyone who is in an ongoing sexual relationship with an HIV-infected partner.
- A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually-transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.
- A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.
- Anyone who has, within the past six months, injected drugs and shared equipment or been in a treatment program for injection drug use.
As of February 23rd, 2016, 12 confirmed and 7 suspect cases of lymphogranuloma venereum (LGV), an uncommon chronic Chlamydia trachomatis infection, have been reported in the state of Michigan (MI). The LGV outbreak in MI is predominantly among African American men who have sex with men (MSM). It is important to increase provider awareness and surveillance for LGV in MSM, especially in states that neighbor Michigan. The Chicago Department of Public Health (CDPH) is asking providers to identify and report all MSM LGV suspect cases. The LGV case definition can be found here.
CDPH recommendations for health care providers:
- Order - confirmatory test for suspect clinical LGV cases
- Report - suspect cases to the health department
- Screen - patients with acute proctocolitis for HIV, syphilis, herpes, gonorrhea, chlamydia, and/or chancroid
- Treat - do not wait for test results before starting empiric LGV treatment in patients for whom clinical suspicion is high
- Manage Sex Partner(s) - sex partners should be offered appropriate partner management services, and prophylactic antibiotic treatment, if exposed.
Lab Ordering: The Chicago LGV Suspected Case Report Form can be found here forms should be faxed to 312-747-7627, attention: Dr. Irina Tabidze. CDC guidance for specimen submission for laboratory confirmation of LGV can be found here.
Submit residual Nucleic Acid Amplification test (NAAT)specimens to the IDPH laboratory. Please keep NAAT specimens refrigerated until ready for submission to the IDPH laboratory. Pack specimens for shipping with an insulated cold pack or freezer pack. Label each specimen with the patient’s clinic ID number, clinic name and anatomical site of specimen collection. To alert IDPH laboratory staff that you are sending a LGV specimen, call 312-793-0276. Send specimens to the following address, with labeling clearly indicating that they should be forwarded to the CDC:
Illinois Department of Public Health Laboratory
2121 W. Taylor Street
Chicago, IL 60612
Attn: Carlos Morales (email:Carlosmanuel.firstname.lastname@example.org/phone:312-793-0276)
Reporting: Report LGV cases to STI/HIV Surveillance. Please fax a confidential morbidity report form to STD/HIV Surveillance at 312-745-7627.To access the form please click here. If you have any other questions related to LGV, please contact CDPH STI Epidemiologist, Dr. Irina Tabidze at Irina.Tabidze@cityofchicago.org or at 312-747-9867. The Chicago LGV Suspected Case Report Form can be found here. Completed forms should be faxed to 312-747-7627, attention: Dr. Irina Tabidze.
Treatment: All patients diagnosed with LGV should be treated according to CDC 2015 STD Treatment Guidelines (i.e. doxycycline 100 mg orally twice a day for 21 days). Sex partners of a probable or confirmed LGV case should be tested for chlamydia infection and presumptively treated with doxycycline 100 mg orally twice a day for 7 days.
For a full pritable copy of the third (March 2017) Health Alert Related to LGV Please click here.
For a full printable copy of the second (March 2016) Health Alert, including the algorithm for LGV treatment and detection please click here.
For a full printable copy of the November 2015 Health Alert related to LGV please click here.
2016 Chicago Regional STI/HIV Prevention
Clinical Update Conference Presentations
On September 29, 2016 a Conference on sexually transmitted infections (STIs) and HIV prevention was held in Chicago. Topics covered included: STI/HIV epidemiology; pre-exposure prophylaxis (PrEP) disparities and implementation; and sexually-transmitted Zika virus infection.
CDPH and fellow Conference sponsors, the St. Louis STD/HIV Prevention Training Center, IDPH and the Midwest AIDS Training and Education Center are pleased to share speaker presentations. (Please click on the Presentation Name in order to view the presentation.)
STI 2016: Where We Need To Go Gail Bolan, MD
STI Burden in Chicago / STI Surveillance Stephanie Schuette, PhD
Zika Virus as an STI John Brooks, MD
PrEP Implementation - Chicago Ramona Bhatia, MD, MS
PrEP Implementation - LHD/CU Candi Crause
PrEP Implementation - UChicago John Schneider, MD, MPH
STI 2016: Emerging Crises, Enduring Concerns Bradley Stoner, MD, PhD
PrEP, Health Disparities, and Future Directions Patrick Sullivan, PhD
The incidence of congenital syphilis (CS) in the United States has declined substantially in recent years and the majority of reported cases remain preventable. Compliance with recommendations of the CDC and the Illinois state law requires that you conduct at minimum of two serological syphilis tests with all pregnant clients in your care. All positive blood tests, diagnoses, or treatment for syphilis should be reported to the Chicago Department of Public Health (CDPH) no later than seven days after laboratory notification of positive test result.
To enhance surveillance of congenital syphilis, the Centers for Disease Control and Prevention (CDC) has released a new Congenital Syphilis Case Investigation and Report Form. As a result, the CDPH STI Surveillance unit has also created a revised local Congenital Syphilis Worksheet. The CS Worksheet should be completed for all pregnant females delivering newborns at your facility and reported to the CDPH STI Surveillance Unit no later than 2 days after delivery. To access the worksheet please click here.
All positive blood tests, diagnoses, or treatment for syphilis should be reported to the Chicago Department of Public Health (CDPH) no later than seven days after laboratory notification of positive test result. To report a CS case, please fax CS worksheet to 312-745-7627. If you have any questions, please feel free to contact the Syphilis Epidemiologist, Irina Tabidze, MD, MPH at 312-747-9867. A full copy of the CDPH Memo regarding congenital syphilis can be accessed here.
New Forms for STI Reporting
The Chicago Department of Public Health (CDPH), STI Surveillance Program within the STI/HIV Services Bureau is responsible for collecting all reports of sexually transmitted infections from laboratories and health care providers. Please see the August 31, 2015 Provider letter with important information about reporting STIs to CDPH.
Please do not change the format on these forms when submitting information. If you should have any questions, comments or concerns regarding these updates or any activities conducted by the STI surveillance program, I can be reached at (312) 747-9661 or via email at email@example.com.