This issue of the MSMA journal is a sobering reminder of the rapidly changing landscape of infectious disease that threatens our public health in Mississippi. The populations discussed in this journal are the sum of communities throughout our state from the Gulf Coast to the Tennessee border. These are the diseases affecting our patients that walk into our primary care offices every day. The efforts of the Mississippi State Department of Health (MSDH) and the Center for Disease Control (CDC) offering surveillance of community diseases remains a necessity in order to increase awareness and alert local physicians. Primary care providers should be vigilant to the emails and notifications from the Mississippi Health Alert Network (HAN) that share the latest information regarding trending disease outbreaks in our communities.
Mississippi continues to see high rates of primary and secondary syphilis. In 2021, Mississippi ranked 6th in the US for overall rate of primary and secondary syphilis per population and 4th in the US for the overall rate of congenital syphilis. Recently, the MSDH implemented a requirement for syphilis testing in all pregnant women in the first trimester or at the initial prenatal care visit. Compounding the issue has been the shortage of penicillin G benzathine suspension (Bicillin L-A) required for treatment for pregnant patients. Nonpregnant individuals can be treated with oral doxycycline. Partners of sexual contact with infected patients should also be treated presumptively even if early serologic tests are negative. Rising cases of congenital syphilis have also increased stillbirths and infant deaths.
More information on the CDC treatment recommendations for syphilis is available at Syphilis - STI Treatment Guidelines (cdc.gov). Guidelines are also available for the treatment of congenital syphilis at Congenital Syphilis - STI Treatment Guidelines (cdc.gov). MSDH has also initiated a Syphilis Hotline to help with diagnostic and treatment guidelines (601-815-0538).
Also in this journal is an update on rapidly changing HIV treatment. Primary Care offices are seeing more and more patients living with HIV than ever before. Along with more patients living with HIV, more recommendations and treatments are now available for prevention in other categories of exposure risks such as those patients with sexual partners with HIV or those sharing needles in IV drug use. Pre-exposure prophylaxis is highly effective for preventing HIV when taken as prescribed. More information and resources are available on the CDC website at Pre-Exposure Prophylaxis (PrEP) | HIV Risk and Prevention | HIV/AIDS | CDC.
Whether it is an infectious disease such as syphilis or HIV, updates and treatment guidelines should be easily accessible in your practice. Alerts from MSDH and the CDC through the Health Alert Network have brought to the forefront intermittent outbreaks of disease in our community. As physicians, we should both combat the outbreak and educate the patient on the way these diseases are transmitted. Patients and communities also need education about the life-threatening severity of both syphilis and HIV if left untreated. The CDC website or resources at MSDH are available and regularly updated based on the latest information. I would encourage all of us to bookmark these resources and keep these infections in the forefront of our differentials.
“In examining disease, we gain wisdom about anatomy, physiology, and biology. In examining the person with disease, we gain wisdom about life.” - Neurosurgeon and author, Dr. Oliver Sacks.