Curbing a Syphilis Outbreak in Alaska

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Curbing a Syphilis Outbreak in Alaska

Transcript Of Curbing a Syphilis Outbreak in Alaska

Curbing a Syphilis Outbreak in Alaska

STD Prevention

Never underestimate the power of teamwork. In times of challenge, this can be especially true, as public health officials and community members saw during a recent outbreak of syphilis in Anchorage, Alaska. During 2017 to 2018, the number of early syphilis cases reported in the state more than tripled. Most cases occurred in Anchorage, as well as among men (88%) – with gay, bisexual, and other men who have sex with other men (MSM) most affected (87% of male cases).

97 cases
of early syphilis in Alaska in 2018 (24 cases reported in 2017, a 300%

of MSM community survey respondents reported using online sites or dating apps to meet sex partners within a 6-month timeframe

Opening the lines of communication with community stakeholders

Noticing a rise in syphilis cases in Anchorage and surrounding areas, the STD/HIV Program of the Alaska Division of Public Health (ADPH) contacted CDC’s Division of STD Prevention (DSTDP) for assistance, and two specialized DSTDP teams were dispatched to gather information on what was causing the increases. The first team focused on community research using a rapid ethnographic assessment (RAP), a qualitative data-gathering method focused on local community factors affecting health outcomes; the second team collected information through an Epi-Aid investigation.

Over the course of a week, the RAP, conducted by Dr. Penny Loosier and her team of investigators, included interviews with 64 people – public health partners, healthcare providers, community groups and members – to help shed light on what was influencing the syphilis spike in Anchorage, particularly among MSM. “The RAP allowed us to collect a great deal of information quickly and to synthesize that down to common themes across different segments of the community,” said Loosier.

At the same time, a team of Epidemic Intelligence Service

(EIS) officers led by Dr. Laura Quilter, an EIS officer in

only 60%
of MSM community survey respondents reported being screened for syphilis in the past
12 months

CDC’s DSTDP, did a deep dive into the state’s case report data and partner investigation records. Quilter and her team also administered surveys to members of the local MSM community and healthcare providers to determine the knowledge, attitudes, and practices of syphilis prevention and control in Alaska among those

two groups. Quilter’s team surveyed MSM in

a variety of Anchorage-based venues and online

CS 312079-A

through a number of dating apps – which proved to be a great outreach tool with close to 1,000 men clicking on survey invitations sent out through one app alone.
The multi-disciplinary approach of the two teams was helped a great deal by the solid connections currently in place between state public health officials and community members. “The state already had established relationships with key community leaders and medical providers which facilitated our ability to collaborate with community stakeholders to investigate the syphilis outbreak. This kind of situation galvanizes the community and elevates the importance of tackling it,” said Quilter.

Paving the way for problem-solving
In the end, the two teams developed and shared recommendations with ADPH designed to promote sexual health, mitigate the risk of more infections, and slow further spread of infections into the community. They found a high level of interest and engagement throughout the tight-knit community – stakeholders, including MSM, who wanted to get to the bottom of the problem and come up with solutions.
The two teams uncovered several key findings that informed their recommendations. In Alaska, migration, travel, tourism, and the use of online sites and dating apps may help facilitate sexual activities that place MSM at higher risk for syphilis. As Quilter noted, “We’ve been seeing increases in syphilis among MSM globally and it was likely just a matter of time before it made its way into more isolated sexual networks, such as those in Anchorage.”
Additionally, for some MSM, the combined effects of substance use and homelessness may lead to an increased risk of syphilis transmission. Overall, prevention strategies like condoms and syphilis screening were reported; however, significant gaps in use were found.
But there is hope on the horizon. Since the investigation in October 2018, ADPH has organized several HIV/STD testing and community outreach events in collaboration with community organizations, and over 300 people have undergone syphilis screening in the Anchorage community through these events since January 2019.
Syphilis screening is just part of the work to tackle the outbreak. “Getting engaged clinicians on board who can communicate prevention strategies directly to MSM community members is a strong tool to combat Alaska’s rising syphilis numbers,” said Quilter. With that in mind, ADPH joined with the University of Washington’s CDC-funded STD Prevention Training Center to host a syphilis webinar in early March 2019 for Alaska healthcare providers to review syphilis screening guidelines, diagnosis, management, and treatment.

Solid teamwork remains key to combatting new syphilis outbreaks
The work of the CDC teams helped to answer some important questions about the syphilis outbreak; however, the strength of this investigation started with the longstanding relationships they found on arrival.
“We saw valuable partnerships in action already,” said Loosier. “There’s a great relationship between the ADPH and local communities – services such as free testing, provider education, and condom giveaways were well-established beforehand and are ongoing. That highly cooperative relationship between the health department in Anchorage and the local community is something that will continue to be beneficial down the road.”

Learn MORE at

• Syphilis: Get the Facts • CDC 2018 STD Surveillance Info • Alaska HIV/STD Program