Substantial increase in reported syphilis cases in New Jersey

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Substantial increase in reported syphilis cases in New Jersey

Date: March 25, 2022

Public Health Message Type: Advisory, Update

Counties Effected:  Statewide

Intended Audience: Healthcare providers, all public health partners, local health departments

NJDOH Contact: Greta Anschuetz  (greta.anschuetz@doh.nj.gov)

 

Message:  In 2021, total reported syphilis cases have increased by 63% in New Jersey (see Table 1 below). For infectious stages of syphilis (primary (e.g., chancre) and secondary (e.g., rash)), reported cases have increased 46%. Two areas identified with substantial transmission (more than 300 cases reported), and higher than the statewide increases include: Camden County (all syphilis diagnoses: 121%, infectious syphilis: 163%) and Union County (all syphilis diagnoses: 96%, infectious syphilis: 116%). Additionally, statewide congenital syphilis cases have increased to 48 cases in 2021 compared to 25 cases in 2020.

 

Healthcare Provider Screening Recommendations, statewide:

• Screen all pregnant women at first prenatal visit, third trimester, and delivery regardless of risk.
• Perform opt-out screening for syphilis in both men and women who use hard drugs, including but not limited to: opioids, cocaine, methamphetamine, and heroin, especially in urgent care/emergency department settings.
• Test all patients who present with lesions and rashes for syphilis.
• Continue to screen sexually active men who have sex with men (MSM) annually and every 3-6 months if at increased risk.
• Continue to screen sexually active persons at least annually and every 3-6 months if at increased risk (e.g., multiple partners, using hard drugs).
• Create electronic reminder systems for clinicians to screen for syphilis if there is no documented screening after 1st prenatal visit and/or after 28-week visit.
• Ensure all positive syphilis screens are followed up with appropriate treatment.

Additional Requirements:

• Adhere to the Centers for Disease Control and Prevention (CDC) STI 2021 treatment guidelines.
• Encourage patients with primary, secondary, or early latent syphilis to notify their sex partners, and encourage those partners to seek testing and treatment.
• Local health departments can provide or facilitate referral to confidential STI testing and treatment for sex partners.

Screening and Treatment:

• Diagnosing syphilis requires two blood tests (treponemal and non-treponemal). Make sure you are ordering the correct syphilis test sequence from your reference lab to automatically reflex an initial positive result to ensure that both a non-treponemal and treponemal test are completed on the same specimen.
• Benzathine penicillin G (2.4 million units IM) in a single dose is recommended for primary, secondary and early latent syphilis (i.e. infection occurred within the past 12 months).
• Benzathine penicillin G (7.2 million units total) administered as 3 doses of 2.4 million units IM each at 1-week intervals is recommended for late latent syphilis (e.g. infection occurred over 12 months ago).
• Benzathine penicillin G can have a large co-pay from several insurance providers. If there is any trouble with your patient getting treated with Benzathine penicillin G, please reach out to NJDOH at 609-826-4869 to facilitate free treatment.
• Penicillin G is the only known effective antimicrobial for preventing maternal transmission to the fetus. Pregnant women who report penicillin allergy should be desensitized and treated with penicillin.
• See the CDC 2021 STI Treatment Guidelines for more information.

Table 1. Preliminary 2021 total syphilis reported to NJDOH presented by percent increase (as of March 11, 2022)

	2019	2020	2021	% change 2019-2021	Rate in 2021 per 100,000 population
ESSEX	416	486	668	60.6%	83.5
HUDSON	353	329	514	45.6%	76.3
CAMDEN	156	219	345	121.2%	68.1
UNION	155	200	304	96.1%	54.7
PASSAIC	172	175	245	42.4%	49.2
MERCER	92	99	144	56.5%	39.4
Statewide	2069	2349	3381	63.4%	38.1
ATLANTIC	54	74	92	70.4%	35.0
BURLINGTON	78	86	142	82.1%	31.8
CUMBERLAND	27	32	44	63.0%	30.1
MIDDLESEX	128	152	226	76.6%	27.5
BERGEN	139	164	218	56.8%	23.4
SALEM	12	11	14	16.7%	22.8
GLOUCESTER	26	49	63	142.3%	21.6
MONMOUTH	89	99	128	43.8%	20.9
SOMERSET	46	34	60	30.4%	18.5
WARREN	4	10	17	325.0%	16.3
MORRIS	61	56	69	13.1%	14.1
HUNTERDON	8	10	14	75.0%	11.4
OCEAN	37	42	56	51.4%	9.0
CAPE MAY	6	8	8	33.3%	8.8
SUSSEX	10	14	10	0.0%	7.2

 

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