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Hanne Harbison
MHS '00, MSN, CRNP
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Syphilis in Alabama
For the last ten months, I have worked as a nurse practitioner and research nurse in the Jefferson County Department of Health STD Clinic in Birmingham, Ala. Since 2004, Birmingham has experienced a steady increase in syphilis cases. While the increase in Birmingham corresponds to similar increases seen nationally among men who have sex with men, as in much of the Southeastern U.S., we have also seen increases among heterosexual men and women. Recently, I saw a patient who exemplifies the current epidemic, a 24-year-old African-American woman who presented for prenatal care at 24 weeks gestation. Her prenatal care provider sent her to the STD clinic for evaluation of unusual genital lesions. Upon examination, we discovered the patient had extensive condylomata lata of secondary syphilis. An ultrasound showed that the fetus also had signs of congenital syphilis.
In Jefferson County, syphilis rates in African-American women have dramatically increased over the past four years. Currently, the county ranks first in syphilis rates among women for all counties in the U.S. (25.7 cases/100,000 population), almost twice the rate of the second-rated county of East Baton Rouge, La. In 2006, in Alabama, the rate of syphilis in African-Americans was 20.6 per 100,000 population, versus 2.1 for whites, 1.9 for Hispanics and 4.9 for Asian/Pacific Islanders. This disparity, combined with the not-infrequent misdiagnosis of syphilis, the reluctance of many providers to test for STDs, and the limited access to and use of timely prenatal care among some at-risk young African-American women, increases the likelihood that a syphilis diagnosis will not be made or will be made too late to prevent congenital syphilis. Congenital syphilis is entirely preventable, and testing and treatment for syphilis are very inexpensive. It is our challenge as a public health community to use our passion and expertise to reverse this trend. In my roles as clinician and researcher I hope to contribute to this effort.
Hanne Harbison works as a nurse practitioner and research nurse coordinator in the Jefferson County Department of Health STD Clinic in Birmingham, Ala.
