Summary from previous Reduced sustained Domestic transmission of primary and secondary syphilis
sample paper and format provided. Follow rubric is attached and the sample paper same format
All of the following required elements are met:
· Presents STD summary in a logical, meaningful, and understandable sequence.
· Summary post includes 3 evidence- based action plans for the STD that student was assigned (may include two peer recommendations but at least one action plan must be the student’s own plan)
· Each action plan must include an evidence based in-text citation
· Includes at least one opposition or barrier to each action plan
· Includes a summary of your peers’ responses to your initial post
(5 required elements)
Clinical Case Presentation Summary
Summary of Primary and Secondary Syphilis
In 2017, a total of 30,644 cases of primary and secondary syphilis were reported in the United States, yielding a rate of 9.5 cases per 100,000 population (CDC, 2018). According to the CDC (2018), this rate signifies a 10.5% increase compared with 2016 (8.6 cases per 100,000 population). Syphilis has a high prevalence among certain racial/ethnic groups, as well as in other groups, such as adolescents, sex workers, men who have sex with men (MSM), and sexually abused women (Hollier, 2018). Syphilis is transmitted through direct contact with an ulcerative lesion, or chancre which appears during the primary stage (most infectious) of syphilis (Hollier, 2018). Patients with this infection may seek medical treatment for signs and/or symptoms of primary syphilis (chancre/ulcer), or secondary syphilis (diffuse rash on palms and soles) (Hollier, 2018). On the other hand, patients may be completely asymptomatic and only diagnosed on routine screening.
Yonglin suggested to me one prevention strategy from the CDC called the “Talk, Test, Treat” method that has been suggested by the CDC is the “Talk, Test, Treat” method. Talking involves discussing sexual health history, testing involves screening for syphilis. The CDC recommends screening all sexually active men who have sex with men at least once a year, and more frequently if they are at-risk for infection. Pregnant women should be tested at their first prenatal visit, and at-risk women should be rescreened in their third trimester and again at delivery to prevent congenital syphilis. Lastly, patients need to be treated with benzathine penicillin G who test positive for syphilis.
Evidence-Based Action Plan #1
Implementing a mobile health unit (MHU) or van that offers community-based screening services for at-risk populations, such as female sex workers, men who have sex with men (MSM), and IV drug users could assist with reducing the transmission of primary and secondary syphilis. An MHU can be used as part of a community education, screening, and counselling program to serve urban and rural communities (Khanna & Narula, 2016). The MHU would have to be clearly identified as a free syphilis testing unit in order to make it more appealing to interested individuals who may approach. The health care providers working the mobile unit would be required to obtain a focused health history and patient contact information in order to provide screening results and the necessary follow-up instructions for any positive test results. Studies have shown that MHUs have been very helpful in detecting new cases of syphilis and beneficial to the at-risk population (Lipsitz et al., 2014). Also, MHUs may even increase patient compliance with the follow-up serologic testing that is required after being treated for syphilis, which may be a barrier for patients of low income or who lack transportation. This evidence-based intervention could be measured by conducting telephone interviews or surveys asking the patients if they found the mobile unit to be beneficial, would they return for future screening and testing, are they staying compliant with the recommended screening intervals, would they recommend the mobile unit to others. The long-term outcome of this intervention is to decrease incidence of primary and secondary syphilis, which can be evaluated and measured by collecting data on how many people were screened during the year and how many cases of early syphilis were diagnosed and treated.
Barrier to Action Plan #1
A potential barrier to having a successful mobile health unit would be the lack of financial resources to fund the mobile unit, supplies, and labor hours. Although, staff members may be willing to volunteer some time in order to make this community-based intervention a success for reducing primary and secondary syphilis.
Evidence-Based Action Plan #2
There are various methods of prevention that can be implemented at the community or individual level in order to lessen the incidence of primary and secondary syphilis. Condom use is one evidence-based intervention, when used properly and consistently, is an effective vehicle in reducing the transmission of syphilis in the community setting (Andrzejewski, Liddon, & Leonard, 2019). Making condoms easily accessible in the community may make the goal of reducing the incidence of syphilis more achievable. Condoms, both male and female, may be made available by placing them in dispensers by bus stops, shopping centers, and hotel lobbies. School-based condom programs can be implemented in high schools as one strategy for reducing the incidence of primary and secondary syphilis. These programs make condoms available to students in places like the school nurse office, school-based health centers, cafeterias, and vending machines (Andrzejewski et al., 2019). According to Andrzejewski et al. (2019), most programs provide condoms to students free of charge and are implemented concurrently with other sexual health promotion strategies, such as sexual health education. In one conducted study on condom availability programs in schools, a decrease in the incidence of chlamydia and gonorrhea was found; and additionally, students were in favor and very much aware of the availability of condoms in schools (Andrzejewski, 2019). For any individual who is sexually active, condoms remain a cheap and effective way to protect oneself against STDs such as syphilis (McCool-Myers, 2019). This evidence-based intervention could be measured by conducting telephone interviews or sending out surveys or questionnaires to collect data on the following: how often do they use condoms, how the general public or students views the availability of condoms in the public and school settings, their level of comfort buying condoms in a store, how likely are they to use a condom from a dispenser, how often have they used condoms from a dispenser, and level of awareness of condom programs.
Barrier to Action Plan #2
However, buying condoms in stores can be challenging and some studies have shown that approximately 80% of stores place condoms behind locks or cases or put them behind the cashier’s counter (McCool-Myers, 2019). Another barrier that could potentially hinder convenience of condoms for public use is the issue of comfort and embarrassment. In one study, condom dispensers were strategically placed in subtle locations yet they found that comfort and embarrassment still influenced the public’s intent to access the dispensers (McCool-Myers, 2019). Physical and environmental barriers lead to embarrassment in purchasing condoms, which in turn negatively impacts condom use (McCool-Myers, 2019).
Evidence-Based Action Plan #3
Expedited partner therapy (EPT) is one evidence-based intervention that can be implemented at the population and individual level to reduce the rate of syphilis infection. EPT has the potential to decrease syphilis, because it allows health care providers to give prescriptions or medications to patients to take to their partners without examining the partners (ACOG, 2018). Research studies show that EPT can decrease infection rates when compared with the standard practice of referring sexual partners for exam and treatment (ACOG, 2018). EPT can be measured by administering surveys and questionnaires asking the patients whether or not they felt EPT was beneficial to their partner, was treatment/medication delivered to the partner, did the partner take the recommended prescription to treat the STD or was it refused, and was the medication effective in treating both the patient and the partner. Data should be collected to determine the effectiveness of EPT in achieving reduced syphilis infections.
Barriers to Action Plan #3
There are various legal, medical, practical, and administrative barriers that hinder the routine use of EPT (ACOG, 2018). These risks may be alleviated through patient education and written materials for partners that provide warnings and encourage visiting a health care provider. According to Hopson and Opiola-McCauley (2017), 73% of the medication was delivered to the partners, there were still a significant number of patients who did not deliver the medication for reasons including not being able to contact their partner, lack of transportation, not wanting to admit to cheating on partner, or keeping the medication for themselves (Hopson & Opiola-McCauley, 2017).
References
American College of Obstetricians and Gynecologists (ACOG). (2018). Expedited partner therapy. ACOG Committee Opinion No. 737. Obstetrics & Gynecology, 131(6), e190-e193. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Gynecologic-Practice/co737.pdf?dmc=1&ts=20190620T1330174075
Andrzejewski, J., Liddon, N., & Leonard, S. (2019). Condom availability programs in schools: A review of the literature. American Journal of Health Promotion, 33(3), 457–467. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=s3h&AN=135528668&site=eds-live&scope=site
Centers for Disease Control and Prevention (CDC). (2016). Sexually transmitted disease surveillance 2015. Retrieved from https://www.cdc.gov/std/stats/archive/STD-Surveillance-2015-print.pdf
Hollier, A. (2018). Clinical guidelines in primary care (3rd ed.). Lafayette, LA: Advanced Practice Education Associates.
Hopson, L. M., & Opiola-McCauley, S. (2017). Expedited partner therapy: A review for the pediatric nurse practitioner. Journal of Pediatric Health Care, 31(5), 525–535. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.pedhc.2017.01.001
Khanna, A. B., & Narula, S. A. (2016). Mobile health units: Mobilizing healthcare to reach unreachable. International Journal of Healthcare Management, 9(1), 58–66. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1080/20479700.2015.1101915
Lipsitz, M. C., Segura, E. R., Castro, J. L., Smith, E., Medrano, C., Clark, J. L., … Cabello, R. (2014). Bringing testing to the people – benefits of mobile unit HIV/syphilis testing in Lima, Peru, 2007-2009. International journal of STD & AIDS, 25(5), 325–331. doi:10.1177/0956462413507443
McCool-Myers, M. (2019). Implementing condom distribution programs in the United States: Qualitative insights from program planners. Evaluation and Program Planning, 74(2019), 20–26. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.evalprogplan.2019.02.006
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