The Challenges of Correctly Diagnosing Syphilis and HIV Co-Infection

Background:  Currently over 40 percent of all Primary and Secondary syphilis cases from Jefferson County are reported as co-infected with HIV. Traditionally, syphilis diagnoses that were given to these co-infected cases were never challenged or questioned and was accepted at face value. This was especially true for those cases that were diagnosed as secondary (Anyone with a rash and a positive RPR was diagnosed as a secondary case).

Objectives:  After reviewing several co-infected cases during 2011 that were deemed as being misdiagnosed, the decision was made to convene a panel of STD experts to review each co-infected case and come to a consensus on each case that was reviewed.

Methods:  The panel will review each case on their own merit independent of each other, and will submit their own decision based on the merit of the case.   The panel then will reconvene and will reach a consensus on a particular case.

Results:  Since each case will receive additional scrutiny throughout the duration of the case being open, we expect much higher degree of accuracy in regard to diagnoses and staging of the disease. The increase in the reviewing process will also increase awareness among the DIS staff to be more thorough in his or her interviewing process.  The one major constraint in making proper diagnosis has been lack of good solid medical information that could solidify the overall decision making process.

Conclusions:  We believe increase vigilance in client’s history and better surveillance data check will result in better case diagnoses and will lead to higher disease intervention rates and overall increase in cases prevented.  The numbers of co-infected secondary cases are expected to decline since we do not believe all reported co-infected secondary syphilis cases are actual secondary cases.

Implications for Programs, Policy, and Research: NA