STD Awareness: What Does “Congenital Syphilis” Mean?

Treponema pallidum, the bacteria that causes syphilis

Treponema pallidum, the bacteria that causes syphilis

Congenital syphilis, for centuries a leading cause of infant mortality, is often thought of as an antique affliction, relegated to history books — but it is on the rise again. Between 2012 and 2014, there was a spike in congenital syphilis rates, which increased by 38 percent and are now the highest they’ve been in the United States since 2001. As of 2014, the last year for which we have data, more babies were born with syphilis than with HIV.

The word “congenital” simply means that the baby was born with syphilis after being infected in the womb. When an expecting mother has syphilis, the bacteria that cause the disease can cross the placenta to infect the fetus — and will do so 70 percent of the time. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. It can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. Congenital syphilis is especially tragic because it’s almost completely preventable, especially when expecting mothers have access to adequate prenatal care and antibiotics. Penicillin is 98 percent effective in preventing congenital syphilis when it is administered at the appropriate time and at the correct dosage.


More babies are being born with syphilis — but this trend can be reversed with wider access to prenatal care.


Incidence of congenital syphilis is growing across all regions of the country, but rates are highest in the South, followed by the West. Rates have also been increasing across ethnic groups, but, compared to white mothers, congenital syphilis rates are more than 10 times higher among African-American mothers and more than 3 times higher among Latina mothers, illustrating the need to increase access to prenatal care for all expecting mothers — and to ensure that this prenatal care is adequate.

Anyone receiving prenatal care should be screened for syphilis at their first visit, and some pregnant people — including those at increased risk or in areas where congenital syphilis rates are high — should be screened a second time at the beginning of the third trimester and again at delivery. Continue reading

Square Pegs, Round Holes: Building Trans-Inclusive Health Care

transgenderFor the first time in history, trans persons are being recognized in the mainstream and their identities are being embraced like never before. Laverne Cox’s cover story for Time and Amazon Prime’s original series Transparent winning four Emmys are examples of this recognition.

Kinda.


Today is National Transgender HIV Testing Day.


Truth is, the trans persons in the media are not representative of the norm. The findings of the National Transgender Discrimination Survey — a survey that collected responses from more than 6,000 transgender and gender-nonconforming individuals — give a clearer picture, and it’s not pretty. The authors of this study found trans persons faced adversity in almost all aspects of life, from experiencing double the rate of unemployment to suffering through a high rate of violent attacks (26 percent and 10 percent of the respondents reported being physically and sexually assaulted, respectively) because of their gender identities. Among all these results, I found one to be particularly unsettling:

“Respondents reported over four times the national average of HIV infection, with rates higher among transgender people of color.”

To me, a person born after the AIDS epidemic of the ’80s and privileged with a world that now has readily accessible condoms and HIV prevention medication (i.e., Truvada), HIV seemed like a relic of the past. Examining the amount of new HIV infections in the cisgender population (0.4 percent for females and 1.2 percent for males), this is an easy assumption to make. I was wrong. Other studies echoed the large disparities of HIV incidence and prevalence in trans persons. One systematic review uncovered four studies that found that 24.8 to 30.6 percent of male-to-female (MTF) transgender persons tested positive for HIV. Another study — conducted in Ontario, Canada — sampled 433 trans persons and found 7 percent of female-to-male (FTM) transgender persons and 19 percent of MTF persons had a high-risk sexual experience in the last year. Yet another found that 35 percent of MTF persons (and 2 percent of FTM persons) had HIV, and again, persons of color — in this case, African-American identified individuals — were at a greater risk. Indeed, in this study, African-American trans persons (FTM and MTF) were approximately three to 12 times more likely to have HIV. Given these data, the cynic in me questions, “Is anyone even trying to prevent HIV in trans persons?” Continue reading

Toward Improved Care for LGBTQ Patients: New Guidelines Shine Spotlight on Addressing Health Disparities

doctorsOn January 5, Florida became the 36th state in the nation to legalize same-sex marriage, joining a movement that is sweeping across the United States. With federal judges striking down same-sex marriage bans left and right, it seems inevitable that we will soon live in a country that recognizes the freedom to marry. Yet, although more Americans than ever support marriage equality, the fight for the full inclusion of lesbian, gay, bisexual, and transgender individuals in our society is not over, as they continue to face significant barriers to quality medical services.


Full equality includes access to high-quality medical care, regardless of sexual orientation or gender identity.


The obstacles that have historically prevented LGBTQ patients from obtaining medical care continue to plague our modern health care system. Sure, the American Psychiatric Association no longer considers homosexuality a mental illness. But a concerning number of health care providers still refuse to serve LGBTQ individuals, and until the passage of the Affordable Care Act, insurance companies were not required to extend domestic partner benefits to same-sex couples. Moreover, the stigma that surrounds homosexuality prevents many patients from disclosing their sexual orientation to doctors. Because the LGBTQ community faces higher rates of certain conditions, including depression and substance abuse, failing to discuss sexual activity can lead to inadequate treatment.

One of the U.S. health care system’s most serious shortcomings is its failure to prepare doctors to work with LGBTQ patients. Young doctors are emerging from medical school ill-equipped to deal with the specific needs of the LGBTQ community. A 2006 study published in Family Medicine surveyed 248 medical students, finding that the vast majority of students held positive attitudes toward LGBTQ patients and hoped to provide them top-tier care. Unfortunately, the same group of students failed spectacularly when tested on LGBTQ-specific health concerns. Another study revealed that most medical schools throughout the United States and Canada devote minimal (if any) instructional time to LGBTQ issues, and that the quality of such instruction varies drastically across institutions. And significantly, many doctors report that they feel uncomfortable discussing sexual behavior with LGBTQ patients. Continue reading

STD Awareness: Gardasil and Males

menIt’s Men’s Health Month, and yesterday was the last day of Men’s Health Week, which means we’re going to look at a men’s health issue that is usually ignored: the impact of human papillomavirus (HPV) on the male population.

You’ve probably heard of HPV in discussions about cervical cancer and Pap testing. But HPV doesn’t care about gender, and is perfectly content to invade cells in anyone’s genital tract, mouth, throat, or anus. In males, HPV can cause genital warts as well as anal, oropharyngeal (mouth and throat), and penile cancers.


HPV will cause more oral cancer than cervical cancer by 2020.


The good news is that most HPV infections can be prevented by a vaccine called Gardasil, and you don’t need to be female to get it. However, few males are actually getting the HPV vaccine: In 2012, 20.8 percent of U.S. males 13 to 17 years of age had received at least one dose of the HPV vaccine, but only 6.8 percent completed the three-dose series.

Gardasil Is for Everybody: Good News from Australia

This huge disparity in promoting Gardasil to female patients rather than male patients has real-world consequences. In Australia, girls have been vaccinated with Gardasil since 2007, covered by their national health system. Four years into the program, genital wart rates fell by 93 percent in females less than 21 years of age. Even though males weren’t being routinely immunized, genital wart rates fell by 82 percent among heterosexual males in the same age group. That’s because their female partners had received the vaccine, which had the effect of protecting much of the male population. That might sound pretty nifty, but the female-only vaccination policy left out gay and bisexual males, whose genital wart rates saw no corresponding decline. Continue reading

Women’s Health Week: Making Time for You and Your Health!

yogaThe following guest post comes to us via Stasee McKeny, Planned Parenthood Arizona’s community engagement intern.

Mother’s Day kicks off National Women’s Health Week (May 11 to 17), a week dedicated to empowering women to make health a priority in their lives.


After celebrating Mother’s Day, make health a priority throughout Women’s Health Week!


Making health a priority isn’t always easy for women. Women are more likely than men to avoid getting necessary health care because of the cost — 30 percent of insured women didn’t fill a prescription, 21 percent didn’t see a specialist, 24 percent skipped medical test treatment or follow-up, and 27 percent had a medical problem but didn’t see a health care provider. Affording health care is significantly more difficult for women who not only make less money than their male counterparts, but also use more health care services, like 12 months of birth control. Luckily, with health care reform, these disparities are slowly changing. Close to 27 million women with private health insurance gained expanded access to preventive health care services with no cost-sharing.

More women than ever now have access to affordable health care services and there is no better time to take advantage of this. During National Women’s Health Week, women are encouraged to do a number of things — whether it is making an appointment with a health care provider for a well-woman exam or deciding to eat healthy and exercise.

Why does National Women’s Health Week matter to Planned Parenthood Arizona? Planned Parenthood Arizona is the largest nonprofit reproductive health care provider in Arizona, and has close to 60,000 visits each year from women for a variety of preventive health care services, including life-saving cancer screenings, breast exams, contraception, sexually transmitted disease testing and treatment and, now, primary care. Planned Parenthood works to provide affordable, honest, compassionate care to ensure that women are able to lead healthier lives.

This year, you can celebrate National Women’s Health Week with Planned Parenthood Arizona — and enjoy five fun fitness events in two cities.

In Scottsdale, PPAZ is partnering up with a fabulous new local yoga studio, Funke Yoga.  Funke Yoga is adding three classes to their schedule during this week. The proceeds from the classes will go to Planned Parenthood Arizona to ensure we can continue to provide affordable health care services to women. Take the time out of your busy schedule and join Funke Yoga and Planned Parenthood for an evening to yourself. Reserve your spot today — space is limited!

In Yuma, PPAZ is hosting two free Zumba Classes on Thursday nights: May 8 and May 15. These classes will be held at Yuma Private Industry Council, MLK Youth Career Center, 300 S. 13th Ave. from 6:30 to 8:30 p.m. Sunset Community Health Center will be there to provide blood pressure checks and there will be a raffle for fantastic prizes. Find more details here.

“I Didn’t Want to Believe It”: Lessons from Tuskegee 40 Years Later

Located among longleaf pine and hardwood trees, low ridges, and broad floodplains, Tuskegee, Alabama, is a small town that’s been a big part of American history. Despite a modest population of less than 10,000 people, Tuskegee has been able to boast many notable residents who have made names for themselves in everything from sports to the arts. Among them have been the Tuskegee Airmen, the first African American Air Force unit, which served during World War II, and Rosa Parks, the icon of the civil rights movement, who sparked the Montgomery bus boycott in 1955.


The Tuskegee syphilis experiment, conducted from 1932 to 1972, examined the natural progression of untreated syphilis in poor, rural black men — without their informed consent.


Tuskegee, though, is also remembered for one of the worst chapters in the history of medical research. Forty years ago, in 1972, newspapers revealed the story of a syphilis study that was callous in its deception of research participants, and damaging, even today, in the distrust it sowed among black Americans. The study had started another 40 years prior, in 1932, when the United States Public Health Service (USPHS) needed to rescue a financially troubled syphilis intervention in Macon County, Alabama. The intervention was first established in partnership with a Chicago-based philanthropic organization, but its future was uncertain when the organization’s funds dried up during the Great Depression.

Syphilis, the sexually transmitted disease caused by the bacterium Treponema pallidum, was the subject of conflicting scientific hypotheses at the time, including the hypothesis that the disease behaved differently in blacks and whites. Interested in testing those hypotheses and faced with disappearing funds for treatment, the USPHS turned its project into a study of untreated syphilis. Also influencing the decision was the fact that the USPHS was discouraged by the low cure rate of the treatments at the time, mercury and bismuth. But by the mid-1940s, penicillin was in use as a proven treatment for syphilis. In spite of that medical advance, the USPHS withheld treatment from a total of 399 infected patients by the time the study ended in 1972. Continue reading

Meet Our Candidates: Dr. Richard Carmona for U.S. Senator

The Arizona general election will be held on November 6, 2012, with early voting starting on October 11. After the many recent legislative challenges to reproductive health care access, both nationally and statewide, the importance of voting in November can’t be overstated. To help voters, Planned Parenthood Action Fund has endorsed candidates who have shown strong commitment to reproductive health and freedom. Along with those endorsements, we are spotlighting our endorsed candidates in a series called “Meet Our Candidates.” To vote in the general election, you must register to vote by October 9 — and can even register online. Make your voice heard in 2012!

When announcing Dr. Richard Carmona’s endorsement by Planned Parenthood Action Fund, President Cecile Richards said that “Arizona women need a champion who has long fought to protect and promote women’s health representing them in Washington” — and as a former U.S. surgeon general, Carmona is uniquely positioned to advocate for scientifically driven, rather than agenda-driven, policies on health and medicine.


“Health care should not be politicized.”


Carmona already has experience fighting for evidence-based health policy in an increasingly polarized political climate. After leaving his position as surgeon general, Carmona testified before Congress that the George W. Bush administration continually hampered his attempts to present scientifically sound public health policy when it conflicted with their political agenda. As Carmona said in his testimony, the Bush administration silenced him on many issues, including emergency contraception and comprehensive sex education — and the public was denied access to the latest unbiased evidence on important public health issues.

Carmona is running against Republican challenger Jeff Flake to succeed Jon Kyl as U.S. senator from Arizona. Flake’s congressional voting record is problematic, and includes support for an amendment to the Affordable Care Act to prohibit abortion coverage, support for defunding Planned Parenthood, and a vote against expanding the Children’s Health Insurance Program (CHIP).

As a U.S. senator, Carmona can bring his lifetime of experience as a physician and public-health expert to the legislature. When it comes to our medical care, no matter our political affiliations, we all need access to the best scientific evidence, and we need someone who will be a champion for our health in the U.S. Senate.

Dr. Carmona generously took time for an interview with us via telephone on October 3, 2012.


Many of us, including myself, are becoming increasingly concerned about the hostility toward science exhibited by some of our current lawmakers. What can you do to inject reason and scientific evidence into an increasingly politicized discourse about public health?

Well, first and foremost, if you remember my tenure as surgeon general, I had to do that. There was a lot of ideological, nonscientific-driven sentiment, and when necessary I stood up and I addressed the issues appropriately. It wasn’t a perfect world, especially when you have many of those ideologues thinking differently, but nevertheless, I will do the same thing as a senator.

And I think I enter the Senate with, if you will, the imprimatur of being a surgeon general and a trauma surgeon and a registered nurse and a paramedic. I bring all those years of cumulative science to the table as I discuss things with my colleagues. And although they may be ideologically driven, and I will certainly acknowledge their personal beliefs, that’s not science and it’s not fact. Continue reading