In 2017, the U.S. reported 30,644 cases of primary and secondary syphilis, marking a 10.5% increase from 2016, with higher prevalence in specific racial/ethnic groups and populations like adolescents and MSM. Recommendations for prevention include annual screening for at-risk groups, mobile health units for community-based screening, and increased access to condoms, along with the implementation of expedited partner therapy to treat partners directly. Barriers to these action plans include financial constraints, societal stigma around condom purchase, and legal issues related to partner therapy.

1. 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.

2. 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

3. 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

4. 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

5. 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

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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-
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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
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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-
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2019.02.006

7. 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)