Not So Fast, I’m Serofast: Using Innovative Education Techniques to Drive Management of People with Syphilis
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Background
An increase in syphilis cases in the United States and the global shortage of Benzathine Penicillin G (BPG) calls for evidence-based optimization. Confusing serologies and incomplete sexual history exacerbate the overprescription of BPG, especially for patients with “serofast” serologies. Seronegative status develops through natural decline and not through additional therapy.
Method
A longitudinal pre-post design was implemented within a health maintenance organization serving Oregon and Southwest Washington. Interventions included microlearning education, allowing quick access to clinical recommendations and actionable patient education empowers patients.
Results
BPG was administered 187 times (69 pre-intervention, 118 post-intervention), and inappropriate administration showed a 7.9% relative decline (10.1% to 9.3%). There was no difference in outcomes between the newly infected and reinfected patients. Patient education utilization increased from 4.3% to 6.8%, representing a 58.1% relative improvement. Clinician microlearning utilization decreased by 25.3% during the post-intervention period.
Conclusion
This project demonstrated modest improvements in the administration of appropriate BPG and utilization of patient education, although the results did not reach statistical significance. Future interventions should focus on automating patient education and enhancing the visibility of clinical resources. This project highlighted the importance of obtaining patients’ treatment histories and recent exposure risks. The increasing prevalence of syphilis among women who have sex with men (WSM) represents an epidemiological shift with implications for maternal-child health. The growing prevalence of syphilis among non-traditional risk groups emphasizes the importance of comprehensive sexual health screening approaches to mitigate adverse outcomes.
What is already known on this topic
Syphilis is a sexually transmitted infection (STI) with public health urgency and a global impact due to shortage and emergence. There are studies on the effects of syphilis and public health, but they do not address how to combat the syphilis epidemic. A common practice is that many medical providers are not familiar with how to interpret syphilis results, which can lead to overtreatment of patients, especially those who are serofast. There are also limited studies that look at the feasibility and utilization of using education to lower syphilis rates.
What this study adds
From this study, we found that using innovative educational methods, microlearning, and patient-centered patient education can modestly reduce the inappropriate treatment of syphilis. Syphilis treatment is complex, and knowledge gaps that exist include too frequent testing and not obtaining an adequate sexual health history. This study also confirms that there is an importance of screening other populations and not just men who have sex with men (MSM).
How might this study affect research, practice, or policy?
This study shows the urgency of the treatment shortage and the rising rate of syphilis, calling for an innovative approach. Institutions need to look at other ways to address the syphilis epidemic, such as utilizing practical tools from this study to decrease the inappropriate use of syphilis treatment. These interventions are helpful for medical providers and provide patients with a means to advocate for their health. Refocusing on the clinical need of appropriate history taking in conjunction with serologies to properly treat people with syphilis. Other innovation measures, such as microlearning videos and artificial intelligence, can be tools to aid in appropriate syphilis treatment.
