Syphilis Case Management

Question 1

What are the key functions of case management?

Answer 1

• Interviewing
• Field Investigation
• Case Analysis

Question 2

Define:

Case Management

Answer 2

The process of systematically pursuing, documenting, and analyzing medical and epidemiologic case information for the purpose of identifying opportunities to develop and implement timely disease intervention plans.

Question 3

Define:

Primary Disease Intervention

Answer 3

The process of preventing disease by treating persons who may have been exposed to infection but who, upon medical examination, have not yet developed S/S of activte disease, and whose lab results are negative or unknown at time of exam.

Referred to as epidemiologic treatment or prophylactic treatment. Doing this may stop the disease before it develops (while it’s still incubating).

Question 4

Define:

Secondary Disease Intervention

Answer 4

The process of stopping the spread and complications of a disease.

(when the person is already infected)

Question 5

Seven steps of case management

Answer 5

• Pre-interview analysis
• Original interview
• Post interview analysis
• Referral of sex partners
• Cluster interview
• Re-interview
• Case closure

Question 6

What five things is the original interview meant to do?

Answer 6

• Assist in the management of infection
• Answer questions and tend to concerns
• Help avoid re-infection/re-exposure (or infection with another STD / HIV)
• Discuss how to handle others that may be involved
• Ensure confidentiality and make sure the patient / partner understands what that means

Question 7

What is VCA?

Answer 7

Visual Case Analysis

Compares social / epidemiological and clinical / medical information about the index patient, with known information about the natural course of infection.

Question 8

VCA is accomplished using the following:

Answer 8

• document medical and epi facts about infection
• analyze those facts
• identify opportunities for disease intervention
• Determine most likely hypothesis of disease transmission
• Develop a plan of action

Question 9

The VCA chart benefits the case management process in the following ways:

Answer 9

• Allows partner services provider to compare info about each case to determine if commonalities exist
• Highlights informational gaps or conflicting information gathered during interview
• Presents info in a way that verifies source / spread relationships. This process is referred to as “ghosting”
• All info helps partner services determine next step to managing the case (including investigative priorities and activities)

Question 10

seven basic facts of VCA chart

Answer 10

• Months of the year
• Patient name
• Reason for exam
• Medical history
• Symptoms
• Critical period
• Exposure dates
• These steps must be done in order

Question 11

Critical period for early latent syphilis

Answer 11

12 months prior to the date of adequate treatment

Question 12

Critical period for secondary syphilis

Answer 12

6 and a half months prior to the onset of symptoms

• 90 day incubation
• 5 week max duration of primary lesion
• 10 week maximum latency period
• 6 week maximum duration of secondary symptoms

Question 13

Critical period for primary syphilis

Answer 13

From date of adequate treatment back three months prior to symptom onset (90 day max possible incubation period)

Question 14

Non-reactive syphilis test within the standard critical period

Answer 14

If a syphilis patient has a non-reactive test sometime prior to diagnosis, they were either not infected at the time or were still in the incubation period. Not knowing which is true, the assumption is made that the patient was in the incubation period, and the critical period will begin four months and one week prior to the date of adequate treatment

Question 15

Historical symptoms for positive syphilis case

Answer 15

If a patient has no symptoms at the time of diagnosis, but is able to give historical symptom, the critical period is developed from the historical symptom.

Question 16

Define:

Ghosting

Answer 16

An important visual aid to determine source / spread relationships.

Use existing symptoms from one patient and what we know about the natural transmission and course of disease to identify likely source and spread periods for a patient to identify likely source and spread periods for a partner who does not have, or recall, symptoms.

Question 17

What are the 3 sets of principles in order to ghost source and spread lesions effectively onto the person with no lesion

Answer 17

• Ghosting hierarchy
• Basic assumptions
• Criteria for related cases

Question 18

Ghosting Hierarchy

Answer 18

To begin ghosting, at least one infected patient must have, or have had, a symptom.

1. Existing primary lesion
2. Historical primary lesion
3. Ghosted primary lesion
4. Secondary symptoms

Question 19

Ghosting criteria for related cases

Answer 19

• One sex partner must be infectious at the time of sexual contact
• Primary lesions on two related people are compatible (penis/vagina, penis/anus, penis/oral)
• There must be a reasonable course of disease

Question 20

Ghosting basic assumptions

Answer 20

• Syphilis is acquired from someone who is in the primary stage of the disease at the time of sexual exposure
• Primary lesions of the original patient and the sex partner are compatible
• Patient has a 3 week incubation period
• patient develops a three week primary lesion
• Patient has no more than a 4 week latency period between primary and secondary stages of syphilis