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Welcome to this edition of AMC.

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Tell you how I got better. I'm glad to be

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here, but a mission

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to. Well, I think that we're, we're talking, we're gonna

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talk about everybody's Arkansas is

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the 2nd highest prescriber.

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Welcome to AFMCTV. I'm Robin

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Ledbetter. Thank you for joining us. Today I

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have with me Mallory Jarreau, and she is an

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infectious disease epidemiology supervisor

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and the set net coordinator

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at the Arkansas Department of Health. Thanks for being

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here. Yeah, thank you so much for having me. I'm excited to do

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this. So tell us about about

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your work. You

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specialize in congenital syphilis.

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Yes, so like you said, I'm the epidemiology

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supervisor and in my section we cover. Infectious

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diseases, which does include syphilis. We

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also include HIV, hep C, gonorrhea,

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and chlamydia.

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Um, but with my program setne, we're focused

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on syphilis, um, that

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affects moms, so congenital syphilis

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and and during pregnancy. So,

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and it is considered an epidemic in

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Arkansas. Tell us about that. Yes, unfortunately

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it is. So in the past 10

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years we had around a 500%

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increase and to kind of put that in perspective,

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congenital syphilis. The numbers

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have surpassed the perinatal

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HIV epidemic when we were in the

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height of the HIV epidemic.

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Um, so that surpassed the perinatal HIV

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cases back then. So that's how kind of how

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bad and urgent it is, um, with the

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crisis we're having in Arkansas. Is it just

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Arkansas? So it's actually all over the United

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States. Um, unfortunately, it

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has hit around almost every single state, but it

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is kind of the highest in the South.

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Is it, and it is preventable.

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Absolutely. So, of course,

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just any other STIs, um, safe

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sex as well as safe,

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safe sex practices as well as regular

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testing, um, but for women especially,

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we have a law in Arkansas where you're supposed to be tested

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in the 1st and 3rd trimester,

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and then if not a delivery. And

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so with that, we are supposed to be able to catch

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and treat syphilis and so this is

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absolutely preventable and unfortunately,

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you know, really sad situation because it's so preventable.

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And so babies are being born with it. Are

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you seeing those numbers

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increase? Yes, so those numbers have

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increased exponentially. There's like a 5-fold increase

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that's happened in the past even 5

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years in Arkansas.

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Um, and again, this is vertically transmitted, which

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means it's passed from mom to baby.

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And with congenital syphilis, why

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this is kind of like a maternal health issue

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is because the detrimental effects it has

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on babies. So they can be born with enlarged

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spleen, they can have like

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rashes and then of course the status

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effects, which would be a stillbirth are babies

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pass away shortly after birth.

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And what does data tell

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us? Does it say that there

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there's no maternal care, testing

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just isn't happening, right?

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So, it says a lot. And so

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one of them is no prenatal care. So

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obviously in Arkansas, it's kind of well

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known that we have our maternal health deserts,

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um, and a lot of women aren't getting prenatal care.

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And so that's one effect. We're also seeing a high rate

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of substance use in our cases, so

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that's kind of um increasing the syphilis

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and that's kind of what we're seeing in the data.

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And you mentioned moms not getting prenatal

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care. Is it a certain parts of the state or

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is their data not being collected in certain areas?

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Right, so right now our highest cases are

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in, um, central Arkansas and Northwest Arkansas,

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and a lot of those moms are getting prenatal care, but

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we do have cases all over the all over

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the Arkansas, um, but obviously

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access to care, access to testing, we might not be

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getting the actual cases in those areas,

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but for now we are seeing. High rates

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in central and northwest Arkansas.

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And there's some stigmas with syphilis

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and testing. What are they? Yeah,

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so like all STIs, you know, a lot

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of times people stigmatize,

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um,

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anything to do with uh sex and

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like things like syphilis, gonorrhea, chlamydia.

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And so with those stigmas that just,

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um, you know, it

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makes people not want to get tested, makes people want

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to talk about their sexual history.

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As well as defers them from getting treatment.

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So all those stigmas are really honing in

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on what's going on in Arkansas.

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And so much of this starts with the provider

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and educating providers. Um, what are,

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what do those efforts look like? Right, so

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with our program, we are

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doing provider education because like I,

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well, so we had a law passed in 21

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and it said that the providers are supposed to

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test in the 1st and 3rd trimester and if not

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it. Delivery.

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Well, during 21, there was the COVID pandemic

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and so I don't know if everyone was tuning in

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to their legislative sessions then. And

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so we, I don't know if we did a good job of

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getting the word out there and so now

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we're having to do a lot of like outreach to providers

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to make sure they know to test in the 1st and 3rd,

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because syphilis is actually eradicate almost eradicated

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in the 2000s. So some of these providers are like,

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I haven't seen syphilis since

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the early 2000s or ever.

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And so just redoing the education and

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letting providers know what's going on.

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What do the resources look like? So we have

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a bunch of resources. They're a bunch on

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the ADH website as well as CDC

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and then most providers have the Redbook,

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which is an infectious disease, a kind of like

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bible per se, um, and it has

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all the resources for treatment

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and testing and so that's something that

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we really recommend all providers get.

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And it tells us about pilot projects you're working

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on. There's, there's yes,

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so one of the ones we're currently doing

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is with the Arkansas Perinatal Quality Collaborative,

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and they actually came to our congenital syphilis summit

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we had 2 years ago and saw the numbers and

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were concerned. So we're doing a

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pilot initiative for 6 months and we are

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testing all moms at delivery. So it doesn't

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matter if you

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had all your tests, if you've been treated, if

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you are delivering in Arkansas, you should be getting

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a test, um, at delivery.

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I think there's 22 hospitals participating right

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now, um, and this is to catch

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these babies, um, or

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these moms who didn't get tested during delivery

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or during pregnancy,

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um, or were tested and then reinfected,

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and we actually have already caught two,

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moms who were negative at the first trimester

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and then were positive delivery. So the

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pilot is going well and we're hoping, um,

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to get our data around like September,

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um, to report that. So that's exciting.

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Very exciting.

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Tell us what providers need to understand

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what the best treatment is. Yes, so

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with pregnant women, it is penicillin.

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So that is how we treat pregnant women. Pregnant

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women cannot have doxycycline, which is the other

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treatment for syphilis. And if a woman

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is allergic to penicillin,

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you do have to or desensitize

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them, um, and that can be done via

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a pharmacist. So we do recommend penicillin

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for treatment for syphilis.

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And it's not just women in educating.

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There this affects men too, right?

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So one of the things we're also seeing is that

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we are seeing providers test and

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treat women and they're getting

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their care, but then their partners aren't

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getting tested or treated. And so

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then, you know, they get their penicillin, they

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go home and they might, um, you know,

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have be with their partners and get reinfected.

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So if we're not also treating and educating the

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partners, um, you know, then we

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can have reinfection and kind of start all over

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again, so.

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And tell us what the Arkansas law is. You

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touched on that a little bit. Tell us a little bit more about that.

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Yeah, so the Arkansas law currently

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is you have to test in the 1st and 3rd

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trimester and if not at delivery,

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but again, we are doing a pilot, so around

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22 hospitals are already testing

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a delivery, um, but right now the law

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is the 1st and 3rd trimester, and we want

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providers to know that, but also women to advocate. So

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maybe if they don't,

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if the provider is unaware of that, the women can also

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advocate for their self.

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Um, to be tested in the 1st and 3rd trimester.

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And that even if they tested negative, that

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it's still so important to do that right,

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yes. And so we encourage testing,

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you know, we wanna, you know, testing for

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any sexual disease,

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you know, there's no stigma attached to it. If you have

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sexual intercourse, you're at risk for

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any STIs and so we want to kind of destigmatize

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that and really encourage

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anyone to get tested, um,

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before or after delivery or pregnancy.

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And before we close, tell us about the program that you're

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working on and this some exciting

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thing. Yes, so my program

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on top of the infectious disease epi section

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is settnet, which is

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surveillance for emerging threats to mothers and babies,

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which is a mouthful, so that's why we say set net, but

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it's a CDC funded project, and we

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do enhanced surveillance. So

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what this program is for is to

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for emerging threats and we want to. know

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everything about it. So we already do surveillance

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on syphilis and this is enhanced surveillance. So

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we do medical abstractions, so we get the medical

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records, we look at interviews

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from the patients and really understand what's

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going on and that's where we're seeing the substance

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use, we're seeing mental health issues

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and what my program does is

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we get that data to the CDC and then they

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they're able to give us resources to do prevention and

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things like that.

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So this is ground floor, I mean,

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information that affects our Kansans at the very,

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very front of this, right? And like

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I said, we're in a crisis and it's

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not going down,

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um, in around almost 15 years

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at this point. And so we want to really

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get the message out there because

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syphilis is very easy to treat and

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test. It's just

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doing it. And we want to save the moms

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and babies of Arkansas with this very preventable

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disease. And so we hope to continue educating

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and really doing this work in Arkansas.

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Well, Mallory, thank you so much for being here today and

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talking about this important information. Awesome. Well, thank

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you so much.

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And that's it for this episode of AFMCTV.

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Have a great day and thanks for watching.
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