MMWR

Morbidity and Mortality Weekly Report

Symptomatic Early Neurosyphilis Among HIV—Positive Men Who Have Sex with Men — Four Cities, United States, 2002–2004

PRESS CONTACT: National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Office of Communication
(404) 639-8895

Due to their high rates of syphilis, HIV-positive men who have sex with men (MSM) are at risk for early symptomatic neurosyphilis (NS), a rare but serious manifestation of syphilis that usually occurs within the first 12 months of infection. CDC and local health departments in Los Angeles, New York, Chicago, and San Diego analyzed local syphilis surveillance and medical records January 2002 - June 2004, identifying 49 cases of HIV-positive MSM with early symptomatic NS. Based on their review, researchers estimated that HIV-positive MSM with syphilis have a roughly one in 50 chance (1.7 percent) of developing early symptomatic NS. Of 37 NS patients with available follow-up information, approximately one-third (11 cases) had persistent symptoms at six-months despite treatment, indicating that some may have permanent disabilities, such as decreased vision or hearing and rarely paralysis from a stroke. Researchers also found that more than half (53 percent) of NS patients had no other syphilis symptoms and that one-quarter (24 percent) were unaware of their HIV infection. These findings reinforce the importance of reducing sexual risk behavior among HIV-positive MSM to prevent syphilis infection, as well as the need for sexually active MSM to get tested regularly for HIV and other STDs. The authors encourage physicians who care for MSM to consider NS, especially with unexplained neurologic symptoms.

Toxic Anterior Segment Syndrome After Cataract Surgery — Maine, 2006

PRESS CONTACT: CDC
Division of Media Relations
(404) 639-3286

Prevention of TASS depends on careful attention to all solutions, medications, and ophthalmic devices used in anterior segment surgery as well as appropriate protocols for cleaning and sterilizing surgical equipment. An outbreak of toxic anterior segment syndrome (TASS) following cataract surgery occurred in eight individuals at a Maine hospital in October 2006. The specific cause of the outbreak was not identified and no additional cases occurred after two series of changes were made to the materials and equipment used for surgery. Toxic anterior segment syndrome (TASS), an acute, noninfectious inflammation of the anterior segment of the eye, is a complication of anterior segment eye surgery; cataract extraction is the most common form of this type of surgery. Various contaminants, usually from surgical equipment or supplies, have been implicated as causes of TASS. Although most cases of TASS can be successfully treated with topical steroids, topical antiinflammatory agents, or both, the inflammatory response associated with TASS can cause serious damage to intraocular tissues, resulting in vision loss. The eight individuals in the Maine outbreak of TASS recovered without any long-term effects.

Preconception Health of Women Delivering Live-Born Infants — Oklahoma, 2000–2003

PRESS CONTACT: National Center for Chronic Disease Prevention and Health Promotion
Office of Communication
(770) 488-5131

The U.S. Public Health Service recommends that all women of childbearing age consume >400 µg of folic acid daily through either supplementation or fortified foods. CDC recommends offering, as a component of maternity care, one pre-pregnancy visit to a health care provider for women planning pregnancy to enable women to receive risk assessment, health education, and specific interventions to address identified risks before conception. Analysis of data collected from women in Oklahoma during 2000–2003 from the Pregnancy Risk Assessment Monitoring System (PRAMS) indicated that 21.5 percent of women with a recent live birth were not aware of folic acid benefits before they became pregnant, 73.5 percent did not consume multivitamins at least four times per week during the month before pregnancy, and 84.8 percent did not receive preconception counseling from a health-care provider. Although pre-pregnancy awareness of the benefits of taking vitamins with folic acid in the prevention of some birth defects was high among Oklahoma women with a recent live birth, actual consumption of multivitamins during the month before pregnancy was low. Promoting preconception health of women is a key public health strategy in the United States to decrease morbidity and mortality associated with negative maternal and infant outcomes. Increased folic acid consumption before conception and during the first trimester of pregnancy can reduce the incidence of neural tube defects by 50–70 percent.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES