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IHS Issues Dear Tribal and Urban Indian Organization Leader Letter on the Syphilis Epidemic Affecting AI/AN Communities

On Wednesday, July 19, 2023, the Indian Health Service (IHS) released a Dear Tribal Leader Letter to provide an update on how IHS plans to address the current syphilis epidemic affecting American Indian and Alaska Natives (AI/AN) communities. 

To address the syphilis epidemic, IHS Chief Medical Officer, Dr. Loretta Christensen, recommended the following guidelines and resources for all IHS, Tribal, and Urban Indian Organizations:

  1. Annual syphilis testing for persons aged 13 to 64 to eliminate syphilis transmission by early case recognition.
  2. Turn on the annual Electronic Health Record reminder at all sites to facilitate testing for two years or until incidence rates decrease locally to baseline.
  3. Three-point syphilis testing for all pregnant people at the first prenatal visit, beginning of the third trimester, and delivery.
  4. Adoption of a sexually transmitted infection (STI)/human immunodeficiency virus (HIV)/Viral hepatitis testing bundle at all sites to screen broadly.
  5. Adoption of "Express STI Testing." Express STI services refer to triage-based STI testing without needing a full clinical exam.
  6. Enhance screening rates by screening outside of hospitals and clinics.
  7. Provide field treatment for syphilis for high-risk adults diagnosed with syphilis and their partners. Public health nurses (PHNs) could provide treatment with Benzathine Penicillin. The Express STI Services Toolkit includes policy examples.
  8. Presumptive treatment of syphilis for anyone having signs or symptoms of syphilis or with known exposure to syphilis.
  9. Create and build awareness and encourage people to get tested and treated. There is a new AI/AN-specific national campaign called STOP SYPHILIS.

To read the full letter, click here.

Please do not hesitate to contact Caitrin Shuy, Director of Government Relations (, or Audrianna Marzette (, Infectious Disease Program Manager, with any questions. 

National Indian Health Board | | 202-507-4070

Visit the NIHB COVID-19 Tribal Resource Center at:

For media inquiries, contact Ned Johnson at

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