Tyler Broghammer, a dedicated sexually transmitted infection (STI) case manager at Oyate Health Center in Rapid City, South Dakota, is on a mission to combat the syphilis epidemic plaguing his community. Armed with a small blue cooler filled with syringes of penicillin, rapid STI tests, and condoms, Broghammer tirelessly reaches out to individuals suspected of having the disease.
The alarming surge in syphilis cases in South Dakota prompted organizations like Oyate Health Center to form collaborative partnerships to address this public health crisis. In 2022 alone, there was an astounding 2,493% increase in adult syphilis cases compared to the five-year median. While the number dropped slightly in 2023 and continues to decrease this year, it remains a pressing issue.
The impact of COVID-19 further exacerbated the situation as hospitals were overwhelmed with treating coronavirus patients and people were reluctant to receive STI screenings or treatment. The challenges faced by rural areas compounded these difficulties as access to healthcare became even more limited for remote communities.
Native American communities have been disproportionately affected by this epidemic—around 90% of congenital syphilis cases in South Dakota are among Indigenous babies. Syphilis can cause various symptoms such as rashes and sores but may go unnoticed and untreated if not properly addressed.
Untreated syphilis poses severe risks—its effects can persist for decades and can lead to death. If pregnant individuals become infected, their babies face dangerous complications such as bone deformities, severe anemia, jaundice, meningitis, or even death itself. In fact,
the CDC recorded multiple stillbirths and infant deaths attributed to congenital syphilis nationwide each year.
The urgency surrounding this issue has led Indigenous leaders from North Dakota,
South Dakota,
Nebraska, and Iowa to request a public health emergency declaration from the federal Department of Health and Human Services. Such a declaration would provide vital support, including increased staffing, funding, and access to contact tracing data.
Education plays a crucial role in combating this epidemic. Broghammer emphasizes the importance of regular screenings and safe sex practices for sexually active individuals. However, finding innovative ways to reach vulnerable populations remains paramount.
Collaborative efforts are crucial in addressing not only the syphilis epidemic but also various other STIs. Investing in mobile healthcare units, like South Dakota’s Wellness on Wheels program set up by the state Department of Health,
can help bridge the gap between rural communities and essential healthcare services. These vans offer basic health care provisions such as STI testing,
treatment,
education,
counseling,
and referrals to community resources—ensuring comprehensive care is accessible to everyone.
While progress has been made in curbing syphilis cases in South Dakota through dedicated individuals like Tyler Broghammer and collaborative initiatives like Wellness on Wheels,
there is still much work to be done.
Efforts should focus on increasing prenatal care for pregnant patients—a significant number currently do not receive adequate prenatal attention—and maximizing screening potential during all healthcare visits. Further education campaigns about safe sex practices can empower individuals with vital knowledge.
The battle against syphilis requires unwavering commitment from both medical professionals and communities at large.
By working together harmoniously and implementing innovative strategies,
we can curb this epidemic once and for all.
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Dementia as a hereditary disease: Researchers find an important risk gene for Alzheimer’s
According to a recent study, people are very likely to develop Alzheimer’s symptoms if the so-called APOE gene is present twice in a particular variant. In addition, the disease begins several years earlier in them than in non-hereditary Alzheimer’s, a Spanish research team now reports in the journal “Nature Medicine”.
APOE is the abbreviation for apolipoprotein E, which has the task of bringing important nutrients to the nerve cells in the brain. In humans it occurs in three forms: APOE2, APOE3 or APOE4. And due to the double set of chromosomes, everyone carries the corresponding APOE gene twice in their genome. This may or may not be the same variant; It is then either homozygous or heterozygous, as it is called in technical jargon. According to the study, APOE4 homozygous people have a significantly increased risk of developing Alzheimer’s disease over the course of their lives compared to heterozygotes or non-carriers.
The APOE4 gene variant has long been associated with a higher risk of developing Alzheimer’s, explains first author Juan Fortea from the Hospital de la Santa Creu i Sant Pau in Barcelona. “But we now know that virtually all people who carry duplicates of this gene develop physical Alzheimer’s traits.” This is important because these people make up between two and three percent of the population, depending on the region.
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In Germany, more than a million people are currently suffering from Alzheimer’s disease, the most common form of dementia. The cause of the disease has not yet been precisely clarified. The main suspicion, however, is directed against the protein fragment beta-amyloid (Aß), which forms deposits, so-called plaques, between nerve cells in the brain that are typical of the condition. These trigger a cascade of brain changes that ultimately damage the nerve cells – and lead to dementia.
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According to the Alzheimer Research Initiative (AFI), this dementia is only rarely hereditary. So far, three genes – for the amyloid precursor protein, APP, presenilin 1 and 2, PSEN1, PSEN2 – were known that can be responsible for a hereditary form if mutations are present. According to the AFI, those affected become ill relatively early: between the ages of 30 and 65. APOE has also been suspected for a long time, but as a “risk factor” rather than a “risk gene”. And as has now been shown, among other things, there is a so-called dose effect with regard to the two APOE gene variants 3 and 4.
From risk factor to risk gene
According to the German Center for Neurodegenerative Diseases (DZNE), studies suggest that APOE4, for example, disrupts the supply of nutrients to the brain and therefore damages the nerve cells. In addition, APOE4 proteins massively accelerated the formation of amyloid plaques. According to the conclusions of the current study, APOE4 is likely to be considered a fourth, important risk gene in the future if it is homozygous. Because unlike APP, PSEN1 and PSEN2, a person has to have the APOE4 variant not just once, but twice in order to have a very high probability of developing a hereditary form of Alzheimer’s.
For the current study, the team led by Juan Fortea and Víctor Montal investigated how strong the connection is between APOE4 homozygosity and Alzheimer’s disease. To do this, the researchers looked at data from several large health studies. This included information on almost 3,300 brain donors, almost one in ten of whom had the APOE4 gene variant in duplicate. The team also analyzed data on characteristic biomarkers and disease progression from more than 10,000 people, including APOE4 homozygotes.
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“The results showed that almost all APOE4 homozygous carriers showed Alzheimer’s pathology and, from the age of 55, had significantly higher levels of Alzheimer’s biomarkers than APOE3 homozygous carriers,” reports Fortea’s team. By the age of 65, more than 95 percent of those affected would have had high amyloid levels in their cerebrospinal fluid; Amyloid deposits in the brain were detected in three out of four patients. This suggests that homozygous carriers of the APOE4 gene almost always develop Alzheimer’s features, according to the study authors.
A commentary published simultaneously in Nature Medicine by researchers at the University of California, San Francisco, said of the study: “Redefining APOE4 homozygosity as a genetic form of Alzheimer’s disease would change the way researchers think about Alzheimer’s disease and how they research the disease. This new definition establishes APOE4 as a causal factor of Alzheimer’s, and not just a risk factor. There is an urgent need to develop a drug that specifically targets it. Around 15 percent of all Alzheimer’s cases can be traced back to this. If you look at the proportion of APOE4 homozygotes in the population of around two percent, this genetic form of Alzheimer’s is probably one of the most common inherited diseases worldwide.
Alfredo Ramírez, head of the “Molecular Neuropsychiatry” section at the University Hospital of Cologne, is convinced by the results: “There is not much left to do to consider APOE4 as a monogenic form of Alzheimer’s disease.” But, among other things, it still needs to be correctly determined , how high the probability of developing Alzheimer’s actually is for homozygous carriers.
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“However, the study has practically no impact on diagnostics in clinical routine – at least not currently in Germany,” says Nicolai Franzmeier, who researches the development of Alzheimer’s disease at the Ludwig Maximilians University in Munich. In clinical routine, APOE4 diagnostics are usually not recommended as there are currently no therapeutic consequences, although this could change in the future. According to Franzmeier, a new antibody therapy that could soon be approved in the EU has more significant side effects in APOE4 carriers than in carriers of other APOE variants.
In any case, the Spanish researchers are convinced that their results will have an impact on advice and recommendations for APOE screening in the population. This may also need to be taken into account when examining patients with cognitive complaints.
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Dementia as a hereditary disease: Researchers find an important risk gene for Alzheimer’s