.17 Syphilis and HIV.

A. Control of a Case.

(1) For an individual who appears to have or who has syphilis in a stage which is or may become communicable, or HIV, a physician shall instruct the individual in the use of any measure and render any treatment which may be necessary to prevent the spread of the disease.

(2) An individual under medical observation for diagnosis of syphilis or HIV shall remain under medical supervision until the:

(a) Observation for diagnosis has been completed;

(b) Syphilis or HIV, if present, has been reported to a health officer;

(c) Individual with syphilis has had the treatment that is necessary for the protection of the public health; and

(d) Individual with HIV has entered into HIV medical care.

(3) A physician shall report to a health officer within 1 working day and in writing the name and address of an individual who is:

(a) Receiving or has received treatment for syphilis; or

(b) Under medical observation for diagnosis or treatment of syphilis in an infectious or potentially infectious stage, who fails to return for observation or treatment within 1 week of the date of a missed appointment, and is not known to the attending physician to be under medical observation or treatment elsewhere for this infection.

(4) A health officer shall:

(a) Investigate an individual reported to the health officer under the provisions of §A(3) of this regulation or Health-General Article, §18-201.1, Annotated Code of Maryland, who is within the health officer’s territorial jurisdiction;

(b) Take such measures as may be deemed necessary for the protection of the public health; and

(c) Forward to the Secretary immediately a report of an individual reported under the provisions of §A(3) of this regulation or Health-General Article, §18-201.1, Annotated Code of Maryland, who is outside the health officer’s territorial jurisdiction for referral to the health officer of the proper jurisdiction.

B. Control of Contacts.

(1) A physician in attendance upon a patient having syphilis or HIV:

(a) Shall endeavor to bring an individual with whom the patient has had potentially infectious contact to examination and, as appropriate, prophylaxis by:

(i) Requesting a health officer to conduct a contact investigation of any case of syphilis or HIV; or

(ii) Interviewing the patient in order to ascertain the names, descriptions, addresses, telephone numbers, and email addresses of those with whom the patient has had potentially infectious contact;

(b) Shall report immediately to a health officer an individual identified as having had potentially infectious contact with a patient having syphilis reported under the provisions of §A(3) of this regulation; and

(c) May report to a health officer an individual identified as having had potentially infectious contact with a patient having HIV reported under Health-General Article, §18-201.1, Annotated Code of Maryland, if a patient that has been informed of the patient’s HIV positive status refuses to notify the patient’s sexual and needle-sharing partners.

(2) A health officer shall:

(a) Investigate and notify immediately an individual reported under the provisions of §B(1)(b) of this regulation, who is within the health officer’s jurisdiction, of the individual’s exposure and advise the individual to undergo a medical examination to ascertain whether the individual is infected with syphilis or HIV; and

(b) Forward immediately to the Secretary all reports of individuals who are outside the health officer’s territorial jurisdiction for referral to the health officer of the proper jurisdiction.

(3) A reported individual shall:

(a) Within 1 week of notification, be examined to ascertain whether the individual has been infected with syphilis or HIV; and

(b) Be treated with a regimen appropriate for the stage of syphilis to which the individual has been exposed.

C. Infection Control. A health care provider shall practice standard precautions.

D. Congenital Syphilis.

(1) A physician in attendance upon a pregnant woman shall:

(a) Serologically test her for syphilis in accordance with Health-General Article, §18-307, Annotated Code of Maryland, by taking a blood sample and assuring the test is completed:

(i) At the time the physician first examines the woman, either at the first prenatal visit or at the time of delivery if the woman has had no prenatal care;

(ii) In the third trimester at the prenatal visit at 28 weeks of gestation or the first prenatal visit after 28 weeks of gestation; and

(iii) At delivery, for high prevalence communities or high risk individuals;

(b) Render appropriate treatment within 1 week whenever syphilis, in any stage, is diagnosed; and

(c) Report the case to a health officer immediately.

(2) A physician in attendance upon an infant born to an untreated woman who has a positive serological test for syphilis shall:

(a) Evaluate the infant for possible congenital syphilis and render all indicated treatment; and

(b) Report immediately to a health officer the following information:

(i) The name, address, and telephone number of the mother;

(ii) The results of the serological testing, including titers; and

(iii) The results of the medical evaluation for congenital syphilis for the infant.

(3) A health officer shall:

(a) Investigate immediately an individual reported to the health officer under the provisions of §D(1)(c) and (2)(b) of this regulation, who is within the health officer's jurisdiction; and

(b) Forward immediately to the Secretary a report of an individual reported under the provisions of §D(1)(c) and (2)(b) of this regulation, who is outside the health officer's jurisdiction for referral to a health officer of the proper jurisdiction.