<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".17" citation="COMAR 10.06.01.17" title_num="10" subtitle_num="06" chapter_num="01" heading="Syphilis and HIV.">
  <paragraph num="A.">
    <text>Control of a Case.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An individual under medical observation for diagnosis of syphilis or HIV shall remain under medical supervision until the:</text>
      <paragraph num="(a)">
        <text>Observation for diagnosis has been completed;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Syphilis or HIV, if present, has been reported to a health officer;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Individual with syphilis has had the treatment that is necessary for the protection of the public health; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Individual with HIV has entered into HIV medical care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A physician shall report to a health officer within 1 working day and in writing the name and address of an individual who is:</text>
      <paragraph num="(a)">
        <text>Receiving or has received treatment for syphilis; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>A health officer shall:</text>
      <paragraph num="(a)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Take such measures as may be deemed necessary for the protection of the public health; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>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.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Control of Contacts.</text>
    <paragraph num="(1)">
      <text>A physician in attendance upon a patient having syphilis or HIV:</text>
      <paragraph num="(a)">
        <text>Shall endeavor to bring an individual with whom the patient has had potentially infectious contact to examination and, as appropriate, prophylaxis by:</text>
        <paragraph num="(i)">
          <text>Requesting a health officer to conduct a contact investigation of any case of syphilis or HIV; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>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;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>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</text>
      </paragraph>
      <paragraph num="(c)">
        <text>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.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A health officer shall:</text>
      <paragraph num="(a)">
        <text>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</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A reported individual shall:</text>
      <paragraph num="(a)">
        <text>Within 1 week of notification, be examined to ascertain whether the individual has been infected with syphilis or HIV; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Be treated with a regimen appropriate for the stage of syphilis to which the individual has been exposed.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Infection Control. A health care provider shall practice standard precautions.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Congenital Syphilis.</text>
    <paragraph num="(1)">
      <text>A physician in attendance upon a pregnant woman shall:</text>
      <paragraph num="(a)">
        <text>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:</text>
        <paragraph num="(i)">
          <text>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;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>In the third trimester at the prenatal visit at 28 weeks of gestation or the first prenatal visit after 28 weeks of gestation; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>At delivery, for high prevalence communities or high risk individuals;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Render appropriate treatment within 1 week whenever syphilis, in any stage, is diagnosed; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Report the case to a health officer immediately.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A physician in attendance upon an infant born to an untreated woman who has a positive serological test for syphilis shall:</text>
      <paragraph num="(a)">
        <text>Evaluate the infant for possible congenital syphilis and render all indicated treatment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Report immediately to a health officer the following information:</text>
        <paragraph num="(i)">
          <text>The name, address, and telephone number of the mother;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The results of the serological testing, including titers; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The results of the medical evaluation for congenital syphilis for the infant.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A health officer shall:</text>
      <paragraph num="(a)">
        <text>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</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>