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Needle in a Haystack: The Yield of Syphilis Outreach Screening at 5 US Sites—2000 to 2007

Lewis, Felicia M.T. MD; Schillinger, Julia A. MD, MSc; Taylor, Melanie MD; Brewer, Toye H. MD; Blank, Susan MD, MPH; Mickey, Tom BA; Furness, Bruce W. MD; Anschuetz, Greta L. MPH; Salmon, Melinda E. BA; Peterman, Thomas A. MD, MSc

Journal of Public Health Management and Practice: November/December 2011 - Volume 17 - Issue 6 - p 513–521
doi: 10.1097/PHH.0b013e3182113954
Original Articles

Background: Screening for syphilis has been performed for decades, but it is unclear if the practice yields many cases at acceptable cost, and if so, at which venues. We attempted a retrospective study to determine the costs, yield, and feasibility of analyzing health department-funded syphilis outreach screening in 5 diverse US sites with significant disease burdens.

Methods: Data (venue, costs, number of tests, reactive tests, new diagnoses) from 2000 to 2007 were collected for screening efforts funded by public health departments from Philadelphia; New York City; Washington, District of Columbia; Maricopa County, Arizona (Phoenix); and the state of Florida. Crude cost per new case was calculated.

Results: Screening was conducted in multiple venues including jails, shelters, clubs, bars, and mobile vans. Over the study period, approximately 926 258 tests were performed and 4671 new syphilis cases were confirmed, of which 225 were primary and secondary, and 688 were early latent or high-titer late latent. Jail intake screening consistently identified the largest numbers of new cases (including 67.6% of early and high-titer late-latent cases) at a cost per case ranging from $144 to $3454. Data quality from other venues varied greatly between sites and was often poor.

Conclusions: Though the yield of jail intake screening was good, poor data quality, particularly cost data, precluded accurate cost/yield comparisons at other venues. Few cases of infectious syphilis were identified through outreach screening at any venue. Health departments should routinely collect all cost and testing data for screening efforts so that their yield can be evaluated.

This is a retrospective study to determine the costs, yield, and feasibility of analyzing health department-funded syphilis outreach screening at 5 diverse US sites with significant disease burdens.

Field Epidemiology Unit, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Lewis, Schillinger, Taylor, Brewer, Blank, Furness, and Peterman); Philadelphia Department of Public Health, Philadelphia, Pennsylvania (Dr Lewis and Mss Anschuetz and Salmon); New York City Department of Health and Mental Hygiene, New York City, New York (Drs Schillinger and Blank); Arizona Department of Health Services, Phoenix (Dr Taylor and Mr Mickey); Florida Department of Health, Tallahassee (Dr Brewer); and District of Columbia Department of Health, Washington (Dr Furness).

Correspondence: Felicia Lewis, MD, Philadelphia Department of Public Health, 500 S. Broad St, Philadelphia, PA 19146 (

Disclosure: The authors declare no conflict of interest.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.