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Social Network Methods for Endemic Foci of Syphilis: A Pilot Project

Rothenberg, Richard MD, MPH*; Kimbrough, Lisa MPH†‡; Lewis-Hardy, Ruby BA§; Heath, Bruce BA†‡; Williams, O. C. BA; Tambe, Pradyna MD; Johnson, David BA‡§; Schrader, Mark BA, MPA§

Sexually Transmitted Diseases: January 2000 - Volume 27 - Issue 1 - p 12–18
Original Articles

Background: Social network methods have improved our understanding of sexually transmitted disease transmission dynamics, and may be of use in routine field operations for partner notification.

Goal: To augment traditional syphilis-control activities with social network methods in an Atlanta area with high syphilis morbidity.

Study Design: Disease investigators conducted interviews, used network diagrams to prioritize their work, and relied on network connections for finding hard-to-reach persons.

Results: A total of 396 contacts were elicited from 48 infected and 50 uninfected persons. The cumulative prevalence of syphilis was 12.6%, and 24 persons infected with HIV were identified. Network methods disclosed a large, interconnected group (276 persons) characterized by high network centrality and the substantial presence of small, interactive subgroups (microstructures).

Conclusion: The network approach is a feasible field technique, and can identify core groups involved in the intense transmission of syphilis. The targeted, network-based approach may be useful in attempts to eliminate syphilis.

*From the Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia; the †Fulton County Department of Health and Wellness, Atlanta, Georgia; the ‡Centers for Disease Control and Prevention, Atlanta, Georgia; and the §Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia

The authors thank Mr. Willie Beard for his invaluable contributions to street-based ethnography and follow-up, and would like to acknowledge the collaboration and assistance of the entire STD-control program at Fulton County.

Reprint requests: Richard B. Rothenberg, MD, Department of Family and Preventive Medicine, Emory University School of Medicine, 69 Butler Street SE, Atlanta, GA 30333. E-mail:

Received for publication April 19, 1999, revised June 15, 1999, and accepted June 25, 1999.

© Copyright 2000 American Sexually Transmitted Diseases Association