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Identifying Likely Syphilis Transmitters: Implications for Control and Evaluation

Kahn, Richard H. MS*; Peterman, Thomas A. MD, MSc*; Arno, Janet MD; Coursey, Emmett John BS; Berman, Stuart M. MD, ScM*

doi: 10.1097/01.olq.0000216063.75575.f8

Background/Objectives: Persistence of syphilis in communities may be maintained by relatively small groups of high-risk persons centrally placed among a larger group with low to moderately risky behavior. We sought to determine which control strategies identified particularly high-risk, early-stage syphilis cases considered to have high prevention value.

Methods: In 2 cities with recent heterosexual outbreaks, data were abstracted for early syphilis cases from 1997 through 2002. Disease stage and number of sex partners were used to create an index to estimate the relative likelihood and magnitude of future transmission had the case not been treated. We estimated the relative transmission potential for each stage of syphilis (primary = 4.3, secondary = 2.5, and early-latent = 1.0) and multiplied by the number of reported partners to determine a prevention value score. Cases scoring >10 were considered high prevention value. Cases were stratified by the method used to detect the case.

Results: Of 1700 female early syphilis cases, 174 (10%) were high value. Cases were identified by private physicians (28% of all female cases and 16% of high-value cases), jails (19% of all, 40% of high-value cases), partner notification (16% of all, 10% of high-value cases), sexually transmitted disease (STD) clinic (9% of all, 13% of high-value cases), and the emergency room (8% of all, 4% of high-value cases). Of 1851 male cases, 228 (12%) were high value. Cases were identified by jails (27% of all male cases and 14% of high-value cases), STD clinic (21% of all, 47% of high-value), private physicians (17% of all, 17% of high-value), partner notification (14% of all, 11% of high-value), and the emergency room (6% of all, 14% of high-value).

Conclusions: Private physicians identified the most female cases; however, jail screening identified the most high-prevention-value female cases. Jail screening identified the most male cases; however, the STD clinic (self-referred) identified the most high-prevention-value cases. Partner notification identified relatively few high-value cases.

An evaluation of syphilis case-detection strategies in 2 cities with heterosexual outbreaks found that private physicians identified the largest number of female cases; however, jails identified the largest number of females who were likely to transmit syphilis. Jails identified the most cases in males, but the sexually transmitted disease clinic (self-referred) identified the most males who were likely to transmit syphilis.

From the * Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; † Indiana University School of Medicine and the Marion County Health Department, Indianapolis, Indiana; and the ‡ Davidson County Metro Public Health Department, Nashville, Tennessee

The authors thank Dr. Virginia Caine, the Surveillance, Clinic and Data Management staff, and the Disease Intervention Specialists of the Davidson and Marion County STD programs for their diligence in collecting and providing the data analyzed in this manuscript.

Correspondence: Richard H. Kahn, MS, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-02, Atlanta, GA 30333. E-mail:

Received for publication November 7, 2005, and accepted February 1, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association