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Identifying likely syphilis transmitters: Implications for control
and evaluation.
Sexually Transmitted Diseases 2006; 33(10):630-635.
Kahn RH, Peterman TA, Arno J, Coursey EJ, Berman SM.
Abstract
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 1,700 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 1,851 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.