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Strategies for syphilis prevention: Findings from surveys
in a high-incidence area.
Sexually Transmitted Diseases 2000;27(6):305-310.
Farley TA, Kahn RH, Johnson G, Cohen DA.
Abstract
BACKGROUND: The persistence of syphilis in the United States suggests that
a better understanding is needed of the potential for various public health
approaches to prevent the spread of the disease. STUDY DESIGN: The authors
conducted surveys of 92 persons with early syphilis, 56 uninfected sexual
contacts, and 143 neighborhood controls in the Baton Rouge, Louisiana area.
The surveys collected information regarding sexual behavior, access to and
use of healthcare services, encounters at sites at which serologic screening
for syphilis could be done, and exposure to interventions designed to prevent
HIV infection. RESULTS: All groups reported high-risk sexual behavior. Cases
and contacts were more likely than controls to report two or more sex partners
in the previous year, but the three groups were similar in the percentage
reporting five or more sex partners. Cases had poor access to health care
and by some measures this access was less than that of controls. The potential
screening site visited most frequently by cases was the public hospital
emergency room (40%). Cases were less likely to have been exposed to programs
designed to prevent HIV infection than uninfected contacts and controls
combined (odds ratios, 0.51-0.66). CONCLUSIONS: Persons with syphilis were
not unlike others in their neighborhoods, suggesting that syphilis is a
sentinel event that indicates an entire neighborhood is at risk. Improvements
in access to health care for sexually transmitted disease-related symptoms,
screening in sites such as public hospital emergency rooms, and emphasizing
sexual risk-reduction interventions may limit the spread of syphilis in
these neighborhoods. To prevent syphilis in the long term, public health
programs should also try to better understand and change other community-level
socioeconomic factors that influence sexual behavior.