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Syphilis in Atlanta during an era of declining incidence.
Sexually Transmitted Diseases 2000;27(2):68-73.
Fleming DT, Levine WC, Trees DL, Tambe P, Toomey K, St. Louis ME.
Abstract
BACKGROUND: Syphilis transmission in Atlanta is ongoing despite declining
incidence. OBJECTIVES: To identify risk factors and missed opportunities
for prevention. STUDY DESIGN: A case-control study design was used. Twenty-five
sexually transmitted disease (STD) clinic patients with primary or secondary
syphilis by polymerase chain reaction and serology and 49 matched controls
were interviewed. RESULTS: Persons with syphilis more frequently had HIV
infection (24% versus 2%; P = 0.005), crack-using sex partners (52% versus
18%; odds ratio [OR] = 5.1; 95% CI = 1.7-15.5), and a history of incarceration
(80% versus 57%; OR = 3.0; CI = 1.0-9.3). Many cases (48%) and controls
(31%) had received drug-abuse treatment. Only 40% of previously incarcerated
patients and 74% of those with a history of drug treatment reported receiving
STD/HIV education in those settings. Among all patients reporting recent
HIV education, 41% were told about STD recognition and treatment. Unprotected
sex and delay in seeking care were common. CONCLUSION: To prevent syphilis
and associated HIV, more extensive STD education is needed in jails and
drug-treatment centers.