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Epidemic Early Syphilis -- Escambia County, Florida, 1987 and July 1989 - June 1990

In Escambia County, Florida, the average number of early syphilis cases reported per quarter increased from 15 in 1987 to 75 in 1990 (Figure 1). To identify potential reasons for this epidemic, the Florida Department of Health and Rehabilitative Services and CDC used patient interview records to compare characteristics of patients with syphilis diagnosed before and during the epidemic. This report summarizes the characteristics of 82 patients diagnosed and treated from January through December 1987 (the preepidemic period) and 256 patients diagnosed and treated from July 1989 through June 1990 (the epidemic period).

Persons with cases reported during the epidemic were older than persons with cases reported before the epidemic (median age: 29 vs. 25 years, p less than 0.05, Kruskal-Wallis test) and less likely to be employed (32% vs. 54%, p less than 0.01). In addition, the proportion of patients who were black increased from 79% to 90% (p less than 0.05). Although the proportion of men among those infected changed only slightly (56% vs. 52%), the proportion of homosexual men decreased from 17% to 3% (p less than 0.01).

Regular syphilis screening at the county jail began in 1984. From the preepidemic period to the epidemic period, the proportion of cases detected through these screenings increased from 6% to 26% (p less than 0.01). Of the 73 epidemic-period cases detected in the jail, 34 (47%) were primary or secondary syphilis, the stages during which sexual transmission most likely occurs.

Information on drug use was available for all cases from the preepidemic period and for 71% of those from the epidemic period. Of persons diagnosed with syphilis during the preepidemic period, 11% reported cocaine use; none reported crack use. In comparison, 35% of persons diagnosed with syphilis during the epidemic period for whom drug use information was available reported cocaine use (p less than 0.01); 94% of cocaine users reported crack use. In addition, crack users named more sex partners than did nonusers (2.8 vs. 1.5, p less than 0.05), and were more likely to report having exchanged sex for money or drugs (54% vs. 1%, p less than 0.01) and having had multiple anonymous sex partners (32% vs. 2%, p less than 0.01).

In October 1990, to identify new cases of syphilis, screenings were done at five ``crack trees'' (i.e., locations where crack was used or sold). Of 38 persons who consented to testing, six had serum specimens that were rapid-plasma-reagin--reactive. Among persons with positive specimens, four had been treated recently for syphilis. The other two were located for treatment: one was treated for early latent syphilis, and one had serologic evidence of reinfection or treatment failure. Reported by: PA Moncrief, JE Wroten, Florida State STD Program; JJ Witte, MD, RS Hopkins, MD, State Epidemiologist, Florida Dept of Health and Rehabilitative Svcs. Div of STD/HIV Prevention, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: In a crack-related syphilis epidemic, partner notification efforts may be hampered by the anonymity of sexual encounters. An example of a strategy designed to locate infected persons in a crack-using population is targeted syphilis screening in locations where crack users are likely to be (e.g., crack trees or crack houses). A recent effort to screen persons for syphilis at crack houses in Philadelphia determined that at least 12% of those tested had untreated syphilis (1). The effectiveness of this approach may be increased by on-site treatment and partner notification interviews. Screening programs in the Escambia County jail and elsewhere (2) represent an additional potential approach to identifying persons with untreated syphilis.

References

  1. CDC. Alternative case-finding methods in a crack-related syphilis epidemic---Philadelphia. MMWR 1991;40:77--80.

  2. Heimberger T, Chang H, Birkhead G, et al. High prevalence of syphilis detected through a jail screening program, New York State (Abstract). In: Proceedings of the Epidemic Intelligence Service 40th Annual Conference. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1991:41.

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