title: Outbreaks of syphilis in rural Texas towns, 1991-1992.
abstract: Between 1986 and 1990, rates of primary and secondary syphilis increased 134% in rural counties in the South. Reasons for the increases are speculative. During the 14 months ending in October 1992, outbreaks in four eastern Texas counties provided an opportunity to characterize syphilis in rural Texas. We reviewed records for 118 patients and 339 sex partners. Three outbreaks were concentrated in neighborhoods where crack cocaine dealers conducted business and exchange of sex for drugs or money was common; the fourth outbreak involved out-of-town prostitutes who visited undocumented alien workers. Among the 118 syphilis cases, 15 (13%) were primary, 35 (30%) were secondary. Most patients were black (105, 89%); the male-female ratio was 1:1. One woman gave birth to an infant with congenital syphilis. Almost half of the sex partners were infected. HIV pretest counseling was completed for only 55 patients (47%), and only 23 (19%) were tested for the human immunodeficiency virus. These four rural outbreaks of syphilis associated with crack cocaine and the exchange of sex for drugs or money mirror recent urban syphilis outbreaks. Patients in these rural syphilis outbreaks are at risk for HIV infection, but HIV testing has not been emphasized by public health workers.
authors.affiliation: Bureau of HIV and STD Control, Texas Department of Health, Austin 78756.
authors.forename: J M
authors.initials: JM
authors.lastname: Schulte
authors.forename: H A
authors.initials: HA
authors.lastname: Ramsey
authors.forename: J M
authors.initials: JM
authors.lastname: Paffel
authors.forename: M A
authors.initials: MA
authors.lastname: Roberts
authors.forename: R L
authors.initials: RL
authors.lastname: Williams
authors.forename: C M
authors.initials: CM
authors.lastname: Blass
authors.forename: C E
authors.initials: CE
authors.lastname: Bell
authors.forename: D M
authors.initials: DM
authors.lastname: Simpson
mesh_terms: D000328:Adult; D003153:Community Health Services; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D011247:Pregnancy; D044469:Racial Groups; D012306:Risk; D012424:Rural Population; D011477:Sex Work; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000150:complications; D013587:Syphilis / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology