title: Providers of syphilis care in the southern United States.
abstract: OBJECTIVE
  The nadir in syphilis incidence in the 1950s provided evidence that current control methods could eliminate the transmission of syphilis. Planning such an effort will require information on the current state of the public and private infrastructure for the control of sexually transmitted disease (STD).
  
  
  OBJECTIVE
  To evaluate the accessibility, acceptability, and quality of delivery of clinical and preventive outreach services for syphilis control in the southern United States.
  
  
  METHODS
  A telephone-and-questionnaire survey of the 7 largest southern city, 10 state, and 9 nonsouthern comparison state STD control programs.
  
  
  RESULTS
  The gender-race composition of public-sector STD providers is very different from their clients. Median ratio of STD clinicians per 1994 infectious syphilis patient was 0.08 (0.01-0.25) in southern states and 0.50(0.07-1.00) in comparison states. The proportion of clients treated within one day of care-seeking in southern states was 58% to 100%; regions with inadequate access were common. A median of 45% to 50% of patients with presumptive congenital syphilis underwent recommended diagnostic procedures.
  
  
  CONCLUSIONS
  Serious deficiencies exist in the accessibility of STD care in the south that make the elimination of syphilis transmission difficult using current clinic-based diagnosis and treatment. A more community-based program of case finding and presumptive treatment may be indicated.
authors.affiliation: South Carolina Department of Health and Environmental Control, Columbia, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gibson
authors.forename: W
authors.initials: W
authors.lastname: Leverette
authors.forename: M
authors.initials: M
authors.lastname: Arvelo
mesh_terms: D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D015144:Southeastern United States; D013587:Syphilis / Q000517:prevention & control*; D013714:Tennessee