title: Syphilis in Atlanta during an era of declining incidence.
abstract: BACKGROUND
  Syphilis transmission in Atlanta is ongoing despite declining incidence.
  
  
  OBJECTIVE
  To identify risk factors and missed opportunities for prevention.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  To prevent syphilis and associated HIV, more extensive STD education is needed in jails and drug-treatment centers.
authors.affiliation: Division of STD Prevention, National Center for HIV, STD and TB Prevention. Flemindt@umdnj.edu
authors.forename: D T
authors.initials: DT
authors.lastname: Fleming
authors.forename: W C
authors.initials: WC
authors.lastname: Levine
authors.forename: D L
authors.initials: DL
authors.lastname: Trees
authors.forename: P
authors.initials: P
authors.lastname: Tambe
authors.forename: K
authors.initials: K
authors.lastname: Toomey
authors.forename: M E
authors.initials: ME
authors.lastname: St Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005835:Genitalia / Q000382:microbiology; D005845:Georgia / Q000453:epidemiology; D006678:HIV / Q000276:immunology; D015658:HIV Infections / Q000097:blood / Q000150:complications; D006679:HIV Seropositivity; D006558:Herpes Genitalis / Q000150:complications / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012309:Risk-Taking; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D018139:Simplexvirus / Q000302:isolation & purification; D013587:Syphilis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D014210:Treponema pallidum / Q000302:isolation & purification; D014456:Ulcer / Q000382:microbiology