title: Strategies for syphilis prevention: findings from surveys in a high-incidence area.
abstract: BACKGROUND
  The persistence of syphilis in the United States suggests that a better understanding is needed of the potential for various public health approaches to prevent the spread of the disease.
  
  
  METHODS
  The authors conducted surveys of 92 persons with early syphilis, 56 uninfected sexual contacts, and 143 neighborhood controls in the Baton Rouge, Louisiana area. The surveys collected information regarding sexual behavior, access to and use of healthcare services, encounters at sites at which serologic screening for syphilis could be done, and exposure to interventions designed to prevent HIV infection.
  
  
  RESULTS
  All groups reported high-risk sexual behavior. Cases and contacts were more likely than controls to report two or more sex partners in the previous year, but the three groups were similar in the percentage reporting five or more sex partners. Cases had poor access to health care and by some measures this access was less than that of controls. The potential screening site visited most frequently by cases was the public hospital emergency room (40%). Cases were less likely to have been exposed to programs designed to prevent HIV infection than uninfected contacts and controls combined (odds ratios, 0.51-0.66).
  
  
  CONCLUSIONS
  Persons with syphilis were not unlike others in their neighborhoods, suggesting that syphilis is a sentinel event that indicates an entire neighborhood is at risk. Improvements in access to health care for sexually transmitted disease-related symptoms, screening in sites such as public hospital emergency rooms, and emphasizing sexual risk-reduction interventions may limit the spread of syphilis in these neighborhoods. To prevent syphilis in the long term, public health programs should also try to better understand and change other community-level socioeconomic factors that influence sexual behavior.
authors.affiliation: Louisiana Office of Public Health, New Orleans 70160, USA. tfarley@dhhmail.dhh.state.la.us
authors.forename: T A
authors.initials: TA
authors.lastname: Farley
authors.forename: R H
authors.initials: RH
authors.lastname: Kahn
authors.forename: G
authors.initials: G
authors.lastname: Johnson
authors.forename: D A
authors.initials: DA
authors.lastname: Cohen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003140:Communicable Disease Control; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D018571:Sentinel Surveillance; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology* / Q000517:prevention & control*