Factors and the sociosexual network associated with a syphilis outbreak in rural North Carolina.
OBJECTIVE
An investigation was conducted to determine factors associated with a syphilis outbreak in a rural North Carolina county.


METHODS
A retrospective chart review was performed on 61 primary (PS), secondary (SS), and early latent (ELS) syphilis case patients reported in Columbus County between January 2001 and February 2002. Sociosexual network analysis was conducted using electronic contact tracing information.


RESULTS
We identified 20 PS, 25 SS, and 16 ELS case patients who were predominantly black. Seventy-two percent had reported >or=1 sexual partner with early syphilis, 51% used crack cocaine and/or had sex with a crack-using partner, and 31% exchanged sex for drugs or money. The sexual network exhibited predominantly linear connections between case patients and sexual partners. Adding social connections to the network further demonstrated dense cyclic interactions characteristic of core groups.


CONCLUSIONS
The syphilis outbreak in this rural community was associated with crack cocaine and exchange of sex for drugs in a densely interconnected sociosexual network.
Seña
Arlene C
AC
Division of Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina 27599, USA. idrod@med.unc.edu
Muth
Stephen Q
SQ
Heffelfinger
James D
JD
O'Dowd
Judy Owen
JO
Foust
Evelyn
E
Leone
Peter
P
D000293:Adolescent; D000328:Adult; D016358:Contact Tracing; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D012309:Risk-Taking; D012423:Rural Health; D012725:Sexual Behavior; D019966:Substance-Related Disorders; D013587:Syphilis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control