title: Factors and the sociosexual network associated with a syphilis outbreak in rural North Carolina.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina 27599, USA. idrod@med.unc.edu
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Seña
authors.forename: Stephen Q
authors.initials: SQ
authors.lastname: Muth
authors.forename: James D
authors.initials: JD
authors.lastname: Heffelfinger
authors.forename: Judy Owen
authors.initials: JO
authors.lastname: O'Dowd
authors.forename: Evelyn
authors.initials: E
authors.lastname: Foust
authors.forename: Peter
authors.initials: P
authors.lastname: Leone
mesh_terms: 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