Epidemic Early Syphilis -- Escambia County, Florida, 1987
and July 1989 - June 1990
In Escambia County, Florida, the average number of early
syphilis cases reported per quarter increased from 15 in 1987 to
75 in 1990 (Figure 1). To identify potential reasons for this
epidemic, the Florida Department of Health and Rehabilitative
Services and CDC used patient interview records to compare
characteristics of patients with syphilis diagnosed before and
during the epidemic. This report summarizes the characteristics
of 82 patients diagnosed and treated from January through
December 1987 (the preepidemic period) and 256 patients diagnosed
and treated from July 1989 through June 1990 (the epidemic
period).
Persons with cases reported during the epidemic were older
than persons with cases reported before the epidemic (median age:
29 vs. 25 years, p less than 0.05, Kruskal-Wallis test) and less
likely to be employed (32% vs. 54%, p less than 0.01). In
addition, the proportion of patients who were black increased
from 79% to 90% (p less than 0.05). Although the proportion of
men among those infected changed only slightly (56% vs. 52%), the
proportion of homosexual men decreased from 17% to 3% (p less
than 0.01).
Regular syphilis screening at the county jail began in 1984.
From the preepidemic period to the epidemic period, the
proportion of cases detected through these screenings increased
from 6% to 26% (p less than 0.01). Of the 73 epidemic-period
cases detected in the jail, 34 (47%) were primary or secondary
syphilis, the stages during which sexual transmission most likely
occurs.
Information on drug use was available for all cases from the
preepidemic period and for 71% of those from the epidemic period.
Of persons diagnosed with syphilis during the preepidemic period,
11% reported cocaine use; none reported crack use. In comparison,
35% of persons diagnosed with syphilis during the epidemic period
for whom drug use information was available reported cocaine use
(p less than 0.01); 94% of cocaine users reported crack use. In
addition, crack users named more sex partners than did nonusers
(2.8 vs. 1.5, p less than 0.05), and were more likely to report
having exchanged sex for money or drugs (54% vs. 1%, p less than
0.01) and having had multiple anonymous sex partners (32% vs. 2%,
p less than 0.01).
In October 1990, to identify new cases of syphilis,
screenings were done at five ``crack trees'' (i.e., locations
where crack was used or sold). Of 38 persons who consented to
testing, six had serum specimens that were
rapid-plasma-reagin--reactive. Among persons with positive
specimens, four had been treated recently for syphilis. The other
two were located for treatment: one was treated for early latent
syphilis, and one had serologic evidence of reinfection or
treatment failure.
Reported by: PA Moncrief, JE Wroten, Florida State STD Program;
JJ Witte, MD, RS Hopkins, MD, State Epidemiologist, Florida Dept
of Health and Rehabilitative Svcs. Div of STD/HIV Prevention,
Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: In a crack-related syphilis epidemic, partner
notification efforts may be hampered by the anonymity of sexual
encounters. An example of a strategy designed to locate infected
persons in a crack-using population is targeted syphilis
screening in locations where crack users are likely to be (e.g.,
crack trees or crack houses). A recent effort to screen persons
for syphilis at crack houses in Philadelphia determined that at
least 12% of those tested had untreated syphilis (1). The
effectiveness of this approach may be increased by on-site
treatment and partner notification interviews. Screening programs
in the Escambia County jail and elsewhere (2) represent an
additional potential approach to identifying persons with
untreated syphilis.
References
CDC. Alternative case-finding methods in a crack-related
syphilis epidemic---Philadelphia. MMWR 1991;40:77--80.
Heimberger T, Chang H, Birkhead G, et al. High prevalence of
syphilis detected through a jail screening program, New York
State (Abstract). In: Proceedings of the Epidemic Intelligence
Service 40th Annual Conference. Atlanta: US Department of Health
and Human Services, Public Health Service, CDC, 1991:41.
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