Outbreaks of Syphilis in Rural Texas Towns, 1991-1992

Jm, Schulte; Ha, Ramsey; Jm, Paffel; Ma, Roberts; Williams, Rozanne Lanczak; Cm, Blass; Ce, Bell; Dm, Simpson

doi:10.1097/00007611-199404000-00014

Cited by 11 publications

(6 citation statements)

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“…In both cases, with 20/20 hindsight, it is likely that these syphilis trends contributed to emerging HIV epidemics and may, simultaneously, have been exacerbated by unrecognized HIV infection [25,26]. Syphilis is now highly concentrated across the southern states, where its epidemiology is strongly linked to exchange of sex for drugs and, increasingly, to a rural distribution that presents new challenges in terms of access to preventive and curative services [27,28].…”

Section: Reality Testing: Std Patterns In the United Statesmentioning

confidence: 99%

The Dynamic Topology Of Sexually Transmitted Disease Epidemics: Implications For Prevention Strategies

Wasserheit

Aral

1996

Journal of Infectious Diseases

303

194

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Each sexually transmitted disease (STD) epidemic evolves through predictable phases, shaped by a dynamic interplay among the pathogen, the behaviors of the subpopulations in which it emerges, and the prevention efforts that are developed to limit its impact. As STD epidemics move through these phases, the sexual and social networks that fuel them become located in subpopulations characterized by progressively higher rates of sex partner change and less contact with the health care system. As a result, phase-appropriate prevention strategies and research issues are essential to reducing STDs and their consequences.

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Section: Reality Testing: Std Patterns In the United Statesmentioning

confidence: 99%

The Dynamic Topology Of Sexually Transmitted Disease Epidemics: Implications For Prevention Strategies

Wasserheit

Aral

1996

Journal of Infectious Diseases

303

194

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“…The effectiveness of this intervention is commonly assessed by calculating the number of new cases of syphilis that were found and brought to treatment due to partner services 1–4 . The average number of partners brought to treatment for each reported case of syphilis has varied over time 2–8 . For example, it was reported to be as high as 0.46 in 4 rural Texas towns during a syphilis outbreak in 1992 and 0.4 in San Diego County in 1990 to 1992 5,6 .…”

mentioning

confidence: 99%

“…[1][2][3][4] The average number of partners brought to treatment for each reported case of syphilis has varied over time. [2][3][4][5][6][7][8] For example, it was reported to be as high as 0.46 in 4 rural Texas towns during a syphilis outbreak in 1992 and 0.4 in San Diego County in 1990 to 1992. 5,6 However, recent estimates of the average number of partners brought to treatment per reported case of syphilis range from a high of 0.28 in Mississippi between 2014 and 2016 to a low of 0.15 in men who have sex with men (MSM) in Texas between 2013 and 2016.…”

mentioning

confidence: 99%

Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions

et al. 2021

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Background: Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient. Methods:We reviewed data from early syphilis cases reported during the 2015-2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate.Results: Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%-14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%-28.3%). Treatment for ≥1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed ≤7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%). Conclusions:Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.

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“…The average number of diagnosed partners treated for syphilis because of DIS intervention per patient (ie, brought-totreat index) has ranged from a high of 0.46 in rural Texas in the early 1990s to a low of 0.07 in Philadelphia in 2010. [9][10][11][12][13] Both the populations served by DIS and the interventions provided have changed over the past several decades. 2,14-18 Yet, our standard set of performance measures has largely remained the same over time.…”

mentioning

confidence: 99%

“…However, published data from the past 40 years suggests DIS consistently cannot find and treat all new cases of disease through STD/HIV partner services. The average number of diagnosed partners treated for syphilis because of DIS intervention per patient (ie, brought-to-treat index) has ranged from a high of 0.46 in rural Texas in the early 1990s to a low of 0.07 in Philadelphia in 2010 9–13 . Both the populations served by DIS and the interventions provided have changed over the past several decades 2,14–18 .…”

mentioning

confidence: 99%

Measuring Success: Disease Intervention Specialists Performance Metrics and Outcome Assessments

2022

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Disease intervention specialists (DIS) are the cornerstone of public health. However, the incremental gains of DIS-led interventions are difficult to detect at the population level. Health departments attempt to quantify the impact of key DIS activities through performance measures that assess how many and how quickly both patients are interviewed, and contacts are notified, tested, and treated. However, DIS work encompasses more than case finding and existing performance measures may not capture the full value DIS provide to health departments. In this article, we first describe how DIS investigations and contact tracing are conducted for sexually transmitted diseases and other communicable diseases to understand how the definition of effectiveness may vary by disease. Then, we examine the benefits and limitations of traditional performance measures using syphilis investigations as an example. Recognizing the limits of existing measures will improve our understanding of DIS impact and assist in the development of new measures of effectiveness that better represent the totality of DIS work.

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Outbreaks of Syphilis in Rural Texas Towns, 1991-1992

Cited by 11 publications

References 0 publications

The Dynamic Topology Of Sexually Transmitted Disease Epidemics: Implications For Prevention Strategies

The Dynamic Topology Of Sexually Transmitted Disease Epidemics: Implications For Prevention Strategies

Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions

Measuring Success: Disease Intervention Specialists Performance Metrics and Outcome Assessments

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