Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 2000 Oct;90(10):1540–1544. doi: 10.2105/ajph.90.10.1540

Implementing a syphilis elimination and importation control strategy in a low-incidence urban area: San Diego County, California, 1997-1998.

R A Gunn 1, S L Harper 1, D E Borntrager 1, P E Gonzales 1, M E St Louis 1
PMCID: PMC1446380  PMID: 11029985

Abstract

OBJECTIVES: This study assessed a strategy designed to contain imported cases of syphilis and prevent reestablishment of ongoing transmission. METHODS: Reported syphilis cases during an endemic period (1990-1992) and an elimination period (1997-1998) were compared in San Diego, Calif. The elimination strategy, which focuses on rapid reporting of infectious syphilis cases by clinicians, prompt partner and sexual network management, outreach to marginalized populations, and implementation of an outbreak containment plan, was evaluated. RESULTS: Infectious syphilis incidence rates declined from 18.3 per 100,000 in 1998 to 1.0 per 100,000 in 1998. Of the 46 cases involving probable infection during 1997-1998, 19 (41%) were imported, mostly (79%) from Mexico. Outbreak containment procedures were implemented successfully for 2 small clusters. Outreach workers provided sexually transmitted disease information to a large number of individuals; however, no cases of infectious syphilis were identified, suggesting that syphilis transmission was not occurring among marginalized groups. CONCLUSIONS: This syphilis elimination and importation control strategy will require monitoring and adjustments. Controlling syphilis along the US-Mexico border is a necessary component of syphilis elimination in the United States.

Full Text

The Full Text of this article is available as a PDF (95.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aral S. Elimination and reintroduction of a sexually transmitted disease: lessons to be learned? Am J Public Health. 1999 Jul;89(7):995–997. doi: 10.2105/ajph.89.7.995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brunham R. C., Plummer F. A. A general model of sexually transmitted disease epidemiology and its implications for control. Med Clin North Am. 1990 Nov;74(6):1339–1352. doi: 10.1016/s0025-7125(16)30484-9. [DOI] [PubMed] [Google Scholar]
  3. DiClemente R. J., Wingood G. M. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. JAMA. 1995 Oct 25;274(16):1271–1276. [PubMed] [Google Scholar]
  4. Farley T. A., Kahn R. H., Johnson G., Cohen D. A. Strategies for syphilis prevention: findings from surveys in a high-incidence area. Sex Transm Dis. 2000 Jul;27(6):305–310. doi: 10.1097/00007435-200007000-00001. [DOI] [PubMed] [Google Scholar]
  5. Garnett G. P., Anderson R. M. Sexually transmitted diseases and sexual behavior: insights from mathematical models. J Infect Dis. 1996 Oct;174 (Suppl 2):S150–S161. doi: 10.1093/infdis/174.supplement_2.s150. [DOI] [PubMed] [Google Scholar]
  6. Gunn R. A., Harper S. L. Emphasizing infectious syphilis partner notification. Sex Transm Dis. 1998 Apr;25(4):218–219. doi: 10.1097/00007435-199804000-00009. [DOI] [PubMed] [Google Scholar]
  7. Gunn R. A., Montes J. M., Toomey K. E., Rolfs R. T., Greenspan J. R., Spitters C. E., Waterman S. H. Syphilis in San Diego County 1983-1992: crack cocaine, prostitution, and the limitations of partner notification. Sex Transm Dis. 1995 Jan-Feb;22(1):60–66. [PubMed] [Google Scholar]
  8. Gunn R. A., Rolfs R. T., Greenspan J. R., Seidman R. L., Wasserheit J. N. The changing paradigm of sexually transmitted disease control in the era of managed health care. JAMA. 1998 Mar 4;279(9):680–684. doi: 10.1001/jama.279.9.680. [DOI] [PubMed] [Google Scholar]
  9. Higgins D. L., Galavotti C., O'Reilly K. R., Schnell D. J., Moore M., Rugg D. L., Johnson R. Evidence for the effects of HIV antibody counseling and testing on risk behaviors. JAMA. 1991 Nov 6;266(17):2419–2429. [PubMed] [Google Scholar]
  10. Hinman A. R., Eddins D. L., Kirby C. D., Orenstein W. A., Bernier R. H., Turner P. M., Jr, Bloch A. B. Progress in measles elimination. JAMA. 1982 Mar 19;247(11):1592–1595. [PubMed] [Google Scholar]
  11. Hook E. W., 3rd, Stephens J., Ennis D. M. Azithromycin compared with penicillin G benzathine for treatment of incubating syphilis. Ann Intern Med. 1999 Sep 21;131(6):434–437. doi: 10.7326/0003-4819-131-6-199909210-00007. [DOI] [PubMed] [Google Scholar]
  12. Oxman G. L., Smolkowski K., Noell J. Mathematical modeling of epidemic syphilis transmission. Implications for syphilis control programs. Sex Transm Dis. 1996 Jan-Feb;23(1):30–39. doi: 10.1097/00007435-199601000-00008. [DOI] [PubMed] [Google Scholar]
  13. Rothenberg R., Narramore J. The relevance of social network concepts to sexually transmitted disease control. Sex Transm Dis. 1996 Jan-Feb;23(1):24–29. doi: 10.1097/00007435-199601000-00007. [DOI] [PubMed] [Google Scholar]
  14. Williams L. A., Klausner J. D., Whittington W. L., Handsfield H. H., Celum C., Holmes K. K. Elimination and reintroduction of primary and secondary syphilis. Am J Public Health. 1999 Jul;89(7):1093–1097. doi: 10.2105/ajph.89.7.1093. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES