Background:
Early syphilis cases among Chicago's women increased in 2004. Transmission continued in 2005: January 1 through October 10, 2005, 57 women with early syphilis (24 primary and secondary [P&S]; 33 early latent [EL]) were reported. Women appeared to be low-risk with no common social/sexual networks identified. Reasons for increases were unclear.

Objective:
Identify women's risk factors for early syphilis. Recommend prevention measures.

Method:
Women diagnosed with early syphilis were interviewed by disease intervention specialists to elicit sexual contacts and risks. Additional ethnographic re-interviews were conducted at women's homes or by phone about their diagnosis, sex partner selection and perceived safety, risk behaviors, STD knowledge and STD prevention.

Result:
Fourteen women were re-interviewed: 8 P&S cases and 6 EL cases; median age=22.5 years (range 17-43); 13 African-Americans, one Hispanic. Fear/shame were common responses to diagnosis. Women perceived themselves at low-risk and epidemiologically they were: few reported drug use, exchanging sex for money/drugs, incarceration, or anonymous sex. Women were unaware of syphilis, but knew about other STDs prior to diagnosis. Most sex partners were met within women's neighborhoods and were known since childhood or introduced by family or friends. These partners were considered safe, particularly when women had an ongoing relationship with them. Women used condoms only early on, or not at all, citing trust in partners as their main prevention strategy. After diagnosis, women retrospectively identified partners' risk factors including incarceration or tendencies to “party.” Women suggested prevention messages encouraging peers to use condoms or else be abstinent, not trust partners and insist partners be tested for STDs.

Conclusion:
Epidemiologically, women with early syphilis were at low-risk for STDs. Women met sex partners within their social and geographic networks, perceived themselves as low-risk and used trust as their main prevention strategy.

Implications:
More work is needed to identify interventions to prevent increases in syphilis among women.