Background:
Two outbreaks, two cities, two different time periods. Danville was one of the original 25 high morbidity areas in 1999. Virginia's outbreak response team spent a year there in 2000 using newly acquired syphilis elimination funds. The last case was reported in 2001. The outbreak in Suffolk was first detected in August 2005. Using lessons learned from the Danville experience, the outbreak response team worked with the local health department in Suffolk to eliminate syphilis in only 4 months.

Objective:
1. To eliminate syphilis using the most rapid means and;
2. Ensure domestic transmission of syphilis did not re-occur.


Method:
Strategies outlined in the national syphilis elimination plan were implemented. Unique, however, was a technique discovered during the Danville outbreak. Social networking was used to target core transmitters, who, according to the literature, represent about 5% of the affected population. When the response effort concluded, the infrastructure remained in place to sustain low incidence levels.

Result:
Social networking had the greatest impact on case management. In both outbreaks, there were countless sex partners who could not be found through traditional partner notification efforts. When these partners were named again in social networking interviews, they were easily located and examined. In Danville, about 40% of cases identified during the outbreak response effort were the result of case finding techniques. This improved to over 80% during the Suffolk outbreak.

Conclusion:
Lessons learned 5 years ago resulted in syphilis being eliminated in Suffolk in less than half the time it took for Danville.

Implications:
Countless studies have shown that when core transmitters (i.e., sex workers) are named in the partner elicitation process, they account for a high number of unlocatable contacts. When they are named by disinterested third parties in the social networking process, most can be found and examined.