Syphilis in the Heartland: A Retrospective Case Study of Innovative Approaches to an Early Syphilis Outbreak in Central Illinois

Background:
In 2006, an early syphilis outbreak occurred in Champaign County, Illinois, a county of 180,000 people. This incident gave rise to a 400% increase in early syphilis cases (n=10), and a 58% increase in total syphilis cases (n=24) from 2005. Seventy-one percent of these cases (n= 17) were either in men who have sex with men (MSM) or bisexual men, with a 33% co-infectivity rate of HIV (n=8). Initiation of a syphilis response program followed, resulting in innovative interventional methods to address this phenomenon.

Objective:
Focus regarding this phenomenon was directed to address contributing factors to this outbreak, in addition to increasing health-care provider and public awareness regarding syphilitic pathogenesis and treatment.

Method:
A multifaceted approach was performed, consisting of adult bookstore testing, Internet chat room outreach, expanded screening clinics, media coverage, field testing/treatment, and aggressive partner elicitation and notification efforts. It is noteworthy to mention that many of these interventions were largely performed by one public health nurse, with ancillary assistance from public health staff.

Result:
Such actions resulted in successful location and treatment of 100% of syphilitic patients in 2006, as well as a 333% decrease in early syphilis cases (n=3), and a 400% decrease in total syphilis cases (n=6) to date (August, 2007).

Conclusion:
Utilization of proactive approaches by this mid-state health department resulted in a swift and subsequent decrease in syphilis morbidity. Furthermore, program expansion has resulted in a sustained MSM clientele accessing health department services, including HIV risk-reduction endeavors.

Implications:
These aforementioned actions can optimally serve as a primer to other semi-rural health departments, where budgetary and staff resources are finite. Future endeavors should include a continuation of methods to reach the vulnerable MSM aggregate, as well as vigilant ongoing disease interventional efforts.