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Background: Despite high STD rates among incarcerated populations, few STD outbreaks have been reported in correctional facilities. A syphilis outbreak occurred in 2007-2008 at a California men’s state prison, from which no cases were reported since 1999.
Objectives: To describe the investigation and control of this outbreak.
Methods: Case-finding included review of case reports, laboratory data and clinic logs; case and sexual contact investigations; and a mass screening. Cases were defined as primary, secondary, or early latent syphilis, or RPR ≥ 1:16 from 1/1/2007-12/31/2008. Outbreak control activities included assurance of appropriate treatment, peer inmate testing promotion, partner elicitation, and mass education and screening. Key surveillance and clinical performance measures were assessed for the periods before and after initiation of investigation on 4/17/2008.
Results: Thirty cases were identified; 90% were diagnosed from 10/2007-5/2008; one-third were detected by mass screening. Cases were concentrated (86.7%) in one residential area. Transmission occurred through consensual male-to-male sexual contact; 56% of cases were HIV co-infected; and 70% were African-American. After control measures were implemented in April/May 2008, there were two cases identified in July/August 2008 and none since then. Prior to investigation initiation date, median time between report of syphilis cases from the county to the state was 56 days, median time from P&S symptom onset to exam was 15 days, and median time from exam to treatment was 7 days. These measures improved post-outbreak investigation.
Conclusions: Lack of adherence to surveillance protocols and clinical management guidelines likely contributed to the progression of this outbreak. Aggressive control measures, including mass screening, curtailed the outbreak.
Implications for Programs, Policy, and/or Research: To prevent STD outbreaks in correctional settings, adherence to standard clinical, surveillance, and reporting procedures, HIV/STD screening after intake and before discharge, and increased inmate HIV/STD education are recommended. Condom distribution within prisons/jails and review of factors facilitating sexual activity within prisons should also be explored.