Symptoms Recognition Related to Early Syphilis Increase in Knox County, Tennessee

Background: Knox County experienced an increase in early syphilis cases in the heterosexual population who exchange sex for drugs or money.

Objectives:  Evaluate a syphilis symptom recognition campaign

Methods: In 2008, Knox County Health Department (KCHD) staff initiated an aggressive syphilis prevention campaign in areas known to be frequented by long distance truck drivers, out of area construction workers, sex workers, and local citizens, after reviewing several cases in this population. Newspaper articles discussed the increase in syphilis, gave descriptions of the symptoms, and testing and treatment locations. Posters picturing the signs and symptoms of syphilis were placed in bathrooms of truck stops and bars known to be frequented by sex workers and truck drivers.  Posters were also placed in parks, convenience stores, and homeless shelters. 

Results: In 2007, Knox County had 39 cases of Primary and Secondary (P&S) syphilis and an additional 11 cases of early latent (EL).  In 2008, KCHD had 63 cases of P&S syphilis, and 31 EL cases.  Approximately one thousand patients presented to the clinic over a three month period in 2009. When these patients were asked about the reason for their visit, they cited the symptom posters and/or had heard about the signs or symptoms from their partner/neighbors/self. The effects of symptom recognition are still being realized with 50 cases of P&S, but only 4 cases of EL.

Conclusions: Symptom recognition encouraged patients to seek treatment for syphilis.

Implications for Programs, Policy, and/or Research: Strategic placement of appropriate STD prevention information can be effective. This requires thorough analysis of data on a local level and good interviewing skills to determine appropriate material and location.