Background:Historically, the rate of syphilis in both North and South Dakota have been low. Starting in 2013, the rate of early syphilis infections has increased in the Dakotas. In 2013, one reservation that spans the Dakotas had an early syphilis rate of 2.55 per 1,000 population. Currently, there are over 45 cases associated with this outbreak.
Methods: In this outbreak (January 1, 2013 - Current) 65% of cases are primary or secondary syphilis. Twenty-seven percent are early latent syphilis. The majority (55%) of cases are female and range in age from 16 to 53 years with a median age of 28 years. All cases associated with this outbreak identify as heterosexual and no cases have identified themselves as men who have sex with men. Tribal public health nurses and community health representatives have begun to play a more active role in syphilis case finding and interviewing to address difficulties of patients and partners returning for treatment as well as identifying partners. Staff present in the community has become resources for providing education and transportation for testing and treatment of both cases and their partners.
Results: The North and South Dakota Departments of Health assist tribal staff on interviewing all syphilis cases. The health department staff has been trained in visual case analysis and identifies time periods where cases need to be re-interviewed for partner solicitation. Original interviews are conducted by tribal or Indian Health Service staff and are important for developing the relationship between public health, state health departments and the case.
Conclusions: Developing a relationship with patients that ensure a confidential environment for communication has been essential for this outbreak. Expanding the role of tribal public health nurses and community health representatives has been important in developing the relationship between the state health department, cases and tribal and Indian Health Service personnel.