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Background: Syphilis is most transmissible in the early stages of infection. Timely diagnosis and immediate treatment are critical to limiting disease morbidity and transmissibility. We estimated the days from first positive test (diagnosis) to first treatment for primary and secondary (P&S) syphilis cases to identify opportunities to avert transmission.
Methods: For all newly-diagnosed P&S cases reported and investigated in NC during 2014-2015, we compared the demographics and testing facility (public/private) of those treated on the same day as diagnosis to those who were not. We fit log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for same-day treatment by key characteristics. We also calculated the number of sex partners at risk for acquiring disease due to treatment delays.
Results: In NC, 1752 P&S syphilis cases were reported (541 primary; 1211 secondary). The median time from diagnosis to treatment was 1 day (interquartile range=0-7), with nearly half receiving same-day treatment (N=794; 45%). We observed a lower prevalence of same-day treatment for P&S cases who were >30 years (PR=0.87; 95% CI 0.78, 0.97), non-black (0.89; 0.82, 0.98) and tested in a private facility (0.68; 0.62, 0.74). Most P&S cases treated ≥1 day after diagnosis reported ≥1 sex partner (N=827; 86%), and partner services were initiated for 1334 (58%) of their 2305 named sex partners (259 syphilis-infected, 329 prophylactically-treated, 93 syphilis-uninfected, 330 syphilis-status-unknown). Overall, 213 (16%) partners reported sex with the P&S case after the P&S case’s diagnosis; 100 (47%) were exposed between the P&S case’s diagnosis and treatment dates (34 syphilis-infected, 40 presumptively-treated, 2 syphilis-uninfected, 24 syphilis-status-unknown).
Conclusions: Syphilis treatment delays place sex partners at risk of acquiring disease. Same-day treatment occurred most often in public clinics, possibly due to medication availability and higher rates of presumptive treatment in the presence of P&S symptoms in these facilities.