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Background: Nationally, primary and secondary (P & S) syphilis cases have increased by 234% from 2000 (N=5,979) to 2014 (N=19,999). In 2014, Maricopa County ranked 7th nationally for P & S syphilis infections with a case rate of 10.3/100,000 population. This rate is expected to increase among Men who Have Sex with Men (MSM) and partnerships with private providers targeting this high-risk group may expedite treatment of potential cases.
Methods: In order to improve syphilis intervention indices, CDIs were placed in three HIV primary care clinics reporting the highest number of syphilis cases in 2007. Four CDIs from the Maricopa County Sexually Transmitted Diseases clinic conducted partner elicitation interviews and administered bicillin one half day per week from February 2008 through December 2015. Intervention indices were compared for the clinics before and after the placement of CDIs using SAS and MS Access databases. Chi-square and Mann-Whitney tests were performed to compare variables before and after CDI placement.
Results: Prior to the placement of the CDIs, 221 syphilis cases were diagnosed at the three clinics and 300 were diagnosed after CDI placement (N=521). Of the 300 patients diagnosed with syphilis after CDI placement, 282 (94%) were treated, and time to treatment improved by an average of 3 days. Although, a smaller percentage of patients completed a partner elicitation interview (80% vs. 41%) and less of these interviews yielded locatable partners (35% vs. 20%), the time to interview partners decreased by 50% from an average of 18 days prior to CDI placement to 9 days after the intervention took place.
Conclusions: Syphilis intervention indices for time to interview and treat patients improved after the placement of CDIs within the HIV clinics. STD programs facing high syphilis/HIV co-morbidity rates should evaluate this intervention as a potential method to improve partner elicitation and program performance.