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Background: Fresno County early syphilis (ES) cases increased seven-fold from 2010-2014, and were predominantly heterosexual. There were concurrent increases in pregnant cases and a five-fold rise in congenital syphilis. From 2015-2016, staffing shortages plus a large increase in open and unassigned investigations required an intensive public health response.
Methods: Fresno County implemented incident command (2/11/16) and implemented: coordination of federal, state and local STD disease intervention specialists (DIS); re-opened an STD clinic and delivered Bicillin; jail syphilis screening men <30 years and women <34 years ; new processes for reactor triage, provider follow up, DIS assignment, and data management. Impact of the intervention was assessed using preliminary STD clinic case data on stage, risk factors, partner outcomes, and treatment.
Results: When the response was implemented 2/11/16, there were 631 open-unassigned syphilis reactors with specimen dates from 6/1/15. There were 391 ES cases; 40.7% female, 58.8% male, 0.5%transgender; 44.5% ≤age 30; 46.5% Hispanic, 28.4% White, 2.0 % Black, 2.8% Asian/Pacific Islander, 8.0% Other/Unknown. Among ES cases, 21.5% were men who have sex with women , 1.5% men who have sex with men and women (MSM/W), 11% MSM, 40.7% women who have sex with men, 25.3% Unknown; 12% of female ES cases were pregnant; 12.8% reported meth; 4.1 % homeless, and 2.8% incarcerated. There were 262 contacts elicited as of June 1, 2016. During the intervention 65 cases (61% ES) were seen at the STD Clinic (3/28/16-6/1/16): 61% female; 32% aged ≤30 years; 87% females aged 15-44; and 88% were treated. Fifty-two percent of ES cases were tested for HIV (no new positives). Seventy sexual/social contacts were elicited: 71% ES; 90% treated.
Conclusions: The multi-pronged public health and community response determined community- and individual-level risk factors contributing to local spread of syphilis, and facilitated timely identification and treatment of contacts and cases.