Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions

BACKGROUND

Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient.

METHODS

We reviewed data from early syphilis cases reported during the 2015-2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate.

RESULTS

Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%-14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%-28.3%). Treatment for ≥1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed ≤7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%).

CONCLUSIONS

Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.

Impact of social network characteristics on shelter use among street youth in San Francisco

PURPOSE

We examined the cross-sectional and longitudinal association between social network characteristics and street youths' shelter use, a determinant of health outcomes for homeless youth.

METHODS

We analyzed interview data from 138 street youth recruited through venue-based sampling in San Francisco, to assess the cross-sectional relationship between shelter use in youths' social networks and youths' reported shelter use. We also assessed the relationship between baseline network shelter use and shelter use at 6-month follow-up.

RESULTS

Low proportions of street youth reported shelter use at baseline (38%) and follow-up (29.6%). Twenty-nine (26.9%) youth were in networks with shelter users at baseline, compared with 17 youth (15.7%) at follow-up. In cross-sectional analysis, youth in networks with shelter users had 5-fold increased odds of reporting shelter use (OR: 5.86, p = .006). A 1-person increase in the number of network shelter users was associated with 2-fold increased odds of youths' shelter use (OR: 2.16, p = .02). In longitudinal analysis, youth in networks with shelter users at baseline had nearly 5-fold increased odds of shelter use at follow-up (OR: 4.95, p = .01). A 1-person increase in the number of network shelter users at baseline was associated with 3-fold increased odds of shelter use at follow-up (OR: 3.15, p = .004).

CONCLUSION

Shelter users seem to cluster together. Shelter use by extended network members was associated with increased odds of youths' own shelter use. Understanding how network behaviors influence street youths' health-related behaviors, such as shelter use, could inform network-based interventions encouraging service uptake among marginalized and hard-to-reach street youth populations.

Sex, drugs (methamphetamines), and the Internet: increasing syphilis among men who have sex with men in California, 2004-2008

OBJECTIVES

We examined primary and secondary syphilis cases among men who have sex with men (MSM) in California, and the association of methamphetamine use and Internet use to meet sex partners (Internet use) with number of sex partners.

METHODS

We analyzed California surveillance data for MSM who were diagnosed with syphilis between 2004 and 2008, to assess differences in the mean number of sex partners by methamphetamine use and mutually exclusive groups of patients reporting Internet use (Internet users).

RESULTS

Large proportions of patients reported methamphetamine use (19.2%) and Internet use (36.4%). From 2006 through 2008, Adam4Adam was the most frequently reported Web site statewide, despite temporal and regional differences in Web site usage. Methamphetamine users reported more sex partners (mean = 11.7) than nonmethamphetamine users (mean = 5.6; P < .001). Internet users reported more sex partners (mean = 9.8) than non-Internet users (mean = 5.0; P < .001). Multivariable analysis of variance confirmed an independent association of methamphetamine and Internet use with increased numbers of sex partners.

CONCLUSIONS

Higher numbers of partners among MSM syphilis patients were associated with methamphetamine and Internet use. Collaboration between currently stand-alone interventions targeting methamphetamine users and Internet users may offer potential advances in sexually transmitted disease control efforts.

Repeat syphilis among men who have sex with men in California, 2002-2006: implications for syphilis elimination efforts

OBJECTIVES

We examined rates of and risk factors for repeat syphilis infection among men who have sex with men (MSM) in California.

METHODS

We analyzed 2002 to 2006 California syphilis surveillance system data.

RESULTS

During the study period, a mean of 5.9% (range: 4.9%-7.1% per year) of MSM had a repeat primary or secondary (PS) syphilis infection within 2 years of an initial infection. There was no significant increase in the annual proportion of MSM with a repeat syphilis infection (P = .42). In a multivariable model, factors associated with repeat syphilis infection were HIV infection (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.14, 2.37), Black race (OR = 1.84; 95% CI = 1.12, 3.04), and 10 or more recent sex partners (OR = 1.99; 95% CI = 1.12, 3.50).

CONCLUSIONS

Approximately 6% of MSM in California have a repeat PS syphilis infection within 2 years of an initial infection. HIV infection, Black race, and having multiple sex partners are associated with increased odds of repeat infection. Syphilis elimination efforts should include messages about the risk for repeat infection and the importance of follow-up testing. Public health attention to individuals repeatedly infected with syphilis may help reduce local disease burdens.