Farley T A, Kahn R H, Johnson G, Cohen D A
Louisiana Office of Public Health, New Orleans 70160, USA.
Sex Transm Dis. 2000 Jul;27(6):305-10. doi: 10.1097/00007435-200007000-00001.
The persistence of syphilis in the United States suggests that a better understanding is needed of the potential for various public health approaches to prevent the spread of the disease.
The authors conducted surveys of 92 persons with early syphilis, 56 uninfected sexual contacts, and 143 neighborhood controls in the Baton Rouge, Louisiana area. The surveys collected information regarding sexual behavior, access to and use of healthcare services, encounters at sites at which serologic screening for syphilis could be done, and exposure to interventions designed to prevent HIV infection.
All groups reported high-risk sexual behavior. Cases and contacts were more likely than controls to report two or more sex partners in the previous year, but the three groups were similar in the percentage reporting five or more sex partners. Cases had poor access to health care and by some measures this access was less than that of controls. The potential screening site visited most frequently by cases was the public hospital emergency room (40%). Cases were less likely to have been exposed to programs designed to prevent HIV infection than uninfected contacts and controls combined (odds ratios, 0.51-0.66).
Persons with syphilis were not unlike others in their neighborhoods, suggesting that syphilis is a sentinel event that indicates an entire neighborhood is at risk. Improvements in access to health care for sexually transmitted disease-related symptoms, screening in sites such as public hospital emergency rooms, and emphasizing sexual risk-reduction interventions may limit the spread of syphilis in these neighborhoods. To prevent syphilis in the long term, public health programs should also try to better understand and change other community-level socioeconomic factors that influence sexual behavior.
梅毒在美国持续存在，这表明需要更好地了解各种公共卫生方法预防该疾病传播的潜力。
作者对路易斯安那州巴吞鲁日地区的92例早期梅毒患者、56名未感染的性伴侣及143名社区对照者进行了调查。这些调查收集了有关性行为、获得和使用医疗服务、在可进行梅毒血清学筛查的场所的接触情况以及接触预防艾滋病毒感染干预措施的信息。
所有组均报告有高危性行为。病例组和性伴侣组比对照组更有可能报告在前一年有两个或更多性伴侣，但三组中报告有五个或更多性伴侣的比例相似。病例组获得医疗保健的机会较差，从某些指标来看，这种机会比对照组少。病例组最常前往的潜在筛查场所是公立医院急诊室（40%）。与未感染的性伴侣和对照组合计相比，病例组接触预防艾滋病毒感染项目的可能性较小（优势比为0.51 - 0.66）。
梅毒患者与其社区中的其他人并无不同，这表明梅毒是一个警示事件，表明整个社区都处于危险之中。改善与性传播疾病相关症状的医疗保健可及性、在公立医院急诊室等场所进行筛查以及强调降低性风险的干预措施可能会限制梅毒在这些社区的传播。为了长期预防梅毒，公共卫生项目还应努力更好地理解并改变其他影响性行为的社区层面社会经济因素。
