Kahn Richard H, Peterman Thomas A, Arno Janet, Coursey Emmett John, Berman Stuart M
Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Sex Transm Dis. 2006 Oct;33(10):630-5. doi: 10.1097/01.olq.0000216063.75575.f8.
BACKGROUND/OBJECTIVES: Persistence of syphilis in communities may be maintained by relatively small groups of high-risk persons centrally placed among a larger group with low to moderately risky behavior. We sought to determine which control strategies identified particularly high-risk, early-stage syphilis cases considered to have high prevention value.
In 2 cities with recent heterosexual outbreaks, data were abstracted for early syphilis cases from 1997 through 2002. Disease stage and number of sex partners were used to create an index to estimate the relative likelihood and magnitude of future transmission had the case not been treated. We estimated the relative transmission potential for each stage of syphilis (primary = 4.3, secondary = 2.5, and early-latent = 1.0) and multiplied by the number of reported partners to determine a prevention value score. Cases scoring >10 were considered high prevention value. Cases were stratified by the method used to detect the case.
Of 1,700 female early syphilis cases, 174 (10%) were high value. Cases were identified by private physicians (28% of all female cases and 16% of high-value cases), jails (19% of all, 40% of high-value cases), partner notification (16% of all, 10% of high-value cases), sexually transmitted disease (STD) clinic (9% of all, 13% of high-value cases), and the emergency room (8% of all, 4% of high-value cases). Of 1,851 male cases, 228 (12%) were high value. Cases were identified by jails (27% of all male cases and 14% of high-value cases), STD clinic (21% of all, 47% of high-value), private physicians (17% of all, 17% of high-value), partner notification (14% of all, 11% of high-value), and the emergency room (6% of all, 14% of high-value).
Private physicians identified the most female cases; however, jail screening identified the most high-prevention-value female cases. Jail screening identified the most male cases; however, the STD clinic (self-referred) identified the most high-prevention-value cases. Partner notification identified relatively few high-value cases.
背景/目的：社区梅毒的持续存在可能由相对少数处于高风险的人群维持，这些人集中在行为风险较低至中等的较大群体之中。我们试图确定哪些控制策略能识别出具有特别高风险且被认为具有高预防价值的早期梅毒病例。
在近期有异性传播梅毒暴发的2个城市，提取了1997年至2002年早期梅毒病例的数据。利用疾病分期和性伴侣数量创建一个指数，以估计若病例未得到治疗，未来传播的相对可能性和程度。我们估计了梅毒各阶段的相对传播潜力（一期 = 4.3，二期 = 2.5，早期潜伏 = 1.0），并乘以报告的性伴侣数量以确定预防价值评分。评分大于10分的病例被视为具有高预防价值。病例按检测病例的方法进行分层。
在1700例女性早期梅毒病例中，174例（10%）具有高价值。病例通过私人医生（占所有女性病例的28%，高价值病例的16%）、监狱（占所有病例的19%，高价值病例的40%）、性伴侣通知（占所有病例的16%，高价值病例的10%）、性传播疾病（STD）诊所（占所有病例的9%，高价值病例的13%）和急诊室（占所有病例的8%，高价值病例的4%）被识别出来。在1851例男性病例中，228例（12%）具有高价值。病例通过监狱（占所有男性病例的27%，高价值病例的14%）、STD诊所（占所有病例的21%，高价值病例的47%）、私人医生（占所有病例的17%，高价值病例的17%）、性伴侣通知（占所有病例的14%，高价值病例的11%）和急诊室（占所有病例的6%，高价值病例的14%）被识别出来。
私人医生识别出的女性病例最多；然而，监狱筛查识别出的具有高预防价值的女性病例最多。监狱筛查识别出的男性病例最多；然而，STD诊所（自我转诊）识别出的具有高预防价值的病例最多。性伴侣通知识别出的高价值病例相对较少。
