Buck Taylor, Herrera Perales Luis Enrique, Berzkalns Anna, Barash Elizabeth, Golden Matthew R, Dombrowski Julia C
From the School of Medicine, University of Washington.
Public Health - Seattle & King County HIV/STD Program.
Sex Transm Dis. 2025 Mar 1;52(3):135-140. doi: 10.1097/OLQ.0000000000002110. Epub 2024 Nov 27.
The incidence of syphilis among cisgender women and heterosexual men in the United States has risen sharply. Public Health - Seattle & King County implemented a voluntary, opt-in syphilis screening program in a jail to reach disproportionately affected populations outside the health care system.
Public Health - Seattle & King County disease intervention specialists conducted syphilis screening 4 days per week in a regional jail. All persons screened January 2022 to March 2023 were included in the analysis. Disease intervention specialists performed point-of-care treponemal-specific tests, collected demographic and risk factor data, worked with jail medical providers to coordinate empiric treatment and confirmatory testing, and determined syphilis history and stage. We categorized persons with reactive rapid tests as "confirmed," "presumed," "possible," or "not new" cases based on confirmatory testing and syphilis history. We compared the characteristics of confirmed cases to overall King County syphilis cases using χ2 tests and examined treatment completion by diagnosis category.
A total of 1371 persons completed screening; 69 (5.0%) had positive results, of whom 51 (73.9%) had confirmatory testing, and 33 had confirmed infections (2.4% of screened persons). Compared with all King County syphilis cases, confirmed cases were more likely to be cisgender women (30.3% vs. 21.9%) or cisgender heterosexual men (66.7% vs. 20.6%), people living homeless (66.7% vs. 24.3%), or people who use methamphetamine (90.9% vs. 20.3%; P < 0.001 for all comparisons). Among 33 persons with confirmed syphilis, 29 (87.8%) started and 18 (54.5%) completed treatment.
Jail screening reached persons at disproportionate risk for syphilis, but treatment was often incomplete.
美国顺性别女性和异性恋男性中的梅毒发病率急剧上升。西雅图和金县公共卫生部门在一所监狱实施了一项自愿参与的梅毒筛查项目，以覆盖医疗保健系统之外受影响尤为严重的人群。
西雅图和金县公共卫生部门的疾病干预专家每周4天在一所地区监狱进行梅毒筛查。2022年1月至2023年3月期间所有接受筛查的人员均纳入分析。疾病干预专家进行即时梅毒螺旋体特异性检测，收集人口统计学和风险因素数据，与监狱医疗服务提供者合作协调经验性治疗和确诊检测，并确定梅毒病史和分期。根据确诊检测和梅毒病史，我们将快速检测呈反应性的人员分类为“确诊”“推定”“可能”或“非新”病例。我们使用χ²检验比较确诊病例与金县总体梅毒病例的特征，并按诊断类别检查治疗完成情况。
共有1371人完成筛查；69人（5.0%）结果呈阳性，其中51人（73.9%）进行了确诊检测，33人确诊感染（占筛查人员的2.4%）。与金县所有梅毒病例相比，确诊病例更有可能是顺性别女性（30.3%对21.9%）或顺性别异性恋男性（66.7%对20.6%）、无家可归者（66.7%对24.3%）或使用甲基苯丙胺者（90.9%对20.3%；所有比较P<0.001）。在33例确诊梅毒的患者中，29例（87.8%）开始治疗，18例（54.5%）完成治疗。
监狱筛查覆盖了梅毒风险不成比例的人群，但治疗往往不完整。
