Blank S, McDonnell D D, Rubin S R, Neal J J, Brome M W, Masterson M B, Greenspan J R
Division of STD Prevention, National Center for HIV, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Sex Transm Dis. 1997 Apr;24(4):218-26. doi: 10.1097/00007435-199704000-00006.
With prostitution and drugs the most common reasons for arrest among New York City (NYC) women, female arrestees are at high risk for acquiring syphilis and delivering congenitally infected babies. Despite routine syphilis screening of all NYC inmates, many are released before the need for treatment is recognized, and once released, few could be found for treatment.
To improve syphilis treatment rates among female correctional inmates in NYC.
At a women's correctional health clinic, on-site, rapid, qualitative nontreponemal syphilis testing (STAT rapid plasma reagin [RPR]) and on-line access to the local syphilis case registry were introduced to supplement the usual admission medical evaluation. Treatment decisions made using the authors' jail protocol were compared with treatment criteria used in NYC's sexually transmitted disease (STD) clinics. Patients consisted of a consecutive sample of 685 remandees admitted one or more times during the day shift, March 24, 1993, to July 31, 1993, who had a full complement of mandatory admission medical tests. Using the study protocol, syphilis treatment decisions were made and needed treatment was furnished at the end of the admission medical evaluation. The main outcome measures were correct identification and treatment of syphilis in this population, compared with standard NYC Department of Health (DOH) STD clinic practice, as well as the effect of the jail protocol on pregnancy outcomes and need to treat offspring for congenital syphilis.
Compared with NYC DOH STD clinic practice, the study protocol was 95% sensitive and 88% specific in arriving at appropriate treatment for syphilis. Treatment at the end of the admission medical evaluation increased syphilis treatment rates from 7% to 84% of women with indications for treatment and to 88% of pregnant women with indications for treatment. Prospective follow-up for birth outcomes revealed no spontaneous abortions and eight live births. Seven of the eight did not need congenital syphilis treatment because their mothers were adequately treated while incarcerated.
Qualitative (or STAT) RPR testing and access to DOH syphilis case registry data provide prompt and accurate diagnostic information that can lead to an overall increase in the number of inmates appropriately treated (with a minimum amoung of overtreatment) in a women's correctional facility. This protocol may be applicable in other high-risk, transient populations.
在纽约市（NYC）女性中，卖淫和吸毒是被捕的最常见原因，被捕女性感染梅毒并生下先天性感染婴儿的风险很高。尽管对所有纽约市囚犯进行常规梅毒筛查，但许多人在需要治疗之前就被释放了，而且一旦获释，很少能找到人接受治疗。
提高纽约市女性教养所囚犯的梅毒治疗率。
在一家女子教养所健康诊所，引入了现场快速定性非梅毒螺旋体梅毒检测（STAT快速血浆反应素试验[RPR]）以及在线访问当地梅毒病例登记处，以补充常规入院医学评估。将根据作者的监狱治疗方案做出的治疗决策与纽约市性传播疾病（STD）诊所使用的治疗标准进行比较。患者包括1993年3月24日至1993年7月31日白天班次期间连续入院一次或多次的685名被拘留者的样本，他们进行了全套强制性入院医学检查。根据研究方案，在入院医学评估结束时做出梅毒治疗决策并提供所需治疗。主要结局指标是与纽约市卫生部（DOH）STD诊所的标准做法相比，该人群中梅毒的正确识别和治疗情况，以及监狱治疗方案对妊娠结局和先天性梅毒患儿治疗需求的影响。
与纽约市卫生部STD诊所的做法相比，研究方案在确定梅毒的适当治疗方面敏感性为95%，特异性为88%。入院医学评估结束时的治疗使有治疗指征的女性梅毒治疗率从7%提高到84%，有治疗指征的孕妇提高到88%。对出生结局的前瞻性随访显示没有自然流产，有8例活产。8例中有7例不需要先天性梅毒治疗，因为他们的母亲在监禁期间得到了充分治疗。
定性（或STAT）RPR检测以及获取卫生部梅毒病例登记数据可提供及时准确的诊断信息，从而导致女子教养所中接受适当治疗（过度治疗最少）的囚犯人数总体增加。该方案可能适用于其他高危、流动人群。
