Use of the Historical Limits Method to Detect Increases in Primary and Secondary Syphilis, Arizona 2011-2014: An Exploratory Study.

Background: Increasing numbers of reported primary and secondary (P&S) syphilis cases in the United States suggest the need for improved surveillance methods. An outbreak detection method using reported syphilis test results, which can be counted before the conclusion of a syphilis case investigation, could lead to timelier outbreak detection.

Methods: The historical limits comparison method was used to compare the number of positive rapid plasma reagin results reported during 2011-2014 with data for the preceding 3 years.

Syphilis Time to Treatment at Publicly Funded Sexually Transmitted Disease Clinics Versus Non-Sexually Transmitted Disease Clinics--Maricopa and Pima Counties, Arizona, 2009-2012.

Delays in syphilis treatment may contribute to transmission. We evaluated time to treatment for symptomatic patients with syphilis by clinical testing site in 2 Arizona counties. Fewer patients were tested and treated at publicly funded sexually transmitted disease clinics, but received the timeliest treatment; these clinics remain crucial to syphilis disease control.

Viral Loads Among HIV-Infected Persons Diagnosed With Primary and Secondary Syphilis in 4 US Cities: New York City, Philadelphia, PA, Washington, DC, and Phoenix, AZ.

Background: Incident syphilis among HIV-infected persons indicates the ongoing behavioral risk for HIV transmission. Detectable viral loads (VLs) among coinfected cases may amplify this risk.

Methods: Primary and secondary cases reported during 2009-2010 from 4 US sites were crossmatched with local HIV surveillance registries to identify syphilis case-persons infected with HIV before or shortly after the syphilis diagnosis.

Viral loads among young HIV-infected men with early syphilis.

High rates of HIV coinfection among men with syphilis suggest HIV transmission opportunities due to biologic and behavioral risk synergy. We abstracted HIV viral loads for HIV-infected males aged 24 years or younger with a diagnosis of early syphilis (ES) in Maricopa County, Arizona, in order to evaluate HIV infectivity. During 2009 to 2012, there were 56 HIV-infected, ES cases meeting the age criteria, of whom 32 (57%) had a detectable viral load performed within 1 year of syphilis diagnosis (median 21 000 copies/mL, range 130-302 844 copies/mL).

Chlamydia and gonorrhea diagnosis, treatment, personnel cost savings, and service delivery improvements after the implementation of express sexually transmitted disease testing in Maricopa County, Arizona.

Background: The demand for low-cost sexually transmitted disease (STD) services in Maricopa County (Phoenix area) is high. Improved methods for STD/HIV testing are needed to increase the number of patients receiving testing.

Objectives: The present study sought to evaluate an STD/HIV express testing (ET) option for patients identified as being at lower risk for infection.

Protecting adolescents' right to seek treatment for sexually transmitted diseases without parental consent: the Arizona experience with Senate Bill 1309.

In 2010, Senate Bill 1309 included language to repeal an existing Arizona law that enables minors younger than 18 years of age to seek diagnosis and treatment of sexually transmitted diseases (STDs) without parental consent. Numerous implications were identified that would have stemmed from parental consent provisions originally proffered in Senate Bill 1309. These implications included diminished access to essential health services among minors, exacerbated existing health disparities, increased health-care spending costs, and thwarted efforts to curb the spread of STDs.

Needle in a haystack: the yield of syphilis outreach screening at 5 US sites-2000 to 2007.

Background: Screening for syphilis has been performed for decades, but it is unclear if the practice yields many cases at acceptable cost, and if so, at which venues. We attempted a retrospective study to determine the costs, yield, and feasibility of analyzing health department-funded syphilis outreach screening in 5 diverse US sites with significant disease burdens.

Methods: Data (venue, costs, number of tests, reactive tests, new diagnoses) from 2000 to 2007 were collected for screening efforts funded by public health departments from Philadelphia; New York City; Washington, District of Columbia; Maricopa County, Arizona (Phoenix); and the state of Florida.

Assessing compliance with a county board order for third trimester syphilis screening in Maricopa County, Arizona.

Objectives: Due to high rates of congenital syphilis, a Maricopa County board order was issued in 2003 to increase prenatal syphilis screening. The provisions of this order included prenatal syphilis screening during the first prenatal visit, to be repeated during the third trimester, and again at delivery. The purpose of the study was to evaluate syphilis screening practices and barriers to screening among obstetric providers.

Epidemiology of syphilis among Hispanic women and associations with congenital syphilis, Maricopa county, Arizona.

Objective: We investigated factors associated with high rates of congenital syphilis among Hispanic infants in Maricopa County, AZ.

Methods: Using 2004-2008 syphilis case report data from the state and county health departments, we examined characteristics of pregnant and nonpregnant women with syphilis and their male partners.

Results: During 2004-2008, 970 women were reported to have syphilis: 49% were Hispanic (of whom 49% were non-US citizens), 27% were white, 13% were black, and 8% were American Indian/Alaskan Native.

Improving partner services by embedding disease intervention specialists in HIV-clinics.

Background/objectives: Notifying partners of HIV-infected persons and referring them for testing and treatment is an effective method of disease control and identification of undiagnosed STD and/or HIV. To improve partner elicitation interviews, disease intervention specialists (DIS) were placed in 3 HIV clinics during 2008 and 2009.

Methods: We reviewed the Arizona state STD surveillance database for 2007 to identify the providers (outside of the public STD clinics) reporting the highest number of syphilis cases.

Integrating routine HIV testing into a public health STD clinic.

Objective: To integrate routine HIV testing into the services offered at a public health department STD clinic and document the rate of acceptance and rate of test positivity during the first 18 months.

Methods: Testing for HIV was added to the array of tests offered to all patients at the Maricopa County STD clinic. Patients were informed of this new option at registration and were provided with a consent form and instructions to read the form and sign it, unless they did not desire testing.