Background and objectives: The nadir in syphilis incidence in the 1950s provided evidence that current control methods could eliminate the transmission of syphilis. Planning such an effort will require information on the current state of the public and private infrastructure for the control of sexually transmitted disease (STD).
Goal of this study: To evaluate the accessibility, acceptability, and quality of delivery of clinical and preventive outreach services for syphilis control in the southern United States.
Study design: A telephone-and-questionnaire survey of the 7 largest southern city, 10 state, and 9 nonsouthern comparison state STD control programs.
Results: The gender-race composition of public-sector STD providers is very different from their clients. Median ratio of STD clinicians per 1994 infectious syphilis patient was 0.08 (0.01-0.25) in southern states and 0.50(0.07-1.00) in comparison states. The proportion of clients treated within one day of care-seeking in southern states was 58% to 100%; regions with inadequate access were common. A median of 45% to 50% of patients with presumptive congenital syphilis underwent recommended diagnostic procedures.
Conclusions: Serious deficiencies exist in the accessibility of STD care in the south that make the elimination of syphilis transmission difficult using current clinic-based diagnosis and treatment. A more community-based program of case finding and presumptive treatment may be indicated.