High Prevalence of Syphilis Detected Through a Jail Screening Program

Abstract

Background: In June 1990, a syphilis initiative was undertaken to help control New York's most extensive syphilis epidemic since the 1940s. Methods: To evaluate the usefulness of syphilis screening in local jails, we reviewed demographic and syphilis screening data from a county jail in an area with a high prevalence of syphilis that has routinely tested incoming inmates. Results: Of 12 685 inmates, 9797 (77%) were screened for syphilis, and 321 (3.3%) had a positive test result; 258 (80%) of the positive results were confirmed. Data were available for 244 of the inmates with a confirmed positive result: 162 (67%) had newly diagnosed syphilis (overall rate, 1.6%), 112 of whom had early syphilis; 50 (20%) had been previously treated for syphilis; and 32 (13%) were unavailable for follow-up. Of 162 inmates with newly diagnosed syphilis, 122 (75%) were treated in jail, and 40 were treated after their release from jail. The median time from screening to treatment was 17 days. The median jail stay was 45 days for inmates who were evaluated for treatment vs 5 days for those who were unavailable for follow-up. Conclusions: Screening inmates for syphilis was a productive public health measure, as inmates accounted for 20% of the county's syphilis morbidity. Given the high prevalence of syphilis among inmates and the inability to reach them for treatment after release, strategies are needed to rapidly screen and treat inmates before their release from jail. (Arch Intern Med. 1993;153:1799-1804)