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. 2001 Aug;91(8):1220-5.
doi: 10.2105/ajph.91.8.1220.

An outbreak of syphilis in Alabama prisons: correctional health policy and communicable disease control

M I Wolfe  1 , F Xu, P Patel, M O'Cain, J A Schillinger, M E St Louis, L Finelli
Affiliations

An outbreak of syphilis in Alabama prisons: correctional health policy and communicable disease control

M I Wolfe et al. Am J Public Health. 2001 Aug.

Abstract

Objectives: After syphilis outbreaks were reported at 3 Alabama State men's prisons in early 1999, we conducted an investigation to evaluate risk factors for syphilis infection and describe patterns of syphilis transmission.

Methods: We reviewed medical, patient interview, and prison transfer records and documented sexual networks. Presumptive source cases were identified. Odds of exposure to unscreened jail populations and transfer from other prisons were calculated for case patients at 1 prison.

Results: Thirty-nine case patients with early syphilis were identified from 3 prisons. Recent jail exposure (odds ratio [OR] = 8.0, 95% confidence interval [CI] = 0.3, 158.7, P = .14) and prison transfer (OR = 32.0, 95% CI = 1.6, 1668.1, P < .01) were associated with being a source case patient.

Conclusions: Probable sources of syphilis introduction into and transmission within prisons included mixing of prisoners with unscreened jail populations, transfer of infected inmates between prisons, and multiple concurrent sexual partnerships. Reducing sexual transmission of disease in correctional settings is a public health priority and will require innovative prevention strategies.

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Figures

FIGURE 1—
FIGURE 1—
Schematic representation of syphilis screening in the Alabama State correctional system (see text for details).
FIGURE 2—
FIGURE 2—
Early syphilis cases, by prison and month of diagnosis: Alabama prison syphilis outbreak, March 1998–March 1999 (N = 39).
FIGURE 3—
FIGURE 3—
Prison A sexual network, syphilis case patients, and selected uninfected contacts: Alabama prison syphilis outbreak, March 1998–February 1999.
See this image and copyright information in PMC

Comment in

  • Can unsafe sex behind bars be barred?
    Spaulding A, Lubelczyk RB, Flanigan T. Spaulding A, et al. Am J Public Health. 2001 Aug;91(8):1176-7. doi: 10.2105/ajph.91.8.1176. Am J Public Health. 2001. PMID: 11499095 Free PMC article. No abstract available.

References

    1. St. Louis ME, Wasserheit JN. Elimination of syphilis in the United States. Science. 1998;281(5375):353–354. - PubMed
    1. Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941–1993. Sex Transm Dis. 1996;23:16–23. - PubMed
    1. Centers for Disease Control and Prevention. Outbreak of primary and secondary syphilis—Guilford County, North Carolina, 1996–1997. MMWR Morb Mortal Wkly Rep. 1998;47:1070–1073. - PubMed
    1. St. Louis ME, Farley TA, Aral SO. Untangling the persistence of syphilis in the South. Sex Transm Dis. 1996;23:1–4. - PubMed
    1. Hammett TM, Widom R, Epstein J, Gross M, Sifre S, Enos T. 1994 Update: HIV/AIDS and STDs in Correctional Facilities. Washington, DC: National Institute of Justice, US Dept of Justice; December 1995.

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