Public health interventions to control syphilis

Abstract

Syphilis control strategies are old, but interventions have changed and there is now a more scientific approach to evidence of effectiveness. We searched PubMed using 'syphilis control' to identify papers that measured the effectiveness of interventions. We also included novel approaches and comprehensive responses to outbreaks. Few papers used high-quality research methodology and fewer evaluated impact on prevalence or incidence; most assessed intermediate outcomes. Syphilis can often be controlled by a combination of case finding, treatment and education. However, outbreaks are unique and ongoing evaluation is needed to see if interventions are producing intended intermediate outcomes at reasonable costs.

Figure 1.

STD Prevention System. Most interventions are evaluated for their effects on immediate outcomes such as clients cured. The impact on incidence is influenced by the stage of syphilis and the number of partners that the infected person has, factors not shown on this already complicated schema.

Figure 2.

Balancing interventions and risks. Multiple interventions usually have a greater effect than any single intervention. The impact of a particular intervention is hard to measure because disease rates are influenced by many factors that are continually changing.