NEW APPROACHES TO SYPHILIS CONTROL - FINDING OPPORTUNITIES FOR SYPHILIS TREATMENT AND CONGENITAL-SYPHILIS PREVENTION IN A WOMENS CORRECTIONAL SETTING

Background: With prostitution and drugs the most common reasons for ar rest among New York City (NYC) women, female arrestees are at high ris k for acquiring syphilis and delivering congenitally infected babies, Despite routine syphilis screening of all NYC;inmates, many are releas ed before the need for treatment is recognized, and once released, few could be found for treatment. Goals: To improve syphilis treatment ra tes among female correctional inmates in NYC. Study Design: At a women 's correctional health clinic, on-site, rapid, qualitative nontreponem al syphilis testing (STAT rapid plasma reagin [RPR]) and on-line acces s to the local syphilis case registry were introduced to supplement th e usual admission medical evaluation, Treatment decisions made using t he authors' jail protocol were compared with treatment criteria used i n NYC's sexually transmitted disease (STD) clinics, Patients consisted of a consecutive sample of 685 remandees admitted one or more times d uring the day shift, March 24, 1993, to July 31, 1993, who had a full complement of mandatory admission medical tests, Using the study proto col, syphilis treatment decisions were made and needed treatment was f urnished at the end of the admission medical evaluation, The main outc ome measures were correct identification and treatment of syphilis in this population, compared with standard NYC Department of Health (DOH) STD clinic practice, as well. as the effect of the jail protocol on p regnancy outcomes and need to treat offspring for congenital syphilis. Results: Compared with NYC DOH STD clinic practice, the study protoco l was 95% sensitive and 88% specific in arriving at appropriate treatm ent for syphilis, Treatment at the end of the admission medical evalua tion increased syphilis treatment rates from 7% to 84% of women with i ndications for treatment and to 88% of pregnant women with indications for treatment, Prospective follow-up for birth outcomes revealed no s pontaneous abortions and eight live births, Seven of the eight did not need congenital syphilis treatment because their mothers were adequat ely treated while incarcerated. Conclusions: Qualitative (or STAT) RPR testing and access to DOH syphilis case registry data provide prompt and accurate diagnostic information that can lead to an overall increa se in the number of inmates appropriately treated (with a minimum amou nt of overtreatment) in a women's correctional facility, This protocol may be applicable in other high-risk, transient populations.