USING SOCIAL NETWORK AND ETHNOGRAPHIC TOOLS TO EVALUATE SYPHILIS TRANSMISSION

Background and Objectives: Partner notification has been the cornersto ne for the prevention and control of syphilis in the United States. Th is technique may not make full use of contextual data that an ethnogra phic and social network approach can offer. Goals of the Study: The oc casion of a syphilis outbreak among young people was used to investiga te the applicability of a social network approach and to test the vali dity of several traditional approaches to syphilis epidemiology. Study Design: An outbreak of syphilis was investigated by interviewing both infected and noninfected people, by directing resources based on netw ork association, by creating and evaluating network diagrams as an aid to the epidemiologic process, and by including ethnographic observati ons as part of outbreak management. Results: Diagrammatic display of n etwork growth provided a useful alternative to the traditional epidemi c curve. Case prevention was demonstrated by identifying uninfected pe ople with multiple concurrent exposures. Concurrent, overlapping expos ure in infected people rendered traditional ''source'' and ''spread'' criteria moot. Conclusions: The current discussions of partner notific ation may be informed by recognizing that it is a subset of a broader and potentially more powerful approach. This approach calls some basic tenets of syphilis epidemiology into question.