Syphilis outbreak assessment

Background: Syphilis rates began to decline in 1991 and have decreased every year since. In 1998, 6,993 cases of primary and secondary syphilis were reported in the United States, for a national incidence of 2.6 cases per 100,000 population. Although syphilis rates are at an historic low, focal outbreaks still occur. On October 7, 1999, the Division of Sexually Transmitted Disease Prevention of the Centers for Disease Control and Prevention, in collaboration with federal and community partners, presented the National Plan for Elimination of Syphilis from the United States. One of the five key strategies of the plan is rapid outbreak response. Methods: Methods for outbreak assessment and response were reviewed in the literature, synthesized, and adapted for use in syphilis outbreaks. Results: Key elements of outbreak assessment and response are detection, surveillance data review, hypothesis generation, intervention development, and the evaluation of clinical, public health, and laboratory services. Conclusions: Outbreak response necessitates community participation and a coordinated interdisciplinary effort to determine social and behavioral contributors to the outbreak and to develop targeted interventions.