BOX 3-1 An Effective Screening and Treatment Protocol for Syphilis in a Correctional Facility

A rapid screening and treatment protocol for syphilis was recently evaluated in New York City's major facility for medical screening of female inmates at time of admission. The protocol's strength lies in its ability to accurately identify inmates needing syphilis treatment and to provide that treatment at the time of the obligatory medical evaluation. This service, piloted by the New York City Department of Health, introduced the use of a quick screening test for syphilis (STAT RPR) and the New York City Syphilis and Reactor Registry (which includes syphilis serologic results and treatment history of New York City residents), in addition to the routine medical evaluation data (which includes pregnancy testing), to make on-site treatment decisions. Information from the STAT RPR test and from the Syphilis Registry are available to clinicians at the time of the medical evaluation. Under the protocol, treatment is recommended for women with reactive STAT RPRs (unless this individual completed treatment within the last three weeks); with evidence in the registry of previously untreated syphilis, regardless of current STAT RPR status; and, in cases of pregnancy, with registry documentation of syphilis (unless treatment was completed within the last week). This protocol resulted in an improvement of syphilis treatment rates from 7 percent of seropositive women prior to implementing the protocol to 87 percent of seropositive women and 94 percent of pregnant seropositive women after implementing the protocol (Blank et al., 1994). The protocol also resulted in treatment for women whom the New York City Department of Health had been unable to locate for treatment in the past.

SOURCE: Margaret Hamburg, M.D., New York City Department of Health, unpublished data, 1996.

York City, Philadelphia, San Francisco, and Washington, D.C.) make condoms available to inmates (CDC, 1996b). Among correctional systems with condom availability programs, there have been few or no problems with the use of condoms as weapons or to smuggle contraband (Hammett et al., 1995). Most correctional systems have a policy for notifying partners of inmates who test positive for a treatable STD if the partner is a fellow inmate. The high annual rate of turnover among prisoners, 800 and 50 percent in jails and prisons, respectively, is a major barrier to screening and follow-up treatment for STDs (Glaser and Greifinger, 1993). Follow-up of released detainees who test positive for STDs and notification of partners who are not inmates are considered to be rare.

Migrant Workers

STDs, including HIV infection, are major health problems among migrant workers (Jones et al., 1991; CDC, 1992a). In addition, lack of condom use and other high-risk sexual behaviors are common among these workers (Jones et al.,

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