Selective Participation in Syphilis Partner Services and Implications for Control Efforts, Fulton County, Georgia, 2013-2015

Abstract

Background. Partner services is an important component of syphilis control, but not all persons with syphilis participate, limiting the strategy’s potential effectiveness and possibly introducing selection biases into analyses of risk factors for reinfection. This study aimed to describe demographic and clinical differences between partner-services participants and non-participants in Fulton County, Georgia, and to assess the association between participation and syphilis re-diagnosis. Methods. Using surveillance data, we identified primary and secondary syphilis cases in Fulton County with a first diagnosis in 2013-2015. We compared the distributions of demographic and clinical characteristics between participants and non-participants using chi-squared tests. We used multivariable log binomial regression to examine the association between syphilis re-diagnosis within two years and partner-services participation. Results. Among 1,067 persons with primary/secondary stage syphilis diagnoses in Fulton County during 2013–2015, partner-services participants (n=698) were younger than non-participants (n=369) (mean age: 31 vs. 34 years), and more likely to be female (7.0% vs. 2.7%) and Black (78.7% vs. 64.8%). Findings from this study suggest that the association of partner services with syphilis re-diagnosis differs by HIV status, with lower risk of syphilis re-diagnosis among men with HIV (adjusted risk ratio [aRR]=0.80, 95% CI: 0.55–1.14) but not among men without HIV (aRR=1.19, 95%CI: 0.57–2.49). Conclusions. Partner-services participants differed notably from non-participants. We encourage other health departments to conduct similar assessments to improve participation by high-risk patients.

Keywords

• syphilis
• treponema pallidum
• partner services