207501 Dual syphilis outbreaks among MSM/Bisexual males and African American heterosexuals in Cleveland, Cuyahoga County, Ohio

Tuesday, November 10, 2009

David Bruckman, MS, MT(ASCP) , Office of Biostatistics, Cleveland Department of Public Health, Cleveland, OH
Matt Carroll, JD , Administration, Cleveland Department of Public Health, Cleveland, OH
Terry Allan, RS , Administration, Cuyahoga County Board of Health, Parma, OH
Ann Avery, MD , Division of Infectious Diseases, MetroHealth System, Cleveland, OH
David Merriman, MSW , Office of HIV Services, Cleveland Department of Public Health, Cleveland, OH
We report simulataneous outbreaks of early syphilis (i.e. primary, secondary, early latent) in Cuyahoga County among both heterosexual males and females (90% Black/African American) and the MSM/bisexual (MSM/Bi) male community of all races and ethnicities. Case counts are nearly equal between these groups.

Since the outbreak began in July 2007, 123 cases were reported up to November 2008. 94 cases were reported in 2008, a 135% increase from Jan-Nov 2007. Annualized rates in past eight months are 4.5 times greater (71 cases, 8.2 cases per 100,000) than baseline. Two-thirds of cases were Cleveland residents. Diagnoses: 10% primary, 50% secondary, 40% early latent.

Fourteen cases were youth age 14 to 19, up 250% since last year. Because Chlamydia is endemic among Black/African American female teens age 15 to 19, (10% incidence by population in 2007), direct interventions to youth are being planned.

Condom use was higher among Black/African American MSM/Bi males compared to heterosexuals, However only 15% of MSM/Bi males reported always using condoms. Interviews by Disease Intervention Specialists (DIS) provided evidence of female-to-female transmission and ‘down low' males, Black/African American and Latino, who self-report as heterosexual but reported sex with other men likely leading to infection.

City, county and state officials developed a joint Action Plan in July 2008, later expanded in January 2009. Actions include temporarily prioritizing DIS to syphilis cases over for partner notification, suggesting care providers to screen all sexually active patients, notifying media sources, LGBT (lesbian, gay, bisexual, transsexual) community and agencies funded for HIV/STI prevention.

Learning Objectives:
1. Describe dual outbreaks among different populations. 2. Compare risk behavior among groups at highest risk. 3. Assess emerging subpopulations at risk: youth age 14 to 24, lesbian females. 4. Describe city/county-wide action plan enacted.

Keywords: STD, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead biostatistician performing all epidemiological analyses and co-chaired the Working Group in presenting data to city, county and state officials and developing the Action Plans.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.