Syphilis: Predisposing, enabling, and reinforcing factors

Introduction: Prevention of sexually-transmitted infections, including syphilis, is suboptimal. While health education with respect to safer sex is necessary, it is not sufficient. As detailed in PRECEDE-PROCEED, predisposing, enabling, and reinforcing are paramount contributors to health behaviors. We sought to discover the prevalence of select factors in cases of early syphilis in two major metropolitan areas in Ohio. Methods: Using 2011 data provided by the Ohio Department of Health, we conducted a county-by-county comparison of early syphilis cases with respect to predisposing, enabling, and reinforcing factors collected by disease intervention specialists (DIS). Results: Two prevalent predisposing factors in males were: Franklin (n = 131): a) anonymous sex: 51.1%; b) use of Internet to find partners: 40%.; Hamilton (n = 129): a) anonymous: 51.9%; b) Internet: 17.8%. Two prevalent enabling factors in males were: Franklin: c) intoxication during sex: 57.3%; d) non-injection drug use: 70.2%.; Hamilton: c) intoxication: 57.4%; d) non-injection: 56.6%. One reinforcing factor was apparent in males: e) sex for drugs or money: Franklin: 5.3%.; Hamilton: 19.4%. Prevalent factors in females were (Franklin, n = 18 and Hamilton, n = 113) a) anonymous: 33.3%, 14.2%; b) Internet: 0%, < 1%; c) intoxication: 61.1%, 38.9%; d) non-injection: 66.7%, 44.2%; e) sex/drugs/money: 16.7%, 4.4%. Conclusions: Prevalent predisposing and enabling factors were found in cases of early syphilis in Ohio. Especially prevalent were: a) intoxication and non-injection drug use in both males and females; and b) anonymous sex and Internet use for partners in males. These factors need addressed in prevention activities.