Syphilis Control Among Incarcerated Men Who Have Sex With Men: Public Health Response to an Outbreak

After the epidemic years of 1986 through 1990, rates of syphilis steadily declined in the United States to an all-time low of 2.5 cases per 100 000 population in 1999.1 Such declines led the Centers for Disease Control and Prevention (CDC) to create a national plan for syphilis elimination.2 Nevertheless, multiple areas of the United States continue to experience disease outbreaks and a resurgence of sexually transmitted diseases (STDs) among men who have sex with men (MSM).3–8 Because syphilis is increasingly characterized by sporadic outbreaks, rapid outbreak response should include enhanced surveillance of groups at high risk (e.g., incarcerated MSM). Although correctional facilities have historically been a useful setting for control of infectious syphilis through screening and prophylactic treatment,9,10 the mass screening and treatment of a population segregated on the basis of sexual orientation has not been previously reported. Los Angeles County Men’s Central Jail (LACMCJ) maintains an inmate unit that houses approximately 300 selfidentified MSM voluntarily segregated from the general inmate population. During an outbreak of syphilis among MSM,7,8 the Los Angeles County Sexually Transmitted Diseases Program (LACSTDP) initiated a syphilis control program in the MSM unit of LACMCJ that consisted of screening, mass prophylactic treatment, high-risk behavior detection, and education. The segregation of MSM from other inmates presented the opportunity to screen and treat patients with syphilis and detect risk behaviors among newly incarcerated MSM.