Syphilis Screening and Treatment at a Large Urban Jail

Syphilis cases have increased by 80% in the United States in the past 5 years, demanding new approaches to screening and treatment, particularly among key populations. This study aimed to assess the impact of syphilis screening in a large urban county jail, determining rates of new syphilis infections, identifying demographic groups most affected by syphilis, and assessing treatment completion rates.

Electronic health records of individuals with positive rapid plasma reagin (RPR) results during incarceration in the Dallas County Jail between April 2023 and March 2024 were reviewed. New cases were defined by either a first positive RPR, a 4-fold titer increase, or a positive result after a previously negative RPR. Data on demographics, HIV coinfection, and recent chlamydia or gonorrhea infection were collected. Treatment medication and completion (no, partial, or full) were recorded. Comparisons of proportions were performed using χ2 analysis, and data analyses were conducted using SAS OnDemand for Academics (SAS 9.4 M8).

Of 15,589 individuals tested for syphilis, 12,607 (80.9%) were male and 2982 (19.1%) were female. Among these, there were 1816 (11.6%) cases of positive test results; 815 individuals (5.2%) were newly diagnosed with syphilis: 568 males (4.5%) and 247 females (8.3%). Among those newly diagnosed, most (71.2%) were treated with doxycycline. Overall, 482 individuals (59.1%) completed treatment, 191 (23.4%) received partial treatment, and 142 (17.4%) were released before receiving any treatment.

Syphilis screening in a large urban jail identified high rates of new infections and provided an opportunity for counseling, testing for other STIs and treatment. Females and African Americans had disproportionately high infection rates. Treatment completion was similar between doxycycline and intramuscular penicillin. Future studies should focus on increasing syphilis screening, treatment, and prevention in jails and other high-incidence settings.