Intensive Screening for Gonorrhea, Syphilis, and Hepatitis B in a Gay Bathhouse Does Not Lower the Prevalence of Infection

Control of Syphilis Outbreaks in Men Who Have Sex With Men: The Role of Screening in Nonmedical Settings

“…This study also found that the cost per case identified via screening at the bathhouse was twice that from cases found in the STD clinic. 32 For the current MSM outbreak in Chicago, the cost of identifying a case of symptomatic syphilis via the "testathon" campaign was roughly $15,000. The cost of identifying 1 early and 1 P&S case via bathhouse screening was approximately $2000 and $4000, respectively.…”

Public health interventions to control syphilis

“…35 When the prevalence is low, understanding the epidemiology will help target screening to persons at highest risk. Target areas may include neighborhoods, 36 bathhouses, 37 jails, 38–40 or HIV care clinics. 34 For example, in 2011 in Seattle, it was estimated that 4% of HIV-infected MSM had acquired syphilis that year, 41 so screening MSM in HIV care settings in Seattle would be a priority.…”

“…56 However, the future of this screening approach is limited because these women will continue to test positive after they are treated. In one report, 94 (18.6%) of 505 persons tested reported they had been previously treated for syphilis, 37 so a treponemal screening test would not be helpful for them. In another report of screening in correctional facilities, over 5% of persons tested had positive treponemal and non-treponemal tests, but only about 5% of those positives were new positive tests.…”

Needle in a Haystack

“…Indeed, most other reports of screenings targeted to MSM have not discovered sufficient infectious cases to slow epidemic transmission. [6][7][8][9][10]12,[16][17][18][19][20][21] Screening may be expected to be more cost-effective when disease prevalence is high, and though syphilis has increased since 2000 (particularly in MSM), rates of P&S syphilis in the 1990s were 4 to 5 times higher than current rates. The low yield of current screening efforts may reflect differences in the population being targeted for screening as well as differences in disease burden.…”

“…[3][4][5] However, few cases have been found in other venues where high disease rates are expected, such as in venues catering to men who have sex with men (MSM). 6,7 In one review that covered 7 large US cities with MSM outbreaks, targeted screening in nonmedical settings only uncovered 132 new cases of syphilis out of 14 143 syphilis screening tests performed. 8 In King County, Washington, an analysis of health department-run syphilis control activities from 1998 to 2005 showed that the proportion of cases diagnosed through screening did not change despite intensified disease control efforts and dramatic increases in syphilis among MSM.…”