Report of the 

Syphilis Elimination Effort Consultation 

August 1-2, 2005 

Grand Hyatt Atlanta Buckhead 

Atlanta, Georgia 

Report prepared by the Division of STD Prevention 

National Centers for HIV, STD and TB Prevention 

Coordinating Center for Infectious Diseases 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

PUBLIC HEALTH SERVICE 

Centers for Disease Control and Prevention 

National Center for HIV, STD, and TB Prevention 
Produced by the Division of STD Prevention 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Center for HIV, STD and TB Prevention 

Centers for Disease Control and Prevention 

Atlanta, Georgia 30333 

October 2005 
Acknowledgements 

“The reward of a thing well done is to have done it.” EMERSON (1844) 

We would like to thank the many presenters, chairs, note-takers, support staff, and the meeting 

participants for their contribution to this meeting. Without your effort, it would not have been a 

success. However, true success, and indeed what we will in fact be judged by, is the ways in 

which our actions have changed. 

Suggested citation: 

Centers for Disease Control and Prevention. Report of the Syphilis Elimination Consultation, 1-2 

August 2005. Atlanta. October 2005. 
SEE Consultation Meeting. August 2005 

Content 

ACKNOWLEDGEMENTS ........................................................................................................................................1

CONTENT ...................................................................................................................................................................2

1. INTRODUCTION ..............................................................................................................................................3

2. AIMS AND OBJECTIVES ................................................................................................................................3

3. ORGANIZATION OF THE MEETING ..........................................................................................................3

PARTICIPANTS............................................................................................................................................................3

MEETING STRUCTURE................................................................................................................................................4

KEY QUESTIONS FOR THE MEETING...........................................................................................................................4

SUMMARY OF BREAKOUT SESSION DISCUSSIONS ......................................................................................................4

4. SYPHILIS ELIMINATION: CELEBRATING THE SUCCESSES AND ACKNOWLEDGING THE 

CHALLENGES ...........................................................................................................................................................5

RECENT TRENDS IN THE EPIDEMIOLOGY OF SYPHILIS IN UNITED STATES .................................................................5

OVERVIEW OF THE U.S. SYPHILIS ELIMINATION EFFORT...........................................................................................6

A SYPHILIS ELIMINATION PROGRESS REPORT FROM FOUR PERSPECTIVES: AN INVITED PANEL DISCUSSION ...........8

5. ENHANCING THE HEALTH SERVICES RESPONSE FOR SYPHILIS ELIMINATION....................11

QUICK SUMMARY ....................................................................................................................................................11

SYPHILIS ELIMINATION AND SURVEILLANCE ...........................................................................................................12

ENHANCING OUTBREAK AND INCIDENT RESPONSE..................................................................................................13

ENHANCING CLINICAL AND LABORATORY SERVICES ..............................................................................................15

ENHANCING PARTNER SERVICES .............................................................................................................................18

6. CREATING EFFECTIVE PARTNERSHIPS FOR SYPHILIS ELIMINATION......................................20

QUICK SUMMARY ....................................................................................................................................................20

TAILORED INTERVENTIONS: JAIL SCREENING ..........................................................................................................21

THE SYPHILIS ELIMINATION EFFORT AND ETHNIC MINORITIES ...............................................................................22

THE SYPHILIS ELIMINATION EFFORT AND MEN WHO HAVE SEX WITH MEN.............................................................24

THE SYPHILIS ELIMINATION EFFORT AND COMMUNITY INVOLVEMENT ..................................................................25

7. ENHANCING THE IMPLEMENTATION OF THE SYPHILIS ELIMINATION EFFORT..................27

QUICK SUMMARY ....................................................................................................................................................27

TRAINING AND STAFF DEVELOPMENT AND THE SYPHILIS ELIMINATION EFFORT ....................................................28

MONITORING AND EVALUATION FOR THE SYPHILIS ELIMINATION EFFORT .............................................................29

HEALTH CARE PROVIDER MOBILIZATION FOR THE SYPHILIS ELIMINATION EFFORT ...............................................30

EFFECTIVE LOCAL IMPLEMENTATION OF THE SYPHILIS ELIMINATION EFFORT........................................................31

8. SUMMARY OF THE MEETING AND NEXT STEPS ................................................................................32

APPENDICES............................................................................................................................................................33

THE SEE CONSULTATION MEETING AGENDA..........................................................................................................34

WORK-GROUP QUESTIONS FOR THE SEE CONSULTATION MEETING: AUGUST 1-2, 2005 .........................................36

PARTICIPANTS LIST ...........................................................................................................................................39

2
SEE Consultation Meeting. August 2005 

Introduction 

1. Introduction 

In 1999, the Centers for Disease Control launched the National Campaign to Eliminate Syphilis 

from the United States. The National Plan, developed in consultation and collaboration with 

local and state health departments, other federal agencies, private interests, and the 

communities most affected by syphilis, had as its chief goal the reduction of infectious syphilis to 

1,000 or fewer cases in the U.S. by 2005. The 1999 national plan was organized around 5 

strategies: 1) Enhanced Surveillance, 2) Strengthened Community Involvement and 

Organizational Partnerships, 3) Rapid Outbreak Response, 4) Expanded Clinical and 

Laboratory Services, and 5) Enhanced Health Promotion. At the national level syphilis 

elimination was defined as the absence of sustained transmission in the U.S. At the local level 

it was defined as the absence of transmission of new cases within a jurisdiction beyond 90 days 

of report of an imported index case. 

In the six years since the launch of the 1999 plan, the changing disease epidemiology and 

consequent shift in prevention priorities have driven the need to reframe the future direction of 

the Syphilis Elimination Effort (SEE). To achieve this, a comprehensive review of the progress 

made is required, alongside early and meaningful consultation with external stakeholders. 

2. Aims and Objectives 

The overall purpose of the August 2005 SEE Consultation Meeting was therefore to provide key 

partners with a SEE progress update, including achievements and challenges, and to solicit 

partner input for adapting implementation strategies. Specific objectives were: 

1) To provide stakeholders with an update on the current status of the SEE and 

achievements to date; 

2) To explore the nature of elimination as it applies to syphilis, including new challenges 

facing the SEE in the 21st Century; 

3) To identify best, promising and innovative practices which might be relevant to future 

SEE; and 

4) To identify new ways of framing the SEE, based on a new understanding of disease 

epidemiology. 

3. Organization of the Meeting 

Participants 

Expert consultants from both the Centers for Disease Control and Prevention (CDC) and 

external partners and stakeholders were invited to participate in the meeting. The participants 

included a wide range of individuals from a variety of disciplines and professions (see Appendix 

C). Additionally, participants were ethnically and geographically diverse, and represented both 

the public and private sector. CDC partners included colleagues external to the Division of STD 

Prevention. 

3
SEE Consultation Meeting. August 2005 

Introduction 

An introductory session 

individual 

breakout workgroup discussions.

SESSION 1 

Elimination 

SESSION 2 

Elimination 

SESSION 3 

• SEE and Surveillance 

•

•

•

• Tailored Interventions: Jail 

• SEE Interventions and Ethnic 

Minorities 

• SEE Interventions and MSM 

• SEE and Community 

Involvement 

•

and SEE 

•

•

Mobilization 

•

of SEE 

ics li

A 

Summary of Breakout Session Discussions 

i

i

Meeting Structure 

The meeting was organized into 4 sessions (see Appendix A). 

(Celebrating the Syphilis Elimination Successes and Acknowledging the Challenges) was 

followed by three sessions which focused on specific aspects of SEE review and 

implementation: Session 2 - Improving the Health Services Response for Syphilis Elimination; 

Session 3 - Creating Effective Partnerships for Syphilis Elimination; and Session 4 - Enhancing 

Implementation of the Syphilis Elimination Effort. Sessions 2, 3, and 4 also included 

 The breakout workgroup topics were as follows: 

Table 1 Breakout Session Topics 

Improving the Health Services 

Response for Syphilis 

Creating Effective 

Partnerships for Syphilis 

Enhancing Implementation of 

the Syphilis Elimination Effort 

Enhancing Outbreak and 

Incident Response 

 Enhancing Clinical and 

Laboratory Services 

Enhancing Partner Services 

Screening 

Training, Staff Development 

Monitoring and Evaluation 

 Health Care Provider 

Effective Local Implementation 

Key Questions for the Meeting 

In preparation for the meeting DSTDP staff prepared a series of background position papers 

based on each of the top sted in Table 1. Included in each of the papers was a set of key 

questions that emerged as a result of findings from the position papers. These central 

questions formed the focus of the discussions conducted during the breakout sessions. 

complete list of the key questions by topic area is included in Appendix B of this report. 

As previously noted, key questions from each of the topic areas (enhancing the health services 

response for syphilis el mination, creating effective partnerships for syphilis elimination, and 

enhancing the implementation of the syphilis el mination effort) formed the basis of the 

discussions in each of the breakout sessions. 

This report summarizes the presentations and discussions held during the consultation meeting. 

What follows is a summary of each the respective discussions under each of the topic areas. 

4 
SEE Consultation Meeting. August 2005 

Introduction 

* 

i

cases. 

percentage decrease

percentage decrease

there a decline in P&S rates (17.9%). 

i

report having sex with men (MSM). 

Since the 

* Atlanta, 

l

4. Syphilis Elimination: Celebrating the Successes 

and Acknowledging the Challenges 

Recent Trends in the Epidemiology of Syphilis in United States 

By Dr Tom Peterman 

During the 1990’s the primary and secondary (P&S) rate of syphilis decreased by approximately 

90%, and by the year 2000, the rate had reached it lowest point since reporting began in 1941.

Reported early latent syphilis cases have also continued to decline from a high of 55,397 cases 

in 1990 to 8,361 cases n 2003. However, there are recognized challenges associated with 

correctly classifying early latent cases; many of which may actually be incorrectly staged P&S 

In 2003, approximately 80% of U.S. counties reported no cases of P&S syphilis, and fully half of 

the total numbers of P&S cases in the U.S. were reported from only 18 counties and 1 city. 

Despite increases in P&S syphilis among men, between 1991 and 2003, the average yearly 

 in P&S syphilis rate in women was 21.4%, and the average yearly 

 in the congenital syphilis rate was 17.2%. The U.S. syphilis epidemic, 

although a long-standing health disparity for African Americans, by 2003 was down from 44:1 to 

only 5.2 times greater than the rate among whites. In 2003 only among African Americans was 

Table 2 illustrates the percent changes in P&S rates 

across U.S. racial/ethnic groups during 2002-2003. 

Table 2. Percentage change in P&S Rates 2002-2003 

Racial/Ethnic Group % Change in P&S Rates 2002-2003 

African Amer cans 17.9% decline 

Asian/Pacific Islanders 25% increase 

Hispanics 20% increase 

American Indians/Alaska Native 38.1% increase 

Whites 25% increase 

Unfortunately a significant factor in the reduction of the syphilis health disparity between African 

Americans and whites is attributable to the increasing rate of P&S syphilis in white men who 

Based on provisional data from 2003-2004, it is estimated 

that more than 60% of infectious syphilis cases are in men-who-have-sex-with-men. 

late 1990’s almost simultaneously there have been increases in syphilis cases among MSM in 

large cities across the U.S. A large proportion of these persons, whose median age is in the 

mid-30s, are also infected with HIV. 

 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2003. 

GA: US Department of Hea th and Humans Services, September 2004. 

5 
SEE Consultation Meeting. August 2005 

Introduction 

Associated with the recent syphilis outbreaks in MSM is the growing epidemic of crystalmethamphetamine abuse. As an example, during the consultation meeting it was noted that in 

the last month, 30-40% of infectious syphilis in San Francisco involved crystalmethamphetamine use. Other participants also expressed concern that they may be seeing an 

emerging problem with syphilis infections and crystal-methamphetamine abuse in 

heterosexuals. 

Overview of the U.S. Syphilis Elimination Effort 

By Dr Kevin Fenton 

Syphilis remains easily preventable and readily curable. Infectious syphilis rates remain very 

low and relatively geographically concentrated. Eliminating infectious syphilis would: 1) improve 

infant health, 2) reduce HIV transmission, 3) reduce health care costs, 4) eliminate a longstanding health disparity in the U.S., and 5) strengthen U.S. public health capacity. Building on 

the lessons learned from past syphilis prevention and control efforts, the 1999 National Plan to 

Eliminate Syphilis from the U.S. had as its primary goal the reduction of P&S syphilis cases to 

1,000 or fewer and to increase the number of syphilis-free counties to 90% by 2005.† The 1999 

plan, developed in collaboration with state and local partners, was organized around 5 key 

strategies: 1) enhanced surveillance, 2) strengthened community involvement and 

organizational partnerships, 3) rapid outbreak response, 4) expanded clinical and laboratory 

services, and 5) enhanced health promotion. The 1999 plan called for new STD prevention and 

control measures, such as more active participation of affected communities in intervention 

efforts, combined with intensified more traditional approaches, such as partner notification and 

rapid outbreak deployments enhance local outbreak response. 

Since the launch of the 1999 campaign, there have been important gains made in the 

prevention and control of infectious syphilis. The numbers of cases in women and in African 

Americans have continued to decrease every year, and congenital syphilis, which peaked in 

1991, has declined by more than 90% in 2003. In general, Syphilis Elimination has meant 

additional fiscal and staff resources, increasing access to quality STD screening, treatment, and 

health education services. Since 1999, CDC has invested more than 107 million dollars in the 

Syphilis Elimination Effort (SEE). SEE funding is approximately at $18 million for 2005. 

Between 2000 and 2003, 36 comprehensive Syphilis Elimination Program Assessments‡

 of 

health department syphilis elimination activities were conducted and there have been 11 Rapid 

Response Team§

 deployments to local communities. 

Despite the significant gains made towards eliminating syphilis in the U.S. since 1999, there are 

important challenges to achieving elimination. The overall number of cases of P&S syphilis did 

increase between 2000-2003, due mainly to increases in men, associated with the syphilis 

outbreaks in MSM in large urban areas across the U.S. Maintaining syphilis elimination 

†

 Centers for Disease Control and Prevention. The National Plan to Eliminate Syphilis from the United 

States. Atlanta, GA: US Department of Health and Human Services, October 1999. 

‡

 Centers for Disease Control. The syphilis elimination program assessment and findings monograph: 

“Lessons Learned”. Atlanta, Ga: U.S. Department of Health and Human Services, 2005. 

§

 Centers for Disease Control and Prevention. Rapid Response Team Procedures. Atlanta, GA: US 

Department of Health and Human Services, November 2003. 

6
SEE Consultation Meeting. August 2005 

Introduction 

momentum in the initially targeted populations of heterosexual minorities while expanding efforts 

to respond to newly affected groups, such as MSM, is likely to be a challenge in a time of limited 

resources. Additionally interventions which have been relatively successful in heterosexual 

minority communities may not translate effectively to MSM groups. As an example, the term 

elimination may need to be changed to eradication to more effectively mobilize recently affected 

gay communities. Specifically tailored interventions may require further tailoring for ethnic and 

cultural differences in gay-identified MSM and non-gay-identified MSM. And given the current 

co-infection rate of HIV and syphilis in MSM groups in particular, it is likely that there will be 

interactions between HIV and syphilis that result in the altered natural history of syphilis and 

reduced effectiveness of syphilis treatments, in addition to the enhanced transmission of HIV. 

New community partners may require a more holistic approach to health if they are to fully 

engage in the elimination effort. It will be important to review and potentially reframe the 

Syphilis Elimination Effort (e.g., health disparity affect vs. HIV viral load affect). 

Additionally, with the ever increasing use of rapid tests for HIV infection, there is a pressing 

need to develop and use effective rapid tests for syphilis, since such tests as OraQuick can act 

as a barrier to syphilis testing which requires a blood sample. A rapid test could enable more 

syphilis screening in a variety of traditional and non-traditional settings, although it is imperative 

to regularly evaluate the effectiveness of these screenings activities. 

Eliminating syphilis requires ongoing commitment and resource investment. Early budget 

estimates for a national syphilis elimination effort were set at upwards of $80 million annually 

and the federal portion of this budget was estimated to be at approximately $37-39 million 

annually. Despite increases in the federal resources the estimated annual budgets were not 

achieved, and currently increases in federal funding is still more limited. In general the CDC 

operating budget has decreased, and state and local budgets have decreased as well. 

The Syphilis Elimination Effort exists within a context of competing public health priorities, and 

greater community level advocacy will be needed to garner resources to continue to support 

syphilis elimination activities adequately. Further, to be effective an elimination initiative will 

involve meaningful collaboration among key stakeholders, such as community opinion leaders, 

STD program managers, and affected community members. Perhaps too there is a need 

promote further integration of STD and HIV prevention and control efforts in general. Crosstraining for health department and community-based organization staff could result in improved 

health promotion broadly. Indeed the restructuring currently underway at CDC may actually 

advance this level of program integration. 

7
SEE Consultation Meeting. August 2005 

Introduction 

A Syphilis Elimination Progress Report from Four Perspectives: 

An Invited Panel Discussion 

The meeting also featured a moderated panel discussion, comprised of 4 panelists drawn from 

the Division of STD, state and local health departments, and an academic institution. The 

discussion was organized around 4 central questions (one per panelist). Table 3 lists the 

questions and the respective panelist assigned. 

Table 3 Panel Discussion Questions 

Question Panelist 

1. Given competing issues and priorities, why should syphilis Susan DeLisle, Division of STD Prevention 

elimination remain a top priority for CDC? 

2. Given recent increases in STDs among men who have sex Dave Novak, Massachusetts Department of 

with men (MSM), is eliminating syphilis among MSM a Health 

valid goal? What should we doing to achieve syphilis 

elimination in MSM? 

3. What impact would rapid (point-of-care) tests make on Sheila Lukehart, University of Washington 

syphilis elimination activities? How can we expedite their 

implementation in the U.S. setting? 

4. What is the role of affected community participation in Stephanie Bailey, Metro Public Health 

syphilis elimination? Should 30% of available funds still Department of Nashville/Davidson County 

be earmarked for community organizations? 

As part of the panel discussion audience participation was encouraged. What follows is a 

summary of the discussions around each of the questions. 

1. Given competing issues and priorities, why should syphilis elimination remain in a top 

priority for CDC? 

Syphilis elimination should remain a CDC priority. Much has been invested in the effort 

thus far, and without these efforts it is likely that the U.S. syphilis epidemic would have 

worsened. It is important to note that U.S. STD programs have never had the luxury of 

looking at one disease. Competing priorities are to be expected. Efforts should be 

expanded to address the emerging disease among men-who-have-sex-with-men. 

Programs will need to examine what works and what does not. Interventions used in the 

past may not be appropriate now. There will be increased costs, yes, but disease 

elimination is a costly undertaking. It is important to be efficient and effective in resource 

allocation, but it is also important to measure the intangible benefits that may not be 

counted in cost-effectiveness formulas. And it would not be appropriate to risk “pitting” 

affected communities and groups against each other for limited resources. 

CDC should leverage CDC’s “clout” and perhaps provide incentives to private companies 

for support, particularly as it relates to the development of a rapid syphilis test. In general, 

8
SEE Consultation Meeting. August 2005 

Introduction 

public health practitioners at all levels should be thinking of more effective ways to use the 

limited funds available. As another example, CDC could lead the way in providing 

incentives to Disease Intervention Specialists (DIS) such as improved training that leads to 

professional certification, similar to what is currently done for those in the medical 

profession. The certification core competencies could include provider visitation, and lab 

visitation, etc. 

In the Syphilis Elimination Effort there should not be a clash between history and the 

present. There are valuable lessons to be learned from the past and important innovations 

emerging now. Syphilis elimination can inform other STD program prevention efforts, 

including those aimed at preventing HIV. There should be careful consideration of the 

heterogeneity across the groups of persons who are at increased risk for syphilis. There 

should be no marginalization of one group over another, and again no encouraged 

competition for the public health response. “When the syphilis elimination effort is 

successful, this will be the most cost effective disease elimination in history.” 

2. Given recent increases in STDs among men who have sex with men (MSM), is 

eliminating syphilis among MSM a valid goal? What should we be doing to achieve 

syphilis elimination in MSM? 

Eliminating syphilis in MSM is a valid goal. However it cannot be “business as usual.” To 

effectively control and prevent syphilis in MSM, STD programs will need to move forward, 

finding more positive ways to intervene. For example, although the current ISTDI 

intervention model is effective with many MSM, for some others the model could be 

perceived as manipulative and victimizing. MSM, after all, are not a monolithic group. 

Prevention materials that assume uniformity are likely to be less effective. This 

heterogeneity in MSM could also be important for the quality of syphilis surveillance. For 

example, perhaps surveillance systems should also be able to capture transgender status, 

in addition ethnic identities such as Afro-Caribbean. In general disease intervention 

specialists need training to improve cultural competency for interactions with MSM. They 

need specialized tools to work in different intervention venues. It could prove very valuable 

to observe the DIS staff who are more effective in their partner interview encounters with 

MSM to ascertain what makes these interactions more effective. How does the more 

effective DIS staff person gain the confidence of MSM clients such that they are able to 

learn the names of sexual partners who may be at risk for syphilis? 

It is important to identify MSM gathering places as well as identify where MSM seek testing 

services. MSM are being tested at private providers in private practice. STD programs will 

need to better identify the key private doctors and work more effectively with them around 

such issues as sexual risk assessments and sexual risk reduction counseling. Achieving 

syphilis elimination in MSM groups is also likely to mean addressing social prejudice and 

discrimination directed towards MSM, in much the same way achieving syphilis elimination 

in African Americans had to address racial prejudice, discrimination, and ongoing health 

disparities. Involving relevant MSM-serving community-based organizations in the effort is 

one means of building trust with MSM populations. 

 It is also critical to more fully understand the role of the Internet in sustaining the U.S. 

syphilis epidemic. A number of health departments are making use of the Internet as a 

means to raise awareness of syphilis, promote testing, and facilitate partner notification, 

however many use weak wording such as you may have been exposed to a STD for 

partner notification purposes; or use a false profile to provide health education information. 

9
SEE Consultation Meeting. August 2005 

Introduction 

It may be better to be honest and use the health department’s true profile. Increased use of 

the Internet is likely to mean more collaborative partnerships with the private sector, such 

as with Manhunt.com. The Massachusetts State Health Department STD program has 

developed a toolkit for mobilizing providers serving MSM, as well as a guide for working 

with Internet Service Providers such as Manhunt.com. 

3. What impact would rapid (point-of-care) tests make on syphilis elimination activities? 

How can we expedite their implementation in the U.S. setting? 

A test for distinguishing treated vs. untreated syphilis would be great. Robert George, a 

microbiologist at the CDC is currently working to identify antigens that can be used for such 

a test. The point-of-care tests may have a place in very low resource areas but 

interpretation (of these tests) is going to be a very big issue. These tests will stay reactive 

even in people who have been adequately treated which may lead to unnecessary 

treatment. A rapid VDRL-based test would be better than the existing treponemal tests 

because of this issue. However, in the antenatal clinic setting in developing countries, there 

are social implications of telling a woman that she has syphilis if, in fact, she does not have 

active disease. Her husband may accuse her of having sex with others; he may kick her 

out of the house, he may kick her. This is an issue that public health practitioners and 

program planners, in the U.S., may not fully appreciate. 

4. What is the role of affected community participation in syphilis elimination? Should 

30% of available funds still be earmarked for community organizations? 

Based on the Nashville/Davidson County experience, community partnership and 

mobilization is an essential component. Communities need to select local leadership to 

support and sustain efforts regardless of funding increases and decreases. The mayor of 

Nashville has publicly supported the syphilis effort and there has been an integration of 

syphilis into other programs to “make the money stretch.” Nashville/Davidson’s County local 

public health infrastructure is stronger because of the SEE collaborations. Integration has 

been essential in improving the quality of syphilis elimination services. 

Syphilis rates have declined in Nashville/Davidson County. The successes in syphilis 

prevention and control are attributed to the health department’s proactive approach to 

partnerships with affected communities. In the past that has primarily meant partnerships 

with African American heterosexual groups, however recently the partnerships have been 

expanded to include MSM, to better understand MSM populations and their risks for syphilis, 

and HIV, as well as other STDs. 

The one critical lesson the local program quickly learned is the important role of the private 

healthcare sector for preventing and controlling syphilis in MSM. As an example, 

approximately 349 cases have recently been reported from the private sector, and because 

many of these cases had not been entered into their system initially, some have gone 

without standard partner notification follow-up. Health departments are encouraged to 

enter into MOA’s with community agencies, hospitals and clinics and with one another to 

create a local standard of care. Such an approach could ensure the appropriate prioritization 

of needs and community mobilization activities around specific issues as they happen. This 

kind of partnering should include diversified funding streams versus single-source resources 

and promote suitable levels of funding flexibility to enhance more effective program planning 

and implementation. 

10
SEE Consultation Meeting. August 2005 

Enhancing the Health Services Responses 

5. Enhancing the Health Services Response for 

Syphilis Elimination 

Quick Summary 

Box 1. Suggestions for Enhancing the Health Services Response for Syphilis Elimination 

Strategy: Suggestions for enhancement 

Surveillance: • Ensure evaluation and epidemiological skills at the local level 

• Ensure adequate local training available for NEDS 

• Examine surveillance indicators at local level 

• CDC to mentor and support local epidemiologists, provide guidance and TA 

• Develop ready-reckoner to easily assess functioning of local surveillance systems 

• CDC to work with CSTE to support local areas and provide TA and build capacity 

• Make gender of sex partner reporting a performance measure. 

Outbreak and incident 

response 

• Project areas and CDC must be clear about what constitutes an outbreak. 

• CDC should create an outbreak response plan template 

• Good disease and behavioral surveillance are key to inform the outbreak plan 

• Guidance is needed to assist project areas to determine outbreak thresholds 

• A “best practice” model is required to help program areas develop outbreak plans 

• Outbreak plans should identify resources for surge capacity 

• Project areas should be encouraged to collaborate regionally 

• CDC should provide guidance for local STD programs on testing outbreak plans 

Clinical and laboratory 

Services 

• Recognize that an increasing proportion of cases are being diagnosed in the 

private sector – especially MSM. 

• Do not lose sight of the heterosexual epidemics and the need to provide culturally 

sensitive services to pregnant women and in venues where cases are found 

• Encourage medical schools to include STD in their curricula 

• STD programs should work with community partners to advocate for their services 

• Health departments should aim for maximum efficiency of their services e.g. by 

improving utilization of resources or patient flow. 

• Health departments should create robust and innovate partnerships with private 

practitioners e.g. STD training, regular liaison, grand rounds, online courses 

Partner Services • CDC should educate health department partners about HIPPA guidelines as they 

apply to partner services 

• Clustering is a good tool for long-term use by more experienced DIS, however 

standardized training is required 

• CDC should take the lead in improving DIS training including competency based 

straining and professional certification. 

• Although PN in non-health department settings is important, it may be costeffective to assign HD employees to non-traditional sites 

11
SEE Consultation Meeting. August 2005 

Enhancing the Health Services Responses 

Syphilis Elimination and Surveillance 

Question 1: What steps can be taken to improve surveillance and epidemiologic capacity 

locally in the short- and long-term? 

It is critical to ensure the efficacy of evaluative and epidemiological skills at the local level in 

order to support any national surveillance system. “Any national system is only as good as 

the local system that feeds it.” To collect appropriate surveillance information and to 

correctly analyze, interpret, and disseminate it, project areas must have appropriate 

epidemiologic expertise on staff and opportunities for epidemiologic training so that such 

expertise may be enhanced over time. Innovative approaches for training and career 

development of STD surveillance personnel should be developed and supported at the 

national level and local levels. Some approaches may include these: providing training for 

health department personnel in a variety of program areas (e.g., STD, HIV, or 

communicable diseases) and public health disciplines (e.g., epidemiology, biostatistics, and 

program management), to improve the capacity of existing personnel to conduct effective 

surveillance; using a variety of training approaches (e.g., rotation of staff through “model 

programs,” distance learning, train-the-trainer programs, teleconferencing, data analysis 

workshops); and encouraging NCSD and CSTE to work with CDC to help provide technical 

assistance to STD prevention programs that have a limited capacity to conduct syphilis 

surveillance. 

The implementation of the National Electronic Disease Surveillance System (NEDSS) and 

specifically the sexually transmitted disease program area module (STD PAM) will require 

that State and Local control programs have staff that is adequately trained in information 

technology system and surveillance policies and principles. Epidemiologic expertise is 

necessary to help ensure that syphilis surveillance data are collected systematically, data 

are analyzed and interpreted appropriately, and that surveillance findings are disseminated 

effectively to promote the elimination of syphilis transmission. 

Important to all of this is sufficient funding for surveillance that will also support solid 

surveillance infrastructure. Additionally consistent use of case definitions would greatly 

improve surveillance, both domestically and internationally. In some locations there seems 

to be a disconnect between case reporting and case definitions. One example of this is the 

reporting of cases (a completeness issue) versus reporting the treatment or non-treatment 

of cases. 

Question 2: What measures should be taken to monitor adequacy of surveillance 

activities? 

Currently CDC has minimal capacity to routinely and systematically assess the quality and 

usefulness of local surveillance data, nor does CDC request that such assessments be 

conducted locally. However, the quality of national surveillance data and its consequent 

usefulness is only as good as the quality of the data collected locally. 

Examining surveillance indicators at the local level would inform the national and local 

stakeholders. CDC needs a means of assisting local programs to provide incentives for 

12
SEE Consultation Meeting. August 2005 

Enhancing the Health Services Responses 

improved provider reporting. Local programs and CDC should work together to ensure that 

data is reported and analyzed in a timely manner to make it more useful for local efforts. 

Perhaps providing specialty certifications associated with quality case reporting and 

surveillance would encourage better case surveillance from private providers. There may 

be value in making syphilis a Health Plan Employer Data and Information Set (HEDIS) 

measure to promote better private provider reporting. CDC may want to explore medical 

coding standards for syphilis and ensure that private providers are educated about the legal 

parameters for reporting. CDC could possibly mentor and support local epidemiologists to 

build capacity. 

 A simple ready-reckoner is needed that can identify if the surveillance system of a 

jurisdiction is working effectively. This could be in the form of a check-list to assist in 

ascertaining what a surveillance system needs to do and how well it is capturing necessary 

data. This could possibly be done annually. Such a check-list could be used as an audit 

tool. Audit results could be linked to funding awards. 

However, it was also recommended that CDC guide versus direct programs in the field 

related to surveillance. Perhaps identifying a CDC epidemiological person to provide 

technical assistance and support for surveillance activities in the field would be very useful. 

In general raising the level of importance of local surveillance in the CSPS announcement 

and encouraging DSTDP leadership/managers to support local surveillance advancement 

is important. However, it was also recommended that CDC guide versus direct programs in 

the field related to surveillance. Identifying CDC personnel with surveillance and 

epidemiological expertise to provide technical assistance and support for local surveillance 

activities in the field would be very useful as better surveillance guidance is needed. 

DSTDP program consultants and epidemiologists could conduct joint site visits to support 

local program surveillance efforts. In addition, the Council of State and Territorial 

Epidemiologists (CSTE) may be useful in supporting, providing technical assistance, and 

building capacity for local STD surveillance programs. 

Question 3: What steps can be taken to improve the collection of gender of sex partner 

information for all (>90%) early syphilis cases? 

Reporting the gender of the sex partners is mandated for syphilis, but it is not being 

consistently collected. The chief recommendation is to make this is a surveillance 

performance measure. Soon CDC will require reporting the “sex of the sex partner” which 

could then include the option of transgender. It is unclear if it would also include a 

specification of either male-to-female or female-to-male. 

Enhancing Outbreak and Incident Response 

Question 1: Are there elements of outbreak response or development and 

implementation of an outbreak response plan that are not being currently addressed? 

Defining an Outbreak. Project areas and CDC need to be clear about what constitutes an 

outbreak. How should project managers decided if they are experiencing an outbreak in 

their jurisdiction? Nationally there is limited consensus about when to apply the term 

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Enhancing the Health Services Responses 

“outbreak” for syphilis. When a definition is established then a program is ready to develop 

an outbreak response plan or plans as warranted. Participants urged CDC to create an 

outbreak response plan template. 

Quantitative and Qualitative Surveillance. Project areas must have good disease and 

behavioral surveillance in order to inform the outbreak response plan. The disease 

surveillance data must be analyzed periodically (e.g. monthly or quarterly) to determine if 

there are significant changes in morbidity. In addition to disease surveillance, project areas 

are strongly encouraged to include qualitative surveillance from observations conducted in 

community based settings with gatekeepers or opinion leaders who could have more 

intimate knowledge of populations who are at risk. 

Setting the Threshold. Although thresholds must be determined locally and are likely to vary 

from one locale to the next, guidance is needed to assist project areas to determine their 

outbreak thresholds. 

An Integrated Approach to Trend Analysis. Outbreak response plans need to include an 

integrated approach to conducting trend analyses to determine or evaluate syphilis morbidity 

trends. This could be achieved by integrating other socioeconomic indicators (e.g. 

substance use, teen pregnancy, and unemployment) in a comparative analysis with 

increase (or decreases) in syphilis morbidity. 

The Need for a Best Practices Model. A “best practice” model could provide project areas 

with much needed structure for developing outbreak response plans. The CDC needs to 

review the outbreak response plans and work with project areas to identify those plans that 

are best in addressing the specific standards. 

 Surge Capacity. Outbreak response plans should include information or elements that 

describe surge capacity for addressing an outbreak. 

Enhanced Program Activity. Project areas are encouraged to have cross-district 

collaboration by sharing information between neighboring states. The information might 

include such things as: increases in syphilis morbidity; peer-to-peer technical assistance in 

disease investigation, and surveillance. 

Identifying Protective Factors. Project areas need to determine those “protective factors” 

(i.e. biological, psycho-social, environmental, and social-cultural risk factors) that minimize 

or reduce the risk of certain populations for infectious diseases. 

Question 3:How can project areas periodically “test” and evaluate the outbreak response 

plan? 

It is important to note that there may be significant differences between testing the plan for 

operation and evaluating the plan for effectiveness. That noted, many project areas do not 

currently have the sophistication to test the outbreak response plan. Some project areas 

are using the outbreak response plan as a working document and have not tested the plan. 

In general, guidance is needed from CDC on how best to test an outbreak response plan. 

As part of this guidance, CDC should create a template for evaluating the outbreak 

response plan. Some participants wondered about the value of testing a project area’s surge 

capacity. 

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Enhancing the Health Services Responses 

Project areas should assess the capacity of an outbreak response plan to allow flexibility for 

local adaptation. It would be helpful if there was a list of national standards that all project 

areas could use. It was also suggested that project areas test their plans using a public 

health prevention model, which includes: 1) defining the problem, 2) identifying causes (i.e. 

risk and protective factors), 3) developing and testing interventions, 4) implementing 

interventions, and 5) evaluating interventions. 

Question 4: What criteria should be used to determine when an outbreak has ended? 

The CDC should provide guidance for defining the end of a syphilis outbreak. There was 

consensus among the participants that rather than establishing an endpoint it may be more 

useful to determine when an outbreak has become endemic. As an example, one location 

has been in an outbreak mode for five years. The outbreak has become “business as 

usual.” Could this then be considered endemic? It was also suggested that a program 

should compare deterministic cases versus probable cases and include variances of all 

factors associated as part of the criteria. DSTDP might want to contact TB and HIV to learn 

how they define the end of an outbreak and assess the applicability to syphilis. 

Enhancing Clinical and Laboratory Services 

Question 1: How has the need for clinical services changed with the shift in the syphilis 

epidemiology and how can we efficiently respond to these needs? 

Traditionally, STD diagnosis and treatment has occurred in publicly-funded STD clinics, 

however increasingly this is changing to include more involvement of private providers, 

particularly as it relates to MSM groups. As an example in Chicago, 75% of syphilis cases 

are reported by private providers. While it is important to note the growing role of private 

providers, it is critical to note too that in a number of these practices there are no stat labs, 

no darkfields, and sometimes even treatment is inadequate. Private sector providers may 

even need training to become more comfortable with asking their patients sexual behavior 

assessment questions. Encouraging medical schools to include STDs in their curricula 

could improve the quality of STD care broadly. 

Changes in the populations affected by syphilis require adaptations in the way STD services 

are delivered. In addition to appreciating the growing role of private providers, there may 

also be a growing need to provide STD outreach services that involve non-traditional 

settings (e.g., mobile vans, bars/clubs or correctional settings) and during non-traditional 

hours (e.g., evenings or weekends). Effective clinical interventions will require cultural 

sensitivity to and competence with different populations (e.g., MSM, ethnic minorities). In 

one example a participant described an outreach intervention to young MSM (18-25) in club 

setting, which requires an ongoing collaboration with a private business partner. The 

intervention utilizes a mobile van where clients can obtain tests for syphilis, gonorrhea, 

Chlamydia, and HIV. As an incentive, persons who test for syphilis get a reduced entry 

pass to club. The hours of operation require dedicated staff willing to work as late as 3 a.m. 

on Saturdays. Outreach screening is popular approach to expanding clinical services to 

reach those at highest risk, however it is critical to monitor yield from such activities. For 

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example, it was reported that in the “8 Cities Project” 14,000 syphilis tests were conducted 

and less than 1% were reactive (23 cases). 

And although there is a growing syphilis epidemic in MSM, the fact remains that there is still 

syphilis in women, and there are still congenital syphilis cases, and there are important 

demographics shifts in these populations as well. Many at-risk women may be delivering 

their babies in suburban hospitals and practitioners in these settings may be in need of STD 

clinical training particularly as it relates to syphilis prevention and control. Additionally there 

are significant border issues to consider, especially in the Southwest and western United 

States. Some Mexican mothers actually cross the boarder to deliver, but do not remain in 

the hospital long enough to get syphilis test results. They return to Mexico and the mother 

and baby go untreated. 

Question 2: How do we ensure sustained clinical services for underserved populations? 

Although there was general consensus regarding the crucial role of outreach for syphilis 

elimination, it was also noted that while an individuals may take a test on a mobile van, that 

same person may not come back for the results. In these situations, in particular, the DIS is 

critical to locating the person and providing treatment. The goal should be ensuring the 

continuity and quality of care. STD is primary care, as one participant stressed, and so it is 

essential to expand the health care network by recruiting primary care providers to the effort. 

In some instances free health care may be available to persons who are at risk for syphilis, 

and in other instances it may be necessary for the local public health department to pay for 

testing and treatment supplies to better ensure the provision of quality of STD services. In 

addition to primary care providers, STD services should be available in HIV care settings 

and in substance abuse treatment centers. The continuity of care should be ensured. 

Ensuring the continuity of care is likely to involve a variety of partners and advocates, going 

beyond just healthcare providers. CDC does not directly fund clinical services, and a 

number of states are experiencing large budget deficits which results in competition for 

limited resources. Partners could advocate at the local and state levels for resources 

needed to sustain care. Otherwise there may be a real risk of decreasing access to STD 

care. Already in some larger cities there is only one STD clinic. In addition to the limited 

resource issues are macro level policy issues that can also affect the accessibility of 

services. For example, in some locations immigration laws prevent persons from accessing 

STD care. Ensuring the provision of services to underserved persons will likely mean 

educating policy makers and other government officials about these important needs. In 

another example, a participant described how it was a city alderman who got involved in an 

STD clinic closing. This alderman was able to get the clinic reopened. 

Finally, it is critical for health departments to maximize the efficiency of clinic operations. 

This is likely to mean developing innovative ways to improve patient flow. As an example, in 

one location where they were experiencing significant staffing shortages the clinic managers 

established a procedure of conducting risk assessments of patients to determine who would 

receive a full examination or shortened one. This improved clinic capacity to serve more 

persons. The risk assessment process has now been expanded to 10 centers in the area. 

In another example, in another city, the STD clinic patients are registered initially and given 

a later time slot to come back for their physical exam. This decreased waiting room time 

and clinic congestion. 

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Question 3: How can we improve testing, diagnosis, and reporting by private providers? 

How do we better target guidance to the appropriate provider populations? 

Although some providers are aware that they can call their respective local health 

departments for assistance, further improvements in the quality of STD care by private 

providers may need to begin with consultations with these providers. Health departments 

may also want to develop liaisons private providers and laboratories to promote syphilis 

screening and reporting. As several participants noted, it is critical to offer STD training to 

private providers. One health department described a poster-based training for local 

physicians to use in their examination rooms. Conducting regular grand rounds around STD 

in general and syphilis in particular is an essential means of providing training to private 

providers. To further encourage private providers to participate in the elimination effort 

CMEs and CMUs could be offered for syphilis and STD courses taken online. Physicians 

often go online to look up information. Also syphilis lab testing could be expedited through 

the use of electronic reporting of results. However, although electronic lab reporting could 

make it is easier to get reports, private providers will still need to be contacted to get more 

information regarding the patients. 

In addition public health departments may also need to pay for syphilis testing and 

treatments to encourage private providers to test for syphilis. In one example a local health 

department offers to provide laboratory services at cost to providers and as a result private 

providers conduct more syphilis testing. In another example, state health department 

reportedly works with pharmaceutical company representatives to help reinforce STD 

reporting rules. CLIA waivers for private clinics could also facilitate more frequent use of 

syphilis RPRs and Darkfields. And private providers could also benefit from raised 

awareness about substance abuse and mental health challenges in their patients. It would 

be helpful to at-risk persons to provide related referrals for these problems, or at least have 

information available in private medical settings. 

Question 4: Is the quality of lab testing for syphilis in the United States adequate to 

support the objectives of the SEE strategy? 

There are significant challenges for syphilis elimination that are associated with the quality 

of laboratory testing for syphilis. Principally there is a great need for a test that can tell if the 

positive result is indicative of a new infection or previously treated one. Another cited 

challenge is the confusion that results from using a treponemal test used as as a screening 

test. In particular, the IgG is of special concern for mothers. Even when physicians order an 

RPR, there is still the question of what to do. Many pediatricians, for example, do not know 

how respond to these tests (i.e., should they treat the infant or not), since the mother could 

have been treated for syphilis many years ago. There is a need for treatment guidelines to 

address this problem, as it has become a major issue in some areas. 

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Enhancing the Health Services Responses 

Enhancing Partner Services 

Question 1: What level of collaboration can be expected among jurisdictions conducting 

partner notification? What will CDC contribute? This applies to sharing strategies, and 

to sharing data and resources for evaluation. 

There was consensus that collaboration is very much needed across the board. STD 

directors should be working with chronic disease directors, and other state health affiliate 

groups for example. In general out-of-state investigations often do not produce good 

returns, with respect to the proper disposition of syphilis cases. There was a general 

consensus that HIPAA could be a barrier to collaborative provision of partner services 

across jurisdictions. It was recommended that CDC take the lead in educating health 

department partners about HIPAA guidelines as they apply to Partner Services. It was also 

recommended that every state have a mobile staff that is ready to not only provide 

increased support to their own district in a syphilis outbreak situation but also for 

neighboring jurisdictions. In some instances, it was observed, DIS might close syphilis 

cases without sufficient follow-up because the clients are mobile and do not reside in a 

specific jurisdiction. It was also noted that there may be many missed opportunities for 

collaboration across jurisdictions as it relates to mobile clients who make use of the Internet 

to meet partners. 

The new SEE needs a major paradigm shift with consideration of the following issues: 1) 

integration of private providers; 2) addressing substance abuse, HIV services, and family 

planning; 3) developing intervention efforts that are more venue-based to promote screening 

and testing, and less partner-information based; and 4) sharing best practices and program 

successes. SEE needs more holistic approaches towards Partner Services, such as 

clustering, Internet and venue-based as opposed to name-based. Partner Notification 

policies and procedures should vary based on online partner notification versus field partner 

notification. Internet contact tracing should be added to community-based organization 

training. Clustering is a good tool for long-term use but the start-up costs can be a barrier. 

Clustering is perhaps best used by more experienced DIS, and standardized training in the 

method may be required for the process to be more effective. Challenges to the quality of 

Partner Services include: 1) low and inconsistent salaries; 2) the high turnover rate in DIS 

staff around the country; 3) the current DIS employee performance measures which 

contribute to lowered staff morale; 4) current perceptions that training is an added 

responsibility, duty, a task that is often burdensome; and 5) the need for increased DIS 

cultural competence and sensitivity to the changing affected populations. 

CDC should take the lead in promoting the professional status of DIS by improving DIS 

training. Much of the DIS training has remained essentially the same for the past 15 years. 

As an example, the 1992 PCRS manual appears outdated. It may be time to assess the 

skills of DIS, leading to the development of competency measures that could include such 

things as cultural sensitivity training. Improved training could ultimately lead to a 

professional certification model, such as the ones for health educators or social workers. 

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Question 2: How willing are those conducting partner notification to permit partner 

elicitation and notification in non-health department settings? How willing are they to 

train and allow non-health department personnel to conduct any part of the partner 

notification process? 

It could perhaps be helpful to permit partner elicitation and notification in non-health 

department settings; however, there could be significant challenges to this method. It may 

be more productive to assign health department employees to non-health department 

settings in order to facilitate partner notification. In another example, one state STD 

program contracts with community health centers to do partner elicitation and notification in 

non-health department settings, and the relationship has worked so well that they now have 

plans to integrate the process in methadone treatment sites. 

In still another example of expanding partner services to non-traditional settings, it was 

suggested that health departments provide incentives to private providers for providing 

partner elicitation and notification services. However, a number of participants expressed 

reservations about this method. Their list of concerns about this idea included: 

• legal and liability issues (only DIS can do door-to-door outreach); 

• ensuring confidentiality; 

• the training for DIS is 6-9 nine months, and community-based organizations may not 

have the infrastructure for staff to complete such intensive training; moreover 

improved DIS training should take priority over CBO staff training; and 

• health department employees often do not have access to sexually explicit 

websites. 

Question 3: What are the minimum data required to evaluate strategies? How much of 

this prospective data collection falls outside the parameters of standard collection? 

What would be the remedy? 

The group agreed the following indicators should be collected: 

• traditional demographic information; 

• location of high-risk venues; behavioral identification, instead of group 

identification to reduce stigmatization; 

• history of other STDs and treatments; 

• gender of partners; and 

• routes of transmission. 

While it was recognized that collecting group identification may be stigmatizing, most 

participants described it as necessary for conducting meaningful evaluations of 

interventions. There was also concern that the current STD*MIS data management system 

is not adequate for tracking Internet partner notification. As an example, DIS staff persons 

are not evaluated favorably if there is a “no contact elicited” noted. It may also be more 

useful to track self-referrals; when a client says they will contact their partner directly. 

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Creating Effective Partnerships 

6. Creating Effective Partnerships for Syphilis 

Elimination 

Quick Summary 

Box 2. Creating Effective Partnerships for Syphilis Elimination 

Strategy: Suggestions for Enhancement 

Jail screening • Evidence suggest that jail based screening is important for finding cases in high 

risk women, but less so for finding high risk men. 

• Evaluative studies of jail screening programs are needed 

• CDC should lead the development of national standards for jail-based screening 

• STD programs should regularly monitor jail-based morbidity 

• STD programs may consider screening for more than one STDs to raise costeffectiveness 

• Jails should have outbreak response plans 

Ethnic minorities • Although focus currently on African American and MSM populations, Hispanic 

communities also an emerging population 

• Multi-sectoral collaborative approaches may facilitate more efficient use of 

resources 

• Avoid stereotyping and consequent normalizing of risk behaviors within 

communities. 

• Adopt an integrated approach to preventing syphilis among ethnic groups by taking 

other, more pressing priorities to be addressed. 

• Health alliances and partnerships can help to expand and improve the quality of 

STD services 

Men who have sex with 

men 

• CBOs play a vitally important role in the MSM response to syphilis epidemics 

• Collaborations with HIV programs, private providers also essential 

• Internet based interventions and community level outreach activities are 

recommended 

• Formative research and needs assessments are required to design more effective 

prevention activities. 

• Encourage private doctors to take sexual histories for their patients 

Community 

involvement 

• There need s to be a commitment to disseminate best practices and lessons 

learned 

• Ensure flexibility to use the 30% of funds to support CBO activities, especially when 

there is no local capacity. 

• STD programs should promote syphilis screening alongside HIV screening 

• Holistic messages are needed 

• The following should be considered in promoting community participation: 1) 

flexibility, 2) integration of efforts, 3) evaluation, and 4) mobilizing and forming 

defined partnerships. 

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Creating Effective Partnerships 

Tailored Interventions: Jail Screening 

Question 1: How well has model jail based syphilis intervention programs performed 

when compared to other SE interventions and activities (i.e., syphilis case management 

activities, community outreach syphilis testing, enhanced syphilis testing and/or 

treatment hospital ERs, etc.)? 

The performance of jail-based programs, in terms of case detection, has varied considerably 

depending largely on the epidemiology of syphilis in the community. An analysis of all early 

syphilis reported to CDC from 1999 -2002 found that 7,725 (12.5%) noted corrections 

facilities as the site that first identified the case. Among men, 4,747 (13.0%) cases were 

from corrections and in women 2,974 (11.8%) of cases were. Counties with a higher 

proportion of cases from corrections facilities were likely to have lower male-to-female rate 

ratios suggesting that areas with primarily heterosexually transmitted syphilis were likely to 

find significant numbers of cases in jails. 

An analysis case detection in two syphilis elimination demonstration sites found that private 

physicians identified the largest number of female cases. However, jail screening was the 

most productive case detection strategy for identifying high-risk females. The jail identified 

the largest number of male cases and the STD clinic (self-referred) identified the most highrisk males. Partner notification identified relatively few high-risk cases. 

The privatization of prisons increasingly impacts the availability jail-based screening. 

Additionally wardens and local police chiefs may also have competing priorities that rank 

above implementing jail screening. Nonetheless good epidemiology analysis is essential to 

assessing where to find syphilis cases, and epidemiology is likely to vary from city to city. 

Given this, jail-based screening is important for finding cases in high risk women because 

incarcerated women are often involved high risk sexual or drug using activities for which 

they are arrested. Identifying high risk men in jail settings seems to be more difficult. 

Evaluative studies of jail screening programs are very much needed. 

Several participants strongly supported the idea of establishing national standards for jailbased screening. Perhaps these standards should be developed by CDC. Using existing 

data, CDC should disseminate “best practices” for jail screening. This may be best 

accomplished through site visits to individual project areas to engage local health officers 

and corrections officials and elevate importance of the activity. Such guidance should 

provide specific directions for organizing STD healthcare such as screening in correctional 

settings. The guidance could ensure standardized jail screening language, which would be 

especially helpful for those programs that contract out for jail screening services. The 

guidance should also highlight important partners such as the: 

• National Commission on Correctional Health Care; 

• American Correctional Association; 

• National Association of Sheriff’s Departments; 

• National Association of Police Chiefs; and 

• Federal Bureau of Prisons. 

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Creating Effective Partnerships 

And the guidance should also include methods for conducting PCRS with incoming 

prisoners, who may already know what infections they have. However, it remains important 

to note that among discussion group participants there was not agreement that there should 

be universal screening in jails. 

Question 2: At what point should an HMA initiate jail screening vs. sentinel surveillance? 

It was recommended that there should be routine screening in jail settings. Risk behaviors 

of incarcerated persons can be a meaningful measure to assess possible syphilis disease 

trends and anticipate potential local outbreaks. Regularly monitoring jail-based morbidity 

rates is one way STD programs could established sentinel surveillance. In some project 

areas STD Programs are screening not only for syphilis, but others STDs as well. Screening 

for multiple infections as opposed to just one (i.e., syphilis) may increase the likelihood of 

jails instituting screening programs. It was agreed that incarceration facilities should have 

outbreak response plans in addition to a standardized inmate health program that supports 

screening for syphilis. Resources for jail-based screening will need to be addressed up 

front, and this may mean concerted efforts to prioritize activities (e.g., screening for other 

STDs). In general, building epidemiological capacity in local health departments, including 

in partnership with correctional facilities is an important activity for syphilis elimination. 

Question 3: In those project areas where virtually no jail testing services occur, what are 

the specific issues and what types of technical assistance is needed to ensure jail-based 

syphilis testing in those project areas? 

Primarily the issue may have to do with epidemiological capacity in an individual project 

area. An independent assessment may be needed to determine the level of disease in a 

community. CDC may need to be prepared to support this kind of activity in order to 

develop an epi-profile which could then be used to encourage establishing a syphilis jailbased screening program. However, it was generally agreed that the local area with low or 

no disease will probably not invest resources in jail-based screening. 

The Syphilis Elimination Effort and Ethnic Minorities 

Question 1: What ethnic minority populations are currently the foci of syphilis prevention 

efforts? 

The current foci of efforts are mainly on African Americans and men who have sex with men 

(MSM). There may be some “bridging” of MSM at risk populations to heterosexual at-risk 

populations. Latino communities may also be emerging as at-risk populations in a number of 

project areas. It is important that individual project areas focus on the target populations and 

groups that are most relevant based on their epidemiological data. However, is it more 

appropriate to define target populations based on race/ethnicity or is it more appropriate to 

define target groups based on risk behaviors? 

Question 2: What contributes to continued morbidity and what strategies can be 

implemented to enhance current SE efforts? 

A primary contributor to the continued morbidity is what is often referred to as a “silo 

mentality” as it relates to STD programs syphilis prevention and control efforts. This 

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Creating Effective Partnerships 

perspective may cause STD programs to disregard other useful resources, both inside and 

outside the health department. As state and local health departments contend with the 

declining availability of funds, these missed opportunities to share resources or generate a 

more synergistic approach to the health status of persons at risk for multiple problems should 

be addressed. Increased collaboration between agencies could more effectively use limited 

resources. 

Another noted contributing factor is the tendency to “normalize” highly risky behaviors. As an 

example, participants noted that there is a pervasive perception that all men who engage in 

sex with other men also engage in very risky behaviors such as “bare-backing”, crystalmethamphetamine abuse, and numerous multiple sex partners. Once these perceptions 

become normalized then they can become what are often referred to as a “self-fulfilling 

prophecies”, which can lead to still more risk-taking behaviors. A strategy to counteract 

these perceptions is to also identify and utilize the protective factors in populations that can 

work to reduce risk taking. STD programs need to better understand the cultures that may 

affect disease risk, and then tailor their intervention efforts. 

Again, an integrative approach to intervening to prevent and control syphilis was 

recommended as vital strategy to enhance syphilis elimination efforts. An integrative 

approach could better allow for multiple points of entry into communities. Participants urged 

partnering with other health department resources (e.g., maternal and child health) and nonhealth department resources (e.g., drug treatment programs) to expand and improve the 

quality of STD services. STD programs could work with the agencies to raise awareness 

about increases in syphilis morbidity and the importance for testing. A more integrative 

strategy will mean more collaboration between STD programs and relevant partners. The 

resulting collaboration means greater sharing of information (e.g., surveillance data) and 

other resources. Collaborative agreements will need to be specific in the descriptions of 

collaborative efforts (e.g., capacity building, or mutual referral arrangement). Essential to 

assessing the effectiveness of these collaborations is cost evaluations that measure the 

resulting interventions to ensure that limited funds are prudently used in support of 

worthwhile activities. 

Question 3: What first steps can be taken to prevent syphilis emergence in populations 

who are at-risk for syphilis emergence? 

See the answers to Question 2. 

Question 4: Are there standards for monitoring emerging diseases? 

There was consensus among the participants that STD programs regularly (e.g., quarterly) 

review disease data, and that there needs to be CDC guidance to assist programs to better 

accomplish this task. There were a number of suggestions regarding what data that should 

be (socioeconomic data, illegal drug use, and other economic indicators). The information 

gleaned from monitoring of sexually transmitted diseases (e.g., syphilis) could be further 

enhanced by mapping these diseases in conjunction with other communicable diseases 

(e.g., TB), or substance use patterns. Combining these data could provide STD programs 

with better knowledge about the susceptibility of populations in their communities. 

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Creating Effective Partnerships 

The Syphilis Elimination Effort and Men who have sex with Men 

Question 1: What interventions should be recommended for preventing syphilis in MSM? 

Several intervention strategies were discussed during the session. The role of communitybased partnering organizations was especially emphasized. The value of the Division of 

HIV/AIDS Prevention’s Diffusion of Effective Behavioral Interventions (DEBI) standards was 

also significantly noted. Modifying effective HIV interventions, including testing programs, 

syphilis interventions may resonate very effectively with MSM. Collaborations with HIV 

programs are essential and intervention will need to be flexible. Collaborations with private 

providers who serve MSM to expand the availability of quality STD health care are also 

critical. In one location, the STD program is piloting a project whereby the STD program 

pays for the patient’s visit to the private provider when a syphilis test is done. 

Several participants recommended Internet-based interventions as well as community level 

outreach activities. In particular there may be a growing role for Internet-based or webbased partner services activities in addition to the provision of health education. Outreach 

settings should include a variety of venues ranging from such places as to churches to bars 

and clubs. Educational mentoring programs aimed at young adults for instance may be an 

important means reaching young men. In several locations STD programs are using 

community-based teams to conduct street testing for syphilis. In another example, the STD 

program supports an information hotline aimed at reaching young MSM. Hotline operators 

can make referrals for syphilis testing. 

There is an important role for formative research and needs assessment to design more 

effective syphilis prevention and control activities. For example, it was noted that some gay 

men in San Francisco will not go to a program referred to as an MSM program. Formative 

research and needs assessments would inform health communications for MSM by 

assisting with framing the syphilis elimination messages (e.g., linking syphilis infections with 

viral load status). Given the extent of HIV prevention information it is possible that many 

MSM are in sexual health information “overload,” and syphilis simply may not be important 

enough. It may be more effective to frame syphilis elimination as a men’s health matter, as 

opposed to STD prevention. Again, community partners can be very valuable in developing 

and disseminating media messages and materials. 

Question 2: What data are required to enhance our interventions with MSM? 

There were a number of important recommendations regarding ways to enhance data 

collection in support of interventions for MSM. In general there was a call for improved 

technologies to manage data (e.g., computer software, and electronic records capacity.) In 

addition to traditional demographic data variables, such as race/ethnicity and age, 

participants recommended that STD programs collect: 

• socio-economic data; 

• the patient and patient partner’s travel history; 

• the patient’s country of origin 

• sexual identity and sexual behavioral data (including transgender identity); 

• preferred source of health information; and 

• preferred source of health care. 

24
SEE Consultation Meeting. August 2005 

Creating Effective Partnerships 

Participants also recommended that STD programs develop methods for collecting 

important service delivery data such as accessibility of health care in communities and 

evaluation data regarding the implementation of programs. Some participants also urged 

that STD programs, as part of their evaluation activities, collect cultural 

sensitivity/competence of their disease intervention staff to ensure a quality of care to MSM. 

Finally, it was suggested that STD programs may want to gather behavioral data from 

affected community members who have not been infected with an STD to perhaps better 

understand important protective factors, although there was a caution that STD programs be 

judicious in what information they attempt to collect and analyze. 

Question 3: Are there methods to monitor syphilis transmission in MSM and women who 

may be bridging populations for spread between MSM and heterosexual communities? 

While more syphilis screening is recommended for MSM, it is also critical that women be 

informed about this potential risk. Women, and men, need to become comfortable 

conversing about their sexual health, associated with this is a need for persons to be able to 

honestly discuss their sexual preferences and practices as well (e.g., bisexual behaviors, or 

sexual fidelity). One way to facilitate this is to encourage private providers to take sexual 

histories for their patients, for both men and women. Providers also need to become more 

adept at sexual risk reduction counseling and partner management. Some providers are 

reportedly unaware of the need to report or provide more information to the local health 

department. Many of them may believe that laboratories are solely responsible for reporting 

cases. Moreover some private providers may actually be working against health department 

surveillance and disease intervention efforts. Some of these challenges to monitoring are 

likely linked to MSM distrust of government entities. 

The Syphilis Elimination Effort and Community Involvement 

Question 1: How do we maintain syphilis elimination community participation in 

originally targeted populations while initiating new efforts in communities recently 

impacted by syphilis? 

It is crucial that syphilis elimination efforts in originally targeted populations be maintained as 

new efforts are implemented in newly affected groups. To best accomplish this there needs 

to be a commitment to the dissemination of best practices and lessons learned for 

interventions efforts (e.g., media campaigns). 

It may also be important to ensure flexibility in the use of the “30% funds”, particularly in 

situations where community-based organization infrastructure may not be adequate to meet 

syphilis prevention and control intervention needs. When forging community partnerships 

and mobilizing community participation it is critical that partners have the credibility, skill and 

expertise to accomplish proposed prevention and control tasks. Target populations are 

likely to continue to evolve over time (e.g., MSM, more affluent heterosexual persons). As 

an example, 30-39 year-old MSM came of age in a time of STDs and then HIV, but younger 

MSM are not likely to have a similar cultural experience. Community organizations and their 

25
SEE Consultation Meeting. August 2005 

Creating Effective Partnerships 

methods and messages that have been relatively successful with 30-39 year old MSM, 

simply may not resonate with a younger target audience. 

Health departments may need to develop more active partnerships with such agencies as: 

family planning agencies, HIV/AIDS organizations, and drug treatment agencies. It may 

also be more appropriate to target intervention activities to venues as opposed to 

individuals. In general STD programs will need to work to ensure the quality of collaborative 

partnerships that are sensitive to organizational challenges common to non-profit agencies, 

particularly as it relates to contractual arrangements and delayed payments. 

Question 2: How do we assist state and local programs to ensure flexibility in resource 

allocation to serve populations in the context of changing epidemics? 

It was agreed that human sexuality is changing due to changing social norms as well as the 

impact of the HIV epidemic. There is a growing intersection between the HIV and STD 

epidemics, and in this context, particularly for MSM syphilis and gonorrhea prevention 

messages are often lost, due to an attitude that seems to suggest that if one already has an 

HIV infection there is less cause to practice safer sex. Common STDs are usually 

considered curable while HIV infection is not. 

STD programs should promote syphilis screening along with HIV screening. Risk reduction 

counseling should be encouraged for bacterial STDs whenever HIV is being addressed. 

Holistic messages are needed. Although there are important historical reasons for creating 

a separate division for HIV/AIDS prevention it may be time now for reintegration of the HIV 

and STD programs. However, there could be a disincentive for HIV programs to reintegrate 

with STD programs. Resources are increasingly limited in many locations. Programs will 

need to identify and demonstrate the positive effects of a more synergistic approach to 

promoting sexual health. 

Question 3: What are the best means of promoting meaningful and practical levels of 

community participation in the development, delivery, and evaluation of syphilis 

elimination interventions? 

The following should be considered in promoting community participation: 1) flexibility, 2) 

integration of efforts, 3) evaluation, and 4) mobilizing and forming defined partnerships. 

26
SEE Consultation Meeting. August 2005 

Summary of meeting 

7. Enhancing the Implementation of the Syphilis 

Elimination Effort 

Quick Summary 

Box 3. Enhancing the Implementation of the Syphilis Elimination Effort 

Strategy: Suggestions for enhancement 

Training and staff 

development 

• CDC and partners should take a strategic look at frontline DIS and their roles in the 

public health system 

• Guidance needs to be specifically developed for SEE coordinators 

• CDC should take advantage of distance learning technologies such as web-casting 

• Can bio-terrorism funds be made available for satellite or distance learning 

• The barriers to training within STD programs are many 

• DIS recruitment and training should involve professional certification 

• CDC should lead the effort to set national standards for DIS staff positions 

Monitoring and 

evaluation for the SEE 

• There should be written policies and standards to enhance interventions aimed at 

reducing syphilis 

• Local programs should be able to tailor their local priorities and standards 

• Local programs should aim to develop measurable process and outcome measures 

• STD programs should consider databases for evaluation activities 

• Monitoring should be required of local SEE activities 

• Priorities need to be identified and evaluation plans developed that reflect local 

priorities 

• Approximately 20% of allocated resources should be used to for M&E activities 

• Evaluations should demonstrate the worthiness of intervention efforts 

Health care 

mobilization 

• STD programs must engage with private sector providers and collaborate to 

develop strategies for effective mobilization 

• Involve pharmaceutical reps in carrying the messages about STD prevention and 

control to private docs 

• Prevention Training Centers should be used in disseminating information about 

effective strategies 

• CDC’s “Prevention for (HIV) Positives campaign is one example of an effective 

mobilizing intervention – what can we learn from this? 

• Health departments need funding for a specific staff person to visit private 

providers and organize provider seminars. 

• With adequate resources, health departments could develop newsletters 

Effective local 

implementation 

• Accountability for implementation of syphilis elimination activities can be increased 

by utilizing best practices; through advocacy, education and increased syphilis 

awareness; By instituting performance measures at the state and at the local 

levels; Through increased organizational development; Ensuring outbreak 

readiness; Conducting evaluation; and Celebrating SEE successes throughout the 

year. 

• Local programs should consider monitoring syphilis rates; partner service indices; 

timeliness of outbreak response times; provision of services outside of STD clinics; 

types and quality of partnerships. 

• Increase the efficiency of local program implementation by establishing priorities; 

developing templates to facilitate routine activities; implementing lab reporting. 

27 
SEE Consultation Meeting. August 2005 

Summary of meeting 

Training and Staff Development and the Syphilis Elimination Effort 

Question 1: What are the current SEE training needs? 

There is a need to take a strategic look at the frontline disease intervention specialists (DIS) 

and their roles in the public health system across the U.S. Participants agreed that nationally 

“the DIS pool is relatively dry” and some considered the situation a public health crisis. It 

was noted that CDC once recruited DIS similarly to the way the Peace Corps recruits, 

however this process has indeed changed. Currently the emphasis seems to be on CDC 

recruitment for the Public Health Prevention Specialist Programs. These specialists are not 

exclusively reserved for STD disease intervention specialist roles. 

Participants identified the enhancement of training for Disease Intervention Specialists, in 

particular, as well as other STD program staff as being critical to achieving syphilis 

elimination. Undoubtedly training needs will be different for newly hired versus current DIS 

staff, but training components should be developed for a variety of duties and levels of 

responsibilities, which are ultimately aimed at improving STD program operations from 

surveillance and data management to basic partner notification services. Participants also 

discussed the need to develop guidance specifically for the roles and responsibilities of 

syphilis elimination coordinators. A job description template for local coordinators was 

suggested. 

Training content should incorporate relevant and recent research as well as emerging best 

practices or lessons learned from the field. And as one means of making the training more 

available, CDC and local and state STD programs should make use of distance learning 

technologies, such as web-casting for example. It was suggested that bio-terrorism funds 

might be available to facilitate satellite or distance training. 

Question 2: What are the barriers to training and how can programs overcome barriers 

such as travel restrictions and limit resources? 

Some participants discussed the loss of more traditional training methods that have 

supported DIS staff in the past, such as chalk-talks, in-service training, and supervisor 

mentoring. In addition, a number of barriers were also noted, one being the timely 

evaluation of training materials to assess the effectiveness and impact of their methods and 

content, and the updating of training materials as warranted. Local travel policies that may 

restrict or even prohibit staff travel for training opportunities is a challenging barrier to 

providing training for STD program staff. Reportedly because some managers do not 

consider DIS positions as professional level positions (with commensurate credentials), they 

are less inclined to support or approve ongoing training, particularly when travel is required. 

Therefore, credentialing DIS positions could lead to more supportive policies regarding 

training. It was also noted that there are also important implications of moving federal field 

staff from state to state since this sometimes means that well-trained staff persons are 

transferred away from programs in need of their skills. 

28
SEE Consultation Meeting. August 2005 

Summary of meeting 

Question 3: How can we raise the priority of training in the program agenda? 

DIS recruitment and their training should involve professional certification. It was suggested 

that CDC lead the effort to set national standards for DIS staff positions. There should be 

more effort to market and advertise training. More proactive approaches to assist local 

programs to overcome barriers such as travel restrictions and costs will need to be applied. 

The participants offered a set of action steps to raise the priority of training in the program 

agenda. The list of recommendations is as follows: 

• evaluate current training materials (making use of the CDC evaluation framework 

tools); 

• update/revise training materials for syphilis elimination (including the Employment 

Development Guide and STDI training modules); 

• assess retention issues associated with maintaining quality DIS staff; 

• develop DIS core competencies for professional certification; 

• use IPP regional meeting model for STD training; and 

• organize regular SEE coordinators conference calls, website updates, and a 

newsletter to enhance communication and best practice-sharing. 

Monitoring and Evaluation for the Syphilis Elimination Effort 

Question 1: Should SEE require written priorities and standards to be developed at the 

local, project area and federal levels? If so, how could SEE ensure the adoption and 

routine evaluation of these priorities? 

There should be written priorities and standards to enhance interventions aimed at reducing 

syphilis. However, there should also be flexibility in these priorities and standards, and local 

programs should be able to tailor their local priorities and standards. Program standards will 

need to allow for priority shifts based regular and thorough reviews of epidemiological data. 

STD programs are encouraged to collaborate with relevant community groups as well as 

with CDC to collect and analyze data. Programs may also want to review findings from the 

recent 8 Cities Project. Also CDC is already in a position to guide local programs by 

adhering to the basic standards through the performance measures, in addition to grants 

language, program announcements, and program operations guidelines. Local programs 

should also aim to develop measurable process and outcome measures. To improve 

evaluation efforts, it is useful for STD programs to construct databases for evaluation 

activities. Although arguably resource intensive, such databases should account for both 

qualitative and quantitative collection and analyses. 

Question 2: Should SEE require and support monitoring at the local, project area, and 

federal levels? 

Monitoring should be required and priorities set by internal and external consensus. 

Priorities need to be identified and evaluation plans developed that reflect the identified 

priorities. 

29
SEE Consultation Meeting. August 2005 

Summary of meeting 

Question 3: How much time and money should be committed to these activities? 

There was some consensus that a 20% allocation of resources to support monitoring at 

local, project areas, and federal levels seems reasonable, particularly in light of 

international programs (e.g., WHO) allocations of 5% to 15% of budget dollars for 

evaluation. STD programs are encouraged to partner with academic institutions that have 

the expertise to assist evaluation including determining the time and money needed to 

support such activities. Monitoring goals should be tailored to local STD program capacity. 

Evaluation should aim to clearly demonstrate the fundamental worthiness of intervention 

efforts; and as programs improve and syphilis morbidity declines, the evaluation analyses 

may reveal that the cost-per-case or case- averted may in fact get higher. 

Health Care Provider Mobilization for the Syphilis Elimination Effort 

Question 1: What were the successful strategies, challenges, and relevant barriers to 

mobilizing health care professionals between 1999 and 2005? How can these inform 

future efforts? 

It is crucial that STD programs engage with private sector medical providers and collaborate 

to develop common strategies for effective mobilization. External organizations, such as 

medical associations and civic organizations can be important facilitators for developing 

relationships with private providers. One suggestion was made to involve pharmaceutical 

sales representatives in carrying the messages about STD prevention and control to private 

doctors. Prevention Training Centers will be helpful in disseminating information about 

effective strategies. As part of that information private doctors need to better understand the 

public health importance of reporting syphilis cases and doing partner management. 

CDC’s “Prevention for (HIV) Positives” campaign was cited as a successful strategy for 

mobilizing healthcare providers. The lessons learned from this effort could inform syphilis 

elimination activities, although STD programs will need to be careful to tailor components of 

the campaign more specifically to their target populations (e.g., heterosexual African 

Americans, white gay men). 

Question 2: What are the local issues around mobilizing HCPs? Which ones are 

generalizable issues that transcend local issues? What are possible strategies that 

would help tackle these issues? 

One problem is that in many areas there is a shortage of local healthcare providers who 

have the expertise to treat STDs. Smaller communities experienced a drain of their primary 

care providers, because they have gone to larger metropolitan areas. Additionally many 

physician training programs do not specifically address STDs or human sexuality. 

Still another problem is the fact that some insurance companies will not reimburse for 

frequent STD repeat testing (e.g., quarterly). It could be important to syphilis elimination to 

get syphilis testing adopted as a HEDIS measure. Perhaps CDC could work with the 

American Medical Association and state AMA chapters to reduce the effects of capitation. 

Still another challenge to address is the need for substance abuse treatment services. 

30
SEE Consultation Meeting. August 2005 

Summary of meeting 

Oftentimes medical providers have no drug treatment referral resources for their patients. 

Private providers should be encouraged to seek more information about substance abuse 

and perhaps develop partnerships with local drug treatment agencies. 

Question 3: What kinds of support do health departments need to mobilize HCPs? 

Health departments need funding for a specific staff person whose primary job is to visit 

private providers and private laboratories. Such a provider liaison could work with clinical 

medical directors and organize provider seminars. With adequate resources health 

departments could perhaps produce newsletters about STDs in general and syphilis in 

particular for provider audiences. CDC could be instrumental too in getting state laboratories 

to report cases in a more timely manner. Finally it was recommended again that health 

departments pay for syphilis tests and treatment. Health departments would need additional 

resources to be able to accomplish this. 

Effective Local Implementation of the Syphilis Elimination Effort 

Question 1: How can we increase accountability for SEE related activities in the field? 

Accountability for implementation of syphilis elimination activities can be increased in the 

following ways: 

• by utilizing best practices 

• through advocacy, education and increased syphilis awareness 

• by instituting performance measures at the state and at the local levels 

• through increased organizational development 

• ensuring outbreak readiness 

• conducting evaluation; and 

• celebrating SEE successes throughout the year. 

Question 2: Apart from action planning, are there other ways of improving monitoring 

and implementation of SEE related activities in the field? 

The group agreed on several core components for monitoring the implementation of SEE 

activities. These components obviously would include monitoring syphilis rates. 

Participants also suggested careful and regular reviews of partner service indices, as well as 

the timeliness of outbreak response time, and the expansion of syphilis elimination services 

in new venues based on the identification of new at-risk populations. And the types and 

quality of partnerships is another recommended indicator. 

Question 3: How much time and money should be committed to these activities? 

Specific amounts of time or money were not set in the context of the discussion. However 

what was recommended is that there should be careful prioritization of activities, and that 

there be enthusiastic support for more efficient ways of using resources for the syphilis 

elimination effort. Increased efficiency could be achieved not only by establishing priorities, 

but also by using such things as electronic lab reporting and the development of templates 

to assist individual local programs to work more competently. 

31
SEE Consultation Meeting. August 2005 

Summary of meeting 

8. Summary of the Meeting and Next Steps 

There have been major accomplishments in eliminating syphilis in the U.S. Significant among 

these successes is the reduction in the black:white health disparity for infectious syphilis, and 

more importantly is the substantial reduction in the incidence of congenital syphilis. 

However there are emerging threats to these successes. The declines in P&S syphilis in 

African American women may be ending, and infectious syphilis in men is increasing. The 

epidemic seems to be growing fastest in western and northeastern parts of the U.S. Syphilis 

Elimination 2005-2010 will have to be achieved in a challenging social context that includes 

rising poverty and unemployment rates. As was true in 1999, there are persistent problems with 

social inequality and discrimination, as well as ongoing illicit substance abuse and increasing 

social polarization. Public health resources at the federal level are limited, while state and local 

programs are contending with budget cuts that profoundly impact their capacity to provide STD 

prevention and control services. 

During the meeting a list of general next steps in the Syphilis Elimination Effort began to 

emerge. Participants recommended: 

• a reformulation of the current Disease Intervention model to improve the effectiveness of 

partner services; 

• an examination of the cost of syphilis case found versus the cost of a syphilis case averted; 

• development of better tools for diagnosing incident infection, which could improve both 

clinical and surveillance efforts; and 

• organization of a national syphilis elimination coordinators forum to discuss current 

activities, provide supports, and facilitate relevant training. 

In addition to the general steps discussed above, there were specific next steps related to the 

consultation meeting itself. The first step is the publishing of the consultation meeting report. 

Work on the 2005-2010 plan should also commence. A first draft of the new plan is anticipated 

by the end September 2005. Following this there will be an extensive period of internal and 

consultation. 

Other consultation activities addressing Syphilis Elimination were also suggested. Participants 

also recommended that CDC and its partners consider hosting some sort of event to recognize 

the successes achieved through the syphilis elimination effort to date. 

32
SEE Consultation Meeting. August 2005 

Appendices 

APPENDICES 

33 
SEE Consultation Meeting. August 2005 

Appendix A 

The SEE Consultation Meeting Agenda 

Day 1: August 1, 2005 

8:00 a.m. - 5:30 p.m. 

Time Item 

8:00 - 8:30 am Registration 

Session 1: Introduction to the U.S. Syphilis Elimination Effort 

Plenary 

8:30 - 8:45 Welcome 

8:45 - 9:00 Introduction: 

Introductions, Objectives, Overview of the Day 

9:00 - 9:15 Recent Trends in the Epidemiology of Syphilis in the U.S. 

9:15 - 9:30 Overview of the U.S. Syphilis Elimination Effort 

9:30 - 9:45 SEE – The Program Perspective 

9:45 - 10:00 SEE – The Community Partnership Perspective 

10:00 - 10:30 Questions and Clarifications 

10:30 - 10:45 Break 

10:45 - 12:00 

Plenary 

Panel Discussion on Syphilis Elimination 

Panelists: Stephanie Bailey Susan DeLisle 

 Sheila Lukehart Dave Novak 

12:00 - 1:15 Lunch 

Session 2: Improving the Health Service Response to the SEE 

Mini-Presentations 

SEE and Surveillance 

Enhancing Clinical and Laboratory Services 

Enhancing Partner Services 

1:30 - 2:00 

Plenary 

Enhancing Outbreak and Incident Response 

Break-Out Session 2: 

Enhancing the Health Service Responses to SEE 

LENOX SEE and Surveillance 

CASCADE Enhancing Outbreak and Incident 

Response 

NEW YORK Enhancing Clinical and Laboratory 

Services 

2:15 - 3:45 

Group 

Discussions 

SAN FRAN Enhancing Partner Services 

3:45 - 4:00 Break 

4:00 - 5:30 

Plenary 

Feedback from Break-Out Session 2: 

Enhancing the Health Service Responses to SEE 

5:30 - 7:00 Informal Evening Reception - Sponsored by the American 

Sexually Transmitted Diseases Association (ASTDA) 

Speaker 

Chair: Ron Valdiserri 

Ron Valdiserri 

John Douglas 

Kevin Fenton 

Richard Kahn 

Kevin Fenton 

Jim Lee 

Frank Strona 

All 

Chair: Jo Valentine 

Chair: John Douglas 

Richard Khan 

Roxanne Barrow 

Matt Hogben 

Kim Seechuk 

Richard Kahn 

Kim Seechuk 

Tom Peterman 

Matt Hogben 

Chair: Virginia Caine 

34
SEE Consultation Meeting. August 2005 

Appendix A 

Day 2: August 2, 2005 

8:30 a.m. – 5:30 p.m. 

Time Item 

8:30 Welcome 

8:30 - 8:45 

Plenary 

Introduction: 

Objective of Day: Review of Key Points from Yesterday 

Session 3: Creating Effective Partnerships for the SEE 

Mini-Presentations 

SEE Interventions and Ethnic Minorities 

SEE Interventions and MSM 

8:45 - 9:15 

Plenary 

Tailored Interventions: Jail Screening 

9:15 - 9:30 Break 

Break-Out Session 3: 

Enhancing Partnerships and Tailoring SEE Interventions 

LENOX Tailored Interventions: Jail Screening 

CASCADE SEE Interventions and Ethnic Minorities 

NEW YORK SEE Interventions and MSM 

9:30 - 11:00 

Group 

discussions 

SAN FRAN SEE and Community Involvement 

11:05 - 12:30 

Plenary 

Feedback Plenary from Break-Out Session 3: 

Effective Partnerships for the SEE 

12:30 - 1:45 Lunch 

Session 4: Enhancing implementation of the SEE 

Mini-Presentations 

Healthcare Provider Mobilization 

Training and Staff Development 

1:45 - 2:15 

Plenary 

Monitoring and Evaluation 

Break-Out Session 4: 

Effective Implementation of the SEE 

LENOX Training, Staff Development and SEE 

CASCADE Monitoring and Evaluation 

NEW YORK Health Care Provider Mobilization 

2:30 - 3:30 

Group 

discussions 

SAN FRAN Effective Local Implementation of SEE 

3:30 - 3:45 Break 

3:45 - 5:00 

Plenary 

Feedback Plenary from Break-Out Session 4: 

Effective Implementation of the SEE 

5:00 - 5:30 Summary - Next Steps 

5:30 Adjourned 

Speaker 

Chair: Gail Bolan 

Sevgi Aral 

Chair: Gail Bolan 

Samantha Williams 

Kevin Fenton 

Norm Fikes 

Norm Fikes 

Samantha Williams 

Fred Bloom 

Jo Valentine 

Chair: Tom Bertrand 

Chair: Jim Lee 

Sureyya Hornston 

Hilda Shepeard 

Cathleen Walsh 

Darien Ogburn 

Cathleen Walsh 

Sureyya Hornston 

Jo Valentine 

Chair: Kevin Fenton 

Rapporteurs 

Kevin Fenton 

35
SEE Consultation Meeting. August 2005 

Appendix B 

Work-group questions for the SEE Consultation Meeting: August 1-2, 2005 

Topic Area Questions SEE& Surveillance 

• What steps can be taken to improve surveillance and epidemiologic capacity locally? In the short and 

• What measures should be taken to monitor adequacy of surveillance activities? • What steps can be taken to improve the collection of gender of sex partner information for all (>90%) e

Enhancing Clinical & Lab Services 

• How has the need for clinical services changed with the shift in the syphilis epidemiology and how can 

these needs? 

• How do we ensure sustained STD clinical services for underserved populations • How can we improve testing, diagnosis, and reporting by private providers? How do we better target g

provider populations? 

• Is the quality of laboratory testing for syphilis in the United States adequate to support the objectives o

Enhancing Partner Services 

• What level of collaboration can be expected among jurisdictions conducting partner notification? Wha

This applies to sharing strategies, and to sharing data and resources for evaluation. 

• How willing are those conducting partner notification to permit partner elicitation and notification in non

settings? How willing are they to train and allow non-health department personnel to conduct any part 

process? 

• What are the minimum data required to evaluate strategies? How much of this prospective data collec

parameters of standard collection? What would be the remedy? 

Enhancing Outbreak & Incident Response 

• Are there elements of outbreak response or development and implementation of an outbreak response 

currently addressed? 

• How can project areas periodically “test” and evaluate the outbreak response plan? • What criteria should be used to determine when an outbreak has ended? 

SEE and Community Involvement 

• How do we maintain syphilis elimination community participation in originally targeted populations whil

communities recently impacted by syphilis? 

• How do we assist state and local programs to ensure flexibility in resource allocation to serve populatio

changing epidemics? 

• What are the best means of promoting meaningful and practical levels of community participation in th

and evaluation of syphilis elimination interventions? 

36
SEE Consultation Meeting. August 2005 

Appendix B 

Topic Area Questions 

SEE Interventions for Ethnic Minorities 

• What ethnic minority populations are currently the focuses of syphilis prevention efforts? • What contributes to continued morbidity and what strategies can be implemented to enhance current S

• What first steps can be taken to prevent syphilis emergence in populations who are at-risk for syphilis 

• Are there uniform standards for monitoring emerging diseases? 

SEE Interventions for Men who have sex with Men 

• What interventions should be recommended for preventing syphilis in MSM? • What data are required to enhance our interventions with MSM? • Are there methods to monitor syphilis transmission in MSM and women who may be bridging populatio

MSM and heterosexual communities? 

Tailored Interventions: Jail screening 

• How well has model jail based syphilis intervention programs performed when compared to other SE i

(i.e., syphilis case management activities, community outreach syphilis testing, enhanced syphilis testhospital ERs, etc.)? 

• At what point should an HMA initiate jail screening vs. sentinel surveillance? • In those project areas where virtually no jail testing services occur, what are the specific issues and wh

assistance is needed to ensure jail-based syphilis testing in those project areas? 

Training and Staff Development 

• What are the current SEE training needs? • What are the barriers to training and how can programs overcome barriers such as travel restrictions a

• How can we raise the priority of training in program agenda? 

Effective Local Implementatio n of SEE 

• How can we increase accountability for SEE related activities in the field? 

• Apart from action planning, are there other ways of improving monitoring and implementation of SEE r

field? What are they? How can they be implemented? 

• How do we increase the efficiency of our monitoring activities in the field? 

Monitoring and Evaluation 

• Should SEE require written priorities and standards to be developed at the local, project area and fede

• If so, how could SEE ensure the adoption and routine evaluation of these priorities? 

• Should SEE require and support monitoring at the local, project area, and federal levels? • How much time and money should be committed to these activities? 

37
SEE Consultation Meeting. August 2005 

Appendix B 

Topic Area Questions 

Healthcare • What were the successful strategies, challenges and relevant barriers to mobilizing health care profesProvider 1999 and 2005? How can these inform future efforts? Mobilization • What are the local issues around mobilizing HCPs? Which ones are generalizable issues that transcen

possible strategies that would help tackle these issues? 

• What kind of support do health departments need to mobilize HCPs? • Which organizations can help? How? 

38 
SEE Consultation Meeting. August 2005 

Appendix C 

PARTICIPANTS LIST 

LAURIE ANDERSON 

Syphilis Elimination Coordinator 

Chicago Department of Health 

530 East 31st Street 

Chicago, IL 60616 

Phone: 312-747-5400 

E-mail: Anderson_laurie@cdph.org 

SEVGI ARAL 

Associate Director for Science / Acting Chief, 

 Behavioral Interventions and Research Branch 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Office of the Director 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8259 

E-mail: soa1@cdc.gov 

SUSAN ARROWSMITH 

Unit Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-8495 

E-mail: sla2@cdc.gov 

STEPHANIE BAILEY 

Medical Director 

Metropolitan Government of Nashville and Davidson

 County – Department of Health 

501 Broadway 

Nashville, TN 37203 

Phone: 615-340-5622 

E-mail: Stephanie.bailey@nashville.gov 

RONALD BALLARD 

Branch Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Laboratory, Reference and Research Branch 

1600 Clifton Road, NE (Mailstop A12) 

Atlanta, GA 30333 

Phone: 404-639-3222 

E-mail: ztp7@cdc.gov 

ROXANNE BARROW 

Acting Branch Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Training and Health Communications Branch 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8503 

E-mail: rrb6@cdc.gov 

JIM BEALL 

Director, STD/HIV 

Indiana State Department of Health 

2 Meridian Street 

Indianapolis, IN 46204 

Phone: 317-233-7426 

E-mail: jbeall@isdh.state.in.us 

TOM BERTRAND 

Director, STD Prevention 

Bureau of Communicable Disease Control 

State Laboratory Institute 

305 South Street 

Jamaica Plain, MA 02130 

Phone: 617-983-6200 

E-mail: thomas.bertrand@state.ma.us 

FRED BLOOM 

Research Scientist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Behavioral Interventions and Research Branch 

1600 Clifton Road, NE (Mailstop E44) 

Atlanta, GA 30333 

Phone: 404-639-8278 

E-mail: fcb8@cdc.gov 

SALLY BLOWER 

Professor 

University of California at Los Angeles 

1100 Glendon Avenue, Penthouse 2 

Los Angeles, CA 90024 

Phone: 310-794-8911 

E-mail: sblower@mednet.ucla.edu 

GAIL BOLAN 

Branch Chief 

California DHS/STD Control Branch 

1111 Broadway Street, 19th Floor 

Oakland, CA 94607 

Phone: 510-286-6605 

E-mail: gbolan@dhs.ca.gov 

SUSAN BRADLEY 

Public Health Analyst 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Policy, Planning and External Relations 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8534 

E-mail: sdb1@cdc.gov 

KATE BUCHACZ 

Epidemiologist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of HIV/AIDS Prevention 

Epidemiology Branch 

Clinical HIV Epidemiology Team 

1600 Clifton Road, NE (Mailstop E45) 

Atlanta, GA 30333 
SEE Consultation Meeting. August 2005 

Appendix C 

Phone: 404-639-5167 Phone: 301-402-0443 

E-mail: acu7@cdc.gov E-mail: cdeal@niaid.nih.gov 

VIRGINIA CAINE HAZEL DEAN 

Medical Director Associate Director 

Marion County Health Department Centers for Disease Control and Prevention 

3838 North Rural National Center for HIV, STD and TB Prevention 

Indianapolis, IN 46205 Office of Health Disparities 

Phone: 317-221-2301 1600 Clifton Road, NE (Mailstop E07) 

E-mail: dharris@HHCorp.org Atlanta, GA 30333 

Phone: 404-639-8009 

RUSS CANTRELL E-mail: hdd0@cdc.gov 

Georgia Sr. Public Health Advisor 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

2 Peachtree Street, NW 

Suite 12-404 

Atlanta, Georgia 30303 

Phone: 404-657-3120 

E-mail: rucantrell@dhr.state.ga.us 

TOM CHAPEL 

SUSAN DELISLE 

Branch Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-8315 

E-mail: syd4@cdc.gov 

Health Scientist 

Centers for Disease Control and Prevention 

Office of the Director 

Office of Strategy and Innovation 

1600 Clifton Road, NE (Mailstop D24) 

Atlanta, GA 30333 

Phone: 404-639-5284 

E-mail: tkc4@cdc.gov 

HARRELL CHESSON 

Health Economist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Health Services Research and Evaluation Branch 

1600 Clifton Road, NE (Mailstop E80) 

Atlanta, GA 30333 

Phone: 404-639-8363 

E-mail: smb1@cdc.gov 

CAROL CIESIELSKI 

Chief, STD/HIV Epidemiology 

Centers for Disease Control and Prevention 

STD/HIV Prevention and Care Program 

Chicago Department of Public Health 

530 East 31st Street 

Chicago, IL 60616 

Phone: 312-747-0105 

E-mail: ciesielski_carol@cdph.org 

JANELLE DIXON 

Deputy Branch Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Health Services Research and Evaluation Branch 

1600 Clifton Road, NE (Mailstop E80) 

Atlanta, GA 30333 

Phone: 404-639-8276 

E-mail: hjd1@cdc.gov 

JOHN DOUGLAS 

Director 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Office of the Director 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8260 

E-mail: jyd3@cdc.gov 

JOY EWELL 

STD Surveillance Manager 

Louisiana Office of Public Health – STD Program 

325 Loyola Avenue, Room 616 

New Orleans, LA 70112 

Phone: 504-568-5509 

E-mail: jewell@cdc.gov 

DAVID COX 

Supervisory Microbiologist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Laboratory, Reference and Research Branch 

1600 Clifton Road, NE (Mailstop D13) 

Atlanta, GA 30333 

Phone: 404-639-3446 

E-mail: dlc6@cdc.gov 

KEVIN FENTON 

Syphilis Elimination (ORISE) 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Office of the Director 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8187 

E-mail: kif2@cdc.gov 

CAROLYN DEAL 

Chief 

National Institute of Allergy and Infectious Diseases 

National Institutes of Health 

Sexually Transmitted Infections Branch 

6610 Rockledge Drive 

Bethesda, MD 20892 
SEE Consultation Meeting. August 2005 

Appendix C 

NORM FIKES MARTY GOLDBERG 

Acting Deputy Branch Chief Program Manager 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-6186 

E-mail: nff1@cdc.gov 

Centers for Disease Control and Prevention 

c/o Philadelphia STD Control Program 

500 South Broad Street 

Philadelphia, PA 19146 

Phone: 215-685-6737 

E-mail: mgoldberg@cdc.gov 

SAM GROSECLOSE 

Branch Chief 

MELINDA FLOCK 

Deputy Branch Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Statistics and Data Management Branch 

1600 Clifton Road, NE (Mailstop E63) 

Atlanta, GA 30333 

Phone: 404-639-8356 

E-mail: mlf1@cdc.gov 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Statistics and Data Management Branch 

1600 Clifton Road, NE (Mailstop E63) 

Atlanta, GA 30333 

Phone: 404-639-8356 

E-mail: slg0@cdc.gov 

HUNTER HANDSFIELD 

Visiting Scientist 

PAULETTE FORD-KNIGHTS 

Public Health Analyst 

Centers for Disease Control and Prevention 

National Center for HIV, STD & TB Prevention 

Office of Planning and Policy Coordination 

1600 Clifton Road, NE (Mailstop E07) 

Atlanta, GA 30333 

Phone: 404-639-8008 

E-mail: pbf7@cdc.gov 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Office of the Director 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8259 

E-mail: hxh2@cdc.gov 

EARL FOWLKES 

President 

International Federation of Black Prides (IFBP) 

531 Ingraham Street, NE 

Washington, DC 20011 

Phone: 202-526-9774 

E-mail: jrfowlkes@aol.com 

DAWN HARBATKIN 

Medical Director 

Callen-Lorde Community Health Center 

356 W. 18th Street 

New York, NY 10010 

Phone: 212-271-7200 

E-mail: dharbaktin@callen-lorde.org 

BRUCE FURNESS 

Medical Epidemiologist 

Centers for Disease Control and Prevention 

717 14th Street, NW, Suite 950 

Washington, DC 20005 

Phone: 202-727-9066 

E-mail: bff0@cdc.gov 

DAN GEORGE 

MATTHEW HOGBEN 

Behavioral Scientist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Behavioral Interventions and Research Branch 

1600 Clifton Road, NE (Mailstop E44) 

Atlanta, GA 30333 

Phone: 404-639-1833 

E-mail: yzh5@cdc.gov 

Senior Public Health Advisor 

Centers for Disease Control and Prevention 

c/o Florida Department of Health 

4052 Bald Cypress Way, Bin A-19 

Tallahassee, FL 32399 

Phone: 850-245-4314 

E-mail: dan_george@doh.state.fl.us 

JOHN GLOVER 

Unit Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8334 

E-mail: jhg6@cdc.gov 

SUREYYA HORNSTON 

Health Communications Specialist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Training and Health Communications Branch 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8532 

E-mail: soh6@cdc.gov 

KIRK JAMES 

Medical Officer 

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services 

Administration 

1 Choke Cherry Road, Room 5-1109 

Rockville, MD 20850 

Phone: 240-276-1617 

E-mail: kirk.james@samhsa.hhs.gov 
SEE Consultation Meeting. August 2005 

Appendix C 

DAVID JOHNSON JEFFREY KLAUSNER 

Rapid Response Team (RRT) – Team Leader Director 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-8509 

E-mail: dbj1@cdc.gov 

STD Prevention and Control Services 

San Francisco Department of Public Health 

1360 Mission Street, Suite 401 

San Francisco, CA 94103 

Phone: 415-355-2000 

E-mail: jeff.klausner@sfdph.org 

DEBORAH KLEIN-WALKER 

Principal Associate 

SHERIDAN JOHNSON 

Project Coordinator 

Johns Hopkins University 

2700 Lighthouse Pointe, Suite 210 

Baltimore, MD 21224 

Phone: 410-396-4448 

E-mail: Sheridan.johnson@baltimorecity.gov 

ABT Associates 

55 Wheeler Street 

Cambridge, MA 02138 

Phone: 617-492-7100 

E-mail: Deborah_walker@abtassoc.com 

JUDITH KURLAND 

Consultant 

ZACHARY JONES DCA Associates 

Bishop, Founder 1272 Beacon Street 

Unity Fellowship Church Brookline, MA 02446 

2578 Atlantic Avenue Phone: 617-367-2774 

Brooklyn, NY 11207 E-mail: jkurland@dcaboston.com 

Phone: 718.385.2406 

E-mail: ufcnycbishop@aol.com JIM LEE 

Senior Public Health Advisor 

RICHARD KAHN 

Acting Deputy Branch Chief / Epidemiologist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Epidemiology and Surveillance Branch 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8363 

E-mail: rhk7@cdc.gov 

MARY KAMB 

International Coordinator 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Office of the Director 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8632 

E-mail: mlk5@cdc.gov 

JOEL KAUFMAN 

Director, Grants / Evaluations 

United Way of Broward County 

Ansin Building 

1300 South Andrews Avenue 

Ft. Lauderdale, FL 33316 

Phone: 954-462-4850 

E-mail: jkaufman@unitedwaybroward.org 

PETER KERNDT 

Director 

Sexually Transmitted Disease Program 

Los Angeles County Department of Health Services 

313 N. Figueroa Street 

Los Angeles, CA 90012 

Phone: 213-744-3093 

E-mail: pkerndt@ladhs.org 

Centers for Disease Control and Prevention 

c/o Texas Department of Health 

1100 West 49th Street 

Austin, TX 78756 

Phone: 512-490-2505 

E-mail: jim.lee@dsha.state.tx.us 

PETER LEONE 

Associate Professor of Medicine 

University of North Carolina 

130 Mason Farm Road, Office 4121 

Chapel Hill, NC 27599-7030 

Phone: 919-966-2536 

E-mail: zu.leone@gmail.com 

DENNIS LEOUTSAKAS 

Assistant Professor 

Salisbury University 

Communication and Theatre Arts Department 

Fulton Hall, Room 206 

1101 Camden Avenue 

Salisbury, MD 21801 

Phone: 410-677-5434 

E-mail: dxleoutsakas@saisbury.edu 

TINA LESTER 

Assistant Director 

Metro Public Health Department 

Family, Youth and Infant Health Division 

311 23rd Avenue North 

Nashville, TN 37203 

Phone: 615-340-5358 

E-mail: tina.lester@nashville.gov 

DEBORAH LEVINE 

Executive Director 

Internet Sexuality Information Services, Inc. 

Post Office Box 14287 

San Francisco, CA 94114 

Phone: 415-215-6184 

E-mail: deb@isis-inc.org 
SEE Consultation Meeting. August 2005 

Appendix C 

LISA LONGFELLOW DAVID NOVAK 

STD Program Manager Syphilis Elimination Coordinator 

Louisiana Office of Public Health – STD Program 

325 Loyola Avenue, Rm. 616 

New Orleans, LA 70112 

Phone: 504-568-5275 

E-mail: llongfe@dhh.la.gov 

Massachusetts Department of Public Health 

State Laboratory Institute 

305 South Street, Room 560 

Jamaica, Plain, MA 02130 

Phone: 617-983-6200 

E-mail: david.novak@state.ma.us 

SHEILA LUKEHART 

Research Professor DARIEN OGBURN 

University of Washington Deputy Director 

Harborview Medical Center Centers for Disease Control and Prevention 

325 Ninth Avenue National Center for HIV, STD and TB Prevention 

Post Office Box 359779 Division of STD Prevention 

Seattle, WA 98104 Office of the Director 

Phone: 206-341-5362 1600 Clifton Road, NE (Mailstop E02) 

E-mail: lukehart@u.washington.edu Atlanta, GA 30333 

Phone: 404-639-8260 

ELVIN MAGEE E-mail: dlo0@cdc.gov 

Health Scientist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Statistics and Data Management Branch 

1600 Clifton Road, NE (Mailstop E63) 

Atlanta, GA 30333 

Phone: 404-639-1848 

E-mail: eem9@cdc.gov 

GORDON MANSERGH 

TOM PETERMAN 

Chief, Field Epi Unit 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Epidemiology and Surveillance Branch 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-6102 

E-mail: tap1@cdc.gov 

Behavioral Scientist 

Centers for Disease Control and Prevention 

Divisions of HIV/AIDS Prevention 

Intervention Research and Support 

Behavioral Intervention Research Branch 

1600 Clifton Road, NE (Mailstop E37) 

Atlanta, GA 30333 

Phone: 404-639-6134 

E-mail: cfg3@cdc.gov 

LARRY PRESCOTT 

Coordinator, Syphilis Elimination 

Houston Department of Health and Human Services 

HIV/STD Program 

8000 North Stadium Drive 

Houston, TX 77054 

Phone: 719-794-9092 

E-mail: larry.prescott@cityofhouston.net 

CHRISTINA MARRA MELANIE ROSS 

Professor, Neurology ORISE Fellow 

University of Washington Centers for Disease Control and Prevention 

Post Office Box 359775 National Center for HIV, STD and TB Prevention 

Seattle, WA 99195 Division of STD Prevention 

Phone: 206-341-5400 Office of the Director 

E-mail: cmarra@u.washington.edu 1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

MARS MCMILLAN Phone: 404-639-8840 

Project Coordinator E-mail: mross@cdc.gov 

AIDS Project Florida 

2817 Oakland Park Blvd. PABLO SANCHEZ 

Ft. Lauderdale, FL 33306 Professor of Pediatrics 

Phone: 954-537-4111, Ext. 143 UT Southwestern Medical Center at Dallas 

E-mail: mmcmillan@chc1.org 5323 Harry Hines Boulevard 

Dallas, Texas 75390 

STEVE MIDDLEKAUFF Phone: 214-648-3753 

Deputy Branch Chief E-mail: pablo.sanchez@utsouthwestern.edu 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention JULIA SCHILLINGER 

Division of STD Prevention Director of Surveillance, Epidemiology and Research 

Behavioral Interventions and Research Branch Centers for Disease Control and Prevention 

1600 Clifton Road, NE (Mailstop E44) c/o New York Department of Health and Mental 

Atlanta, GA 30333 Hygiene 

Phone: 404-639-8296 Bureau of STD Control 

E-mail: smiddlekauff@cdc.gov 125 Worth Street, Room 207, CN#73 

New York, NY 10013 

Phone: 212-788-4429 

E-mail: jschilli@health.nyc.gov 
SEE Consultation Meeting. August 2005 

Appendix C 

KIM SEECHUK EMMETT SWINT 

Acting Branch Chief Scientific Information Specialist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-8315 

E-mail: kgs0@cdc.gov 

Centers for Disease Control and Prevention 

Division of STD Prevention 

National Center for HIV, STD and TB Prevention 

Statistics and Data Management Branch 

1600 Clifton Road, NE (Mailstop E63) 

Atlanta, GA 30333 

Phone: 404-639-8348 

E-mail: eswint@cdc.gov 

ANI SHAKARISHVILI WALKER TISDALE 

Acting STD Team Leader Public Health Analyst 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Global AIDS Program, Prevention Branch 

1600 Clifton Road, NE (Mailstop E04) 

Atlanta, GA 30333 

Phone: 404-639-8012 

E-mail: afs9@cdc.gov 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Policy, Planning and External Relations 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8190 

E-mail: wct7@cdc.gov 

HILDA SHEPEARD 

Health Communications Specialist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Training and Health Communications Branch 

1600 Clifton Road, NE (Mailstop E02) 

Atlanta, GA 30333 

Phone: 404-639-8656 

E-mail: hhs2@cdc.gov 

JULIA VALDERRAMA 

Technical Officer 

Pam American Health Organization 

STI Control, Prevention of the Mother to Child 

 Transmission and Prevention of Congenital Syphilis 

HIV/AIDS/STI Unit 

525 Twenty-third Street, NW 

Washington, DC 20037 

Phone: 202-974-3596 

E-mail: valdrrj@paho.org 

MIKE ST. LOUIS 

Associate Director for Science 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Global AIDS Program 

1600 Clifton Road, NE (Mailstop D69) 

Atlanta, GA 30333 

Phone: 404-639-7463 

E-mail: mes2@cdc.gov 

RONALD VALDISERRI 

Deputy Director 

Centers for Disease Control and Prevention 

Office of the Director 

1600 Clifton Road, NE ( Mailstop E07) 

Atlanta, GA 30333 

Phone: 404-639-8000 

E-mail: rov1@cdc.gov 

FRANK STRONA JO VALENTINE 

Special Projects Coordinator National Syphilis Elimination Program Coordinator 

STD Prevention and Control Services 

San Francisco Department of Public Health 

1360 Mission Street, Suite 401 

San Francisco, CA 94103 

Phone: 404-355-2000 

E-mail: frank.strona@sfdph.org 

DAVID SULLIVAN 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-8366 

E-mail: jvalentine@cdc.gov 

Public Health Advisor 

Centers for Disease Control and Prevention 

Division of STD Prevention 

National Center for HIV, STD and TB Prevention 

Program Development and Support Branch 

1600 Clifton Road, NE (Mailstop E27) 

Atlanta, GA 30333 

Phone: 404-639-4257 

E-mail: dbs1@cdc.gov 

CATHLEEN WALSH 

Acting Branch Chief 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Health Services Research and Evaluation Branch 

1600 Clifton Road, NE (Mailstop E80) 

Atlanta, GA 30333 

Phone: 404-639-8276 

E-mail: cmw0@cdc.gov 
SEE Consultation Meeting. August 2005 

Appendix C 

JUDY WASSERHEIT CYNTHIA WRIGHT 

Director Syphilis Elimination Coordinator 

HIV Vaccine Trials Network 

Member, Program in Infectious Diseases 

Fred Hutchinson Cancer Research Center 

Professor of Medicine, University of Washington 

1100 Fairview Avenue, North, LE-500 

Seattle, WA 98109 

Phone: 206-667-6712 

E-mail: jwasserh@fhcrc.org 

JOHN WEISER 

Associate Professor 

Albert Einstein School of Medicine 

Soho Medical Associates 

568 Broadway Suite – 208 

New York, NY 10012 

Phone: 917-596-7009 

E-mail: jkweiser@gmail.com 

South Carolina HIV/AIDS Council 

Post Office Box 2531 

Columbia, SC 29202 

Phone: 843-876-1078 

E-mail: waanyaa@aol.com 

AKBAR ZAIDI 

Mathematical Statistician 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Statistics and Data Management Branch 

1600 Clifton Road, NE (Mailstop E63) 

Atlanta, GA 30333 

Phone: 404-639-8185 

E-mail: aaz1@cdc.gov 

LEV ZOHRABYAN 

EDDIE WHITE Health Care Analyst V, Contractor 

Pastor 

Mount Sinai Faith, Hope and Love Ministries 

42 East Main Street 

Thomasville, NC 27736 

Phone: 336-475-5800 

E-mail: mtsinai@northstate.net 

Northrop Grumman Mission Systems Inc. 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Global AIDS Program, Prevention Branch 

1600 Clifton Road, NE (Mailstop E04) 

Phone: 404-639-6306 

Email: lbz8@cdc.gov 

SAMANTHA WILLIAMS 

Research Psychologist 

Centers for Disease Control and Prevention 

National Center for HIV, STD and TB Prevention 

Division of STD Prevention 

Behavioral Interventions and Research Branch 

1600 Clifton Road, NE (Mailstop E44) 

Atlanta, GA 30333 

Phone: 404-639-1825 

E-mail: stw8@cdc.gov 

CARMEN ZORRILLA 

Professor, Obstetrics and Gynecology 

University of Puerto Rico School of Medicine 

PI Maternal and Infant Studies Center 

Post Office Box 365067 

San Juan, PR 00936 

Phone: 787-753-5913 

E-mail: czorrilla@rcm.upr.edu