Congenital syphilis in New York City: 1985-1990.

The Bureau of STD Control continues to combat NYC's epidemic of congenital syphilis. The demographic profile of this population has remained constant with only a clearer identification of previously reported risk factors: most notably poor prenatal care and substance abuse. There is a suggestion of a plateau having occurred in adult and congenital syphilis, possibly caused by saturation effect on the high-risk population. During the period 1989 through 1990, the rates for cocaine/crack use have remained relatively constant among mothers infected with syphilis. A recent study by the Division of Substance Abuse Services of New York State school-age children demonstrated a drop in cocaine use from 14% in 1983 to 6%. If a similar decline is seen in substance abuse in other age groups, the rate of congenital syphilis may diminish.

Early syphilis in New York City: 1985-1990.

The resurgence of syphilis since 1986 and 1987 in NYC has been mirrored in other major urban centers nationwide. Since 1988, P&S syphilis have declined, but early latent and congenital syphilis have continued to increase. A number of features characterize this most recent epidemic: Starting in 1987, Brooklyn replaced Manhattan as the borough with the most number of cases of early syphilis. The age distribution of reported cases has remained constant. Women constitute a growing proportion of early syphilis, and in fact, are the majority of cases of EL syphilis. As in other parts of the nation, this may be due to diminishing risk behavior among male homosexuals and the continuing effect of the cocaine epidemic and "drugs for sex," prostitution. The black and Hispanic communities continue to be disproportionately infected. Public Health education and control efforts should continue to be focused on the communities most affected.

Reductions in STD infections subsequent to an STD clinic visit. Using video-based patient education to supplement provider interactions.

BACKGROUND AND OBJECTIVES: Video-based patient education has been effective in a variety of clinical settings. The authors studied the efficacy of a video-based educational intervention in an inner-city public sexually transmitted diseases (STD) clinic. GOAL: To evaluate the efficacy of video-based patient education in reducing STD infections subsequent to a clinic visit. DESIGN: African-American and Hispanic men attending a large public STD clinic were assigned at random to either an experimental video-based educational intervention or a control condition in which they received regular clinic services. Patients in the experimental group were exposed to video-based interventions that provided information about STDs and their prevention, portrayed positive attitudes about condom use, and modeled appropriate strategies for encouraging condom use in different sexual relationships. During 1992, 2,004 subjects were tracked for an average of 17 months through the New York City STD surveillance database for the occurrence of new STD infections. RESULTS: The overall rate of new infection among male STD clinic patients was 24.2%. Rate of new infection was significantly lower among those exposed to video-based prevention education than among controls (22.5% compared with 26.8%, p < .05). Subjects reporting multiple sex partners had a significantly higher new infection rate but also experienced the greatest impact of educational intervention. There was a 32.2% new infection rate among high-risk controls compared with a 24.8% rate among high-risk intervention groups (p < 0.025). CONCLUSION: Results of this randomized clinical trial indicate that using video-based patient education to supplement regular STD clinic services and provider interactions can be effective in reducing rates of new STD infection, particularly among those at greatest risk.