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Mitchell I. Wolfe, MD, MPH, Fujie Xu, MD, PhD, Priti Patel, MD, MPH, Michael O'Cain, Julia A. Schillinger, MD, MSc, Michael E. St. Louis, MD, MPH and Lyn Finelli, DrPH

At the time of the study, Mitchell I. Wolfe was with the Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), and the Medical Examiner Program, National Center for Environmental Health, CDC, Atlanta, Ga; Fujie Xu was with the Epidemic Intelligence Service, Epidemiology Program Office, CDC, and the Epidemiology and Surveillance Branch, National Center for HIV, STD, and TB Prevention, CDC. Priti Patel is with the Epidemiology Program Office, CDC. Michael O'Cain is with the Program Development and Support Branch, National Center for HIV, STD, and TB Prevention, CDC, and the Alabama Department of Public Health, Montgomery. Julia A. Schillinger, Michael E. St. Louis, and Lyn Finelli are with the Epidemiology and Surveillance Branch, National Center for HIV, STD, and TB Prevention, CDC.

Correspondence: Requests for reprints should be sent to Mitchell I. Wolfe, MD, MPH, Centers for Disease Control and Prevention, Mailstop E-47, 1600 Clifton Rd NE, Atlanta, GA 30333 (e-mail: msw6{at}cdc.gov).

Objectives. After syphilis outbreaks were reported at 3 Alabama State men's prisons in early 1999, we conducted an investigation to evaluate risk factors for syphilis infection and describe patterns of syphilis transmission.

Methods. We reviewed medical, patient interview, and prison transfer records and documented sexual networks. Presumptive source cases were identified. Odds of exposure to unscreened jail populations and transfer from other prisons were calculated for case patients at 1 prison.

Results. Thirty-nine case patients with early syphilis were identified from 3 prisons. Recent jail exposure (odds ratio [OR] = 8.0, 95% confidence interval [CI] = 0.3, 158.7, P = .14) and prison transfer (OR = 32.0, 95% CI = 1.6, 1668.1, P < .01) were associated with being a source case patient.

Conclusions. Probable sources of syphilis introduction into and transmission within prisons included mixing of prisoners with unscreened jail populations, transfer of infected inmates between prisons, and multiple concurrent sexual partnerships. Reducing sexual transmission of disease in correctional settings is a public health priority and will require innovative prevention strategies.

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