Effectiveness and Cost-benefit of Enhancements to a Syphilis Screening and Treatment Program at a County Jail

Background: High rates of syphilis are found in inmates of county jails. Treatment of this infected transient population necessitated the development of a rapid protocol. Goal: To evaluate a rapid screening and treatment protocol for syphilis in a county jail. Study Design: Over a 2-year period 18,442 inmates were screened for syphilis with a nontreponemal test and record search for treatment history. Confirmatory test results were reviewed following treatment. Cost was defined as deflated marginal outlays. Benefit was calculated as the discounted expected cost of treatment of congenital, late, and neurosyphilis. Results: The sensitivity, specificity, and positive predictive value of the protocol were 99.6%, 80.8%, and 79.3%, respectively. Of 257 confirmed cases, 183 were offered treatment in jail. The percentage of short-term inmates treated increased following implementation. The cost-benefit ratio was 9.14:1. Conclusions: The protocol was highly effective in patient identification and treatment delivery, and cost-effective as well.