Targeted mass antibiotic treatment for an outbreak of syphilis is feasible but the experience of Canadian clinicians indicates it should not be done routinely.
Reacting to an outbreak of sexually-transmitted infectious syphilis mainly in heterosexual men and women and concentrated in Vancouver, a targeted mass treatment program provided azithromycin (1.8 g orally) to those at risk.
The rate of syphilis dropped initially, but then rebounded, reports Dr Michael L Rekart and colleagues with the British Columbia Centre for Disease Control. Between mid-1997 and 2000, the rate of syphilis across the province of British Columbia increased from less than 0.5 to 3.4 per 100,000, and the rate in Vancouver reached 12.9 per 100,000. The Vancouver outbreak was centered on a downtown area, and propagated mainly through heterosexual contact — 42% of patients associated with the sex industry, and only 6% were homosexual men.
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