1. Figure 1. HIV and syphilis co-morbidity, 2000 – 2009 *diagnosed within 2000 – 2009

2. Figure 2. Relative risk* of TES syphilis morbidity by sex, 2007 – 2009 Of the 1,369 interviews conducted during this time, 36% were identified as MSM. *Reference is female.

3. Figure 3. Relative risk* of TES syphilis infection among racial and ethnic minorities, 2007 – 2009 *Reference is white (non-Hispanic).

4. Figure 4. Relative risk* of TES syphilis infection by age, 2007 – 2009 *Reference is 30-39.

5. Figure 5. TES syphilis morbidity by region, 2007 – 2009

7. Internet Partner Services (IPS) Since 2-25-05, there have been 248 internet partners named: 219 were unable to locate 12 were located and refused examination 7 were epi treated 0 were brought to treatment 2 were closed as "Other" data thru May 2010

8. Two Different Syphilis Outbreaks, Two Different Responses, Same Outcome

9. Syphilis Outbreak Response Cost Comparison Cost*Duration Danville ‘00 $ 279,07012 months Lynchburg ‘07 $ 34,3002 months Cities are similar in size, location, and population dynamics Both have previous histories of syphilis outbreaks Only difference is WHEN the response effort occurred * Costs include salary, travel related, supplies, and contracts

10. Issues Successes Can deploy DIS rapidly Rate of increase slowing Monthly webinar for LHD staff CBO partnerships Challenges Timeliness of disease intervention IPS – low Tx yield Training needs HIV co-infection DIS resources Media campaign approval