In late 1990, a regional health department in southwestern Saudi Arabia became concerned over 70 VDRL and TPHA seropositive persons detected through routine screening of pregnant women in a remote rural area of 31,216 people. Initial information indicated that all 70 were asymptomatic. We reviewed medical records, registration books in local hospitals, primary health centers, and the laboratory serving the affected area. Using a standard questionnaire we interviewed 51 seropositive persons and 51 seronegative controls concerning illness and sexual behavior. We compared responses of the 2 groups and medical records using the Fisher exact test and the Chi square test.
Among 31,216 residents, 68 seropositive persons were identified, 82% females and 18% males. 71% were of reproductive age (20- 49). Of 51 interviewed seropositive persons 61% reported complaints of characteristic primary or secondary syphilis. However, only 10% had these complaints recorded in their medical records. Seropositive persons were more likely (61%) than seronegative controls (27%) to complain of one or more characteristic symptoms of syphilis (p<0.01). Questions concerning sexual behavior were difficult to apply in this community. The positive tests resulted from treponomal infection with the signs and symptoms indicating syphilis not bejel (endemic syphilis). For control we emphasized improved diagnostic services, establishing a good reporting surveillance system for prompt identification of new cases and their contacts, and enhanced treatment or refused services.
Conclusion: