Background St. Louis, Missouri remains a high-morbidity syphilis community. Implementation of a small-media intervention in 2005 to improve provider knowledge and awareness of syphilis led to transient declines in infectious syphilis, but rates have increased in recent years. We describe a formative collaborative project between university, health department, and community service organisation workers to develop a pocket-sized visual aid for boosting healthcare providers’ awareness and understanding of syphilis epidemiology, clinical presentation, and treatment recommendations.

Methods In 2012, physician and nurse-practitioner key informants (N = 18) provided foundational data on essential areas of provider knowledge deficit, including (1) clinical aspects of syphilis management such as lesion characteristics, diagnostic tests, and treatment approaches; (2) epidemiological aspects such as populations affected and distribution by age, race/ethnicity, and gender; and (3) health department linkages for partner referral and evaluation. Best practises for reaching providers were also considered, including mail-based and internet-based modalities.

Results Several important aspects of current syphilis clinical presentation and epidemiological patterns were underappreciated by local healthcare providers, including high rates of syphilis among men who have sex with men (MSM), as well as high rates of syphilis-HIV co-infection. Rectal and oropharyngeal infection were also underrecognized. All of these were new developments since the previous version of small-media intervention. Informant recommendations led to the development of a high-contrast pocket-size small-media pamphlet containing text as well as visual prompts to boost provider knowledge and awareness of syphilis. The booster intervention is currently being rolled out city-wide through direct-mail and in-person distribution to primary healthcare providers.

Conclusion Changing syphilis epidemiology requires continued vigilance among provider groups tasked with early identification, treatment, and referral of populations at risk. Small-media visual aids to boost provider awareness and knowledge of syphilis transmission patterns are an important component of larger community-level syphilis prevention agendas.