{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:37:43Z","timestamp":1780551463688,"version":"3.54.1"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health","award":["R01 AI067913"],"award-info":[{"award-number":["R01 AI067913"]}]},{"name":"National Institute of Health","award":["R01 AI067913"],"award-info":[{"award-number":["R01 AI067913"]}]},{"name":"National Institute of Health","award":["R01 AI067913"],"award-info":[{"award-number":["R01 AI067913"]}]},{"name":"National Institute of Health","award":["R01 AI067913"],"award-info":[{"award-number":["R01 AI067913"]}]},{"name":"National Institute of Health","award":["R01 AI067913"],"award-info":[{"award-number":["R01 AI067913"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>In 2001, the primary and secondary syphilis incidence rate in rural Columbus County, North Carolina was the highest in the nation. To understand the development of syphilis outbreaks in rural areas, we developed and used the Bayesian Maximum Entropy Graphical User Interface (BMEGUI) to map syphilis incidence rates from 1999\u20132004 in seven adjacent counties in North Carolina. Using BMEGUI, incidence rate maps were constructed for two aggregation scales (ZIP code and census tract) with two approaches (Poisson and simple kriging). The BME maps revealed the outbreak was initially localized in Robeson County and possibly connected to more urban endemic cases in adjacent Cumberland County. The outbreak spread to rural Columbus County in a leapfrog pattern with the subsequent development of a visible low incidence spatial corridor linking Roberson County with the rural areas of Columbus County. Though the data are from the early 2000s, they remain pertinent, as the combination of spatial data with the extensive sexual network analyses, particularly in rural areas gives thorough insights which have not been replicated in the past two decades. These observations support an important role for the connection of micropolitan areas with neighboring rural areas in the spread of syphilis. Public health interventions focusing on urban and micropolitan areas may effectively limit syphilis indirectly in nearby rural areas.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001714","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T17:27:54Z","timestamp":1683221274000},"page":"e0001714","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Progression of a large syphilis outbreak in rural North Carolina through space and time: Application of a Bayesian Maximum Entropy graphical user interface"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3737-6506","authenticated-orcid":true,"given":"Lani C.","family":"Fox","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne","family":"Gesink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9752-8930","authenticated-orcid":true,"given":"Irene","family":"Doherty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1131-9274","authenticated-orcid":true,"given":"Kristen H.","family":"Hampton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delbert E.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Akita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3145-4024","authenticated-orcid":true,"given":"Marc L.","family":"Serre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"pgph.0001714.ref001","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/00007435-199803000-00009","article-title":"Using social network and ethnographic tools to evaluate syphilis transmission.","volume":"1","author":"R Rothenberg","year":"1998","journal-title":"Sexually transmitted diseases."},{"key":"pgph.0001714.ref002","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/01.olq.0000237776.15870.c3","article-title":"Factors and the sociosexual network associated with a syphilis outbreak in rural North Carolina.","volume":"1","author":"A Se\u00f1a","year":"2007","journal-title":"Sexually transmitted diseases."},{"key":"pgph.0001714.ref003","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1097\/01.olq.0000175378.20009.5a","article-title":"Sexually transmitted diseases in the Southeastern United States: location, race, and social context","volume":"1","author":"T. 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