STD Quarterly

Syphilis rates climb for the second year

Double up on your efforts to detect syphilis. Syphilis rates in the United States rose in 2002 for the second consecutive year, following a decade-long decline that resulted in an all-time low in 2000, according to new data from the Atlanta-based Centers for Disease Control and Prevention (CDC).¹

Between 2001 and 2002, the overall rate of syphilis increased 9.1%, from 2.2 cases to 2.4 cases per 100,000 population, the highest rate since 1999, according to the CDC’s statistics. The total number of reported cases increased 12.4%, from 6,103 to 6,862 cases. Since some syphilis cases go undiagnosed, the actual number of infections may likely be higher, say public health officials.

Syphilis cases among men increased 27.4% between 2001 and 2002, from 4,134 to 5,267 cases. While the CDC does not collect syphilis data by sexual orientation, the study authors estimate that more than 40% of all syphilis cases reported in 2002 occurred among gay and bisexual men, accounting for much of the reported overall increase in the disease.

MSM present challenges

The recent increases in reported syphilis cases in the United States among men who have sex with men (MSM) may be due to a number of complex prevention challenges this group faces, observes Ronald Valdiserri, MD, MPH, deputy director of the CDC’s National Center for HIV, STD, and TB Prevention.

"Many gay and bisexual men who already have HIV may have a lower level of concern about other STDs," he states. "Others may lack information on the health risks of syphilis or have a more relaxed attitude about safer sex due to the impression that available treatments have made HIV less of a threat."

A high rate of HIV coinfection has been reported among gay and bisexual men involved in the recent syphilis outbreaks.^2,3,4 A new CDC multistate study indicates a 17% increase in HIV diagnoses among men who have sex with men between 1999 and 2002.⁵ These increases have raised concerns about a resurgence of HIV in gay and bisexual men; there is a two- to fivefold increased risk of acquiring HIV infection when syphilis is present.⁶

Take a closer look

When looking at the figures by race, the increase in syphilis cases among men included an 85.2% increase among non-Hispanic white men and a 35.6% increase among Latino men. Syphilis cases among African-American men declined slightly (2.6%); however, African-American men continue to have the highest rate of syphilis among men: 13.5 cases per 100,000 population, compared to 4.5 among Latino and 2.2 among non-Hispanic white men.

Ongoing syphilis education and testing efforts may have resulted in declines in syphilis among African-Americans and among women of all ethnic groups, says the CDC. However, vigilance is needed to keep these declines in motion, state public health officials.

Valdiserri says the CDC is working alongside state and local community partners in cities that are most affected to reverse the increasing toll of syphilis among gay and bisexual men.

"It is essential that efforts address the challenges among gay and bisexual men by increasing knowledge of the health complications of syphilis infection, particularly for people with HIV; implementing prevention programs in venues such as the Internet that may facilitate unprotected sex; and continuing to alert health care providers who serve gay and bisexual patients of the urgent need for routine STD screenings, particularly among their HIV-infected patients," he states.

Community-based programs are adapting to meet the needs of the patients they serve, observes John Douglas, director of the CDC’s Division of STD Prevention.

The CDC is developing a syphilis-elimination "tool kit," a packaged set of strategies that local and state health departments can use to orchestrate syphilis prevention responses, with a large emphasis on awareness, he states.

References

1. Centers for Disease Control and Prevention. Primary and secondary syphilis — United States, 2002. MMWR 2003; 52;1,117-1,120.

2. Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease among men who have sex with men — King County, Washington, 1997-1999. MMWR 1999; 48:773-777.

3. Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with men — Southern California, 2000. MMWR 2001; 50:117-120.

4. Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex with men — New York City, 2001. MMWR 2002; 51:853-856.

5. Centers for Disease Control and Prevention. Increases in HIV diagnoses — 29 states, 1999-2002. MMWR 2003; 52:1,145-1,148.

6. National Center for HIV, STD and TB Prevention, Division of Sexually Transmitted Diseases, Centers for Disease Control and Prevention. Some Facts about Syphilis. May 2001. Accessed at www.cdc.gov/stopsyphilis/SyphilisFact.htm.