STD Quarterly: Syphilis rate rises for first time since 1990

Put syphilis detection on your radar screen: Overall rates of primary and secondary syphilis have increased slightly for the first time in more than a decade, according to a new report from the Atlanta-based Centers for Disease Control and Prevention (CDC).1

Cases of primary and secondary syphilis in the United States rose from 5,979 cases in 2000 to 6,103 cases in 2001, representing an increase of 2%. The overall syphilis rate grew from 2.1 per 100,000 people to 2.2 per 100,000 people, the first such increase since 1990, according to the CDC.

In 1998, the CDC initiated efforts to eliminate syphilis from the United States, with elimination defined as the absence of sustained transmission. (Contraceptive Technology Update reported on the national campaign in its September 1997 article, "Syphilis hits 40-year low; can elimination be within reach?" p. 111.) Since those efforts began, public health officials have reported progress in combating the sexually transmitted disease (STD), states the CDC.

The increase in rates found in the new report can be attributed to an upsurge of syphilis diagnoses among men, states Ronald Valdiserri, MD, MPH, deputy director of CDC’s HIV, sexually transmitted disease, and tuberculosis prevention programs. Between 2000 and 2001, the syphilis rate among men in the United States grew by 15%, he says. These increases are associated with recent syphilis outbreaks among gay and bisexual men of all races reported in Chicago, Los Angeles, New York City, San Francisco, Seattle, and Miami.

Any rise in syphilis can prove problematic when it comes to HIV prevention; according to the CDC, there is a two- to fivefold increased risk of acquiring HIV infection when syphilis is present.2

"While the goal of syphilis elimination remains unchanged, we cannot accept syphilis increases in any population as the way things are, especially since syphilis outbreaks could signal an HIV resurgence," states Valdiserri.

Some groups see drop

The new CDC reports show positive gains in the syphilis elimination campaign:

  • Cases among African-Americans declined by 9.9 % (3.5% and 18.1% among African-American men and women, respectively).
  • While the South continues to have the largest proportion of syphilis cases (56% of total U.S. cases), public health officials note an 8% decline in syphilis rates.
  • Syphilis cases among women overall declined by 19%.

The increase in syphilis rates among gay and bisexual men of all races pose new challenges to eliminate the disease, says the CDC. Syphilis cases among white and Latino men rose 63% and 50%, respectively, from 2000 to 2001. And while African-American males were the only men in any racial or ethnic group to experience a decline, the 3.5% decline represents a significant slowdown from the 15% drop reported from 1999 to 2000.

Heighten STD awareness

The CDC is working with local communities and health departments on new and aggressive strategies to control syphilis, states Jo Valentine, MSW, National Syphilis Elimination Program coordinator. In addition to rapid response teams, CDC is conducting research into possible factors underlying outbreaks and will use this data to guide intervention efforts, she says.

In focusing on outreach to the gay and bisexual male population, the CDC is developing new primary and secondary prevention approaches, including Internet-based health education and community-based syphilis screening events to alert men to the dangers of syphilis and increase early access to care, says Valentine. Expanded surveillance, including enhanced behavioral surveillance and improved health communications also is being introduced, she notes.

To better understand why gay and bisexual men may be vulnerable to syphilis, CDC has conducted studies in several cities to identify factors that may be playing a key role in syphilis transmission.3-8

The findings reveal a lack of knowledge about STDs among men who have sex with men, limited counseling and diagnostic screening for STDs offered by health care providers, and the need for a much more concentrated and comprehensive community response.

"We cannot and should not accept an increase in syphilis cases in any population as inevitable," says Valdiserri. "The new data do make it clear that our strategies need to evolve as patterns in disease do."

References

1. Heffelfinger JD, Weinstock HS, Berman SM, et al. Primary and secondary syphilis — United States, 2000-2001. MMWR 2002; 51:971-973.

2. 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/nchstp/dstd/Fact_Sheets/Syphilis_Facts.htm.

3. 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.

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

5. Bronzan R, Echavarria L, Hermida J, et al. Syphilis among men who have sex with men in Miami-Dade County, Florida. Presented at the 2002 National STD Prevention Conference. San Diego; March 2002.

6. 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.

7. Chen SY, Gibson S, Katz MH, et al. Continuing increases in sexual risk behavior and sexually transmitted diseases among men who have sex with men: San Francisco, California, 1999-2001. Am J Public Health 2002; 92:1,387-1,388.

8. Ciesielski CA, Boghani S. HIV infection among men with infectious syphilis in Chicago, 1998-2000. Presented at the Ninth Conference on Retroviruses and Opportunistic Infections. Seattle; February 2002.