STD Quarterly: Focus continues on syphilis elimination
STD Quarterly
Focus continues on syphilis elimination
Rewind to 1998: The Centers for Disease Control and Prevention (CDC) launches its plan to eliminate syphilis in the United States, with the goals of reducing the total number of primary and secondary syphilis cases to 1,000 or fewer — 0.4 cases per 100,000 people — and increasing the number of syphilis-free counties to 90% by 2005.
Fast forward to today: The CDC reports a number of gains and lessons learned, says Kevin Fenton, MD, PhD, chief of the National Syphilis Elimination Effort (SEE) in the CDC’s National Center for HIV, STD, and TB Prevention, Division of STD Prevention:
- Primary and secondary (P&S) syphilis rates reached their lowest point ever in 2000 and 2001 at 2.1 cases per 100,000 people.
- Concomitant declines in the numbers of P&S syphilis cases among women and among African Americans have occurred every year since 1990. Between 2002 and 2003, P&S syphilis cases declined 23.6% among women and 17.8% among African Americans. The black/white rate ratios declined from 42:1 (black:white) in 1997 to 5:1 in 2003.
- Improvements have been made in training, community mobilization, provider education, and awareness raising across the country.
Despite these gains, Fenton reports that the overall number of cases of P&S syphilis increased between 2000 and 2003. This increase was largely due to increases among men, associated with outbreaks among men who have sex with men (MSM), he says. In 2003, 7,177 cases of P&S syphilis were reported, a rate of 2.5 cases per 100,000 population, Fenton states. Data for 2004 are not finalized. Syphilis remains a highly concentrated infection especially in the South and, increasingly, in urban areas of the country that have large populations of MSM, says Fenton.
Officials at Public Health Seattle — King County (PHSKC) in Seattle have seen a jump in the number of early syphilis cases. Between 2003 and 2004, such cases almost doubled from 76 to 140, reports Matthew Golden, MD, MPH, medical director of the PHSKC STD Clinic. Factors that may have led to the increase include growing methamphetamine use among MSM, increased partnerships over the Internet, and continued high levels of unsafe sex among a highly sexually active minority of MSM, he observes.
The agency is taking a multipronged approach to the challenge, Golden reports. Increased screening is an important tool. In 2004, PHSKC performed more than 10,000 tests for syphilis, a 37% increase since 1998. Syphilis screening is being offered at the Gay City Wellness Center, local bath houses, and at the Public Health STD Clinic at Harborview. Syphilis screening and treatment are offered on a sliding-fee scale, he says.
In addition, the agency is focusing on partner notification by helping people infected with syphilis ensure that their sex partners are made aware of risky exposures and are screened and treated, says Golden. The number of partners identified through partner notification per syphilis case increased 350% between 1999 and 2004, he reports.
Seattle public health officials also are using public awareness media campaigns and community-based initiatives to keep information front and center for populations at risk. Ongoing surveillance and collaboration with CDC round out the agency’s control strategies, he says.
How can your facility join in the syphilis elimination effort? Go to the CDC’s web site, www.cdc.gov/std/see, to review information about the SEE Community Mobilization Toolkit. The materials in the toolkit can be used to increase local awareness and visibility of the SEE program, as well as support efforts to change knowledge, attitudes, behaviors, and perceptions about syphilis and the syphilis elimination effort.
The SEE Toolkit has been well received by public health practitioners, says Sureyya Hornston, PhD, MPH, CDC health communications specialist. Professionals at local and state health departments and community-based organizations are enthusiastic about the toolkit; they especially like that materials are ready-to-use and available on CD-ROM for customizing to local needs, she notes.
What is the next step for the syphilis elimination project? The need for sustained mobilization in the fight against syphilis is as relevant today as it was in 1998, says the CDC. While substantial gains have been made, the agency continues to maintain multifaceted, coordinated efforts.
"Five years into SEE, CDC is evaluating progress made and lessons learned, with a view to developing new strategies to guide elimination activities over the next decade," Fenton observes. "Key within this effort will be the need to tackle new challenges, including the changing disease epidemiology with the growing disease burden borne by men who have sex with men; the role of the Internet and drug abuse, especially crystal meth-amphetamine, in facilitating syphilis transmission; and supporting sexually transmitted disease treatment services to meet the challenges of the changing epidemic."
Rewind to 1998: The Centers for Disease Control and Prevention (CDC) launches its plan to eliminate syphilis in the United States, with the goals of reducing the total number of primary and secondary syphilis cases to 1,000 or fewer 0.4 cases per 100,000 people and increasing the number of syphilis-free counties to 90% by 2005.Subscribe Now for Access
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