JACKSONVILLE, FLA. — Tailored and targeted interventions to educate men who have sex with men and to reduce ethnic disparities are key components of a revised Syphilis Elimination Effort recently released by the Centers for Disease Control and Prevention.
“The new syphilis elimination effort is a very comprehensive plan. It is targeted toward urban areas and men who have sex with men [MSM] in the United States,” Dr. John F. Beltrami said at a conference on STD prevention sponsored by the CDC.
Syphilis prevalence has been increasing since 2000, when it reached its lowest rate since 1941. In 2005, the overall primary and secondary syphilis rate was 3.0 per 100,000 people in the United States, according to provisional CDC data.
The CDC launched the Syphilis Elimination Effort (SEE) in 1999. The initial effort addressed the primarily heterosexual route of transmission from the late 1980s to late 1990s. The CDC has now released a revised syphilis elimination plan, because the epidemiology of syphilis has changed enough to warrant new strategies. “The elimination plan has about 75 specific activities, and the … MSM disparity is highly emphasized in the new plan,” said Dr. Beltrami, epidemiologist at the epidemiology and surveillance branch of the CDC.
MSM now account for the largest increases in new syphilis cases, Dr. Beltrami said. For example, of the 7,389 primary and secondary syphilis cases among males reported in provisional 2005 CDC data, 5,702 (77%) were among MSM.
Previously, outbreaks among MSM were inferred from an increasing male-to-female ratio. This ratio increased steadily in recent years up to 2.7:1 in 2004, although it dropped slightly to 2.5:1 in 2005, Dr. Beltrami said.
Another indirect measure is location: Increases are occurring in urban areas with large MSM populations. The highest incidence of new syphilis cases in 2004 occurred in New York, Los Angeles, San Francisco, Chicago, Atlanta, and Miami, “suggesting substantial MSM transmission,” he said.
The revised SEE plan includes a new MSM variable that calls for partner gender reporting. This will be more accurate but prone to underreporting, Dr. Beltrami predicted. “Only since 2005 has CDC requested gender-of-partner information.” He added that not all states are providing complete data.
To support education and outreach to MSM, the new plan also calls for data collection on recreational drug use—including methamphetamine and Viagra—and venues people use to meet and have sex with partners. To aid clinicians and enhance surveillance, “the CDC divisions for STD and HIV prevention are working together to develop a combined interview form,” Dr. Beltrami said.
Although white MSM in recent years have driven the syphilis epidemic in terms of the number of new cases, syphilis goes beyond this population. “Racial disparities are growing,” he said. “African Americans consistently have had the highest primary and secondary syphilis rates compared to other races and ethnicities.” The incidence of new syphilis cases was 14.8 per 100,000 African American males in 2005.
Ethnic disparities occur with congenital syphilis as well. Reflecting higher overall prevalence, congenital rates among African Americans are consistently higher than are those of other groups, but they are decreasing, Dr. Beltrami said.
Overall, congenital and female primary and secondary syphilis rates have decreased each year from 1997 to 2005.
During the next 6 months to 2 years, the agency will develop a specific action plan with a 5-year timetable of activities, a syphilis elimination research and development strategy, and a template “outbreak response plan” to be adapted by state and local health departments.
The 63-page SEE document is available online at www.cdc.gov/stopsyphilis