CHICAGO — The rate of syphilis in the United States has increased for the seventh consecutive year, jumping 12% from 2006 to 2007, according to preliminary evidence released by the Centers for Disease Control and Prevention.
The upsurge was driven largely by a 14% rise in cases of primary and secondary syphilis among men, Dr. Hillard Weinstock said at a conference on STD prevention sponsored by the CDC. “As in recent years, the 2007 data show that men—particularly men who have sex with men—account for the vast majority of syphilis cases and contribute significantly to the overall syphilis increases. Men who have sex with men [accounted for] approximately 64% of reported syphilis cases in 2007,” said Dr. Weinstock, chief of surveillance at the CDC's division of STD prevention.
The overall 12% increase reflected about 1,300 additional cases reported to the CDC in 2007—a population rate of 6 per 100,000, Dr. Weinstock said at a press briefing during the conference.
The rate among men was six times greater than that among women.
Blacks experienced a disproportionate increase in the disease, compared with whites, Dr. Weinstock noted; the rate of syphilis among blacks was seven times higher than that among whites. Black men were six times more likely to have the disease than white men were, and black women were 13 times more likely to have it than white women were. From 2006 to 2007, the disease rate rose 25% in black men and 12% in black women.
“While men who have sex with men bear the heaviest burden of syphilis infections, ongoing increases among women and African Americans are also troubling and threaten to undo recent progress,” Dr. Weinstock said.
Following a 1999 federal commitment to end syphilis nationwide, infection rates reached an all-time low in 2000, dipping to just two cases per 100,000. The rate has increased each year since then. The new prevalence numbers represent a 76% increase over the 2000 nadir.
Inadequate routine screening combined with complacency about the disease appear to be influencing the increase, said Dr. John Douglas, the director of CDC's Division of STD Prevention. “When the incidence of a disease decreases so much, we often see an accompanying decrease in recognition of the disease among both providers and the public. And this is especially true among men who are already infected with HIV.”
These men might see syphilis and other STDs as a nuisance rather than a serious health threat. But about 2% of syphilis patients suffer permanent neurologic sequelae, including stroke, blindness, and deafness, Dr. Douglas noted.
The CDC recommends that sexually active gay men receive annual testing for both syphilis and HIV, with more frequent testing recommended for men who engage in high-risk same-sex behavior. But the new prevalence numbers, along with other studies, indicate that the rate of screening is too low.
“We really need help from our health care partners,” Dr. Douglas said. “A major message is that the word about the need for annual testing is not getting out to providers. We need to work much more closely with these partners both to get the word out and to find resources for testing.”
'A major message is that the word about the need for annual testing is not getting out to providers.' DR. DOUGLAS