Syphilis rates continue to climb in the U.S.
In 1998, the United States was on the verge of eliminating syphilis, one of the most prevalent sexually transmitted diseases (STDs). Today, the national syphilis rate has increased for the seventh consecutive year, according to preliminary data presented at the March 2008 National STD Prevention Conference.1
The new information include cases of primary and secondary (P&S) syphilis in 2007 reported to the Centers for Disease Control and Prevention (CDC) from all 50 states.
Public health officials say the increase largely reflects continued syphilis increases among men who have sex with men (MSM). However, the syphilis rate among females also increased in 2007 for the third consecutive year, which heightens concerns about a potential resurgence of the disease among women.
The national syphilis rate reached a low of 2.1 per 100,000 population in 2000. Since that time, the rate has increased by 76%. According to the preliminary data released at the conference, figures indicate that the rate of P&S syphilis in 2007 was 3.7 cases per 100,000 population, a 12% increase from 2006's rate of 3.3 per 100,000. The number of cases increased from 9,756 in 2006 to 11,181 in 2007.
Further examination of the data shows the overall increases in 2007 are largely among males. The 2007 rate for U.S. males was 6.4 cases per 100,000, for a 14% increase from the 2006 rate in 2006 (5.6 per 100,000) and a 146% increase from the rate in 2000 (2.6 per 100,000).
Sexually transmitted diseases such as syphilis remain a major threat to the health of gay and bisexual men, in part because having an STD other than HIV can increase the risk of transmitting or acquiring HIV, says Kevin Fenton, MD, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. The resurgence of syphilis in this population represents a formidable challenge to STD prevention efforts, but one that is surmountable, he says.
"The solution comes down to making STD screening and treatment a central part of medical care for gay and bisexual men, while finding innovative ways to help MSM avoid STD infections, including HIV, in the first place," states Fenton.
Missed opportunities?
Since 1999, the CDC has worked with public health and community partners on national syphilis elimination efforts to stem the sustained transmission of syphilis in the United States. In May 2006, the agency issued an updated National Plan to Eliminate Syphilis, designed to sustain progress made since the early 1990s in populations traditionally at risk, including African-Americans and women of all races, and to support solutions to fight the resurgence of syphilis among MSM. The agency revamped its Syphilis Elimination Effort tool kit to help clinicians increase awareness of the disease. (To access the tool kit online, go to the CDC web page, www.cdc.gov/std/see. Click on "Health care provider materials" to access such resources as a "Syphilis — Physician's Pocket Guide on Syphilis" and "Screening and Testing Men who Have Sex with Men (MSM) for Syphilis — A Guide for Health Care Professionals.")
Since 2002, CDC has recommended that sexually active MSM be tested at least annually for syphilis, chlamydia, and gonorrhea at all anatomic sites of reported STD exposure (oral, anal, and/or urethral). CDC also recommends at least an annual STD testing for all individuals with HIV infection.2
Despite the uptick in prevention efforts, clinicians still may miss opportunities to screen MSM at risk for syphilis. According to a new study presented at the 2008 National STD Prevention Conference, fewer than half of HIV-negative MSM report annual syphilis and gonorrhea testing.3 In the largest study of its kind to date, CDC researchers analyzed data from more than 10,000 HIV-negative MSM (n = 10,030) in 15 cities collected by the National HIV Behavioral Surveillance System from 2003 to 2005. They found within the previous year, only 39% reported having been tested for syphilis, and 36% reported having been screened for gonorrhea.
Similarities reported elsewhere
In two other studies presented at the conference, researchers reported similar missed screening opportunities. The first report was gathered from STD clinics in Chicago, Denver, Houston, New York City, Philadelphia, San Francisco, Seattle, and Washington, DC. It found as many as one-third of gonorrhea infections among MSM who were not HIV-infected were missed because MSM were not tested at all relevant anatomical sites.4 MSM were tested at all three sites only about half (52%) of the time, researchers report.
In the second report, researchers found that 82% of HIV-infected MSM in eight cities were tested for syphilis in the past year, but only 22% or fewer were tested for gonorrhea or chlamydia.5 The study was conducted in HIV clinics in Chicago, New York, Miami, Atlanta, San Francisco, and Los Angeles from 2004 through 2006.
"While STD screening is by no means the only weapon in our STD prevention arsenal, it is certainly one of our best tools for ensuring prompt diagnosis and treatment and slowing the transmission of these diseases," says John Douglas Jr., MD, director of CDC's Division of STD Prevention. "We are committed to supporting the efforts of physicians in the community as they work to increase screening among their patients. At the same time, we're working to support broader STD prevention programs for MSM, women, African-Americans, and others who remain at risk."
References
- Weinstock H. Syphilis in the United States: Epidemiology and Emerging Issues. Presented at the 2008 National STD Prevention Conference. Chicago; March 2008.
- Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55(RR-11):1-94.
- Tai E. Self-reported Syphilis and Gonorrhea Testing among Men Who Have Sex with Men (MSM) in the United States, National HIV Behavioral Surveillance System, 2003-2005. Presented at the 2008 National STD Prevention Conference. Chicago; March 2008.
- Mahle KC. Missed Gonorrhea Infections by Anatomic Site Among Asymptomatic Men Who Have Sex with Men (MSM) Attending U.S. STD Clinics, 2002-2006. Presented at the 2008 National STD Prevention Conference. Chicago; March 2008.
- Hoover K, Butler MO. STD Testing of HIV-Infected MSM at Eight U.S. Clinics. Presented at the 2008 National STD Prevention Conference. Chicago; March 2008.
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