1. Division of STD Prevention Centers for Disease Control and Prevention
Primary and Secondary Syphilis in the United States: Epidemiology and Emerging Issues
Hillard Weinstock
Division of STD Prevention
Centers for Disease Control and Prevention
March 11, 2008

2. Background
Genital ulcerative infection
Facilitates the transmission of HIV
Syphilis and other STDs are a marker of behaviors associated with HIV transmission
Untreated early syphilis during pregnancy results in infection of the fetus in >70% cases
Prior to 2000, rates of primary and secondary syphilis declined for 10 years
Since 2000, rates among men have increased while those among women continued to decline until 2003
In 2005, CDC began collecting information on the sex of sex partners of patients with syphilis

3. Primary and secondary syphilis rates in the United States, 1981–2007*
Rate (per 100,000 population)
*2007 data are preliminary

4. Primary and secondary syphilis rates By sex, United States, 1990–2007*
Rate (per 100,000 men/women)
* 2007data are preliminary

5. Primary and secondary syphilis — Age- and sex-specific rates: United States, 2006

6. Primary and secondary syphilis — Cases by reporting source and sex: United States, 1998–2007*
*Preliminary 2007 data

7. Primary and secondary syphilis: Rates by race and ethnicity, 1997–2007*
Rate (per 100,000 population)
* 2007 data are preliminary

8. Primary and secondary syphilis cases: United States, 2004-2007
2007*
% Change
Sex
Men
6,722
9,502
+41.3
Women
1,255
1,671
+33.1
Race/Ethnicity
African-American
3,071
4,944
+60.9
White
2,982
3,664
+22.8
Hispanic
1,196
1,728
+44.5
Asian/PI
143
166
+16.1
American Indian/NA 73 67
-11.0
Total
7,980
11,181
+40.1
* 2007 data are preliminary

9. Primary and secondary syphilis — Rates by county: United States, 2006
Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. In 2006, 2,360 (75.2%) of 3,140 counties in the U.S. reported no cases of P&S syphilis.

10. Primary and secondary syphilis cases, by sex, in 10 counties with largest number of cases, 2006
San Francisco
Cook County, IL
New York County
Los Angeles
Fulton County, GA
San Diego
Miami/Dade, FL
Harris County, TX
Dallas County, TX
Jefferson County, AL
Men
Women

11. Primary and secondary syphilis rates by sex and race, 2004-2007*
*2007 data are preliminary

12. Primary and secondary syphilis cases among men by region, 2004-2007*
*2007 data are preliminary

13. Primary and secondary syphilis cases among women by region, 2004-2007*
*2004 data are preliminary

14. Primary and secondary syphilis rate ratios between African Americans and Whites, by sex, 1996-2007*
* 2007 data are preliminary

15. Primary and secondary syphilis by sexual orientation and race/ethnicity, 2007*
Number of cases
* 2007 are preliminary

16. Primary and secondary syphilis by sex and sexual orientation, in 23 states, 2005-2007*
Number of cases
* 2007 data are preliminary

17. Primary and secondary syphilis among MSM by race/ethnicity in 23 states, 2005-2007*
Number of cases
* 2007 data are preliminary

18. Primary and secondary syphilis among heterosexual men by race/ethnicity in 23 states, 2005-2007*
Number of cases
* 2007 data are preliminary

19. Primary and Secondary Syphilis by Stage and Sexual Orientation, 2007*
Number of cases
* 2007 data are preliminary

20. Congenital syphilis — Reported cases for infants <1 year of age and rates of primary and secondary syphilis among women, 1997–2006

21. Rates are greatest among African American men
Summary
Rates of syphilis among MSM continue to increase; MSM account for >60% of all P&S syphilis cases
Rates are greatest among African American men
A larger proportion of syphilis cases among MSM and women present in the secondary stage
Smaller increases over past 3 years in women, especially in the South, are concerning

22. State and local STD programs Deborah Dowell Sharon Clanton
Acknowledgements
State and local STD programs
Deborah Dowell
Sharon Clanton
Darlene Davis
Rob Nelson
The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the CDC/ATSDR

24. Primary and secondary syphilis: Male-to-female rate ratios, 1981–2007*
Male:female rate ratio

25. Possible reasons for behavior change among MSM
HIV/AIDS prevention fatigue among older gay men
Few prevention efforts reaching marginalized MSM
Serosorting
Internet chat rooms
Treatment optimism
Viral load beliefs
Recreational drug use (e.g., methamphetamine use)

26. STD surveillance
“High quality national surveillance is the cornerstone of infectious disease prevention and control.”
--- WHO, 2004
Information base for public health decision making and action
Must respond to need for new information
Must accommodate changing priorities

27. STD Surveillance in the U.S.
Major Components
Case Reporting
Prevalence-monitoring
Sentinel Surveillance
Population-based surveys
Special projects