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Syphilis
Syphilis, a genital ulcerative disease, facilitates the transmission
of HIV and may be important in contributing to HIV transmission
in those parts of the country, such as the South, where rates of
both infections are high. Untreated early syphilis during pregnancy
results in perinatal death in up to 40% of cases and, if acquired
during the four years preceding pregnancy, may lead to infection
of the fetus in over 70% of cases.1
The
rate of primary and secondary (P&S) syphilis reported in the
United States is the lowest since reporting began in 1941. This unprecedented
low rate and the concentration of the majority of syphilis cases
in a small number of geographic areas have led to the development
of the National Plan to Eliminate Syphilis from the United States,
which was announced by Surgeon General David Satcher in October 1999.2 Collaboration
with diverse organizations, public health professionals, the private
medical community, and other partners working in STD and HIV is essential
for the success of this effort.3
The
rate of P&S syphilis in the United States declined by 89.2% from
1990 through 2000. Nevertheless, syphilis remains an important problem
in the South and in some urban areas in other regions of the country.
Recently, outbreaks of syphilis among men who have sex with men (MSM)
have been reported, possibly reflecting an increase in risky behavior
in this population associated with the availability of highly active
antiretroviral therapy for HIV infection.4,5
- In 2000, P&S
syphilis cases reported to CDC declined to 5,979 from 6,617 in
1999, a decline of 9.6%. The number of P&S syphilis cases reported
in 2000 is the lowest yearly number of cases ever reported (Table 1).
The reported rate of P&S syphilis in the United States in 2000
(2.2 cases per 100,000 persons) was slightly below the rate reported
in 1999 (2.4 cases per 100,000), although it is greater than the
Healthy People 2010 (HP2010) objective of 0.2 case per 100,000
persons (Figure
21, Table 1).6
- Since 1990, the
rate of early latent syphilis has exceeded the rate of P&S
syphilis. There were approximately 0.9 case per 100,000 persons
of early latent syphilis for every reported case of P&S syphilis
in the five years preceding 1990 and 1.6 reported cases of early
latent syphilis for every reported case of P&S syphilis in
2000 (Table 1).
- Since 1993, the
rate of late and late latent syphilis has exceeded the rate of
P&S syphilis. There were approximately 0.6 case per 100,000
persons of late and late latent syphilis for every reported case
of P&S syphilis in the five years preceding 1993 and 2.6 reported
cases of late and late latent syphilis for every reported case
of P&S syphilis in 2000 (Table 1).
- In 2000, P&S
syphilis rates in 14 states were less than or equal to the HP2010
national objective of 0.2 case per 100,000 persons (Figure 22, Table
23). Fifteen states and two outlying areas reported five or
fewer cases of P&S syphilis in 2000 (Table 25).
- In 2000, 2,520
(80.3%) of 3,139 counties in the United States reported no cases
of P&S syphilis compared with 2,473 (78.8%) counties reporting
no cases in 1999. Of 619 counties reporting at least one case of
P&S syphilis in 2000, 24 (3.9%) reported rates at or below
the HP2010 objective of 0.2 case per 100,000 persons. Rates of
P&S syphilis were above the HP2010 objective for 595 counties
in 2000 (Figure 23).
These 595 counties (18.9% of the total number of counties in the
U.S.) accounted for more than 99.5% of the total P&S syphilis
cases reported in 2000.
- In 2000, 2,544
(81.0%) of the 3,139 United States counties reported P&S syphilis
rates equal to or less than the HP2010 objective of 0.2 case per
100,000 persons.
- In 2000, the largest
numbers of cases of P&S syphilis were reported from 21 counties
and the city of Baltimore, MD (Table 24).
These 22 areas account for half of the total number of P&S
syphilis cases that were reported in the United States in 2000.
- In 2000, the reported
rate of P&S syphilis among men (2.7 cases per 100,000 males)
was 1.5 times greater than the rate among women (1.8 cases per
100,000 females). The overall male to female rate ratio has risen
steadily since 1994 when it was 1.1 (Figure 26).
- The P&S syphilis
rate for 2000 in the South (3.8 cases per 100,000 persons) was
higher than the rate reported in any other region of the country.
The 2000 reported rates in all regions were greater than the HP2010
objective of 0.2 case per 100,000 persons (Figure 24, Table
25).
- Reported rates
and case counts for P&S syphilis were calculated within each
of the four geographic regions of the United States (Northeast,
Midwest, South, and West) and for each of four categories representing
the level of urbanization (urban, peri-urban, peri-rural, rural)
(see Figure 25 and
the Appendix for definitions of the categories).
Reported P&S syphilis rates in the South were higher than the
other regions of the country for all urbanization categories. Of
the 5,979 cases of P&S syphilis reported at the county level
in 2000, 62.0% occurred in the South.
- The overall rate
of P&S syphilis reported in 2000 for selected large U.S. cities
with populations of 200,000 persons or more (4.6 per 100,000 persons)
was slightly less than the rate reported for these cities in 1999
(5.0 per 100,000 persons) (Table 29). However, rates exceeded the
HP2010 objective of 0.2 case per 100,000 persons in 57 (89.0%)
of 64 large cities in the United States and outlying areas for
which data were available (Table 28).
- In 2000, the rate
of P&S syphilis reported in African-Americans (12.8 cases per
100,000 persons) was 21 times greater than the rate reported in
whites (0.6 case per 100,000 persons). However, this differential
was substantially less than that in 1996, when the rate of P&S
syphilis among African-Americans was 50 times greater than the
rate reported among whites (Table 32B).
- Between 1996 and
1999, the rates of P&S syphilis within racial and ethnic groups
generally declined. Group-specific rates remained relatively constant
between 1999 and 2000, with the exception of the rate among African-Americans,
which decreased from 15.0 to 12.8 cases per 100,000 persons during
this period (Figure 27, Table
32B).
- Between 1999 and
2000, the overall rate of congenital syphilis decreased by 7.6%
in the United States, from 14.5 to 13.4 cases per 100,000 live
births (Figure 29, Table
37). In addition, among the 21 states and outlying areas with
five or more reported cases of congenital syphilis in 2000, 10
had rates that decreased since 1999. Three of these states and
Puerto Rico had rate decreases of 30% or more between 1999 and
2000 (Table 39).
- The continuing
decrease in the rate of congenital syphilis (Figure 30)
likely reflects the substantial reduction in the rate of P&S
syphilis among women that has occurred in the last decade (Figure 29).7 During
the period from 1991 through 2000, the average yearly percentage
decrease in the congenital syphilis rate was 22% (Table 37).
The average yearly percentage decrease in the rate of P&S syphilis
reported among women for the years 1991 through 2000 was 21.0%.
- In 2000, 27 states
and one outlying area had reported rates of congenital syphilis
that exceeded the HP2010 objective of 1.0 case per 100,000 live
births (Table 38).
- Thirty-three (51.6%)
of the 64 selected cities with populations of 200,000 persons or
more had congenital syphilis rates greater than the HP2010 objective
of 1.0 case per 100,000 live births (Table 40).
All of these cities had reported rates that were more than six
times the HP2010 objective.7
- Additional information
on syphilis and congenital syphilis can be found in the
Special Focus Profiles section.
1Ingraham NR. The value of penicillin alone
in the prevention and treatment of congenital syphilis. Acta Derm Venereol 31 (suppl 24): 60, 1951.
2Division of STD Prevention. The National Plan to Eliminate Syphilis from the
United States.
National Center for HIV, STD, and TB Prevention, Centers for
Disease Control and Prevention, 1999.
3Centers for Disease Control and Prevention. Primary and secondary syphilis – United States,
1999. MMWR 2000;50:113-117.
4Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease
among men who have sex with men – King County, Washington, 1997-1999. MMWR 1999; 48:773-777.
5Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with
men -Southern California, 2000. MMWR 2001;
50(7): 117-20.
6U.S. Department of Health and Human Services. Healthy People
2010 2nd ed. With Understanding and Improving Health
and Objectives for Improving Health. 2 vols. Washington, DC:
U.S. Government Printing Office, November 2000.
7Centers for Disease Control and Prevention. Congenital Syphilis - United States, 2000. MMWR 2001;50(27):573-77.
Figure
20. Syphilis — Reported cases by stage of illness: United
States, 1941–2000
Figure
21. Primary and secondary syphilis — Reported rates: United
States, 1970–2000 and the Healthy People year 2010 objective
Note: The Healthy
People 2010 (HP2010) objective for primary and secondary syphilis
is 0.2 case per 100,000 population.
Syphilis
figures continue in Syphilis - page 2
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