Syphilis epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Syphilis, a genital ulcerative disease, causes significant complications if untreated and facilitates the transmission of HIV. Untreated early syphilis in pregnant women 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 80% of cases.

The rate of primary and secondary syphilis reported in the United States decreased during the 1990s; in 2000, the rate was the lowest since reporting began in 1941. The low rate of infectious syphilis and the concentration of the majority of syphilis cases in a small number of geographic areas in the United States led to the development of the CDCs National Plan to Eliminate Syphilis, which was announced by Surgeon General David Satcher in October 1999 and revised in May 2006.2

Although the rate of primary and secondary syphilis in the United States declined 89.7% between 1990 and 2000, the rate of primary and secondary syphilis increased annually between 2001 and 2007. Overall increases in rates between 2001 and 2007 were observed primarily among men (from 3.0 cases per 100,000 population to 6.6 cases per 100,000 population). After persistent declines from 1992 to 2003, the rate of primary and secondary syphilis among women increased from 0.8 cases per 100,000 population in 2004 to 0.9 cases per 100,000 population in 2005 to 1.0 case per 100,000 population in 2006, to 1.1 case per 100,000 population in 2007.

Syphilis remains an important problem in the South and in urban areas in other regions of the country. Increases in cases among MSM have occurred and have been characterized by high rates of HIV co-infection and high-risk sexual behavior.3-7 The estimated proportion of primary and secondary syphilis cases attributable to MSM increased from 4% in 2000 to 62% in 2004. In 2005, CDC requested that all state health departments report sex of sex partners for persons with syphilis. In 2007, 65% of those primary and secondary syphilis cases in 44 states and Washington D.C. with available information were among MSM. Of reported male cases with primary and secondary syphilis, sex of partner information in 2007 was available for 79%.

Syphilis — All Stages (Primary & Secondary , Early Latent, Late, Late Latent, Congenital)

Between 2006 and 2007, the number of cases of early latent syphilis reported to CDC increased 17.2% (from 9,186 to 10,768), while the number of cases of late and late latent syphilis increased 3.5% (from 17,644 to 18,256)3. The total number of cases of syphilis (all stages: primary and secondary, early latent, late, late latent, and congenital syphilis) reported to CDC increased 10.7% (from 36, 959 to 40, 920) between 2006 and 2007 3.

Primary & Secondary Syphilis — United States

In 2007, primary and secondary syphilis cases reported to CDC increased to 11,466 from 9,756 in 2006, an increase of 17.5%. The rate of primary and secondary syphilis in the United States in 2007 (3.8 cases per 100,000 population) was 15.2% higher than the rate in 2006 (3.3 cases per 100,000 population), and it is greater than the HP 2010 target of 0.2 case per 100,000 population 3.

Note: The Healthy People 2010 target for primary & secondary syphilis is 0.2 case per 100,000 population

Primary & Secondary Syphilis by Region

The South accounted for 48.8% of the primary and secondary syphilis cases in 2007 and 47.1% in 2006. Between 2006 and 2007, rates increased 21.4% in the South (from 4.2 to 5.1 cases per 100,000 population), 30.8% in the Northeast (from 2.6 to 3.4), 8.1% in the West (from 3.7 to 4.0) and 5.6% in the Midwest (from 1.8 to 1.9). The 2007 rates in all regions were greater than the HP 2010 target of 0.2 cases per 100,000 population 4.

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population.

Resources

CDC Syphilis stats

References

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