Syphilis Rates in US Doubled Since 2000, Still Rising

Laurie Barclay, MD

May 08, 2014

Syphilis incidence is continuing to rise and is now twice that of the US nadir, according to an analysis of data from the National Notifiable Diseases Surveillance System (NNDSS), published in the May 9 issue of the Morbidity and Mortality Weekly Report. Rates are highest among black men and men who have sex with men (MSM), with recent increases among Hispanic and white men.

In 2013, states reported an overall rate of 5.3 cases of primary and secondary syphilis per 100,000 population, which is more than 2-fold higher than the nadir of 2.1 in 2000, write Monica E. Patton, MD, Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues.

The trend is strongest among men, particularly MSM. From 2005 to 2013, rates of primary and secondary syphilis among men of all ages and races/ethnicities nearly doubled, climbing from 5.1 cases per 100,000 population in 2005 to 9.8 in 2013. At that time, men accounted for 91.1% of all US cases reported.

Rates of primary and secondary syphilis stabilized during 2009 to 2010 but have increased since 2011, primarily among men and particularly among MSM, who accounted for the vast majority of male primary and secondary syphilis cases during 2009 to 2012.

Syphilis is therefore at present "predominantly an MSM epidemic," with the largest and most accelerated increases in the number of cases occurring among MSM, the authors note.

Among women, rates of syphilis rose during 2005 to 2008 and declined during 2009 to 2013, with trends varying among racial/ethnic groups.

Clinicians Should Screen for and Recognize Syphilis

Dr. Patton and colleagues urge providers to be aware of the resurgence of syphilis and to know its signs and symptoms. They also recommend risk assessments and at least annual screening of all sexually active MSM with syphilis serologic tests, using confirmatory testing when needed. MSM who have multiple or anonymous sex partners should be screened at 3- to 6-month intervals.

"Public health practitioners might want to consider focusing on efforts to strengthen linkages with practicing physicians to improve case identification and reporting, partner-notification programs, and outreach to MSM," the authors write.

Rising increase in syphilis incidence among MSM has major public health implications because syphilis and behaviors underlying transmission also increase the risk for HIV acquisition and transmission. Among MSM infected with primary and secondary syphilis, reported rates of HIV coinfection are 50% to 70%.

"Syphilis prevention measures for MSM of all races/ethnicities should be strengthened throughout the United States, including 1) encouraging safer sexual practices (e.g., reducing the number of sex partners, using latex condoms, and having a long-term mutually monogamous relationship with a partner who has negative test results for sexually transmitted diseases); 2) promoting syphilis awareness and screening as well as appropriate screening for gonorrhea, chlamydia, and [HIV] infection; and 3) notifying and treating sex partners," the authors conclude. "In addition, efforts to prevent and treat syphilis among heterosexual men and women should continue in order to prevent congenital syphilis."

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2014;63:402-406. Full text

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