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Primary and secondary syphilis--United States, 2003-2004.

Article Excerpt
In 2000, the rate of primary and secondary (P&S) syphilis in the United States was 2.1 cases per 100,000 population, the lowest since reporting began in 1941. From 2001 to 2004, the P&S syphilis rate increased to 2.7, primarily as a result of increases in cases among men who have sex with men (MSM). To characterize the recent epidemiology of syphilis in the United States, CDC analyzed national notifiable disease surveillance data for 2000-2004, focusing on 2003-2004. * This report describes the results of that analysis, which indicated that the disparity between syphilis rates among blacks and whitest in 2004 increased for the first time since 1993 and is associated with a substantial increase of syphilis among black men. Syphilis rates continue to increase among MSM. After declining for 13 years, the rate of P&S syphilis in 2004, compared with 2003, increased in the South ([section]) and remained the same among women. The findings underscore the need for enhanced prevention measures among blacks and MSM. In addition, enhanced surveillance is needed to detect any early increases in P&S syphilis among women.

CDC analyzed surveillance data reported weekly from health departments nationwide during 2000-2004. Data included patient demographics (i.e., age, sex, race/ethnicity, and county of residence) and stage of syphilis. Data on P&S syphilis were analyzed because these cases represent incidence (i.e., newly acquired infections within the specified period). P&S syphilis rates were calculated using population denominators from the U.S. Census Bureau (1). Because states do not routinely report information on sexual practices or sex of sex partners, male-to-female (M:F) rate ratios were used as a surrogate measure to monitor occurrence of syphilis among MSM and were calculated by dividing the male case rate by the female case rate for a specified period. M:F rate ratios in excess of 1:1 suggest male-to-male transmission.

From 2000 to 2004, the number of cases of P&S syphilis increased from 5,979 to 7,980, and the rate increased from 2.1 to 2.7 cases per 100,000 population. Of the 7,980 cases of P&S syphilis reported in 2004, approximately 84% (6,722) occurred among men. The rate of P&S syphilis among men increased from 2.6 to 4.7. Among women, the rate of P&S syphilis decreased from 1.7 to 0.8 from 2000 to 2003 and remained at 0.8 in 2004, the first time since 1991 that the rate among women did not decrease. The M:F rate ratio increased steadily from 1.5 in 2000 to 5.3 in 2003, but the increase slowed in 2004...

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