1. Syphilis Trends in the United States James D. Heffelfinger, MD, MPH Epidemiology and Surveillance Branch, DSTD Centers for Disease Control and Prevention

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

3. Primary and secondary syphilis rates in the United States, 1981–2003 Rate (per 100,000 population ) *Preliminary data

4. Primary and secondary syphilis rates by sex in the United States, 1981–2003 Rate (per 100,000 men/women) *Preliminary data

5. Primary and secondary syphilis: Male-to-female rate ratios, 1981–2003 *Preliminary data Male:female rate ratio

6. Primary and secondary syphilis: Rates by race and ethnicity, 1981–2003 Rate (per 100,000 population) *Preliminary data

7. Primary and secondary syphilis: Rates by race and ethnicity, 1997–2003 Rate (per 100,000 population) *Preliminary data

8. Primary and secondary syphilis rates among men by race/ethnicity in the United States, 1997–2003 *Preliminary data

9. Primary and secondary syphilis rates among women by race/ethnicity in the United States, 1997–2003 *Preliminary data Rate (per 100,000 population)

10. Primary and secondary syphilis: Male-to-female rate ratios by race and ethnicity, 1997–2003 *Preliminary data Male:female rate ratio

11. Primary and secondary syphilis among men: Age-specific rates, 1997-2003 Rate (per 100,000 population) *Preliminary data

12. Primary and secondary syphilis among women: Age-specific rates, 1997-2003 Rate (per 100,000 population) *Preliminary data

13. Primary and secondary syphilis: Rates by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

14. Primary and secondary syphilis: Male-to-female rate ratios by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

15. Primary and secondary syphilis: Rates among whites by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

16. Primary and secondary syphilis: Rates among African-Americans by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

17. Primary and secondary syphilis: Rates among Hispanics by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

18. Cases of P&S syphilis by sex during 1996-2002 in the six U.S. cities with the highest burden of infection in 2000

19. Cases of P&S syphilis by sex during 1996-2002 in the six U.S. cities with the highest burden of infection in 2002

20. Primary and secondary syphilis cases: United States, 2002-2003 20022003 *% Change Sex Men5,2675,851+11.1 Women1,5941,230-22.8 Race/Ethnicity Black3,4212,820-17.6 White2,3252,928+25.9 Hispanic9711,149+18.3 Asian/PI94122+29.8 American Indian/NA5162+21.6 Total6,8627,082+3.2 *Preliminary data

21. Estimates of the number of primary and secondary syphilis cases occurring among men who have sex with men (MSM) *MSM cases = ([annual MFCR – 1998 MFCR]/ annual MFCR) x (annual # cases among men) †Preliminary data

22. Rates of congenital syphilis among infants and P&S syphilis among women, 1981–2003 Rate (per 100,000 women)Rate (per 100,000 live births) Congenital syphilis surveillance case definition changed*Preliminary data

23. Congenital syphilis among infants by race/ethnicity in the United States, 1997–2003 *Preliminary data

24. Summary of current syphilis trends Increasing rate of P&S syphilis among men, particularly MSM –Proportion of cases occurring among MSM estimated to be >60% in 2003 –Cases among heterosexual men declining Continued decline in P&S syphilis rate among women Continued rate decline among African-Americans –Decreases among women accounts for most of recent decline –Annual number of cases higher among whites for first time in 2003 Changing geographic pattern and distribution of cases by sex in cities with the highest burden of infectious syphilis

25. Recommendations Continue to monitor trends and maintain syphilis elimination efforts among minority populations Modify the syphilis elimination plan to develop and implement more effective prevention activities among MSM Continue efforts to collect information on behavior to permit better monitoring of syphilis trends and improve programs to prevent and treat syphilis Work with communities to determine local patterns of syphilis transmission and develop effective, targeted intervention strategies that include education, risk reduction, and appropriate screening and treatment of persons at risk for syphilis

26. Primary and secondary syphilis: Male-to-female rate ratios among whites by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

27. Primary and secondary syphilis: Male-to-female rate ratios among African-Americans by region, 1997–2003 Rate (per 100,000 population) *Preliminary data

28. Primary and secondary syphilis: Male-to-female rate ratios among Hispanics by region, 1997–2003 Rate (per 100,000 population) *Preliminary data