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In the United States, the reported rate of syphilis is at the lowest level since reporting began in 1941. In 1999, 79 percent of the 3,115 counties in the United States reported no cases of primary and secondary syphilis (P&S syphilis). The unprecedented low rate of syphilis overall, combined with cases concentrated in only 20 percent of U.S. counties, has created a unique but narrow window of opportunity to eliminate syphilis in the United States. In October 1999, CDC launched the National Plan to Eliminate Syphilis in the United States.

Since the introduction of penicillin and the organization of a national STD control program in the 1940s, the initial near elimination of syphilis in 1957 has been followed by cyclic national epidemics every seven to 10 years (St. Louis, CDC, 1998).

National Plan to Eliminate Syphilis
In 1999, the CDC launched a five step program to outright eliminate syphilis. That program consists of the following:

1) Enhanced surveillance.

2) Rapid outbreak response activities.

3) Enhanced clinical and laboratory services.

4) Strengthened community involvement and organizational partnerships.

5) Enhanced health promotion.

Unfortunately, the plan hasn't been as successful as hoped for since 1999. Syphilis rates have been rising with men who have sex with other men. In response, nine strategies were created in 2006. Those are as follows:

1) Surveillance.

2) Clinical and Laboratory Services.

3) Community Mobilization.

4) Health Care Provider Mobilization.

5) Tailoring of Interventions.

6) Evidence-based Action Planning.

7) Monitoring and Evaluation.

8) Training and Staff Development.

9) Research.

Syphilis Epidemic
The most recent epidemic peaked in 1990 at 20.3 per 100,000 people. Since 1990, syphilis rates have declined 88 percent to 2.5 cases per 100,000 people in 1999 (CDC, 2000).

In 1999, 6,657 cases of primary and secondary syphilis were reported to CDC, a decline of 22.2 percent from 1997 when 8,556 cases were reported. Cases of primary and secondary syphilis reported to CDC are believed to represent about 80 percent of all recently acquired cases (Cates, 1999).

In 1999, 556 cases of congenital syphilis — infants acquiring infection from their mothers during pregnancy or delivery — were reported. Rates of congenital syphilis closely follow trends in primary and secondary syphilis in women. Peaks in congenital syphilis usually occur one year after peaks in primary and secondary syphilis in women. The congenital syphilis rate in the United States peaked in 1991 at 107.3 cases per 100,000 live births and declined 87 percent to 14.3 cases per 100,000 live births in 1999.

In 1999, the overall male-to-female ratio of primary and secondary syphilis was 1.5, with 50 percent more cases among men than women. Increases in the male-to-female rate ratio in 1999 were observed in certain cities corresponding to an increase in syphilis among men who have sex with men (MSM). Recently, outbreaks of syphilis among MSM have been reported, possibly reflecting an increase in risk behavior in this population associated with the availability of highly active antiretroviral therapy for HIV infection.

Primary and secondary syphilis rates in 1999 were highest among women ages 20 to 29 years old and among men ages 35 to 39 years old. However, the age groups at highest risk vary by race and ethnicity.

< Syphilis | STD Prevention >

If you think you may have a sexually transmitted disease, you should see a physician immediately to be properly diagnosed and treated. You should not try to diagnose or treat symptoms on your own.

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