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Syphilis on the Rise

November 9, 2005
The national syphilis rate in the United States increased for the fourth consecutive year in 2004, according to new data on nationally notifiable sexually transmitted diseases (STDs) released by the federal Centers for Disease Control and Prevention (CDC).

The report, which provides data on three STDs -- Chlamydia, gonorrhea and syphilis -- also finds that in 2004, the gonorrhea rate reached an all-time low, and chlamydia rates increased, possibly due to expanded and improved screening.

Syphilis

The national rate of primary and secondary (P&S) syphilis -- the early stages of the disease that indicate recent infection -- has increased every year since an all-time low in 2000.

From 2003 to 2004, the rate of P&S syphilis increased 8 percent from 2.5 to 2.7 cases per 100,000 population. The number of cases increased from 7,177 in 2003 to 7,980 in 2004.

The rise in the national P&S syphilis rate is largely due to increases among men. Overall, the P&S syphilis rate among men increased 11.9 percent from 2003 to 2004 (4.2 cases per 100,000 to 4.7 cases per 100,000) and 81 percent since 2000 (2.6 cases per 100,000 to 4.7 cases per 100,000).

While surveillance data are not available by risk behavior, a separate CDC analysis suggests that approximately 64 percent of all adult P&S syphilis cases in 2004 were among men who have sex with men, up from an estimated 5 percent in 1999.

“Syphilis increases, especially among men who have sex with men, demonstrate the need to continually adapt our strategies to eliminate syphilis in the United States,” said Dr. Ronald O. Valdiserri, acting director of CDC’s HIV, STD and TB prevention programs. “While there is no silver bullet to reduce syphilis rates, innovative screening and prevention programs around the country are having a positive impact in many areas and providing crucial lessons that will help us meet new challenges.”

Gonorrhea

The national rate of gonorrhea reached an all-time low in 2004, falling 1.5 percent between 2003 and 2004 (from 115.2 to 113.5 cases per 100,000). Despite this reduction, several significant challenges remain, the CDC said.

CDC conducted sentinel surveillance in 28 cities and found the proportion of cases resistant to fluoroquinolone antibiotics (a first-line treatment for gonorrhea) increased from 4.1 percent in 2003 to 6.8 percent in 2004.

Resistance is especially worrisome in men who have sex with men, where it was eight times higher than among heterosexuals (23.8 percent vs. 2.9 percent). In April 2004, CDC recommended that fluoroquinolones no longer be used as treatment for gonorrhea among men who have sex with men.

These antibiotics were also not recommended to treat the disease in anyone in California or Hawaii, where resistance has been widespread for years. Outside of these states, the prevalence of fluoroquinolone resistance among heterosexuals remains low at 1.3 percent.

Racial disparities in gonorrhea were seen in 2004. Blacks were most affected, with a rate 19 times higher than that of whites (629.6 cases per 100,000 vs. 33.3 cases per 100,000).

Chlamydia

Chlamydia was the most common infectious disease in the United States reported to the CDC in 2004, with 929,462 cases. The national rate increased 5.9 percent (301.7 per 100,000 in 2003 to 319.6 in 2004).

The increase is likely due to screening and identification of cases of the disease rather than an actual increase in infection rates. However, experts caution that the majority of chlamydia cases remain undiagnosed. CDC estimates that 2.8 million new chlamydia infections occur each year.

“Reported cases are just the tip of the iceberg. Health care providers urgently need to step up screening for chlamydia, particularly among young, sexually active women, who are at greatest risk of infertility and other complications if the disease is not diagnosed and treated,” said Dr. John Douglas, director of CDC’s STD prevention programs.

The rate of reported chlamydia cases was 3.3 times higher among women than men in 2004 (485 cases vs. 147.1 per 100,000), most likely due to increased screening among women.

Health and Economic Impact

CDC estimates that 19 million STD infections, including HIV and other non-notifiable STDs, occur each year. In addition to their immediate and long-term health consequences, these diseases result in direct medical costs of an estimated $13 billion annually.

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