syphilis trends in the united states
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Syphilis Trends in the United States. James D. Heffelfinger, MD, MPH Epidemiology and Surveillance Branch, DSTD Centers for Disease Control and Prevention. Background. Genital ulcerative infection Facilitates the transmission of HIV - PowerPoint PPT PresentationTRANSCRIPT
Syphilis Trends in the United States
James D. Heffelfinger, MD, MPHEpidemiology and Surveillance Branch, DSTD
Centers for Disease Control and Prevention
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
Primary and secondary syphilis rates in the United States, 1981–2003
0
5
10
15
20
25Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis rates by sex in the United States, 1981–2003
0
5
10
15
20
25
Men
Women
Rate (per 100,000 men/women)
*Preliminary data
Primary and secondary syphilis: Male-to-female rate ratios, 1981–2003
0
2
4
6
*Preliminary data
Male:female rate ratio
Primary and secondary syphilis: Rates by race and ethnicity, 1981–2003
0
30
60
90
120
150
White
Black
Hispanic
Asian/PI
AI/AN
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Rates by race and ethnicity, 1997–2003
0
5
10
15
20
25
White
Black
Hispanic
Asian/PI
Am. Indian
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis rates among men by race/ethnicity in the United States, 1997–2003
0
10
20
30
40
1997
1998
1999
2000
2001
2002
2003
*
White
Black
Hispanic
Asian/PI
Am. Indian
*Preliminary data
Primary and secondary syphilis rates among women by race/ethnicity in the United States,
1997–2003
*Preliminary data
0
10
20
30
40
White
Black
Hispanic
Asian/PI
Am. Indian
Rate (per 100,000 population)
Primary and secondary syphilis: Male-to-female rate ratios by race and ethnicity, 1997–2003
0
5
10
15White
Black
Hispanic
*Preliminary data
Male:female rate ratio
Primary and secondary syphilis among men: Age-specific rates, 1997-2003
0
5
10
15 15-19
20-24
25-29
30-34
35-39
40-44
45-54
55-64
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis among women: Age-specific rates, 1997-2003
0
5
10
15 15-19
20-24
25-29
30-34
35-39
40-44
45-54
55-64
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Rates by region, 1997–2003
0
2
4
6
8
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Male-to-female rate ratios by region, 1997–2003
0
2
4
6
8
10
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Rates among whites by region, 1997–2003
0
1
2
3
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Rates among African-Americans by region, 1997–2003
0
10
20
30
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Rates among Hispanics by region, 1997–2003
0
2
4
6
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Cases of P&S syphilis by sex during 1996-2002 in the sixU.S. cities with the highest burden of infection in 2000
#
#
##
#
#
220200180160140120100806040
1996 1997 1998 1999 2000 2001 2002
Detrot
350300250200150100500
1996 1997 1998 1999 2000 2001 2002
Chcago
160140120100806040200
1996 1997 1998 1999 2000 2001 2002
Nashv l e
400350300250200150100500
1996 1997 1998 1999 2000 2001 2002
Ba tmo e
20018016014012010080604020
1996 1997 1998 1999 2000 2001 2002
Memphis
220200180160140120100806040200
1996 1997 1998 1999 2000 2001 2002
Indanapo is
#
#
##
#
#
220200180160140120100806040
1996 1997 1998 1999 2000 2001 2002
Detrot
350300250200150100500
1996 1997 1998 1999 2000 2001 2002
Chcago
160140120100806040200
1996 1997 1998 1999 2000 2001 2002
Nashv l e
400350300250200150100500
1996 1997 1998 1999 2000 2001 2002
Ba tmo e
20018016014012010080604020
1996 1997 1998 1999 2000 2001 2002
Memphis
220200180160140120100806040200
1996 1997 1998 1999 2000 2001 2002
Indanapo is
Legend
Men
Women
Legend
Men
Women
Cases of P&S syphilis by sex during 1996-2002 in the sixU.S. cities with the highest burden of infection in 2002
Legend
Men
Women
Legend
Men
Women
##
#
#
#
#
450400350300250200150100500
1996 1997 1998 1999 2000 2001 2002
NewYorkCiy
220200180160140120100806040
1996 1997 1998 1999 2000 2001 2002
Deroi
350300250200150100500
1996 1997 1998 1999 2000 2001 2002
SanFrancisco
350300250200150100500
1996 1997 1998 1999 2000 2001 2002
LosAngees
20018016014012010080604020
1996 1997 1998 1999 2000 2001 2002
Atanta
350300250200
150
100500
1996 1997 1998 1999 2000 2001 2002
Chicago
##
#
#
#
#
450400350300250200150100500
1996 1997 1998 1999 2000 2001 2002
NewYorkCiy
220200180160140120100806040
1996 1997 1998 1999 2000 2001 2002
Deroi
350300250200150100500
1996 1997 1998 1999 2000 2001 2002
SanFrancisco
350300250200150100500
1996 1997 1998 1999 2000 2001 2002
LosAngees
20018016014012010080604020
1996 1997 1998 1999 2000 2001 2002
Atanta
350300250200
150
100500
1996 1997 1998 1999 2000 2001 2002
Chicago
Primary and secondary syphilis cases: United States, 2002-2003
2002 2003 * % ChangeSex
Men 5,267 5,851 +11.1
Women 1,594 1,230 -22.8
Race/Ethnicity
Black 3,421 2,820 -17.6
White 2,325 2,928 +25.9
Hispanic 971 1,149 +18.3
Asian/PI 94 122 +29.8
American Indian/NA 51 62 +21.6
Total 6,862 7,082 +3.2
*Preliminary data
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
Total
Cases
Cases
among Men
Cases among
Women
Male:Female
Case Ratio
Cases among
MSM* (%)
Total Cases Minus
Cases among MSM
1998 7,018 3,918 3,100 1.26 0 (0%) 7,018
1999 6,613 3,833 2,780 1.38 333 (5%) 6,280
2000 5,973 3,528 2,445 1.44 441 (7%) 5,532
2001 6,100 4,132 1,968 2.10 1,653 (27%) 4,447
2002 6,862 5,268 1,594 3.30 3,257 (48%) 3,605
2003† 7,081 5,851 1,230 4.76 4,302 (61%) 2,779
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
0
5
10
15
20
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
0
20
40
60
80
100
120
Women
Infants
2003*
Congenital syphilis among infants by race/ethnicity in the United States, 1997–2003
0
20
40
60
80
100
120
1997
1998
1999
2000
2001
2002
2003
*
White
Black
Hispanic
Asian/PI
Am. Indian
*Preliminary data
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
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
Primary and secondary syphilis: Male-to-female rate ratios among whites by region, 1997–2003
0
5
10
15
20
25
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Male-to-female rate ratios among African-Americans by region, 1997–2003
0
2
4
6
8
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data
Primary and secondary syphilis: Male-to-female rate ratios among Hispanics by region, 1997–2003
0
2
4
6
8
10
12
14
Northeast
Midwest
South
West
Rate (per 100,000 population)
*Preliminary data