Slight increase in new syphilis cases in U.S. in 2001

In October 1999 the Centers for Disease Control in Atlanta initiated the National Plan to Eliminate Syphilis in the United States. The national goals for syphilis elimination are to reduce the annual

number of primary and secondary (P&S) syphilis cases to

During 2001 a slight increase in P&S syphilis cases occurred among men. However, the number of P&S syphilis cases continued to decline among women and among non-Hispanic blacks. The available data indicate that syphilis cases occurring among gay men contributed to the increase in cases.

In 2000, the rate of P&S syphilis in the United States declined to 2.1 cases per 100,000 population, the lowest rate since reporting began in 1941. In 2001, the rate of P&S syphilis increased slightly to 2.2, the first annual increase since 1990, and 6,103 cases were reported, a 2.1% increase in reported cases since 2000.

In 2001, rates of P&S syphilis were 114.3% higher for men than for women, an increase of 15.4% among men. Increases in male-female occurred among all racial/ethnic groups. The rate of P&S syphilis among non-Hispanic blacks was 15.7 times the rate reported among non-Hispanic whites. During 2000-2001 the rate among non-Hispanic blacks declined 9.8%, reflecting a 3.5% decrease in the number of cases among men (from 2,371 to 2,289) and an 18.1% decrease among women (from 1,864 to 1,523). The rate among non-Hispanic whites increased 40%; cases among men increased 63% (from 698 to 1,138), and cases among women decreased 35.3% (from 385 to 249). The rate among Hispanics increased 31%; cases among men increased 50.1% (from 405 to 608), and cases among women decreased 9.3% (from 162 to 147).

The South continues to have the highest rates of P&S syphilis, accounting for 56.2%of cases occurring in 2001and 62% in 2000. During 2000-2001 rates increase 40% in the West and 57.1% in the Northeast.

In 2001, no cases of P&S syphilis were reported in 2,516 (80.2%) of the 3,139 U.S. counties.

in several cities of syphilis outbreaks among gay men; these outbreaks were characterised by high rates of HIV coinfection and high-risk behaviour among subpopulations of gay men. Although syphilis cases reported nationally in the U.S. do not include data on behaviour risk, the continuing decline in syphilis rates among women in conjunction with the increasing male-to-female ratio suggests that the syphilis rate probably is increasing among gay men and decreasing among heterosexual men.

The National Syphilis Elimination Plan focused initially on reducing syphilis in the South and among minority populations. The increase in new cases among gay men highlights the need for the U.S. to modify the plan and develop more effective prevention activities among this population.