Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
Newsday - November 1, 2002
Laurie Garrett, Staff Writer
The increase, reported yesterday by the U.S. Centers for Disease Control and Prevention, has public health officials worried for two reasons. First, the same men who are at risk for syphilis are also more likely to acquire HIV infection. Second, the CDC's ongoing campaign to eliminate syphilis in the United States may now be threatened.
"We are very, very concerned about what the future might hold if these trends continue," the CDC's Dr. Ronald Valdiserri said in a teleconference. "We are very concerned about what could be happening in various gay populations. We have been trying to sound this alarm for the last 24 months."
The increase was registered despite a decline in some populations: Rates in 2001 fell by 17.6 percent among women, by 9.9 percent among African-American men and by 8 percent among residents of much of the Deep South. But rates jumped -- in some cases sharply -- among men generally, and among gay white and Hispanic men in particular. Regionally, the increase was 57 percent in the Northeast and 40 percent on the West Coast.
Rates rose by 63 percent for white men and 50 percent for Hispanic men.
Because syphilis had been in decline for a decade, in 1999 the CDC launched the National Plan to Eliminate Syphilis in the United States, with goals of 90 percent of the nation's counties free of the disease by 2005, with a national rate of less that 0.04 cases per 100,000 Americans.
But last year's jump put the national rate at 2.2 cases per 100,000 Americans, with one in five counties reporting cases. The highest rates were recorded among men (3 per 100,000), Hispanics (male and female combined, 2.1 per 100,000) and African-Americans (male and female combined, 11 per 100,000).
The absolute numbers remain small: 6,103 cases in 2001, up from 5,979 in 2000. But Valdiserri said the CDC is concerned less about absolute numbers than the upward trend, particularly in the gay community, because syphilis tends to track closely with HIV.
"Our challenge is to underscore the connection between HIV and syphilis and renew the commitment these [gay action] groups brought in the early years of the HIV epidemic," he said.
Most of the increase is due to cases among men who are having sex without condoms. Most of the cities with increases have large gay populations: New York, Miami, San Francisco, Chicago and Seattle.
New York City had a syphilis rate of 4 per 100,000, well above the national average in 2000, and it rose to 9.4 per 100,000 in 2001. Last month, the New York City Department of Health reported another 50 percent jump in the first six months of this year; 90 percent of the cases involved men who had sex with men.
Investigations in New York and other cities have shown outbreaks of syphilis among men who frequent particular sex clubs, or who meet via online gay chat rooms and at gay bathhouses. Up to 70 percent of gay men infected in these recent syphilis outbreaks have tested positive for HIV.
"It highlights the need for a comprehensive approach to gay men's health," J.E. Miles Jr., assistant director for community outreach at Gay Men's Health Crisis in Manhattan, said in an interview. "Men are telling us, 'Look, we're tired of hearing about this.' Because it's hard for people to sustain the kind of effort that's needed for safe sex over time."
GMHC is calling for new strategies to tackle this problem. Valdeserri said the CDC concurs, because the agency "can't do this on our own. We must have the support of the community."
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