Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
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United Press International - Thursday, 29 November 2001
Ellen Beck, UPI Science News
Dr. George Counts, director of syphilis eradication efforts at the Centers for Disease Control and Prevention in Atlanta, said in 2000 there were only 5,979 cases reported in America, half concentrated in just 21 counties and one city.
That is a 9.6 percent drop since 1999, a 30 percent decline since 1997 and an 89.2 percent reduction since the last peak for syphilis cases in 1990.
Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said despite the attention grabbed by the Sept. 11 and anthrax attacks, "Absolutely this is a big deal."
Syphilis can be transmitted from person to person during kissing, anal and vaginal intercourse and oral-genital contact. It is caused by the bacteria T. pallidum and if left untreated, it can lead to cardiovascular and neurological diseases and infant death in 40 percent of cases in women who have the disease during pregnancy, Valdiserri said
The STD also can increase the risk of getting HIV. The infection is highly treatable, however, with penicillin or other antibiotics.
The CDC's interim goal is reducing cases of syphilis to 1,000 per year. Elimination is defined as the absence of sustained transmission. There may be occasional outbreaks, but Valdiserri said they would be contained and eliminated. Syphilis has been eradicated in Canada and England.
"It is possible and readily achievable," Valdiserri said.
Dr. Mohammad Akhter, executive director of the American Public Health Association agreed. "There are only a few pockets where we need to concentrate. ...Technical and professionally it is feasible to (eliminate the disease) in a reasonable period."
Three pilot partnership projects -- in Nashville, Indianapolis and Raleigh, N.C., have led to reductions in syphilis cases. The projects bring together religious, community, health care and educational groups to focus on prevention and treatment information efforts.
In Nashville, the number of cases declined from 250 in 1999 to 200 cases in 2000. In Indianapolis, case numbers fell from 407 in 1999 to 301 in 2000 and in Raleigh a 27 percent decline was recorded.
Valdiserri said historically, syphilis outbreaks have gone in seven to 10 year cycles but added, "We may have altered that trend." He warned, however, unless efforts at prevention and increasing access to care in poor communities continue and are enhanced, the outbreak cycle could return.
Despite the good news on declining cases, there continue to be pockets of problems, Counts said.
"Minorities and men continue to be disproportionately impacted by syphilis," he said.
African Americans rates are down by 47 percent but remain much higher than for whites. Among Hispanics and Latinos, the number of cases in 2000 was 12.5 percent higher than in 1999 and for men, the rate is 1.5 times greater than for women.
"The male to female ratio has risen steadily since 1994, when it was 1 to 1," Counts added.
More needs to be done to educate men, particularly men of color said Akhter. "We need to shift our strategy a little bit to provide them education and treatment."
Another troublesome area is the increase of cases among gay men, although CDC is putting together a plan to work through the gay community on education and prevention efforts.
Even once the disease is eliminated in the U.S. continued monitoring will be necessary said Akhter because of the large numbers of visitors to America. "Anyone can bring in new cases and start things all over again," he noted.
(With additional reporting by Dee Ann Divis in Washington)
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