The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #73860

Stuart Berman, MD, ScM, Division of STD Prevention, Centers for Disease Controm and Prevention, 1600 Clifton Road, MS E02, Atlanta, GA 30333, 404-639-8363, smb1@cdc.gov

Background: During the 1990's syphilis rates declined dramatically in the United States, the disease seeming so vulnerable that in 1999 the US launched an initiative to eliminate syphilis. Soon thereafter, increases in syphilis among MSM were noted in cities such as Seattle and Los Angeles. Results: Increases in syphilis among MSM have since been noted in multiple cities and have been responsible for syphilis rates in the US increasing 15% from 2000-2002; during that time rates among men increased 42%, while decreasing 35% among women. Some cities have experienced dramatic increases in rates (San Francisco reported 30 cases of primary/secondary syphilis in 1999, but over 300 in 2002). Cases of syphilis among MSM have been characterized by: median age in the mid-30's; a high proportion being HIV-infected; having multiple and anonymous partners; being unwilling or unable to identify partners (limiting partner elicitation/notification efforts). In contrast with epidemics of syphilis among heterosexuals, there is no particular racial/ethnic distribution noted among MSM syphilis cases. In several cities, transmission is facilitated by various opportunities for sexual mingling -- bathhouses, steambaths, x-rated bookstores, circuit parties, and private sex parties – where anonymous sex may occur on-site. Use of condoms in such settings has been inconsistent (in some settings it’s reportedly unwelcome), and HIV serostatus is not typically discussed. Conclusion: Syphilis elimination efforts, initially targeting minority populations and the South, appear successful in reducing syphilis among African-Americans, women, and in the South. However, effective approaches to address the increase of syphilis among MSM are still elusive.

Learning Objectives:

• Background: During the 1990's syphilis rates declined dramatically in the United States, the disease seeming so vulnerable that in 1999 the US launched an initiative to eliminate syphilis. Soon thereafter, increases in syphilis among MSM were noted in cities such as Seattle and Los Angeles.

Keywords: Epidemiology,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.