Dual syphilis outbreaks among MSM/Bisexual males and African American heterosexuals in Cleveland, Cuyahoga County, Ohio

We report simulataneous outbreaks of early syphilis (i.e. primary, secondary, early latent) in Cuyahoga County among both heterosexual males and females (90% Black/African American) and the MSM/bisexual (MSM/Bi) male community of all races and ethnicities. Case counts are nearly equal between these groups.

Since the outbreak began in July 2007, 123 cases were reported up to November 2008. 94 cases were reported in 2008, a 135% increase from Jan-Nov 2007. Annualized rates in past eight months are 4.5 times greater (71 cases, 8.2 cases per 100,000) than baseline. Two-thirds of cases were Cleveland residents. Diagnoses: 10% primary, 50% secondary, 40% early latent.

Fourteen cases were youth age 14 to 19, up 250% since last year. Because Chlamydia is endemic among Black/African American female teens age 15 to 19, (10% incidence by population in 2007), direct interventions to youth are being planned.

Condom use was higher among Black/African American MSM/Bi males compared to heterosexuals, However only 15% of MSM/Bi males reported always using condoms. Interviews by Disease Intervention Specialists (DIS) provided evidence of female-to-female transmission and ‘down low' males, Black/African American and Latino, who self-report as heterosexual but reported sex with other men likely leading to infection.

City, county and state officials developed a joint Action Plan in July 2008, later expanded in January 2009. Actions include temporarily prioritizing DIS to syphilis cases over for partner notification, suggesting care providers to screen all sexually active patients, notifying media sources, LGBT (lesbian, gay, bisexual, transsexual) community and agencies funded for HIV/STI prevention.