As syphilis rates decline overall, black men are infected at significantly higher rates than other racial groups, the Centers for Disease Control and Prevention (CDC) announced February 22. Other groups hit hard include Latinos and men who have sex with men (MSM). A complete report will be published in the CDC Morbidity and Mortality Weekly Report.

A total of 6,657 cases of primary and secondary syphilis were reported in the United States in 1999. Syphilis rates for African Americans did decline between 1998 and 1999 by 10 percent -- from 16.9 cases to 15.2 cases per 100,000 people. Yet in 1999 syphilis cases were 30 times higher for African Americans than whites.

 

We have a real obligation to eliminate remaining racial disparities.

"It’s time to improve the efforts in these communities regarding syphilis elimination. We have a real obligation to eliminate remaining racial disparities, " says Catherine McLean, MD, medical epidemiologist with the division of STD prevention at the CDC in Atlanta.

Outbreaks of syphilis in the 1990's were more common among heterosexual blacks in the south and in large cities, Dr. McLean told GayHealth.com.

Recently, however, there have been a number of outbreaks of syphilis among MSM, and the CDC has the most data concerning an outbreak in Southern California. A 20 percent increase in rates of syphilis for Hispanics -- while rates remained stable for whites -- may be linked to these outbreaks.

The CDC, along with state and local health departments, recently completed a second investigation of the syphilis outbreak in Southern California -- mostly of white and Latino gay and bisexual men.

Between January and July 2000, 66 cases of syphilis were reported among MSM (out of 130 total cases), representing a 96 percent increase from that reported in 1999. Most of the MSM involved in the outbreak were white (41 percent) or Latino (36 percent), and 60 percent were infected with HIV.

Fifty percent of the MSM reported having anonymous sex, 26 percent reported meeting partners at bathhouses, and only 20 percent reported using a condom during their last sexual encounter. (A sexual encounter doesn't necessarily mean anal sex.) Forty percent reported taking illegal drugs in the last year.

HIV is of particular concern to Dr. McLean, given that a large percentage of the cases of syphilis in Southern California were among men with HIV.

Syphilis is known to accelerate the spread of HIV infection by two to five times. "We need to maintain a reasonable level of concern regarding HIV infection despite the improvements in therapy and the decline in AIDS deaths that we’ve seen in the last several years," says Dr. McLean.

"The substantial decreases in syphilis nationwide points to the remarkable progress that’s been made toward syphilis elimination," says Dr. McLean. "But this decline in rates does highlight the remaining challenges for African Americans, Latinos and gay and bisexual men."

The CDC does not have comparable data nationwide for sexual orientation for syphilis. Sexual orientation is currently not a part of the standard STD surveillance interview that is usually conducted. "CDC is currently working to extend the information that we gather regarding these populations so that we can report this information a little bit more consistently."

In the United States, you can call the CDC National STD hotline at 1-800-227-8922 for a referral to a syphilis testing site in your area.

Updated: Thursday, 22 February 2001