Primary Care Corner with Geoffrey Modest MD: Syphilis on the Rise

Data from CDC on US syphilis rates, which bottomed out in 2000 at 2.1/100K people, but in 2013 rose to 5.3/100K — as in: more than doubled!! (see here). in 2005, database included sex of sex partners, and found that in “2005-2013, primary and secondary syphilis rates increased among men of all ages and races/ethnicities cross all regions of the United States. Recent years have shown an accelerated increase in the number of cases, with the largest increases occurring among MSM.” in women rates increased during 2005-8, then decreased 2009-13 (from 0.9/100K in 2005 to 1.5/100K in 2008 then back to 0.9/100K in 2013). in the time period 2005-2013, overall annual rate almost doubled from 2.9 to 5.3 cases/100K people, with increasing male representation — up to 91.1% of all cases in 2013. rate in black men was 5.2x that of white men (27.9 vs 5.4 cases/100K) and black women had 13.3x the rate of white women (4.0 vs 0.3/100K). highest rate in the West (beating out the South for the first time in 50 years)

so, after being on the verge of syphilis elimination in 2000, there has been a dramatic rebound. of concern is the increased transmission of HIV in those with syphilis, and CDC reported rate of 50-70% HIV coinfection in MSM infected with primary or secondary syphilis. this all confirms the general sense from other data that there has been less aggressive use of barrier protection with sex, esp with MSM… and the need to use data such as above in reinforcing the importance of protection.

geoff

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