Primary and Secondary Syphilis – United States, 2005-2013

Published: May 9, 2014

 In 2013, based on data reported as of April 28, 2014, the rate of reported primary and secondary syphilis in the United States was 5.3 cases per 100,000 population, more than double the lowest-ever rate of 2.1 in 2000. To characterize the recent epidemiology of syphilis in the United States, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for cases of primary and secondary syphilis diagnosed during 2005–2013 with a focus on states that reported the sex of sex partners during 2009–2012 to describe reported syphilis among gay, bisexual, and other men who have sex with men (collectively referred to as MSM). During 2005–2013, primary and secondary syphilis rates increased among men of all ages and races/ethnicities across 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. Among women, rates increased during 2005–2008 and decreased during 2009–2013, with different trends among different racial/ethnic groups. Racial/ethnic disparities in reported syphilis persisted during 2005–2013, likely reflecting social determinants of health, such as socioeconomic status, that might contribute to the burden of syphilis in a community (1). These findings underscore the need for continued syphilis prevention measures among MSM.

CDC analyzed notifiable disease surveillance data on reported syphilis, including patient demographics and stage of syphilis (i.e., primary and secondary, early latent, late, late latent, and congenital*) reported by health departments to NNDSS nationwide for cases diagnosed during 2005–2013. Trends in annual primary and secondary syphilis (representing more recently acquired infections, which usually are infectious) were analyzed for 2005–2013. Geographic trends were analyzed by U.S. census region, age group, and NNDSS racial/ethnic categories (white, black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native, for which all racial groups were non-Hispanic). In addition, to describe syphilis among MSM, annual cases of primary and secondary syphilis among MSM that were reported during 2009–2012 were reviewed from 34 states and the District of Columbia, where the sex of sex partners was reported for ≥70% of male primary and secondary syphilis cases (CDC began collecting data on the sex of sex partners in 2005). Rates were calculated using population denominators from the U.S. Census Bureau.

During 2005–2013, the number of primary and secondary syphilis cases reported each year in the United States nearly doubled, from 8,724 to 16,663; the annual rate increased from 2.9 to 5.3 cases per 100,000 population (Table). Men contributed an increasing proportion of cases, accounting for 91.1% of all primary and secondary syphilis cases in 2013. The rate among men increased from 5.1 in 2005 to 9.8 in 2013 (Figure 1). Increases occurred among men of all ages and races/ethnicities, but race/ethnicity shifts occurred in 2009. During 2005–2009, rate increases were greatest among black men (104.1%, from 14.6 in 2005 to 29.8 in 2009) compared with Hispanic men (52.0%, 5.0 to 7.6) and white men (19.4%, 3.1 to 3.7). During 2009–2013, rates increased among Hispanic men (52.6%, from 7.6 in 2009 to 11.6 in 2013) and white men (45.9%, 3.7 to 5.4), but decreased slightly among black men (6.4%, 29.8 to 27.9). From 2005 to 2009, men aged 20–24 years had the greatest percentage increase (149.4%, 8.1 to 20.2), and from 2009 to 2013, men aged 25–29 years (the same approximate birth cohort) had the greatest increase (48.4%, 18.2 to 27.0) (Table).

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