Though more likely to affect individuals who belong to lower socioeconomic groups, lack access to healthcare, or have multiple sexual partners, syphilis is a venereal disease found worldwide. The World Health Organization estimated that 12 million new cases of syphilis occurred in 1999, largely in developing countries, where it remains a leading cause of perinatal and neonatal deaths (4).

As noted earlier, after the first outbreak of syphilis in the 15th century, the disease remained quite common throughout Europe with periodic epidemic flares. It spread throughout the United States with similar numbers. The U.S. Surgeon General of 1937, Thomas Parran, considered it the greatest health problem in the United States and estimated that 10% of Americans would be infected with syphilis at some point (1). The reporting of syphilis and recording of statistical data began in 1941, when there were over 100,000 primary and secondary cases in the United States. Public health measures and early use of penicillin dropped the incidence to 66.4 cases per 100,000 in 1947, and widespread use of penicillin nearly eradicated the disease by 1956, with only 3.9 cases per 100,000. Over the following decades, the incidence waxed and waned, with a few minor epidemics. By the 1970s, syphilis in the United States was found primarily among the homosexual male population. With the outbreak of HIV, the 1980s brought a new epidemic, and increased numbers of heterosexual and congenital syphilis were noted. A peak of 20 cases per 100,000 developed in 1990. Further public health measures and a Centers for Disease Control and Prevention (CDC)-sponsored plan to eradicate the disease facilitated gradual decline to a nadir of 2.1 cases per 100,000 in 2000 (5,6).

The latest data available from the CDC indicate that after a 13-year decline, the incidence of primary and secondary syphilis again increased in the United States, with a rate of 2.7 cases per 100,000 in 2004. This increase was attributed largely to an outbreak among men who have sex with men, with an estimated 64% of all reported cases from this population. Racial disparities continue to persist, with the rate among African Americans about six times higher than that among Caucasians (6). The distribution throughout the United States is highly skewed to the southeastern states, where syphilis remains an epidemic for unclear reasons. The disease is prevalent during the years of peak sexual activity, with most new cases affecting those 15 to 30 years old.

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