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U.S. Syphilis Rates Climb for the Second Year: LA, Georgia, Chicago
  The syphilis rate rose in the United States by 9.1 percent between 2001 and 2002, according to new statistics released on Thursday by the Centers for Disease Control and Prevention.
"This represents the second consecutive increase following a decade-long decline and an all-time low in 2000," the CDC's Dr. John Douglas said.
The total number of reported syphilis cases in 2002 was 12.4 percent higher than in the previous year, 6,862 versus 6,103 cases, but since many cases of syphilis go undiagnosed the actual number is "probably significantly higher," he said. The overall increase-- 9.1 percent-- reflects a change from 2.2 cases per 100,000 population to 2.4 per 100,000.
As in 2001, the increase in syphilis rates occurred only among men. The number of reported cases among men jumped 27.4 percent between 2001 and 2002. This included increases of 85.2 percent among white men and 35.6 percent among Latino men, while African American men experienced a slight decline of 2.6 percent.
Although the new statistics do not include information about sexual orientation, the CDC estimates that more than 40 percent of reported cases in 2002 were among men who have sex with men. "These cases account for much of the reported increase overall," Douglas said.
In contrast to the increases among men, the new CDC data show "substantial progress" at reducing syphilis cases among women and African Americans. Syphilis cases fell 19.3 percent among women overall and 21.7 percent among black women between 2001 and 2002. Syphilis cases declined 10.3 percent among African Americans.
"These declines are likely the result of ongoing syphilis education and testing programs in these populations," Douglas said. "Although the syphilis rate was still 8.2 times higher among African Americans than among whites, the continuing declines in reported cases clearly show that progress is possible in the groups most affected," Douglas added.
[Reuters Health, 11/20/03; Morbidity and Mortality Weekly Report CDC Surveillance Summary, 11/21/03]
San Francisco Has Nation's Highest Rate of Syphilis
San Francisco had the highest rate of syphilis in the nation. From 2001 to 2002, the overall rate of syphilis in the U.S. increased 9.1 percent, from 2.2 cases to 2.4 cases per 100,000 population-- the highest rate since 1999, according to a study by the Centers for Disease Control and Prevention. The rate in San Francisco was 40.6 cases per 100,000, apparently driven largely by infection among gay and bisexual men.
The high number of cases may be attributed in some part to improved screening and outreach efforts, health officials said. The city, in collaboration with community groups, has opened three testing sites and created a Web page, and the number of syphilis tests has risen 33 percent from 1999 to 2002.
"San Francisco has seen a tremendous increase in the proportion of gay men, and men who have sex with men, being tested for syphilis," said Dr. Jeffrey Klausner, director of sexually transmitted disease control in San Francisco.
Even so, Klausner emphasized, the increase is not due solely to stepped up screening. "We know that the increased number of cases is definitely related to increased transmission," he said. "People are coming in with lesions; people have sores, and there is an increased number of syphilis cases of the brain. That's real disease and real transmission."
State health officials said California's cases almost doubled from 2001 to 2002, rising to 1,046. Most troubling, health officials said, is that the new data indicate that gay and bisexual men continue to engage in risky behavior that also exposes them to HIV. Syphilis sores facilitate the transmission of HIV, and public health experts fear that the rise in syphilis may presage a corresponding rise in HIV cases.
While releasing the CDC figures Thursday, officials cited a study in New York City comparing the behavior of gay and bisexual men with syphilis to those without syphilis. The men with syphilis were more likely to report engaging in ³unprotected² anal intercourse, attending private sex parties to meet partners, and using methamphetamine and Viagra or other drugs before having sex. They also were more likely to have HIV.
Both groups reported an average of 11 or more partners in the previous six months.
The Internet has fueled the problem, officials said. When syphilis began to surface among gay and bisexual men in Los Angeles three years ago, activists were able to mobilize prevention campaigns focusing on bath houses and sex clubs, said Lee Klosinski of AIDS Project Los Angeles.
[Los Angeles Times, 11/22/03]
Georgia Leads Other States in Syphilis Cases
Georgia's rate of syphilis cases led the nation last year amid a resurgence of the disease among gay and bisexual men, the Centers for Disease Control and Prevention announced Thursday. Atlanta recorded the third-highest urban rate of syphilis, behind San Francisco and Detroit. Georgia was also listed among the top five states for cases of gonorrhea and chlamydia.
The CDC is based in Atlanta, Georgia.
[The Atlanta Journal-Constitution, 11/21/03]
Syphilis Cases Climbing in Chicago Area
Significant jumps in the number of syphilis cases reported in Chicago-area counties in the first three months of 2003 have put health officials on alert, especially since the sores associated with the disease increase by up to five times the likelihood of contracting HIV and hepatitis.
In the Chicago area, "it is starting to look like one of every four cases is co-infected with HIV," said Colette Petit, STD clinic charge nurse for the DuPage County Health Department. Officials do not yet know how the outbreak will affect suburban HIV rates.
Chicago led the nation in new syphilis cases in 2001; more recently, it has ranked second nationally in the number of cases. Although city numbers have stabilized, the disease has spread to outlying areas. Suburban Cook County saw an 80 percent increase in new cases - from 50 in 2001 to 90 in 2002. This year, only 28 cases have been reported through September in suburban Cook County, but the area is still considered by CDC to be in the midst of an outbreak.
DuPage County numbers increased from 10 total in 2002 to 16 for the first nine months of 2003. During the first three months of 2002 and 2003, Lake County cases jumped from zero to four but have since leveled off.
Double-digit percentage increases have yet to hit nearby counties like Will and Kane, although health officials say it may just be a matter of time. "Pathogens and human behavior don't respect boundaries on a map," said Thad Zajdowicz, Chicago Public Health Department medical director for the HIV/STD program.
Right now, syphilis increases are showing up primarily among white men- and to a lesser extent Latino men- having sex with other men. Illinois health officials are split on whether enough bisexual men are functioning as crossover carriers to spread the disease to the heterosexual community, as is occurring in Detroit.
According to Dr. Ronald Valdiserri, deputy director for CDC's HIV, STD and TB prevention programs, "Our challenge- and the challenge for gay and bisexual communities across America- is to underscore the connections between syphilis and HIV, and renew the kind of commitment these communities brought to HIV prevention in the early years of the epidemic."
[Daily Herald, 11/16/03]
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