Syphilis cases were almost eliminated in 2000 but the numbers have rebounded since then, according to the CDC. During 2005–2013, there has been an overall increase despite stabilization during 2009–2010. The CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for cases of primary and secondary syphilis diagnosed from 2005–2013 with an emphasis 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 (MSM).

Based on data reported as of April 28, 2014, the rate of reported primary and secondary syphilis in the U.S. in 2013 was 5.3 cases per 100,000 population–more than double the lowest-ever rate of 2.1 in 2000. The largest increase in the number of cases was particularly seen among MSM. Men comprised 91.1% of all primary and secondary syphilis cases in 2013.

In 2012, over 80% of all nationwide cases was made up of 35 reporting areas that reported the sex of sex partners of >70% of male cases. The greatest percentage increases occurred among MSM aged 25–29 years (53.2%, 1,073 to 1,644). The primary and secondary syphilis rate in women increased from 0.9 to 1.5 per 100,000 population per year during 2005–2008 and decreased to 0.9 in 2013. Overall, primary and secondary syphilis rates were greater in 2013 than 2005 across all 4 U.S. census regions. The highest rate (6.5 cases per 100,000 population) was seen in the West region.

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Results from these analyses highlight the need for strengthened syphilis prevention measures for MSM of all races/ethnicities through the U.S. Possible methods for private and public healthcare providers include:

  • Be aware of the resurgence in syphilis and be able to recognize the signs and symptoms of syphilis, conduct risk assessments, and screen all sexually active MSM for syphilis at least annually with syphilis serologic tests with confirmatory testing where indicated.
  • More frequent screening (eg, at 3–6 month intervals) is recommended for MSM who have multiple or anonymous sex partners.
  • Elicit sexual histories of their patients in a culturally appropriate manner, including recognition of sexual orientation, gender identity, and the sex of patients’ sex partners.

Due to the strong link between syphilis and HIV co-infection, providers are encouraged to urge safer sexual practices, promote syphilis awareness and screening (including screening for gonorrhea, chlamydia, and HIV), and notify and treat sex partners. Public health practitioners are encouraged to strengthen ties with practicing physicians to improve syphilis case identification and reporting, partner-notification programs, and outreach to MSM.

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