U.S. Syphilis Rate Declines to All-Time Low in 2000

— CDC Releases Data on the Counties with Highest Syphilis Rates—

— Dramatic Successes Seen in Areas With More Intensive Elimination Efforts—

DALLAS – The overall syphilis rate in the United States fell to an all-time low in 2000, continuing a decade-long decline that places elimination of this sexually transmitted disease within closer reach, according to the Centers for Disease Control and Prevention (CDC). The new data were released today at the opening of a CDC-sponsored conference in Dallas of community leaders and public health officials from around the country. The meeting, which will last until November 30, will address the CDC-led nationwide effort to eliminate syphilis, focusing in particular on public-private partnerships that have accelerated progress towards elimination in several communities. Data were released from three community-based programs that have experienced dramatic rates of decline.

In 2000, only 5,979 cases of primary and secondary (P&S) syphilis were reported in the United States, a decline of 9.6 percent since 1999. The reported rate of syphilis for 2000 was 2.2 cases per 100,000 people, slightly less than the 1999 syphilis rate, which was 2.4 cases per 100,000 people. The decline in syphilis rates across the United States is associated with CDC’s National Campaign to Eliminate Syphilis in the United States.

"Syphilis rates in the United States have declined dramatically over the past four years, indicating significant progress in our syphilis elimination efforts," said CDC Director Jeffrey P. Koplan, M.D., M.P.H. "However, there are a significant number of communities where syphilis remains a public health threat. Prevention and treatment efforts must be accelerated in these areas if the disease is going to be eliminated from the United States."

Only Eleven Regions Report More than 100 Cases of Syphilis

In 2000, half of all P&S syphilis cases in the United States were concentrated in only 21 counties and one independent city. Eleven of those areas reported more than 100 cases of syphilis in 2000 (in ranking order –see chart attached): Cook County, Ill (Chicago); Marion County, Ind. (Indianapolis); Wayne County, Mich. (Detroit); Shelby County, Tenn. (Memphis); Baltimore, Md.; Fulton County, (Atlanta) Ga.; Davidson County, Tenn. (Nashville); Maricopa County, Ariz. (Phoenix); Los Angeles County, Calif.; Miami-Dade County, Fla.; and Dallas County, Texas.

Only 619 counties – out of 3,135 counties in the United States – reported at least one case of syphilis. Eighty percent of the nation’s counties were syphilis free in 2000. Although the disease has declined overall nationwide, there have been outbreaks of syphilis among men who have sex with men in several U.S. cities, including Los Angeles, Seattle, New York City, Chicago, Miami Beach, among others.

CDC Syphilis Elimination Demonstration Sites Experience Remarkable Declines

In addition to syphilis elimination efforts nationwide, CDC has funded syphilis elimination demonstration sites in three separate counties: Davidson County, Tenn., Marion County, Ind., and Wake County, N.C. At these sites, CDC provided extra funding to support comprehensive community outreach programs, which all utilize public-private partnership to fight disease. The demonstration sites are helping CDC evaluate and refine national strategies for the syphilis elimination efforts. Those key strategies include: enhancing community awareness and involvement in syphilis prevention, expanding surveillance and outbreak response in each community, supporting rapid screening in and out of medical settings, expanding laboratory services and improving agency partnerships.

From 1999 to 2000, CDC-sponsored demonstration sites experienced dramatic decreases in their syphilis rates. While the national syphilis rate declined nearly 10 percent from 1999 to 2000, Davidson County rates dropped by 20 percent, while the number of syphilis cases in Marion County decreased by nearly 25 percent (24.6%). In Tennessee, Wake County’s rates dropped by almost 27 percent (26.8%). (For more information on these projects, please see the Syphilis Elimination Community Briefs.)

"Through such innovative programs, these three sites have experienced more than twice the rate of decline seen in the rest of the nation," said Ronald O. Valdiserri, M.D., M.P.H., deputy director of CDC’s National Center for HIV, STD and TB Prevention. "These programs demonstrate the power of taking public health to the people, where it is needed most."

Left untreated, syphilis, which is sexually transmitted, can cause cardiovascular and neurological diseases. It also can accelerate the spread of the HIV epidemic. The presence of syphilis increases the chances of both acquiring and spreading HIV infection at least two- to five-fold. Moreover, untreated syphilis during pregnancy can result in infant death in up to 40 percent of cases.

"By eliminating syphilis, communities can improve infant health, slow the spread of HIV infection, and reduce disparities in health," said George W. Counts, MD, director of CDC’s syphilis elimination program. "Rates of the disease will almost certainly rise again if communities do not continue to work hand-in-hand to fight this disease." Historically, syphilis was nearly eliminated in 1957, but rates of the disease rebounded – a pattern that has been repeated every seven to 10 years for the last 44 years. Previous trends suggest that without syphilis elimination efforts, rates of syphilis, which last peaked in 1990, would have been expected to increase. With syphilis elimination efforts, however, the rates of syphilis have continued to decrease. From 1990 to 2000, syphilis rates have dropped 89.2 percent.

"We have a brief window of opportunity to eliminate syphilis," said Counts. "We must work together to rid our communities of this scourge. We cannot let this chance slip from our grasp."

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Centers for Disease Control and Prevention

Primary and Secondary Syphilis – Counties and Independent Cities

ranked by number of reported cases: United States, 2000

Rank County/Independent City Cases Rate per 100,000 People

1 Cook County, Ill. 326 6.3

2 Marion County, Ind. 301 37.1

3 Wayne County, Mich. 288 13.7

4 Shelby County, Tenn. 246 28.2

5 Baltimore, Md. 218 34.5

6 Fulton County, Ga. 203 27.3

7 Davidson County, Tenn. 200 37.7

8 Maricopa County, Ariz. 172 6.0

9 Los Angeles County, Calif. 152 1.6

10 Miami-Dade County, Fla. 126 5.8

11 Dallas County, Texas 100 4.8

12 Oklahoma County, Okla. 90 14.4

13 Guilford County, N.C. 70 17.9

14 Harris County, Texas 70 2.2

15 Bexar County, Texas 67 4.9

16 Philadelphia County, Pa. 67 4.7

17 New York County, N.Y. 62 4.0

18 Robeson County, N.C. 58 49.7

19 Jefferson County, Ky. 57 8.5

20 Palm Beach County, Fla. 54 5.1

21 San Francisco County, Calif. 51 6.8

22 King County, Wash. 50 3.0

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.