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Syphilis rates rising among gay men in US, CDC data show
Liz Highleyman, 2016-09-29 07:20:00
New state-level data reveal that syphilis cases continue to rise among gay and bisexual men in the US, with men in the south having the highest rates, according to a presentation at the 2016 STD Prevention Conference last week in Atlanta. A related study found that half of gay and bisexual men in 20 US cities were screened for syphilis during the past year, with 11% testing positive.
Alex de Voux of the US Centers for Disease Control and Prevention (CDC) and colleagues calculated the first-ever state-level estimates of primary and secondary syphilis rates among men who have sex with men (MSM).
Syphilis rates have been rising in the US in recent years. During 2014 there were more than 63,000 reported new cases of syphilis, including 20,000 cases of primary and secondary syphilis, with more than 80% of the latter occurring among MSM, according to the CDC. Reported syphilis cases rose by 15% from 2013 to 2014 and another 19% from 2014 to 2015, Dr de Voux said.
Primary syphilis, or initial infection, is marked by a single chancre or lesion in the genital or anal region where Treponema pallidum bacteria enter the body. These sores are typically painless, heal on their own and may never be noticed. If left untreated the infection progresses to the secondary stage, characterised by a rash on the mucous membranes and skin, including the palms and soles of the feet, sometimes accompanied by fever, swollen lymph nodes, fatigue and other flu-like symptoms.
These symptoms also go away without treatment, but the bacteria remain in the body and untreated infection progresses to the latent stage, which can last for years without symptoms. A minority of infected people go on to develop late-stage syphilis, which can involve damage to the heart, eyes (ocular syphilis), nervous system (neurosyphilis) and other organs. Pregnant women with syphilis can pass it to their babies (congenital syphilis).
Dr de Voux's team based their estimates on 2015 national syphilis case report data from the National Notifiable Diseases Surveillance System, along with 2014 estimates of the number of adult gay and bi men by state. State-level estimates of syphilis among gay men were not previously possible because state-by-state estimates of this population were not available, they noted. This missing denominator was provided by recent estimates of the number of MSM in each state from researchers at Emory University.
The CDC researchers calculated rates for the 44 states that reported the sex of partners for at least 70% of men diagnosed with primary and secondary syphilis during 2015 – which accounted for 84% of all such cases – comparing rates among men with any male partners versus those reporting only female partners.
Nationwide there were 17,887 cases of primary and secondary syphilis among all men and 2030 cases among women in these 44 states in 2015. Among men, the case numbers were 12,118 for MSM, 2866 for heterosexual men and 2903 for men with unknown sex of partners.
The nationwide syphilis rate among gay and bi men in 2015 was 309.0 cases per 100,000, compared with 2.9 per 100,000 among heterosexual men. Although there were about four times as many cases of syphilis among MSM compared to heterosexuals, when taking into account their much smaller number in the population the rate was 107 times higher.
Alaska had the lowest rate of primary and secondary syphilis among MSM (73.1 per 100,000), while North Carolina had the highest rate (748.3 per 100,000). Three other states in the southeast also had among the highest rates in the nation: Mississippi (658.9 per 100,000), Louisiana (601.8 per 100,000) and South Carolina (536.9 per 100,000).
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