Alarming Trend in Syphilis Rates Across the USA- Racial Disparities Abound

Treponema pallidum- the agent of syphilis: Source BMJ.com

As an infectious diseases physician in an urban, tertiary care, university hospital, I am still struck by the seemingly endless cases of new HIV and syphilis diagnoses seen in young men. These  men, many of whom are gay, were born after the HIV epidemic began. Shouldn't they be practicing safe sex?

A recent publication in the Annals of Internal Medicine highlights an alarming trend in the rates of syphilis.

From 2005 to 2008, 27 states from all U.S. census regions reported data on the sex of sex partners for 70% or more of male cases of primary and secondary syphilis. Regression analysis revealed significantly different trends in rates of primary and secondary syphilis: Absolute increases in rates among black MSM and Hispanic MSM were, respectively, 8.0 times and 2.4 times the absolute increase in rate among white MSM. By region, rates among MSM increased 30% in the Midwest, 48% in the South, 73% in the Northeast, and 77% in the West. By age group, the largest absolute increase in rates occurred among MSM aged 20 to 29 years.

Rates of primary and secondary syphilis disproportionately increased among young, black and Hispanic MSM.

Sure, these findings have implications for point of care safe sex counseling by healthcare providers. But, they also reflect, in my opinion, a public health failure, the result of inconsistent education (by schools, health departments and parents) on sexual risks and safe sex counseling, including an under promotion of condom use. 

Until this is addressed, we are destined for more of the same.