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BACKGROUND: Primary and secondary (P&S) syphilis rates have increased since historic lows in 2000. P&S syphilis increasingly affects men, particularly men who have sex with men (MSM). However, P&S syphilis continues to occur among women, which is concerning because congenital syphilis rates typically mirror P&S syphilis rates among women. We describe P&S syphilis and congenital syphilis during 2005–2012.
METHODS: We analyzed U.S. syphilis case data reported to CDC during 2005–2012. In 35 jurisdictions where gender of sex partner data was >70% complete, we analyzed P&S syphilis among MSM.
RESULTS: During 2005–2012, the P&S syphilis rate increased from 2.9 to 5.0 cases per 100,000 population (n=8,724 to n=15,667). Men comprised 90.6% of P&S syphilis cases in 2012. During 2005–2012, the male P&S syphilis rate increased from 5.1 to 9.3 cases per 100,000 population (n=7,383 to n=14,190). Annual male rates increased by 11–14% during 2005–2008, 1–2% during 2009–2011, and 14% during 2011–2012. During 2005–2012, rates increased among men of all ages and races/ethnicities, but some shifts occurred in 2009. During 2005–2009, rate increases were greatest among blacks (14.6 to 29.8 cases per 100,000 population) compared to Hispanics (5.0 to 7.6) and whites (3.1 to 3.7). During 2009–2012, rates increased among Hispanics (7.6 to 10.9) and whites (3.7 to 5.0) but decreased slightly among blacks (29.8 to 28.1). Preliminary 2013 data suggest continuation of these trends. In 35 jurisdictions, MSM comprised 84% of male P&S syphilis cases in 2012. Cases increased among MSM of all ages and races/ethnicities; Hispanics and whites had the greatest increases. The female P&S syphilis rate increased from 0.9 to 1.5 cases per 100,000 population (n=1,339 to n=2,242) during 2005–2008 then decreased to 0.9 (n=1,458) by 2012. Rates among black women increased from 4.2 to 7.9 during 2005–2008 then decreased to 4.5 in 2012. Rates among white and Hispanic women remained stable. Congenital syphilis rates increased from 8.2 to 10.5 per 100,000 live births (n=339 to n=446) during 2005–2008 then decreased to 7.8 (n=322) by 2012, the lowest rate and number of cases reported since the case definition was changed in 1988.
CONCLUSIONS: Increases in syphilis among men highlight a need to better promote safer sexual practices, awareness and testing, and partner services among MSM. Efforts to prevent and treat syphilis among heterosexual men and women should continue in order to prevent congenital syphilis.