Syphilis Control in the Postelimination Era: Implications of a New Syphilis Control Initiative for Sexually Transmitted Disease/Human Immunodeficiency Virus Programs

摘要

I n 1999, the US Centers for Disease Control and Prevention (CDC) announced an ambitious plan to eliminate syphilis from the United States. Syphilis rates at the time were near historic lows, and the goal of decreasing the number of diagnoses of primary and secondary syphilis occurring nationally to below 1000 cases per year seemed within reach. However, by 2001, syphilis rates among men began what has proven to be an unremitting climb, and in 2016, there were over 27,000 cases of primary and secondary syphilis reported in the United States. Like high- and middle-income nations throughout the world, the United States now confronts an explosive syphilis epidemic. That epidemic, which was originally highly concentrated among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), is diffusing into a larger population of HIV-uninfected MSM. Rates of syphilis among women are also rising. More worrying still, the rate of congenital syphilis in 2016 (15.7 per 100,000 live births) was double the rate in 2012 (7.8 per 100,000), though still a small fraction of the rate in 1991 (107.3 per 100,000 live births), the modern peak in congenital syphilis in the United States.