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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.070417v1 97/6/1076    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Heffelfinger, J. D. Articles by Weinstock, H. S. Search for Related Content PubMed PubMed Citation Articles by Heffelfinger, J. D. Articles by Weinstock, H. S. Related Collections Epidemiology Other Race/Ethnicity Sexual Health

James D. Heffelfinger, MD, MPH, Emmett B. Swint, MS, Stuart M. Berman, MD, ScM and Hillard S. Weinstock, MD, MPH

James D. Heffelfinger is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Ga. At the time of this study, Emmett B. Swint, Stuart M. Berman, and Hillard S. Weinstock are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta.

Correspondence: Requests for reprints should be sent to James D. Heffelfinger, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Mailstop E-46, 1600 Clifton Rd NE, Atlanta, GA 30333 (e-mail: izh7{at}cdc.gov).

Objectives. We assessed the epidemiology of primary and secondary syphilis in the United States and estimated the percentages of cases occurring among men who have sex with men (MSM).

Methods. We reviewed US syphilis surveillance data from 1990 through 2003. We estimated the number of cases occurring among MSM by modeling changes in the ratio of syphilis cases among men to cases among women.

Results. During 1990 through 2000, the rate of primary and secondary syphilis decreased 90% overall, declining 90% among men and 89% among women. The overall rate increased 19% between 2000 and 2003, reflecting a 62% increase among men and a 53% decrease among women. In 2003, an estimated 62% of reported cases occurred among MSM.

Conclusions. Increasing syphilis cases among MSM account for most of the recent overall increase in rates and may be a harbinger of increasing rates of HIV infection among MSM. National efforts are under way to improve monitoring of syphilis trends, better understand factors associated with the observed increases, and improve efforts to prevent syphilis transmission.

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