National Syphilis Rate Up Fourth Consecutive Year in 2004, Gonorrhea Rate Reached Record Low, CDC Report Says

The national rate of syphilis increased for the fourth consecutive year in 2004, while the gonorrhea rate hit a record low, according to an annual report on sexually transmitted diseases released by CDC on Tuesday, Reuters reports. The report also shows an increase in the rate of chlamydia, which could be attributed to improved screening rather than a rise in infections, the agency said (Reuters, 11/8). Syphilis, gonorrhea and chlamydia are bacterial infections that can be treated with antibiotics. People with one of the infections are three to five times as likely to acquire HIV if they are exposed to the virus (Guthrie, Atlanta Journal-Constitution, 11/9). Overall, 19 million new cases of the three STDs occurred in 2004 at estimated health care costs of $19 billion, according to CDC (Altman, New York Times, 11/9). The rate of primary and secondary syphilis increased 8%, from 2.5 cases per 100,000 people in 2003 to 2.7 cases per 100,000 people last year (Reuters, 11/8). Among men, the rate of primary and secondary syphilis increased 11.9% between 2003 and 2004 and 81% over the last five years, CDC researchers said. A separate CDC analysis shows that the increase in syphilis was being driven in part by an increase of new cases among men who have sex with men. In 2004, about 64% of syphilis cases occurred among MSM, compared with about 5% in 1999 (CQ HealthBeat, 11/8). The syphilis rate among blacks increased last year for the first time in a decade, rising nearly 17% (Johnson, San Francisco Chronicle, 11/9). The national gonorrhea rate fell from to 113.5 cases per 100,000 people last year, the lowest since the government began tracking the disease in 1941, researchers said (Stobbe, AP/Philadelphia Inquirer, 11/9). According to the report, 929,462 chlamydia cases were reported in 2004, but up to 2.8 million new cases might occur annually, according to the Journal-Constitution (Atlanta Journal-Constitution, 11/9).

Explanations
Researchers said that the "seemingly paradoxical" findings can be explained by the cyclical nature of syphilis outbreaks, an increase in risky sexual behavior among MSM and an increase in STD screening, according to the AP/Philadelphia Inquirer. Because of the life cycle of the syphilis bacterium, the number of infections tends to peak at eight- to 11-year periods, London researchers reported earlier this year. Sexual behavior has an effect on the general number of infections, but highs and lows are characteristic of the disease, researchers said. In comparison, gonorrhea follows a different pattern and rates have been falling gradually since the 1980s. Ronald Valdiserri, acting director of CDC's National Center for HIV, STD and TB Prevention, attributed the majority of the increased syphilis rate to a rise in risky sexual behavior among MSM. "It's very clear that for the last four years, when we've seen an increase, it's primarily been in men and predominantly in men who have sex with men," Valdiserri said, adding, "We know that's being fueled by increases in high-risk sexual behavior. We have good data to substantiate that" (AP/Philadelphia Inquirer, 11/9). Valdiserri said risky sexual behavior among MSM has increased because of more widespread use of crystal methamphetamine, which decreases sexual inhibitions (Maugh, Los Angeles Times, 11/8). John Douglas, director of the CDC's STD prevention programs, said that increases in unprotected sexual intercourse among young people and the use of the Internet to find anonymous sex partners also are helping to fuel the spread of STDs (Ricks, Long Island Newsday, 11/9). Valdiserri said, "While there is no silver bullet to reduce syphilis rates, innovative screening and prevention programs around the country are having a positive impact in many areas and providing crucial lessons that will help us meet new challenges" (CDC release, 11/8).