Syphilis, an infection that has plagued kings and paupers around the globe for centuries, may soon be eliminated from the United States.
Reported new cases, already at a historic low, declined further in 1998, and health officials last week announced the kickoff of a campaign to eliminate syphilis in this country.
"We have an unprecedented opportunity to eliminate syphilis . . . because disease rates are at an all-time low and because the disease is so concentrated geographically," said Judith Wasserheit, director of the division of sexually transmitted disease prevention at the U.S. Centers for Disease Control and Prevention (CDC).
Syphilis is a sexually transmitted infection that, if untreated, can damage the brain and other organs and can be passed from a mother to her unborn infant, causing stillbirth or birth defects. It can also produce a genital sore called a chancre that increases an infected person's susceptibility to the human immunodeficiency virus (HIV), which causes AIDS. Transmission of syphilis has been controlled in most other industrialized countries, but in the United States the disease has continued to rise and fall in approximately 10-year cycles.
In recent years, new U.S. cases have been increasingly concentrated in a few counties and urban areas, especially in the South. Twenty-eight counties or independent cities, representing less than 1 percent of all U.S. counties, accounted for half of last year's 6,993 reported cases of primary and secondary syphilis, according to data released last week by the CDC. Such cases represent recently acquired infections.
Baltimore City reported the largest number of cases of any jurisdiction--456--but that figure represented a 31 percent decrease from the 1997 total of 665. The District ranked 16th with 81 reported cases, which also was 31 percent below the D.C.'s 1997 total of 117 cases.
Health officials emphasize that cases reported to health departments represent a fraction of all new cases, but provide an indication of the frequency of syphilis in a community. Reported cases also reflect the quality of local health services, so a city's or county's total may be deceptively low if there are barriers to treatment or if public health workers are not doing an adequate job of interviewing people with new infections and contacting their sexual partners for testing.
"Syphilis is really sort of a barometer of community health," Wasserheit said.
Nationally, the number of new syphilis cases reported last year was 19 percent lower than in 1997 and 86 percent lower than the number reported in 1990. In that year, the peak of the most recent syphilis epidemic, there were 50,578 new cases of the disease.
Syphilis is a sexually transmitted infection caused by a bacterium, Treponema pallidum, that can damage tissues in many organs of the body. The initial symptoms--a painless sore, followed by a rash--often go unnoticed and disappear without treatment. However, the bacteria remain in the body, producing a "latent" infection that may injure the brain, spinal cord, major blood vessels, bones or other tissues.
Syphilis rates within the population vary among ethnic groups. The rate has historically been highest among African Americans, and in 1998 it was still much higher (17.1 cases per 100,000 population) than the national average (2.6 cases per 100,000) or the rates among other racial or ethnic groups. The data indicated that African Americans were 34 times more likely to be reported with syphilis than whites.
"Syphilis is a completely preventable disease that can be cured with one dose of penicillin, yet it takes a staggering toll on the African American community," said Helene Gayle, director of the CDC's National Center for HIV, STD and TB Prevention, in a statement. "Syphilis remains one of the most glaring examples of racial inequities in health status facing this nation."
U.S. Surgeon General David Satcher and CDC director Jeffrey P. Koplan joined state and local health officials in Nashville last Thursday to launch a national campaign to eliminate syphilis. Wasserheit said the campaign will focus on reducing transmission of the infection, with the goal of having fewer than 1,000 new cases reported annually and at least 90 percent of U.S. counties syphilis-free by 2005. Last year, about 80 percent of U.S. counties reported no new cases of syphilis.
As part of the elimination plan, the CDC is providing additional funds for syphilis control to 33 states and cities with a heavy burden of disease or a high potential for an outbreak. Baltimore and Washington, as well as Maryland and Virginia, are among the recipients.
The plan calls for expanded surveillance for syphilis, rapid testing in clinics and other settings, expanded laboratory services, improved partnerships with social service organizations, schools, churches and other agencies, and efforts to enhance community awareness of the disease.
Federal health officials estimate that fully implementing the plan would cost $37 million. So far, Congress has appropriated $10 million for syphilis elimination, Wasserheit said.
Peter Moore, acting chief of the bureau of STD (sexually transmitted disease) control in the D.C. Health Department, said the District received $175,000 from the CDC in September for syphilis elimination activities and is applying to receive $210,000 next year. He said some of the money will probably be used for syphilis education and testing by community outreach workers, and that part of it may also be used to open one of the neighborhood health centers in Northwest Washington on some evenings and weekends, specifically to treat patients with sexually transmitted diseases.
The health department closed an STD clinic in Northwest Washington in 1995. Currently the only public STD clinic in the District is in Southeast Washington at D.C. General Hospital.
Moore said despite the need for better STD treatment services in Northwest Washington, he is encouraged by the 31 percent drop in new cases reported from the District during 1998. "I think it's a real decline," he said.
Wasserheit said if the national elimination campaign succeeds, sporadic cases of syphilis may still occur, but "syphilis would no longer spread within the United States. It would no longer be a health threat, just as . . . people living in the United States don't need to worry about cholera [or] malaria."
While the number of new syphilis cases is declining, other sexually transmitted diseases continue to spread. These health risks are often unrecognized by the general public, partially because of the stigma they carry and the difficulty in tracking them.
Sexually Transmitted Disease Reported Cases in 1998
Sexually transmitted Reported
SOURCE: Centers for Disease Control and Prevention; 1998 statistics