The Public Health Response to Epidemic Syphilis, San Francisco, 1999–2004

Abstract

In 1999, the Centers for Disease Control and Prevention launched the National Plan to Eliminate Syphilis. From 1999 to 2003 in San Francisco, early syphilis was epidemic, increasing from 44 cases to 522 cases a year. Syphilis cases were more likely to be in gay or bisexual men, those with human immunodeficiency virus (HIV) infection, those who had anonymous partners, and those who met sex partners on the Internet. Increases in sexual activity and sexual risk behavior in men who have sex with men during this period have been attributed to the improved physical health of HIV-infected men on highly active antiretroviral therapy, HIV treatment optimism, increases in methamphetamine use, and the use of Viagra. The San Francisco Department of Public Health's response to the epidemic included enhanced surveillance, expanded clinical and testing services, provider and community mobilization and sexual health education, and risk factor identification and abatement through investigations, public health advocacy, and treatment. Collaborations with community-based organizations and local businesses were key to the successful implementation of disease-control efforts. A multitude of converging risk factors and new environments contributed to the syphilis epidemic, requiring a comprehensive, innovative, and flexible disease-control strategy.

Sexually transmitted infections: challenges ahead

“…Fourth, it is possible that testing and treatment is reducing levels of immunity against 380 chlamydia in the population leading to increased susceptibility to infection. 64 Fifth, auto-381 inoculation in women of cervical chlamydia infection from the rectal site has been suggested 382 as a factor that could contribute to repeated detection of chlamydia in genital samples; 107 …”

Syphilis Among Men Who Have Sex With Men: Challenges to Syphilis Elimination in the United States

“…Other relevant information, such as HIV status, geographic and social networks for syphilis transmission, and commercial sex venues involved in transmission, may be more readily available from local research and enhanced surveillance efforts, as described in the reports in this issue from San Francisco and Florida. 12,13 Such activities may complement more routinely collected surveillance data, thereby enhancing our ability to better target prevention efforts. In addition, because health care facilities outside of STD clinics are the source of a large and growing proportion of reported cases of syphilis in men in general 2,3 and of MSM in particular, 12,14 there is a need to build collaborative relationships with, and encourage rapid reporting from, those providers.…”

“…12,13 Such activities may complement more routinely collected surveillance data, thereby enhancing our ability to better target prevention efforts. In addition, because health care facilities outside of STD clinics are the source of a large and growing proportion of reported cases of syphilis in men in general 2,3 and of MSM in particular, 12,14 there is a need to build collaborative relationships with, and encourage rapid reporting from, those providers. In this regard, community partnerships are as important for surveillance activities as they are for the other strategies of the syphilis elimination plan.…”

“…23 Other innovations in service expansion, such as expanding laboratory access by using internet-based forms, may be helpful in some locales, and their evaluation is a priority. 12 Unfortunately, options to simplify treatment have been made more difficult by the recent detection of high levels of resistance to azithromycin, 24 an otherwise promising approach to single-dose oral therapy. Fifth, enhanced health promotion is especially important at the beginning of an epidemic when persons at risk are not aware of the symptoms and signs of infection.…”

Psychiatric Manifestations of Neurosyphilis

“…Until the 1990s syphilis has become a rare disease. Due to the low incidence a "syphilis eradication program" was planned by the Centers for Disease Control and Prevention (CDC) (Klausner et al, 2005). At present, it is obvious that the disease has not been eradicated.…”