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Rising Rates of Syphilis in the Era of Syphilis Elimination

Kerani, Roxanne P. PhD*†; Handsfield, H Hunter MD*‡; Stenger, Mark S. MS§; Shafii, Taraneh MD*†; Zick, Ellen BA; Brewer, Devon PhD; Golden, Matthew R. MD, MPH*†

Sexually Transmitted Diseases: March 2007 - Volume 34 - Issue 3 - p 154-161
doi: 10.1097/01.olq.0000233709.93891.e5

Objective: The objective of this study was to assess the impact of syphilis control activities in King County, Washington.

Study Design: We calculated rates of early syphilis and trends in numbers of persons tested and diagnosed through screening and partner notification from 1998 to 2005.

Results: Early syphilis cases increased from 38 in 1998 to 188 in 2005 with 92% occurring among men who have sex with men (MSM). Our health department conducted public awareness campaigns, increased publicly financed syphilis screening among MSM by 179%, and intensified partner notification efforts. Despite these efforts, the prevalence of syphilis among screened populations was only 1.1%, and 71% syphilis cases were diagnosed after seeking care for symptoms. The proportion of cases diagnosed through screening and partner notification did not significantly change during the evaluation period. Early syphilis incidence among MSM more than doubled between 2003 and 2005.

Conclusions: New, innovative approaches to syphilis control are needed.

An evaluation of the syphilis control program in King County, Washington, found that expansion of traditional syphilis control activities has not slowed the current men who have sex with men syphilis epidemic.

From the *University of Washington, Seattle, Washington; †Public Health–Seattle & King County, Seattle, Washington; the ‡Battelle Center for Public Health Research and Evaluation, Seattle, Washington; §Washington State Department of Health, Olympia, Washington; and ∥Interdisciplinary Scientific Research, Seattle, Washington

The authors gratefully acknowledge the assistance and support of Barbara Krekeler, Keith Okita, Fred Koch, Rolf Pedersen, Michelle Perry, the disease intervention specialists, and other staff of the Public Health–Seattle and King County STD Control Program.

Correspondence: Roxanne P. Kerani, PhD, Public Health–Seattle & King County STD Program, Harborview Medical Center, Box 359777, 325 9th Avenue, Seattle, WA 98104-2499. E-mail:

Received for publication January 18, 2006, and accepted May 29, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association