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Epidemiologic Characteristics of an Ongoing Syphilis Epidemic Among Men Who Have Sex With Men, San Francisco

Bernstein, Kyle T. PhD, ScM*†; Stephens, Sally C. MPH*; Strona, Frank V. MPH; Kohn, Robert P. MPH*; Philip, Susan S. MD, MPH*

Sexually Transmitted Diseases: January 2013 - Volume 40 - Issue 1 - p 11–17
doi: 10.1097/OLQ.0b013e31827763ea
Original Study

Background Since 2001, San Francisco has experienced a sustained syphilis epidemic that has been nearly exclusively limited to men who have sex with men. We examined the characteristics associated with changes in the syphilis epidemic in San Francisco.

Methods All primary and secondary (P&S) syphilis cases reported to the San Francisco Department of Public Health between 2001 and 2011 were examined using joinpoint analysis to identify periods within the broader epidemic. Characteristics of the index cases were compared across the periods using χ2 statistics and t tests.

Results Three distinct periods were identified, an acute increase, decline, and then period of resurgence. In the most recent period of resurgence, compared with earlier periods, patients with P&S syphilis were more likely to have a prior syphilis infection, were older, were more likely to meet partners online, and were more likely to have a partner from outside San Francisco.

Conclusions In an analysis of 11 years of P&S syphilis data, several factors were associated with declines or resurgences. Innovative prevention measures are needed to reduce syphilis morbidity among men who have sex with men.

A review of 11 years of syphilis morbidity identified a handful of characteristics associated with the changing epidemic.

From the *San Francisco Department of Public Health, San Francisco, CA; †Division of Epidemiology, School of Public Health, University of California, Berkeley, CA; ‡Centers for Disease Control and Prevention, Atlanta, GA

We thank Rilene Ng, Nicole Olson, and Michael Samuel, California Department of Public Health, for providing data and analysis of Bay Area primary and secondary syphilis case reports; Mark Pandori, San Francisco Public Health Laboratory, for providing data on VDRL testing; and Jen Hecht from the STOP AIDS Project for providing data on syphilis testing among men who have sex with men.

Supported (in part) by the Comprehensive STD Prevention Projects

(1H25PS001354-01), Centers for Disease Control and Prevention.

Conflict of interest: None to report

Correspondence: Kyle Bernstein, PhD, ScM, STD Prevention and ControlServices, San Francisco Department of Public Health, 1360 Mission St, Suite 401, San Francisco, CA 94103. E-mail:

Received for publication June 29, 2012, and accepted October 3, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association