In 1998, syphilis incidence in the United States declined to a historic low—6,993 total cases, or 2.6 cases per 100,000 people—prompting the Centers for Disease Control and Prevention (CDC) earlier this fall to announce a national plan to completely eradicate this sexually transmitted disease (STD). "We have an unprecedented window of opportunity to eliminate syphilis in the United States," says Judith Wasserheit, director of CDC's STD prevention division, "because rates are at an all-time low and because the disease is now extremely concentrated geographically." Indeed, half of all new cases in 1998 were reported from only 28 counties, primarily in southeastern states.
CDC officials say that syphilis elimination would have far-reaching public health implications, because it would remove two "devastating consequences of the disease—increased likelihood of HIV transmission and compromised ability to have healthy babies due to miscarriages, stillbirths and multi-system disorders caused by congenital syphilis acquired from mothers with syphilis." In addition, they say, it would significantly decrease "one of this Nation's most glaring racial disparities in health." Although the disparity between reported syphilis rates for black and white Americans has decreased markedly since the early 1990s, blacks living in poverty are still disproportionately affected by the disease.
While syphilis is a complex STD, it is relatively easy to diagnose and treat; one dose of penicillin can cure a person who has been infected for less than a year. Moreover, because syphilis also is entirely preventable—indeed, recent reductions in syphilis infections have been attributed in part to safer sex practices, such as using condoms and having fewer partners, as well as increased funding for treatment—Wasserheit adds, "no American should have to face this disease in the 21st century."
Other industrialized countries already have eliminated syphilis, and to move the United States toward that goal, CDC has targeted 33 areas in the country with the heaviest current caseload or with a high potential for reemergence. With funds redirected from other CDC activities and matched with state and local funds, these targeted areas will implement comprehensive programs aimed at expanding surveillance, providing screening and laboratory services, improving agency partnerships and enhancing community awareness and involvement in preventive efforts. CDC has set two goals for 2005: fewer than 1,000 cases nationwide and an increase in the proportion of syphilis-free counties from 78% to 90%.