men who have sex with men 

Unfortunately, syphilis cases among gay and bisexual 

men of all races pose new challenges to efforts to 

eliminate the disease in the United States. On the whole, 

P&S syphilis rates among U.S. men rose by about 46 

percent between 2000 and 2002 (from 2.6 to 3.7 cases/ 

100,000 people), an increase that coincided with outbreaks among gay and bisexual men in several cities, 

including Los Angeles, Seattle, San Francisco, New York 

City, Chicago, and Miami Beach, among others, reflecting an increase in risky behavior in this population. 

The rate of P&S syphilis increased 13.5% among men 

between 2002 and 2003. 

CDC and its partners are actively looking into the 

factors that have made some gay and bisexual men 

particularly vulnerable to syphilis. They are working 

with community organizations and local health 

departments on research and health interventions 

to understand current trends and to avoid future 

outbreaks. 

let’s see together. 

Together, we can help eliminate the problem of 

syphilis in our communities. To fight syphilis, the SEE 

initiative needs the support of health care providers, 

members of community-based organizations, religious 

leaders, policy makers, and activists. 

; 

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department of health and human services 

centers for disease control and prevention 

A community-based effort to eliminate syphilis in the United States. 

taking steps to eliminate 

syphilis in your community. 

Community and religious leaders and organizations 

can play a role in eliminating syphilis by making syphilis 

education a part of community health programs

coordinating syphilis elimination activities within their 

organization; educating policy makers and opinion 

leaders about the importance of syphilis elimination; 

invo ving health care providers in syphilis elimination 

activities; or assisting their local health department in 

SEE outreach activities. 

If you are a health care provider, you can help by 

increasing screening treatment, reporting, counseling

and prevention efforts. Information on syphilis prevention methods (or strategies) can inc ude abstinence

monogamy, i.e., being fa thful to a single sex partner, 

or using condoms cons stent y and correctly. These 

approaches can avoid risk (abstinence) or effect ve

reduce risk for getting syphilis (monogamy, cons stent 

and correct condom use). 

syphilis elimination will only 

work if you and others like you 

are involved. we cannot let this 

chance slip away. 

For more information, visit www.cdc.gov/std/see/

syphilis and affected communities 
primary and secondary syphilis – counties 

and independent cities by number of reported 

cases: united states, 2003.* Centers for Disease 

Control and Prevention (CDC) 

what is the syphilis elimination where is syphilis Rank† County/ Cases Rate per effort (see)? concentrated? Independent City 100,000 people 

In 1999, the Centers for Disease Control and Prevention, Currently, most cases of syphilis are concentrated in the 1 Los Angeles County, CA 523 5.3 

(CDC) together with other federal, state, and local South; in disadvantaged and minority communities where 2 San Francisco County, CA 332 43.5 

partners, initiated the Syphilis Elimination Effort (SEE), access to health care is limited; and in urban areas with 3 Cook County, IL 302 5.6 

a national initiative bringing health care providers, large communities of men who have sex with men (MSM). 4 Fulton County, GA 298 36.1 

members of community-based organizations, religious In 2003, 18 counties and one city accounted for half of 5 New York County, NY 273 17.6 leaders, policy makers, and activists together to eliminate the total number of reported P&S syphilis cases (see 

syphilis in the United States. The goals of this initiative chart). The South continues to have the largest portion 6 Wayne County, MI 205 10.0 

are to reduce the number of primary and secondary (P&S) of syphilis cases. 7 Harris County, TX 196 5.5 

syphilis cases in the United States to 1,000 or fewer – 0.4 8 Dade County, FL 194 8.3 

cases/100,000 people – and to increase the number of who is most affected by 9	 Broward County, FL 179 10.5 

syphilis-free counties to at least 90 percent. The National syphilis in the united states? 10 Dallas County, TX 165 7.2


Plan outlines five strategies to accomplish these goals:


increase monitoring and tracking of the disease, strength- african americans and latinos 11 Baltimore (City), MD 153 24.0


12 Maricopa County, AZ 132 4.0 en community and partnership involvement, rapidly While race or ethnicity itself is not a risk factor for syphilis 

respond to outbreaks, raise community health aware- and other sexually transmitted diseases (STDs), commu- 13 Franklin County, OH 116 10.7 

ness, and expand clinical and laboratory services. nities burdened by poverty, racism, drug use, unemploy- 14 Kings County, NY 114 4.6 

ment, low rates of health insurance, and inadequate 15 San Diego County, CA 111 3.8 

what is the overall rate of access to health care are plagued with increased cases 16 DeKalb County, GA 108 16.0 

of syphilis. Also, prevention outreach efforts for STDs 17 Philadelphia County, PA 98 6.6 syphilis in the united states? may not yet be a high priority in some communities. 18 Essex County, NJ 76 9.5 P&S syphilis rates in the United States decreased during 19 Shelby County, TN 76 8.4 the 1990s and reached their lowest ever in 2000. However,	 When compared to other racial groups, African 

these rates have begun rising again, increasing slightly in Americans and Latinos are disproportionately affected * Accounting for 50% of reported primary and secondary 

2001 and more substantially in 2002. In 2003, reported by syphilis. In 2003, the P&S syphilis rate among African syphilis cases. 

† Counties were ranked in descending order by number P&S syphilis cases increased 4.6 percent. Because syphilis	 Americans (7.8 cases/100,000 people) was 5.2 times 

of cases. 

tends to rebound in 7- to 10-year cycles, we must seize	 greater than the rate reported among whites (1.5 cases/ 

this opportunity to eliminate syphilis now while rates	 100,000 people). The P&S syphilis rate among Hispanics


(3 cases/100,000 people) was twice that reported among
 are still relatively low. non-Hispanic whites. Moreover, despite declines in con-	 While this is a great health disparity, progress is being 

genital syphilis (syphilis passed from mother to child) 

rates among the major racial/ethnic groups, this disease 

remains a problem that disproportionately affects African 

American and Hispanic infants. In 2003, the rate of 

made. During 2002-2003, the P&S syphilis rate declined 

27.3% among women. The rate of P&S syphilis among 

African Americans declined from 9.5 to 7.8 cases/100,000 

people during the same time period. Still, there is much 

congenital syphilis was 26 times higher among African work to be done. By working together, we can make


American infants (33.9 cases/100,000 live births), and our communities healthier now and in the future.


14 times higher among Hispanic infants (18.1 cases/


100,000 live births), compared to non-Hispanic whites


(1.3 cases/100,000 live births).