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Syphilis Epidemiology. Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health. Why a lecture on syphilis? Although syphilis is an eminently treatable disease, its continuing occurrence illustrates that our control efforts still need to be

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syphilis epidemiology

Syphilis Epidemiology

Thad Zajdowicz, MD, MPH

Medical Director, STD/HIV Program

Chicago Dept of Public Health


Why a lecture on syphilis?

Although syphilis is an eminently treatable

disease, its continuing occurrence illustrates

that our control efforts still need to be

improved. The disease remains elusive clinically

even today, and unless thought of and sought

for can silently cause disease as it has for

centuries. Further, control of syphilis is vital

because of its interactions with HIV. This lecture will focus on syphilis epidemiology; following lectures will explore the clinical manifestations of this most protean of diseases.

  • To understand the prior and current impact of syphilis
  • To define current trends of syphilis in the U.S.
  • To understand how syphilis and HIV interact
etiology and course
Etiology and Course

Syphilis is a chronic, systemic infection caused by a spirochete, Treponema pallidum. The primary mode of transmission is via sexual contact. Untreated, syphilis progresses through a primary and secondary stage before becoming latent. Up to 1/3 of people with untreated syphilis develop tertiary disease late in life, primarily cardiovascular and neurologic. Syphilis is also transmitted congenitally from an infected mother to her infant.

historical issues
Historical Issues
  • Emergence of syphilis in Europe in 1490s
  • ? Imported from the Americas (Columbian theory) or ? Emergence in Europe from other treponematoses
  • Severe disease (called The Great Pox to distinguish it from smallpox)
pre penicillin era
Pre-Penicillin Era
  • Highly prevalent in many countries/societies in pre-penicillin era
  • Estimates of 10% of U.S. population infected in early 20th Century
    • Higher rates in socially disadvantaged populations, e.g. rural African-Americans in the South
  • Dramatic drop in incidence/prevalence after introduction of penicillin in mid-1940s
syphilis worldwide
Syphilis Worldwide
  • WHO estimates 12 million new cases of syphilis worldwide (
  • Greatest burden in adolescents and young adults
  • Greatest numbers of new cases in South and Southeast Asia, followed by sub-Saharan Africa
syphilis in the u s
Syphilis in the U.S.

current u s syphilis epidemiology
Current U.S. Syphilis Epidemiology
  • Rates of primary and secondary (P&S) syphilis declined every year from 1990-2000
  • In 2001, rates of P&S syphilis began rising again
    • However, rise in new cases is seen in men who have sex with men (MSM)
    • Male:female ratio of cases rose from ~ 1:1 to ~3.5:1 in past 8 years
p s syphilis cases by region
P&S Syphilis Cases by Region

Primary and Secondary Syphilis --- United States, 2002

race ethnicity
Race & Ethnicity
  • In 2001-2002, P&S syphilis rates increased 71.4% among non-Hispanic white men and 28.6% among Hispanic men
    • No changes in rates in females of same groups
  • Among non-Hispanic blacks, P&S syphilis rates decreased 10.9%
    • 2.2% for men, 22.6% for women
  • There were significant rate changes in both Asian/Pacific Islanders and American Indians/Alaska Natives
    • However, very few cases in both groups overall

P&S Syphilis , by Gender and Sexual Orientation, 1998-2003*, Chicago







congenital syphilis
Congenital Syphilis
  • Syphilis is transmissible from mother to infant
  • Transmission usually occurs during early stages, but may occur at any stage in an untreated mother
  • Incidence of infection rose in U.S. in late 1980s-early 1990s with rise in heterosexual cases
congenital syphilis17
Congenital Syphilis
  • Rates of congenital syphilis in U.S. continue to decline as new cases of P&S syphilis decline in heterosexuals
epidemiological synergy
Epidemiological Synergy
  • HIV and syphilis co-facilitate transmission of each other
  • Biological plausible because:
    • STDs facilitate HIV shedding
    • Cellular recruitment of HIV susceptible cells occurs
    • Mucosal barriers are breached
    • Immunosuppression
behavioral risk
Behavioral Risk
  • Behaviors that are risky for transmission of syphilis are also risky for transmission of HIV
  • This has been demonstrated in studies in various areas of the world
sources of information
Sources of Information

The following sites are useful if more

information on syphilis epidemiology is sought: Centers for Disease Control World Health Organization American Social Hygiene Assoc Virtual Naval Hospital