Sexually Transmitted Disease Surveillance 1996

Division of STD Prevention September 1997

U.S. Department of Health and Human Services 
Public Health Service 
Centers for Disease Control and Prevention  
National Center for HIV, STD, and TB Prevention 
Division of STD Prevention 
Atlanta, Georgia 30333

Copyright Information 

All material contained in this report is in the public domain and may be
used and reprinted without special permission; citation to source, however,
is appreciated.

Suggested Citation

Division of STD Prevention. Sexually Transmitted Disease Surveillance,
1996. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1997.

Copies can be obtained from the Office of Communications, National Center
for HIV, STD, and TB Prevention, Centers for Disease Control and
Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

The reports for 1993 through 1996 are available electronically on CDC
WONDER. For information about registering for CDC WONDER, please contact
CDC's Epidemiology Program Office at (888) 496-8347. These reports are also
available from the Internet via the CDC home page address
http://wonder.cdc.gov/wonder/data/Reports.html. 


Syphilis

Although the U.S. syphilis rate declined in 1996 to its lowest level in
many years, syphilis remains an important problem in certain geographic
areas, particularly among African-Americans. Syphilis, a genital ulcerative
disease, facilitates the transmission of HIV and may be particularly
important in contributing to HIV transmission in those parts of the
country, such as the South, where rates of both infections are high.
Untreated early syphilis during pregnancy results in perinatal death in up
to 40% of cases, and, if acquired during the previous four years, may lead
to infection of the fetus in over 70% of cases. For syphilis, as for other
STDs, differential reporting of cases from public and private sectors may
magnify the differences in reported rates by race and ethnicity.

--  In 1996, 11,387 cases of primary and secondary (P&S) syphilis were
    reported to CDC. This is the lowest number of cases reported since
    1959. Between 1995 and 1996, the incidence of primary and secondary
    syphilis in the United States declined from 6.3 to 4.3 cases per
    100,000 persons (Figure_24, Table_1).

--  In 1996, P&S syphilis rates in 33 states and 1 outlying area were below
    the Healthy People 2000 (HP2000) national objective of 4 cases per
    100,000 persons (Figure_25, Table_25). Thirteen states and 1
    outlying area reported fewer than 5 cases of P&S syphilis in 1996.

--  In 1996, 2,260 (73%) of 3,116 counties in the United States reported no
    cases of P&S syphilis compared with 2,144 (69%) counties in 1995. Of
    856 counties reporting at least one case of P&S syphilis in 1996, 374
    (44%) counties reported rates of 4 cases or fewer per 100,000 persons
    (Figure_26). Therefore, rates of P&S syphilis were above the HP2000
    objective (4.0 per 100,000) for 482 counties in 1996. These counties
    (15% of the total number of counties in the United States) accounted
    for 84% of all reported P&S syphilis cases.

--  In 1996, the rates of P&S syphilis continued to decline for all regions
    of the United States. However, the rate of 8.7 cases per 100,000
    persons in the South remained above the  HP2000 objective
    (Figure_27, Table_26). The P&S syphilis rates of the other 3
    regions were below the HP2000 objective.

--  The overall rate of P&S syphilis in selected large cities (over 200,000
    population) declined from 10.1 cases per 100,000 persons in 1995 to 7.6
    in 1996 (Figure_28, Table_30). However, rates exceeded the
    HP2000 objective in 35 (55%) of 64 large cities in the United States
    and outlying areas for which data were available (Table_29).

--  During the period 1993-1996, the rates of P&S syphilis within racial
    and ethnic groups have generally declined, except for American
    Indian/Alaska Native (Figure_30, Table_24B). However, the 1996
    rate for non-Hispanic blacks of 30.2 cases per 100,000 persons was 50
    times greater than the rate for non-Hispanic whites (Figure_30,
    Table_24B).

--  Between 1995 and 1996, the overall rate of congenital syphilis
    decreased from 47.4 to 30.4 cases per 100,000 live births
    (Figure_33, Table_37). However, compared with 1995, increases
    were observed in 1996 for 4 (Alabama, Maryland, Massachusetts,
    Tennessee) of the 24 states reporting more than 5 cases (Table_38).

--  In 1996, 8 states (Arkansas, Illinois, Maryland, Mississippi, New
    Jersey, New York, South Carolina, Tennessee) had congenital syphilis
    rates that exceeded the HP2000 objective of 40 cases per 100,000 live
    births (Table_38).

--  Additional information on syphilis and congenital syphilis can be found
    in the Special Focus Profiles section.

Figure_23.  Syphilis -- Reported cases by stage of illness: United 
                States, 1941-1996
Figure_24.  Primary and secondary syphilis -- Reported rates: United 
                States, 1970-1996 and the Healthy People year 2000
                objective
Figure_25.  Primary and secondary syphilis -- Rates by state: United
                States and outlying areas, 1996
Figure_26.  Primary and secondary syphilis -- Counties with rates above 
                and counties with rates below the Healthy People year 2000
                objective: United States, 1996
Figure_27.  Primary and secondary syphilis -- Rates by region: United 
                States, 1981-1996 and the Healthy People year 2000
                objective
Figure_28.  Primary and secondary syphilis -- Rates in selected U.S. 
                cities of >200,000 population, 1981-1996 and the Healthy
                People year 2000 objective
Figure_29.  Primary and secondary syphilis -- Rates by gender: United 
                States, 1981-1996 and the Healthy People year 2000
                objective
Figure_30.  Primary and secondary syphilis -- Rates by race and 
                ethnicity: United States, 1981-1996 and the Healthy People
                year 2000 objective
Figure_31.  Primary and secondary syphilis -- Age- and gender-specific 
                rates: United States, 1996
Figure_32.  Congenital syphilis -- Reported cases for infants <1 year 
                of age and rates of primary and secondary syphilis among
                women: United States, 1970-1996
Figure_33.  Congenital syphilis -- Rates for infants <1 year of age: 
                United States, 1981-1996 and the Healthy People year 2000
                objective

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