After leveling off for more than two years, and declining in 2006, new syphilis cases spiked in New York City during the first three months of 2007. The Health Department announced today that doctors reported 260 cases of primary and secondary syphilis during January, February and March, compared with 128 cases during the same period last year.
Interviews with patients suggest that the increase is concentrated among men who have sex with men, especially in the Chelsea area of Manhattan. As in past years, half of those newly diagnosed with syphilis also report being infected with HIV.
While men account for the vast majority (96%) of new syphilis cases, the infection may also be increasing among women. Ten cases were reported among women during the first quarter of 2007, compared to just three in the same period of 2006. Since the numbers are very small, it is not clear if the increase among women is significant, but if it were, it would be the first such increase in 10 years.
These increases are the latest in an ongoing outbreak among men who have sex with men in New York City. After plummeting during the 1990s, syphilis cases started rising in 1999. The rate leveled off in 2005 and 2006 but is now moving upward again. “For the first time in several years, we are seeing a large spike in new cases of syphilis in New York City,” said Dr. Susan Blank, the Health Department’s Assistant Commissioner for Sexually Transmitted Disease Prevention and Control. “It is critical that sexually active New Yorkers reduce their risk of getting syphilis. The infection itself can be devastating, and it fuels the spread of HIV.”
“The level of unsafe sexual behavior among HIV positive men is deeply concerning,” said Dr. Monica Sweeney, the Health Department’s Assistant Commissioner for HIV Prevention. “Syphilis and HIV are both preventable, and we know how: reduce the number of sexual partners and use condoms every time you have sex. Also, every sexually active New Yorker should know his or her HIV status.”
Last year, New York City’s syphilis rate (7.2 cases per 100,000 people) was more than double the 2005 national rate (3.0). But the resurgence isn’t confined to New York City. Other large cities, including Los Angeles and Chicago have experienced a recent rise in syphilis cases. Nationwide, the rate rose by 11% from 2004 to 2005, from 2.7 cases to 3.0 cases per 100,000.
The problem is not limited to exclusively gay men. In New York City, the proportion of men with syphilis who report having sex with both men and women increased from 13% in the first quarter of 2006 to 18% in the first quarter of 2007. This change could herald further increases in syphilis infections among women as well as in congenital syphilis cases.
In New York City, blacks and Hispanics continue to account for most new cases of syphilis (29% and 27% of cases, respectively), but whites are experiencing faster rates of increase. During the first quarter of 2007, incidence among white men was more than three times the comparable 2006 rate.
Health Department Actions to Reduce STDs in New York City
- Providing free and confidential screening in all Health Department clinics. Testing is also available through a number of community providers serving vulnerable populations (e.g., Gay Men’s Health Crisis, Callen-Lorde, African Services, Asian/Pacific Islander Coalition on HIV/AIDS).
- Distributing free NYC Condoms through clinics, bars, restaurants and community groups. More than 15 million NYC Condoms have been already been distributed since Valentine’s Day 2007.
- Meeting regularly with community stakeholders in the Syphilis Advisory Group, which has been further expanded to include representatives for women at risk.
- Offering confidential partner notification for people who think they may have exposed others. This can now be done through email and will soon be available through text messaging.
- Providing information and guidance to help health care providers diagnose, manage and prevent new cases of syphilis.
Protect Yourself from Syphilis and other Sexually Transmitted Infections.
Not having sex is the best way to avoid sexually transmitted infections. If you are sexually active, you can reduce your risk of sexually transmitted diseases (STDs), including HIV, by having sex only with only one person you are sure is not infected. If you are having sex outside of such a relationship, reduce your risk:
- Limit the number of people you have sex with. More partners means higher risk.
- Always use a latex condom (or other type of latex barrier) whenever you have sex – vaginal, anal, or oral. Condoms made of natural materials, such as lambskin, do not prevent STDs. If you are allergic to latex, you can use condoms made of polyurethane or other synthetic materials. Free NYC Condoms are available throughout the five boroughs (for locations, visit nyccondom.org). Organizations can place bulk orders by visiting the website or calling 311.
- Avoid alcohol and drugs when you have sex. Drinking or getting high makes it much harder to remember to use condoms to protect yourself and others.
- Know your sex partners. Before having sex with someone, ask them with whom else he or she has sex. Get yourself tested, and get your partner tested for STDs before you have sex. All New Yorkers should know their HIV status. Free and confidential testing is available at Health Department clinics in all five boroughs, regardless of age, immigration status or ability to pay. For a list of clinics and hours, visit nyc.gov/health, or call 311.
Syphilis is curable and preventable. If treated early, syphilis can be easily cured with a single injection of penicillin. Left untreated, however, syphilis can cause serious health problems and having syphilis makes it easier to become infected with and spread HIV.