With all these populations where syphilis incidence is on the rise, are there geographical patterns that you can see?
In men who have sex with men, we've seen increases throughout the country both in the [U.S.] west, in the South, in the Midwest, and east and Northeast. In heterosexuals, particularly in women—African-American women, more specifically—the increases that we've seen have been limited to the South. We're concerned that this might spread to other regions of the country, but for now, they're limited to the southern parts of the United States.
Any ideas why incidence is on the rise in the South? Poor quality of sexual education, maybe?
We don't have all the answers to that. We've always seen higher prevalence of syphilis in the South. It's not surprising that when there are increases that we would see them first in that region. The South is where we saw some of the biggest gains in syphilis control in the '90s.
What is the public health community doing to curb these increases?
CDC is working actively to promote better linkages between HIV and STD prevention programs nationwide. We're offering more STD testing at HIV testing sites. We're funding innovative STD prevention sites on the Internet, which is where many men who have sex with men, for example, meet partners [as well as] programs at bathhouses and other kinds of venues where men who have sex with men may meet and gather.
Everyone around the age of 30 or older has a pretty keen understanding of how the world became aware of HIV/AIDS in the 1980s. Does syphilis have a similar backstory?
At one time, syphilis, like HIV, was not treatable. Before the advent of penicillin, many more tens of thousands of Americans had syphilis. If you go back to the 1940s, almost 100,000 cases of primary and secondary syphilis were reported to the CDC at that time. So it was, at one time, the AIDS of its day—before antibiotics were developed and it became a very treatable disease. But, nevertheless, it is still associated with severe sequela and also associated with increased transmission and acquisition of HIV.
Is the perception, that relative to HIV/AIDS syphilis isn't something to worry about, a big hurdle for public health officials?
I think that is a challenge, constantly reminding the sexually active individuals, adolescents and even older persons—as well as health care providers—that this is still a problem, that this is still to be reckoned with and addressed. Gay men, for example, who are sexually active need to be tested for syphilis and other sexually transmitted diseases on a regular basis. Health care providers need to have a high level of suspicion in their patients that are sexually active for this disease.