The National Plan to Eliminate Syphilis from the United States
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The National Plan to Eliminate Syphilis from the United States

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    As we approach the end of the 20th century, the United States is faced with a unique opportunity to eliminate syphilis within its borders. Syphilis is easy to detect and cure, given adequate access to and utilization of care. Nationally, it is at the lowest rate ever recorded and it is confined to a very limited number of geographic areas. The last epidemic peaked in 1990, with the highest syphilis rate in 40 years. By 1998, the number of cases had declined by 86 percent. Although the national syphilis rate has declined to historic lows, syphilis remains a severe public health problem in a small number of U.S. counties. In 1998, over 50% of infectious (primary and secondary or P&S) syphilis cases were reported from only 28 (<1%) U.S. counties, the majority of which are in the South. In addition, where syphilis does persist in the U.S., it disproportionately affects African Americans living in poverty. Although the Black:White ratio for re- ported syphilis rates has decreased by almost one-half since the early 1990s, the 1998 P&S syphilis rate for non-Hispanic Blacks was still 34 times greater than that for non-Hispanic whites.

    Elimination of syphilis would have far-reaching public health implications because it would remove two devastating consequences of the disease—increased likelihood of HIV transmission and compromised ability to have healthy babies due to spontaneous abortions, still- births, and congenital syphilis acquired from mothers with syphilis. In addition, more than $996 million is spent annually as a result of syphilis. Eliminating syphilis in the United States would be a landmark achievement because it would remove these direct health burdens, and it would significantly decrease one of this Nation’s most glaring racial disparities in health.

    The persistence of high rates of syphilis in the United States is a sentinel event identifying communities in which there is a fundamental failure of basic public health capacity to control infectious diseases and ensure reproductive health. In these areas, syphilis elimination will be the leading edge of a broader effort to begin re-building this capacity. Based on the repeatedly observed seven-to-ten-year syphilis cycle, there is currently a narrow window of opportunity to eliminate this disease while cases are still on the decline.

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