Syphilis Reported Increasing for First Time in a Decade

By SHERYL GAY STOLBERG

ASHINGTON, Oct. 31 — Syphilis, which federal health officials are trying to eliminate, is increasing in the United States for the first time in more than a decade, the Centers for Disease Control and Prevention reported today. Agency officials attributed the turnaround to new infections in gay and bisexual men.

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The increase was slight. Last year, 6,103 cases were reported, up from 5,979 in 2000, the agency said. For every 100,000 Americans, 2.2 were infected with syphilis in 2001, compared with 2.1 in 2000.

Health authorities said the increase was troubling for two reasons. First, it is a setback for the two-year-old effort to eliminate syphilis. Second, it sends yet another signal that many gay and bisexual men are no longer practicing safe sex, a trend that experts say has worrisome implications not only for syphilis, which can be cured with antibiotics, but also for the AIDS epidemic.

"We're concerned about it, even though it is a relatively small number of cases and a relatively slight increase," said Dr. Ronald O. Valdiserri, a C.D.C. expert in sexually transmitted diseases. "We are concerned about it in the context of other reports of unsafe behavior."

Often regarded as a 19th-century disease, syphilis is caused by a spirochete bacterium. Its first symptoms are genital sores, which can also help transmit H.I.V. The sores go away without treatment, and patients often do not realize that they are infected. Six weeks to several months later, patients experience a rash that fades if left untreated. The disease can then recur, causing heart damage and blindness.

In October 1999, officials at the disease centers in Atlanta announced that the syphilis rate had reached its lowest level since 1941, when the government began keeping statistics. They said they believed syphilis could be eliminated in five years. The officials added that they would focus the campaign on those most vulnerable, African-Americans and people living in the South, home to more than half the syphilis cases.

The statistics today suggested that those efforts have had some success. In the South, Dr. Valdiserri said, cases declined 8 percent. Infections among African-American women fell 18.1 percent. Syphilis fell 3.5 percent among African-American men, although Dr. Valdiserri noted that the decline was much smaller than the 15 percent drop last year.

"These data clearly show that a targeted concerted national effort to eliminate syphilis can and will work," he said.

The agency's goal, he added, is to have 90 percent of counties free of syphilis by 2005. Now, 80 percent are. The overall goal is to reduce cases to 1,000 or fewer a year, putting the United States on a par with some other industrialized nations, Dr. Valdiserri said.

Although his agency has focused on blacks and Southerners, it did not foresee outbreaks in big cities with large gay and bisexual populations. Over the last 18 months, Dr. Valdiserri said, the agency has sent "rapid response teams" to help investigations in Chicago, Los Angeles, Miami, New York and San Francisco.

In September, the New York City Department of Health and Mental Hygiene announced that reported syphilis cases in the city had increased more than 50 percent in the first six months of the year. The outbreak began in Manhattan, according to Health Commissioner Thomas R. Frieden, and has moved to other boroughs.

"We need to emphasize that syphilis is back," Dr. Frieden said, "that it can be treated, and that it's important to seek care."