Introduction The national syphilis elimination goal was to reduce infectious syphilis cases to 1,000 or fewer and to increase the number of syphilis-free counties to 90% by 2005 through enhanced surveillance, community involvement, rapid outbreak response, expanded clinical and laboratory services, and enhanced health promotion. Despite these efforts, there has been resurgence in cases of syphilis in Clark County, Nevada.
Methods We reviewed data collected on cases of syphilis diagnosed from January 2003 through December 2005 in Clark County (including Las Vegas), Nevada.
Definitions For the purposes of surveillance, cases were defined as primary syphilis: A clinically compatible case with one or more chancres consistent with primary syphilis and a reactive serologic test. Secondary Syphilis: A clinically compatible case with a nontreponemal titer greater than or equal to 4. Latent Syphilis: No clinical signs or symptoms of syphilis and the presence of one of the following: (1) no past diagnosis of syphilis, a reactive nontreponemal test, and a reactive treponemal test; (2) a past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or greater increase from the last nontreponemal test titer. The term early/infectious syphilis was used to include cases of primary, secondary, and early latent syphilis (occurring within the last 12 months). Data were collected on their HIV serostatus.
Results During the period from January 2003 through December 2005, the total cases of syphilis increased 116% from 126 to 272. Early cases of syphilis increased 414% (28-144) during the same period. In 2005, the majority of cases (78%) occurred in males. In males, the majority of cases occurred among Caucasian (50%), whereas African American women make up the largest proportion among females (62%). In 2005, 19% of cases (65/272) were coinfected with HIV, a condition seen in 37% of early syphilis cases (53/144).
Conclusion Despite efforts to eliminate syphilis, the number of cases has been rising in Clark County, Nevada. The majority of this increase is as a result of resurgence among men who have sex with men, although the number of women infected also increased especially among minorities. A significant proportion of cases were coinfected with HIV.
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