U.S. Syphilis Rates Increased By 10 Percent In 2013

The final numbers for syphilis infections in the U.S. during 2013 were released in December 2014, and they aren't good news — particularly for men who have sex with men. Just over 17,000 people were diagnosed with primary or secondary syphilis in the U.S. in 2013, the new report shows. This bumped the national incidence rate of syphilis infection to 5.5 per 100,000 – a 10 percent increase.
"This national rate increase was only among men, particularly gay and bisexual men," the CDC reports in a fact sheet released by the agency. "Trend data show that men who have sex with men (MSM)* account for three quarters (75 percent) of all primary and secondary syphilis cases," the CDC reports. "Primary and secondary syphilis are the most infectious stages of the disease, and if not adequately treated, can lead to long-term infection which can cause visual impairment and stroke. Syphilis infection can also place a person at increased risk for acquiring or transmitting HIV infection. Available surveillance data indicate that an average of half of MSM with syphilis are also infected with HIV."
That assessment is shown in syphilis numbers for Michigan, as well. Jennifer Smith, a spokesperson for the Michigan Department of Community Health, says in 2013 there were 498 cases of primary and secondary syphilis identified in Michigan, and 347 of those cases were in men who have sex with men. Among the men who have sex with men, 178 were co-infected with HIV. Co-infection with HIV and syphilis increases the risk of transmission of the virus by 2.5 times, studies have determined. This is because the immune system launches a response at the location of the syphilis invasion, which in turn causes an opening in the skin. As a result, the syphilis infection location is a target for HIV to infect. As the immune system also floods the area with responsive immune cells when a person is infected with syphilis, it also increases the likelihood a person with HIV will shed the virus from the location, infecting their partner.
Despite years of increasing reports of syphilis, diagnosis has required a blood test, often requiring a visit to a doctor and a vial of blood to be drawn. But the day before the CDC released the 2013 report, the Food and Drug Administration (FDA) approved the use of a rapid test for syphilis in non-laboratory settings. The test, which is similar to rapid tests for Hepatitis C and HIV, requires a drop of blood drawn from a finger prick. It had been approved in 2011 for use only in certified labs. The Dec. 15 announcement now makes the test available for non-laboratory settings — including community based organizations like AIDS service organizations.
"The recent announcement by the U.S. Food and Drug Administration (FDA) that it has granted the first-ever waiver, under certain laboratory regulations, for a rapid screening test for syphilis, is very welcome news," Smith said in an email statement to Between The Lines. "The Michigan Department of Community Health looks forward to having a rapid screening test for syphilis available and will follow CDC guidance on implementation when that becomes available."
At least one AIDS service organization thinks the new test availability will be helpful in their work. "Provided it follows the same standards we have for HIV (which I would suspect it does), there wouldn't really be an obstacle that I can think of to adding this to our CTR (Counseling, Testing, Referral) protocol (we've already successfully added HepC)," Kevin Gierman, a prevention manager at Red Project Grand Rapids, says. "We would need to make sure we're connected to community partners (particularly medical) ready to respond when we identify someone as positive for syphilis and that our test counselors are all trained on syphilis testing and information (the training process could be the biggest challenge as scheduling the entire team would take time). We're already doing a great job of connecting with the MSM community and I suspect there would be a strong response if the option to test for syphilis was offered." Gierman says finding funding for the testing could be an obstacle. Currently, HIV testing, prevention and counseling are funded through HIV specific funding streams, while syphilis funding comes through CDC sexually transmitted disease funding streams.