FACT SHEET - CDC's Updated Plan to Eliminate Syphilis in the United States
In 1999, the Centers for Disease Control and
Prevention (CDC) launched The National Plan to Eliminate Syphilis from the
United States to capitalize on a decade of declining rates of syphilis. The
ambitious plan was designed to end the sustained transmission of the disease
in the U.S. by focusing efforts on the populations most affected by syphilis – heterosexual
minority populations, particularly African Americans. In these populations,
substantial progress has been made in reducing the burden of syphilis, yet
overall syphilis rates have been on the rise since 2001, largely due to increasing
rates of syphilis among men who have sex with men (MSM).
What is syphilis elimination and what will it mean for the nation’s
health?
At the national level, syphilis elimination is defined as the absence of
sustained transmission of the disease. Despite recent challenges, generally
low syphilis rates provide an opportunity to achieve this goal. Syphilis elimination
is possible because the disease is easy to cure once diagnosed, and because
the syphilis epidemic is concentrated in a small number of geographic areas.
In 2004, more than 50 percent of infectious (also called primary and secondary,
or P&S) syphilis cases were reported from just 20 U.S. counties.
Elimination of syphilis would have far-reaching public health benefits because
it would remove two serious consequences of the disease – increased
likelihood of HIV transmission, and serious complications in pregnancy and
childbirth, such as spontaneous abortions, stillbirths, and congenital syphilis
(syphilis among newborns who acquired it from their mothers).
Syphilis elimination accomplishments to date
Since CDC’s original plan was issued in 1999, there have been significant
declines in syphilis rates among key populations at risk, including African
Americans, women, and newborns. Between 1999 and 2004:
P&S syphilis rates among blacks decreased 37 percent, from
14.3 to 9.0 cases per 100,000
The black-white racial disparity in syphilis rates fell from 28.6:1 to
5.6:1
Rates among women overall fell 60 percent, from 2.0 to 0.8 cases per
100,000
Rates of congenital syphilis declined 39 percent, from 14.5 to 8.8 per
100,000 live births
Elimination efforts face new challenges
Despite important gains in many populations, overall syphilis rates have
been on the rise since 2001, largely due to increases among MSM. Overall,
the P&S syphilis rate among males increased 68 percent from 1999 to 2004.
While surveillance data are not available by risk behavior, a separate CDC
analysis suggests that approximately 64 percent of all adult P&S syphilis
cases in 2004 were among MSM, up from an estimated 5 percent in 1999. In addition,
P&S syphilis rates increased among African Americans in 2004, for the
first time in more than a decade. The increase largely reflected significant
increases among black men (up 22.6% from 2003 to 2004).
CDC’s updated plan expands elimination efforts to meet the
latest challenges
CDC’s updated plan, Together
We Can: The National Plan to Eliminate Syphilis from the United States, is designed to sustain elimination efforts
in populations traditionally at risk, and to carry out innovative solutions
to the resurgence of syphilis among MSM.
The plan is guided by three goals, each of which includes concrete activities
for CDC, state and local health departments, community organizations, and
private healthcare providers.
Goal One: Invest in and enhance public health services and interventions
Ensuring that the nation’s public health system – including
the local and state health departments on the front lines of the fight – is
adequately equipped to fight syphilis is critical to success.
Improve surveillance and outbreak response. Accurate and detailed surveillance
data are essential to design effective syphilis prevention programs and to
respond to syphilis outbreaks in specific populations. The updated plan recommends
that state and local health departments:
By the end of 2006, collect information on the gender of sexual partners
and the sexual orientation of individuals diagnosed with syphilis, to more
accurately assess the impact on MSM
Provide epidemiology training to STD program staff at local health departments,
many of which do not have personnel with significant expertise in this area,
to ensure that program planners can interpret and respond to emerging trends
Establish a Syphilis Outbreak Response Plan to address rapid, local increases
in syphilis, as occurred among MSM in some U.S. cities over the past several
years
Improve diagnosis, treatment, and prevention services. Limited resources
in public STD clinics and limited training in private healthcare settings
result in sub-standard syphilis prevention, care, and diagnosis in many
communities.
The plan calls for:
New and strengthened partnerships between health departments and other
healthcare providers, such as community health centers and outreach
clinics that serve at-risk populations, to ensure wider coverage of syphilis
screening efforts
Routine syphilis screening of MSM by HIV care providers and increased
awareness among MSM of the importance of routine syphilis screening
Where transmission is primarily among heterosexual populations, increasing
the proportion of inmates screened in local jails, particularly female
inmates. This strategy may help reach incarcerated commercial sex workers,
a population
at high risk for syphilis
Increasing the proportion of pregnant women screened during prenatal
care visits
Improve testing and laboratory services. Among other activities, CDC
and its partners are working to develop a rapid syphilis test to quickly
diagnose
syphilis, particularly in non-traditional community settings such as
bars, clubs, and community centers, where people at risk can be reached effectively.
The goal is to make a rapid test available for use in the U.S. within
the
next few years.
Goal Two: Prioritize and target interventions to populations at greatest
risk
Expanded partnerships with affected communities, community-based organizations
(CBOs), and local healthcare providers can help health officials tailor interventions
and select venues to reach populations most at risk.
Target interventions for groups most at risk. The plan calls for:
Areas with high syphilis burdens to devote 15 to 30 percent of their
CDC syphilis elimination funding to support the activities of local CBOs, in
order to better reach affected populations (e.g., African Americans, MSM, and
other minorities)
Assessing healthcare access, and use of care and screening services,
in affected populations
Developing Internet-based interventions to reach the increasing number
of MSM and others who meet partners online, and increasing outreach and
screening for MSM in bathhouses, bookstores, HIV testing sites, and other venues
State and local health departments to partner with local drug treatment
centers to reach MSM and others who use drugs such as crystal methamphetamine
Mobilize and support private healthcare providers. A growing number of
people are diagnosed with syphilis by private physicians or by healthcare
workers in community clinics. Many private practitioners, in particular,
need training on case reporting, partner notification, and other public health
practices. The plan calls for state and local health departments to provide
training, policy guidance, and up-to-date syphilis information to private
providers, community clinics, and others who provide services to populations
at risk.
Goal Three: Improve accountability of prevention efforts
Improving the accountability – and results – of syphilis elimination
efforts nationwide requires investing in training, data-driven planning and
evaluation, and research to enhance syphilis screening and prevention efforts.
The plan prioritizes the following areas:
Improve training and staff development. CDC and its public health partners
will work to ensure access to needed training for health department staff
responsible for carrying out syphilis elimination activities. Training
will address skills such as clinical and laboratory methods, data analysis,
health
communications, and community outreach. These efforts complement the healthcare
provider training called for under Goal Two of the plan.
Use data-driven planning and evaluation. Evidence-based planning and
evaluation of programs help ensure the best use of limited program resources.
The plan
calls for all state and local health departments to develop annual syphilis
elimination action plans based on local surveillance and research data.
Carry out new research and development activities. The plan calls for
research into the development of new strategies to diagnose and prevent
syphilis. Among other activities, CDC and its partners will conduct research
on the
cost-effectiveness of new syphilis prevention interventions; examine
the economic, social, and behavioral factors that must be addressed in
order for interventions
to succeed; and develop more effective screening programs.
Next steps – Implementing the plan
CDC is moving rapidly with its partners to implement the revised plan.
A national network of Syphilis Elimination Coordinators, drawn from state
and local health agencies, has been established to find ways to streamline
training for STD program staff, and identify other ways to ensure rapid
implementation of the plan. CDC is also taking additional steps to guide
federal, state, and local health partners. During the next 6 months to two
years, the agency will develop a specific action plan with a five-year timetable
of activities, a Syphilis Elimination Research and Development strategy,
and a template “outbreak response plan” to be adapted by state
and local health departments.