Infectious syphilis among adolescent and young adult men: implications for human immunodeficiency virus transmission and public health interventions.

BACKGROUND: In 2008, an increase in syphilis among young black men was noted in New York City (NYC), Miami-Fort Lauderdale, and Philadelphia. To explore this trend, we examined infectious syphilis cases from 2000 to 2008 among adolescent and young adult men in these areas. METHODS: Descriptive analysis of male infectious syphilis cases reported to public health authorities in NYC, FL, and Philadelphia. RESULTS: From 2000 to 2008, infectious syphilis cases among males increased in NYC (107-1027 cases), Miami-Fort Lauderdale (109-374), and Philadelphia (41-142). This increase was largely attributable to cases among men who have sex with men. Rates among black adolescent males (15-19 years) increased in NYC ([2.6-43.0]/100,000), Miami-Fort Lauderdale ([5.5-48.1]/100,000), and Philadelphia (]8.3-40.3]/100,000). Among males with infectious syphilis in 2008 in NYC, 9.1% of blacks and 6.6% of Hispanics were adolescents compared with 1.6% of whites (P < 0.001). In Miami-Fort Lauderdale, 12.2% of black males were adolescents compared to 2.0% of whites (P < 0.01) and 2.7% of Hispanics (P < 0.01). Black males dominated all age groups in Philadelphia, but were more likely to be <25 years of age than whites (P = 0.02). Human immunodeficiency virus coinfection rates were 14.8% among adolescent males in NYC, 15.4% in Philadelphia, and 25.0% in Miami-Fort Lauderdale. CONCLUSIONS: Very young black males have emerged as a risk group for syphilis in these 3 areas, as have young Hispanic males in NYC. Many are men who have sex with men and some are already human immunodeficiency virus-infected. Targeted risk reduction interventions for these populations are critical.

Florida's multifaceted response for increases in syphilis among MSM: the Miami-Ft. Lauderdale initiative.

After many years of declining rates, it became apparent in 1999 that syphilis cases were on the rise in Florida. Data analysis identified that the outbreak was predominately contained in Miami and Ft. Lauderdale and among men who have sex with men. An in-depth investigation was undertaken to identify the risk factors, the best way to attack the outbreak, and how to build sustainability into implemented strategies. After thorough review of the data and extensive dialogue with local public health and community participants, the Bureau of STD Prevention & Control developed initiatives that focused public awareness through print, radio, and television media resources; expanded access to men's health services; and enhanced education/training for public and private health care providers, STD program field staff, and community representatives. This initiative has resulted in unprecedented community involvement in syphilis control efforts.

Activities to increase provider awareness of early syphilis in men who have sex with men in 8 cities, 2000-2004.

OBJECTIVE: Describe provider awareness campaigns undertaken in response to syphilis epidemics among men who have sex with men (MSM). METHODS: Descriptive data from 8 cities facing MSM syphilis epidemics was compiled. RESULTS: Provider awareness efforts included medical alerts, provider visits, lectures to providers on symptom recognition and treatment, and ongoing provision of syphilis and other sexually transmitted diseases (STD) morbidity information through mailings, visits, and e-mail communications. Increases in private provider reporting of syphilis cases followed provider visits in Atlanta and overall provider education efforts in New York City. Decreases in reporting delays and increases in physician calls to the STD program were reported in San Francisco following provider syphilis lectures. Increases in provider participation in community action meetings followed provider awareness efforts in Houston, Chicago, and Miami. CONCLUSIONS: Various methods were used to increase provider awareness of syphilis in these 8 cities. The cost and impact of these activities merits more formal evaluation to determine their contribution to syphilis control in MSM.

Interventions in the commercial sex industry during the rise in syphilis rates among men who have sex with men (MSM).

OBJECTIVE: Describe sexually transmitted disease/human immunodeficiency virus prevention interventions targeting men who have sex with men (MSM) in commercial sex venues (CSV). STUDY: Compilation of descriptive and evaluation data from the CDC 8-city MSM Syphilis Response on interventions conducted in bathhouses/sex clubs, circuit parties, the Internet, male sex workers, and the adult film industry. RESULTS: Interventions in the commercial sex industry (CSI) often involved multiple collaborative efforts between public health departments (PHD), community-based organizations (CBO), and CSV owners and managers. Education and condoms were provided at multiple venues, including circuit parties, bathhouses, and sex clubs. CBO staff reported one-on-one street and CSV outreach to engage MSM at risk. Evaluation data demonstrate that MSM exposed to media campaigns were more aware of syphilis and more likely to have been tested for syphilis than MSM who did not see the campaigns. CONCLUSIONS: PHD and CBO are using multiple means of reaching MSM in the CSI. Evaluations are needed to determine which of these efforts decreases syphilis transmission.