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.