*Rate per 100,000 population based on the U.S. Census Bureau’s population data as of July 1, 2002
Early syphilis includes primary and secondary syphilis, and early latent syphilis, as defined by the U.S. Centers for Disease Control and Prevention (CDC). These definitions can be found in Case Definitions for Infectious Conditions under Public Health Surveillance, Morbidity and Mortality Weekly Report, Vol. 46, No. RR-10, May 2, 1997, or at the following Web site: http://www.cdc.gov/mmwr/preview/mmwrhtml/00047449.htm.
Elimination of syphilis is an explicit CDC objective. Historically low incidence coupled with the etiologic agent’s role in facilitating human immunodeficiency virus (HIV) transmission and compromising women’s ability to deliver healthy children prompted the CDC to plan and implement the elimination campaign.
In 2002, the Indiana State Department of Health received 66 reports of early syphilis, indicating a rate of 1.07 cases per 100,000 residents, a significant decrease from 2001 (4.5/100,000). These persons were infected with Treponema pallidum, the causative agent of syphilis, and diagnostically staged as primary, secondary, or early latent syphilis cases.
The significant decrease in reported syphilis cases is attributed to the collaborative campaign between local, state, and federal public health agencies in Marion County to eliminate syphilis. This campaign started in 2000. The outcome of that effort was evident in the reduction of subsequent incident cases (Figure 1). The number of reported cases decreased by 82 percent between 2000 and 2002. This trend demonstrates significant progress toward syphilis elimination in Indiana.
A significant racial disparity exists between the white population and the black population. The race-specific rate for blacks (6.9) was higher than that for whites (0.4). Blacks contributed disproportionately to 2002’s early syphilis morbidity; 55 percent (36 cases) of Indiana's early syphilis infections were among this racial group.
Most early syphilis cases were reported among adolescents and young adults, with a somewhat older population affected relative to the age distribution of reported cases among other sexually transmitted diseases under surveillance. The greatest number of cases and the highest age-specific rates were among those 20-39 years of age (Figure 2).
Looking ahead to further progress toward elimination of this pathogen from Indiana, the counties with the historically highest morbidity will be those with the greatest potential for resurgence. The presence of even one early case, other than one occurring within 90 days of an imported case, is evidence of sustained transmission.
The incidence rates were highest among the following counties reporting five or more cases: LaPorte (9.07) and Marion (4.3). Figure 3 shows counties reporting five or more cases.
You can learn more about syphilis by visiting the following Web site: