The 130th Annual Meeting of APHA

Abstract #47068

Michael C Samuel, DrPH¹, Gail E. Kennedy, MPH², Terrence Lo, MPH¹, George W. Rutherford, MD², and Gail Bolan, MD¹. (1) STD Control Branch, California Department of Health Services, 1947 Center Street - Suite 201, Berkeley, CA 94704, (2) University of California, San Francisco, 74 New Montgomery, Suite 508, San Francisco, CA 94105

Background: In 1999, because of low numbers of syphilis cases and the ease of detecting and treating cases, syphilis was slated for elimination in the US by 2005. In response, a California syphilis elimination plan was developed, with key components being improved surveillance and collaboration with affected populations.

Methods: In 2000, California enhanced syphilis data collection by including behavioral risk factors including specific sexual practices, self-reported HIV status and venues for meeting partners. Automated systems were developed to analyze and disseminate the findings, including outbreak detection.

Results: After many years of decreases in syphilis, California experienced increases in 2000 and 2001. In 2001, 532 primary-and-secondary syphilis (P&S) cases were reported, corresponding to a rate of 1.5 per 100,000, a 107% increase from the low of 0.72 in 1999. In 2001, 73% of P&S cases were among men who have sex with men (MSM), a significant increase from 36% in 1999 (p < 0.0001). The increase in MSM cases was concentrated in the Los Angeles and San Francisco areas, but increases were seen throughout the state. Syphilis is now considered an epidemic in this population. Among MSM cases in 2001, 19% reported meeting sexual partners at bathhouses/spas, 16% over the Internet; 62% reporting being HIV positive.

Conclusions: Enhanced syphilis surveillance is in place in California. Increases in syphilis are associated with MSM; many are HIV co-infected. Reports of meeting sexual partners over the Internet and at bathhouses are common. Targeted prevention efforts have been initiated and are being refined and expanded.

Learning Objectives: At the conclusion of the session, participants will be able to

• Describe enhanced syphilis surveillance strategies in California.
• Describe the characteristics of current syphilis cases in California, particularly the association with men who have sex with men.
• Apply lessons learned to STD and HIV prevention messages targeting men who have sex with men.

Keywords: STD, Gay

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.