By Melanie R. Margolis
A goal of the federal Healthy People Program for the year 2000 was to reduce the syphilis rate in the United States to 4.0 cases per 100,000 persons. By 1997, the goal had been surpassed. On October 7, 1999, the U.S. Centers for Disease Control and Prevention (CDC) announced that a number of state departments of health will receive federal money as part of a national plan to eliminate syphilis. The national program calls for the elimination of syphilis as a public health threat in the next 5 years.
Statistics led the CDC to conclude that now is an optimal time to try to eliminate syphilis because the rate is low and occurrence is geographically concentrated. According to the CDC, 6,993 cases of syphilis were reported in 1998, the lowest number of cases reported since 1959. Between 1996 and 1997, the incidence of syphilis in the U.S. declined from 4.3 to 3.2 cases per 100,000 persons. In 1998, the rate was further reduced to 2.6 per 100,000 population. In 1998, half of all syphilis cases in the U.S. were reported from 28 counties, and the counties with a rate above 4.0 cases per 100,000 persons were concentrated in the southeastern U.S.
While the overall rate of syphilis in the U.S. has been below 4.0 cases per 100,000 persons, the same has not been true for all racial and ethnic groups. The rate of infection among whites, Hispanics and other racial and ethnic groups was below the 4.0 mark by 1997, but the rate among blacks was much higher at 22 cases per 100,000 in 1997. In 1998, the rate of syphilis for blacks declined to 17.1 cases per 100,000, while the rate for whites was a mere 0.5 cases per 100,000. A goal of the federal government is to eliminate racial and ethnic disparities in health care in the U.S. See Surgeon General Promotes Health of the Nation: Unlocking Health Care for the Uninsured, Underserved, Underrepresented, Uninspired, and Uninformed. The decision to target syphilis is in keeping with this goal.
Syphilis is also an appropriate choice of a disease to eradicate in light of the Tuskeegee Syphilis Study conducted in the U.S. beginning in the 1930s, during which hundreds of black men with syphilis who thought they were receiving medical care went untreated. On May 16, 1997, President Bill Clinton apologized for the Tuskeegee study, and the federal government implemented various programs to strengthen medical research ethics. Efforts at eliminating syphilis with its significantly higher rate of incidence in blacks seems particularly appropriate.
Syphilis, spread by sexual contact, is caused by the Treponema pallidum bacterium and can be cured with antibiotic treatment. If untreated, syphilis can cause blindness, brain damage, and death. Pregnant females infected with syphilis can pass the disease to their unborn babies, resulting in miscarriage, stillbirths, and birth defects. According to the CDC, the genital sores caused by syphilis make it easier to transmit and acquire HIV infection sexually.
Texas Commissioner of Health
William R. Archer, M.D. has stated that the keys to elimination include
getting infected people to refrain from risky sexual behavior, to seek
testing and treatment, and to let their sex partners know that they should
also be tested.
The elimination of a disease in a country is a tremendous achievement. On September 3, 1999, the CDC announced that, as a result of the U.S. vaccination program, measles is no longer an indigenous disease in the U.S. (A small number of cases of measles were imported or were associated with the imported cases). The successful elimination of measles in this country should motivate and inspire policymakers to focus on eliminating other diseases. It is clear that the end of syphilis and many other diseases is within reach.