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Epidemiology (continued)
Although the national syphilis rate has declined to a historic low, syphilis remains an important problem in the South and, increasingly, in urban areas of the country that have large populations of men who have sex with men (MSM). Recent outbreaks of syphilis in subpopulations of MSM have also been characterized by high rates of HIV co-infection and high-risk sexual behavior.
Syphilis incidence
is usually represented in terms of primary and secondary
(P&S) syphilis. P&S syphilis represents incidence better
than cases of latent infection, which are acquired months or
years before diagnosis. The South continues to have a higher
rate of P&S syphilis than any other region of the country.
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Over the past several years, the rate of P&S syphilis has
increased in men and for the first time in ten years
increased in women beginning in 2005. However,the
male-to-female rate ratio for P & S syphilis has increased.
This suggests an increase particularly among MSM.
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Syphilis disproportionately affects African Americans and
Hispanics. Disparities have increased markedly in recent
years as rates of disease have increased.
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After 14 years of decline in the United States, the rate
of congenital syphilis increased between 2005 and 2006 The
small increase in the rate of congenital syphilis may relate
to the increase in the rate of P&S syphilis among women that
has occurred in recent years. Transmission to the fetus in
pregnancy can occur during any stage of syphilis, but the
risk is much higher during primary and secondary syphilis.
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