Health Alert
INCREASES IN SYPHILIS IN MEN WHO HAVE SEX WITH MEN (MSM)

The Delaware Division of Public Health (DPH) wishes to alert Delaware’s medical community about an increase in Syphilis cases among men who have sex with men (MSM) and the need for enhanced testing. This trend suggests some in this group may continue to engage in unsafe sexual activities.

In 2011, Delaware reported a total of 27 cases of primary and secondary (P&S) syphilis compared to 9 cases for the same time period in 2010 (a 300% increase). Ninety six percent (26/27) of the P&S cases were identified in men and of these, 85% (22/26) were reported in MSM. Ten cases were identified in Caucasian men and 16 cases were identified in African American men. The cases were reported in all three counties (Kent, New Castle and Sussex Counties).

In 2011 there were 49 cases of early latent syphilis cases compared to 14 cases for the same period in 2010. Ninety two percent (45/49) of these early latent cases were identified in men of whom 40% (18/45) were reported in MSM. Seventeen cases were identified in Caucasian men and 26 cases were identified in African American men. Eighty-two percent (40/49) of the early latent cases were located in New Castle County with 39% (19/49) located in the City of Wilmington.

According to the Centers for Disease Control and Prevention, increases in syphilis among MSM have been reported in Chicago, Seattle, San Francisco, Southern California, Miami, and New York City over the past several years. High rates of HIV co-infection have been documented in recent outbreaks, ranging from 20 percent to 70 percent.

Background

Syphilis is known as "the great imitator" because early symptoms and signs may mimic other diseases. Providers are strongly encouraged to test for syphilis in those who have been tested and/or treated for other STDs, such as gonorrhea or chlamydia.

Patients presenting with any of the following symptoms should be tested for syphilis:

• A macular and/or papular rash on the palms of the hands or on the soles of the feet
• A generalized rash that may be macular, papular, or papulosquamous on the back, chest, or stomach
• A lesion in the genital, rectal, or oral area
• Moist papules in the ano-genital region or the mouth
• Sudden “moth-eaten” scalp alopecia, typically with onset at the back of the head
• Loss of eyelashes and the lateral third of the eyebrows
• Generalized lymphadenopathy
• Malaise

Clinicians may consult the 2010 CDC Sexually Transmitted Disease Treatment Guidelines available on the Internet at http://www.cdc.gov/std/treatment.

For Additional Information about this or any other STD or to report a case, call the Delaware Division of Public Health, Sexually Transmitted Disease Program at 302-744-1050 or visit our web page.

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