Rolfs R T, Nakashima A K
Division of Sexually Transmitted Diseases/Human Immunodeficiency Virus Prevention, Centers for Disease Control, Atlanta, GA 30333.
JAMA. 1990 Sep 19;264(11):1432-7.
Between 1981 and 1989, the incidence of primary and secondary syphilis in the United States increased 34%, from 13.7 to 18.4 cases per 100,000 persons, the highest since 1949. The populations affected most by syphilis also changed substantially. From a peak of 10.0 cases per 100,000 persons in 1982, the incidence among white men had decreased 69% by 1989 (3.2 cases per 100,000 persons). From 1982 to 1985, the incidence also decreased among black men (30%, 101.9 to 71.5 cases per 100,000) and black women (22%, 45.8 to 35.8 cases per 100,000). However, in 1986 this trend reversed, and the incidence among blacks more than doubled from 1985 to 1989 (52.6 to 121.8 cases per 100,000 persons). Racial differences in syphilis incidence increased (black-to-white incidence rate ratio in 1981 was 14.5 and in 1989 was 47.8), as did regional differences. Trends in syphilis incidence indicate changes in sexual behavior that may determine future sexual transmission of human immunodeficiency virus. Targeting resources at populations most affected by this recent epidemic is an urgent public health priority.
1981年至1989年间，美国一期和二期梅毒的发病率上升了34%，从每10万人13.7例增至18.4例，达到1949年以来的最高水平。受梅毒影响最大的人群也发生了显著变化。白人男性的发病率从1982年每10万人10.0例的峰值降至1989年的69%（每10万人3.2例）。1982年至1985年期间，黑人男性（下降30%，从每10万人101.9例降至71.5例）和黑人女性（下降22%，从每10万人45.8例降至35.8例）的发病率也有所下降。然而，1986年这一趋势逆转，1985年至1989年期间黑人的发病率增加了一倍多（从每10万人52.6例增至121.8例）。梅毒发病率的种族差异增大（1981年黑人和白人的发病率之比为14.5，1989年为47.8），地区差异也是如此。梅毒发病率趋势表明性行为发生了变化，这可能决定未来人类免疫缺陷病毒的性传播情况。将资源投向受这一近期疫情影响最大的人群是当务之急的公共卫生重点。
