Webster L A, Rolfs R T
MMWR CDC Surveill Summ. 1993 Aug 13;42(3):13-9.
PROBLEM/CONDITION: From 1986 through 1990, an epidemic of syphilis occurred throughout the United States. In 1991, the number of reported cases of primary and secondary (P&S) syphilis in the United States declined for the first time since 1985.
To examine how this decline reflected sex-specific, race/ethnicity-specific, and regional patterns of syphilis morbidity, we analyzed data for syphilis cases reported to CDC from 1984 through 1991.
Summary data for cases of syphilis reported to state health departments were sent quarterly and annually to CDC. The quarterly data from each state included total number of syphilis cases by sex, stage of disease (primary, secondary, early latent, and late latent), and source of report (public or private). The annual data from each state included total number of P&S syphilis cases by sex, racial/ethnic group (white, not of Hispanic origin; black, not of Hispanic origin; Hispanic; Asian/Pacific Islander; or American Indian/Alaskan Native), 5-year age group, and source of report.
The decline in both the number and rate of reported syphilis cases in 1991 occurred in every racial group in the United States and in both sexes. This decline also occurred in every region of the United States except the Midwest, where the total P&S syphilis rate increased 37.3% from 1990 through 1991. Despite the increase in syphilis rates in the Midwest, the highest rates of P&S syphilis in 1991 were reported from the South.
The reasons for the decline in syphilis are unclear. No data exist to conclusively identify which STD control program activities affected the level of syphilis morbidity or to what extent those activities may have contributed to the decline. Changes in drug use and limited immunity to Treponema pallidum may have accounted for some of the decrease in syphilis incidence. Higher levels of poverty in the South and poor access to health-care services associated with poverty probably contributed to continued high levels of disease transmission in the South.
Better evaluation of STD control program activities will be necessary to help determine the most effective strategies for preventing and controlling syphilis in different high-risk populations.
问题/状况：1986年至1990年期间，梅毒在美国各地爆发了疫情。1991年，美国报告的一期和二期（P&S）梅毒病例数自1985年以来首次下降。
为研究这一下降如何反映梅毒发病率的性别、种族/族裔和地区模式，我们分析了1984年至1991年向美国疾病控制与预防中心（CDC）报告的梅毒病例数据。
各州卫生部门向CDC每季度和每年发送梅毒病例的汇总数据。每个州的季度数据包括按性别、疾病阶段（一期、二期、早期潜伏和晚期潜伏）以及报告来源（公共或私人）分类的梅毒病例总数。每个州的年度数据包括按性别、种族/族裔群体（非西班牙裔白人、非西班牙裔黑人、西班牙裔、亚太岛民或美国印第安人/阿拉斯加原住民）、5岁年龄组以及报告来源分类的P&S梅毒病例总数。
1991年报告的梅毒病例数和发病率的下降在美国的每个种族群体以及男女两性中均有发生。除中西部地区外，美国其他每个地区也都出现了这种下降，在中西部地区，P&S梅毒总发病率从1990年到1991年上升了37.3%。尽管中西部地区梅毒发病率上升，但1991年P&S梅毒发病率最高的地区是南部。
梅毒下降的原因尚不清楚。没有数据能够确凿地确定哪些性传播疾病控制项目活动影响了梅毒发病水平，或者这些活动在多大程度上促成了下降。药物使用的变化以及对梅毒螺旋体免疫力有限可能是梅毒发病率下降的部分原因。南部较高的贫困水平以及与贫困相关的获得医疗服务机会有限，可能是南部疾病传播持续处于高水平的原因。
有必要对性传播疾病控制项目活动进行更好的评估，以帮助确定在不同高危人群中预防和控制梅毒的最有效策略。
