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Syphilis rates in the United States are on the decline, and public health officials are cautiously optimistic that this deadly sexually transmitted disease (STD) may soon be eliminated. Between 1997 and 1998 rates decreased 19 percent, according to the Centers for Disease Control and Prevention. The national rate in 1998 was 2.6 cases per 100,000 population, down from 3.2 cases in 1997, and the lowest level ever recorded in the United States.

In addition, syphilis transmission is increasingly concentrated in fewer geographic areas. Half of all reported cases occurred in less than one percent of all counties, and half of all new cases appear to be concentrated in just 28 U.S. counties, primarily in the south. About 80 percent of all counties reported no cases of syphilis in 1998.

The data, which appeared in the October 8, 1999, issue of the "Morbidity and Mortality Weekly Report," also shows that syphilis disproportionately affects persons according to race/ethnicity, age, and gender. Black Americans have a much higher incidence than any other minority groups, and their rate of infection is 34 times that of whites. Men are also more likely to be infected than women, and the incidence of syphilis was highest among women aged 20 to 24 years and among men aged 30 to 39 years.

But despite the overall national decline, several states and regions did report increasing rates. A rising infection rate in the Indianapolis metropolitan area, for example, was associated with the exchange of sex for drugs or money. King County, Washington, experienced an increase in cases among homosexual men. The CDC also acknowledges that all cases of syphilis are not reported, as the quality and methodology of STD surveillance is not standardized throughout the country and varies greatly at the local and state levels. Also, there may be a tendency to over report cases of minorities who seek treatment in public STD clinics.

Historically, syphilis infection has been cyclical. Declines in the overall infection rate have usually been followed by epidemics, which occur approximately every seven to 10 years. The last epidemic was reported in 1990, with decreasing rates since then, so at this time the potential exists for another large scale epidemic.

To ensure that rates remain on the decline, the CDC, in conjunction with numerous government agencies, state and local health departments and other organizations, has created a National Plan for Elimination of Syphilis from the United States. Their goal is to reduce the total number of cases to less than 1,000 or 0.4 per 100,000 population and increase the number of syphilis-free counties to 90 percent by year 2005.