Background:
Syphilis is a sexually transmitted disease that progresses in stages and increases the likelihood of sexual HIV transmission by 2-5 times. It can be transmitted to the fetus during any stage in pregnancy, and it can cause perinatal death in 40% of the infants affected.

Objective:
To compare three stages of syphilis (Primary and Secondary, Early Latent and Late Latent) in Puerto Rico (PR) between 1996 and 2004, and determine the syphilis rates in PR, by age, gender and health region during 2004.


Method:
Data from the US Census Bureau and Puerto Rico STD Surveillance Office was used to describe the demographic characteristics and geographic distribution of Syphilis cases in PR during 2004.

Result:
From 1996 to 2004, the rate of Primary and Secondary Syphilis decreased 17.19% (from 5.64 to 4.67 per 100,000 populations). The rate of Early Latent Syphilis decreased 46.2% between 1996 and 2004 (from 16.91 to 9.09 per 100,000 populations). From 1996 to 2004, the rate of Late Latent Syphilis decreased 18.7% (from 16.31 to 13.25 per 100,000 populations).
In 2004, the rate of P&S Syphilis in PR was higher among men than among women for all age groups, and the 30-34 year old age group had the highest rate of P&S Syphilis in both genders.
In 2004, the P&S syphilis rates in Mayaguez and Arecibo health regions were higher than any other region in PR.


Conclusion:
The rates of P&S, Early Latent, Late Latent, and congenital syphilis reported in Puerto Rico decreased between 1996 and 2004. However, syphilis remains a major public health problem in Puerto Rico, especially among women and men of 20-44 years of age.

Implications:
Collaboration with media organization, public health professionals, Community Based Organizations, and other partners working with STD and HIV is essential for the successful elimination of syphilis in Puerto Rico.