Background:
In Puerto Rico, in the past few years, the number of P&S and early latent syphilis cases decreased while the number of late latent syphilis cases increased, reflecting a delay in diagnosis. After reviewing the morbidity reports and the structure of the DIS Division, programmatic changes were implemented starting in January of 2005. Some changes included transferring staff to new locations and reassigning DIS personnel to new positions to maximize available human resources.

Objective:
To describe changes in the number of P&S syphilis cases between 2004 and 2005 after restructuring the DIS Division in Puerto Rico.

Method:
Data from STD-MIS was used to analyze the number of P&S syphilis cases reported to the STD surveillance office during 2004 and 2005.

Result:
During the first three quarters of 2005, the number of P&S syphilis increased to 167 cases in Puerto Rico (Quarter 1-Quarter 3, 2004: 111 P&S cases). The percentage of change between 2004 and 2005 was 50.4%. The percentages of cases in males of P&S syphilis in 2004 and 2005 were 66% and 62% respectively. The number of cases in females of P&S syphilis between 2004 and 2005 increased 66%. During 2004 and 2005 the highest percentages of P&S syphilis were in the 30-34 and 20-24 age group, respectively.

Conclusion:
After beginning the restructure of the DIS Division in Puerto Rico, the STD Surveillance Office reported an increase of more than 50% in P&S syphilis cases.

Implications:
Further research is needed to define if the changes in the DIS Division help to identify new syphilis cases in an earlier stage, prevent syphilis complications and reduce congenital syphilis cases in Puerto Rico.