Increases in Female P&S in the Wake of a Long Standing Male P&S Outbreak

Background: Over the past decade, New York City (NYC) has experienced an outbreak of primary and secondary syphilis (P&S) among men who have sex with men.  In recent years, female P&S has increased. Men who have sex with both men and women are a likely bridge to the female population.

Objectives: Examine whether female P&S increases are associated with changes in the sexual behavior of male P&S cases.

Methods: We reviewed available data for P&S cases reported January 1, 2005 - June 30, 2009, including demographics, behavioral characteristics, partner information; 2009 data are annualized.    

Results: Male P&S cases increased 73%, from 596 to1,036; 75% were interviewed.  The proportion male cases reporting sex with women (sex with only women (~7%) and sex with both men and women (~6%), together, ‘MSW’) did not change, however the number of such cases increased 55% and 54% respectively. In all years, the median age of MSW was ~30 years and a majority (54% to 61%) was black, non-Hispanic (B-NH). Among interviewed MSW, median number of sex partners increased from 1  to 2.  Median age of MSW’s partners stayed constant (~25 years) and the proportion B-NH remained ~55%.  During 2005-2009, female P&S more than doubled: 23 to 56; 84% were interviewed.  Median age decreased (39 to 26.5 years) and the proportion of B-NH cases increased (47% to 68%).   Among interviewed females, median number of sex partners increased from 1 to 2.  Partners’ median age decreased from 40 to 28 years; the proportion B-NH increased (60 to 70%).

Conclusions: Increases in absolute number of MSW cases are associated with increases in female P&S. Childbearing-aged women are affected; congenital syphilis may be expected to rise.

Implications for Programs, Policy, and/or Research:  Increases in MSW cases signal a need to prepare for increases in female syphilis.  Outreach to providers who see young and pregnant females is indicated.