From Elimination to Proliferation: Syphilis Elimination in North Carolina An Opportunity Lost

Background: The National Syphilis Elimination Effort (SEE) was launched in October of 1999 with the goal of reducing the rates of primary and secondary syphilis to less than 2.2 per 100,000 by 2010. Forsyth County was one of five North Carolina (NC) counties designated high morbidity areas for syphilis.

Objectives: To describe the elimination of syphilis from Forsyth County, NC and the loss of that achievement in part by a substantial reduction in SEE funding.

Methods: The North Carolina Syphilis Elimination Project (NCSEP) began in 1998 when 28 counties were identified as reporting more than 50% of the nation’s morbidity for infectious syphilis. NC had five counties – Forsyth, Guilford, Mecklenburg, Robeson, and Wake – on that list. Syphilis data from Forsyth county for 1998, 2003 ( the nadir of syphilis cases) and projected cases for 2009 is contrasted with SEE funding.

Results: At the start of NCSEP in 1998, Forsyth County reported 54 cases of Primary and Secondary (P&S) syphilis with a case rate of 18.6/100,000. SEE was launched in 1999 with funding peaking in 2003 at $167,000.Starting in 2003, SEE funding was cut and reached a nadir in 2009 of $57,000 (~ 66% reduction in funding, ~80 reduction in state funding). In 2003, Forsyth county reported 1 case of P&S syphilis with a rate of 0.32/100,000.  From 2002- 2004, Forsyth reported 8 cases of P&S syphilis. The projected number of P&S cases for 2009 (calculated through September 18^th) is 133 with an expected case rate of 23.4/100,000.  

Conclusions: Syphilis elimination was achieved in Forsyth through the activities of SEE. Funding decreased as disease rates fell. A nearly 70% reduction of funding over a 3 year period was associated with the emergence of a syphilis outbreak.

Implications for Programs, Policy, and/or Research:Base support is a required and necessary element to sustain elimination levels of syphilis.