Syphilis and the US Army, New Concerns for an Old Disease

Background: Consideration of syphilis in the US Army conjures images of WWII posters warning the unsuspecting Soldier of impending doom from ‘venereal disease’.   Seventy years later, both the politically incorrect posters and the threat of syphilis to military readiness are gone. However, like the bourgeoning epidemic in US civilian communities, the US Army is seeing a resurgence of primary and secondary syphilis. We undertook the current analysis to evaluate and quantify the magnitude of the problem and explore issues of screening, diagnosis and treatment.

Methods: Utilizing data from the Defense Medical Surveillance System (DMSS), we evaluated healthcare visits and notifiable medical event reports for primary and secondary syphilis for the years 2002 to 2012.  Standardized case definitions were used to screen all healthcare visits for active duty Army personnel. Additionally, we surveyed US Army Medical Center laboratories to collect information on current screening and diagnostics.

Results: Primary and secondary syphilis rates have seen a slight increase in the Army in recent years. During the surveillance period, the relative frequency of the diagnoses by gender has reversed with male cases now outnumbering females (2002 M/F ratio 0.41; 2012 M/F ratio 1.37). Similar to trends seen in the civilian community, incidence rates in black-non Hispanic soldiers far exceeds other racial groups with 64 cases per 100,000 Soldiers per year.   Army medical centers conducted over 58,000 screening tests for syphilis with over 800 confirmed positives, although assay types and screening protocols varied across the labs.

Conclusions: Despite drastic reductions in syphilis rates in the US Army in the late 20^th century, syphilis is staging a comeback that reflects the risk demographics seen in civilian communities.  Although specific sexual risk categories are often unknown to military providers, even in the post- ‘Don’t Ask, Don’t Tell’ era, targeted screening and prevention campaigns should be considered to address this epidemic.