Primary and secondary syphilis - Jefferson county, Alabama, 2002-2007.

In June 2006, the Alabama Department of Public Health (ADPH) requested assistance from CDC to investigate and control a multiyear epidemic of syphilis in Jefferson County. The county had experienced a decrease in primary and secondary (P&S) syphilis cases, from 279 in 1995 to nine in 2002. By 2005, the incidence had begun to rise substantially, culminating with 238 cases in 2006 and 166 in 2007. Beginning in August 2006, CDC assisted the Jefferson County Department of Health (JCDH) in investigating the increase in cases and in planning control measures. This report summarizes the results of that investigation, which found that the characteristics of cases during 2002-2004 differed substantially from cases during 2005-2007. Declines in U.S. syphilis rates, which reached their lowest point in 2000, led to optimism that syphilis elimination (defined as the absence of sustained syphilis transmission) in the United States was possible, and CDC's National Syphilis Elimination Plan was launched in 1999. Although increased U.S. syphilis rates in the early 2000s have been reported to be associated primarily with transmission among men who have sex with men (MSM), the findings from this investigation indicate reemergence of syphilis among women and heterosexual men in Jefferson County. Public health officials in other areas should remain alert for similar epidemiologic shifts. Public health departments should facilitate access to effective treatment in sexually transmitted disease (STD) clinics or other settings, consider selective screening in high-prevalence populations (e.g., in correctional settings), and ensure adequate partner notification and treatment.