Clarifying New York City Syphilis Numbers

With the New York City Department of Health and Mental Hygiene widely disseminating data only on primary and secondary syphilis cases, the city's outbreak among gay and bisexual men may be larger than previously reported. "Primary and secondary are the stages that have symptoms," said Dr. Susan Blank, of the department's STD control. "It's during those stages that there is the highest chance of communicating disease. ..."

The department has reported 433 primary and secondary syphilis cases in 2002, with 413 (95 percent) among men. Among the men, 343 (83 percent) were gay or bisexual. In 2001, there were 282 cases, with 263 (93 percent) among men, and in 2000 there were 117 cases, with 107 (91 percent) among men.

The department has not widely distributed data on early latent or late latent syphilis, though the data were posted on its Web site and reported to CDC. Early latent stage comes between six months and a year after the primary stage, and late latent means the person was infected over a year before their diagnosis. "Early latent disease, that is less than a year, can still potentially transmit disease to sex partners," Blank said. There were 727 early latent cases in 2002, with 566 (78 percent) among men. The higher number of male cases suggests at least some of the men are part of the outbreak among gay and bisexual men.

In the late latent stage, the bacteria can seriously damage the heart, brain and nervous system though it can take decades for that to happen. "Late latent disease is less likely to transmit sexually, although it can," said Blank. Late latent cases ranged from 2,097 in 2000 to 2,258 cases in 2002. The ratio of male-to-female was nearly one-to-one during 2000-2001, with a slight increase in the male ratio in 2002.

The department broadcasts only the primary and secondary data because it represents the "most recently acquired" infections and it reflects the current status of any outbreak. "Once we get the clear picture of the outbreak's leading edge ... that guides the interventions that we use," Blank said.

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