Syphilis outbreak in Cuyahoga County, 2008-2009

March 3, 2009 - Local health officials released a report that describes an outbreak of syphilis that began in July 2007. Infection rates from April 2008 to November 2008 increased significantly. A Public Health Alert letter to notify medical professionals has been written by the medical directors of the local public health offices.

Primary, secondary and early latent syphilis cases, and overall infection rates per 100,000 for Cuyahoga County, by month of diagnosis

Local health officials have identified an increasing outbreak of syphilis in Cuyahoga County.

From July 2007 to November 2008, 123 new cases of early syphilis were reported to local health departments. Early syphilis is any person that was diagnosed with infective primary, secondary, and early latent syphilis.

The full epidemiological report can be accessed at this link.

The most recent incidence rates for April through November 2008 were 8.2 per 100,000 population, 4 ½ times greater than observed before the outbreak began.

Two populations dominate recent cases:

• males who have sex with men and bisexual males (MSM/bi males)
• heterosexual males and females

What makes this outbreak unusual is that the number of cases among heterosexuals is very close to the number of MSM/bisexual males reported.  In past outbreaks, the majority of cases were MSM/bisexuals.

Almost 9 in every 10 of the heterosexual cases were African American; cases among MSM/bisexual males were mixed among African Americans, Whites and Hispanics.

CDPH reports that condom use was inconsistent, and that most of cases reported anonymous partners. This makes partner notification a difficult task for Disease Intervention Specialists, state trained agents that encourage cases to refer their sexual contacts for screening and treatment. Referral is an important part of stopping the spread of syphilis.

Not all of the cases were Cleveland residents. Two-thirds (68%) of outbreak cases in Cuyahoga County reported Cleveland as residence, with the remainder (32%) reported residence in other county municipalities.

Cases among youth and young adults

Over one-third (38%) of cases were among youth age 14 to 24 years. Because Chlamydia and gonorrhea rates are highest in this age group, the risk of a female becoming pregnant while infected and passing the bacterium, T. palladium, to the fetus is a serious public health issue. Congenital syphilis can cause blindness, neurological disorders and even death.

Medical community to be informed of outbreak   

Medical Directors of the Cleveland Department of Public Health, Cuyahoga County Board of Health and the Shaker Heights Division of Health will present a Public Health Alert letter to the media at 4:00 PM on March 4, 2009 at the CDPH offices. The letter askes the medical community to recognize the symptoms of syphilis and increase screening of all sexually active individuals. Because the symptoms of syphilis can mimic other illnesses, diagnosis can be missed.

The epidemiological report released today includes graphics showing the increase in cases over time and maps with areas where the highest case counts were reported. Maps help public health officials determine where intervention should be targetted. 

What is syphilis? How can it be recognized and treated? What are the dangers of infection?

A detailed fact sheet on the symptoms and dangers of syphilis from the Centers for Disease Control and Prevention (CDC) can be found at this link.