EPIDEMIOLOGY SF SYPHILIS IN THE UNITED-STATES, 1941-1993

Background and Objectives: The distribution and trends of syphilis are influenced by biologic factors, sexual behaviors, biomedical technolo gy, availability of and access to health care, public health efforts, changes in population dynamics, and sociocultural factors, The objecti ve of this article is to review the epidemiology of syphilis in the Un ited States during the period 1941-1993 in the context of some of thes e factors, Study Design: Surveillance data on cases of syphilis and co ngenital syphilis reported by state and city health departments to the Centers for Disease Control and Prevention were analyzed to show dist ribution and trends by geographic location, racial and ethnic groups, gender, and age, Results: Historically, syphilis was distributed widel y throughout the country and declined rapidly after the introduction o f penicillin therapy and broad-based public health programs, attaining its lowest levels in the 1950s, Hoc-ever, in recent years, the diseas e has returned and become focused in the southern region and in urban areas outside that region, Rates of syphilis have remained highest in black Americans, and the most recent national epidemic of syphilis pri marily involved them. Rates in white men were at intermediate levels d uring the early 1980s but have declined to low rates in the 1990s, pos sibly because of changes in behavior in response to the AIDS epidemic, Rates in white women and other racial and ethnic groups have remained low throughout the 1980s and 1990s, Conclusions: Syphilis remains a s ignificant problem in the United States, and its epidemiology is influ enced by a complex combination of factors, To prevent and control syph ilis effectively, public health practitioners must understand these fa ctors and design programs and interventions that address the disease i n the context of these factors.