Elimination and reintroduction of primary and secondary syphilis

Objectives. This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary s yphilis in King County, Washington, from 1987 through 1998. Methods. Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. Results. During the epidemic spread of syphilis, only 15.8% of cases were i mported. A total of 24.0% of patients reported cocaine use, and 18.3% of fe male patients reported having commercial sex. During the elimination of syp hilis, significantly higher percentages of cases were imported and lower pe rcentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were seropositive for HIV Most men reporting sex with men were 30 years or older and recruited many anonymous partners. Conclusions. As syphilis wanes, local control must focus on outbreaks follo wing its reintroduction. Resurgence of syphilis among men reporting sex wit h men recapitulates the epidemiology of syphilis before the historical adve nt of AIDS, warranting immediate attention to this problem.