Definition

Rate of newly reported cases of primary and secondary syphilis by date of diagnosis per 100,000 persons.

Numerator

Number of newly reported cases of primary and secondary syphilis by date of diagnosis.

Denominator

Total Utah population.

Data Interpretation Issues

Reported primary and secondary syphilis rates are calculated by dividing the number of cases within the population of interest by the total number of persons within that population, then multiplying by 100,000. It should be noted that because of the relatively small number of primary and secondary syphilis infections reported in Utah, rates can be volatile: a small change in the number of cases can noticeably change the rate. This change may look significant, but, statistically, it may not be. Caution is strongly recommended when interpreting small case numbers and rates.

Why Is This Important?

Syphilis is a complex sexually transmitted infection (STI) caused by the bacterium ''Treponema pallidum'' (spp. ''pallidum''). The initial stage (primary syphilis) is characterized by a highly infectious painless open sore, called a chancre, at the site of infection. Chancres occur mainly on the external genitals, vagina, anus, rectum, or in the mouth in the case of oral exposure. Syphilis is passed from person to person through direct contact with the chancre. Sexual transmission can also occur during the secondary stage of syphilis. In the second stage of syphilis, a skin rash can appear as well as other more generalized symptoms such as swollen lymph nodes, fatigue, and hair loss. Some patients can have additional skin manifestations including mucous patches (raised patches in the mouth or anus) and condylomata lata (wart-like lesions in the genital or rectal areas). Without treatment, syphilis will persist in the body even though symptoms resolve. This latent stage of syphilis is divided into early latent and late latent. Early latent syphilis refers to an infection that has been acquired in the past 12 months and late latent refers to an infection that has been acquired more than 12 months ago. Neurological, ocular, and otic manifestations can occur at any stage of syphilis and are caused by syphilis bacteria invading the brain, eyes, and auditory system, respectively. These manifestations can present as altered mental status, meningitis, decreased vision, hearing loss, and vertigo. In later stages of the disease (tertiary syphilis), the bacteria can move throughout the body, damaging internal organs over time. Affected organs can include the brain, spinal cord, heart, liver, and bones. An infant can acquire syphilis in utero through the placenta if the mother is infected. This is referred to congenital syphilis (CS). CS can have major health impacts on an infant including miscarriage, stillbirth, prematurity, low birth weight, vision, hearing loss, and bone abnormalities. Children aged 2 years of older may have signs such as abnormal tooth development, eye disorders, changes to the facial bones, and deafness. The open nature of syphilis sores makes it easier to acquire HIV, if exposed, or to transmit the virus, if infected. Public health intervention and education measures are crucial in eliminating syphilis.

How Are We Doing?

In 2022, 239 cases of primary and secondary (P&S) syphilis were diagnosed and reported in Utah. P&S syphilis rates have continued to rise, with an 84.2% increase from 2017. During 2022, 90% of P&S syphilis cases were diagnosed among residents within the Wasatch Front (Salt Lake, Davis, Utah, and Weber Counties); which is consistent with recent years. Davis County Health District had the highest rate of P&S syphilis at 23.3 cases per 100,000 persons. P&S syphilis cases were primarily diagnosed among men during 2022 at a rate of 12.6 cases per 100,000 male persons. Males between the ages of 25-29 years experienced the highest rates (31.2 cases per 100,000 people). Females between the ages of 25-29 years experienced the highest rates in 2022 (4.0 cases per 100,000 people). Overall females have had a 333.3% increase from 2017 to 2022. The increase in syphilis among females is particularly concerning as congenital syphilis rates closely follow female syphilis rates. During 2022, the P&S syphilis cases were diagnosed primarily among White, non-Hispanic individuals (69.4%) followed by Hispanics (26.1%).

How Do We Compare With the U.S.?

P&S syphilis rates in Utah have consistently been lower than rates in the U.S., although Utah has experienced several increases in recent years. The overall 2022 rate for P&S syphilis in the U.S. was 17.7 cases per 100,000 persons, compared to 10.7 cases per 100,000 in 2018. Nationally in 2022, rates were not only the highest, but the same rate among males aged 25 to 29 and 30 to 34 (24.1 cases per 100,000 persons). Males had a significantly higher rate than females: 26.8 cases per 100,000 males as compared to 8.7 cases per 100,000 females (CDC. [https://www.cdc.gov/std/statistics/2022/tables/34.htm ''Sexually Transmitted Disease Surveillance''], 2024).

What Is Being Done?

Persons who test positive for syphilis are confidentially interviewed by a disease intervention specialist (DIS) at a local health department (LHD) to educate the patient, ensure proper treatment, and to obtain sexual partner information for follow-up. This process potentially prevents those diseases reported from being spread of infection keeps the patient becoming reinfected. The Centers for Disease Control and Prevention recommendations for testing, treatment, and follow-up are adhered to by the Utah Department of Health and Human Services (DHHS) and LHDs. The DHHS HIV/STD, Elimination, Analysis, Response, and Treatment (HEART) program, along with LHDs, currently provide STI presentations upon request to a variety of organizations, agencies, and facilities. Educational pamphlets are available upon request.

Available Services

Some local health districts (LHDs) have STI clinics located at their facility where the public can be tested and treated for STIs at minimal or no cost. Planned Parenthood and other community based organizations have locations throughout Utah that also provide STI services at minimal cost. Condoms are also available at these locations. STI presentations are available through the Utah Department of Health and Human Services HIV/STD, Elimination, Analysis, Response, and Treatment (HEART) program. Educational pamphlets are available upon request. Utah's consent of minor to treatment law allows adolescents 14 and older to be tested and treated for an STD without the consent of a parent. The exact law can be found here: [https://le.utah.gov/xcode/Title26B/Chapter7/26B-7-S214.html?v=C26B-7-S214_2023050320230503]

Relevant Population Characteristics

Although the vast majority (83.5%) of P&S cases are diagnosed among residents within the Wasatch Front (Salt Lake, Davis, Utah, and Weber Counties); in 2020, San Juan County Health District had the highest rate of P&S syphilis at 13.1 cases per 100,000 persons. In 2022, P&S syphilis cases were primarily diagnosed among men (88%), with men aged 25 to 29 experiencing the highest rate of P&S syphilis (31.2 cases per 100,000 persons). The majority of cases (69.4%) were White, non-Hispanic.

Health Care System Factors

Syphilis is the target of a nationwide elimination effort.

Risk Factors

Risk factors for sexually transmitted diseases include: * sexual activity among young adults 25 and younger * multiple sex partners * prior history of STDs * unprotected sex * sexual contact with sex workers * illicit drug use[[br]] [[br]] Those who fall within one or more of these categories should be tested for STDs in regular intervals. Sites of primary syphilis infection may include penis, rectum, anus, vagina, cervix, vulva, or mouth.

Health Status Outcomes

Elimination of syphilis will aid in the fight against HIV, as the open nature of the syphilitic sores makes it easier to acquire HIV, if exposed, or to transmit the virus, if infected. Public health intervention and education measures are crucial in eliminating syphilis.

Data Notes

Rates were calculated by dividing the number of cases for each year by the total population within that year and multiplying by 100,000.

Data Notes

Rates were calculated by dividing the number of cases within each age/gender group by the total population in that group and multiplying by 100,000.

Data Notes

Rates were calculated by dividing the number of cases within a race/ethnicity group by the population in that group and multiplying by 100,000.

Data Notes

Rates were calculated by dividing the number of cases within a local health district by the total population in that district and multiplying by 100,000.

References and community resources

Fact sheets for communicable diseases may be found on the Office of Communicable Disease website [https://epi.health.utah.gov/a-list/]. STI resources and reports are available on the DHHS HIV/STD, Elimination, Analysis, Response, and Treatment (HEART) Program website [https://epi.utah.gov/ptc-std/]. Screening Guidelines [https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm]. Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention website [https://www.cdc.gov/std/default.htm]. Centers for Disease Control and Prevention. ''Sexually Transmitted Disease Surveillance 2022''. Atlanta: U.S. Department of Health and Human Services; 2024. [https://www.cdc.gov/std/statistics/2022/default.htm]. Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines 2021 [http://www.cdc.gov/std/treatment].