Sexually Transmitted Disease Surveillance 2006 Supplement Syphilis Surveillance Report Division of STD Prevention December 2007 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention Atlanta, Georgia 30333 Centers for Disease Control and Prevention .................................Julie Louise Gerberding, M.D., M.P.H. Director Coordinating Center for Infectious Diseases ........................................Mitchell L. Cohen, M.D. Director National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention..............................Kevin Fenton, M.D., Ph.D. Director Division of STD Prevention ....................John M. Douglas, Jr., M.D. Director National Syphilis Elimination Effort...........................................................Jo Valentine, M.S.W. Chief Epidemiology and Surveillance Branch ................................... Stuart M. Berman, M.D., Sc.M. Chief Surveillance and Special Studies Team .............................Hillard S. Weinstock, M.D., M.P.H. Lead Syphilis Surveillance Activity ...................John F. Beltrami, M.D., M.P.H. & T.M. Medical Epidemiologist Statistics and Data Management Branch .........................Samuel L. Groseclose, D.V.M., M.P.H. Chief iii Copyright Information All material contained in this report is in the public domain and may be used and reprinted without special permission; citation to source, however, is appreciated. Suggested Citation Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2006 Supplement, Syphilis Surveillance Report. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, December 2007. Printed copies can be obtained from either the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-07, Atlanta, Georgia 30333 or the STD publication ordering system at: http://www.cdc.gov/std The report is also available by Internet via the CDC home page at: http://www.cdc.gov/std/Syphilis2006/ iv Acknowledgements The publication of this report would not have been possible without the contributions of the State and Territorial Health Departments and the STD Control Programs, which provided state and local surveillance data to CDC. This report was prepared by the following staff of the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention: Office of the Director Jo Valentine Epidemiology and Surveillance Branch John Beltrami Riduan Joesoef Hillard Weinstock Statistics and Data Management Branch Susan Bradley Darlene Davis Sharon Clanton Rose Horsley Rob Nelson v Update: U.S. Syphilis Elimination EffortIn October 1999, the Centers for Disease Control and Prevention (CDC), in collaboration with federal, state, local, and non-governmental partners, launched the National Plan to Eliminate Syphilis.1 The plan’s five key strategies included: 1) enhanced surveillance, 2) rapid outbreak response activities, 3) enhanced clinical and laboratory services, 4) strengthened community involvement and organizational partnerships, and 5) enhanced health promotion. In the seven years since its establishment, numerous gains have been made in reducing disease incidence in key groups, raising professional and public awareness of syphilis, increasing financial investment into public Sexually Transmitted Disease (STD) clinic services, and building local public health and community capacity to fight this devastating disease. However, new challenges have emerged. After reaching a nadir in 2000, case reports of primary and secondary syphilis are again on the increase, and today more than 60% of new infections are estimated to occur in men who have sex with men.2 Syphilis is now increasingly diagnosed in the private sector, generating concerns about the effectiveness of its detection and management in this setting. The evolving epidemiology, changing risk groups, and social environments pose challenges for elimination and STD program activities. Moreover, public health services face increasing pressures from rising demand and decreasing financial resources; and the social contexts of poverty, racism, homophobia, and socio-economic discrimination continue to drive the concentration of the disease in those with high-risk sexual behaviors, poor access to care, or both. In 2006 CDC, in consultation with state, local, and community partners, updated the national plan to eliminate syphilis.3 The 2006 plan, Together We Can SEE: The National Plan to Eliminate Syphilis from the United States provides a dynamic, evidence-based framework to guide current and future syphilis elimination efforts and promotes culturally competent prevention and control services.4 By 2010, interim elimination targets will be to: • reduce rates of primary and secondary syphilis in the United States to 2.2 cases per 100,000 population; • reduce congenital syphilis to 3.9 cases per 100,000 live births; and Syphilis Surveillance Report 1• reduce the Black:White racial disparity to 3:1. In order to achieve this, CDC will focus syphilis elimination activities towards achieving three strategic goals: investment in and enhancement of public health services; prioritization of evidence-based, culturally competent interventions; and increasing accountability for syphilis elimination services and interventions. Each of the three goals in the updated plan corresponds with 3 specific strategies, resulting in a total of nine strategies : 1) Surveillance, 2) Clinical and Laboratory Services, 3) Community Mobilization, 4) Health Care Provider Mobilization, 5) Tailoring of Interventions, 6) Evidence-based Action Planning, 7) Monitoring and Evaluation, 8) Training and Staff Development, and 9) Research. The 3-by-3 approach to implementing syphilis elimination is illustrated below. SYPHILIS ELIMINATION GOAL SYPHILIS ELIMINATION STRATEGIES Investment in, and enhancement of, public health services and interventions - Public health services will achieve excellence in the diagnosis, management, and reporting of syphilis and its adverse outcomes, especially those at greatest risk of health disparities. 1. Improve and enhance syphilis surveillance and outbreak response 2. Improve and quality assure clinical and partner services 3. Improve and quality assure laboratory services Prioritization of evidence-based, culturally competent interventions - Public health services will improve the advocacy, acceptability, and appropriateness of their response to syphilis epidemics through the creation of productive and proactive partnerships with external stakeholders. 1. Mobilization of affected communities 2. Tailoring intervention strategies for affected populations. 3. Mobilization of, and creating alliances with health care providers Accountable services and interventions - Public health services will improve the effectiveness of their interventions by improving accountability for their planning, implementation, and evaluation. 1. Training and staff development 2. Evidence-based action planning, monitoring, and evaluation 3. Research and development 2 Syphilis Surveillance Report This updated plan provides guidance to assist local, state, and national partners to effectively focus on the infectious syphilis epidemic in order to get the most important things done in the most cost-effective, ethical, and acceptable ways possible. Further details on the recommended strategies and recommended activities are contained in an accompanying Syphilis Elimination Technical Appendix (SETA).5 In 1999, the persistence of syphilis in the United States was said to reflect a failure in our public health capacity. Today, population-wide changes in sexual behavior, in turn driven by a number of social and economic factors, continue to influence which locale and who is affected by this disease. However, the benefits of elimination - improvements in health, reductions in healthcare costs, development of public health capacity, and reductions in racial disparities - nevertheless remain as pertinent today as ever. Syphilis Surveillance Report 3IntroductionSyphilis, a genital ulcerative disease, can cause significant complications if untreated and facilitates the transmission of HIV.6 Untreated early syphilis during pregnancy results in perinatal death in up to 40% of cases and, if acquired during the four years preceding pregnancy, may lead to infection of the fetus in 80% of cases.7 Reports of outbreaks and increased numbers of primary and secondary syphilis cases among men who have sex with men have been documented and characterized by high rates of HIV co-infection and high-risk sexual behavior.8-11 In recent years, men who have sex with men have accounted for an increasing number of estimated primary and secondary syphilis cases in the United States12 and now account for 64% of primary and secondary syphilis based on information available from 29 states and Washington, D.C.13 After decreasing from 2001 to 2004, the rate of primary and secondary syphilis among women increased from 0.8 cases per 100,000 population in 2004 to 1.0 cases per 100,000 population in 2006.14 After 14 years of decline in the United States, the rate of congenital syphilis increased 3.7% from 2005 to 2006 (from 8.2 to 8.5 cases per 100,000 live births).14 Despite the majority of U.S. syphilis cases occurring among men who have sex with men, heterosexual syphilis may be an emerging problem given the recent increases among women and infants. Additionally, a substantial proportion of early syphilis cases is from correctional facilities,15 in which high rates of reactive serologies and disease are known to occur,16-19 particularly in areas experiencing heterosexual syphilis epidemics.15-17 Information from both case reports and STD Prevalence Monitoring Projects is important for STD prevention, treatment, planning, and evaluation activities. The use of data to inform, evaluate, and modify interventions and other activities is critical to the effort to prevent syphilis. To that end, this Syphilis Surveillance Report consists of national and state profiles that contain and describe figures and tables, which provide an overview of syphilis morbidity in the United States. These profiles present adult and congenital syphilis trends and other statistics in the United States through 2006 and are based on case reports from the 65 sexually transmitted disease (STD) project areas. Case report data are the foundation of surveillance systems, which are operated by state and local health department STD control programs. 4 Syphilis Surveillance Report Population Denominators and Rate Calculations 2000–2006 Rates and Population Crude incidence rates (new cases/population) were calculated on an annual basis per 100,000 population. In this report, the 2006 rates for the United States, all states, counties, metropolitan statistical areas (MSAs), and outlying areas were calculated by dividing the number of cases reported from each area in 2006 by the estimated area-specific 2005 population (the most current detailed population file available at time of publication). The National Center for Health Statistics released bridged race population counts for 2000–2005 resident population based on the Census 2000 counts. These estimates resulted from bridging the 31 race categories used in Census 2000, as specified in the 1997 Office of Management and Budget (OMB) standards, to the five race/ethnicity groups specified under the 1977 OMB standards. From 2001 to 2002, population estimates for Guam were obtained from the Guam Bureau of Statistics and Plans; estimates for Puerto Rico were obtained from the Bureau of Census; and estimates for the Virgin Islands were obtained from the University of the Virgin Islands. After 2002, population estimates for all outlying areas were obtained from the Bureau of Census web site http://www.census.gov/ipc/www/idbprint.html. The 2005–2006 rates for outlying areas were calculated using the 2005 population estimates. Due to use of the updated population data, rates for the period 2000–2005 may be different from prior Surveillance Reports. 1990–1999 Rates and Population The population counts for 1990–1999 incorporated the bridged single-race estimates of the April 1, 2000 resident population. These files were prepared by the U.S. Census Bureau with support from the National Cancer Institute. 1981–1989 Rates and Population For the United States, rates were calculated using Bureau of the Census population estimates for 1981 through 1989 (Bureau of the Census; United States Population Estimates by Age, Sex and Race:1980–1989 [Series P-25, No. 1045]; Washington: U.S. Government Printing Office, 1990; and United States Population Estimates by Age, Sex and Race: 1989 [Series P-25, No. 1057]; Washington: U.S. Government Printing Office, 1990. 1941–1980 Rates and Population Rates for 1941–1980 are based on population estimates from the Bureau of Census and currently maintained by the Division of STD Prevention. 1963–2006 Congenital Syphilis Rates and Live Births CS data in Table 1 of Sexually Transmitted Disease Surveillance Syphilis Surveillance Report 11National Profile of Syphilis Surveillance DataOverall The rate of primary and secondary (P&S) syphilis reported in the United States decreased during the 1990s and in 2000 was the lowest since reporting began in 1941.14 However, the number of cases of P&S syphilis increased during 2000-2005. In 2006, P&S syphilis cases reported to CDC increased to 9,756 from 8,724 in 2005, an increase of 11.8% (Figure 1). The rate of P&S syphilis in the United States was 13.8% higher in 2006 than in 2005 (3.3 vs. 2.9 cases per 100,000 population).14During 2005-2006, the number of cases reported to CDC increased 12.4% for early latent syphilis (from 8,176 to 9,186), 9.9% for late and late latent syphilis (from 16,049 to 17,644), and 11.0% for the total number of cases of syphilis (P&S, early latent, late, late latent, and congenital syphilis) (from 33,288 to 36,935).14Sex The overall increase in primary and secondary (P&S) syphilis cases during 2000-2006 was observed primarily among men.14 During 2005-2006, P&S syphilis reported to CDC increased among men (from 7,383 to 8,293 cases) and women (from 1,339 to 1,458 cases).14During 2005-2006, the rate of P&S syphilis increased 11.8% among men (from 5.1 cases to 5.7 cases per 100,000 men) and increased 11.1% among women (from 0.9 cases to 1.0 cases per 100,000 women) (Figure 2).14In 2006, the rate of P&S syphilis was highest among women in the 20-24 year-old age group (2.9 cases per 100,000 population) and among men in the 35-39 year-old age group (13.5 cases per 100,000 population) (Figure 3).14 In 2004 and 2005, the highest rates of syphilis among women and men were in these same respective age groups. The male-to-female (M:F) rate ratio for P&S syphilis had risen steadily since 1996 when it was 1.2 (Figure 4), suggesting an increase in syphilis among men who have sex with men during this time. From 2005-2006, the M:F rate ratio increased in Puerto Rico, the District of Columbia, and in 20 of 34 (59%) states that reported at least 25 cases in 2006.14During 2005-2006, the M:F rate ratio for P&S syphilis increased among whites (from 11.0 to 11.7), African Americans (from 3.5 to 6 Syphilis Surveillance Report 3.7), Asian/Pacific Islanders (from 11.0 to 25.0), American Indian/Alaska Natives (from 2.1 to 2.5), and Hispanics (from 6.0 to 7.9).14Congenital Syphilis During 1996-2003, the rate of primary and secondary (P&S) syphilis reported among women decreased from 3.9 to 0.8 cases per 100,000 population, remained the same in 2004, and then increased to 0.9 and 1.0 cases per 100,000 population in 2005 and 2006, respectively.14 During 1996-2005, the average yearly percent decrease in the congenital syphilis (CS) rate was 14.1%.14 Between 2005 and 2006, the overall rate of CS increased 3.7% in the United States, from 8.2 to 8.5 cases per 100,000 live births.14In 2006, 26 states, the District of Columbia, and one outlying area had rates of CS that exceeded the HP2010 target of 1.0 case per 100,000 live births (Figure 6).14Race/Ethnicity During 1990-1996, rates of primary and secondary (P&S) syphilis decreased among all racial and ethnic groups. From 1997 to 2000, rates of P&S syphilis were fairly stable in all racial and ethnic groups except African Americans, in whom the rate continued to decrease steadily.14During 2000-2006, the P&S syphilis rate increased among non-Hispanic whites (from 0.5 to 1.9 cases per 100,000 population), Hispanics (from 1.6 to 3.6 cases per 100,000 population), and Asian/Pacific Islanders (from 0.3 to 1.3 cases per 100,000 population) (Figure 7). During 2000-2003, the P&S syphilis rate among African Americans decreased (from 12.0 to 7.7 cases per 100,000 population), but during 2003-2006, the rate increased to 11.3 per 100,000 population. The rate among American Indian/Alaska Natives increased during 2000-2001 (from 2.2 to 3.8 cases per 100,000 population), decreased to 2.1 cases per 100,000 population in 2002, and then increased to 3.3 cases per 100,000 population in 2006.14In 2006, 43.2% of reported cases of P&S syphilis occurred among African Americans compared with 41.4% of cases reported in 2005.14 Although the rate of P&S syphilis remains higher among African Americans than among non-Hispanic whites, the difference in rates between the two populations has decreased over time because of the declining rate of P&S syphilis among African Americans and the increasing rate of infection among non-Hispanic whites. In 2005 and 2006, the rate of P&S syphilis was 5.4 and 6.0 times higher among African Americans than among non-Hispanic whites, respectively, in contrast to 1992 when the African American rate was 62 times that of the non-Hispanic white rate. In 2006, the rates of P&S syphilis were highest among African American men (18.3 cases per 100,000 population) and Hispanic Syphilis Surveillance Report 7men (6.3 cases per 100,000 population) (Figure 8).14Geography In 2006, the South continued to have a higher rate of primary and secondary (P&S) syphilis (4.3 cases per 100,000 population) than any other region in the United States, and cases in the South accounted for 47.1% of total P&S syphilis cases reported, compared to 46.4% in 2005.14 (See page 12 for definition of regions). Since 2000, however, the percentage of cases from the South has decreased from 62%. At the same time, the percentage of cases from the West has increased from 10.5% in 2000 to 26.5% in 2006. During 2005-2006, the P&S syphilis rate increased 13.2% in the South (from 3.8 to 4.3 cases per 100,000 population), 13.0% in the Northeast (from 2.3 to 2.6 cases per 100,000 population), and 15.2% in the West (from 3.3 to 3.8 cases per 100,000 population), but remained the same in the Midwest (1.8 cases per 100,000 population). Rates in all regions were greater than the HP2010 target of 0.2 case per 100,000 persons in 2006 (Figure 9).20During 2005-2006, M:F P&S syphilis rate ratios increased in the Northeast (from 14.7 to 16.7) and West (from 8.3 to 9.9), decreased in the Midwest (from 8.3 to 6.2), and remained the same in the South (3.8).14Of the 30 counties and independent cities with the most cases in 2006, 20 counties and two independent cities had increases in the M:F P&S syphilis rate ratio, and 10 counties had a decrease between 2005 and 2006 (Table 1). In 2006, P&S syphilis rates in only 4 states were less than or equal to the Healthy People 2010 national target of 0.2 case per 100,000 persons (Figure 10).14In 2006, 2,360 (75.2%) of 3,140 counties in the United States reported no cases of P&S syphilis compared with 2,434 (77.5%) counties reporting no cases in 2005.14 Of 773 counties reporting at least one case of P&S syphilis in 2006, 7 (0.9%) had rates at or below the Healthy People 2010 target of 0.2 cases per 100,000 population. Rates of P&S syphilis were above the Healthy People 2010 target for 766 counties in 2006 (Figure 11). These 766 counties (24.4% of the total number of counties in the United States) accounted for 99.9% of the total P&S syphilis cases reported in 2006.14In 2006, half of the total number of P&S syphilis cases was reported from 20 counties and two cities.14 Corrections STD Prevalence Monitoring Project The median percentage of reactive syphilis tests by facility was 3.9% (range, 0.0-21.7) for women entering 32 adult corrections facilities and 1.4% (range, 0.0-7.8) for men entering 58 adult corrections facilities in 2006 (Table 2). 8 Syphilis Surveillance Report Source of Case Report The proportion of P&S syphilis cases reported from sources other than STD clinics increased from 1999 to 2006 among both men (42% to 66%) and women (49% to 61%) (Table 3). Syphilis Surveillance Report 9Interpreting STD Surveillance DataData Limitations Syphilis data should be interpreted with caution. Case report data are likely to underestimate the true burden of disease in the United States, because of underreporting of diagnosed cases, infected persons not accessing health care, and persons who are otherwise not screened. The prevalence of reactive serology from persons entering correctional facilities may not reflect the prevalence of syphilis in communities where the facilities are located or where the inmates were living at the time of arrest. Because confirmatory test results were not available for the majority of serologic tests for syphilis, biologic false positives could not be excluded from the proportion calculations. Sources of Data Syphilis case report data are used to create the tables and graphics in this report and are from either hardcopy summary reporting forms (monthly, quarterly, and annual) or individual case records transmitted electronically via the National Electronic Telecommunications System for Surveillance (NETSS), which is the system that provides notifiable disease information that is published in the Morbidity and Mortality Weekly Report (MMWR). Project areas have been in the process of converting from hardcopy reporting of STD data to electronic submissions of individual line-listed data since 1996. In 2006, primary and secondary (P&S) syphilis data from hardcopy reports were used from Puerto Rico, Guam, and Virgin Islands. Data on reported cases of P&S syphilis were analyzed for this report because these cases best represent the incidence of infectious syphilis (i.e., newly acquired infections within a specific time period). For congenital syphilis (CS), 29 states and outlying territories used hardcopy reports. Reports and corrections sent to CDC on hardcopy forms and electronically via NETSS through April 29, 2005, were used to create the line-graphs, bar charts, and county-level maps in this report. Sixteen states reported information from syphilis serology data from persons entering correctional facilities as part of the Corrections STD Prevalence Monitoring Project. 10 Syphilis Surveillance Report Population Denominators and Rate Calculations 2000–2005 Rates and Population Crude incidence rates (new cases/population) were calculated on an annual basis per 100,000 population. In this report, the 2006 rates for the United States, all states, counties, metropolitan statistical areas (MSAs), and outlying areas were calculated by dividing the number of cases reported from each area in 2006 by the estimated area-specific 2005 population (the most current detailed population file available at time of publication). The National Center for Health Statistics released bridged race population counts for 2000–2005 resident population based on the Census 2000 counts. These estimates resulted from bridging the 31 race categories used in Census 2000, as specified in the 1997 Office of Management and Budget (OMB) standards, to the five race/ethnicity groups specified under the 1977 OMB standards. From 2001 to 2002, population estimates for Guam were obtained from the Guam Bureau of Statistics and Plans; estimates for Puerto Rico were obtained from the Bureau of Census; and estimates for the Virgin Islands were obtained from the University of the Virgin Islands. After 2002, population estimates for all outlying areas were obtained from the Bureau of Census web site http://www.census.gov/ipc/www/idbprint.html. The 2005–2006 rates for outlying areas were calculated using the 2005 population estimates. Due to use of the updated population data, rates for the period 2000–2005 may be different from prior Surveillance Reports. 1990–1999 Rates and Population The population counts for 1990–1999 incorporated the bridged single-race estimates of the April 1, 2000 resident population. These files were prepared by the U.S. Census Bureau with support from the National Cancer Institute. 1981–1989 Rates and Population For the United States, rates were calculated using Bureau of the Census population estimates for 1981 through 1989 (Bureau of the Census; United States Population Estimates by Age, Sex and Race:1980–1989 [Series P-25, No. 1045]; Washington: U.S. Government Printing Office, 1990; and United States Population Estimates by Age, Sex and Race: 1989 [Series P-25, No. 1057]; Washington: U.S. Government Printing Office, 1990. 1941–1980 Rates and Population Rates for 1941–1980 are based on population estimates from the Bureau of Census and currently maintained by the Division of STD Prevention. 1963–2005 Congenital Syphilis Rates and Live Births CS data in Table 1 of Sexually Transmitted Disease Surveillance 2006 present the number of CS Syphilis Surveillance Report 11cases per 100,000 live births for all years during the period 1941 through 2006. Previous publications presented congenital syphilis rates per 100,000 population for 1941-1994 and for cases diagnosed at < 1 year of age per 100,000 live births. To allow for trends in CS rates to be compared over time, beginning in 2006 live births will be used as the denominator for CS and case counts will no longer be limited to those diagnosed within the first year of life. CS morbidity (cases) are assigned to their year of birth. Rates of CS for 1963–1988 were calculated using published live birth data (NCHS; Vital Statistics Report, United States, 1988 [Vol.1-Natality]). CS rates for 1989–2003 were calculated using live births from the National Center for Health Statistics (NCHS) (Vital Statistics: Natality Tapes 1989–2002 or Vital Statistics Reports, United States 1999, Vol. 48 No.10-Natality). Race-specific rates for 2004–2006 were calculated using live birth data for 2004. Definition of Regions The four regions referred to in the text and figures include the following jurisdictions: Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.12 Syphilis Surveillance Report References 1Centers for Disease Control and Prevention. The National Plan to Eliminate Syphilis from the United States. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, National Center for HIV, STD, and TB Prevention, 1999:1-84. 2Centers for Disease Control and Prevention. Primary and secondary—United States, 2003-2004. MMWR 2006;55:269-273. 3Centers for Disease Control and Prevention. Report of the Syphilis Elimination Consultation, August 1-2, 2005. Atlanta, GA. October 2005. 4Centers for Disease Control and Prevention. The Together We Can SEE.The National Plan to Eliminate Syphilis from the United States. Atlanta, GA: US Department of Health and Human Services, May 2006. 5Centers for Disease Control and Prevention. The Syphilis Elimination Technical Appendix. Atlanta, GA: US Department of Health and Human Services, May 2006. 6Holmes KK, Sparling PF, Mardh P-A, et al. eds. Sexually Transmitted Diseases. 3rd ed. New York: McGraw-Hill, 1999. 7Ingraham NR. The value of penicillin alone in the prevention and treatment of congenital syphilis. Acta Derm Venereol 1951;31(suppl24):60-87. 8Beltrami JF, Shouse RL, Blake PA. Trends in infectious diseases and the male to female ratio: possible clues to changes in behavior among men who have sex with men. AIDS Educ Prev 2005;17(Suppl B):49-59. 9D'Souza G, Lee JH, Paffel JM. Outbreak of syphilis among men who have sex with men in Houston, Texas. Sex Transm Dis 2003;30:872-873. 10 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex with men – New York City, 2001. MMWR 2002;51:853-856. 11Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with men – Southern California, 2000. MMWR 2001;50:117-20. 12Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends in primary and secondary syphilis among men who have sex with men in the United States. Am J Public Health 2007;97:1076-1083.13Beltrami JF, Weinstock H.S. Primary and secondary syphilis among men who have sex with men in the United States, 2005. In: program and abstracts of the 17th Biennial meeting of the ISSTDR, Seattle, WA, July 29-August 1, 2006 [abstract O-069]. 14Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2006. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, November 2007. 15Kahn RH, Voigt RF, Swint E, Weinstock H. Early syphilis in the United States identified in corrections facilities, 1999-2002. Sex Transm Dis 2004;31:360-364. 16Kahn RH, Scholl DT, Shane SM, Lemoine AL, Farley TA. Screening for syphilis in arrestees: usefulness for community-wide syphilis surveillance and control. Sex Transm Dis 2002;29:150-156. 17Finelli L, Farley TA, Gibson JJ, Langley C, Hwang L-Y, Levine WC. Prevalence monitoring in syphilis surveillance: results from a multicenter research program. Sex Transm Dis 2002;29:769-774. 18Mertz KJ, Voigt RF, Hutchins K, Levine WC. Jail STD Prevalence Monitoring Group. Findings from STD screening of adolescents and adults entering corrections facilities: implications for STD control strategies. Sex Transm Dis 2002;29:834-839. 19Silberstein GS, Coles FB, Greenberg A, Singer L, Voigt RF. Effectiveness and cost-benefit of enhancements to a syphilis Syphilis Surveillance Report 13screening and treatment program at a county jail. Sex Transm Dis 2000;27:508-517. 20U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.14 Syphilis Surveillance Report Table 1. Primary and secondary syphilis — Reported cases and rates* among men and women and male-to-female rate ratios in the counties and independent cities ranked in the top 30 for cases in 2006: United States, 2005–2006 Males Females Male-to- Female Rate Ratios 2005 2006 2005 2006 Cities Cases Rates Cases Rates Cases Rates Cases Rates 2005 2006Jefferson County, AL 61 19.6 149 47.8 34 9.8 89 25.7 2.0 1.9Maricopa County, AZ 87 4.8 135 7.4 22 1.2 18 1.0 4.0 7.4Los Angeles County, CA 650 13.2 798 16.2 59 1.2 68 1.4 11.0 11.6Riverside County, CA 99 10.2 73 7.5 7 0.7 7 0.7 14.6 10.7San Diego County, CA 169 11.4 223 15.1 25 1.7 12 0.8 6.7 18.9San Francisco County, CA 246 65.6 241 64.3 3 0.8 2 0.5 82.0 128.6Washington, DC 103 39.4 110 42.1 11 3.8 6 2.1 10.4 20.0Broward County, FL 180 20.9 147 17.0 16 1.7 8 0.9 12.3 18.9Miami-Dade County, FL 180 20.9 173 0.0 16 1.7 30 0.0 12.3 1.0Orange County, FL 84 16.5 71 14.0 14 2.7 10 1.9 6.1 7.4De Kalb County, GA 174 52.7 170 51.5 3 0.9 12 3.4 58.6 15.1Fulton County, GA 269 59.3 226 49.8 24 5.2 16 3.5 11.4 14.2Cook County, IL 418 16.2 317 12.3 44 1.6 32 1.2 10.1 10.3East Baton Rouge County, LA 55 27.8 61 30.8 53 24.8 36 16.8 1.1 1.8Baltimore (City), MD 121 40.8 113 38.1 74 21.8 46 13.6 1.9 2.8Jackson County, MO 56 17.4 72 22.4 3 0.9 13 3.8 19.3 5.9Clark County, NV 82 9.4 100 11.5 21 2.5 32 3.8 3.8 3.0Bronx County, NY 64 10.1 98 15.4 3 0.4 3 0.4 25.3 38.5Kings County, NY 174 14.9 152 13.0 8 0.6 7 0.5 24.8 26.0New York County, NY 268 35.4 233 30.8 9 1.1 7 0.8 32.2 38.5Mecklenburg County, NC 69 17.6 77 19.6 16 4.0 27 6.7 4.4 2.9Franklin County, OH 81 15.2 72 13.5 22 4.0 28 5.0 3.8 2.7Philadelphia County, PA 80 11.7 124 18.2 6 0.8 1 0.1 14.6 182.0Shelby County, TN 83 19.0 88 20.2 47 9.9 44 9.3 1.9 2.2Bexar County, TX 93 12.6 100 13.5 34 4.4 31 4.0 2.9 3.4Dallas County, TX 128 11.0 124 10.7 44 3.9 82 7.2 2.8 1.5Harris County, TX 202 10.9 316 17.1 50 2.7 58 3.1 4.0 5.5Tarrant County, TX 61 7.6 64 7.9 43 5.3 20 2.5 1.4 3.2Travis County, TX 35 7.6 70 15.3 2 0.5 11 2.6 15.2 5.9King County, WA 116 13.0 145 16.2 3 0.3 2 0.2 43.3 81.0 *Cases per 100,000 population Counties and independent cities are listed alphabetically by state. Note: For calculating male-to-female rate ratios in instances of 0.0 rates among women, 0.5 was added to both the male and female rates, before dividing the male rate by the female rate. Syphilis Surveillance Report 21Figure 3. Primary and secondary syphilis — Age- and sex-specific rates: United States, 2006 Men Rate (per 100,000 population) WomenAge15 12 9 6 3 0 0 3 6 9 12 150.0 0.110-143.1 2.315-1910.0 2.920-2413.0 2.525-2910.4 1.630-3413.5 1.535-3912.0 1.340-446.1 0.845-542.3 0.255-640.5 0.065+5.7 1.0Total Figure 4. Primary and secondary syphilis — Male-to-female rate ratios: United States, 1997–2006 Male-Female rate ratio 02:14:16:18:110:11997 98 99 2000 01 02 03 04 05 06 16 Syphilis Surveillance Report Figure 5. Congenital syphilis (CS) — Reported cases for infants <1 year of age and rates of primary and secondary syphilis among women: United States, 1997–2006 CS cases (in thousands) P&S rate (per 100,000 women)P&S Syphilis0.00.30.60.91.21997 98 99 2000 01 02 03 04 05 0601234 Figure 6. Congenital syphilis — Rates for infants < 1 year of age by state: United States and outlying areas, 2006 Rate per 100,000live birthsGuam 0.0 Puerto Rico 25.4 Virgin Is. 0.0 <=1.01.1-10.0>10.0(n= 26)(n= 16)(n= 12)VT 0.0NH 0.0MA 0.0RI 0.0CT 0.0NJ 13.0DE 0.0MD 25.5DC 12.615.10.017.1 18.112.1 2.99.66.50.00.08.3 0.00.02.5 1.819.90.010.01.40.03.90.00.042.624.76.05.00.00.03.90.00.03.50.07.520.73.92.90.00.00.00.0 Note: The total rate of congenital syphilis for infants < 1 year of age for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 8.7 per 100,000 live births. The Healthy People 2010 target is 1.0 case per 100,000 live births. Syphilis Surveillance Report 17Figure 7. Primary and secondary syphilis — Rates by race/ethnicity: United States, 1997–2006 Rate (per 100,000 population)American Indian/AK NativeAsian/Pacific IslanderBlackHispanicWhite 0 8 16 24 32 401997 98 99 2000 01 02 03 04 05 06 Figure 8. Primary and secondary syphilis — Rates by race/ethnicity and sex: United States, 2006 Men Rate (per 100,000 population) WomenRace20 16 12 8 4 0 0 4 8 12 16 204.7 1.9AI/AN2.5 0.1Asian/PI18.3 4.9Black6.3 0.8Hispanic3.5 0.3White5.7 1.0Total 18 Syphilis Surveillance Report Figure 9. Primary and secondary syphilis — Rates by region: United States, 1997–2006 and the Healthy People 2010 target Rate (per 100,000 population)WestMidwestNortheastSouth2010 Target 0 2 4 6 8101997 98 99 2000 01 02 03 04 05 06 Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. Figure 10. Primary and secondary syphilis — Rates by state: United States and outlying areas, 2006 Rate per 100,000populationGuam 1.8 Puerto Rico 3.8 Virgin Is. 0.9 <=0.20.21-4.0>4.0(n= 4)(n= 40)(n= 10)VT 0.5NH 1.0MA 1.9RI 1.3CT 1.8NJ 2.0DE 2.4MD 5.4DC 21.17.01.73.4 2.85.1 1.54.06.41.40.23.4 1.50.61.0 1.77.60.71.20.92.92.90.10.45.74.13.83.60.21.62.00.82.11.61.74.24.70.92.52.90.61.20.0 Note: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 3.3 per 100,000 population. The Healthy People 2010 target is 0.2 case per 100,000 population. Syphilis Surveillance Report 19 Figure 11. Primary and secondary syphilis — Rates by county: United States, 2006 Rate per 100,000population<=0.2 (n= 2,367)0.21-2.2 (n= 377)>2.2 (n= 396) Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. In 2006, 2,360 (75.2%) of 3,140 counties in the U.S. reported no cases of P&S syphilis. 20 Syphilis Surveillance Report Table 1. Primary and secondary syphilis — Reported cases and rates* among men and women and male-to-female rate ratios in the counties and independent cities ranked in the top 30 for cases in 2006: United States, 2005–2006 Males Females 2005 2006 2005 2006 Male-to- Female Rate Ratios Cities Cases Rates Cases Rates Cases Rates Cases Rates 2005 2006Jefferson County, AL 61 19.6 149 47.8 34 9.8 89 25.7 2.0 1.9Maricopa County, AZ 87 4.8 135 7.4 22 1.2 18 1.0 4.0 7.4Los Angeles County, CA 650 13.2 798 16.2 59 1.2 68 1.4 11.0 11.6Riverside County, CA 99 10.2 73 7.5 7 0.7 7 0.7 14.6 10.7San Diego County, CA 169 11.4 223 15.1 25 1.7 12 0.8 6.7 18.9San Francisco County, CA 246 65.6 241 64.3 3 0.8 2 0.5 82.0 128.6Washington, DC 103 39.4 110 42.1 11 3.8 6 2.1 10.4 20.0Broward County, FL 180 20.9 147 17.0 16 1.7 8 0.9 12.3 18.9Miami-Dade County, FL 180 20.9 173 0.0 16 1.7 30 0.0 12.3 1.0Orange County, FL 84 16.5 71 14.0 14 2.7 10 1.9 6.1 7.4De Kalb County, GA 174 52.7 170 51.5 3 0.9 12 3.4 58.6 15.1Fulton County, GA 269 59.3 226 49.8 24 5.2 16 3.5 11.4 14.2Cook County, IL 418 16.2 317 12.3 44 1.6 32 1.2 10.1 10.3East Baton Rouge County, LA 55 27.8 61 30.8 53 24.8 36 16.8 1.1 1.8Baltimore (City), MD 121 40.8 113 38.1 74 21.8 46 13.6 1.9 2.8Jackson County, MO 56 17.4 72 22.4 3 0.9 13 3.8 19.3 5.9Clark County, NV 82 9.4 100 11.5 21 2.5 32 3.8 3.8 3.0Bronx County, NY 64 10.1 98 15.4 3 0.4 3 0.4 25.3 38.5Kings County, NY 174 14.9 152 13.0 8 0.6 7 0.5 24.8 26.0New York County, NY 268 35.4 233 30.8 9 1.1 7 0.8 32.2 38.5Mecklenburg County, NC 69 17.6 77 19.6 16 4.0 27 6.7 4.4 2.9Franklin County, OH 81 15.2 72 13.5 22 4.0 28 5.0 3.8 2.7Philadelphia County, PA 80 11.7 124 18.2 6 0.8 1 0.1 14.6 182.0Shelby County, TN 83 19.0 88 20.2 47 9.9 44 9.3 1.9 2.2Bexar County, TX 93 12.6 100 13.5 34 4.4 31 4.0 2.9 3.4Dallas County, TX 128 11.0 124 10.7 44 3.9 82 7.2 2.8 1.5Harris County, TX 202 10.9 316 17.1 50 2.7 58 3.1 4.0 5.5Tarrant County, TX 61 7.6 64 7.9 43 5.3 20 2.5 1.4 3.2Travis County, TX 35 7.6 70 15.3 2 0.5 11 2.6 15.2 5.9King County, WA 116 13.0 145 16.2 3 0.3 2 0.2 43.3 81.0 *Cases per 100,000 population Counties and independent cities are listed alphabetically by state. Note: For calculating male-to-female rate ratios in instances of 0.0 rates among women, 0.5 was added to both the male and female rates, before dividing the male rate by the female rate. Syphilis Surveillance Report 21Table 2. Syphilis — Positivity among men and women in adult corrections facilities, 2006 Men Women State No. of Sites No. of Tests Median % Reactive (Range) No. of Sites No. of Tests Median % Reactive (Range) Arizona 1 25,009 2.6 1 5,382 5.6 California* 1 679 5.3 2 3,364 4.0 (2.5-5.4) Florida 5 6,463 3.4 (2.9-4.3) 1 229 12.2 Illinois 1 320 0.3 1 117 1.7 Indianapolis 1 1,276 1.2 1 605 1.8 Kentucky 1 1,215 0.3 1 360 0.3 Louisiana 0 - - 1 926 21.7 Maryland 10 24,971 1.8 (0.6-3.1) 7 3,540 4.1 (0.0-10.4) Massachusetts 18 18,773 0.9 (0.0-1.4) 4 3.919 1.8 (1.2-3.1) Mississippi 3 895 3.4 (2.5-7.8) 0 - - Missouri 2 5,957 1.6 (1.0-2.1) 2 1,191 4.0 (1.6-6.3) New York** 2 8,513 1.3 (1.1-1.4) 2 1,023 2.6 (1.6-3.6) North Carolina 5 3,969 1.4 (0.9-4.8) 3 1,544 7.8 (4.3-9.3) Tennessee 2 9,695 3.3 (2.3-4.2) 1 5,275 9.4 Texas 5 33,863 3.3 (2.0-5.6) 4 6,654 6.9 (3.7-10.6) Wisconsin 1 657 0.0 1 206 0.0 TOTAL 58 142,255 1.4 (0.0-7.8) 32 34,335 3.9 (0.0-21.7) Note: The median positivity by facility is presented from facilities reporting > 100 test results. *Includes San Francisco project area only. **New York data are based on confirmatory tests. 22 Syphilis Surveillance Report Table 3. Primary and secondary syphilis — Reported cases by sex and reporting source: United States, 1999-2006. Male Female Total Non-STD Source STD Source Non-STD Source STD Source Non-STD Source STD Source Year Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent Cases Percent1999 1,610 42 2,224 58 1,352 49 1,425 51 2,964 45 3,652 55 2000 1,565 44 1,967 56 1,193 49 1,252 51 2,758 46 3,221 54 2001 2,099 51 2,035 49 1,025 52 942 48 3,125 51 2,978 49 2002 3,132 59 2,135 41 869 55 725 45 4,001 58 2,861 42 2003 3,979 67 1,886 32 741 61 444 36 4,722 66 2,331 32 2004 4,374 65 2,244 33 762 61 477 38 5,137 64 2,722 34 2005 5,031 68 2,222 30 853 64 463 35 5,885 67 2,686 31 2006 5,447 66 2,630 32 890 61 531 36 6,340 65 3,163 32 *The sum of male and female cases may not equal total cases because of some male or female cases with missing information for reporting source. Sex was not identified for < 1% of P&S syphilis cases during 1999-2006. Syphilis Surveillance Report 23 Alabama, 2006 25Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Alabama reported 319 cases in 2006.•RATES: Alabama ranked 3 among 50 states, DC, and3 territories with 7 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Alabama, the rate among males was 9.2 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 4.9 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Alabama, the race/ethnicity adjusted rates per100,000 population were 2.1 among whites, 20.6among blacks, 1.9 among Hispanics, 4.9 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 9.8 times that of whites.•The rate among Asian/Pacific Islanders was 2.3 timesthat of whites.Congenital syphilis•CASES: Alabama reported 9 cases in 2006.•RATES: Alabama ranked 9 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 15.1 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Alabama, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 3.0 6.0 9.012.09798992000010203040506 0 8 16 24 32Total P&S Syphilis Rates by County, Alabama, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Alaska, 2006 26 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Alaska reported 11 cases in 2006.•RATES: Alaska ranked 29 among 50 states, DC, and3 territories with 1.7 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Alaska, the rate among males was 2.6 per 100,000population compared to the total male rate of 5.7 per100,000.•The rate among females was 0.6 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Alaska, the race/ethnicity adjusted rates per100,000 population were 1.8 among whites, 3.6among blacks, 3.0 among Hispanics, 2.7 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 2 times that of whites.•The rate among Hispanics was 1.7 times that ofwhites.•The rate among Asian/Pacific Islanders was 1.5 timesthat of whites.Congenital syphilis•CASES: Alaska reported 0 cases in 2006.•RATES: Alaska had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000.Syphilis: P&S Rates and Congenital Cases, Alaska, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 1.0 2.0 3.0 4.09798992000010203040506 0 1 2 3 4Total P&S Syphilis Rates by County, Alaska, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Arizona, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Arizona, 1997-2006• CASES: Arizona reported 203 cases in 2006.• RATES: Arizona ranked 15 among 50 states, DC, andP&S rate (per 100,000 population) CS cases12.0 Male P&S RateFemale P&S RateCongenital Cases 40 3 territories with 3.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 9.0 30Rates of primary and secondary syphilis, by sex• In Arizona, the rate among males was 5.6 per 100,000population compared to the total male rate of 5.7 per 6.0 20100,000. • The rate among females was 1.1 per 100,000compared to the total female rate of 1.0 per 100,000. 3.0 10Rates of primary and secondary syphilis, byrace/ethnicity0 0In Arizona, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 2.3 among whites, 15.1among blacks, 4.4 among Hispanics, 0.7 amongTotal P&S Syphilis Rates by County, Arizona, 2006Asian/Pacific Islanders, and 4.4 among AmericanIndians/Alaska Natives.• The rate among blacks was 6.6 times that of whites.• The rate among Hispanics was 1.9 times that ofwhites. • The rate among American Indians/Alaska Natives was1.9 times that of whites.Congenital syphilis• CASES: Arizona reported 16 cases in 2006.• RATES: Arizona ranked 8 among 26 states, DC, and 1territory reporting congenital syphilis cases with a rateof 17.1 cases per 100,000 live births compared to thetotal rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 27 Arkansas, 2006 28 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Arkansas reported 77 cases in 2006.•RATES: Arkansas ranked 20 among 50 states, DC,and 3 territories with 2.8 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Arkansas, the rate among males was 3.1 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 2.5 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Arkansas, the race/ethnicity adjusted rates per100,000 population were 1.1 among whites, 11.8among blacks, 0.8 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 10.7 times that of whites.Congenital syphilis•CASES: Arkansas reported 7 cases in 2006.•RATES: Arkansas ranked 7 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 18.1 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Arkansas, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 11 22 33 44Total P&S Syphilis Rates by County, Arkansas, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 California, 2006 29Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: California reported 1,835 cases in 2006.•RATES: California ranked 7 among 50 states, DC, and3 territories with 5.1 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In California, the rate among males was 9.5 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.7 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn California, the race/ethnicity adjusted rates per100,000 population were 5.5 among whites, 12.3among blacks, 4.4 among Hispanics, 1.7 amongAsian/Pacific Islanders, and 3.5 among AmericanIndians/Alaska Natives.•The rate among blacks was 2.2 times that of whites.Congenital syphilis•CASES: California reported 66 cases in 2006.•RATES: California ranked 12 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 12.1 cases per 100,000 live births comparedto the total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, California, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 3.0 6.0 9.012.09798992000010203040506 0 41 82123164Total P&S Syphilis Rates by County, California, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Colorado, 2006Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Colorado, 1997-2006• CASES: Colorado reported 69 cases in 2006.Syphilis Surveillance Report • RATES: Colorado ranked 34 among 50 states, DC,and 3 territories with 1.5 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Colorado, the rate among males was 2.7 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.2 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityP&S rate (per 100,000 population)4.03.02.01.0 0Male P&S RateFemale P&S RateCongenital Cases CS cases 4 3 2 1 0In Colorado, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05100,000 population were 1.4 among whites, 1.6among blacks, 1.5 among Hispanics, 1.5 amongTotal P&S Syphilis Rates by County, Colorado, 2006Asian/Pacific Islanders, and 2.8 among AmericanIndians/Alaska Natives.• The rate among blacks was 1.1 times that of whites.• The rate among Hispanics was 1.1 times that ofwhites. • The rate among Asian/Pacific Islanders was 1.1 timesthat of whites.• The rate among American Indians/Alaska Natives was2 times that of whites.Congenital syphilis• CASES: Colorado reported 2 cases in 2006.• RATES: Colorado ranked 24 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 2.9 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 30 06Connecticut, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Connecticut reported 64 cases in 2006.• RATES: Connecticut ranked 27 among 50 states, DC,and 3 territories with 1.8 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Connecticut, the rate among males was 3.6 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.1 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Connecticut, the race/ethnicity adjusted rates per100,000 population were 1.1 among whites, 7.1among blacks, 2.4 among Hispanics, 1.7 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 6.5 times that of whites.• The rate among Hispanics was 2.2 times that ofwhites. • The rate among Asian/Pacific Islanders was 1.5 timesthat of whites.Congenital syphilis• CASES: Connecticut reported 0 cases in 2006.• RATES: Connecticut had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, Connecticut, 1997-2006P&S rate (per 100,000 population)CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 3.0 3 2.0 2 1.0 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Connecticut, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 31 Delaware, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Delaware, 1997-2006• CASES: Delaware reported 20 cases in 2006.• RATES: Delaware ranked 22 among 50 states, DC,P&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 and 3 territories with 2.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 3.0 3Rates of primary and secondary syphilis, by sex• In Delaware, the rate among males was 3.9 per100,000 population compared to the total male rate of 2.0 25.7 per 100,000.• The rate among females was 0.9 per 100,000compared to the total female rate of 1.0 per 100,000. 1.0 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Delaware, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 1.0 among whites, 6.3among blacks, 5.9 among Hispanics, 0.0 amongTotal P&S Syphilis Rates by County, Delaware, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 6.3 times that of whites.• The rate among Hispanics was 5.9 times that ofwhites.Congenital syphilis• CASES: Delaware reported 0 cases in 2006.• RATES: Delaware had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 32 District of Columbia, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, District of Columbia, 1997-2006• CASES: District of Columbia reported 116 cases in2006. P&S rate (per 100,000 population) CS cases44.0 Male P&S RateFemale P&S RateCongenital Cases 12 • RATES: District of Columbia ranked 1 among 50states, DC, and 3 territories with 21.1 cases per100,000 population compared to the total rate of 3.333.0 9cases per 100,000 population.Rates of primary and secondary syphilis, by sex 6• In District of Columbia, the rate among males was22.0 42.1 per 100,000 population compared to the totalmale rate of 5.7 per 100,000.• The rate among females was 2.1 per 100,00011.0 3compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, by0 0race/ethnicity97 98 99200001 02 03 04 05 06In District of Columbia, the race/ethnicity adjustedrates per 100,000 population were 27.2 among whites,Total P&S Syphilis Rate, District of Columbia, 200620.0 among blacks, 12.7 among Hispanics, 5.6 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.Congenital syphilis• CASES: District of Columbia reported 1 case in 2006.• RATES: District of Columbia ranked 11 among 26states, DC, and 1 territory reporting congenital syphiliscases with a rate of 12.6 cases per 100,000 live birthscompared to the total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 33 Florida, 2006 34 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Florida reported 719 cases in 2006.•RATES: Florida ranked 11 among 50 states, DC, and3 territories with 4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Florida, the rate among males was 7.1 per 100,000population compared to the total male rate of 5.7 per100,000.•The rate among females was 1.1 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Florida, the race/ethnicity adjusted rates per100,000 population were 2.4 among whites, 11.1among blacks, 4.1 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 3.7 among AmericanIndians/Alaska Natives.•The rate among blacks was 4.6 times that of whites.•The rate among Hispanics was 1.7 times that ofwhites.•The rate among American Indians/Alaska Natives was1.5 times that of whites.Congenital syphilis•CASES: Florida reported 21 cases in 2006.•RATES: Florida ranked 14 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 9.6 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Florida, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 24 48 72 96Total P&S Syphilis Rates by County, Florida, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Georgia, 2006 35Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Georgia reported 581 cases in 2006.•RATES: Georgia ranked 4 among 50 states, DC, and3 territories with 6.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Georgia, the rate among males was 12.0 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.9 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Georgia, the race/ethnicity adjusted rates per100,000 population were 3.1 among whites, 14.3among blacks, 3.4 among Hispanics, 1.2 amongAsian/Pacific Islanders, and 9.6 among AmericanIndians/Alaska Natives.•The rate among blacks was 4.6 times that of whites.•The rate among Hispanics was 1.1 times that ofwhites.•The rate among American Indians/Alaska Natives was3.1 times that of whites.Congenital syphilis•CASES: Georgia reported 9 cases in 2006.•RATES: Georgia ranked 17 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 6.5 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Georgia, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 5.010.015.020.09798992000010203040506 0 6 12 18 24Total P&S Syphilis Rates by County, Georgia, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Hawaii, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Hawaii, 1997-2006• CASES: Hawaii reported 18 cases in 2006.• RATES: Hawaii ranked 36 among 50 states, DC, andP&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 3 territories with 1.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 3.0 3Rates of primary and secondary syphilis, by sex• In Hawaii, the rate among males was 2.7 per 100,000population compared to the total male rate of 5.7 per 2.0 2100,000. • The rate among females was 0.2 per 100,000compared to the total female rate of 1.0 per 100,000. 1.0 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Hawaii, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 2.1 among whites, 8.8among blacks, 1.0 among Hispanics, 0.9 amongTotal P&S Syphilis Rates by County, Hawaii, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 4.2 times that of whites.Congenital syphilis• CASES: Hawaii reported 0 cases in 2006.• RATES: Hawaii had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 36 Idaho, 2006 37Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Idaho reported 3 cases in 2006.•RATES: Idaho ranked 51 among 50 states, DC, and 3territories with 0.2 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Idaho, the rate among males was 0.1 per 100,000population compared to the total male rate of 5.7 per100,000.•The rate among females was 0.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Idaho, the race/ethnicity adjusted rates per 100,000population were 0.2 among whites, 0.0 among blacks,1.5 among Hispanics, 0.0 among Asian/PacificIslanders, and 0.0 among American Indians/AlaskaNatives.•The rate among Hispanics was 7.5 times that ofwhites.Congenital syphilis•CASES: Idaho reported 0 cases in 2006.•RATES: Idaho had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000.Syphilis: P&S Rates and Congenital Cases, Idaho, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 1.0 2.0 3.0 4.09798992000010203040506 0 1 2 3 4Total P&S Syphilis Rates by County, Idaho, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Illinois, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Illinois reported 431 cases in 2006.• RATES: Illinois ranked 15 among 50 states, DC, and 3territories with 3.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Illinois, the rate among males was 6.3 per 100,000population compared to the total male rate of 5.7 per100,000. • The rate among females was 0.6 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Illinois, the race/ethnicity adjusted rates per 100,000population were 2.0 among whites, 10.1 amongblacks, 3.3 among Hispanics, 0.9 among Asian/PacificSyphilis: P&S Rates and Congenital Cases, Illinois, 1997-2006P&S rate (per 100,000 population) CS cases12.0 Male P&S RateFemale P&S RateCongenital Cases 76 579.06.0 38 3.0 190 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Illinois, 2006Islanders, and 0.0 among American Indians/AlaskaNatives.• The rate among blacks was 5.1 times that of whites.• The rate among Hispanics was 1.7 times that ofwhites.Congenital syphilis• CASES: Illinois reported 15 cases in 2006.• RATES: Illinois ranked 15 among 26 states, DC, and 1territory reporting congenital syphilis cases with a rateof 8.3 cases per 100,000 live births compared to thetotal rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 38 Indiana, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Indiana reported 93 cases in 2006.• RATES: Indiana ranked 34 among 50 states, DC, and3 territories with 1.5 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Indiana, the rate among males was 2.7 per 100,000population compared to the total male rate of 5.7 per100,000. • The rate among females was 0.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Indiana, the race/ethnicity adjusted rates per100,000 population were 1.1 among whites, 4.9among blacks, 2.5 among Hispanics, 1.2 amongSyphilis: P&S Rates and Congenital Cases, Indiana, 1997-2006P&S rate (per 100,000 population) CS cases8.0 Male P&S RateFemale P&S RateCongenital Cases 20 6.0 15 4.0 10 2.0 50 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Indiana, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 4.5 times that of whites.• The rate among Hispanics was 2.3 times that ofwhites. • The rate among Asian/Pacific Islanders was 1.1 timesthat of whites.Congenital syphilis• CASES: Indiana reported 0 cases in 2006.• RATES: Indiana had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 39 Iowa, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Iowa reported 19 cases in 2006.• RATES: Iowa ranked 47 among 50 states, DC, and 3territories with 0.6 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Iowa, the rate among males was 0.9 per 100,000population compared to the total male rate of 5.7 per100,000. • The rate among females was 0.4 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Iowa, the race/ethnicity adjusted rates per 100,000population were 0.3 among whites, 9.3 among blacks,0.9 among Hispanics, 0.0 among Asian/PacificSyphilis: P&S Rates and Congenital Cases, Iowa, 1997-2006P&S rate (per 100,000 population) CS cases1.2 Male P&S RateFemale P&S RateCongenital Cases 4 0.9 3 0.6 2 0.3 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Iowa, 2006Islanders, and 22.9 among American Indians/AlaskaNatives. • The rate among blacks was 31 times that of whites.• The rate among Hispanics was 3 times that of whites.• The rate among American Indians/Alaska Natives was76.3 times that of whites.Congenital syphilis• CASES: Iowa reported 0 cases in 2006.• RATES: Iowa had a rate of 0.0 cases per 100,000 livebirths compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 40 Kansas, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Kansas, 1997-2006• CASES: Kansas reported 27 cases in 2006.• RATES: Kansas ranked 40 among 50 states, DC, andP&S rate (per 100,000 population) CS cases2.0 Male P&S RateFemale P&S RateCongenital Cases 4 3 territories with 1 case per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 1.5 3Rates of primary and secondary syphilis, by sex• In Kansas, the rate among males was 1.8 per 100,000population compared to the total male rate of 5.7 per 1.0 2100,000. • The rate among females was 0.1 per 100,000compared to the total female rate of 1.0 per 100,000. 0.5 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Kansas, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 1.0 among whites, 3.0among blacks, 0.0 among Hispanics, 0.0 amongTotal P&S Syphilis Rates by County, Kansas, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 3 times that of whites.Congenital syphilis• CASES: Kansas reported 1 case in 2006.• RATES: Kansas ranked 26 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 2.5 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 41 Kentucky, 2006 42 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Kentucky reported 73 cases in 2006.•RATES: Kentucky ranked 29 among 50 states, DC,and 3 territories with 1.7 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Kentucky, the rate among males was 3.2 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Kentucky, the race/ethnicity adjusted rates per100,000 population were 1.3 among whites, 5.9among blacks, 3.7 among Hispanics, 2.4 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 4.5 times that of whites.•The rate among Hispanics was 2.8 times that ofwhites.•The rate among Asian/Pacific Islanders was 1.8 timesthat of whites.Congenital syphilis•CASES: Kentucky reported 1 case in 2006.•RATES: Kentucky ranked 27 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 1.8 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Kentucky, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 1.0 2.0 3.0 4.09798992000010203040506 0 2 4 6 8Total P&S Syphilis Rates by County, Kentucky, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Louisiana, 2006 43Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Louisiana reported 342 cases in 2006.•RATES: Louisiana ranked 2 among 50 states, DC,and 3 territories with 7.6 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Louisiana, the rate among males was 10.0 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 5.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Louisiana, the race/ethnicity adjusted rates per100,000 population were 2.4 among whites, 18.4among blacks, 0.0 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 7.7 times that of whites.Congenital syphilis•CASES: Louisiana reported 13 cases in 2006.•RATES: Louisiana ranked 6 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 19.9 cases per 100,000 live births comparedto the total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Louisiana, 1997-2006CS casesP&S rate (per 100,000 population) Male P&S RateFemale P&S RateCongenital Cases0 4.0 8.012.016.09798992000010203040506 0 6 12 18 24Total P&S Syphilis Rates by County, Louisiana, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Maine, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Maine, 1997-2006• CASES: Maine reported 9 cases in 2006.• RATES: Maine ranked 46 among 50 states, DC, and 3P&S rate (per 100,000 population)CS cases1.6 Male P&S RateFemale P&S RateCongenital Cases 4 territories with 0.7 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 1.2 3Rates of primary and secondary syphilis, by sex• In Maine, the rate among males was 1.1 per 100,000population compared to the total male rate of 5.7 per 0.8 2100,000. • The rate among females was 0.3 per 100,000compared to the total female rate of 1.0 per 100,000. 0.4 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Maine, the race/ethnicity adjusted rates per 100,00097 98 99 2000 01 02 03 04 05 06population were 0.6 among whites, 8.8 among blacks,0.0 among Hispanics, 0.0 among Asian/PacificTotal P&S Syphilis Rates by County, Maine, 2006Islanders, and 0.0 among American Indians/AlaskaNatives.• The rate among blacks was 14.7 times that of whites.Congenital syphilis• CASES: Maine reported 0 cases in 2006.• RATES: Maine had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 44 Maryland, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Maryland, 1997-2006• CASES: Maryland reported 300 cases in 2006.• RATES: Maryland ranked 6 among 50 states, DC, andP&S rate (per 100,000 population) CS cases20.0 Male P&S RateFemale P&S RateCongenital Cases 60 3 territories with 5.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.15.0 45Rates of primary and secondary syphilis, by sex• In Maryland, the rate among males was 8.8 per100,000 population compared to the total male rate of10.0 305.7 per 100,000.• The rate among females was 2.1 per 100,000compared to the total female rate of 1.0 per 100,000. 5.0 15Rates of primary and secondary syphilis, byrace/ethnicity0 0In Maryland, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 1.9 among whites, 13.9among blacks, 1.9 among Hispanics, 1.1 amongTotal P&S Syphilis Rates by County, Maryland, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 7.3 times that of whites.Congenital syphilis• CASES: Maryland reported 19 cases in 2006.• RATES: Maryland ranked 2 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 25.5 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 45 Massachusetts, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Massachusetts reported 124 cases in 2006.• RATES: Massachusetts ranked 26 among 50 states,DC, and 3 territories with 1.9 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex• In Massachusetts, the rate among males was 3.8 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.2 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Massachusetts, the race/ethnicity adjusted rates per100,000 population were 1.6 among whites, 5.7among blacks, 2.8 among Hispanics, 1.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 3.6 times that of whites.• The rate among Hispanics was 1.8 times that ofwhites.Congenital syphilis• CASES: Massachusetts reported 0 cases in 2006.• RATES: Massachusetts had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, Massachusetts, 1997-2006P&S rate (per 100,000 population) CS cases8.0 Male P&S RateFemale P&S RateCongenital Cases 4 6.0 3 4.0 2 2.0 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Massachusetts, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 46 Michigan, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Michigan, 1997-2006• CASES: Michigan reported 118 cases in 2006.• RATES: Michigan ranked 38 among 50 states, DC,P&S rate (per 100,000 population)CS cases8.0 Male P&S RateFemale P&S RateCongenital Cases 44 and 3 territories with 1.2 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 6.0 33Rates of primary and secondary syphilis, by sex• In Michigan, the rate among males was 1.8 per100,000 population compared to the total male rate of 4.0 225.7 per 100,000.• The rate among females was 0.5 per 100,000compared to the total female rate of 1.0 per 100,000. 2.0 11Rates of primary and secondary syphilis, byrace/ethnicity0 0In Michigan, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.5 among whites, 5.1among blacks, 1.3 among Hispanics, 0.4 amongTotal P&S Syphilis Rates by County, Michigan, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 10.2 times that of whites.• The rate among Hispanics was 2.6 times that ofwhites.Congenital syphilis• CASES: Michigan reported 13 cases in 2006.• RATES: Michigan ranked 13 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 10.0 cases per 100,000 live births comparedto the total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 47 Minnesota, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Minnesota, 1997-2006• CASES: Minnesota reported 47 cases in 2006.• RATES: Minnesota ranked 42 among 50 states, DC,P&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 and 3 territories with 0.9 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 3.0 3Rates of primary and secondary syphilis, by sex• In Minnesota, the rate among males was 1.7 per100,000 population compared to the total male rate of 2.0 25.7 per 100,000.• The rate among females was 0.2 per 100,000compared to the total female rate of 1.0 per 100,000. 1.0 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Minnesota, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.8 among whites, 3.0among blacks, 1.6 among Hispanics, 0.5 amongTotal P&S Syphilis Rates by County, Minnesota, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 3.8 times that of whites.• The rate among Hispanics was 2 times that of whites.Congenital syphilis• CASES: Minnesota reported 1 case in 2006.• RATES: Minnesota ranked 28 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 1.4 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 48 Mississippi, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Mississippi reported 86 cases in 2006.• RATES: Mississippi ranked 17 among 50 states, DC,and 3 territories with 2.9 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Mississippi, the rate among males was 3.5 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 2.4 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Mississippi, the race/ethnicity adjusted rates per100,000 population were 0.5 among whites, 7.1among blacks, 0.0 among Hispanics, 0.0 amongSyphilis: P&S Rates and Congenital Cases, Mississippi, 1997-2006P&S rate (per 100,000 population) CS cases16.0 Male P&S RateFemale P&S RateCongenital Cases 44 12.0 33 8.0 22 4.0 110 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Mississippi, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 14.2 times that of whites.Congenital syphilis• CASES: Mississippi reported 0 cases in 2006.• RATES: Mississippi had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 49 Missouri, 2006 50 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Missouri reported 168 cases in 2006.•RATES: Missouri ranked 17 among 50 states, DC,and 3 territories with 2.9 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Missouri, the rate among males was 5.3 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.6 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Missouri, the race/ethnicity adjusted rates per100,000 population were 1.6 among whites, 12.0among blacks, 4.5 among Hispanics, 1.2 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 7.5 times that of whites.•The rate among Hispanics was 2.8 times that ofwhites.Congenital syphilis•CASES: Missouri reported 3 cases in 2006.•RATES: Missouri ranked 20 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 3.9 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Missouri, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 4 8 12 16Total P&S Syphilis Rates by County, Missouri, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Montana, 2006 51Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Montana reported 1 case in 2006.•RATES: Montana ranked 53 among 50 states, DC,and 3 territories with 0.1 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Montana, the rate among males was 0.2 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Montana, the race/ethnicity adjusted rates per100,000 population were 0.1 among whites, 0.0among blacks, 0.0 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.Congenital syphilis•CASES: Montana reported 0 cases in 2006.•RATES: Montana had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000.Syphilis: P&S Rates and Congenital Cases, Montana, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 0.4 0.8 1.2 1.69798992000010203040506 0 1 2 3 4Total P&S Syphilis Rates by County, Montana, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Nebraska, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Nebraska, 1997-2006• CASES: Nebraska reported 7 cases in 2006.• RATES: Nebraska ranked 50 among 50 states, DC,P&S rate (per 100,000 population)CS cases1.2 Male P&S RateFemale P&S RateCongenital Cases 4 and 3 territories with 0.4 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 0.9 3Rates of primary and secondary syphilis, by sex• In Nebraska, the rate among males was 0.7 per100,000 population compared to the total male rate of 0.6 25.7 per 100,000.• The rate among females was 0.1 per 100,000compared to the total female rate of 1.0 per 100,000. 0.3 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Nebraska, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.3 among whites, 1.3among blacks, 0.8 among Hispanics, 0.0 amongTotal P&S Syphilis Rates by County, Nebraska, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 4.3 times that of whites.• The rate among Hispanics was 2.7 times that ofwhites.Congenital syphilis• CASES: Nebraska reported 0 cases in 2006.• RATES: Nebraska had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 52 Nevada, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Nevada, 1997-2006• CASES: Nevada reported 137 cases in 2006.• RATES: Nevada ranked 5 among 50 states, DC, andP&S rate (per 100,000 population)CS cases12.0 Male P&S RateFemale P&S RateCongenital Cases 16 3 territories with 5.7 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 9.0 12Rates of primary and secondary syphilis, by sex• In Nevada, the rate among males was 8.4 per 100,000population compared to the total male rate of 5.7 per 6.0 8100,000. • The rate among females was 2.9 per 100,000compared to the total female rate of 1.0 per 100,000. 3.0 4Rates of primary and secondary syphilis, byrace/ethnicity0 0In Nevada, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 3.9 among whites, 23.6among blacks, 4.2 among Hispanics, 7.1 amongTotal P&S Syphilis Rates by County, Nevada, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 6.1 times that of whites.• The rate among Hispanics was 1.1 times that ofwhites. • The rate among Asian/Pacific Islanders was 1.8 timesthat of whites.Congenital syphilis• CASES: Nevada reported 15 cases in 2006.• RATES: Nevada ranked 1 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 42.6 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 53 New Hampshire, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: New Hampshire reported 13 cases in 2006.• RATES: New Hampshire ranked 40 among 50 states,DC, and 3 territories with 1 case per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex• In New Hampshire, the rate among males was 2.0 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn New Hampshire, the race/ethnicity adjusted ratesper 100,000 population were 1.0 among whites, 0.0among blacks, 0.0 among Hispanics, 4.1 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among Asian/Pacific Islanders was 4.1 timesthat of whites.Congenital syphilis• CASES: New Hampshire reported 0 cases in 2006.• RATES: New Hampshire had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, New Hampshire, 1997-2006P&S rate (per 100,000 population)CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 3.0 3 2.0 2 1.0 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, New Hampshire, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 54 New Jersey, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, New Jersey, 1997-2006• CASES: New Jersey reported 173 cases in 2006.• RATES: New Jersey ranked 24 among 50 states, DC,P&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 88 and 3 territories with 2 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 3.0 66Rates of primary and secondary syphilis, by sex• In New Jersey, the rate among males was 3.8 per100,000 population compared to the total male rate of 2.0 445.7 per 100,000.• The rate among females was 0.3 per 100,000compared to the total female rate of 1.0 per 100,000. 1.0 22Rates of primary and secondary syphilis, byrace/ethnicity0 0In New Jersey, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 1.2 among whites, 6.2among blacks, 2.0 among Hispanics, 0.8 amongTotal P&S Syphilis Rates by County, New Jersey, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 5.2 times that of whites.• The rate among Hispanics was 1.7 times that ofwhites.Congenital syphilis• CASES: New Jersey reported 15 cases in 2006.• RATES: New Jersey ranked 10 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 13.0 cases per 100,000 live births comparedto the total rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 55 Syphilis Surveillance Report New Mexico, 2006Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, New Mexico, 1997-2006• CASES: New Mexico reported 79 cases in 2006.• RATES: New Mexico ranked 10 among 50 states, DC,and 3 territories with 4.1 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In New Mexico, the rate among males was 6.0 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 2.2 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn New Mexico, the race/ethnicity adjusted rates per100,000 population were 2.3 among whites, 2.5among blacks, 3.1 among Hispanics, 4.0 amongAsian/Pacific Islanders, and 17.4 among AmericanIndians/Alaska Natives.• The rate among blacks was 1.1 times that of whites.• The rate among Hispanics was 1.3 times that ofwhites. • The rate among Asian/Pacific Islanders was 1.7 timesthat of whites.• The rate among American Indians/Alaska Natives was7.6 times that of whites.Congenital syphilis• CASES: New Mexico reported 7 cases in 2006.• RATES: New Mexico ranked 4 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 24.7 cases per 100,000 live births comparedto the total rate of 8.7 cases per 100,000. P&S rate (per 100,000 population)CS cases8.0 Male P&S RateFemale P&S RateCongenital Cases 8 6.0 6 4.0 4 2.0 20 097 98 99200001 02 03 04 05Total P&S Syphilis Rates by County, New Mexico, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 56 06New York, 2006 57Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: New York reported 736 cases in 2006.•RATES: New York ranked 12 among 50 states, DC,and 3 territories with 3.8 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In New York, the rate among males was 7.6 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn New York, the race/ethnicity adjusted rates per100,000 population were 2.0 among whites, 9.8among blacks, 6.0 among Hispanics, 1.2 amongAsian/Pacific Islanders, and 7.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 4.9 times that of whites.•The rate among Hispanics was 3 times that of whites.•The rate among American Indians/Alaska Natives was3.5 times that of whites.Congenital syphilis•CASES: New York reported 15 cases in 2006.•RATES: New York ranked 18 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 6.0 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, New York, 1997-2006CS casesP&S rate (per 100,000 population) Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 27 54 81108Total P&S Syphilis Rates by County, New York, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 North Carolina, 2006 58 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: North Carolina reported 309 cases in 2006.•RATES: North Carolina ranked 14 among 50 states,DC, and 3 territories with 3.6 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex•In North Carolina, the rate among males was 5.7 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 1.5 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn North Carolina, the race/ethnicity adjusted rates per100,000 population were 1.6 among whites, 11.0among blacks, 1.3 among Hispanics, 0.6 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 6.9 times that of whites.Congenital syphilis•CASES: North Carolina reported 6 cases in 2006.•RATES: North Carolina ranked 19 among 26 states,DC, and 1 territory reporting congenital syphilis caseswith a rate of 5.0 cases per 100,000 live birthscompared to the total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, North Carolina, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 3.0 6.0 9.012.09798992000010203040506 0 7 14 21 28Total P&S Syphilis Rates by County, North Carolina, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 North Dakota, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: North Dakota reported 1 case in 2006.• RATES: North Dakota ranked 51 among 50 states,DC, and 3 territories with 0.2 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex• In North Dakota, the rate among males was 0.3 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn North Dakota, the race/ethnicity adjusted rates per100,000 population were 0.0 among whites, 0.0among blacks, 0.0 among Hispanics, 21.2 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.Congenital syphilis• CASES: North Dakota reported 0 cases in 2006.• RATES: North Dakota had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, North Dakota, 1997-2006P&S rate (per 100,000 population)CS cases0.8 Male P&S RateFemale P&S RateCongenital Cases 4 0.6 3 0.4 2 0.2 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, North Dakota, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 59 Ohio, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Ohio reported 184 cases in 2006.• RATES: Ohio ranked 32 among 50 states, DC, and 3territories with 1.6 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Ohio, the rate among males was 2.5 per 100,000population compared to the total male rate of 5.7 per100,000. • The rate among females was 0.7 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Ohio, the race/ethnicity adjusted rates per 100,000population were 1.3 among whites, 4.2 among blacks,1.5 among Hispanics, 0.0 among Asian/PacificSyphilis: P&S Rates and Congenital Cases, Ohio, 1997-2006P&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 12 3.0 9 2.0 6 1.0 30 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Ohio, 2006Islanders, and 0.0 among American Indians/AlaskaNatives. • The rate among blacks was 3.2 times that of whites.• The rate among Hispanics was 1.2 times that ofwhites.Congenital syphilis• CASES: Ohio reported 0 cases in 2006.• RATES: Ohio had a rate of 0.0 cases per 100,000 livebirths compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 60 Oklahoma, 2006 61Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Oklahoma reported 70 cases in 2006.•RATES: Oklahoma ranked 24 among 50 states, DC,and 3 territories with 2 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Oklahoma, the rate among males was 2.9 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 1.1 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Oklahoma, the race/ethnicity adjusted rates per100,000 population were 1.0 among whites, 10.8among blacks, 2.6 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 1.9 among AmericanIndians/Alaska Natives.•The rate among blacks was 10.8 times that of whites.•The rate among Hispanics was 2.6 times that ofwhites.•The rate among American Indians/Alaska Natives was1.9 times that of whites.Congenital syphilis•CASES: Oklahoma reported 2 cases in 2006.•RATES: Oklahoma ranked 20 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 3.9 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Oklahoma, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 4 8 12 16Total P&S Syphilis Rates by County, Oklahoma, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Oregon, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Oregon, 1997-2006• CASES: Oregon reported 29 cases in 2006.• RATES: Oregon ranked 45 among 50 states, DC, andP&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 3 territories with 0.8 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 3.0 3Rates of primary and secondary syphilis, by sex• In Oregon, the rate among males was 1.6 per 100,000population compared to the total male rate of 5.7 per 2.0 2100,000. • The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000. 1.0 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Oregon, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.8 among whites, 1.4among blacks, 0.8 among Hispanics, 0.0 amongTotal P&S Syphilis Rates by County, Oregon, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 1.8 times that of whites.Congenital syphilis• CASES: Oregon reported 0 cases in 2006.• RATES: Oregon had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 62 Pennsylvania, 2006 63Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Pennsylvania reported 264 cases in 2006.•RATES: Pennsylvania ranked 23 among 50 states,DC, and 3 territories with 2.1 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex•In Pennsylvania, the rate among males was 3.8 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.5 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Pennsylvania, the race/ethnicity adjusted rates per100,000 population were 1.1 among whites, 9.1among blacks, 4.7 among Hispanics, 1.8 amongAsian/Pacific Islanders, and 5.4 among AmericanIndians/Alaska Natives.•The rate among blacks was 8.3 times that of whites.•The rate among Hispanics was 4.3 times that ofwhites.•The rate among Asian/Pacific Islanders was 1.6 timesthat of whites.•The rate among American Indians/Alaska Natives was4.9 times that of whites.Congenital syphilis•CASES: Pennsylvania reported 0 cases in 2006.•RATES: Pennsylvania had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Pennsylvania, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 1.0 2.0 3.0 4.09798992000010203040506 0 10 20 30 40Total P&S Syphilis Rates by County, Pennsylvania, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Rhode Island, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Rhode Island reported 14 cases in 2006.• RATES: Rhode Island ranked 37 among 50 states,DC, and 3 territories with 1.3 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex• In Rhode Island, the rate among males was 2.7 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Rhode Island, the race/ethnicity adjusted rates per100,000 population were 1.4 among whites, 3.5among blacks, 0.0 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 2.5 times that of whites.Congenital syphilis• CASES: Rhode Island reported 0 cases in 2006.• RATES: Rhode Island had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, Rhode Island, 1997-2006P&S rate (per 100,000 population) CS cases8.0 Male P&S RateFemale P&S RateCongenital Cases 4 6.0 3 4.0 2 2.0 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Rhode Island, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 64 South Carolina, 2006 65Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: South Carolina reported 66 cases in 2006.•RATES: South Carolina ranked 32 among 50 states,DC, and 3 territories with 1.6 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex•In South Carolina, the rate among males was 2.7 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.5 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn South Carolina, the race/ethnicity adjusted rates per100,000 population were 0.7 among whites, 3.7among blacks, 0.7 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 5.3 times that of whites.Congenital syphilis•CASES: South Carolina reported 2 cases in 2006.•RATES: South Carolina ranked 23 among 26 states,DC, and 1 territory reporting congenital syphilis caseswith a rate of 3.5 cases per 100,000 live birthscompared to the total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, South Carolina, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 3.0 6.0 9.012.09798992000010203040506 0 8 16 24 32Total P&S Syphilis Rates by County, South Carolina, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 South Dakota, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: South Dakota reported 13 cases in 2006.• RATES: South Dakota ranked 29 among 50 states,DC, and 3 territories with 1.7 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex• In South Dakota, the rate among males was 2.1 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 1.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn South Dakota, the race/ethnicity adjusted rates per100,000 population were 0.7 among whites, 0.0among blacks, 0.0 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 11.7 among AmericanIndians/Alaska Natives.• The rate among American Indians/Alaska Natives was16.7 times that of whites.Congenital syphilis• CASES: South Dakota reported 0 cases in 2006.• RATES: South Dakota had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, South Dakota, 1997-2006P&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 4 3.0 3 2.0 2 1.0 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, South Dakota, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 66 Tennessee, 2006 67Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Tennessee reported 249 cases in 2006.•RATES: Tennessee ranked 9 among 50 states, DC,and 3 territories with 4.2 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Tennessee, the rate among males was 6.0 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 2.4 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Tennessee, the race/ethnicity adjusted rates per100,000 population were 1.5 among whites, 17.3among blacks, 2.2 among Hispanics, 1.3 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 11.5 times that of whites.•The rate among Hispanics was 1.5 times that ofwhites.Congenital syphilis•CASES: Tennessee reported 6 cases in 2006.•RATES: Tennessee ranked 16 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 7.5 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Tennessee, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 4.0 8.012.016.09798992000010203040506 0 8 16 24 32Total P&S Syphilis Rates by County, Tennessee, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Texas, 2006 68 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Texas reported 1,064 cases in 2006.•RATES: Texas ranked 8 among 50 states, DC, and 3territories with 4.7 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Texas, the rate among males was 7.1 per 100,000population compared to the total male rate of 5.7 per100,000.•The rate among females was 2.3 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Texas, the race/ethnicity adjusted rates per 100,000population were 2.0 among whites, 21.5 amongblacks, 3.3 among Hispanics, 0.9 among Asian/PacificIslanders, and 1.2 among American Indians/AlaskaNatives.•The rate among blacks was 10.8 times that of whites.•The rate among Hispanics was 1.7 times that ofwhites.Congenital syphilis•CASES: Texas reported 79 cases in 2006.•RATES: Texas ranked 5 among 26 states, DC, and 1territory reporting congenital syphilis cases with a rateof 20.7 cases per 100,000 live births compared to thetotal rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Texas, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 38 76114152Total P&S Syphilis Rates by County, Texas, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Utah, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Utah reported 21 cases in 2006.• RATES: Utah ranked 42 among 50 states, DC, and 3territories with 0.9 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex• In Utah, the rate among males was 1.5 per 100,000population compared to the total male rate of 5.7 per100,000. • The rate among females was 0.2 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Utah, the race/ethnicity adjusted rates per 100,000population were 0.6 among whites, 4.1 among blacks,1.9 among Hispanics, 3.0 among Asian/PacificSyphilis: P&S Rates and Congenital Cases, Utah, 1997-2006P&S rate (per 100,000 population)CS cases1.6 Male P&S RateFemale P&S RateCongenital Cases 4 1.2 3 0.8 2 0.4 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rates by County, Utah, 2006Islanders, and 0.0 among American Indians/AlaskaNatives.• The rate among blacks was 6.8 times that of whites.• The rate among Hispanics was 3.2 times that ofwhites. • The rate among Asian/Pacific Islanders was 5 timesthat of whites.Congenital syphilis• CASES: Utah reported 2 cases in 2006.• RATES: Utah ranked 20 among 26 states, DC, and 1territory reporting congenital syphilis cases with a rateof 3.9 cases per 100,000 live births compared to thetotal rate of 8.7 cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 69 Vermont, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Vermont, 1997-2006• CASES: Vermont reported 3 cases in 2006.• RATES: Vermont ranked 49 among 50 states, DC,P&S rate (per 100,000 population) CS cases2.0 Male P&S RateFemale P&S RateCongenital Cases 4 and 3 territories with 0.5 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 1.5 3Rates of primary and secondary syphilis, by sex• In Vermont, the rate among males was 1.0 per100,000 population compared to the total male rate of 1.0 25.7 per 100,000.• The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000. 0.5 1Rates of primary and secondary syphilis, byrace/ethnicity0 0In Vermont, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.5 among whites, 0.0among blacks, 0.0 among Hispanics, 0.0 amongTotal P&S Syphilis Rates by County, Vermont, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.Congenital syphilis• CASES: Vermont reported 0 cases in 2006.• RATES: Vermont had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 70 Virginia, 2006 71Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Virginia reported 190 cases in 2006.•RATES: Virginia ranked 21 among 50 states, DC, and3 territories with 2.5 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Virginia, the rate among males was 4.5 per 100,000population compared to the total male rate of 5.7 per100,000.•The rate among females was 0.6 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Virginia, the race/ethnicity adjusted rates per100,000 population were 1.3 among whites, 7.2among blacks, 1.8 among Hispanics, 0.8 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 5.5 times that of whites.•The rate among Hispanics was 1.4 times that ofwhites.Congenital syphilis•CASES: Virginia reported 3 cases in 2006.•RATES: Virginia ranked 24 among 26 states, DC, and1 territory reporting congenital syphilis cases with arate of 2.9 cases per 100,000 live births compared tothe total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Virginia, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 2 4 6 8Total P&S Syphilis Rates by County, Virginia, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Washington, 2006 72 Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Washington reported 182 cases in 2006.•RATES: Washington ranked 17 among 50 states, DC,and 3 territories with 2.9 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Washington, the rate among males was 5.7 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.1 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn Washington, the race/ethnicity adjusted rates per100,000 population were 2.7 among whites, 9.8among blacks, 3.4 among Hispanics, 1.3 amongAsian/Pacific Islanders, and 1.0 among AmericanIndians/Alaska Natives.•The rate among blacks was 3.6 times that of whites.•The rate among Hispanics was 1.3 times that ofwhites.Congenital syphilis•CASES: Washington reported 0 cases in 2006.•RATES: Washington had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Washington, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 2.0 4.0 6.0 8.09798992000010203040506 0 1 2 3 4Total P&S Syphilis Rates by County, Washington, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 West Virginia, 2006 73Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: West Virginia reported 11 cases in 2006.•RATES: West Virginia ranked 47 among 50 states,DC, and 3 territories with 0.6 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex•In West Virginia, the rate among males was 1.1 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 0.1 per 100,000compared to the total female rate of 1.0 per 100,000.Rates of primary and secondary syphilis, byrace/ethnicityIn West Virginia, the race/ethnicity adjusted rates per100,000 population were 0.6 among whites, 0.0among blacks, 0.0 among Hispanics, 0.0 amongAsian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.Congenital syphilis•CASES: West Virginia reported 0 cases in 2006.•RATES: West Virginia had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000.Syphilis: P&S Rates and Congenital Cases, West Virginia, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 0.3 0.6 0.9 1.29798992000010203040506 0 1 2 3 4Total P&S Syphilis Rates by County, West Virginia, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Wisconsin, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Wisconsin, 1997-2006• CASES: Wisconsin reported 68 cases in 2006.• RATES: Wisconsin ranked 38 among 50 states, DC,P&S rate (per 100,000 population) CS cases4.0 Male P&S RateFemale P&S RateCongenital Cases 12 and 3 territories with 1.2 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 3.0 9Rates of primary and secondary syphilis, by sex• In Wisconsin, the rate among males was 2.4 per100,000 population compared to the total male rate of 2.0 65.7 per 100,000.• The rate among females was 0.1 per 100,000compared to the total female rate of 1.0 per 100,000. 1.0 3Rates of primary and secondary syphilis, byrace/ethnicity0 0In Wisconsin, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.8 among whites, 5.3among blacks, 3.6 among Hispanics, 0.9 amongTotal P&S Syphilis Rates by County, Wisconsin, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.• The rate among blacks was 6.6 times that of whites.• The rate among Hispanics was 4.5 times that ofwhites. • The rate among Asian/Pacific Islanders was 1.1 timesthat of whites.Congenital syphilis• CASES: Wisconsin reported 0 cases in 2006.• RATES: Wisconsin had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 74 Wyoming, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Wyoming, 1997-2006• CASES: Wyoming reported 0 cases in 2006.• RATES: Wyoming ranked 54 among 50 states, DC,P&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases 01234CS cases0.8 and 3 territories with 0 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 0.6Rates of primary and secondary syphilis, by sex• In Wyoming, the rate among males was 0.0 per100,000 population compared to the total male rate of 0.45.7 per 100,000.• The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000. 0.2Rates of primary and secondary syphilis, byrace/ethnicity0In Wyoming, the race/ethnicity adjusted rates per97 98 99 2000 01 02 03 04 05 06100,000 population were 0.0 among whites, 0.0among blacks, 0.0 among Hispanics, 0.0 amongTotal P&S Syphilis Rates by County, Wyoming, 2006Asian/Pacific Islanders, and 0.0 among AmericanIndians/Alaska Natives.Congenital syphilis• CASES: Wyoming reported 0 cases in 2006.• RATES: Wyoming had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases per100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 75 Guam, 2006Syphilis Surveillance Report Primary and secondary syphilisSyphilis: P&S Rates and Congenital Cases, Guam, 1997-2006• CASES: Guam reported 3 cases in 2006.• RATES: Guam ranked 27 among 50 states, DC, and 3P&S rate (per 100,000 population) CS cases12.0 Male P&S RateFemale P&S RateCongenital Cases 4 territories with 1.8 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population. 9.0 3Rates of primary and secondary syphilis, by sex• In Guam, the rate among males was 2.3 per 100,000population compared to the total male rate of 5.7 per 6.0 2100,000. • The rate among females was 1.2 per 100,000compared to the total female rate of 1.0 per 100,000. 3.0 1Congenital syphilis0 0• CASES: Guam reported 0 cases in 2006.97 98 99 2000 01 02 03 04 05 06• RATES: Guam had a rate of 0.0 cases per 100,000live births compared to the total rate of 8.7 cases perTotal P&S Syphilis Rate, Guam, 2006100,000. Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 76 Puerto Rico, 2006 77Syphilis Surveillance ReportPrimary and secondary syphilis•CASES: Puerto Rico reported 150 cases in 2006.•RATES: Puerto Rico ranked 12 among 50 states, DC,and 3 territories with 3.8 cases per 100,000 populationcompared to the total rate of 3.3 cases per 100,000population.Rates of primary and secondary syphilis, by sex•In Puerto Rico, the rate among males was 5.5 per100,000 population compared to the total male rate of5.7 per 100,000.•The rate among females was 2.3 per 100,000compared to the total female rate of 1.0 per 100,000.Congenital syphilis•CASES: Puerto Rico reported 13 cases in 2006.•RATES: Puerto Rico ranked 3 among 26 states, DC,and 1 territory reporting congenital syphilis cases witha rate of 25.4 cases per 100,000 live births comparedto the total rate of 8.7 cases per 100,000.Syphilis: P&S Rates and Congenital Cases, Puerto Rico, 1997-2006CS casesP&S rate (per 100,000 population)Male P&S RateFemale P&S RateCongenital Cases0 3.0 6.0 9.012.09798992000010203040506 0 8 16 24 32Total P&S Syphilis Rates by Municipality, Puerto Rico, 2006Rate (per 100,000 population)<=0.4 0.41-2.2>2.2 Virgin Islands, 2006Syphilis Surveillance Report Primary and secondary syphilis• CASES: Virgin Islands reported 1 case in 2006.• RATES: Virgin Islands ranked 42 among 50 states,DC, and 3 territories with 0.9 cases per 100,000population compared to the total rate of 3.3 cases per100,000 population.Rates of primary and secondary syphilis, by sex• In Virgin Islands, the rate among males was 1.9 per100,000 population compared to the total male rate of5.7 per 100,000.• The rate among females was 0.0 per 100,000compared to the total female rate of 1.0 per 100,000.Congenital syphilis• CASES: Virgin Islands reported 0 cases in 2006.• RATES: Virgin Islands had a rate of 0.0 cases per100,000 live births compared to the total rate of 8.7cases per 100,000. Syphilis: P&S Rates and Congenital Cases, Virgin Islands, 1997-2006P&S rate (per 100,000 population) CS cases12.0 Male P&S RateFemale P&S RateCongenital Cases 4 9.0 3 6.0 2 3.0 10 097 98 99200001 02 03 04 05 06Total P&S Syphilis Rate, Virgin Islands, 2006Rate (per 100,000 population)<=0.4 0.41-2.2 >2.2 78

Sex Transm Dis

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Sex Transm Dis

Abstract

Extracted data

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