In January 1992, the Ford County (Kansas) Health Department
received a report of a pregnant woman with a positive serologic
test for syphilis. Syphilis had not been reported in the county
(1990 population: 27,463) since September 1989. As a result of the
investigation summarized in this report, six additional persons
with syphilis were identified by contact tracing.
Patients ranged in age from 15 to 21 years (median: 16 years);
five were female, including two who were pregnant. All were
residents of Ford County. All patients had positive serologic tests
(i.e., Venereal Disease Research Laboratory/rapid plasma reagin and
fluorescent treponemal antibody tests) for syphilis. Two patients
were symptomatic; both had a rash consistent with secondary
syphilis. Early latent syphilis was diagnosed in the other
patients. Three patients were tested for human immunodeficiency
virus; all were negative.
Two of the patients were in drug-abuse rehabilitation; these
two were the only patients who reported use of crack cocaine. The
primary patient was a male who traveled frequently to Wyandotte
County, Kansas (in the Kansas City metropolitan area), which
reported a 290% increase in early syphilis from 1990 (48 cases)
through 1991 (187 cases). Although much of the increase in
Wyandotte County has been associated with the use of crack cocaine,
none of the patients in this investigation reported exchanging
drugs or money for sex.
Reported by: E Chipman, Ford County Health Dept, D Gamble, MD,
Dodge City; J Johnson, MPH, P Lauber, A Mayer, A Pelletier, MD,
Acting State Epidemiologist, Kansas Dept of Health and Environment.
Div of Field Epidemiology, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: The cases of syphilis in Ford County, a rural area,
reflect national trends for the occurrence of this problem and are
of concern for three reasons. First, transmission of infection is
occurring in a geographic area largely unaffected by the increase
in syphilis (1,2). Until recently, rates of primary and secondary
syphilis have been low in rural areas of the Midwest (1). Second,
the incidence of syphilis is increasing among adolescents. From
1987 through 1991, the national incidence of primary and secondary
syphilis for persons aged 15-19 years increased 40% (3). Third,
exposure to syphilis and infection may be associated with drug use,
particularly crack cocaine (1,4).
Because syphilis has been rare in rural areas of Kansas, some
health-care workers in those areas may not be familiar with
characteristics of this disease. In particular, physicians may need
to increase their clinical suspicion for syphilis because risk
factors for the disease are widespread. Screening for syphilis
during pregnancy must remain a public health priority, and
increased efforts are needed to educate adolescents about safer sex
practices and substance-abuse prevention.
References
CDC. Primary and secondary syphilis -- United States, 1981-1990.
MMWR 1991;40:314-5,321-3.
Webster L, Rolfs R, Nakashima A, Greenspan J. Regional and
temporal trends in the surveillance of syphilis, United States,
1986-1990. In: CDC surveillance summaries. MMWR 1991:40(no.
SS-3):29-33.
Division of Sexually Transmitted Diseases and HIV Prevention.
Sexually transmitted disease surveillance, 1991. Atlanta: US
Department of Health and Human Services, Public Health Service, CDC
(in press).
CDC. Relationship of syphilis to drug use and
prostitution -- Connecticut and Philadelphia, Pennsylvania. MMWR
1988;37:755-8,764.
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