Agenda - 11-03-1999 - 9c - Laserfiche WebLink

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6 Despite substantial achievements in controlling syphilis during the current syphilis epidemic, North Carolina continues to have unacceptably high syphilis morbidity, including small numbers of congenital syphilis cases. Outbreaks of syphilis continue to appear in areas with lazge at-risk populations. To interrupt syphilis transmission in these high risk communities, the state proposes to develop acommunity-wide syphilis elimination plan for afive-county area in central North Carolina where syphilis morbidity has recently intensified. This five-county target area Forsyth; Guilford, Alamance, Orange, and Durham Counties-- accounted for 285 (39.5%) of the 721 primary and secondary syphilis cases reported from North Carolina's 100. counties in 1997. ~:4CKGROiJND North Carolina ranks~first in the nation in the number of primazy and secondary syphilis cases, and third in the primary and secondary syphilis rate. The current syphilis epidemic, beginn?ng in the middle 1980s, peaked in North Carolina with a primary and secondary syphilis rate of 36.2 cases per 100,000 population in 1992, and subsequently waned, dropping to a raze of 9.7 cases per 100,000 in 1997, a drop of 73.2% in five years. During this time, syphilis rates dropped in all age, race, and gender groups. However, there has been substantial geographic and demographic variability in total syphilis morbiaity and in syphilis trends. From 1992 to 1997, primary and secondary syphilis in the five-county tazget area increased by 4.0%. Among African- Americans in North Cazolina, the primary and secondary syphilis rate dropped 74.7% from 149.3 cases per 100,000 population in 1992 to 37.7 cases per 100,000 in 1997, yet African-Americans .- accounted for 84.3% of primary and secondary syphilis cases in 1997 and had razes more than 25-fold higher than whites. Ten percent of 1997 cases were in whites and the remaining 5.5% in other ethnic groups. Persons with syphilis are older, on average, than persons with other sexually transmitted diseases (STDs). During the current syphilis epidemic in North Carolina, the highest rates inmost years have be°..n among 20- to 24-year-olds. and 25- to 29-year-olds, but since 1995, rates have been. similar in all age groups 20-34 years. In 1997, the highest rate was in 30- to 34-yeaz-olds (24.1 cases/100,000). This relative aging of the population acquiring syphilis is consistent with local observations that the disease has become foctsed in core populations of drag users, commercial sex workers, and associated persons. As the syphilis epidemic has waned in North Carolina., congenital syphilis rates have dropped as well. From 1992 to 1997, cases dropped 82.1 %, from 78 to I4 annual cases. During this time, cases in African-Americans dropped 84.9%, v~~ile cases in whites and Hispanics were stable at low numbers. Populations at risk for syphilis are also at risk for HN, a risk which is compounded by the enhancement of HIV tr~n~~~sion in the presence of genital ulcers. As in other parts of the southeastern United States, heterosexual +*a*-~i~sion is increasingly responsible for the HIV epidemic in North Carolina. The proportion of HIV cases attributed to heterosexual contact in 1994-96 was 3 9%, up from onty 11 % in 199D-93. As with syphilis, minorities are disproportionately impacted by HIV in North Carolina. Outing the 1990-96 period, a stable 77% of HIV cases were in African-Americans, with whites accounting for the majority of the