July 2004

KING COUNTY - From May to July 2004 primary or secondary syphilis was diagnosed in four heterosexual, African-American men, and one woman in King County. Three of the men acknowledged using crack cocaine and having sex with commercial sex workers. The men each reported sex with 5-50 female partners in the 90 days preceding their onset of symptoms. All five syphilis cases were HIV negative. One man reported a sex partner from out of the area. The sole case in a woman occurred in a commercial sex worker.

Although the number of cases is small, they are of special concern because of their epidemiologic similarity to cases occurring in the late 1980s and early 1990s, when there was an epidemic of syphilis, both nationally and in King County, among commercial sex workers and crack cocaine users; most cases at that time were in African-Americans1. That epidemic ended in King County in the mid-1990s, and no cases of syphilis were acquired locally in 1996. From then until this year, King County has seen few syphilis cases in heterosexuals, with no apparent link between the infection and commercial sex or specific drugs2.

These new cases highlight the continued vulnerability of commercial sex workers, their clients, and crack cocaine users to syphilis. Clinicians should continue to have a low threshold for suspecting syphilis, and should undertake diagnosis and laboratory screening in heterosexuals who acknowledge commercial sex or crack cocaine use. Because King County's epidemic of syphilis in men who have sex with men (MSM) continues unabated, vigilance in testing for syphilis in MSM also remains a priority.

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1.	Alternative case-finding methods in a crack-related syphilis epidemic--Philadelphia. MMWR Morb Mortal Wkly Rep 1991; 40:77-80.
2.	Williams LA, Klausner JD, Whittington WL, Handsfield HH, Celum C, Holmes KK. Elimination and reintroduction of primary and secondary syphilis. Am J Public Health 1999; 89:1093-7.