The 2006 National Plan to Eliminate Syphilis from the United States – Executive Summary

In 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. In the plan, CDC identified key strategies needed for successful elimination of syphilis from the United States: expanded surveillance and outbreak response activities, rapid screening and treatment in and out of medical settings, expanded laboratory services, strengthened community involvement and agency partnerships, and enhanced health promotion.

In the six 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 2001, diagnoses of primary and secondary syphilis are again on the increase. Today, more than 60% of new infections are diagnosed in men who have sex with men (MSM).

The evolving epidemiology, changing risk groups, and social environments present challenges for elimination and STD program activities. Syphilis is now increasingly diagnosed in the private sector, raising concerns about the effectiveness of the identification and management in this setting. Public health services face increasing pressures from rising demand and decreasing financial resources. 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 reframing the future of the Syphilis Elimination Effort, CDC’s vision is to create a dynamic, evidence-based and culturally competent prevention and control action plan for the elimination of syphilis from the United States. By 2010, interim elimination targets will be to reduce rates of primary and secondary syphilis in the United States to less than 2.2 per 100,000 population; congenital syphilis to fewer than 3.9 per 100,000 live births; and Black: White racial disparities to a ratio of less than 3:1. In order to achieve this, CDC will focus syphilis elimination activities in achieving three strategic goals: Investment in and enhancement of public health services; prioritization of evidence-based, culturally competent interventions; and creating accountable services and interventions.

For each of the three goals, CDC recommends that syphilis elimination activities be delivered in three strategic areas of focus (The 3-By-3 approach to syphilis elimination). This results in nine strategies: Surveillance, Clinical and Laboratory Services, Community Mobilization, Health care Provider Mobilization; Tailoring of Interventions; Evidence-based Action Planning, Monitoring and Evaluation; Training and Staff Development; and Research.

This plan provides a framework for continuing to deliver interventions aimed at eliminating syphilis as a public health problem in the United States. It should not be seen as a rigid blueprint for eliminating syphilis instantly. Rather, the plan provides guidance that helps local, state, and national partners to effectively focus on the problem in order to get the most important things done in the most cost-effective, ethical, and acceptable ways possible. Further details on the strategies and recommended activities are contained in an accompanying Syphilis Elimination Technical Appendix (SETA).