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{{CMG}} {{AE}} {{AA}}; {{NRM}}
{{Syphilis}}
{{Syphilis}}
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==Overview==
In 2012, the incidence of syphilis was estimated to be 6 million cases worldwide. From year 2005 to 2014, the incidence of syphilis in the United States increased from 2.9 to 6.3 cases/100,000/year. The rate of reported cases increased by 15.1% between 2013 and 2014 in the United States.<ref name=CDC>https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref> Syphilis incidence increased in every region of the Untied States in 2014, with the highest rate in the West and lowest rate in the Midwest. In 2012, the [[prevalence]] of syphilis was estimated to be approximately 18 million cases in men and women aged 15-29 worldwide.<ref name="pmid26646541">{{cite journal| author=Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N et al.| title=Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. | journal=PLoS One | year= 2015 | volume= 10 | issue= 12 | pages= e0143304 | pmid=26646541 | doi=10.1371/journal.pone.0143304 | pmc=4672879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26646541  }} </ref> The incidence and prevalence of syphilis may be affected by age, gender, race, sexual behavior and geographical distribution.<ref name=CDC>https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref><ref name="pmid23403598">{{cite journal| author=Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC et al.| title=Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 3 | pages= 187-93 | pmid=23403598 | doi=10.1097/OLQ.0b013e318286bb53 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23403598  }} </ref><ref name=WHO2012>http://apps.who.int/iris/bitstream/10665/85376/1/9789241505895_eng.pdf?=1 Accessed on September 16, 2016</ref><ref name="pmid23049658">{{cite journal| author=Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P et al.| title=Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. | journal=Open AIDS J | year= 2012 | volume= 6 | issue=  | pages= 98-107 | pmid=23049658 | doi=10.2174/1874613601206010098 | pmc=3462414 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23049658  }} </ref><ref name="pmid17463387">{{cite journal| author=Heffelfinger JD, Swint EB, Berman SM, Weinstock HS| title=Trends in primary and secondary syphilis among men who have sex with men in the United States. | journal=Am J Public Health | year= 2007 | volume= 97 | issue= 6 | pages= 1076-83 | pmid=17463387 | doi=10.2105/AJPH.2005.070417 | pmc=1874206 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17463387  }} </ref><ref name="pmid6893897">{{cite journal| author=Judson FN, Penley KA, Robinson ME, Smith JK| title=Comparative prevalence rates of sexually transmitted diseases in heterosexual and homosexual men. | journal=Am J Epidemiol | year= 1980 | volume= 112 | issue= 6 | pages= 836-43 | pmid=6893897 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6893897  }} </ref>
 
==Epidemiology ==
===Incidence===
*Worldwide incidence of syphilis:
**2004: approximately 12 million cases<ref name="pmid15247352">{{cite journal| author=Hook EW, Peeling RW| title=Syphilis control--a continuing challenge. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 2 | pages= 122-4 | pmid=15247352 | doi=10.1056/NEJMp048126 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15247352  }} </ref>
**2008: approximately 10.9 million cases<ref name="WHO">http://apps.who.int/iris/bitstream/10665/75181/1/9789241503839_eng.pdf Accessed on September 16, 2016</ref><ref name="pmid23198131">{{cite journal| author=Herbert LJ, Middleton SI| title=An estimate of syphilis incidence in Eastern Europe. | journal=J Glob Health | year= 2012 | volume= 2 | issue= 1 | pages= 010402 | pmid=23198131 | doi=10.7189/jogh.02.010402 | pmc=3484754 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198131  }} </ref><ref name="pmid27167068">{{cite journal| author=Kenyon CR, Osbak K, Tsoumanis A| title=The Global Epidemiology of Syphilis in the Past Century - A Systematic Review Based on Antenatal Syphilis Prevalence. | journal=PLoS Negl Trop Dis | year= 2016 | volume= 10 | issue= 5 | pages= e0004711 | pmid=27167068 | doi=10.1371/journal.pntd.0004711 | pmc=4864207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27167068  }} </ref>
**2012: approximately 6 million cases<ref name="pmid26646541">{{cite journal| author=Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N et al.| title=Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. | journal=PLoS One | year= 2015 | volume= 10 | issue= 12 | pages= e0143304 | pmid=26646541 | doi=10.1371/journal.pone.0143304 | pmc=4672879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26646541  }} </ref>
*Incidence of syphilis in the United States:
**From 2005 to 2014, the incidence of primary and secondary syphilis increased from 2.9 to 6.3 cases/100,000/year.
**From 2009 to 2014, the incidence of late and latent syphilis increased from 5.6 to 7.4 cases/100,000/year.
**The rate of reported cases increased by 15.1% between 2013 and 2014.<ref name="CDC">https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref>
**Syphilis incidence increased in every region of the Untied States in 2014, with the highest rate in the West and lowest rate in the Midwest.
[[Image:Syphliscdcgraph2.jpg|800px|center|thumb|Source: https://www.cdc.gov/]]
 
===Prevalence===
*In 2008, the [[prevalence]] of syphilis was estimated to be 36.4 million cases worldwide.<ref name=WHO>http://apps.who.int/iris/bitstream/10665/75181/1/9789241503839_eng.pdf Accessed on September 16, 2016</ref>
*In 2012, the prevalence of syphilis is estimated to be 18 million cases in men and women aged 15-29 worldwide.<ref name="pmid26646541">{{cite journal| author=Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N et al.| title=Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. | journal=PLoS One | year= 2015 | volume= 10 | issue= 12 | pages= e0143304 | pmid=26646541 | doi=10.1371/journal.pone.0143304 | pmc=4672879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26646541  }} </ref>
*In 2014, the prevalence of syphilis in the United States was estimated to be 20 cases/100,000 individuals.<ref name=CDC>https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref>


==Overview==
==Demographics ==  
Syphilis, a genital ulcerative disease, causes significant complications if untreated and facilitates the transmission of [[HIV]]. Untreated early syphilis in pregnant women 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.<ref name="pmid14829195">{{cite journal |author=INGRAHAM NR |title=The value of penicillin alone in the prevention and treatment of congenital syphilis |journal=[[Acta Dermato-venereologica. Supplementum]] |volume=31 |issue=Suppl. 24 |pages=60–87 |year=1950 |pmid=14829195 |doi= |url= |accessdate=2012-02-10}}</ref>
The incidence and prevalence of syphilis may be affected by the following demographic factors:<ref name=CDC>https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref><ref name=WHO2012>http://apps.who.int/iris/bitstream/10665/85376/1/9789241505895_eng.pdf?ua=1 Accessed on September 16, 2016</ref>


The rate of primary and secondary syphilis reported in the United States decreased during the 1990s; in 2000, the rate was the lowest since reporting began in 1941. The low rate of infectious syphilis and the concentration of the majority of syphilis cases in a small number of geographic areas in the United States led to the development of the CDCs National Plan to Eliminate Syphilis, which was announced by Surgeon General David Satcher in October 1999 and revised in May 2006.[http://www.cdc.gov/stopsyphilis/plan.htm 2]
===Age===
In 2014, the highest rate of primary and secondary syphilis in the United States was seen in age groups 20-24 years and 25-29 years.<ref name=CDC>https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref><ref name="pmid23403598">{{cite journal| author=Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC et al.| title=Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 3 | pages= 187-93 | pmid=23403598 | doi=10.1097/OLQ.0b013e318286bb53 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23403598  }} </ref>


Although the rate of primary and secondary syphilis in the United States declined 89.7% between 1990 and 2000, the rate of primary and secondary syphilis increased annually between 2001 and 2007. Overall increases in rates between 2001 and 2007 were observed primarily among men (from 3.0 cases per 100,000 population to 6.6 cases per 100,000 population). After persistent declines from 1992 to 2003, the rate of primary and secondary syphilis among women increased from 0.8 cases per 100,000 population in 2004 to 0.9 cases per 100,000 population in 2005 to 1.0 case per 100,000 population in 2006, to 1.1 case per 100,000 population in 2007.
[[Image:Syphilis Age and sex.jpg|center|500px|thumb|Source: https://www.cdc.gov/]]


Syphilis remains an important problem in the South and in urban areas in other regions of the country. Increases in cases among MSM have occurred and have been characterized by high rates of HIV co-infection and high-risk sexual behavior.3-7 The estimated proportion of primary and secondary syphilis cases attributable to MSM increased from 4% in 2000 to 62% in 2004. In 2005, CDC requested that all state health departments report sex of sex partners for persons with syphilis. In 2007, 65% of those primary and secondary syphilis cases in 44 states and Washington D.C. with available information were among MSM. Of reported male cases with primary and secondary syphilis, sex of partner information in 2007 was available for 79%.
===Gender===
*There is increased [[incidence]] of primary and secondary syphilis in men who have sex with men (MSM).
**In 2014, 61% of 19,999 total reported cases of primary and secondary syphilis were estimated to be among MSM.<ref name="CDC">https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref><ref name="WHO2012">http://apps.who.int/iris/bitstream/10665/85376/1/9789241505895_eng.pdf?=1 Accessed on September 16, 2016</ref><ref name="pmid23049658">{{cite journal| author=Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P et al.| title=Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. | journal=Open AIDS J | year= 2012 | volume= 6 | issue=  | pages= 98-107 | pmid=23049658 | doi=10.2174/1874613601206010098 | pmc=3462414 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23049658  }} </ref><ref name="pmid17463387">{{cite journal| author=Heffelfinger JD, Swint EB, Berman SM, Weinstock HS| title=Trends in primary and secondary syphilis among men who have sex with men in the United States. | journal=Am J Public Health | year= 2007 | volume= 97 | issue= 6 | pages= 1076-83 | pmid=17463387 | doi=10.2105/AJPH.2005.070417 | pmc=1874206 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17463387  }} </ref><ref name="pmid6893897">{{cite journal| author=Judson FN, Penley KA, Robinson ME, Smith JK| title=Comparative prevalence rates of sexually transmitted diseases in heterosexual and homosexual men. | journal=Am J Epidemiol | year= 1980 | volume= 112 | issue= 6 | pages= 836-43 | pmid=6893897 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6893897  }} </ref>


==Syphilis: All Stages==
====Primary and Secondary Syphilis — Reported Cases by Stage, Sex, and Sexual Behavior, 2014====
Depending on the different manifestations that occur depending on the stage of the disease, syphilis is classified into primary & secondary, early latent, late, late latent and congenital.


Between 2006 and 2007, the number of cases of early latent syphilis reported to CDC increased 17.2% (from 9,186 to 10,768), while the number of cases of late and late latent syphilis increased 3.5% (from 17,644 to 18,256)[http://www.cdc.gov/std/stats07/tables/1.htm 3]. The total number of cases of syphilis (all stages: primary and secondary, early latent, late, late latent, and congenital syphilis) reported to CDC increased 10.7% (from 36, 959 to 40, 920) between 2006 and 2007 [http://www.cdc.gov/std/stats07/tables/1.htm 3].
[[Image:Syphilis 3.jpg|500px|center|thumb|Source: https://www.cdc.gov/]]


==Primary & Secondary Syphilis: United States==
===Race===
In 2007, primary and secondary syphilis cases reported to CDC increased to 11,466 from 9,756 in 2006, an increase of 17.5%. The rate of primary and secondary syphilis in the United States in 2007 (3.8 cases per 100,000 population) was 15.2% higher than the rate in 2006 (3.3 cases per 100,000 population), and it is greater than the HP 2010 target of 0.2 case per 100,000 population [http://www.cdc.gov/std/stats07/tables/1.htm 3].
*Syphilis is more prevalent in the African American population as compared to other racial groups.<ref name="pmid26646541">{{cite journal| author=Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N et al.| title=Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. | journal=PLoS One | year= 2015 | volume= 10 | issue= 12 | pages= e0143304 | pmid=26646541 | doi=10.1371/journal.pone.0143304 | pmc=4672879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26646541  }} </ref>
*In 2014, the highest incidence of primary and secondary syphilis in the United States was reported to be in the African American population and the lowest incidence was observed in Caucasisans, Asians and multiracial groups.<ref name=CDC>https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016</ref>


[[File:Primary and secondary syphilis rates.gif|thumb|Note: The Healthy People 2010 target for primary & secondary syphilis is 0.2 case per 100,000 population.|left|650px]]<br clear="left"/>
====Primary and Secondary Syphilis — Reported Cases by Sex, Sexual Behavior, and Race/Ethnicity, United States, 2014====


===By Region===
[[Image:Syphilis 4.jpg|500px|center|thumb|Source: https://www.cdc.gov/]]
The South accounted for 48.8% of the primary and secondary syphilis cases in 2007 and 47.1% in 2006. Between 2006 and 2007, rates increased 21.4% in the South (from 4.2 to 5.1 cases per 100,000 population), 30.8% in the Northeast (from 2.6 to 3.4), 8.1% in the West (from 3.7 to 4.0) and 5.6% in the Midwest (from 1.8 to 1.9). The 2007 rates in all regions were greater than the HP 2010 target of 0.2 cases per 100,000 population [http://www.cdc.gov/std/stats07/tables/25.htm 4].


[[File:Primary and secondary syphilis rates by region.gif|thumb|Note: The Healthy People 2010 target for primary & secondary syphilis is 0.2 case per 100,000 population.|left|650px]]<br clear="left"/>
===Geographical distribution===


===By State===
Worldwide, the highest [[incidence]] and [[prevalence]] of syphilis was seen in Africa and South East Asia, while the lowest was seen in Europe and the Eastern Mediterranean region in 2012.<ref name="pmid26646541">{{cite journal| author=Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N et al.| title=Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. | journal=PLoS One | year= 2015 | volume= 10 | issue= 12 | pages= e0143304 | pmid=26646541 | doi=10.1371/journal.pone.0143304 | pmc=4672879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26646541  }} </ref>
In 2007, primary and secondary syphilis rates in three states were less than or equal to the HP 2010 target of 0.2 case per 100,000 population [http://www.cdc.gov/std/stats07/tables/24.htm 5]. Four states and one outlying area reported five or fewer cases of P&S syphilis in 2007 [http://www.cdc.gov/std/stats07/tables/24.htm 5].


[[File:Primary and secondary syphilis rates by state.gif|thumb|Note: The total rate of primary & secondary syphilis for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 3.8 per 100,000 population. The Healthy People 2010 target is 0.2 case per 100,000 population.|left|650px]]<br clear="left"/>
'''United States'''


===By Metropolitan Statistical Area (MSA)===
:*Rates of reported cases of primary and secondary syphilis by state for 2014 is shown in the map below:
The rate of primary and secondary syphilis in 2007 for the 50 most populous MSAs (5.7) exceeded the HP 2010 target of 0.2 cases per 100,000 population [http://www.cdc.gov/std/stats07/tables/28.htm 6].


:[[Image:Syphilis 7.jpg|500px|thumb|center|Source: https://www.cdc.gov/]]


:*Rates of reported cases of primary and secondary syphilis by region for 2014 is shown in the map below:


==Resources==
:[[Image:Syphilis 6.jpg|500px|center|thumb|Source: https://www.cdc.gov/]]
[http://www.cdc.gov/std/stats07/syphilis.htm CDC Syphilis stats]


==References==
==References==
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Overview

In 2012, the incidence of syphilis was estimated to be 6 million cases worldwide. From year 2005 to 2014, the incidence of syphilis in the United States increased from 2.9 to 6.3 cases/100,000/year. The rate of reported cases increased by 15.1% between 2013 and 2014 in the United States.[1] Syphilis incidence increased in every region of the Untied States in 2014, with the highest rate in the West and lowest rate in the Midwest. In 2012, the prevalence of syphilis was estimated to be approximately 18 million cases in men and women aged 15-29 worldwide.[2] The incidence and prevalence of syphilis may be affected by age, gender, race, sexual behavior and geographical distribution.[1][3][4][5][6][7]

Epidemiology

Incidence

  • Worldwide incidence of syphilis:
    • 2004: approximately 12 million cases[8]
    • 2008: approximately 10.9 million cases[9][10][11]
    • 2012: approximately 6 million cases[2]
  • Incidence of syphilis in the United States:
    • From 2005 to 2014, the incidence of primary and secondary syphilis increased from 2.9 to 6.3 cases/100,000/year.
    • From 2009 to 2014, the incidence of late and latent syphilis increased from 5.6 to 7.4 cases/100,000/year.
    • The rate of reported cases increased by 15.1% between 2013 and 2014.[1]
    • Syphilis incidence increased in every region of the Untied States in 2014, with the highest rate in the West and lowest rate in the Midwest.
Source: https://www.cdc.gov/

Prevalence

  • In 2008, the prevalence of syphilis was estimated to be 36.4 million cases worldwide.[9]
  • In 2012, the prevalence of syphilis is estimated to be 18 million cases in men and women aged 15-29 worldwide.[2]
  • In 2014, the prevalence of syphilis in the United States was estimated to be 20 cases/100,000 individuals.[1]

Demographics

The incidence and prevalence of syphilis may be affected by the following demographic factors:[1][4]

Age

In 2014, the highest rate of primary and secondary syphilis in the United States was seen in age groups 20-24 years and 25-29 years.[1][3]

Source: https://www.cdc.gov/

Gender

  • There is increased incidence of primary and secondary syphilis in men who have sex with men (MSM).
    • In 2014, 61% of 19,999 total reported cases of primary and secondary syphilis were estimated to be among MSM.[1][4][5][6][7]

Primary and Secondary Syphilis — Reported Cases by Stage, Sex, and Sexual Behavior, 2014

Source: https://www.cdc.gov/

Race

  • Syphilis is more prevalent in the African American population as compared to other racial groups.[2]
  • In 2014, the highest incidence of primary and secondary syphilis in the United States was reported to be in the African American population and the lowest incidence was observed in Caucasisans, Asians and multiracial groups.[1]

Primary and Secondary Syphilis — Reported Cases by Sex, Sexual Behavior, and Race/Ethnicity, United States, 2014

Source: https://www.cdc.gov/

Geographical distribution

Worldwide, the highest incidence and prevalence of syphilis was seen in Africa and South East Asia, while the lowest was seen in Europe and the Eastern Mediterranean region in 2012.[2]

United States

  • Rates of reported cases of primary and secondary syphilis by state for 2014 is shown in the map below:
Source: https://www.cdc.gov/
  • Rates of reported cases of primary and secondary syphilis by region for 2014 is shown in the map below:
Source: https://www.cdc.gov/

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 https://www.cdc.gov/std/stats14/surv-2014-print.pdf Accessed on September 16, 2016
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N; et al. (2015). "Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting". PLoS One. 10 (12): e0143304. doi:10.1371/journal.pone.0143304. PMC 4672879. PMID 26646541.
  3. ↑ 3.0 3.1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC; et al. (2013). "Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008". Sex Transm Dis. 40 (3): 187–93. doi:10.1097/OLQ.0b013e318286bb53. PMID 23403598.
  4. ↑ 4.0 4.1 4.2 http://apps.who.int/iris/bitstream/10665/85376/1/9789241505895_eng.pdf?=1 Accessed on September 16, 2016
  5. ↑ 5.0 5.1 Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P; et al. (2012). "Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates". Open AIDS J. 6: 98–107. doi:10.2174/1874613601206010098. PMC 3462414. PMID 23049658.
  6. ↑ 6.0 6.1 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS (2007). "Trends in primary and secondary syphilis among men who have sex with men in the United States". Am J Public Health. 97 (6): 1076–83. doi:10.2105/AJPH.2005.070417. PMC 1874206. PMID 17463387.
  7. ↑ 7.0 7.1 Judson FN, Penley KA, Robinson ME, Smith JK (1980). "Comparative prevalence rates of sexually transmitted diseases in heterosexual and homosexual men". Am J Epidemiol. 112 (6): 836–43. PMID 6893897.
  8. ↑ Hook EW, Peeling RW (2004). "Syphilis control--a continuing challenge". N Engl J Med. 351 (2): 122–4. doi:10.1056/NEJMp048126. PMID 15247352.
  9. ↑ 9.0 9.1 http://apps.who.int/iris/bitstream/10665/75181/1/9789241503839_eng.pdf Accessed on September 16, 2016
  10. ↑ Herbert LJ, Middleton SI (2012). "An estimate of syphilis incidence in Eastern Europe". J Glob Health. 2 (1): 010402. doi:10.7189/jogh.02.010402. PMC 3484754. PMID 23198131.
  11. ↑ Kenyon CR, Osbak K, Tsoumanis A (2016). "The Global Epidemiology of Syphilis in the Past Century - A Systematic Review Based on Antenatal Syphilis Prevalence". PLoS Negl Trop Dis. 10 (5): e0004711. doi:10.1371/journal.pntd.0004711. PMC 4864207. PMID 27167068.


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