Contrary to a recent trend, syphilis may no longer be primarily linked to homosexual encounters, CDC investigators conclude. In Jefferson County, Ala., almost nine out of 10 new cases involved heterosexual patients.

Public health officials elsewhere in the nation “should remain alert for similar epidemiological shifts,” the authors recommend (MMWR. 2009;58:463-467).

During the first half of this decade, men having sex with men (MSM) accounted for almost half (46.3%) of all new syphilis cases in Jefferson County, which includes the city of Birmingham. The number of cases was also declining, with only nine cases reported in 2002.

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Both trends reversed between 2005 and 2007. The proportion of cases attributable to MSM dropped to 12.3% while the proportion of heterosexual cases rose to 87.7%. The overall number of cases rose to 238 in 2006 before dropping to 167 in 2007.

Women also comprise a larger share of new syphilis cases in the South, the CDC reports. After declining for more than 10 years, syphilis cases in women increased by 69% between 2003 and 2007.

Meanwhile, the U.S. Preventive Services Task Force recently renewed its recommendation that all pregnant women be screened for the disease at their first prenatal visit (Ann Intern Med. 2009; 150:705-709).