{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:17:00Z","timestamp":1790295420467,"version":"4.1.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T00:00:00Z","timestamp":1695427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,30]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n We characterized the rapid increase in syphilis among cisgender women in King County, Washington, and compared it with trends among cisgender men who have sex with men.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n We used surveillance data from King County, 2007 to 2022, to describe incidence trends stratified by syphilis stage, gender, and gender of sex partners; trends in pregnant cases and congenital syphilis; and trends in rapid plasma reagin titer at diagnosis among late\/unknown duration cases. We used joinpoint regression to analyze trends.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among cisgender women, all-stage syphilis incidence remained stable from 2007 to 2010 but then increased by 16.3% per year (95% CI, 12.0%\u201320.7%) from 2010 to 2020 and 90.1% per year (95% CI, 26.4%\u2013185.9%) from 2020 to 2022. Early syphilis rates rose gradually from 2007 to 2017 (18% per year; 95% CI, 7.4%\u201329.6%) and then rapidly from 2017 to 2022 (62.5% per year; 95% CI, 24.1%\u2013112.9%). In contrast, the increase in late\/unknown duration syphilis incidence was delayed. Among cisgender men who have sex with women, all-stage syphilis remained stable from 2007 to 2014 and increased 25.0% per year (95% CI, 14.0%\u201337.0%) from 2014 to 2022. Syphilis incidence increased steadily among men who have sex with men, with all-stage incidence increasing 7.0% per year (95% CI, 4.8%\u20139.2%) from 2007 to 2022. Median rapid plasma reagin titer among late\/unknown duration cases increased significantly over the analysis period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n An explosive epidemic of syphilis is ongoing in King County. The delayed increase in asymptomatic late\/unknown duration cases relative to early symptomatic cases suggests that there is a large and growing reservoir of recently acquired undiagnosed syphilis in women. New clinical and public health activities are urgently needed to control the growing epidemic.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ofid\/ofad481","type":"journal-article","created":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T00:38:42Z","timestamp":1695515922000},"source":"Crossref","is-referenced-by-count":14,"title":["The Syphilis Epidemic Among Heterosexuals Is Accelerating: Evidence From King County, Washington"],"prefix":"10.1093","volume":"10","author":[{"given":"Anna","family":"Berzkalns","sequence":"first","affiliation":[{"name":"HIV\/STD\/HCV Program, Public Health\u2013Seattle & King County , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meena S","family":"Ramchandani","sequence":"additional","affiliation":[{"name":"HIV\/STD\/HCV Program, Public Health\u2013Seattle & King County , Seattle, Washington , USA"},{"name":"Department of Medicine, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chase A","family":"Cannon","sequence":"additional","affiliation":[{"name":"HIV\/STD\/HCV Program, Public Health\u2013Seattle & King County , Seattle, Washington , USA"},{"name":"Department of Medicine, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne P","family":"Kerani","sequence":"additional","affiliation":[{"name":"HIV\/STD\/HCV Program, Public Health\u2013Seattle & King County , Seattle, Washington , USA"},{"name":"Department of Medicine, University of Washington , Seattle, Washington , USA"},{"name":"Department of Epidemiology, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C","family":"Dombrowski","sequence":"additional","affiliation":[{"name":"HIV\/STD\/HCV Program, Public Health\u2013Seattle & King County , Seattle, Washington , USA"},{"name":"Department of Medicine, University of Washington , Seattle, Washington , USA"},{"name":"Department of Epidemiology, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R","family":"Golden","sequence":"additional","affiliation":[{"name":"HIV\/STD\/HCV Program, Public Health\u2013Seattle & King County , Seattle, Washington , USA"},{"name":"Department of Medicine, University of Washington , Seattle, Washington , USA"},{"name":"Department of Epidemiology, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,23]]},"reference":[{"key":"2023101818430217500_ofad481-B1","volume-title":"Sexually transmitted disease surveillance 2021","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"2023101818430217500_ofad481-B2","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1001\/jama.1990.03450110078031","article-title":"Epidemiology of primary and secondary syphilis in the United States, 1981 through 1989","volume":"264","author":"Rolfs","year":"1990","journal-title":"JAMA"},{"key":"2023101818430217500_ofad481-B3","first-page":"13","article-title":"Surveillance for primary and secondary syphilis\u2014United States, 1991","volume":"42","author":"Webster","year":"1993","journal-title":"MMWR CDC Surveill Summ"},{"key":"2023101818430217500_ofad481-B4","first-page":"155","article-title":"Comparison of early and late latent syphilis\u2013Colorado, 1991","volume":"42","author":"Centers for Disease Control and Prevention","year":"1993","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023101818430217500_ofad481-B5","volume-title":"Behavioral risk factor surveillance system","author":"Centers for Disease Control and Prevention","year":"2023"},{"key":"2023101818430217500_ofad481-B6","volume-title":"HIV\/AIDS epidemiology report and community profile","author":"Washington Department of Health, Public Health\u2013Seattle & King County","year":"2022"},{"key":"2023101818430217500_ofad481-B7","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":". Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"2023101818430217500_ofad481-B8","volume-title":"Joinpoint regression program, version 4.9.1.0","author":"Statistical Methodology and Applications Branch","year":"2022"},{"key":"2023101818430217500_ofad481-B9","volume-title":"2020 King County sexually transmitted infection epidemiology report","author":"Public Health\u2013Seattle & King County","year":"2021"},{"key":"2023101818430217500_ofad481-B10","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciab287","article-title":"Previous syphilis alters the course of subsequent episodes of syphilis","volume":"74","author":"Marra","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2023101818430217500_ofad481-B11","volume-title":"Shadow on the land: syphilis","author":"Parran","year":"1937"},{"key":"2023101818430217500_ofad481-B12","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1093\/oxfordjournals.aje.a114527","article-title":"Epidemiology of an outbreak of infectious syphilis in Manitoba","volume":"125","author":"Lee","year":"1987","journal-title":"Am J Epidemiol"},{"key":"2023101818430217500_ofad481-B13","article-title":"Rapid syphilis testing in jail: results of a pilot project in King County","author":"Dombrowski","year":"19\u201322 2022"},{"key":"2023101818430217500_ofad481-B14","article-title":"Congenital syphilis letter to providers and screening guidelines","author":"Washington Department of Health, Public Health\u2013Seattle & King County","year":"2022"},{"key":"2023101818430217500_ofad481-B15","article-title":"Expanded syphilis screening recommendations for the prevention of congenital syphilis","author":"California Department of Health","year":"2022"},{"key":"2023101818430217500_ofad481-B16","article-title":"2022 Oregon STI screening recommendations","author":"Oregon Health Authority","year":"2022"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofad481\/51740270\/ofad481.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/10\/10\/ofad481\/52222097\/ofad481.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/10\/10\/ofad481\/52222097\/ofad481.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T14:43:24Z","timestamp":1697640204000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofad481\/7281641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,23]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,9,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofad481","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,10]]},"published":{"date-parts":[[2023,9,23]]},"article-number":"ofad481"}}