New Hampshire, which saw only a sporadic incidence of syphilis for almost a decade, reported 19 cases in 2003. The state's case load fell from 19 in 1993 to five in 1994. Over the next seven years combined, it saw just eight cases. Then cases jumped to eight in 2002 before more than doubling in 2003.
State medical director William Kassler likened the upturn to "the canary in the coal mine. That indicates we've got some real problems," he says, calling syphilis "a marker for unsafe sex." Most of the new cases involved gay men, but there is also a small outbreak among young heterosexuals.
Kassler blames the syphilis rise on complacency among gay men, who are no longer as fearful of contracting HIV as they were at the height of the AIDS crisis. He says the most disturbing aspect of the syphilis increase is that it indicates New Hampshire will likely see a rise in HIV cases in the next few years because syphilis infection aids in the transmission of HIV. Four of the individuals contracting syphilis were also HIV-infected. While the number of annually diagnosed HIV cases has not fluctuated much in recent years, more people are being diagnosed in the later stages of the illness.
Chlamydia has steadily increased in New Hampshire from 1999 to 2003, when 1,610 cases were reported. While gonorrhea cases held steady at 123, both diseases infected an increased number of teenagers.
"STDs are among the most underrecognized health problems in the country," Kassler says. "Teens are more biologically susceptible to STDs, and behaviorally they're at a stage of their life when they take risks."