Déjà vu? A Comparison of Syphilis Outbreaks in Houston, Texas

After reaching an all-time low in 2000, syphilisincidence in the United States has increased as the burden shifted from heterosexuals to men who have sexwith men(MSM). Houston, Texas, experienced 2 outbreaks of syphilisduring this transformation in trends. Further evaluation is necessary to determine if these outbreaks occurred among the same subpopulations.Surveillance data collected on all reported infectious syphiliscases in Houston from 1971 to 2013 were analyzed. Trends in incidence among MSM and human immunodeficiency virus-positive Houston residents were examined. Peak syphilisyears subsequent to 1999, years 2007 and 2012, were compared to determine if outbreaks arose in distinctive subpopulations. Categorical variablesbetween these years were compared using chi-square and Fisher's exact tests, whereas further associations between the years were evaluated using multivariable logistic regression.Incidence among MSM was 20.9 to 32.1 times higher than other men from 2005 to 2013. After adjusting for covariates, cases in 2012 were significantly more likely to be Hispanic (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [95% CI], 1.03-2.53), reported meeting partners via the Internet (AOR, 1.74; 95% CI, 1.18-2.58), and engaged in anonymous sex (AOR, 1.92; 95% CI, 1.40-2.63) in comparison to cases in 2007.We found marked disparities of syphilisby subpopulation in Houston. Herein, we present evidence that outbreaks have been distinct in a major southern city with a high burden of syphilis.