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SYPHILIS (EARLY AND CONGENITAL) Reported cases and case rates of early syphilis decreased in 1993, the third year of decreases in New York State excluding New York City since the peaking of the epidemic in 1990. Syphilis reports in New York City and nationally experienced similar downturns. New York State excluding New York City cases totaled 767 in 1993 compared to 1,090 in 1992, a decrease of 29.6 percent and less than half the 1,584 cases reported in 1991. Nationally, reported cases totaled 96,805 in 1993 compared to 105,355 in 1990 (-8.1%), while New York City had 4,876 cases in 1993 vs. 7,619 in 1992 (-36.0%). Syphilis continued to be a disease that afflicts minority and economically distressed populations residing primarily in urban areas. Nassau, Suffolk, Westchester, Rockland and Orange counties, proximate to New York City, continue to display the highest case rates (along with New York City) in the state. Drug abuse remains a catalyst for transmission. Behaviors associated with use, possession and sale of "crack" cocaine - sex for drugs/drugs for sex, more traditional prostitution activity, multiple and anonymous sexual events which routinely occur in "crack" houses - facilitate disease transmission and confound case intervention efforts by public health workers. Congenital syphilis has not sustained its trend of dramatic increase first noted in 1988 in New York City (357 reports vs. 142 the previous year) and outside New York City (20 vs. three in 1987). Numbers of reported cases showed a leveling trend starting in 1990 and continuing through 1993, with 671 cases reported in New York City and 94 cases reported upstate. Syphilis Early Latent Rate per 100,000 NYS (excluding NYC), New York City & Total NYS 1984 - 1993 110 100 90 80 70 60 50 40 30 20 10 0 1984 1985 1986 1987 1988 1989 1990 1991 NYS (excluding NYC) New York City Total New York State 48 1992 1993