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rom January to August of this year, syphilis cases in San Francisco were up 54 percent over the same period in 2007, from 305 to 409. City health officials estimate the year-end tally for early syphilis cases will be 493 -- the highest number since 2005, when the agency recorded 551 cases.

"I am very concerned about this recent increase because it comes after three years of consistent and steady declines," said Dr. Jeffrey Klausner, director of STD control for the San Francisco Department of Public Health.

The rising number of cases this year mirrors a trend seen nationally. CDC data show US early and secondary syphilis cases jumped 12 percent last year over 2006, for a total of 11,181. While cases of the STD typically spike in the summer and early fall, San Francisco has logged increases each month since January.

"We do see a trend in the wrong direction," said Klausner. "For the last eight months in a row there has been a steady increase. August was the highest month we have seen in years, probably since 2004," he said.

The characteristics of syphilis patients remain consistent: 97 percent are male, 86 percent are men who have sex with men, and 65 percent are co-infected with HIV. White men comprise 61 percent of cases, Hispanic males 19 percent, black men 13 percent, Asians 6 percent, and Native Americans and Pacific Islanders under 1 percent.

Especially alarming to Klausner is syphilis' impact on African-American women, a group not affected by the STD in over a decade. Though they make up just under 5 percent of cases overall, "going from no cases to less than 5 percent is concerning on multiple levels," particularly given the risk for congenital transmission, he said.