western europe have also seen a major increase in syphilis in recent times. a study called "are trends in hiv, gonorrhea, and syphilis worsening in western europe?" in a journal of medicine called bmj outlines the data collected from 1995 to 2000 on sexually transmitted diseases throughout western europe. as with russia and china there was a big decline in syphilis before 1980 but a big resurgence during the 1990s. another major way of spreading the disease is the sharing of needles between drug users. england and wales saw a slight drop and then increase of syphilis cases between 1995 and 2000 and a drastic increase in syphilis contraction through homosexual men in 2000. the increase in western europe can be attributed to the practice of unprotected sex and young people are having more sex than they have had in the past. due to a lack of modern surveillance programs and various governments in europe there is not definitive data to show how prevalent the spread of syphilis is throughout every country in western europe. united states the united states mirrored the global trend with a sharp increase in syphilis during the 1990s up till the present. the united states saw a big decrease in the number of cases in the 1950s, with only around 6500 cases were reported per year, which was statistically about what other countries were seeing at the time. this continued with a varying increase around the 1960s and 1970s with around 19,000 and 26,000 cases per year up until the beginning of the 1990s. the centers for disease control and prevention (cdc) published their findings in 2013 with 19,738,800 almost 15% of those were from syphilis. it has been found that men and women are equally as likely to have syphilis in the united states. it is thought that the number of new cases of syphilis along with the current amount is around 117,000 people have syphilis in the united states. to combat the increase in syphilis and other various sexually transmitted diseases, the united states focuses on prevention programs where the focus is on practicing safe sex and being aware of whether ones partner has syphilis. pregnant women, which have a high risk of infecting their children, are required to take syphilis screening and given treatment if they are found to be carrying the disease. modern travel and the internet all of these countries have in common a theme of travel in between countries which increases how prevalent and far reaching the disease can reach. not only is travel linked to the reemergence of syphilis but also the internet has been a major factor in syphilis being transferred from person to person. a study done in 2000 titled "tracing a syphilis outbreak through cyberspace" published in the journal of the american medical association shows that internet chat rooms increase the frequency of sexual contact between people, especially those of gay men. in a specific outbreak in san francisco gay men with syphilis were found to be a lot more probable to have met their significant other through the internet. the ratio was found to be that 67% of the men met their partner through an internet chat room and only 19% of those with reported syphilis were not linked to the internet. the internet is a global force that facilitates sexual encounters among people which spreads the disease to many people who otherwise would not be in contact with syphilis. global impacts this global re-emergence of syphilis is a major problem for every country affected. according to a study titled "global prevalence and incidence estimates of selectable curable std's" in a journal named sex transm inf the number of syphilis cases reported within the 9 main un territories in 1995 was roughly around 12 million cases. the main population that was reported to have the disease was the people who were lower in the economy and younger people are reported to have more of the disease than older people. out of the nine un regions that were surveyed the region that syphilis was the most prevalent was south and south eastern asia. the second highest was found to be in the sub saharan parts of africa and the third highest was latin america and the caribbean areas. this study in 1995 was one of the first big attempts by the world health organization to find a good estimate of the total population of people with syphilis and other stds. studies by the world health organization pinpoint how prevalent syphilis is globally. an article called "congenital syphilis re-emerging" in a medical journal titled jddg outlines the world health organizations findings as recently as 2008. it is estimated that globally 12 million people acquire the disease every year and of these 12 million patients 2 million are pregnant women. this high number of pregnant women with the disease estimates that it will cause about 50% of the pregnancies to result in stillbirth or prenatal death. the world health organization estimates that syphilis in within the mother can cause syphilis in the baby between 713,600 cases and 1,575,000 cases. eradication because of the increased numbers of patients globally there have been many initiatives to prevent the spread of the disease and there has been a global effort to eradicate the disease. an article titled "a road map for the global elimination of congenital syphilis" within a medical journal called obstetrics and gynecology international outlines the global efforts to combat congenital syphilis mostly dealing with the world health organization. many of the efforts are focused on screening women who are pregnant for the disease and treating them. of the two million pregnancies each year that test positive for syphilis they make up 1.5% of every pregnancy throughout the world. in 2007, the world health organization estimated that in the countries that are affected most by congenital syphilis, it would cost roughly 3 to 4 million dollars to start a program that could potentially eliminate most of the threat of congenital syphilis by focusing a lot more on screening and treatment. countries in sub-saharan africa find it difficult to implement these kinds of treatment due to a lack of health services for their citizens which in turn makes this area a big breeding ground for congenital syphilis and the spread of syphilis through sexual contact. the world health organization outlines a four-pillar plan that could help countries eliminate or at least decrease the numbers of cases of congenital syphilis. the four pillars are "ensure advocacy and sustained political commitment for a successful health initiative, increase access to, and quality of, maternal and newborn health services, screen and treat pregnant women and partners, and establish surveillance, monitoring, and evaluation systems." the united nations has also added goals related to the lowering of syphilis which they call the millennium development goals. these goals include reducing infant death from syphilis and increasing the health of mothers with syphilis. the united nations have taken steps to include on site screening and testing for syphilis among other sexually transmitted diseases along with an increase in partner notification.