RALEIGH, N.C. _ As health departments battle the H1N1 flu virus, North Carolina health workers worry that another epidemic may be brewing - one for a sexually transmitted disease that had almost disappeared from the state 10 years ago.

Cases of syphilis in the state have nearly doubled in the past year: 684 in the first nine months, compared to 359 cases for the same period a year earlier.

Numbers are up across almost all age and racial groups, including teenage girls and blacks - groups already disproportionately affected by STDs.

"I have to be honest: This is pretty bad," said Evelyn Foust, director of the communicable diseases branch of the N.C. Department of Health and Human Services. "We are in the middle of a really serious syphilis outbreak, and we're very, very, very concerned about it."

The trend mirrors national statistics, which show syphilis and other sexually transmitted disease rates rising across the country.

The highly treatable infection had largely been contained in North Carolina, which reported thousands of cases annually throughout the 1990s. In 1999, the Centers for Disease Control and Prevention began to fund a syphilis elimination plan that focused on the 28 counties nationwide with major outbreaks. Five, including Mecklenburg and Wake, were in North Carolina.

The extra resources helped. North Carolina's cases fell off after 2000. But as the state's numbers improved, the CDC moved more than $1.3million in funding for syphilis programs from North Carolina to other states, Foust said.

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