Age-standardized death from<unk>  per 100,000 inhabitants in 2004.<unk>  is a bacterial infection transmitted by sexual contact and is believed to have infected people in 1999 with greater than 90% of cases in the developing world. It affects between 700,000 and 1.6 million pregnancies a year, resulting in spontaneous abortions, stillbirths, and congenital<unk> . In Sub-Saharan Africa<unk>  contributes to approximately 20% of perinatal deaths. In the developed world,<unk>  infections were in decline until the 1980s and 1990s due to widespread use of antibiotics. Since the year 2000, rates of<unk>  have been increasing in the US, UK, Australia, and Europe primarily among men who have sex with men. This is attributed to unsafe sexual practices. A Sexually transmitted disease (STD)) Surveillance study done by the Centers for Disease Control and Prevention in 2016 showed that men who have sex with men only account for over half (52%) of the 27,814 cases during that year. Nationally, the highest rates of primary and secondary<unk>  in 2016 were observed among men aged 20–34 years, among men in the West, and among Black men. Increased rates among heterosexuals have occurred in China and Russia since the 1990s.<unk>  increases the risk of HIV transmission by two to five times and co-infection is common (30–60% in a number of urban centers). Untreated, it has a mortality rate of 8% to 58%, with a greater death rate in males. The higher incidence of mortality among males compared to females is not well understood, but is thought to be related to immunological differences across gender. The symptoms of<unk>  have become less severe over the 19th and 20th century in part due to widespread availability of effective treatment and partly due to decreasing virulence of the spirochete. With early treatment few complications result.
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