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New Syphilis Cases Rise for First Time in 11 Years

California is among hardest-hit states, with gay and bisexual men being most affected. Increase is a setback for goal of eliminating the disease by 2005.

November 01, 2002|Charles Ornstein | Times Staff Writer

The number of new syphilis cases rose in 2001 for the first time in 11 years, with large increases among gay men outpacing continued declines among blacks and Southerners, federal health officials said Thursday.

California was among the hardest-hit states last year, with 547 early-stage syphilis cases, an increase of nearly 68% from 2000. The vast majority of those infections were among gay and bisexual men, most of whom also were HIV-positive, according to data from the California Department of Health Services.

Nationwide, the overall increase, albeit slight, represents a setback for a four-year-old effort to eliminate syphilis by 2005. Until last year, the goal of having fewer than 1,000 new cases annually appeared to be on track, health experts said, but now the effort seems to be faltering.

The U.S. Centers for Disease Control and Prevention reported 6,103 new infectious syphilis cases nationwide in 2001, up 2.1% from the previous year. The number of cases among men increased 17.3%, while the number of female infections dropped 19.6%.

In announcing the 2001 syphilis numbers Thursday, CDC officials said they continue to make progress among the major populations affected by syphilis in the last few decades.

The number of cases among African Americans declined 9.9% and cases in the South dropped 8%. But cases among white males jumped 63%, and the number of infected Latino men increased 50%.

Although syphilis is treatable with antibiotics, its sores greatly facilitate the spread of HIV. Public health experts fear that the same unsafe sex practices that foster the spread of syphilis place people at risk for acquiring HIV.

The most cases nationally, 379, were reported in Wayne County, Mich., which includes Detroit. Federal and state health officials have criticized the city for relaxing its prevention efforts after a decline in cases during the 1990s.

Despite aggressive prevention campaigns, many gay and bisexual men don't appear to be practicing safer sex. During the first nine months of this year, Los Angeles has logged more cases than in all of 2001. San Francisco has already more than doubled its 2001 count.

"Awareness [of syphilis] is tremendous," said Dr. Jeffrey Klausner, director of sexually transmitted disease control in San Francisco. "But we don't have any evidence yet that there's been a change in sexual behavior in terms of unsafe sex practices."

In a precedent-setting move, San Francisco health officials recently began offering syphilis patients doses of the antibiotic Azithromycin to give to their sexual partners and friends who practice unsafe sex. Since July, though, only 10 patients have taken antibiotics to give to others -- a small percentage of those seeking care.

Los Angeles County health officials said sexually transmitted disease prevention is one of the few areas that received more county funding this year despite a severe budget crisis. Even so, public health authorities say they can't control the outbreak until gay and bisexual men change their behavior.

"In public health, we have to always look at what more we can do," said Dr. Jonathan Fielding, the county's director of public health. "But this cannot be solved entirely without those who are at risk realizing that they bear some responsibility as well."

There are some causes for optimism. Groups that provide syphilis testing have seen a rise in demand for their services. The Los Angeles Gay & Lesbian Center performed 1,798 syphilis blood tests in the first half of 2002, compared with 1,381 in the first half of 2001, a 30% increase.

The center is now encouraging people seeking HIV tests to also be screened for sexually transmitted diseases, said Joshua Bobrowsky, the center's deputy director of health policy.

"The behaviors are the same and the prevention efforts are the same, but all too often the efforts to address" HIV and other sexually transmitted diseases are "uncoordinated, and there's hardly been any new money provided," he said.

The outbreak among gay and bisexual men, experts say, can be traced to a rise in anonymous sex-seeking activities in bathhouses, sex clubs and through Internet chat rooms.

Health experts say the CDC's attempt to address the new situation is far more complicated than its efforts to eliminate the disproportionate rate of infection among blacks. That effort had widespread support. By contrast, political pressure from conservatives in the Bush administration has stymied some efforts to talk openly about sex and condom use among gay men, some advocates say.

"I think CDC is constrained about what they can do because of the political issues in dealing with gay men," said Dr. Jonathan Zenilman, an STD expert and infectious disease professor at Johns Hopkins University School of Medicine. "The way to deal with this is to be ... open and frank about what the risks are and what you need to do to protect yourself."

CDC officials defended their efforts, but they said they have not received increased funding from Congress in recent years for prevention of sexually transmitted diseases. The agency sent teams to several large cities last year to help coordinate their responses to the outbreaks.

Dr. Ronald O. Valdiserri, a top STD official at CDC, said he believes the 2005 goal for syphilis elimination is still within reach. Eighty percent of U.S. counties didn't report a single case of early-stage syphilis in 2001. And half of the cases are concentrated in 20 counties and an independent city, allowing the CDC to focus its resources.

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