Washington Blade - November 30, 2001
Eric Erickson

And two counties in the South -- Harris County, Texas and Fulton County, Ga. -- rank among the top 15 areas in the U.S. with the highest syphilis rates, though local and federal health officials stressed that those rankings aren't necessarily driven by infections among gay men.

"It is true that nationally we are seeing declines in syphilis," said Dr. Ronald Valdisseri, the deputy director for the National Center of HIV, STD & TB Prevention at the CDC.

"But we also understand that in communities like Miami, like Los Angeles, like Chicago, where there have been outbreaks among men who have sex with men, that we really have to intensify our efforts," he added.

Infections are on the rise among gay and bisexual men, particularly in large cities, the CDC said. That concerns experts because they suspect it reflects more risky sexual behavior, which could lead to a spike in HIV infections.

Valdisseri joined Dr. George Counts, the CDC's assistant director for the Syphilis Elimination Activities program Wednesday in a teleconference briefing with the media to announce that fewer than 6,000 cases of sexually transmitted disease were reported nationwide last year, a drop of nearly 10 percent from 1999.

Syphilis appears first as a sore, usually on the genitals, then develops as a rash. It can be cured with penicillin, but left untreated it can damage the heart, eyes, brain and other body parts.

The CDC reported that half of all syphilis cases in 2000 were concentrated in only 22 counties and one city.

Despite an 85 percent drop in syphilis cases since 1991, health officials in Houston, which ranked 14th with 70 cases, are concerned about infections increasing, said John Paffel, STD prevention program manager for the city's health department.

"What we're starting to see now are increases once again," Paffel said. "After about 10 years of leveling off and decreases, we're starting to see increases." Dr. Adewale Troutman, director of the Department of Health & Wellness in Fulton County, Ga., which includes Atlanta, noted slight decreases in the number if new syphilis cases, although Fulton County ranked sixth with 203 cases in the CDC's report. Even if numbers were to fluctuate, he said it may not be due to an outbreak, rather expanded outreach and surveillance.

"There is a significant under-reporting of certain kinds of diseases even though the state law require that [syphilis cases] be reported," Troutman said. "We know that there's a very low compliance rate overall when it come to physicians giving us the information on reportable disease."

But Paffel said even recent increases can be misleading. The CDC records syphilis cases at a rate per 100,000 people; because Harris County encompasses the entire city of Houston and its 3.4 million residents, it has a rate of 2.2 cases per 100,000 people, putting the city at the bottom of the list of counties when ranked by rates of infections.

But when only new cases are considered, Harris County ranks sixth for 2000.

"What we're concerned about now is some of the dramatic increases among men who have sex with men, it's a relatively alarming trend and we're seeing it here in Houston, that's a situation that we're really concerned about," Paffel said. Valdiserri said one way to intensify the CDC's efforts against syphilis is to focus on people with HIV. Valdiserri said studies have shown that in some geographic locations, as many as 70 percent of the people diagnosed with syphilis are co-infected with HIV.

"Those men are co-infected with HIV, hence the concern on the HIV side of the equation," Valdiserri said. "Some of these men in some of these populations may no longer be adhering to safer sex sexual practices."

Valdiserri said there have been dramatic increases in the number of African American and Hispanic people diagnosed with syphilis over the last few years. While Paffel said Houston is seeing increases in the number of gay men with syphilis, the CDC said that's not the case for the entire country. Fulton County health officials said a majority of syphilis cases are among heterosexuals.

"Although we are seeing gradual increases in syphilis occurring in men who have sex with men around the country, the total number of such cases is relatively small compared to the total number of syphilis cases occurring each year," Counts said. "The total number of cases that you see in any given year are heavily driven by heterosexuals not men who have sex with men."

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