Washington Blade - June 14, 2002
Rhonda Smith

While the two Northern Virginia cities are not experiencing a syphilis outbreak, like those reported in recent years in some metropolitan cities nationwide, health officials in Virginia said the trend is troubling.

"What we're seeing is an increase over a period of three years among men who have sex with men," said Jan Tenerowicz, communicable disease bureau chief for the Arlington County Public Health Division. "I'm really concerned for people because they don't recognize that syphilis can be a major health problem. If they're co-infected with HIV, they can get really sick."

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.

Six syphilis cases were diagnosed in Arlington in 1998, statistics from the Arlington County Public Health Division show. This number climbed to eight cases in 1999 and to 12 cases in 2000. Public health officials diagnosed 15 syphilis cases in Arlington in 2001.

Debby Dimon, public health nurse supervisor in the Alexandria Health Department, said between mid-March and the first week of May this year that city reported eight cases of syphilis.

"Prior to last year, the average annual number of cases used to be five to seven in an entire calendar year," she said. "In 2001, we had 10 cases in 12 months.

All eight cases involved gay or bisexual men, four of whom also are infected with HIV and knew their HIV status before becoming infected with syphilis.

"So we're aware that there are people with HIV participating in behaviors that can expose others to HIV," Dimon said.

Even the other four gay or bisexual men in Alexandria, who were diagnosed with syphilis but are not HIV-positive, participated in sexual behaviors that would put them at risk for contracting HIV, Dimon said, based on their recent exposure to syphilis.

She also noted that in Arlington last year, public health officials identified new syphilis cases among gay and bisexual white and Latino men.

"In Alexandria," Dimon said, "we're seeing exposure among white and black men, gay and bisexual."

Public health officials in Alexandria have begun redirecting their HIV prevention resources to reach men who are having sex with men, Dimon said.

Valerie McDonald, the city's minority HIV coordinator, has been working with the Black Men's Health Project of Alexandria on this matter.

"We're also taking our concern to the Northern Virginia HIV Consortium," Dimon said. "There are meetings scheduled later this month with the prevention and the executive committees to determine how we can collaborate on our prevention efforts."

Public health authorities in Alexandria also have been meeting with officials in other local jurisdictions to determine whether there are any other similarities among the syphilis cases so strategies could be implemented to curb the problem.

Brent Minor, chair of the Alexandria Commission on AIDS, said an increasing number of people appear to have forgotten how devastating HIV/AIDS can be.

"People are having unprotected sex, and that's causing the spread of more sexually transmitted diseases, which in this case is syphilis," he said. "If the past is prologue, what we know is when we see a spike in STDs, a rise in HIV cases is inevitable because [the infections] are spread in the same manner. That's our concern."

Minor is HIV positive, a member of the Presidential Advisory Council on HIV/AIDS and chair of its Care & Treatment Committee.

Last November, the Centers for Disease Control & Prevention reported that while the number of reported syphilis cases in the U.S. hit an all-time low in 2000, outbreaks of the disease have been seen among gay men in a handful of large cities such as Miami, Los Angeles, and Chicago.

Cesar Peña, an epidemiologist for the STD Division of the Maryland Department of Health & Mental Hygiene, in Baltimore, said the number of syphilis cases in that state is decreasing, thanks to initiatives aimed at reducing the rate of infection in Baltimore.

He also said, however, that syphilis cases are increasing in Prince George's County, Md., a Washington suburb. In addition, there has been a slight increase in the number of syphilis cases reported in Harford County, near Baltimore.

There were 18 syphilis cases reported in Prince George's County in 1999, Peña said. In 2000, there were 20 cases reported, and in 2001 he said 29 cases were reported.

Dr. Karyn Berry, chief of the Bureau of Communicable Disease Control in the D.C. Department of Health, said the overall incidence for syphilis cases in the District of Columbia has decreased.

"But when you look at men, there have been fluctuations" in the number of syphilis cases diagnosed. "We'd like to see it lower, and that's what we're aiming for, by investigating cases and contacts and working with community-based organizations."

In 2001, the most recent year for which information was available, she said the total number of syphilis cases diagnosed among men in Washington was 179.

Michelle Stoll, a spokesperson for the Division of HIV & STD in the Virginia Department of Health, said the cities of Danville, Richmond and Norfolk have had the greatest amount of syphilis cases in the past few years. Norfolk has had the most cases in Virginia in 2001, with 63 cases.

News reporter Rhonda Smith can be reached at rsmith@washblade.com.

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