Associated Press - December 22, 2003

"Now the concern is that it's beyond its original group and it's spreading. Clearly, we haven't got a handle on it," said Patricia Daly, health officer for the Vancouver Coastal Health Authority.

"The (province's) Center for Disease Control has stepped up and is being as aggressive as they can trying to identify cases," Daly said. "We've been advising doctors, trying to get cases treated and treat as many contacts as we can, but it's not working."

Since a case was imported in 1997, likely by a traveler, syphilis has spread through the prostitution-plagued slum.

Reported syphilis cases in British Columbia, almost all in central Vancouver, have soared from 16 in 1993 to 250 so far this year.

Authorities believe it is the world's largest per capita outbreak of syphilis, which once was close to being eliminated in North America, said Dr. Michael Rekart, the provincial agency's director of sexually transmitted disease control.

In the United States, where syphilis is on the increase for the first time in more than a decade, most outbreaks have been among gay and bisexual men in big cities.

Most of those with the disease in Vancouver have been prostitutes and their customers, but Rekart says that appears to be changing. This year 72 gay or bisexual men were diagnosed with syphilis, compared with 30 in 2002.

Rates of HIV, gonorrhea and hepatitis also have been rising in Vancouver's gay community, indicating fewer are using condoms and raising the specter of a much larger syphilis outbreak, he said.

"We know it spreads very quickly in the gay community. Almost every other outbreak in the world is confined to that community. We'd be silly not to pay attention with all that staring us in the face," Rekart said.

Syphilis, which killed millions in the Middle Ages, is now easy to treat with antibiotics but also easy to miss in its early stages.

Ulcerative lesions form on the genitals but usually are not painful. In women, they can be inside the vagina while in men, the sores typically go away, suggesting the problem has cleared up.

Left unchecked, syphilis eventually attacks the heart and brain. Babies born to pregnant women with the disease may have brain damage and deformities.

Two babies with congenital syphilis have been born in Vancouver since the outbreak began.

A media campaign is being prepared for the new year. Already public health nurses are also visiting doctors to raise awareness of the risk and to ask them to start checking patients they believe have unprotected sex, even if they are just there for a flu shot.

Provincial health officials also are trying to modernize the old approach of identifying and tracking down the sexual partners of syphilis patients.

Trying to stop the spread of syphilis, nurses walk the neighborhood trying to find out who's sleeping with whom and check hotels and bars for previous partners to persuade them to get tested.

Prostitutes' customers, many of whom live in the suburbs are more difficult to find and often don't realize for months that they've been infected, authorities say.

Rekart is working with Health Canada to develop a computer program to map the frequently overlapping relationships.

"In a few months, we hope to be able to put it on a Palm Pilot so when the nurses are out on the street and someone with the infection tells them the name of a partner, they can type it into the database and all of their partners will pop up.

"In many cases, it would then be as easy as walking across the street and giving that person antibiotics instead of having to go back to the office and look at all the hand drawn maps we have," she said.

One earlier effort backfired.

The city did a massive antibiotic blitz, handing out thousands of pills to people in the Downtown Eastside whether they had syphilis or not. Just one would clear up an infection.

Hookers were encouraged to take a handful of the pills for their friends, pimps and johns.

Once the medicine ran its course, however, people were again at risk but didn't seem to get that message and apparently thought they had been immunized, causing the infection rate to rise even higher.

"It didn't work," Daly said. "In fact, it seems to have exacerbated the problem."
031222
AP031240

Copyright © 2003 - Associated Press. Reproduction of this article (other than one copy for personal reference) must be cleared through the AP Permissions Desk.

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Broadway Cares/Equity Fights AIDS, Elton John AIDS Foundation, National Library of Medicine, Pacific Life Foundation, and donations from users like you.

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .