Bay Windows - Local News, November 29, 1999
Beth Berlo, Bay Windows staff

Jean Flatley McGuire, director of the HIV/AIDS Bureau at the Massachusetts Department of Public Health (DPH), was part of last week's discussion, which included nearly 25 organizers. Among them: city and state health officials; leaders from MOCAA, the Latino Health Institute, AIDS Action, the Fenway Community Health Center, and several other AIDS and health organizations, and individuals who work with the gay community.

In the wake of three back-to-back cases of syphilis among gay men who reported having sex at the Safari Club exclusively, the DPH swiftly organized the meeting.

"We felt very strongly that we needed to have gay community members and leadership members talk to us about how to disseminate information," McGuire told Bay Windows. "We called Seattle and San Francisco, who have had much larger outbreaks of syphilis this year [which] further confirmed that we needed to work closely with the gay community."

So far this year, there have been 88 confirmed cases of syphilis in Massachusetts. This number is down significantly from previous years. The significant drop-off in numbers is attributed to education and outreach, officials say.

Asked why there's a heightened attention being given to these three cases, Kevin Cranston, director or AIDS Prevention and Education at DPH's HIV/AIDS Bureau, said, "Whenever we see a cluster of cases, in the very absence of significant numbers of cases in recent history among MSM's (men who have sex with men), it raises the concern that syphilis is being reintroduced to the population. So, by acting swiftly and somewhat aggressively when there are only three cases -- particularly given the high infectiousness of syphilis in the early stages -- we have both the responsibility and opportunity to nip in the bud what could be a more significant number of cases."

Syphilis is spread by having sexual conduct with an infected person. Initial symptoms of syphilis usually appear as a painless sore at the site of initial contact. It may be accompanied by swollen glands, which develop within a week after the appearance of the initial sore. These generally last two to six weeks, and will go away even if not treated. What people need to understand most, health advocates say, is that it can be transmitted without visible symptoms or without ejaculation. Latent, or untreated syphilis (untreated syphilis of over four years' duration) may involve the skin, bones, central nervous system and heart, and could lead to blindness and death if left untreated. Symptoms can appear anywhere from 10 - 90 days after contact, but usually occur between three and four weeks.

Anyone with a compromised immune system, such as HIV, has an increased chance of contracting syphilis. Also, someone who is HIV negative who has syphilis increases their risk of contracting HIV.

"In each of these cases, it was diagnosed in secondary-stage syphilis," said Brian Byrnes, director of education at AIDS Action Committee (AAC). This, he said, occurs "after the initial lesion disappears. The person can get flu-like symptoms or a rash on the hands or palms. That can disappear and then it can lay latent for many years. That's why diagnosis is important. These men had a rash, and sought care when they had these odd symptoms."

The three men, Byrnes said, were over the age of 34. "The cluster was identified through [health] care in the greater Boston area. But the men lived in western Mass., outside Route 128, and in Boston. It's important people understand this is a statewide concern." By law, all physicians must report syphilis cases to the DPH.

Dr. Paul Etkind, director of the Division of STD Prevention at DPH, said that although the overall number of cases in Massachusetts is down this year from 1998 (150 cases in 1998, 88 so far this year), and the cases they are focusing on are few, their concern is that they have seen very little syphilis in the gay community or among MSM's in the last few years.

"Historically [especially the 1980s], 50 percent of cases were attributed to MSM's," Etkind said. "This is from their self-declaration interviews. What we're concerned about seeing is that HIV walks in the footsteps. The highest rates of HIV around the country are the same places that have the highest rates of syphilis. The relationship is certainly there. So, though the numbers may not sound all that impressive, we want to be proactive and do as much as we possibly can to prevent the re-establishment of syphilis in the gay community."

According to Dr. Etkind, the ethnic breakdown of the 150 reported cases of infectious syphilis in 1998 in Massachusetts was: Caucasian, 25; African-American, 84; Hispanic, 35; Asian or Pacific Islander, 5; and the remainder were unspecified. The breakdown of 88 cases reported this year is: Caucasian, 13; African-American, 45; Hispanic, 27; and the rest are unspecified. Etkind refused to comment on the ethnicity of the three cases that prompted last week's meeting.

Since the bulk of reported cases both years occurred in the African-American and Latino communities, health educators have already stepped up outreach efforts. Asked about her intervention plans, Pam Johnson, executive director of MOCAA, said, "We have started a lot of word-of-mouth at the moment, and have been generating information, which people will see at Chaps on Thursday nights," Johnson said. MOCAA sponsors "Music Factory" at the club every Thursday. "Also, we have a recent collaboration with gay men of African descent (GMAD) in New York and are sending this information over the wire because the men who have recently been diagnosed with syphilis are men who are frequenters of the tri-state area. So, this is something that may impact other cities as well."

As for additional outreach, McGuire said there are people who are distributing information at public sex areas and bars. "We have a range of things planned, including clinician alerts and joint advertising. à If [the] Safari [Club] was still open, we would probably be there doing screening already."

McGuire said the DPH's gravest concern right now is "reaching men who are not gay-identified. The DPH is also collaborating with clubs similar to Safari in Providence and Nashua in disseminating information about the new cluster of syphilis. ... At this juncture, any man who has unprotected sex with another man should really think about getting a syphilis test. It's a safe and helpful thing to do. We're going to have to rely on the breadth of the gay community to reach out to people who are not gay-identified."

While the numbers of syphilis cases have dropped steadily in recent years, discussions around the possibility of elimination of the disease were being discussed, Etkind said, which is why these most recent incidents are cause for concern. "This is happening at a time when rates are so low that it reinforces the fact that we need to keep our guard up because that's when things can come back."

(For referral information on syphilis screening, call AAC's hotline at 1-800-235-2331.)
991129
BY991105

Always watch for outdated information. This article first appeared in 1999. 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, 1999. 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. .