Los Angeles Times - August 22 2001
Nicholas Riccardi, Times Staff Writer

In fact, officials say this year's cases stem from the same outbreak as last year, when public health authorities took well-publicized steps to stop the spread of syphilis, mostly among gay men.

The numbers represent the most recent disturbing sign that safe-sex practices are eroding among some segments of the gay population, boding ill not just for the fight against syphilis, but also for the fight against HIV, the virus that causes AIDS. "You can't do good HIV prevention in the absence of a good public health system, and the [syphilis] resurgence shows the county public health system is severely lacking," said Michael Weinstein, director of the AIDS Healthcare Foundation.

After several months and hundreds of thousands of dollars in publicity, the county declared in June 2000 that the number of new syphilis cases was declining and the danger was abating.

But this year there have actually been more new syphilis cases than last year--85 to date, compared with 69 at this time last year. Of the new cases, officials said, all were among men who had sex with men, and 58% involved HIV-positive men.

Until last year, Los Angeles County had about 120 syphilis cases a year, virtually all of them among heterosexuals.

But in a memo distributed to county supervisors, health officials describe the disease as now "endemic" in the county's population of gay men, although at lower levels than before the AIDS epidemic. "Endemic" means there is a reservoir of disease that is constantly present.

Syphilis is transmitted through sores, usually in the course of unprotected sex.

In its early stages, syphilis can be easily treated with penicillin, but growing numbers of cases are worrisome because its spread is indicative of the same unsafe sexual practices that lead to HIV--unprotected sex, often with multiple partners. Also, syphilis sores make it easier for HIV to spread. Studies in Los Angeles and other major cities suggest that safe-sex practices are on the wane among some gay men, leading to increased HIV infection.

Some AIDS activists accuse the county of declaring victory against syphilis far too soon.

"When you've got a public health authority saying syphilis is gone, that's what leads to these [unsafe sex] practices," said Cesar Portillo of the AIDS Healthcare Foundation.

Fred Leaf, acting director of the Department of Health Services, admitted that his agency did not follow through on the outbreak. The publicity campaign "wasn't as sustained as it should have been," he said. "We kind of did it for 60 days and stopped."

On Tuesday, Supervisor Zev Yaroslavsky asked the Health Department to devise a new plan to deal with the syphilis outbreak.

"Given the critical nature of this outbreak and the relationship to the spread of HIV infection, it is imperative that the department make the development of this strategy a top priority," he said.

Weinstein, the director of the AIDS Healthcare Foundation, urged the county to "take the necessary action [and] sustain it."

Health officials said the new syphilis cases are spread throughout the county but that a majority of the men contacting the disease have frequented clubs, bars or bathhouses for sex.

John Schunhoff, chief of operations for the Health Department, said the agency needs to step up its screening for the disease in sex clubs and bars.

He said it is possible that some of the reported new cases are actually infections from last year that had not been detected.

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