Miami Herald - Thursday, November 29, 2001
Stephen Smith, sfsmith@herald.com

Data released Wednesday by the Centers for Disease Control and Prevention in Atlanta show that while syphilis is in the midst of a significant decline nationally, that success is not shared universally.

In fact, cases in Miami-Dade rose more than 50 percent from 1999 to 2000, with state statistics showing a climb from 82 to 126. That ranked the county as 10th-highest in the nation, the only Florida county among the top 10. Chicago had the most syphilis cases.

The mixed picture -- success nationally contrasting with challenges locally -- demonstrates the complexity in shackling a disease that strikes with disproportionate fury in urban communities, especially among African Americans and Hispanics.

Across the country, syphilis increased 12.5 percent among Hispanics from 1997 to 2000.

"Syphilis elimination is not a given without ongoing sustained efforts," said Dr. Ronald O. Valdiserri, deputy director of CDC's National Center for HIV, Sexually Transmitted Disease and Tuberculosis Prevention. "It's possible for that progress to reverse."

Since 1998, health authorities have embarked on a crusade to drive syphilis into oblivion, melding the expertise of health agencies with the on-the-ground moxie of faith-based groups and community organizations, taking a campaign of protection and detection to barber shops and nightclubs, billboards and radio stations.

It's working nationally. Syphilis cases have plummeted 30 percent since 1997, including a 41 percent decline among African Americans.

In Florida, the disease has plunged precipitously since an epidemic a decade ago, with 5,133 cases statewide in 1990. But after registering eight years of declines, syphilis cases crept upward in 1999 and again in 2000, with 413 cases.

Miami-Dade had more than three times as many cases in 2000 as Broward, which reported 36.

"It's very dangerous," said Dr. Karen Simmons, a University of Miami obstetrician-gynecologist. "Maybe 126 cases in Dade doesn't sound like a lot, but if they are passing it on to others, it's a very significant amount. It's not only the person who tests positive -- but who are they in contact with?"

Reasons for the increase are complicated. For instance, there has been a troubling turnover among state disease investigators whose job is tracking down infected people and locating their sex partners -- one of the best ways to halt syphilis' spread.

"Experienced investigators do that better than new babies on the block," said Karla Schmitt, chief of the sexually transmitted disease branch in the state Department of Health.

Researchers are especially concerned with increases in syphilis among men who have sex with men. An outbreak was reported in South Beach this past summer, a development that worries people engaged in the war on AIDS.

They're concerned because people infected with syphilis are two to five times more likely to contract HIV. The increase in syphilis, they fear, could be a harbinger of a new wave of HIV infections at a time when the mantra of safe sex has grown worn and the promise of powerful AIDS drugs has led to risky behavior.

"There is an HIV/AIDS fatigue," said Jeff Wilkinson, executive director of the South Beach AIDS Project. "If we know there's an outbreak, it's incumbent upon public health officials and community-based organizations to take that information and make sure everyone is as aware of it as they need to be."

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