Miami Herald - Sunday, March 23, 2003
Monica Rhor, mrhor@herald.com

The numbers -- which have grown steadily over the past five years -- are certainly alarming.

Broward County, where just 13 cases were reported in 1998, is now seeing an average 11 new cases a month. From 2001 to 2002, the number of new syphilis cases in the county jumped 88 percent; in Dade, the cases rose 19 percent. In the first two months of this year, Broward cases increased 43 percent compared with the same period last year; Dade cases went up 30 percent.

Last November, Miami and Fort Lauderdale were ranked among the eight U.S. cities with the highest number of new syphilis cases by the Centers for Disease Control and Prevention.

But, the numbers are not the only cause for concern. The reasons behind the resurgence may be even more troubling, say health officials and community leaders, who are joining forces to combat the epidemic.

The new outbreak -- primarily among gay and bisexual men -- signals a return to high-risk sexual behavior of the pre-HIV/AIDS era, as well as a backlash against the "safe sex" messages of the past two decades, say state and county health officials.

That "prevention message burnout," combined with the perception that HIV/AIDS is not a death sentence but something that can be controlled by powerful new drugs, may be creating an atmosphere in which unprotected sex with multiple, anonymous partners is not only tolerated, but encouraged, say health officials.

In addition, the rise of "club drugs," such as ecstasy, crystal meth and Viagra, is also contributing to the trend toward high-risk behavior.

"We are concerned about it. Absolutely," said Tom Burns, program manager of the Miami-Dade County Health Department's STD program. "There seems to be 'prevention message burnout. Maybe we don't have the right messages out there."

A "rapid response team" from the CDC will meet with officials in Miami-Dade on Tuesday and with Broward officials on Wednesday to discuss prevention and intervention strategies for tackling the outbreak.

In 1999, the CDC launched a campaign to wipe out syphilis by 2005. But federal officials did not foresee the outbreaks in big cities with large gay and bisexual communities.

Instead, noted Dr. James Cresanta, disease prevention specialist for the Broward Health Department: "It looks like it's getting worse. It's not something that went away."

In Miami-Dade County, health officials have responded to the outbreak by stepping up a community education campaign and outreach efforts in the gay community. The message -- placed on billboards, posters at Metrorail stations, palm cards and in ads in newspapers serving the gay community -- is simple: Kiss & Tell.

In other words, talk to sexual partners and healthcare providers about sexually transmitted diseases. In addition, the campaign urges anyone who is sexually active to be tested for syphilis and to use protection.

TASK FORCE

Dade officials are also working with the Sobe Syph Coalition, a task force of community activists and health workers that focuses on men's health issues. A similar task force is being formed in Broward County, where activists say more needs to be done to fight the syphilis outbreak.

"People want to go back to the early days, when sex was free and everyone was having a great time," said Jay McLaughlin, health coordinator at the Gay and Lesbian Community Center of South Florida. "But we want people to realize what can happen."

Although syphilis can be cured with antibiotics, the disease is often overlooked in its early stages, when symptoms first appear as genital sores or rashes that go away after a few weeks. That means an infected person can be spreading the disease without knowing it.

If left untreated, the disease can recur, leading to heart damage and blindness. In addition, syphilis lesions increase the rate of HIV transmission. People infected with syphilis are three to five times more likely to contract HIV.

The GLCC has started offering free syphilis testing two times a month. Within the past month, five new cases were discovered through the GLCC testing. McLaughlin says he regularly fields calls from people trying to get information about syphilis.

LESS ORGANIZED

In Broward, where the gay community is less organized than in Dade, health officials say they face greater obstacles in getting the word out.

In the past, officials relied on partner notification to track down anyone who might have been infected, said Howard Somers, acting director of the Broward STD program. But, in many of the new cases, the infected person does not know the names of his sexual partners.

"We're not talking about everyone doing this," said Somers, noting that the number of syphilis cases still reflect only a small percentage of the gay community.

So, Broward health officials have started outreach efforts to healthcare providers who work with HIV/AIDS patients. They hope to encourage doctors to test patients for syphilis, which could help spot early cases before the disease is spread further.

Health officials say such new strategies are needed to reach those at risk of syphilis. Otherwise, say health officials, the epidemic could continue to spiral.

"Syphilis can shoot through the ceiling and spike in numbers at any time," said Dan George, field operations manager with the state health department's Bureau of STD Prevention and Control. "We need to increase public awareness not just to syphilis, but to the behavior that leads to the disease."

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