The New York Times - August 31, 2007
Anthony Ramirez

Dr. Susan Blank, a senior health department official for the city, is naturally wide-eyed in a bobbing your head, waving your hands kind of way. Her latest challenge is syphilis, which in the 1990s seemed headed for extinction but now, for unknown reasons, is surging back in New York City.

When asked if things happen in her field of sexually transmitted diseases that make her say "holy cow," her eyes widen to a you-gotta-be-kidding-me circumference.

"Oh, baby, welcome to the land of holy cow!" she said.

There was the time, for example, when an investigator tracing the outbreak of a venereal disease asked an infected man the name, address and appearance of his most recent lover.

The man said he couldn't remember what his lover looked like. Pressed by the investigator about the utmost importance of the information, the man suddenly brightened and said he had a photograph of "him."

The man produced a cellphone, called up a digital photo, and, with satisfaction, showed the investigator. It was a picture of genitalia.

When it comes to sex and disease, nothing human is alien to Dr. Blank, 46. At less than 5 feet tall and 95 pounds, Dr. Blank, who has blond Little Orphan Annie curls, is a dynamo comfortable with a startling vocabulary and equally startling field of investigation.

She used street lingo to describe the impotence that follows crystal-meth drug use and the change in male sexual position that such use sometimes prompts. Dr. Blank then stared at this reporter's tape recorder.

"Oh, I'm sorry," she said. "Burn it when you're done. Put it in a bag when you leave."

As assistant commissioner in the city's Bureau of Sexually Transmitted Disease Control, she is confronting an old and new scourge in syphilis.

Earlier this month, the city's Department of Health and Mental Hygiene reported that in the first 13 weeks of 2007, cases of syphilis more than doubled to 260 from 128 in the same period a year ago. Nearly all - 250 - were among men, and many were found in Chelsea, a neighborhood popular with homosexual men.

In one early 1990s outbreak, syphilis appeared to be closely linked to the epidemic of crack cocaine.

The city conducted rapid syphilis screening tests at jails, prisons and juvenile detention facilities, Dr. Blank said. Carriers of syphilis also tended to carry human immunodeficiency virus, or H.I.V., the virus that causes AIDS. Before the widespread use of antiretroviral drugs to treat AIDS, Dr. Blank said, those syphilis carriers may have died out. "But there is no absolute proof of that," she said.

BOTH gonorrhea and syphilis are spread by sex or from mother to baby during delivery. If there are noticeable symptoms, syphilis shows itself through skin lesions and gonorrhea through discharge. Both diseases may help the spread of AIDS by abrading skin or exposing sensitive cells to H.I.V.

But there is a difference. Gonorrhea, which has grown resistant to some antibiotics, is declining. Syphilis, which can be cured for the most part with penicillin, is on the rise.

That paradox appeals to Dr. Blank's problem-solving mind. Born in Bridgeport, Conn., she is the daughter of a father who is a lawyer and a mother who is a family physician. At the Massachusetts Institute of Technology, she majored in applied biology and at the University of Pittsburgh medical school, she considered becoming a pediatrician. ("I'm small, kids are small," she said.)

But while serving a medical residency at Yale-New Haven Medical Center, she spent time at Machame Hospital, a rural mission hospital near the town of Moshi, Tanzania.

The health problems there were stark but largely curable, often for a few pennies, with supplies, like intravenous needles, that would be plentiful at an American hospital.

Returning from Africa to her residency in New Haven, Dr. Blank had an epiphany. In 1989, a drug addict in her second trimester of pregnancy came in suffering from seizures and infected with many diseases, including hepatitis and H.I.V.

The hospital staff "did superhuman stuff to deliver a live baby who was premature, only 24 weeks," she recalled. "I got this infant on service and he had really ominous things going on in the first 24 hours of life. He was having seizures, expanding head circumference, meaning he could have a bleed in the brain." The mother died that day, the baby weeks later.

Dr. Blank thought about the Tanzania and New Haven experiences, where a small early expenditure of money to prevent disease could have saved lives and the expenditure of tens of thousands of dollars later. "There must be a better way to float all these health boats," she said.

Dr. Blank applied to the Epidemic Intelligence Service, the medical detective branch of the Centers for Disease Control and Prevention in Atlanta. She spent much of her time, however, in the C.D.C. offices here in New York.

By 1992, the city needed an epidemiologist, and she got the job. She later rose to assistant commissioner (while still, technically, on loan from the C.D.C., a common practice).

To fight syphilis and understand its spread, she and her investigators are tracking down and interviewing all 260 cases, visiting bathhouses, public parks, restrooms, and private sex parties. "It's very labor intensive," she said.

Through it all, she retains her blunt style. One patient told her it was God's will that he contracted syphilis. "It may be God's will," she remembers replying, "but it's a man's penis."

Has Dr. Blank ever had a sexually transmitted disease?

Dr. Blank's eyes neither widen nor narrow. "I don't have to answer that question," she said. "I am accorded all the confidentialities of anybody else that we deal with."

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