San Francisco Chronicle - Friday, November 21, 2003
Sabin Russell, Chronicle Medical Writer

Driven by an increase in new cases among gay white men, the nation's syphilis rate rose 9.1 percent in 2002, the second consecutive increase after a decade of decline that had raised hopes the sexually transmitted disease could be eliminated in the country.

With a 127 percent increase in syphilis cases last year, San Francisco jumped from sixth place nationally to first, ahead of Detroit, Atlanta, Newark, Baltimore and Oklahoma City.

"The job of eliminating syphilis in the United States is not done," said Dr. Ronald Valdiserri, a deputy director of the Centers for Disease Control and Prevention.

San Francisco health officials said the latest figures confirmed at a national level a trend first noticed in the city two years ago. The good news, they say, is that while the 2002 numbers are bad, there are signs that prevention efforts have slowed down the disease this year.

Despite a nationwide rise in syphilis cases, particularly among white men, the federal statistics show some encouraging signs that rates are decreasing among African American men, who historically have the highest rates among ethnic groups. Rates fell 2.2 percent for black men and were down 22 percent among African American women.

The nationwide increase, Valdiserri said, is driven by an 85 percent increase among white men. He estimated that 40 percent of the cases last year were among gay men, and that this group accounts for much of the overall increase.

More unsettling are statistics that show that two-thirds of the new infections in San Francisco are among HIV-positive men.

The rise in cases among gay men around the country has alarmed AIDS prevention experts, because syphilis is transmitted through the same unprotected sexual practices that spread HIV, the virus that causes AIDS. In addition, syphilis increases by two to five times the risk of HIV transmission, because the genital sores serve as "portals" for the AIDS virus to enter the bloodstream.

In San Francisco during 2002, there were 315 new syphilis cases, for a case rate of 40.6 for every 100,000 residents. That is nearly 20 times the case rate of 2.2 for the nation as a whole.

"For a moderate-size city like San Francisco, the rate is important, particularly because it is concentrated in a population of around 50,000 gay men," said Dr. Jeffrey Klausner, director of sexually transmitted disease prevention and control at the San Francisco Department of Public Health. "The rate tells us where we should be focusing our resources."

So far this year, there have been 285 new cases of syphilis diagnosed, a rate similar to that of 2002. But that is good news, because it suggests the two-year climb in syphilis rates has begun to taper off. Indeed, the latest tracking data suggest the rate may now be in decline.

San Francisco's higher rates must also be taken in the context that more tests are being conducted, as more men seek out the test. In the third quarter of 2003, a total of 4,789 syphilis tests were reported, compared with 2,595 in a similar period four years ago.

"The CDC numbers are last year's syphilis news," said Shana Krochmal, spokeswoman for Stop-AIDS, an HIV-prevention program that also works on preventing other sexually transmitted infections. Data collection at the federal agency takes longer than it does in local communities. San Francisco officials detected the alarming rise in syphilis cases in 2001 and have been stepping up prevention efforts ever since.

According to Klausner, the city spends $2 million a year on its syphilis prevention efforts, which include testing, partner notification and a highly public and sometimes controversial marketing effort called the "Healthy Penis" program. Billboards on bus shelters depict cartoon characters of the male organ, and a character dressed up in a penis costume carries the prevention message directly to the sidewalks of gay neighborhoods.

Total cases of syphilis in the United States

Total cases of syphilis broken down by race and ethnicity

2001

White* ----------1,387

Black* ----------3,813

Latino----------754

Asian/Pac. Islander----------55

Am. Indian/Alaska Native----------90

6,103 cases**

2002

White* ----------2,325

Black* ----------3,421

Latino ----------971

Asian/Pac. Islander ----------94

Am. Indian/Alaska Native ----------51

6,862 cases

* Non-Hispanic, **Includes some cases missing race/ethnicity data

Source: Centers for Disease Control and Prevention

E-mail Sabin Russell at srussell@sfchronicle.com.
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