Washington Blade - July 26, 2002
Rhonda Smith

"This particular population deserves an enhanced focus," said Dr. Emily J. Erbelding, chief of the STD Clinical Services for the Baltimore City Health Department.

Erbelding, who also is an assistant professor of medicine at Johns Hopkins University in Baltimore, said there were 26 cases of syphilis reported in the first six months of 2002 among men who have sex with men, compared with just two cases among this population during the same period last year.

"It's definitely an important outbreak, but not an epidemic," she said.

Deidre Thompson, a registered nurse and nursing clinical manager for Chase Brexton Health Services Inc., a nonprofit health organization in Baltimore that primarily addresses the health needs of gay men and lesbians, echoed Erbelding.

"There's been some clustering of cases identified among men who have sex with men," she said. "This is consistent with what has been reported in Seattle, Los Angeles County, Chicago, New York City, London, Birmingham, Ala., and Amsterdam."

Syphilis appears first as a sore, usually on the genitals, then develops as a rash. It can be cured with penicillin, but left untreated it can damage the heart, eyes, brain and other body parts. Public health officials in Baltimore are recommending that men who have sex with men be tested for syphilis every six months.

"Anybody who thinks they've been exposed to HIV should also ask for a syphilis test," she said. "And anyone who notices the signs or symptoms of syphilis in themselves or in a sex partner should also be tested for it."

Erbelding said lesbians also could be at risk for syphilis.

"It's extremely rare for a woman who only has sexual contact with other women to contract syphilis," she said. "But if they occasionally have sex with their bisexual male friends, then they probably should get tested for syphilis."

In June, public health officials in Alexandria and Arlington, Va., said they were concerned about the increase in the number of gay and bisexual men who have tested positive for syphilis in the past three years. They warned that a spike in sexually transmitted diseases such as syphilis could mean a rise in HIV cases is inevitable because the infections are spread in the same manner.

Cesar Peña, an epidemiologist for the STD Division of the Maryland Department of Health & Mental Hygiene, in Baltimore, said the number of syphilis cases statewide is decreasing thanks to initiatives aimed at reducing the rate of infection in Baltimore. He also noted, however, that syphilis cases are increasing in Prince George's County, Md., a Washington suburb, and in Harford County, near Baltimore.

Last November, the U.S. Centers for Disease Control & Prevention reported that while the number of reported syphilis cases in the U.S. hit an all-time low in 2000, outbreaks of the disease have been seen among gay men in a handful of large cities such as Miami, Los Angeles, and Chicago.

FOR MORE INFO What is syphilis?

Complex STD described as "great imitator" because symptoms are indistinguishable from other diseases.

How is it spread?

Through direct contact with syphilis sore, mainly on external genitals, vagina, anus, or in rectum; also can occur on lips and in mouth.

What are the symptoms?

Within 10 to 90 days (average is 21), a single sore, or chancre, appears but may be multiple sores. Chancre is usually firm, round, small and painless, lasts three to six weeks and will heal on its own. If left untreated, infection progresses to secondary stage, with rough red or brown rash that usually does not itch on palms or bottom of feet. Even without treatment, rashes clear up on their own.

How is syphilis diagnosed?

Examination of material from infectious sores, or by blood test.

Link with HIV?

Syphilis genital sores make it 2-5 times easier to transmit and acquire HIV.

Is there a cure for syphilis?

Yes, penicillin or antibiotic.

Protection against syphilis?

Use latex condom before beginning sex and keep it on until the penis is withdrawn.

Source: National Center for HIV, STD & TB Prevention

Thompson said the syphilis cases reported among gay men in Baltimore appear to be concentrated in clusters among people engaging in specific kinds of risky behavior. A questionnaire conducted by the Baltimore City Health Department revealed that in general syphilis seems to be a risk factor among men who are exchanging sex with people they may or may not know, she said.

"Anonymous sex definitely seems to be a risk factor," Thompson said. "Also, unprotected sex is a risk factor."

Erbelding said that the availability of recreational drugs and less fear of contracting HIV may also be factors.

To address the rise in syphilis cases overall, Baltimore's public health officials began an aggressive syphilis elimination program in conjunction with a national initiative announced in 1998 by the CDC.

"The focus of our plan is to improve STD prevention services to communities that have had less access in the past," Erbelding said. "So we're trying to increase syphilis awareness and testing in the community and particularly now in the gay community."

FOR MORE INFO Baltimore City Health Department Druid STD Clinic 1515 W. North Ave. Baltimore, MD 21202 410-396-0176

The Baltimore Health Department is working with various community-based organizations on this effort.

"We're going to start offering [STD] testing using mobile vans," she said, that travel across Baltimore. "Currently, a lot of AIDS service organizations are trying to expand their mobile van programs to offer HIV as well as syphilis testing."

The Baltimore health department has provided funds for syphilis prevention initiatives involving six community-based organizations, including Chase Brexton and HERO, an acronym for Health Education Resource Organization, Inc., an HIV/AIDS service organization in Baltimore founded in 1983.

Indira Kotval, deputy executive director at HERO, said that organization plans next week to expand its Street/Mobile Outreach and Education program to reach more male sex workers and people leaving gay bars with information about HIV/AIDS as well as about syphilis. Baltimore health officials are scheduled to begin placing outreach workers on the vans that HERO operates so they can share information about syphilis.

Non-invasive testing involves obtaining blood or urine specimens from a person instead of swabbing the urethra.

News reporter Rhonda Smith can be reached at rsmith@washblade.com.
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