Syphilis Cases Double in L. A. County, N.Y., Florida

In an unexpected reversal of a downward historical trend, the number of reported syphilis cases in the United States is increasing dramatically, nearly doubling in Los Angeles County, South Florida and New York City in early 1987 compared to the first quarter of last year.

The upturn appears to be caused by a rise in heterosexual cases, often involving black and Latino female prostitutes and intravenous drug users, according to public health officials from across the country.

They cautioned, however, that the outbreaks are still under investigation and that different factors may turn out to be important in various regions of the country.

Nationally, cases of infectious syphilis increased about 25% through April, 1987, compared to 1986, according to the federal Centers for Disease Control. In Los Angeles County, syphilis cases increased about 95%, in Florida 97.4%, and in New York City 103.5%.

Reported cases of primary and secondary syphilis, the earliest and most infectious stages of the bacterial disease, totaled 27,599 nationwide in 1986, including 5,240 in California. Since many cases of syphilis are not reported, the true incidence of the disease is thought to be several times higher.

The concentration of new syphilis cases occur in regions of the country with high numbers of AIDS cases. This suggests that many heterosexuals are failing to protect themselves against exposure to the deadly AIDS virus despite the blitz of publicity about contracting the virus through sexual contact.

At the same time, syphilis cases in male homosexuals appear to be declining, continuing a trend seen in recent years in San Francisco and other cities.

“To date, the trends in the heterosexual community have not followed the trends in the gay male community,” said Dr. Ward Cates, director of the division of sexually transmitted diseases at the federal Centers for Disease Control in Atlanta.

“The homosexuals started to behave a little bit better (because of AIDS), but the heterosexuals do not have the same AIDS fear,” said Dr. Surekha Mishal, acting director of Los Angeles County’s sexually transmitted diseases program. “They do not take the precautions in terms of limiting their sexual partners. . . . They are exposing themselves more and more to get sexually transmitted diseases.”

There are other possible explanations for the new surge in syphilis cases. One is the difficulty in tracing the contacts of individuals diagnosed with syphilis because some patients refuse to name their sexual partners and because many other infections result from anonymous sexual encounters.

Another--cited by Cates and others--is a “diversion” of public health resources from control of syphilis, gonorrhea and other traditional venereal diseases to AIDS prevention and testing programs.

This hypothesis appears to be supported by similar dramatic increases in cases of a penicillin-resistant strain of gonorrhea, primarily in California, Florida and New York City. There were an estimated 5,040 cases of penicillin-resistant gonorrhea in the United States in the first quarter of 1987, compared to 2,517 in the first quarter of 1986.

Although the total number of gonorrhea cases has not increased, the resistant strain of gonorrhea must be treated with antibiotics that are much more expensive than penicillin and can cause serious complications, such as infertility and pelvic inflammatory disease in women.

Starts With Painless Sores

Syphilis is usually transmitted through intimate contact with infectious areas of the skin, which are teeming with Treponema pallidum bacteria that cause the disease. It is often discovered in the “primary” stage as a painless sore on the genital organs between 10 to 90 days after exposure or in the “secondary” stage as a characteristic rash over the body about two months later. Syphilis can also be diagnosed through blood tests, often among people with no symptoms.

Untreated, the syphilis bacteria continues to infect the bloodstream, often causing serious nervous system or heart disease many years later. One of the most tragic consequences occurs in infected mothers, who may deliver a dead child or one that is deformed or blind.

Public health officials first noticed significant increases in infectious syphilis cases in Florida’s Broward County, north of Miami, in 1985. The outbreak contrasted with the general downward trend of the disease throughout the nation since 1982.

Sex Exchanged for Cocaine

Since 1985, the upward syphilis trend in south Florida has continued, with many infections being transmitted by women who exchange sex for “crack” cocaine, according to Jack Wroten of the Florida Department of Health and Rehabilitative Services. Nearly 80% of all syphilis cases are developing in blacks, he said.

In 1986, new clusters of syphilis were also noticed in California, including about a 55% increase in cases in Orange County, primarily among Latino migrant workers from contact with infected prostitutes.

(Cases for the first quarter of 1987 are down in Orange County. Dr. Thomas Prendergast, Orange County epidemiologist, said that for the first quarter of 1987, Orange County recorded 176 cases of syphilis compared to 195 for the same period last year--a nearly 10% decrease.)

As a results of such clusters, the number of primary and secondary syphilis cases increased to 5,240 statewide, compared to 4,286 cases in 1985. The number of cases in newborn children nearly doubled--totaling 59 in 1986, compared to 34 in 1985.

The national syphilis problem, also involving Georgia, Maryland and Tennessee, became evident in mid-April as public health officials reviewed venereal disease statistics for the first three months of 1987, according to CDC officials.

In Los Angeles, the majority of the increased number of syphilis cases are developing in blacks, according to Mishal. In recent months, there has been a sharp increase in cases in black women, many of whom exchange sex for intravenous drugs, she said.