County Syphilis Cases Rise Sharply as Screening Drops

Syphilis in Los Angeles County is spreading dramatically, in some areas reaching levels that health officials say are unprecedented since the advent of penicillin 45 years ago.

At the same time, the number of people being screened at the county’s sexually transmitted disease clinics has dropped ominously over the last 20 months--in response, some health officials suspect, to the county’s decision to raise money by charging a fee for screening.

The turnout for screening, considered essential to controlling the spread of disease, has dropped 40% since the $20 fee was imposed in August, 1986. Over the same period, the rate of reported cases of infectious syphilis climbed by more than 60%.

In 1987, the rate of reported cases rose by 57.9% to a level of 55.6 cases per 100,000 population. In South-Central Los Angeles, where the epidemic has hit hardest, the rate per 100,000 rose from 82 in 1985 to 402.4 in 1987.

Those levels exceed any since 1943, when the syphilis rate in California was 387 per 100,000, one county health official said. The introduction of penicillin brought the nationwide level down to 4 per 100,000 by the mid-1950s. Until recently, it hovered near 10 per 100,000.

“The problem is so great now with syphilis, we don’t know that we will be able to control it without some extraordinary efforts,” said Dr. Deborah Cohen, a physician specialist with the county Department of Health Services’ sexually transmitted disease program.

Members of the county’s Public Health Commission decided Thursday to write to the Board of Supervisors to recommend that the clinic fee be abolished. But one top county health official said it remains to be proven that the fee caused the drop in attendance.

Warning on Fees

“If we take a precipitous action regarding the fees, we’re going to have a fall-off in revenue and we won’t have money to pay staff,” said Larry Roberts, director of health center operations. “You’re caught between a rock and a hard place.”

County health officials trace the syphilis epidemic to a combination of causes.

- Routine screening is less and less common in hospital admissions, routine physicals, family planning clinics and jails. Officials estimate that the infectious syphilis rate among women in county custodial facilities is as high as 800 per 100,000.

- Demand for drugs like crack cocaine has increased the frequency of so-called “sex for drugs,” officials said.

- There is no longer a full-time county staff person assigned to ensure better reporting of syphilis cases. Without that surveillance and reporting, the county is unable to identify infected people and treat their sexual partners.

- There has been a drop in the number of investigators assigned to the laborious task of finding the sexual partners of people with sexually transmitted diseases. There are 17 field investigators--described by health officials as a “half complement” of staff.

- Federal and state resources for public health have been shifted away from diseases like syphilis to fight the AIDS epidemic. County health officials say they have lost eight of the 11 state-funded employees formerly assigned to the area of sexually transmitted diseases.

“When people talk about all the new money that goes into AIDS, it’s not all new money,” Dr. Shirley Fannin, associate deputy director of disease control programs, said Thursday at a county Public Health Commission hearing. “Sometimes it’s robbing Peter to pay Paul.”

Most of the syphilis cases are occurring among black men and women age 25 to 30. As a result, the number of children born with syphilis rose from 10 in 1985 to 39 in 1987--cases that Cohen said cost society an estimated $88,000 each in medical and educational expenses.

County health officials said screening is central to controlling and preventing syphilis because its symptoms may not be apparent for months after infection.