Syphilis: ‘a Flaming Crisis’

The unexpected outbreak of syphilis in Los Angeles County highlights two failings--a failure in resources and organization of the public-health program, and a failure to affect behavior in the black and Latino communities with the safer-sex education programs.

Robert C. Gates, director of the county Department of Health Services, underscored a basic problem when he said, “It’s got to be a flaming crisis before we can get someone’s attention to put resources in.” The Board of Supervisors, struggling with the pinch of Proposition 13 tax limits, has been squeezing public-health budgets. So have Sacramento and Washington. But it is by no means clear that the county is getting its money’s worth from what it is spending--an issue that may be faced as the department considers reorganization. It looks as if the department is not flexible enough to respond quickly to new problems.

Dr. Shirley Fannin, the pediatrician who heads the department’s communicable-disease control program, has brought the issue into public debate, and that is a good thing. She charges that her early warning on the syphilis problem was watered down by administrators in the department--a charge not yet proved. But she is persuasive when she appeals for a system that does not isolate those engaged in public-health action programs.

The rate of syphilis has almost quintupled in some areas of the county since 1985, and is now at the highest level of incidence in those areas since shortly after the invention of penicillin. That is ominous evidence that sex is being widely practiced without the protection of condoms despite extensive public information campaigns, tied to the pandemic of AIDS, that urge safer sex practices.

The AIDS spread may be a factor in the slowness of the public-health response. Some venereal-disease experts were reassigned to AIDS. Earlier there was an outbreak of penicillin-resistant gonorrhea that distracted health officers as well. There also have been serious declines in the staffing of government venereal-disease programs--federal, state and local. That problem has now been partly remedied by concentrating workers in South-Central Los Angeles, the center of the outbreak. There is also evidence that fees imposed at county clinics served as a deterrent to people requiring prompt treatment. Those fees have now been ordered lifted, and county supervisors have committed emergency funds.

From these events the Department of Health Services needs to develop a more responsive and flexible organization. All levels of government will need to reexamine the adequacy of fundingfor the sexually transmitted disease programs. And for informed citizens there are new reasonsto avoid high-risk sexual activities.