Disease Sleuth Tracks Down Unaware Victims

Business is better than ever for disease detective Yolanda Vargas.

The number of reported syphilis cases in Ventura County is double what it was last year at this time--the result, health officials say, of an increased incidence of syphilis among out-of-town prostitutes visiting Latino farm workers.

Vargas often visits not long afterward.

As a communicable disease representative for the state Department of Health in Ventura County, her job is to interview those who test positive for syphilis and gonorrhea, get names of their sex partners and track them down to come in for treatment.

So far this year, the county has logged 56 cases of syphilis, up from about 28 at this time last year, said Dr. Larry Dodds, the county’s Director of Public Health.

Vargas--the only person who tracked those cases from January until this month, when the state filled a second position--has had her hands full.

“You run into some very awkward situations,” she says. “The worst is when you’re dealing with an unfaithful husband.”

Tracking Down Cases

Vargas’s job takes her to gay bars, seedy cantinas, middle-class homes and offices. She leaves handwritten notes in mailboxes and cruises streets where her quarry might hang out. Her job requires tact and tenacity, an ability to dole out facial tissues as well as to remain cucumber-cool when doors are slammed in her face and phones in her ear. And for those who need further persuasion that treatment is necessary, there’s a nasty set of color photos to illustrate the ravages of secondary and tertiary syphilis.

“I don’t like to use them unless I have to,” Vargas says drily. “I say, would you like to see some pictures. . . .”

The rise in Ventura County’s syphilis incidence mirrors a national trend. In Los Angeles County, syphilis has reached levels unprecedented since the advent of penicillin 45 years ago. Los Angeles County reported 4,198 cases of infectious syphilis in 1987, up from 1,558 in 1984.

Because its initial symptoms are painless and appear fleetingly weeks after infection, the disease can go undetected or ignored for years.

Unless treated with antibiotics, however, the bacteria that cause syphilis can infect the bloodstream and eventually damage the nervous system or cause heart disease. Infected mothers may give birth to deformed or blind babies. Some are born dead. Additionally, syphilis may heighten a person’s risk of infection with the AIDS virus, which can be transmitted through open sores in the genital area.

In Los Angeles, authorities attribute the rise of syphilis in part to the practice of exchanging sex for drugs, which has increased with the spread of addictive crack cocaine. The Los Angeles County Board of Supervisors voted last month to spend $2.7 million to curb the disease, and has suspended the $20 fee charged for diagnosis and treatment at county-run health clinics.

The state administers Ventura County’s communicable disease program and, despite the doubled syphilis caseload, at present there are no plans by this county’s board of supervisors to augment that program. Patients are adequately diagnosed and screened at county clinics for $8, Vargas said.

In Ventura County, health officials trace the syphilis increase to prostitutes from Los Angeles, Fresno and San Diego who do a thriving weekend business at local migrant labor sites, plying their trade in cars or from cheap hotels in Fillmore, Santa Paula, Oxnard or Ventura.

Farm Workers Affected

Vargas says that most of the prostitutes are intravenous drug users and that most of the cases she runs across are in the the county’s agricultural areas. Very few cases surface in Thousand Oaks and Simi Valley, she says.

Health officials also attribute the dramatic increase to the discovery of previously undiagnosed cases among Latinos who recently have applied for amnesty.

In her daily work, Vargas is well acquainted with the thrill of victory and the agony of defeat, and she tabulates both carefully. One coup she recalls with relish was locating a farm worker who tested positive for a stubborn, penicillin-resistant strain of gonorrhea.

The lab results put her on red alert, so within an hour she hopped into her county-issued car and headed north for a Santa Maria ranch where the infected man worked picking vegetables.

Vargas, who was then working for the Santa Barbara County health department, told the ranch foreman that she was from a doctor’s office and that the man needed a new medicine urgently.

Impressed by her authoritative manner, the foreman bundled Vargas into his jeep and roared past rows of broccoli and cauliflower until he found the worker.

The man agreed to get treatment and named a prostitute as his sexual contact. Vargas was unable to track down the woman; she apparently had passed through the county on her way north.

Wife Was Infected

Then there are the disappointments.

Vargas once quizzed a man who had been separated from his wife for a year and had contracted syphilis from a prostitute. The husband emphatically denied sleeping with his wife during that time, even after Vargas described the horrible lesions and damage that would result if the wife had been exposed and was not treated.

A month later, Vargas saw the man in a county medical clinic and learned he had brought “a friend” in for treatment of syphilis. It was his wife, who had developed the primary symptoms of the disease.

“I felt like it was my fault, that I hadn’t done my job properly,” Vargas says.

Vargas sometimes juggles up to 15 cases at once. She’ll make two or three field visits a week, scouting out contacts. On one recent, hot afternoon, she played chauffeur, driving out to Fillmore to fetch for treatment a woman whose unfaithful boyfriend had given her syphilis.

It isn’t easy on the psyche--or on the soles--being a communicable disease representative for the state of California. Nor is it terribly lucrative. A state health department spokesman said annual salaries range from $23,712 to $29,614.

The work requires common sense, as well as innovative sleuthing.

One infected man told Vargas he had slept with a Santa Paula barmaid. The man knew the bar’s location but told her he couldn’t recall which woman he had slept with.

Met With Barmaids

So Vargas phoned the bar manager, explained the predicament and asked to come in and talk to the entire staff.

The seven barmaids came willingly to Vargas’ impromptu educational session, and even told some friends about it. Vargas spent several weeks ferrying the women (and their friends) back and forth from clinics. As a result, she discovered a dozen venereal-disease cases, including three of penicillin-resistant gonorrhea, which must be treated with other antibiotics.

“The more we dig, the more we find,” she says.

Vargas also gives presentations in Spanish to migrant farm workers on the dangers of venereal disease and the importance of using condoms. She says some people she counsels don’t understand how the diseases are transmitted or that there is a heightened danger to pregnant women.

On her rounds, Vargas carries a little black book with names, addresses and other leads. She rarely flashes her badge, preferring to schmooze with them. (Many of the Latinos she contacts are afraid of her at first because they fear deportation, she says).

The first step, however, is to call anyone who has been named as a sexual contact by an infected person. Confidentiality laws bar her from telling anyone but that person the exact nature of her call.

Vargas leaves her first name and a direct phone number, which she answers with: “This is Yolanda. Can I help you?” If that gets no response, she sends out pre-printed letters that say: “It is important that you get in touch with me as soon as possible regarding a health matter.” The envelope is blank and stamped “Confidential.” Then the personal visits start.

Pregnant Teen-Ager

One day this week, Vargas was asked by public health nurses to check up on a 14-year-old girl who had tested positive for the sexually transmitted disease chlamydia. Repeated phone calls for a week had yielded no response.

As Vargas pulled up to the east Ventura address, she wrote a note on notebook paper and walked up the steps, anticipating that she might have to fend off questions from parents. (She sometimes identifies herself as a friend. Under state law, if the child is over 14, it isn’t necessary to inform the parents.)

The door opened on the first knock, revealing a young, pregnant girl and two young men introduced as her fiance and her brother. A baby crawled on the floor.

Vargas took the girl upstairs, explained the problem to her privately and urged her to see a doctor promptly, since chlamydia can cause pneumonia in newborns.

The girl listened intently, her eyes widening with fear until Vargas assured her that the disease could be easily cured with proper treatment. It soon emerged that the girl had no idea her tests had yielded problems because her phone wasn’t working.

Vargas left the house 10 minutes later, her mission accomplished. But as she paused to ponder the case, her lips pursed momentarily.

“If she had gonorrhea,” Vargas said, gesturing toward her county car, “I would have taken them both in right now for treatment.”