Syphilis Outbreak Declared Among Gay Men

Los Angeles County health officials declared an outbreak of syphilis among gay men Wednesday after discovering at least 23 new cases, most of them in the past six weeks.

The outbreak appears to be clustered in Hollywood, West Hollywood and Silver Lake and has struck men between the ages of 25 and 50. The sudden spread is unusual in a county that normally sees only about 100 cases a year, mostly among heterosexual men and women.

“This is different, and that’s why we’ve jumped on it,” said Dr. Jonathan Fielding, director of public health for Los Angeles County. But, he added, “This is not an epidemic” and there is no reason for panic.

There is no evidence that the outbreak has spread to heterosexuals or that it has links to other geographic areas in this state or elsewhere. But the outbreak is worrisome to health officials because the numbers are growing by the day, and the spread of syphilis, a sexually transmitted disease, suggests that safe sex practices--particularly condom use--are not being followed.

In fact, the spike in syphilis cases could presage an increase in transmission of HIV, the virus that causes AIDS. Some of those men infected with syphilis also have HIV--a matter of concern because the genital sores caused by syphilis make it easier to spread (and acquire) HIV sexually.

Health officials are scrambling this week to notify health providers to test appropriate patients and to locate sexual partners of those stricken to ensure they are tested and treated, if necessary. Syphilis usually is diagnosed through a blood test.

“I am sure we are going to see a significant increase in cases,” Fielding said. “We are urging those at risk to be screened and urging physicians with high-risk patients to screen them.”

“The good news is it’s very treatable,” Fielding said. “Penicillin, the old standby, is the primary treatment.”

One dose of penicillin will cure a person who has had syphilis less than a year. More doses are needed for someone who has had it longer. There are no home remedies or over-the-counter drugs that cure syphilis.

Fielding said it is likely that syphilis in Los Angeles County and elsewhere is consistently underreported. Still, the outbreak is somewhat surprising because syphilis is considered to be in decline. The U.S. Centers for Disease Control and Prevention has even talked about the possibility of eradication, Fielding said.

Nationally, rates of syphilis have been on the wane since the last national epidemic in 1990, according to the agency. In 1998, 6,993 cases were reported in the country, which meant an all-time low of 2.6 cases per 100,000 population.

But “this outbreak shows [syphilis] can be resilient,” Fielding said. “My concern is that we quickly work to control it.”

The syphilis bacterium is spread through direct contact with syphilis sores, which mainly occur on the external genitals, vagina, anus or rectum, according to the Centers for Disease Control and Prevention. Sores also can occur on the lips and mouth. The disease cannot be spread by contact with objects such as toilet seats, doorknobs or eating utensils. Transmission cannot be prevented by washing, urinating or douching after sex.

Initial symptoms can seem minor and might be overlooked. The first sign is a single painless lesion, called a chancre, within three or four weeks. The chancre, which is firm, round and small, is especially likely to go unnoticed if it occurs in the rectum.

Even with no treatment, the lesion will heal in one to five weeks. As it is fading, the second phase commences with a body rash, often a rough “copper penny” rash on the palms of the hands or the bottom of the feet, or sometimes a prickly heat rash. This phase often includes a fever or sore throat as well.

Again, these symptoms will clear without treatment. But the disease then remains latent for years and ultimately can cause severe damage to the heart, brain and other organs. It can be deadly.

“I would underline the message that it is really critical that people use safe-sex practices . . . basically using condoms and limiting the number of partners,” Fielding said.

The public health department will offer free testing for syphilis and other sexually transmitted diseases over the next few weeks. For information on test locations, call 1-800-758-0880. For information on treatment or to report a case, call 213-744-3376 (8 a.m. to 5 p.m.) or 213-458-5915 (evenings).