Syphilis Outbreak in California Linked to Risky Behavior and Failure of Public Health System
The recent rise in syphilis cases in California, mostly in Los Angeles County, reflects an increase in high-risk sexual behavior by gay and bisexual men and a failure of the state's public health tracking system, the Sacramento Bee reports. Early in 2000, syphilis had "nearly disappeared" from Los Angeles County's gay population, when an AIDS Healthcare Foundation clinic reported diagnosing about 50 cases among gay and bisexual men. Health officials then launched a $560,000 safe-sex media campaign and "four months later declared the outbreak under control." But this summer, the officials "made a startling about-face," conceding that syphilis -- which often indicates a rise in other sexually transmitted diseases, including HIV -- was endemic among men who have sex with men, "[b]ucking a nationwide trend." In San Francisco this year, syphilis cases have nearly doubled, while Sacramento County has recorded 10 cases -- six involving men who had sex with men -- compared to one last year. The outbreaks mark a "setback" for the CDC's national syphilis elimination project, launched two years ago.
'Denial and Incompetence'
A CDC official attributed the outbreak to a "combination of denial and incompetence." Investigators have discovered that most of the men who contracted syphilis "shrugged off the lessons of the AIDS epidemic and had unprotected sex." Meanwhile, doctors either failed to diagnose the disease or were "ignoring a state law" requiring them to report cases of 85 communicable diseases to the county. The Bee reports that the law is "rarely enforced," and fewer than a "handful of doctors" have been disciplined under it. Dr. Jonathan Fielding, Los Angeles County's health officer, said that some cases were reported "six months late" because doctors were "too busy or thought someone in their office would do the paperwork." Lee Klosinski, director of education for AIDS Project Los Angeles, said, "I don't think the public health people were ready for this [outbreak] in this community."
A Bad Omen for Bioterror Response?
The failure of Los Angeles County's public health system to track the outbreak raises concerns that the same system may not be able to detect a bioterrorist attack, the Bee reports. According to public health officials, low funding levels have prevented them from "keep[ing] pace with infectious diseases they encounter on a day-to-day basis," leaving them uncertain whether they could quickly ascertain that a smallpox attack, for example, was underway. A 1998 survey by the California Conference of Local Health Officers estimated that counties would need $22 million in state funding to improve local disease surveillance across the state and upgrade communication across counties. But this proposal has "not generated much support" among state lawmakers, leaving strapped counties struggling to deal with disease outbreaks. Cesar Portillo, an outreach worker with the AIDS Healthcare Foundation, asked, "How are we ever going to stop anthrax or smallpox when we couldn't stop syphilis?" (Rojas, Sacramento Bee, 11/27).
Government Announces Syphilis Cases at 'All-Time Low'
With fewer than 6,000 reported cases of syphilis last year, the U.S. government announced Wednesday at a conference in Dallas that syphilis infections are at an "all-time low," the Associated Press reports. The three-day conference was organized to explore ways that public-private partnerships could help eradicate the disease that now primarily affects poor African-Americans and Latinos in the South. Of the nation's counties, 80% reported no new cases in 2000. The CDC has catalogued a 10% decrease in syphilis infections from 1999 to 2000 and a 30% decrease since 1997. In 1997, U.S. health officials enacted a syphilis eradication plan that aims to have "fewer than 1,000 cases by 2005, with 90% of counties syphilis-free." Despite the "concern[ing]" reports of increased infection rates among men who have sex with men in some states such as California and Florida, the infection rate among African-Americans has dropped 40% and the rate of vertical transmission has decreased by more than 50% since the plan was implemented. The CDC said it is concentrating resources in the counties where syphilis rates are still high (McClam, Associated Press, 11/28).