While the annual number of syphilis cases in Chicago has declined by 85 percent since 1991, a new increase in cases among gay men was reported this week by the Chicago Department of Public Health. Windy City Times has been reporting on this trend for several months, and these statistics reinforce the fears of the medical community.
In 2001 to date, CDPH has identified 61 cases of primary and secondary syphilis among gay men in the city, compared to just 44 cases among gay men in all of 2000. The cases are geographically concentrated, most notably in the Lakeview, Uptown and Rogers Park neighborhoods. Among all Chicagoans, there were 292 cases of primary and secondary syphilis in 2000, down from 2,045 in 1991.
"This increase in cases is of considerable concern," stated CDPH Commissioner John Wilhelm, M.D. "With the decline in AIDS deaths in recent years and with an emerging generation of young men who have literally never lived in a world without HIV, complacency about safer sex and risk reduction may be reaching alarmingly high levels. Complacency can, unfortunately, open the door for new infections of HIV, syphilis and other sexually transmitted diseases."
Syphilis is a complex sexually transmitted disease ( STD ) caused by the bacterium Treponema pallidum, CDPH noted in a press release. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. Syphilis is passed from person to person through direct contact with a painless syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. A rash often appears on the palms of the hands and soles of the feet. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying.
Public health officials are concerned that complacency about safer sex, coupled with the failure of many infected men to seek medical attention, could lead not only to more syphilis cases, but an increase in HIV infections. Syphilis multiplies the risk of HIV infection by two to five times, CDPH said. About half of the 61 gay men diagnosed with syphilis this year also are infected with HIV.
CDPH is working with a coalition of community-based healthcare providers, social-service agencies, advocacy organizations and others to "redouble existing efforts to provide information to gay men about syphilis and about the benefits of safer sexual practices, especially the regular use of latex condoms," CDPH stated.
Similar increases in syphilis among gay men have been reported by public health officials in New York City, Miami, San Francisco, Los Angeles and Seattle.
Anyone who is experiencing symptoms characteristic of syphilis, as well as men who have recently had unprotected sex with other men-- including oral sex-- -should seek medical attention and get tested. For more information on clinics that provide syphilis testing and related services, call 1-800-243-AIDS.
The Chicago Department of Public Health provides free testing and treatment for syphilis and other sexually transmitted diseases at six locations:
Lakeview Clinic, 2861 N. Clark, ( 312 ) 744-5507
South Austin Public Health Center, 4958 W. Madison, ( 773 ) 378-3900
Mile Square Clinic, 2045 W. Washington, ( 312 ) 413-8000
Englewood Neighborhood Health Center, 641 W. 63rd Street, ( 312 ) 747-8900
31st Street Clinic, 530 E. 31st Street, ( 312 ) 747-0101
Roseland Neighborhood Health Center, 200 E. 115th Street, ( 312 ) 747-2817
Other resources include:
Howard Brown Health Center, 4025 N. Sheridan, ( 773 ) 388-1600
Test Positive aware Network, ( 773 ) 404-TPAN
Additional Facts About Syphilis
The U.S. Centers for Disease Control and Prevention has more details about syphilis, including the following:
Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, clothing, or eating utensils.
What are the signs and symptoms in adults? Primary Stage ( infectious ) : The time between infection with syphilis and the start of the first symptom can range from 10-90 days ( average 21 days ) . The primary stage is usually marked by the appearance of a single sore ( a chancre ) , but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3-6 weeks, and it will heal on its own. If treatment is not administered, the infection progresses to secondary stage.
Secondary Stage ( infectious ) : The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash also may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. In addition to rashes, second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.
Late Syphilis: The latent ( hidden ) stage of syphilis begins when the secondary symptoms disappear. Without treatment, the person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage may show up many years later in the late or tertiary stage of syphilis. Late-stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may cause death.
How common is syphilis?: In the U.S., more than 35,600 cases of syphilis were reported by health officials in 1999, including 6,650 cases of primary and secondary syphilis ( a decline of 5.4% from 1998 ) and 556 cases of congenital syphilis in newborns. More cases occur each year than come to the attention of officials. Of the nine states with the highest 1999 syphilis rates ( 2-5 times higher than the national rate of 2.5 cases per 100,000 ) , eight were in the South. Although syphilis rates remain higher in the South, the South had a 32% decline in the primary and secondary syphilis rate from 1997 to 1999, illustrating that the greatest improvements in disease control have taken place where syphilis incidence has been the greatest. In 1999, 25 counties accounted for 50% of all primary and secondary syphilis cases. Two hundred sixty-five counties had syphilis rates above the U.S. Public Health Service's Healthy People 2000 objective of 4 cases per 100,000. These 265 counties ( 9% of the counties in the U.S. ) accounted for approximately 74% of the total primary and secondary syphilis cases.
In 1999, syphilis occurred primarily in persons 20-39, and the rate in men was 1.5 times greater than in women. The incidence was highest in women 20-29 and in men 30-39. Some societal problems, such as poverty, inadequate healthcare, and lack of education are associated with disproportionately high levels of syphilis in certain populations. Cases of primary and secondary syphilis in 1999 had the following distribution: African Americans 75%, whites 16%, Hispanics 8%, and others 1%. The rate for African Americans was nearly 30 times the rate for whites.
What is the link between syphilis and HIV? The genital sores caused by syphilis also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.
Is there a cure for syphilis?
Yes! A single dose of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Larger doses are needed to cure someone who has had it for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis.
How can people protect themselves against infection? When someone's syphilis status is unknown, a good defense against becoming infected is to use a latex condom before beginning sex and to keep it on until the penis is withdrawn. Condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. This is equally important for other STDs, including HIV, as well. Only lab tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Washing the genitals, urinating, or douching after sex does not prevent STDs, including syphilis. Any unusual discharge, sore, or rash should be a signal to stop having sex and to see a doctor.
