ChristiansUnite Forums

Syphilis rise worries health workers

Web Posted: 06/12/2007 01:04 AM CDT

Don Finley
Express-News Medical Writer

On many nights, in the back rooms of bars, community centers and church meeting halls around the city, George Perez sits around a platter of cold cuts with perhaps a dozen other men to talk about sex.

While the conversation is often explicit — even lascivious — these gatherings are deadly serious. Some 25 years after the AIDS epidemic began, Perez, an 18-year veteran counselor with the Metropolitan Health District, tries to help the other men at the table understand why they're risking their own health — and the health of others — through unsafe sex practices.

"If my need right now is a 20 (dollar) bag of cocaine, HIV is not even an issue," Perez said. "However I have to get that, I'm going to get it. That need is greater."

While HIV cases have remained relatively steady, health officials here and across the country are worried that a sharp rise in syphilis, which is easily curable if detected, could fuel an increase in HIV and AIDS, which are not.

Syphilis rates have risen in recent years, in contrast to the beginning of the decade when the bacterial disease reached its lowest levels ever recorded and public health officials expressed cautious hope it could be eradicated.

In San Antonio, health officials have redoubled efforts to track down partners of those who test positive for syphilis, offer testing and counseling in bars, drug havens and the jail, and encourage safer sex practices. Perez leads intensive behavior modification classes.

 "A disturbing trend is that many of our (syphilis) cases we're seeing here and also nationwide are amongst co-infected people — people who are also HIV positive," said Scott Salo, who oversees the outreach programs for the health district. "That's disturbing because they're now putting people at risk for HIV as well as syphilis."

More than doubled

In April, the Centers for Disease Control and Prevention reported that most of the nationwide increase in syphilis involved gay men, who made up almost two-thirds of cases in 2003. The rate of the two most infectious types of syphilis rose by 70 percent between 2001 and 2005. The rate among men is now six times higher than in women. A decade ago it was roughly the same.

 "The reversal in syphilis trends in recent years is a significant public health concern," said Jennifer Ruth, a spokeswoman for the CDC, citing the risk of HIV spread.

In Bexar County, syphilis cases reached their lowest point in 2003 — three years after the rest of the country. Between 2003 and 2006, the number of local cases more than doubled, from 217 to 438.

Of particular concern, syphilis in teenagers also doubled between 2004 and 2006, from 19 to 39 cases. In 2006, nine of those cases were in children 14 and younger.

"The scary thing about the teens is, there's not been this disease introduced into that social network," Salo said. "Now we've seen it."

The earliest symptom of syphilis is an ulcer at the site of infection, which increases the odds of also transmitting HIV by two to five times. A second stage is often characterized by a rash on the hands and feet. Even without penicillin, the standard treatment, those symptoms will clear up, but the infection can progress to damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. The unborn babies of infected mothers can suffer developmental problems and stillbirth.

A team of six Metropolitan Health District staff members is assigned to tracking down people potentially infected with syphilis — along with HIV — trying to contain it before it spreads further. When someone is diagnosed, that person is asked for the names of sex partners and even friends who visit the same bars and social networks.

The goal is to find infected people within a window of a few days so they can be treated before they become infectious to others. That is how the public health community came so close to snuffing out the disease only seven years ago.

Vital to community

Once a month, John Downum invites the health department to his bar, the Saint, to offer free HIV and syphilis testing, and counseling to his customers. Other bars that cater to gays do the same, but Downum takes it a step further. Anyone who gets tested receives a 30-day pass to get in without a cover charge. It's not unusual to see 60 to 80 people in line, he said.

"It's extremely important to the community, for the safety of the people in the community," Downum said. "All we can do is try to push people to more safety precautions and help them learn what they can or cannot do. In lieu of all of that, just come in and get tested and get counseling — particularly when they come up positive."

It would be easier if people would avoid multiple partners or at least use a condom. So why — after more than a half million Americans have died from AIDS — don't they?

"The youth of today is so far removed from the face of AIDS and the quick kill of AIDS," Perez said. "To them, they see it as a manageable disease, something they can get a shot for, take a pill for. It doesn't scare them."

The CDC's Ruth said that several factors might be to blame. Drug and alcohol abuse, prevention fatigue (gradually losing the willpower to continue a healthy behavior) and complacency related to effective treatments for HIV are mentioned. Even the use of the Internet to find sex partners might be a factor.

Perez spends a lot of time in his behavior modification sessions teaching safe sex practices. But most of the discussion is on negotiation skills and "triggers," the kind of situations that lead people into unhealthy behaviors. The language is borrowed from the substance abuse treatment community. And like substance abuse treatment, people often relapse a few times before the changes take hold, he said.

But the sessions will soon come to an end. On Wednesday, the city was informed that its $250,000 state grant for HIV prevention that includes Perez and one other staff member won't be renewed, and will run out of money Aug. 30. Instead the grant funds will go to not-for-profit community organizations that also do HIV outreach.

"Now we sort of have to defer to them to take over this role," said Dr. Bryan Alsip, assistant director of the health district. "We really just hope they pick it up and move forward."

Syphilis rise worries health workers (http://www.mysanantonio.com/news/metro/stories/MYSA061207.01B.Syphilis.33f7241.html)

Another reason why, the Bible is always right............