Syphilis Cases Double in L.A. County, N.Y., Florida

In an unexpected reversal of a historical trend, the number of reported syphilis cases in the United States is increasing dramatically, nearly doubling in Los Angeles County, Florida and New York City in early 1987, compared to the first quarter of last year.

The increase appears to be primarily among heterosexuals, often involving black and Latino female prostitutes and intravenous drug users, according to public health officials across the country.

They cautioned, however, that the outbreaks are still under investigation and that different factors may turn out to be important in various regions of the country.

Nationally, cases of infectious syphilis increased about 25% through April, 1987, compared to the same period in 1986, according to the federal Centers for Disease Control. In Los Angeles County, syphilis cases increased 96.3%, in Florida 97.4% and in New York City 103.5%.

Reported cases of primary and secondary syphilis, the earliest and most infectious stages of the bacterial disease, totaled 27,599 nationwide in 1986, including 5,240 in California. Because many cases of syphilis are not reported, the true incidence of the disease is thought to be several times higher.

The new syphilis cases are concentrated in regions with high numbers of AIDS cases. This suggests that many heterosexuals are failing to protect themselves against exposure to the deadly acquired immune deficiency syndrome virus despite the blitz of publicity about contracting the virus through sexual contact with infected people.

At the same time, syphilis cases in male homosexuals appear to be declining, continuing a trend seen in recent years in San Francisco and other cities.

“To date, the trends in the heterosexual community have not followed the trends in the gay male community,” said Dr. Ward Cates, director of the division of sexually transmitted diseases at the federal Centers for Disease Control in Atlanta.

“The homosexuals started to behave a little bit better (because of AIDS), but the heterosexuals do not have the same AIDS fear,” said Dr. Surekha Mishal, acting director of Los Angeles County’s sexually transmitted diseases program. “They do not take the precautions in terms of limiting their sexual partners. . . . They are exposing themselves more and more to get sexually transmitted diseases.”

There are other possible explanations for the surge in syphilis cases. One is the difficulty in tracing the contacts of people diagnosed with syphilis, because some patients refuse to name their sexual partners and because many infections result from anonymous sexual encounters.

Another--cited by Cates and others--is a “diversion” of public health resources from control of syphilis, gonorrhea and other traditional venereal diseases to AIDS prevention and testing programs.

Increase in Gonorrhea

This hypothesis appears to be supported by similar dramatic increases in cases of a penicillin-resistant strain of gonorrhea, primarily in California, Florida and New York City as well. There were an estimated 5,040 cases of penicillin-resistant gonorrhea in the United States in the first quarter of 1987, compared to 2,517 in the first quarter of 1986.

Although the total number of gonorrhea cases has not increased, the resistant strain of gonorrhea must be treated with antibiotics that are much more expensive than penicillin and can cause serious complications, such as infertility and pelvic inflammatory disease in women.

Syphilis is usually transmitted through intimate contact with infectious areas of the skin, which are teeming with Treponema pallidum bacteria that cause the disease. It is often discovered in the “primary” stage as a painless sore on the genital organs between 10 to 90 days after exposure, or in the “secondary” stage as a characteristic rash over the body about two months later. Syphilis can also be diagnosed through blood tests, often among people with no symptoms.

Untreated, the syphilis bacteria continues to infect the bloodstream, often causing serious nervous system or heart disease many years later. One of the most tragic consequences occurs in infected mothers, who may deliver dead children or babies that are deformed or blind.

Public health officials noticed significant increases in infectious syphilis cases in Florida’s Broward County, north of Miami, in 1985. The outbreak contrasted with the general downward trend of the disease throughout the nation since 1982.

Sex for Cocaine

Since 1985, the upward syphilis trend in Florida has continued, with many infections being transmitted by women who exchange sex for crack cocaine, according to Jack Wroten of the Florida Department of Health and Rehabilitative Services. Nearly 80% of reported syphilis cases are developing in blacks, he said.

In 1986, new clusters of syphilis were also noticed in California, including about a 55% increase in cases in Orange County, primarily among Latino migrant workers from contact with infected prostitutes. (Cases for the first quarter of 1987 have decreased in Orange County.)

As a results of such clusters, the number of primary and secondary syphilis cases increased to 5,240 statewide, compared to 4,286 cases in 1985. The number of cases in newborn children nearly doubled: 59 in 1986, compared to 34 in 1985.

The national syphilis problem, also involving Georgia, Maryland and Tennessee, became evident in mid-April as public health officials reviewed venereal disease statistics for the first three months of 1987, according to CDC officials.

In Los Angeles, most of the increased number of reported syphilis cases are developing in blacks, according to Mishal. In recent months, there has been a sharp increase in cases in black women, particularly among those who exchange sex for intravenous drugs, she said.

Prostitutes Cited

In non-urban areas of California, many syphilis cases are developing in Latinos. Often a few female prostitutes are responsible for a cluster of cases, according to James Felten, acting chief of the sexually transmitted disease section in the state Department of Health Services.

Public health officials have been aware of the epidemic of penicillin-resistant gonorrhea since 1984; last year about two-thirds of the 16,608 cases nationally occurred in Florida, Los Angeles or New York City, almost all in heterosexuals.

INCREASE IN VENEREAL DISEASE Reported Cases of Primary and Secondary Syphilis

1987 1986 % Change United States (Jan.-April) 10,009 7,697 +23.1% California (Jan.-March) 1,816 1,222 +48.6% L.A. County 970 489 +96.3% Orange County 176 195 -9.7% Riverside County 25 20 +25.0% S. Bern. County 44 15 +193.3% S. Diego County 66 50 +32.0% San Francisco 48 88 -45.4% Florida (Jan.-April) 2,123 1,075 +97.4 New York City (Jan.-April) 1,229 604 +103.5%

California Syphilis Cases in 1986

Black Latino White Other Los Angeles County 57.6% 25.2% 11.5% 5.7% San Francisco 22.9% *20% 46.4% *11% All other areas 23.8% 49.5% 24.6% 2.1%

Gonorrhea and Penicillin-Resistant Gonorrhea

Jan.-March Jan.-March 1987 1986 % Change United States Total cases 211,809 223,410 -5.2% Resistant cases *5,040 2,517 *+100.1% California Total cases 25,927 24,160 +7.3% Resistant cases 727 179 +306.1% L.A. County 436 74 +489.2% Orange County 26 2 +1300.0% Riverside County 2 0 -- S. Bern. County 9 0 -- S. Diego County 85 27 +214.8% San Francisco 18 10 +80.0% Florida Resistant cases 1362 1175 +15.9% New York City Resistant cases 1082 497 +117.7%

Sources: U.S. Centers for Disease Control, California Department of Health Services, San Francisco Department of Public Health, Los Angeles County Department of Health Services. *estimated.