Following a level off in 2004, early syphilis cases (infections contracted within the past year) in L.A. County climbed steeply in 2005, reaching 1,217 total cases - a 40% increase from 2004 (865 cases), and a 188% increase from total reported in the County in 2001 (423 cases).
Men who have sex with men (MSM) continue to be most affected by syphilis in L.A. County, with two-thirds of syphilis cases in 2005 reported in MSM. However, female cases increased even more rapidly in 2005, going from 89 cases (10.2% of total) to 139 cases (11.4% of total) - a 56% increase.
"We are concerned that despite considerable efforts since 2000 syphilis is rising in L.A. County," says Dr. Jonathan E. Fielding, MD, MPH, Director of Public Health and Health Officer. "Syphilis is a devastating disease and also makes it easier both to transmit and be infected by HIV."
The increase in female cases is also worrisome because it could lead to a new wave of infections in a new population, and because any increase in syphilis among women of child- bearing age always raises the concern about increased syphilis among newborns. Syphilis is easily detected with a simple blood test and completely curable with the right antibiotics.
Disproportionate increases were experienced by African- Americans (49% increase, to 239 cases) and Hispanics (42% increase, to 451 cases). Among MSM cases, the largest proportion of cases are among Whites (44.8%); in contrast; among females, the largest share of cases are among African- Americans (42.4%) and Latinas (41.7%). Similarly, there has been a steady increase of Chlamydia and gonorrhea among African-American and Latina females who are disproportionately affected by these diseases.
The increase in syphilis cases is likely the result of a number of factors according to Dr. Peter R. Kerndt, MD, Director of the L.A. County STD Program. "To some extent, our efforts to increase syphilis testing -- through our media campaign 'Stop the Sores,' better STD testing access, and increased screening in the men's jail in 2005, has increased our ability to find cases resulting in a greater number of reported cases."
Kerndt adds that positive efforts alone do not explain the substantial increase and there are continuing factors to the increase including unprotected sex by individuals with HIV, use of the internet to make a large number of sexual contacts in a short time, and use of methamphetamine and other drugs which can reduce safer sex behaviors. "As syphilis increases among women, we must expand awareness of syphilis and other STDs in that population, and among their health care providers."
As has been the case consistently since syphilis first began to increase in 2000, the majority of MSM cases are among HIV-positive individuals (61.3% of MSM cases in 2005 were HIV-positive by self-report, down only slightly from 62.2% in 2004). Syphilis increases the risk of transmitting or acquiring HIV (if exposed) up to 5 fold. A study by the L.A. County Sexually Transmitted Disease (STD) Program found that roughly one fourth of individuals with syphilis also showed evidence of relatively new HIV infection, suggesting that syphilis may indeed be adding to the burden of new HIV cases in the County. HIV-positive individuals are also at greater risk for certain complications of syphilis, particularly brain damage.
Syphilis first began to increase in L.A. County in 2000. Many other large urban areas in the U.S. experienced similar outbreaks around the same time. In response, the County Department of Health Services has, often in partnership with community organizations, implemented a wide range of measures to prevent syphilis, including increased awareness among healthcare providers, including those who provide care to HIV-positive individuals, increased screening at the County jail, increased STD clinic hours, and expansion of STD clinic services targeted to MSM.