An outbreak of syphilis among men who have sex with men, first identified March 10, continues to grow in Southern California -- the count was 87 cases on May 2. Making matters even more dangerous, 53 percent of the 87 are also infected with HIV, says Peter Kerndt, M.D., M.P.H., director of the STD control program for the Los Angeles County Department of Health Services. A majority of the cases have been linked to anonymous sex in bathhouses and sex clubs, says Kerndt. "If you have HIV and syphilis, you are three to five times more likely to transmit HIV to a partner if you have unprotected anal or oral sex. If you have sexually transmitted diseases (STDs), including syphilis, you are more likely to acquire or transmit HIV," says Gail Bolan, M.D., chief of the STD control branch for the California Department of Health Services.

Though cases are concentrated in Los Angeles and Orange Counties, some have been reported as far south as San Diego County. Men who live outside of Southern California can also be at risk. "If you have anonymous partners, they may be from L.A. or may have recently traveled there," says Dr. Bolan. Of the reported cases, five had sexual contact with partners in Atlanta, Montreal, Europe and the Phillipines, says Dan Wohlfeiler, chief of the policy and communications unit of the STD control branch.

In response to the outbreak, the Los Angeles Board of Supervisors allocated $1.7 million for condom distribution, awareness and screening programs. "Right now, we're trying to identify as many people as we can in these high risk groups and [screen them]," says Dr. Kerndt. Part of the money will also go "to make [sex clubs and bathhouses] safer. We're putting in place a system that will allow us to offer STD screening, treatment and referral [in these environments]," adds Dr. Kerndt.

Syphilis is a bacterial infection usually acquired through sexual contact. Over time, untreated syphilis can attack the brain and can cause loss of hearing and sight, stroke, paralysis and death. People with HIV are susceptible to brain injury as early as two months after exposure, says Dr. Bolan. A simple blood test can identify infection, which is treatable.

Syphilis is marked by a highly contagious and painless lesion called a chancre, which occurs at the site of entry (usually the penis, mouth or rectum). A lesion is infectious, making it crucial to use a condom or dental dam. Penetration is not necessary for you to catch syphilis -- skin to skin contact is more than enough. A chancre will heal even without treatment, but you are still contagious. If not treated, infectious skin rashes, wart-like growths on the genitals or lesions in the mouth may appear.

"We want people to get the message that syphilis is back and [that] it is a treatable disease," says Dr. Bolan. "Because syphilis can be asymptomatic, sometimes partners don't know they have it. Take responsibility to protect yourself. When in doubt, get yourself checked," Dr. Bolan adds.

In the United States, you can call the CDC National STD hotline at 1-800-227-8922 for a referral to a syphilis testing site in your area.

Updated: Thursday, 4 May 2000