In Los Angeles County, CA, an outbreak of syphilis among men who have sex with men (MSM) is back with a vengeance.

The disappointing news comes after a half-a-million dollar effort last year by L.A. County health officials to contain the spread of the disease through public awareness campaigns, hotlines, condom distribution programs and free STD screening services.
  

Half of the men caught syphilis from partners met in a bar or sex club.

"Our outbreak has not gone away. It's never been over," Peter Kerndt, M.D., M.P.H., director of the STD control program for the Los Angeles County Department of Health Services, told GayHealth.com

As of August 24, 103 cases of syphilis among MSM have been diagnosed in the county this year -- including 18 cases in the past two weeks alone. Disturbingly, almost 60 percent of this year's cases tested positive for HIV. By comparison, around 20 percent fewer cases were reported by this time last year, and half were HIV-infected.

HIV and syphilis make a worrisome combination, because people co-infected are three to five times more likely to transmit HIV through unprotected oral, anal or vaginal sex. Syphilis also poses a danger to people with HIV, whose weakened immune systems leave them more susceptible to syphilis' late-stage attacks on the brain, which can cause death.

Indeed, "the syphilis outbreak is contributing to new infections of HIV," Dr. Kerndt explained.

Based on rough estimates, around half of the men contracted syphilis from sexual partners whom they met in a bar or commercial sex club, 20 percent from partners in bathhouses, and 10 percent from partners met on the Internet. Of the 103 cases, 45 percent are Hispanic, 40 percent Caucasian, 14 percent African American and 2 percent Asian/Pacific Islander.

"If you're having sex in these environments without a condom," warned Dr. Kerndt, "you're exposing yourself to HIV."

To combat the wave of infections, the L.A. County Department of Health Services has requested special funding from the Centers for Disease Control and Prevention (CDC), the state of California and the local health department. So far, only the CDC has come through, with around $63,000 earmarked to fund an agency that will work directly with bathhouse owners on prevention initiatives, "a drop in the bucket," according to Dr. Kerndt.

In the meantime, "we're going to do everything we can with [the resources] we have," he added.

The key to curbing new infection rates, said Dr. Kerndt, is to go directly to the source. "The bottom line is -- we need to bring into the [commercial sex club and bathhouse] environment a harm reduction model that works," he explained.

The harm reduction plan would bring to these venues rapid HIV testing (available in six months to a year), psychologists trained in sexual addiction and peer counselors, or regular customers of these venues who counsel other customers on safer-sex.

In light of the high rates of HIV infection among MSM who frequent commercial sex venues (estimated at around 10 to 15 percent), prevention efforts should also target clients of AIDS service organizations, said Dr. Kerndt. "We're trying to identify the care centers where these men attend, and do intervention there," he added.

For the efforts of the health department to be successful, however, the gay community -- and in a larger sense, MSM -- must protect themselves, and each other, from sexually transmitted infections. "The community has to take the lead," Dr. Kerndt urged. "It shouldn't be like putting a pistol to your head every time you go in [to commercial sex venues]."

Syphilis is a bacterial infection usually acquired through oral, anal or vaginal sex. It is marked by a highly contagious and painless lesion (or "chancre") at the site of entry, typically the penis, mouth, rectum or vagina. A lesion not covered by a condom or dental dam is infectious, and even when lesions go away on their own, a person remains infected. If syphilis goes untreated, infectious skin rashes, wart-like growths on the genitals or lesions in the mouth may appear. Over time, untreated syphilis can attack the brain and cause loss of hearing and sight, stroke, paralysis and death.

On the bright side, syphilis is a treatable condition, and a simple blood test can identify infection.

Updated: Friday, 24 August 2001