By Nick Mattos, PQ Monthly
New infections of syphilis have risen dramatically amongst the gay men of Multnomah County, and in response the health department is making it easier than ever for men who have sex with men to get tested and treated.
“There has been an increase in syphilis among gay and bisexual men in many urban areas in the U.S.,” said Kim Toevs, adolescent health promotion and STD/HIV/HCV program manager for the Multnomah County Health Department. “Locally, in Multnomah County, our increase has been on the order of 1,000 percent over the past two years in particular.”
According to Toevs, between 2003 and 2008 the county saw about 20 to 40 cases each year. “In 2010 we had 66 cases; in 2011, 116 cases; and in 2012, 221 new cases,” she said. “It’s increasing quite rapidly — this is the highest it’s been in any population locally since the late 1980s … and this is causing us great concern.”
Toevs also noted that this dramatic increase is primarily seen amongst Multnomah County men who have sex with men, with 215 of the 221 cases in 2012 being reported in men, and 197 of those saying they’d had recently sexual contact with other men. And while there has been a small increase amongst Latino and African-American men, she added, the majority of cases were reported in white non-Hispanic men.
It’s also important to note that, unlike the outbreaks of the 1980s, which were connected with the prevalence of crack cocaine use, syphilis infection is being seen amongst men on all points of the sexual activity spectrum.
“While we have seen a connection amongst guys who are using meth, and with guys who have a lot of partners whom they’ve met anonymously online,” Toevs said, “there are still a substantial number of cases who have only had one to two partners in the last year and don’t use drugs.”
Syphilis is, in a sense, easier to transmit than some other sexually transmitted infections, while simultaneously harder to detect. A bacterial infection, syphilis is spread via contact with a syphilis sore — a painless lesion which can be visible externally on the genitals or hidden within the mouth or rectum. As a result of the transmission method, syphilis can be easily spread through oral sex if there is a sore somewhere hidden in the mouth.
“People can be doing a great job using condoms and still end up with syphilis,” said Shireen Khormorji, supervisor and disease intervention specialist at the Multnomah County Health Department.
Toevs also noted that when HIV-positive and HIV-negative individuals have sex with each other, either person having syphilis increases the chance of HIV infection to the HIV-negative individual by two to five times.
Stage two, after the sore has healed, results in a rash that can form on the palms of the hands, soles of the feet, or trunk of the body; this is also painless and can go away on its own. The third stage, however, is where things get very bad: after a “latent period,” the infection then moves into what is termed neurosyphilis. According to the Centers for Disease Control, symptoms of this stage include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. In the late stages of syphilis, the disease damages the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can result in death. HIV positive individuals in particular can be quickly and fatally impacted by this stage.
“If someone has an HIV infection, especially if their immune system is compromised, they can move quickly into neurosyphilis within the first year of infection,” Toevs said. “Since about 60 percent of our syphilis cases locally are co-infected with HIV, this is of particular concern for us.”
In response to the public health crisis, the health department has mobilized to make it easy for all men who have sex with men to access testing, treatment and education on how to take care of themselves and their partners. The critical part of this mobilization is testing.
“If men are sexually active and have more than one partner … we really do recommend getting checked for syphilis and other STDs once every three months, [or] at very minimum once a year,” Toevs said.
To make this as simple, easy, low-cost, and accessible as possible, the health department has set up a partnership with Cascade AIDS Project to create mobile testing units that go to local bars and bathhouses to test for syphilis and other STIs; these sites include every first Thursday at CC Slaughters, second Fridays at Scandals, four times a month at Steam, and twice a month at Hawks. Testing is also available five days a week at the Multnomah County Health Department, three days a week at Pivot, and at various times in other locations throughout the area.
If you choose to go through your own physician, be certain to ask them specifically for a syphilis test, and be as open as possible with your doctor about your sexual life.
“Sometimes people think that if they get a regular checkup, including a blood test, that anything that was wrong would show up,” Toevs said. “Healthcare providers don’t necessarily know that we’re in the middle of an outbreak, or to look for the symptoms or run the test. People need to specifically ask for a syphilis test from their regular doctor when getting a checkup to ensure that they’re getting tested.”
Luckily, syphilis tests are very simple and non-invasive.
“It’s a small needle and a very quick [blood] draw, so it really doesn’t hurt very much,” Toevs said. Even if one does test positive (or if the clinician feels that preemptive treatment is appropriate due to exposure) syphilis is very easily treated at its early stages with penicillin.
So don’t delay — care for yourself, your partners, and your community by getting tested today.
For more information about syphilis, testing, and treatment, contact the Multnomah County Health Department at 503-988-3700 or visit multco.us/health/hiv-and-std-services; or reach Pivot at 503.445.7699 or PivotPDX.org.