Syphilis resurges across N.C.

By: BY SADIA LATIFI

Published: Sun, 11/22 @ 2:00AM

As health departments battle the H1N1 flu virus, health workers worry that another epidemic may be brewing - one for a sexually transmitted disease that had almost disappeared from North Carolina 10 years ago.

Cases of syphilis in the state have nearly doubled in the past year: 684 in the first nine months, compared to 359 cases for the same period a year earlier.

Numbers are up across almost all age and racial groups, including teenage girls and blacks - groups already disproportionately affected by STDs.

"I have to be honest: This is pretty bad," said Evelyn Foust, director of the communicable diseases branch of the N.C. Department of Health and Human Services. "We are in the middle of a really serious syphilis outbreak, and we're very, very, very concerned about it."

The trend mirrors national statistics, which show syphilis and other sexually transmitted disease rates rising across the country.

The highly treatable infection had largely been contained in North Carolina, which reported thousands of cases annually throughout the 1990s. In 1999, the Centers for Disease Control and Prevention began to fund a syphilis elimination plan that focused on the 28 counties nationwide with major outbreaks. Five, including Mecklenburg and Wake, were in North Carolina.

The extra resources helped. North Carolina's cases fell off after 2000. But as the state's numbers improved, the CDC moved more than $1.3million in funding for syphilis programs from North Carolina to other states, Foust said.

"We are back having this problem again because of a lack of commitment and investment," Foust said.

Cuts to funding

Left untreated, syphilis can worsen even as symptoms disappear. It's one of the few STDs that can lead to death. Because people with skin sores characteristic of syphilis increase their risk of contracting HIV from an infected person, state health officials worry that HIV cases will increase soon, too.

Six years ago, buses in Wake were running large ads about syphilis. Doctors were routinely screening patients for the disease. Extra money allowed public health workers to reach out to communities and to offer screenings in bars and jails.

In 2007, though, the CDC changed the way it funded states for its syphilis elimination program, Foust said. When fewer North Carolina cases were reported in 2005 and 2006, the federal agency responded by moving money to other states.

The state received less than $600,000 in 2008. Although the state's own budget provides some money for HIV/STD programs, there nothing is specific to syphilis.

In a written statement, CDC spokesman Scott Bryan said money had been redistributed "in an effort to ensure a more equitable distribution of Syphilis Elimination funds based on morbidity." He added that funding for syphilis elimination programs nationwide has remained flat for years.

Education lacking

Jessica Goodman, who leads syphilis efforts for the Wake HIV/STD Community Program, said reduced resources have been a challenge. There are simply fewer people working on the ground to test and educate individuals. Though the county is still performing some outreach, the overall attitude about syphilis needs to change, Goodman said.

"The problem is that people think about it as something that happened years ago, not as an infection that can make you two to five times more likely to contract HIV," she said. "There needs to be more education."

People are still engaging in risky behavior, and doctors aren't being as vigilant about screening, said Dr. Peter Leone, chairman of the National Coalition of STD Directors and an epidemiologist in UNC-Chapel Hill's Division of Infectious Diseases.

At greatest risk

Syphilis cases across most age and racial groups have increased, but the current outbreak centers on young black men who have sex with men, Leone said. These men are otherwise healthy and often don't have health insurance. They may only visit emergency rooms and urgent care clinics, which don't routinely test for syphilis, Leone said.

"We don't have great forums for discussion within these communities, so it's challenging," he said.

He added that North Carolina's current sexual education curriculum could be better at informing students.

"We have young men who have sex with men who know about HIV transmission but were never educated on risk prevention for other STDs like syphilis," he said.

In a report released last week, the CDC also cited inadequate sexual education as a cause for the nationwide STD increase.

In the Triangle, an abstinence-only curriculum for students in Wake, Johnston and Orange county schools must be replaced in the 2010-11 school year to meet a new state law passed over the summer. The law requires schools to teach about contraception and STDs, and to provide students with a list of local testing sites. The law still states that instruction should teach that "a mutually faithful monogamous heterosexual relationship in the context of marriage is the best lifelong means of avoiding sexually transmitted diseases."

Chapel Hill-Carrboro City Schools and Durham Public Schools already offer comprehensive sexual education. The N.C. Department of Public Instruction does not keep a record of how many schools in the state teach abstinence-only versus comprehensive education.

"When we pulled back on our community education efforts, some teenagers didn't know painless sores could be syphilis, and they didn't know to go to the doctor," Foust said. "You've got some kids that have just now become sexually active, and they don't know what to look out for."

H1N1 has precedence

For now, the state's No. 1 health priority is H1N1, Foust said. But she hopes for improved syphilis screenings and education.

"It is very frustrating to be in this position again," she said.