[Noozhawk’s note: Second in a series on sexually transmitted diseases in Santa Barbara County. Click here for a series index. Coming June 25: Pacific Pride Foundation Starts Mobile HIV Testing With New Health Utility Vehicle.]
The sharp increase of sexually transmitted diseases is a national trend, and one that worries public health officials who saw syphilis practically eradicated in the last century.
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“While it’s true that a single early syphilis infection is curable and easily treatable, the later complications can be devastating and life-threatening,” said Dr. Lynn Fitzgibbons, an infectious disease physician with the Santa Barbara County Public Health Department.
Santa Barbara County has seen a steady increase of reported syphilis cases over the last five years, with four cases in 2011 and 44 in 2015, according to the Public Health Department.
There were five reported cases of primary and secondary syphilis in the first three months of 2016.
The numbers of cases and rates of syphilis per-100,000 people are similarly increasing for California and the United States.
“Syphilis was nearly eradicated around the year 2000, and what we’ve seen is this very alarming rate nationally and locally in syphilis cases,” Fitzgibbons told Noozhawk. “We had a cluster of several patients with syphilis impacting their eyes in the last few years, and it can cause blindness.”
Syphilis is spread by direct contact with a syphilis sore during vaginal, oral or anal sex, and can also be spread from an infected mother to her unborn baby, according to the Centers for Disease Control and Prevention.
“After national syphilis rates hit historic lows in 2001, they increased almost every year since, peaking in 2014 with the highest rate reported in 20 years,” the CDC reported.
Syphilis causes sores in the first stage — usually firm, round and painless — and a nonitchy body rash in the secondary stage if left untreated.
In latent or late-stage syphilis, sometimes decades after the infection, the disease can cause paralysis, blindness, dementia, organ damage and death, according to the CDC.
“Symptoms of early syphilis often resolve themselves, but that person who was not treated is at risk of severe complications down the road and spreading it to others,” Fitzgibbons said.
The bacterial infection is treatable with Bicillin, the proprietary form of benzathine penicillin.
Congenital Syphilis
Like the rise of primary- and secondary-stage syphilis cases, California has seen a rapid increase in the number of congenital syphilis cases. Six cases of congenital syphilis stillbirth were reported in 2014 and the number of congenital syphilis cases nearly doubled from 2009 to 2014, to 100 cases.
Congenital syphilis, in which mothers pass the infection to their unborn babies, has a risk of birth defects and stillbirth. Babies born with congenital syphilis can have deformed bones, nerve problem like blindness or deafness, an enlarged liver or spleen, jaundice, meningitis or skin rashes, according to the CDC.
All pregnant women should be tested for syphilis, which can be treated with antibiotics, health officials say.
As of May, Santa Barbara County had seven reported suspected cases of congenital syphilis and three probable cases, said Paige Batson, the Public Health Department’s director of disease control and prevention.
When a pregnant woman has syphilis, she said, it’s recommended that she gets treatment at least 30 days before delivery to prevent the baby from being infected.
The seven suspected cases refer to the number of pregnant women who had syphilis, and the three “probable” cases — mothers who didn’t get treatment before giving birth — are likely not going to be confirmed cases since babies do get treated, she explained.
“Even though we don’t have a congenital case yet, for us our day-to-day language is we have congenital cases, because the mother was pregnant and may or may not have received treatment,” she noted. “It only can be called congenital case if and when the baby becomes infected.”
There have been cases in which the babies were not infected when they were born, but are monitored to make sure they don’t become infected, she added.
Syphilis Treatment
While early syphilis infection is curable and syphilis is treatable with bicillin, the drug is expensive and not all health-care providers stock it, Batson said.
That creates a barrier for the individual to get treatment — the Public Health Department has the drugs, but serves mainly safety-net patients and the individual with private insurance would likely have to pay out of pocket for something that would have been covered if a primary-care doctor had the treatment, she said.
Bicillin isn’t always stocked since syphilis rates in many communities are still relatively low, the CDC reported.
“If a provider prescribes bicillin but doesn’t stock it, the responsibility falls on the patient: they’ll need to find a pharmacy who has bicillin, keep it refrigerated, and go back to their doctor to get the injection,” according to the CDC. “These steps can lead to delays in treatment — or, worse, a patient not getting treated at all. This increases the risk of syphilis spreading in the community.”
Batson emphasized the importance of comprehensive screening — testing for all sexually transmitted diseases, not just one or two, as needed — and follow-up for treatment to stop the spread of infection.
“If you’re going to test, be ready to treat or know where to send patients to get their treatment,” she said. “A decision to test is a decision to treat.”
There currently is a shortage of the treatment drug as Pfizer, the only manufacturer of Bicillin L-A in the United States, “is experiencing a manufacturing delay of this product,” the CDC reported in May.
Co-Infection of Syphilis and HIV
“What we are doing here … when we speak of HIV, we speak of syphilis and vice versa,” Batson said of the Public Health Department.
“There’s a growing concern they are priorities, and often we see a lot of co-infection with HIV and syphilis.”
The number of newly diagnosed HIV cases has remained stable over recent years while syphilis rates continue to increase in gay, bisexual and other men who have sex with men, according to health officials. Recent outbreaks have included increased incidences of HIV co-infection.
There is now a daily medication designed to lower the risk of HIV infection for high-risk individuals, such as people who have an HIV-positive partner, called PrEP, or pre-exposure prophylaxis.
“We’ve been using it more in 2016 than ever before, and it’s shown to be highly effective to protect people at risk of HIV from HIV,” Fitzgibbons said.
“But the concern is that by using PrEP, it may be less tempting to use condoms. Obviously, it doesn’t protect against other STDs.”
PrEP is a pill that a patient at risk of HIV infection takes daily. In addition to condom use and other methods, it has been shown to help prevent HIV infection, Fitzgibbons said.
How to Prevent STDs
Using condoms correctly, minimizing the number of partners, and avoiding substances that impair decision-making are three ways to be as sexually healthy as possible, Fitzgibbons said.
This year’s STD Awareness Month theme was “Talk, Test, Treat” and the Centers for Disease Control and Prevention recommends sexually active people talk openly and honestly with their partners and health-care providers about sex and STDs.
Condoms are the only birth control that reduces the risk of both pregnancy and STDs, but they cannot always protect against some STDs such as herpes, syphilis or human papillomavirus (HPV) that causes genital warts and cervical cancer, according to the CDC.
When to Get Tested for STDs
Sexually transmitted diseases don’t always cause symptoms, but the CDC recommends frequent testing for sexually active adults.
Screening recommendations from the CDC include:
» All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
» Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
» Annual gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
» Syphilis, HIV, chlamydia and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants.
» Screening at least once a year for syphilis, chlamydia and gonorrhea for all sexually active gay, bisexual and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STDs (i.e., at 3-to-6 month intervals).
» Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year. Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).
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— Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.
