Friday, March 23 , 2018, 5:55 am | Fair 50º

Your Health
A Noozhawk partnership with Cottage Health

Syphilis Makes an Alarming Comeback in Santa Barbara County

For a disease that was nearly eradicated in 2000, public health officials increasingly concerned at how quickly it’s reappearing

The number of syphilis cases reported in Santa Barbara County has been increasing for five years, according to the Public Health Department.
The number of syphilis cases reported in Santa Barbara County has been increasing for five years, according to the Public Health Department. (Santa Barbara County Public Health Department graphic)

[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.

                          STDs in Santa Barbara County  |  About This Series  |

“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.

The rates of syphilis have been increasing in Santa Barbara County, in California and across the United States for more than five years. Click to view larger
The rates of syphilis have been increasing in Santa Barbara County, in California and across the United States for more than five years. (Santa Barbara County Public Health Department graphic)

“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).​

                          STDs in Santa Barbara County  |  About This Series  |

Noozhawk managing editor Giana Magnoli can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click here to get started >

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made through PayPal below, or click here for information on recurring credit-card payments.

Thank you for your vital support.

Reader Comments

Noozhawk is no longer accepting reader comments on our articles. Click here for the announcement. Readers are instead invited to submit letters to the editor by emailing them to [email protected]. Please provide your full name and community, as well as contact information for verification purposes only.


Special Reports

Heroin Rising
<p>Lizette Correa shares a moment with her 9-month-old daughter, Layla, outside their Goleta home. Correa is about to graduate from Project Recovery, a program of the Santa Barbara Council on Alcoholism & Drug Abuse, and is determined to overcome her heroin addiction — for herself and for her daughter. “I look at her and I think ‘I need to be here for her and I need to show her an example, I don’t want her to see me and learn about drugs’,” she says.</p>

In Struggle to Get Clean, and Stay That Way, Young Mother Battles Heroin Addiction

Santa Barbara County sounds alarm as opiate drug use escalates, spreads into mainstream population
Safety Net Series
<p>Charles Condelos, a retired banker, regularly goes to the Santa Barbara Neighborhood Clinics for his primary care and to renew his prescription for back pain medication. He says Dr. Charles Fenzi, who was treating him that day at the Westside Clinic, and Dr. Susan Lawton are some of the best people he’s ever met.</p>

Safety Net: Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

Clinics that take all comers a lifeline for low-income patients, with new health-care law about to feed even more into overburdened system. First in a series
Prescription for Abuse
<p>American Medical Response emergency medical technicians arrive at Santa Barbara Cottage Hospital with little time to spare for victims of prescription drug overdoses.</p>

Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

Evidence of addiction shows an alarming escalation, Noozhawk finds in Prescription for Abuse special report
Mental Health
<p>Rich Detty and his late wife knew something was wrong with their son, Cliff, but were repeatedly stymied in their attempts to get him help from the mental health system. Cliff Detty, 46, died in April while in restraints at Santa Barbara County’s Psychiatric Health Facility.</p>

While Son Struggled with Mental Illness, Father Fought His Own Battle

Cliff Detty's death reveals scope, limitations of seemingly impenetrable mental health system. First in a series