Called "The Great Imitator" for its ability to mimic other diseases, syphilis, according to health officials, is making an insidious comeback in Multnomah County. Reflective of a nationwide trend, the disease is marked in its primary stage by a small, painless sore that often appears on or inside the mouth, vagina, or anus. Its subtle nature allows the disease to easily go undetected.
Syphilis had all but disappeared in Multnomah County, but a combination of unsafe and anonymous sex, and lack of awareness has brought the numbers back up.
"It's looking to become an emerging epidemic," says Jan Karius, Oregon Health Services STD program manager. Karius says the population most affected by the recent outbreak is men having sex with men. In 2001 that group represented a quarter of the total cases in Multnomah County, half in 2002, and 68 percent of the cases officially reported from January to June of this year.
Syphilis is transmitted through contact with a lesion--considered a primary symptom--while the secondary stage is characterized by a rash commonly seen on the palms or the soles of the feet that can look like any number of skin irritations. Both primary and secondary symptoms go away on their own, and at these stages syphilis is easily treated with penicillin. But if left unchecked, syphilis can ravage the heart and the nervous system, as well as cause blindness. Moreover, a syphilis lesion facilitates the transmission of HIV. Health experts are concerned that the boom in syphilis numbers is a predecessor to a subsequent rise in HIV rates.
"In 2002, syphilis cases more than doubled in Multnomah County," says Lynne Weidel, manager of special projects and operations for disease prevention for the Multnomah County Health Department--a jump from 16 to 38 cases. Reports from the first half of 2003 indicate that the numbers show no signs of slowing.
Worse yet for health officials is the rise in anonymous sex. "When someone's diagnosed with the disease [we] call their partners and have them treated," says Margaret Lentell, manager of STD program for the Multnomah County Health Department. "But one of the things we're finding is that people are having sex with people they meet over the internet," continues Lentell. "If they contract an STD, we then need to contact their partners, [but] we're having a hard time tracing them," admits Lentell. "People just don't have the names of their partners. That's why it's been hard to get this outbreak under control."
"98 percent of the [people with] newly reported cases of syphilis have admitted to sleeping with anonymous partners through the internet, bath houses, and adult bookstores," adds Karius. Nationwide studies have reported that people are returning to sexually risky behavior, after the chill in the '80s and '90s. One recent study comparing current condom use to use five years ago shows a decline from 63 to 23 percent. In an epidemiological study conducted by the Oregon Department of Human Services this June, more than 45 percent of gay males reported having unprotected anal intercourse during their last sexual encounter.
Although counterintuitive, health officials also admit that past efforts to educate gay males about safe sex may now be contributing to the message's downfall. "The community has been so bombarded with safe sex messages that there's a burnout," laments Karius.
Screening for syphilis and other STDs is done at the Multnomah County Health Department at 426 SW Stark Street 6th Floor, 988-3700.