Syphilis cases down in Baltimore, U.S.

City remains No. 1 but is on track for another decline in '99

October 08, 1999|By DIANA K. SUGG AND JONATHAN BOR | DIANA K. SUGG AND JONATHAN BOR,SUN STAFF

After years of going nowhere but up, Baltimore's syphilis cases are finally in decline.

The city continues to rank No. 1 in syphilis cases nationwide, according to new figures released yesterday by the U.S. Centers for Disease Control and Prevention. But last year, Baltimore posted 456 cases, a 31 percent reduction from its 665 cases in 1997.

"We clearly have a serious problem, but we've made major strides against it," said Dr. Peter L. Beilenson, city health commissioner. "We had one of the biggest drops in the country last year, and we continue to go down even more."

The city is on track for another big drop this year, Beilenson said, predicting a total of about 350 cases.

The decline of syphilis cases could mean that the city will drop to second place behind Cook County, Ill., by the end of the year, according to Dr. Judith Wasserheit, who heads programs at the CDC to prevent sexually transmitted diseases (STDs). Cook County, which includes Chicago, has a much larger population than Baltimore City.

Nationally, the syphilis rate declined 19 percent last year to its lowest reported level ever -- raising hopes, said Wasserheit, that the United States might be on its way toward eliminating the disease within its borders. Half of all cases are concentrated in 28 cities and counties, with Baltimore heading the list.

Yesterday, CDC officials announced their plan to reduce -- and potentially eliminate -- syphilis from the hard-hit communities.

For its part, Baltimore will receive $400,000 in federal money each year for five years, Beilenson said. Next week, more than 100 people will be meeting to discuss ideas to stop the epidemic, including new approaches to reach those at risk.

`Real progress'

"I think there has been real progress in Baltimore," said Wasserheit, who was the medical director of a Baltimore STD clinic in the 1980s.

Baltimore's Health Department has attacked the epidemic by educating health care providers, testing suspects who pass through the Central Booking and Intake Center, and sending outreach workers to neighborhoods most affected by syphilis.

The final piece was restoring six full-time staffers cut a few years ago from the city's STD clinics. Now, city clinics are seeing 30,000 patients a year, up from 22,000 two years ago.

In retrospect, Beilenson said he might have done things differently.

"I don't think it hit our radar screen well enough, and I take the responsibility for that," he said. "I think we could have jumped on it a year earlier."

Syphilis is a bacterial disease spread mainly through sexual contact. In its early stages, the condition causes genital sores and a skin rash, and later, if left untreated, widespread organ damage and even death. The disease can also spread from women to their babies. When caught early, it is easily cured with a shot of penicillin.

Beilenson said he believes that the rankings are skewed by how well the cases are counted. He said he finds it difficult to believe that other large Northeastern cities such as Washington -- which has similar demographics and a comparable drug problem -- don't have more syphilis cases.

According to the CDC data, Washington, ranked 16th overall, had 81 cases last year, compared with Baltimore's 456.

A 1998 CDC study found that when the District of Columbia closed one of its public health clinics in 1995, leaving one clinic for the entire city, syphilis cases dropped significantly. The researchers concluded that the decline was artificial: Cases just weren't being reported.

10-year cycles

Since syphilis epidemics tend to run in 10-year cycles from peak to valley, Wasserheit warned that time might be running out to wipe out the disease. Nationally, the syphilis epidemic reached its high point in 1990, meaning it might be ready to rise again if not stopped.

"I think the real problem is that we have a very narrow window of opportunity to eliminate syphilis," Wasserheit said. "To be perfectly frank, I think the window is about to slam shut."

Incidence of syphilis cases

Here are the 10 U.S. jurisdictions with the highest number of syphilis cases last year.

County (Major city) ........................1997 ............1998 ...........% change

Baltimore * ......................................665 ..............456..................... - 31

Cook County, Ill. (Chicago) .............379 ..............364 .......................- 4

Shelby County, Tenn.(Memphis) .....343 ..............260 ....................- 24

Davidson County, Tenn. (Nashville) 203 ..............210 ......................+ 3

Maricopa County, Ariz. (Phoenix) ....118 ..............173 ....................+ 47

Wayne County, Mich. (Detroit) .........101 .............169 ....................+ 67

Marion County, Ind. (Indianapolis) ....64 ..............161 ..................+ 152

Fulton County, Ga. (Atlanta) ...........190 ..............151..................... - 21

Dallas County, Texas .......................148 ..............126 ....................- 15

Los Angeles County, Calif. ..............134 ...............108................... - 19

* Baltimore is included as an independent city.

SOURCE: Centers for Disease Control and Prevention

Pub Date: 10/08/99

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