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Published Date: 2013-05-22 18:05:47
Subject: PRO/EDR> Syphilis - USA: (CA) MSM, RFI
Archive Number: 20130522.1730900

SYPHILIS - USA: (CALIFORNIA) MEN WHO HAVE SEX WITH MEN, REQUEST FOR INFORMATION
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Date: Mon 20 May 2013
Source: khsltv.com, Butte County Public Health report [edited]
http://www.khsltv.com/content/localnews/story/Syphilis-Cases-Increasing-in-Butte-County/YqDDyl62HEC6fvz1HD7Ubg.cspx


Butte County Public Health Department has noticed a substantial increase in the number of syphilis cases reported so far this year [2013]. In the 1st quarter of 2013, Butte County Public Health investigated 4 cases of syphilis.

"Although 4 does not seem like very many cases," explained Dr Mark Lundberg, a Butte County Health Officer, "it is concerning because typically in Butte County 4 is the average total cases for an entire year. If this trend continues in 2013, we may experience a 3- to 4-fold increase in the annual number of syphilis cases."

Syphilis is a disease that laboratories and providers must report to the Public Health Department. Public Health nurses investigate all syphilis cases to ensure that anyone who may have been exposed is notified. In investigating the 4 recent cases, a total of 19 sexual contacts or possible exposures were identified. All 4 cases were young men, in their late teens to early 20s, who have sex with men but contacts included both males and females and also include many anonymous contacts.

According to the California Department of Public Health (CDPH), syphilis is increasing throughout all regions of California, especially in the larger cities such as San Francisco and Los Angeles.

Syphilis is a sexually transmitted disease (STD) caused by a bacterium [_Treponema pallidum_]. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. The primary stage of syphilis is often marked by the appearance of a single sore, called a chancre. Skin rash and lesions characterize the 2nd stage. In the latent (hidden) stage of syphilis there are typically no symptoms. If untreated, someone can have latent syphilis for years without knowing. Latent syphilis may damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can cause difficulty with muscle coordination, blindness, dementia, and even death.

Testing for syphilis requires a visit to a doctor's office or clinic for a blood test and if caught in the early stages can easily be treated by antibiotics. Annual STD testing is recommended for anyone who is sexually active under the age of 25 as well as for anyone starting a new relationship.

For individuals who believe they may be at risk, testing is strongly recommended. Testing is available at Butte County Public Health Department clinics in both Chico and Oroville. For more information or to make an appointment please call 891-2731 in Chico or 538-7341 in Oroville. Information is also available on our website at http://www.buttecounty.net/publichealth] and by calling our STD information line at 1-877-STD-INFO.

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[Butte County, located in the Central Valley of the US state of California, is rural and agricultural (http://www.buttegeneralplan.net/products/SettingandTrends/01_LandUse.pdf), with a population (in 2010) of 220 000 (http://en.wikipedia.org/wiki/Butte_County,_California#Demographics). The city of Chico, Butte County's largest urban community with a total population (in 2010) of 86 187, is home to a major California State University campus with about 16 500 college students. Chico is located in the northwest part of Butte County, about 85 miles (137 km), via California State Route 99, north of the nearest large metropolis, Sacramento, the California state capital.

Butte County reported in the period 2006 to 2011 only one case of primary or secondary syphilis, in 2009 (http://www.cdph.ca.gov/data/statistics/Documents/STD-Data-2010-Report.pdf) and 2 cases in 2011 (http://www.cdph.ca.gov/data/statistics/Documents/STD-Data-LHJ-Butte.pdf).
By contrast, Sacramento is among 70 counties and independent cities in the United States that in total accounted for 70 percent of reported primary and secondary syphilis cases in 2011 (http://www.cdc.gov/std/stats11/tables/32.htm). The incidence for primary and secondary syphilis in Sacramento, with 118 cases in 2011, is 8.2 per 100 000
(http://www.cdph.ca.gov/data/statistics/documents/std-data-lhj-sacramento.pdf).

The news report above says that if the trend of 4 cases of syphilis reported in Butte County in the 1st quarter of 2013 were to continue for the rest of 2013, there would be a 3- to 4-fold increase in the annual number of syphilis cases for the county. However, the news report fails to describe the cases in detail, except to say that all 4 were men in their late teens to early 20s, who had sex with men (MSM) with multiple sexual contacts, "many" of whom were anonymous. We are not told if the syphilis cases were college students or where syphilis was acquired, in Butte County or in Sacramento, which is probably a more gay-friendly community (http://www.city-data.com/forum/california/948768-gay-life-chico-v-sacramento.html). The news report also fails to say if any of the cases were co-infected with HIV, involved high-risk sexual behavior, use of drugs such as methamphetamines, or use of the Internet to meet sex partners, such as via smartphone applications such as Grindr (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5510a1.htm), a gay social networking that runs on iPhone, Blackberry, and Android devices (http://en.wikipedia.org/wiki/Grindr). The app allows users to meet other men within close proximity using the mobile device's location-based services to show men nearby who are also on Grindr.

More detailed epidemiologic information will be needed to plan an effective prevention program that targets specific characteristics driving the outbreak in Butte County.

In the USA, the rate of primary and secondary (contagious) syphilis initially decreased among homosexual and bisexual males, largely because of changes in sexual behavior due to AIDS. In 2000, the overall rate of primary and secondary syphilis in the United States was 2.1 cases per 100 000 population, the lowest since reporting began in 1941. However, from 2001 to 2004, the primary and secondary syphilis rate increased nationally to 2.7, primarily as a result of increases in cases among MSM (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5510a1.htm). Reported increases in incidence of primary and secondary syphilis among MSM have been characterized by high rates of human immunodeficiency virus (HIV) co-infection, high-risk sexual behavior, use of drugs such as methamphetamines, and use of Internet chat rooms to meet sex partners (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5510a1.htm), which have been attributed in part to "HIV prevention fatigue".

A map of California counties can be found at http://geology.com/county-map/california.shtml.
A HealthMap/ProMED-mail map on which California can be located can be accessed at the URL below. - Mod.ML]

See Also

2012
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Syphilis - USA (03): (IN) RFI 20121001.1317081
Syphilis - USA (02): (CA) adult film industry, RFI 20120819.1251661
Syphilis - USA: (CA) 20120312.1068136
2011
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Syphilis - USA (02): background 20111116.3383
Syphilis - USA: (AL) 20111116.3378
2009
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Syphilis - USA: (NC) RFI 20090831.3069
2008
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Syphilis - USA, Canada 20081112.3561
Syphilis - USA: (IN) 20080826.2668
2007
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Syphilis - USA (NY) 20070814.2650
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