In certain areas of San Francisco, cases of syphilis are as common and casual as the flu, and Billy Lemon can’t even remember how many times he got the flu.
“3, 4? 5 times in my life?” He has a hard time remembering. “It doesn’t seem like a big deal.”
At that time, about 10 years ago, Lemon continued to drink methamphetamine frequently, kicking his libido wildly, and silently in his head that condoms were a wise choice at intense sex parties.
“It lowers your restraint, and also distorts your decision-making ability,” said 50-year-old Lemon.
He is now calm and runs a Castro Country Club in San Francisco. It’s not a resort, but it’s a place where gay men come to help with addiction, especially stimulants. Lemon said that syphilis was attached to the territory.
“In a 12-step community, if the stimulant was yours, everyone had syphilis,” he said.
In 2000, the incidence of syphilis was so low that public health officials believed that eradication was imminent. However, that percentage began to rise in 2001. From 2015 to 2019 alone, cases increased by 74%.According to the report, there were about 130,000 cases nationwide in 2019. data Released on Tuesday by the Centers for Disease Control and Prevention.
In California and the United States Half of syphilis cases I have a man who has sex with a man.is more than One-third of women In the West, which suffers from syphilis, methamphetamine is also used. Rapidly increased in recent years. These are just a few of the trends that have caused nationwide cases of sexually transmitted diseases to hit record highs for the past six years in a row, reaching 2.5 million. And the results are spreading from mothers to babies with syphilis. The incidence of congenital syphilis almost quadrupled between 2012 and 2019.
This was all before the coronavirus pandemic in the United States, and the CDC couldn’t get any better in 2020 as contact tracers and inspection supplies were diverted from STD to covid-19. I’m predicting.
Dr. Erica Pan, a state epidemiologist in California, said: “Unfortunately, we haven’t had enough money and infrastructure for public health for years, and of course, for the past year, we’ve focused on follow-up on sexually transmitted diseases and syphilis, both at the local and state levels. Many of the people who were there were really redirected to a pandemic. “
There is no single cause
Many factors contribute to the increase in sexually transmitted diseases, especially syphilis.
For example, in the San Francisco gay community, the rise of mobile dating apps such as Grindr and Tinder allowed us to find dates “faster than delivering pizza to home,” said STD Prevention Specialist and co-founder. Dan Wohlfeiler said. Build a healthy online communityImprove the health of gay men using these apps.
Dating apps first appeared around 2009, and men don’t always know the names of men with sexually transmitted infections, so they track the spread of sexually transmitted diseases and people who may have been infected. It has become difficult to notify. ..
“They sometimes only know their online handles,” he said. Dr. Inapark, Associate Professor, University of California, San Francisco School of Medicine, “Strange bed fellow, “About the history of sexually transmitted diseases. “And if sex goes wrong, they sometimes block the person from their app and they won’t even know how to reach that person again.”
Online dating began in the late 1990s, and effective drugs to prevent HIV transmission became available. The first was an antiretroviral drug that suppresses the virus in HIV-positive people, followed by pre-exposure prophylaxis in 2012. , Or PrEP prevents new infections in people who are HIV negative but who are considered at risk of being infected with the virus.
Condoms are even more disadvantaged than they used to be, as the risk of getting a fatal illness has dropped to near zero, Park said.
“If one man is taking PrEP and the other man is suppressed by the virus, there is no risk of HIV,” she said. “Then why do you use condoms when you don’t mind touching syphilis?”
Diagnosis of syphilis is difficult
Syphilis is not benign, but it can cause blindness, deafness, and brain damage, but it is easy to treat. Usually, a shot of penicillin in the butt cures it.
However, diagnosing syphilis can be difficult, Park said, treating patients with STDs. San Francisco City Clinic.. She often finds herself crouching in the laboratory, “lifting the scrotum and lifting the penis,” and bending her head to see from all angles.
She does these exercises to find the rash associated with syphilis. Some are obvious and some are subtle. She said regular family doctors are often untrained in where and when to look.
“Patients have said,’I’m tired,'” Park said, citing the common symptoms of syphilis. “How many people will say,’Take off your pants and lift your scrotum. I want to see’? That’s what we do, so we only do it at the STD clinic. “
However, specialized public sexually transmitted disease clinics, such as Park works, Shut down Nationwide. One reason is the persistent lack of funding for public health programs. The trend became clear During a pandemic. Another reason is the affordable care method. Curiously, the 2010 law aimed at increasing access to health care actually contributed to the closure of the STD clinic.
“Honestly, I think no one needed it.” Dr. Karen Smith She said in 2019 when she was the director of the California Public Health Service. She said that when Obamacare was implemented, it was thought that a STD test would be done at the primary care clinic.
“We thought it would be enough if you had health insurance and could see a doctor,” she said. “I found that it wasn’t the only thing I really needed.”
People still had things they didn’t want to talk to their doctor. Also, some family doctors did not want to investigate the patient’s sexual life. Young people, in particular, prefer a clinic that suits them from the perspective of their parents.
“The loss of anonymous care was really a problem,” Smith said.
The epidemic of syphilis reaches babies
When Christian Faulkenberry-Miranda decided to become a pediatrician, she didn’t expect to be a syphilis expert.
After finishing her medical training in 2010, Community Community Medical Center In Fresno, California, she began seeing a baby with a rash on her belly that looked like a blueberry muffin. She considered it a common viral infection until these babies tested positive for syphilis.
In those early days, Dr. Faulkenberry-Miranda probably saw some examples of congenital syphilis each year. Currently she sees two cases each week. Although it is important to start 10 days of antibiotic treatment immediately to avoid complications, she is still following the patient during the first year of life, often throughout childhood, with vision and hearing problems, development. We are monitoring delays, attention deficit, and learning. Disorders, all of which can result from congenital syphilis infections. In 2019, 128 cases were stillborn or neonatal deaths.
“Unfortunately, syphilis is very curable,” she said. “This is completely preventable and requires proper screening and treatment of these pregnant mothers.”
Cases of congenital syphilis reached a nasty milestone in 2019, rising 279% over five years to a high of 1,870 cases.This is higher than the peak number of mother-to-child HIV infections 1991..
With an increasing number of cases of congenital syphilis in San Francisco, Park said, “Why does this happen? The test is cheap and widely available. The same treatments I’ve been using since the 1940s still work. I have. ” “Still, there is this completely uncontrollable epidemic among the most vulnerable babies in our society.”
Many women who give birth to syphilis babies do not receive prenatal care. They often use medicine — Mainly methamphetamine — And often homeless, said Smith, a former California public health director. This makes them more likely to exchange their gender for housing, food and drugs. Drug use, in particular, makes it completely difficult for women to recognize that they are pregnant and makes them less likely to seek health care if they are pregnant.
“They are very worried about what happens when they find out they are pregnant and taking drugs,” Smith said. “They are worried that their drug use will be reported and then … their children will be taken away.”
The complications of life in these women also make investigating and contact tracing illnesses very difficult. Veteran contact tracer Romni Neiman remembers having a hard time tracking pregnant women during her career. Niemann works for the CDC and worked in California to prevent sexually transmitted infections, including congenital infections, before being redirected to covid last year.
I remember she was looking for a woman in Chicago in the late 80’s. Pregnant women used drugs and were exposed to syphilis. Her residence was so volatile that Niemann went to three places before finding her. The woman didn’t have a car, so Niemann offered to take her to the clinic for examination. The woman did not have a safe place to leave her toddler because the man in the place where she was staying was abusive, so Niemann took care of the child while the woman was looking at the doctor. did.
“She was trying to do her best, but she was really afraid,” Niemann recalled. “Sometimes it’s really hard and really sad, and you go home at the end of the day and you’re like” wow, wow “. “
Such challenges, coupled with a persistent lack of funding for public health, led to the first surge in congenital syphilis in Fresno County in the 2010s, Park said. Local contact tracers couldn’t catch up and the state had to intervene in reinforcements.
According to state epidemiologist Pan, the state is taking new steps to address this rate, requiring women to be screened for syphilis twice during pregnancy instead of once. And instead of waiting for women to come for antenatal care, the state is doing more outreach and screening pregnant women in emergency rooms, prisons and prisons.
Pandemic believes that it has created an opportunity to invest in agile responses to emerging and emerging public health issues such as syphilis.
“”Responding to this pandemic has been a very long and difficult year, but people really recognized and recognized the impact of divestment on public health infrastructure, “she said. The long term after this pandemic also benefits sexually transmitted diseases. “
This story is part of a partnership that includes: KQED, NPR And KHN.
