Hamilton County syphilis numbers down, but health officials warn 'We're not out of the woods yet'

CINCINNATI -- A new report says the nearly two-year effort to break the syphilis epidemic in Hamilton County has produced results: a whopping 40 percent reduction in the number of adult cases in 2013 over the previous year.

But county public health officials say there is still more work to do, especially to eradicate the instances when children are born with syphilis.

“We’re certainly pleased to see some progress made and reduction of the number of cases. That’s the right direction,” said Tim Ingram, who oversees the Hamilton County Public Health Department. “But the Hamilton County rate is still five times higher than the state rate. We’re not out of the woods yet.”

Syphilis is a fatal disease most often transmitted through sexual activity. At the turn of the millennium, syphilis had been nearly wiped out in the United States, but the disease has raged back in the 21st Century, largely among African-Americans. Hamilton County is ranked 15th in the nation in syphilis cases.

In March 2012, alarmed by the upward trend of statistics, Ingram declared syphilis an epidemic and convened a summit of the area’s hospital systems to develop a comprehensive counterattack to bring the epidemic under control by 2016. Today, anyone who goes to an emergency room for care and displays symptoms of any sexually transmitted disease is tested, and treatment begins even before test results come back.

The aggressive approach is having an effect:

  • In 2012, Hamilton County reported a record 431 cases of syphilis.
  • In its 2013 year-end report, released Feb. 12, the county said the trend line had dropped sharply, to 344 cases.

Despite that success, Ingram said the number of cases in Hamilton County of congenital syphilis, when a mother passes the disease to her baby during pregnancy, remains at startling levels--indicating that a large number of women are not getting prenatal care, which requires testing for syphilis.

“There were 20 cases of congenital syphilis in the entire state of Ohio last year, and eight of those cases came from Hamilton County,” he said. “Completely unacceptable.”

In October, WCPO.com reported in a three-part series on the county’s syphilis epidemic that explained how the disease is preventable with condom use and treatable with injections of penicillin. In a telephone interview last week, Ingram said that more tactics against syphilis must be deployed to meet the 2016 target of bringing the disease under control.

“I’m still finding it surprising that some of the medical providers in the city still don’t know that we have an epidemic on our hands; there are still way too many of our medical colleagues who don’t understand that,” Ingram said. “We have to change that.”

Ingram said he and county medical director Stephen Bjornson will conduct sessions with medical staffers in the hospital systems to educate them about the epidemic.

“I’m telling the staff here as well as other health-care leaders that this has to be the year, if we’re going to get to pre-epidemic levels, this has to be the year we make a bigger dent in the program. It’s going to be a tough uphill climb.”

About Syphilis: Symptoms, treatment

Recent DNA analysis shows that the bacteria Treponema was in the New World when Christopher Columbus arrived in 1492. His crew took the bacteria back home, where it mutated to cause a contagious infection that was sexually transmitted. Europeans accused each other of spreading it around. Italian physician and poet Girolamo Fracastoro gave the ailment its name with his 1530 poem “Syphilis sive morbus gallicus” – “Syphilis or the French Disease.”

Stages:

  1. Primary syphilis arrives with a sore, called a chancre (SHANK-er), at the site where the bacteria infected the body, usually the penis, vagina or mouth. The sore is painless and heals by itself in three to six weeks.
  2. Secondary syphilis brings a rash on the palms or soles, fever, malaise, loss of appetite, muscle aches, joint paint, swollen lymph nodes, vision changes, hair loss or sores around the mouth or genitals.
  3. Tertiary or latent syphilis damages the heart and central nervous system, and triggers tumor growth. Death is not far behind. For centuries, the only diagnosis of syphilis was looking for symptoms, and the most common treatment was with the toxin mercury.

Infectiousness: Primary and secondary syphilis are contagious. Avoid sexual contact with a chancre or other symptoms are present. Condoms can protect against syphilis and other sexually transmitted infections.

Treatment: In 1906, a blood test was developed for syphilis. In 1943, a cure was found in penicillin. Other antibiotics are used today, including doxycycline or tetracycline. Length of treatment depends on the stage of syphilis and the patient’s overall health. Once treated, syphilis is cured in weeks, although it can last a year. Penicillin is always used against syphilis in pregnancy. Several hours after treatment,

patients can experience the Jarish-Herxheimer reaction, a flu-like response as the body’s immune system combats the infection that lasts about 24 hours.

More information:

Connect with WCPO Contributor Anne Saker on Twitter: @apsaker

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