CINCINNATI - In our series "Out from the shadows: Cincinnati's syphilis epidemic," WCPO contributor Anne Saker, reports on the disease's impact and the battle to defeat its scourge in the Tri-State.
Stephen Bjornson has spent more than 20 years keeping an eye on the well-being of Hamilton County as medical director of the Public Health Department. Now he also is confronting an alarming syphilis epidemic; Hamilton County is No. 15 in national rankings for the rate of infection.
Bjornson sat down with WCPO to talk about the medical consequences of syphilis. The interview was edited for clarity and brevity.
Other than through sexual contact or mother-to-fetus transmission, how else can you contract syphilis? Can you get it from a doorknob?
Bjornson: If you touch an individual who has syphilis and has a lesion, and he has cracks in his skin, from dry skin, he could transmit the syphilis bacteria to you through the cracks in the skin. If you have relationships with somebody who has had relationships with somebody with syphilis, and that person have an oral lesion, you could get syphilis from kissing – even nothing more than a casual interaction. You can’t get syphilis from toilet seats. You can’t get it from doorknobs. But you can get it in ways other than full sexual contact.
How does syphilis go unnoticed?
Bjornson: The initial lesion, the chancre, forms where the syphilis bacteria enter your body, and it’s painless, The sore forms three to 90 days after the syphilis bacteria get into the body. It persists for about three to six weeks. That’s why it’s so difficult to take care of the epidemic. People have nothing that alerts them to the fact that there is something bad going on.
Mike Samet, the department’s public information director, jumps in: Is that more true for women because it’s less visible?
Bjornson: Men don’t recognize it either. Don’t ask me why.
What’s going on in the body at this point?
Bjornson: The bacteria are in the bloodstream, and they’re stimulating the body’s immune response. When we see no symptoms – if the chancre is resolved – we diagnose it serologically (through blood testing) looking for antibodies directed against the syphilis bacteria. Or the syphilis treponema.
Is the syphilis bacteria not the same thing as the syphilis treponema?
Bjornson: It’s not the same thing. Technically it’s a treponema.
And that’s a different critter than a bacteria.
Bjornson: Right. Second cousin. It’s treponema pallidum. That’s the genus and species. But let’s just call it bacteria.
What’s going on in the body if syphilis isn’t treated in the first year of infection?
Bjornson: The body is trying to fight, but the bacteria are very good at eluding the body’s host defense mechanisms. Many people but not all develop a skin rash, usually on the hands and soles. Sometimes, it also goes up on the arms and the trunk. It’s a skin rash, so people don’t associate that with syphilis. And the prevalence has been so low for so long that a lot of physicians don’t recognize the rash as a hallmark of what’s called secondary syphilis.
Does a person with syphilis have any clue that he or she is sick?
Bjornson: Nope. And for up to a year, people with syphilis are highly contagious, so they can transmit the infection to others fairly easily. Once you go beyond the first year, the body has sort of brought it under control. The bacteria are no longer in the bloodstream, and they’ve gone to the places in the body where they will cause their long term damage.
What’s going on in the body in the latent or tertiary stage?
Bjornson: There are the skin lesions that are typical of syphilis. On bone, syphilis causes masses or swelling. In the central nervous system, the bacteria have crossed the blood-brain barrier, and that’s usually associated with abnormal changes in personality. Basically, people go crazy. A lot of the French Impressionists died of syphilis, and they did some of their better work as they were dying. The problem for them was that there was no therapy back then. I don’t even think they were using mercury. They just couldn’t do anything about it.
Next page: What happens if you never get treated?
What happens if you never get treated?
Bjornson: You die. Usually, it’s in about 10 to 15 years. In most cases, this is a central-nervous-system death, where the brain gets eaten up. That doesn’t happen very often nowadays. We have urged the hospital systems, especially the emergency rooms, to screen individuals. That screening is increasing. We’re picking up more and more early and late cases. We maybe see one or two late neuro-syphilis cases a year, and many of those are in patients who have HIV who deny that they have any infection, and delay treatment.
What’s the deal with congenital syphilis?
Bjornson: Our biggest problem is trying to get the obstetrician-gynecologists to routinely screen all pregnant females whether or not they have risks. Because if you were sexually active when you were an adolescent or late teen, you could have gotten infected then, and if you weren’t treated, you have the bacteria in your body. So a pregnant woman who has primary, secondary or late latent syphilis is at extremely high risk for congenital syphilis or stillbirth. It is estimated that 40 percent of pregnant women with syphilis have spontaneous abortion. Syphilis causes serious birth defects, oral cavity, bone, brain. Bottom line is: Pregnant females, if their Ob-gyns forget to screen them, remind the Ob-gyn about it. They should be screened in the first trimester or that first visit following their pregnancy. If they’re at high-risk for getting infected, they should be screened in the third trimester. We’re trying to get the Ob-gyns to routinely screen early and late, regardless of the risk factors.
OK, let’s say a person’s been diagnosed. What does treatment look like?
Bjornson: A long needle. It’s an 18-gauge, 2 1/2 to 3-inch long needle. And it goes into your gluteus maximus, about a teaspoon full of penicillin suspended in oil so it’s gradually released into the body. If you’ve had syphilis for less than a year, you get one dose.
And for more than a year?
Bjornson: Three doses from the big needle.
How do you counsel needle-phobes?
Bjornson: I just tell ‘em to relax. Since a lot of our individuals who are treated have tattoos, we’ve found in surveys that the shot doesn’t hurt as much as getting a tattoo. When you talk about getting a shot in your behind, people get real anxious about that. But That’s the only spot where you want this injected.
Read parts one & two of "Out from the shadows: Cincinnati's syphilis epidemic"
- 'The numbers are way too high:' say Hamilton Co. health officials battling syphilis epidemic
- Local non-profit takes the fight against syphilis epidemic to communities, in an RV
- Hamilton County’s syphilis data for the second quarter of 2013: http://www.hamiltoncountyhealth.org/files/files/Reports/Syph_Q2_2013.pdf
- City of Cincinnati Health Department fact sheet: http://www.cincinnati-oh.gov/health/personal-health/syphilis-prevention/
- Data about 2011 syphilis rates from the Centers for Disease Control and Prevention: http://www.cdc.gov/std/syphilis2011/default.htm