By Amy Doogan, RN, BSN
Over the past year, a Syphilis outbreak has happened in Alaska. It is affecting MSM, (Men who have sex with men) at an alarming rate. The Department of Health and Social Services has teamed with Identity Inc., Planned Parenthood, and the Alaskan Aids Assistance Association to bring new testing options and information to the LGBTQIA community and others.
I was talking to a friend the other day and she asked how work was going.
“It’s great,” I responded. “Well, except for the statewide syphilis outbreak, of course.”
“Syphilis?” my friend said. “Really? Huh. I didn’t think people got that anymore.”
Therein lies the problem. As a public health nurse who specializes in the prevention and treatment of sexually transmitted infections (STIs), I spend a lot of my time talking with patients, colleagues, and members of the public about syphilis. Some of these people have never heard of syphilis. Those who have almost universally regard it as a problem of the past; an old-school disease that has been rendered largely irrelevant by modern medicine.
A few years ago, these people wouldn’t have been wrong. After a peak in the late 1940s and early 1950s, the number of syphilis cases reported in the United States started to steadily decline. In 1999, scientists at the Centers for Disease Control and Prevention (CDC) were so confident in these declining numbers that they announced they were implementing a plan they believed would completely eradicate syphilis in the United States.
It didn’t work. In the mid-2000s, the nationwide syphilis rate rebounded. Since then, there has been a steady increase in the number of cases reported nationwide. Last year, the CDC announced that the national syphilis rate had increased by 72.7 percent between 2013 and 2017.
Alaska was not exempt from this increase. In 2018, the State of Alaska Department of Health and Social Services (DHSS) Section of Epidemiology (SOE) released a bulletin formally announcing that Alaska was experiencing a syphilis outbreak. According to this bulletin, the number of syphilis cases that were reported in the first three months of 2018 equaled the total number of syphilis cases reported in 2017. While the state has not yet released data from all of 2018, extrapolation of the data from the bulletin would suggest Alaska experienced a fourfold increase in syphilis rates over the course of a single year. Here in Anchorage, data from the Anchorage Health Department (AHD) shows that the total number of syphilis cases investigated in 2018 was approximately three times the number of cases handled in 2017. Data shows that rates of syphilis are highest among men who have sex with men. It also shows that syphilis patients are frequently co-infected with another STI such as gonorrhea, chlamydia, or HIV.
When I share this information with people, I almost inevitably get asked a single question – why? What is making syphilis rates rise so steeply and suddenly, especially within the community of men who have sex with men? The truth is that we don’t know. Fortunately, we do know what steps people can take to keep themselves safe from syphilis and other STIs.
The first step in any battle is knowing your enemy. Syphilis is a bacterial infection that is spread through sexual contact. The first symptom of syphilis is a chancre, a sore that appears at the site where syphilis enters the body. The problem with chancres is that they’re painless, so if they appear in a part of the body you can’t easily see (such as the rectum or the vagina) you often don’t even know you have one. After the chancre goes away, secondary symptoms can develop. These symptoms include a rash (often, but not always, concentrated on the palms of the hands and the soles of the feet), white patches in mucous membranes (i.e. the mouth, rectum, or vagina), wart-like growths, or patchy hair loss. Untreated syphilis infections can lead to neurological problems, blindness, or even death. Congenital syphilis (syphilis passed from a woman to her unborn baby) is particularly devastating, leading to stillbirth in many cases or causing serious medical complications in the newborn in many others.
Fortunately, syphilis is preventable through the use of safer sex practices. Practicing mutual monogamy or reducing your number of sex partners, especially anonymous partners, will decrease your risk of contracting syphilis. Correctly using condoms during every act of intercourse, including oral sex, will also reduce your chances of getting infected. Condoms can be purchased at most grocery stores and drugstores, and free condoms and lube are available in locations throughout Anchorage including the Four As, Planned Parenthood, and the Anchorage Health Department.
Syphilis is detected through a simple blood test. The CDC recommends routine testing for pregnant women and for anyone who has symptoms or a partner who is diagnosed with syphilis. They also recommend that men who have sex with men get tested at least yearly, with testing every three to six months recommended for high risk men who have sex with men (such as men with multiple partners or men whose partners have multiple partners). Anyone with HIV should test at least yearly.
Testing can be obtained at hospitals and clinics throughout the Anchorage area, and is available either free or at very low cost through the Anchorage Health Department. Free testing will also be available at several upcoming outreach events: Identity (March 30, April 20, and May 18), Spenard Recreation Center (April 27), and the Fairview Recreation Center (May 11.)
If you find out that you do have syphilis, don’t despair! Syphilis is easily cured with antibiotics, especially when treated early. Penicillin is the first choice for syphilis treatment. People who have developed syphilis recently only need one penicillin injection to cure the disease, while people who have had syphilis for a longer period of time may require three injections given one week apart. Cases in which neurological complications have developed may require treatment with intravenous antibiotics, which are usually administered during a stay in the hospital. If you are allergic to penicillin, consult your health care practitioner – alternative treatments are available. If you are uninsured and concerned that you can’t afford treatment, medication can be provided to you free or at low cost through the Anchorage Health Department.
Questions? Call the Anchorage Health Department at 343-4696. We’re here to help.