Outbreak 

Syphilis festers in southwest Idaho

Treponema paillidum, the bacteria known to the 21st century as the infamous and often mysterious sexually transmitted disease syphilis, has been making an aggressive reappearance throughout the United States in the last several years. Locally, Idaho has seen a spike in the number of reported cases particularly in southwest Idaho's Canyon County.

Historical references to syphilis date back to ancient Greece and it is mentioned in literature from Plato to Shakespeare. The French called it the "Italian disease," the Italians called it the "Spanish disease," the Russians blamed it on the Polish while the Arabs said it was the "disease of the Christians." It was in 1530, when Italian physician, scholar and poet Girolamo Fracastoro wrote a poem about the disease, that syphilis took the name by which we now call it.

A glance at the list of likely syphilis victims throughout history claims some of the most well-known figures in art, literature and nation-ruling. Syphilis is said to have been the cause behind the creative genius of Mozart, Beethoven, Nietzsche, Schubert, Van Gogh, Oscar Wilde, Poe, Dostevsky, Tolstoy and James Joyce. Some have purported that the most ambitious military and political figures in history were fueled by the insanity of the disease, King Henry VIII (and all five of his wives), Napoleon, Stalin, Mussolini and not surprisingly, Adolph Hitler. Our nation's beloved Abraham Lincoln and his wife Mary are rumored to have shared the mysterious illness, though many historians doubt the validity of the claim that Mary's stint in a mental hospital at the end of her life was due to the venereal disease. Even invincible gagster Al Capone suffered from syphilis, having contracted it as a young man and suffering from its third and final devastating stage while incarcerated in Alcatraz.

Despite the overly romanticized history of syphilis through the accomplishments of its well-known victims and the rampant rate at which syphilis once infected entire populations, the dawn of antibiotics rendered the once fatal disease nearly non-existent. For the last half-century, efforts have been underway to eliminate the disease all together. In fact, in Canyon County where a recent outbreak has health officials undertaking a massive public education effort on the disease, syphilis was nearly completely eradicated three years ago.

According to the Idaho Department of Health and Welfare's STD/HIV Statistics Department, not a single case of syphilis was reported in the southwest district of Idaho, which includes Canyon County, in 2000. In 2001 a single case of syphilis was treated in the district but in 2002, the tally jumped to nine cases. That number quadrupled in 2003.

"Since the beginning of 2003 as of today 46 adult cases and six congenital cases have been recorded," says Jennifer Tripp, staff epidemiologist at Southwest District Health. "We treated 38 cases in 2003 and 14 to date in 2004."

By comparison, Jared Bartschi, Disease Intervention Surveillance Specialist at the Idaho Department of Health and Welfare reports that the Central District, which includes Ada County, recorded only eight cases in 2003 and nine cases in 2004.

The significant difference between the Southwest and Central districts' numbers may raise a few eyebrows, but compare those numbers per capita and the difference is as astonishing as it is epidemic--especially since the number of cases reported in Canyon County only reflect the number of cases correctly diagnosed and treated as syphilis. It is possible that many more people are infected with the disease but have yet to be correctly diagnosed as syphilitic.

Syphilis is only contracted through oral, vaginal or anal sexual relations in which a person comes into direct contact with a syphilis lesion on an infected person. Once infected the disease affects victims in three major stages, the first of which is visible as lesions that will disappear if left untreated. The second stage usually occurs as a rash that does not itch or a slight fever with fatigue and muscle aches. Oftentimes patients exhibiting these symptoms are misdiagnosed by their health care provider and without proper treatment, they continue to spread the disease.

"Because it's so asymptomatic," says Tripp, "if people do have symptoms it's often confused with other things. Especially in the second stage. The rash is very often misdiagnosed as other things. We've seen mouth sores diagnosed as stomach problems."

If incorrectly diagnosed and left untreated, syphilis advances to the third latent stage in which the disease begins to cause damage to the brain and blood vessels that may not be visible for many years. Dementia and eventually death will result from untreated syphilis.

In the outbreak in the southwest district of Idaho, the majority of the cases have been in Canyon County but without a core transmitter--a person clearly identifiable as a link among cases--it has been difficult for health officials to contain the spread of syphilis.

Most of the Canyon County cases are reported as being new victims of the disease and relatively young. According to Tripp the demographic being infected is fairly specific: young adult, Hispanic men and women. Patients have been as young as 16 years old, but the median age of patients being treated for syphilis is 21.5. Of the 46 infected patients since 2003, 38 of them, or 83 percent, are Hispanic.

"As soon as we learn about a case, we interview the patient, determine who their partners are and what their social network is," says Tripp. "The real focus of public health is prevention and we want to treat someone as well as educated them to keep from spreading the disease."

In Canyon County, the attack against syphilis lies in public education. The Southwest District Health office is working closely with organizations like the Idaho Migrant Council to fortify partnerships that will work toward prevention of the disease. Radio announcements in both Spanish and English have been aired and fliers have been posted in grocery stores, public park restrooms and laundromats. And since nearly one-fifth of the cases in Canyon County come from the correctional facilities, inmate screening is currently underway.

But public education is only one tool in the effort to solve the problem. Tripp thinks that drugs definitely play a role in furthering the spread of not only syphilis but all sexually transmitted diseases. Many people may be hesitant to seek medical care for their condition because of their involvement in illegal drugs. According to Tripp about 20 percent of the patients in this outbreak have a history of use and she emphasizes that it is the responsibility of the health department to stop the spread of the disease, not to focus on any type of illegal activity.

In addition to educating the public about the present prevalence of syphilis, Tripp urges that health care providers be more aware of the problem.

"If we can make health care providers aware that screening for syphilis is necessary it will really help prevent the spread of the disease. When we're having an outbreak, anyone who has an STD should be tested for syphilis," says Tripp adding that because people with syphilis are more at risk to contract HIV, everyone with syphilis should be tested for HIV.

Syphilis is detected through a simple blood test by a health care provider and is easily treated in its earlier stages with antibiotics. National Testing Day for syphilis is June 25 and free syphilis, HIV and Hepatitis C screening will be conducted at all Idaho District Health Clinics. To make an appointment for a confidential and free screening, call 455-5345.

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