When Madeline Meisburger warns her clients at the needle exchange about syphilis, many don’t know much about the disease — except that it was the downfall of a legendary gangster.
“I’ve had a lot of people say, ‘Oh that’s the one that makes you crazy,’ or they’ll say ‘Is that what Al Capone had?’ ” said Meisburger, a community outreach worker with the Point Defiance AIDS Project. “I’ll say yes, but they had very late stages of syphilis, and I always tell them this is what it looks like, this is how you get it, and this is how it’s treated.”
As part of Meisburger’s job, she administers free HIV, hepatitis C and syphilis tests to intravenous drug users who come to the needle exchange seeking clean syringes. She’s started talking to them more lately about syphilis and recently began testing for it, she said, because rates of new infections are booming.
Across the country, infections have increased significantly over the past few years, and syphilis rates are particularly high on the West Coast.
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30 primary and secondary (earliest stage) syphilis cases in Pierce County in 2014
51 primary and secondary syphilis cases in Pierce County in first 10 months of 2016
17 early latent (acquired within the past year) syphilis cases in Pierce County in 2014
45 early latent syphilis cases in Pierce County in first 10 months of 2016
Pierce County also is seeing a surge. In the first 10 months of 2016, instances of the earliest stage of syphilis infection leaped by 55 percent in Pierce County, and cases of syphilis cases contracted within the past year jumped 80 percent compared with the same period in 2015, according to preliminary data from the Washington State Department of Health.
Pierce had 30 new infections of syphilis in 2014. In the first 10 months of 2016, there were 51. For syphilis cases contracted within the past year, that number went from 17 in 2014 to 45 in the first 10 months of 2016.
Tacoma-Pierce County Health Department officials plan to issue an advisory next week alerting medical providers to the trend in primary and secondary syphilis (the earliest stages when ulcers and rashes begin to appear) and early latent syphilis (found in patients who have contracted the disease in the past year).
“Like many places in the nation, Pierce County has experienced a marked increase in the number of syphilis cases in the past two years,” said Nigel Turner, division director for communicable disease control at the county health department. “Men who have sex with men are at highest risk for syphilis, although it is also linked to substance abuse — especially methamphetamine use and trading sex for drugs.”
Pierce County’s recent surge isn’t as dramatic as the increase in some counties; new syphilis cases are up 95 percent in Snohomish County this year, from 19 to 37 cases, and they’re up 117 percent in Kitsap County, from six to 13.
But the increase here is more substantial than in other neighboring counties. King County is seeing only a 10 percent increase in new infections this year (although they were up 37 percent last year). King County, as the state’s most populous county, ranks No. 1 in new syphilis cases, at 229. Pierce County is third.
… certainly the message we want to say is if people are sexually active and not in long-term, mutually monogamous relationships, they should be tested regularly for these diseases
Nigel Turner, division director for communicable disease control at Tacoma-Pierce County Health Department
Thurston County is bucking the syphilis trend this year, and saw a drop in early-stage infections during the first 10 months of 2016 compared with the same period last year.
Overall in the state, new syphilis infections went up 25 percent from the first 10 months of 2015 to the same time in 2016, rising to to 464.
Some of the increase in Pierce and elsewhere could be attributable to more people getting tested, Turner said. When treated in early stages, syphilis is easily curable with penicillin.
“We like to think with more people with insurance coverage, more people are getting tested, but certainly the message we want to say is if people are sexually active and not in long-term, mutually monogamous relationships, they should be tested regularly for these diseases,” he said.
He said it could also partly be the result of the proliferation of online and app-based dating, increasing chances for sex with a stranger.
“I think certainly hooking up with people on the internet is a source of concern: you don’t know people’s backgrounds. Obviously, taking measures, using condoms to protect yourself makes a lot of sense,” he said.
341 primary and secondary syphilis cases in Washington in 2014
464 primary and secondary syphilis cases in Washington in first 10 months of 2016
199 early latent syphilis cases in Washington in 2014
348 early latent syphilis cases in Washington in first 10 months of 2016
Homelessness and drug use also are major risk factors. That means the opiate and heroin epidemic seen across the country and locally could be having an effect on STD rates: People on drugs are less likely to be in the mindset to use preventive measures or seek treatment, he said.
Syphilis is passed from person to person through direct contact with a syphilitic chancre. But it can also be passed through a pregnant woman to her child, sometimes with dire consequences. Centers for Disease Control and Prevention says untreated early syphilis in pregnant women, if acquired in the four years before delivery, can lead to infection in up to 80 percent of cases and may result in stillbirth or death of the child in up to 40 percent of cases.
Meisburger said the needle exchange hands out male and female condoms and dental dams for free to try to blunt the spread of the disease.
“I’ve been doing more informational types of things with participants,” she said. “There is misinformation out there — I don’t think people know exactly what syphilis is.”
Facts about syphilis in
▪ The majority of syphilis cases reported in Pierce County are male, and being a man who has sex with other men is the primary risk factor
▪ The risk of getting syphilis increases with age from the late teens through the 20s, with the highest rates among those in their early 30s
▪ Females make up 14 percent of syphilis cases reported in Pierce County so far this year
Source: Tacoma-Pierce County Health Department