Will Condom Keep Me From Catching Syfyllis Again

Syphilis cases in California have contributed to soaring national caseloads of sexually transmitted diseases. Experts bespeak to the advent of dating apps, less condom use and an increment in meth. Wladimur Bulgar/Science Photo Library/Getty Images hide caption

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Wladimur Bulgar/Science Photograph Library/Getty Images

Syphilis cases in California have contributed to soaring national caseloads of sexually transmitted diseases. Experts point to the appearance of dating apps, less condom use and an increase in meth.

Wladimur Bulgar/Science Photo Library/Getty Images

In certain circles of San Francisco, a example of syphilis can be equally common and casual as communicable the flu, to the point where Billy Lemon can't even think how many times he's had it.

"Iii or four? V times in my life?" he struggles to recall. "It does not seem like a big deal."

At the time, about a decade agone, Lemon went on frequent methamphetamine binges, kicking his libido into overdrive and silencing the voice in his head that said condoms would exist a wise option at a raging sexual practice party.

"It lowers your inhibitions, and too your controlling abilities are skewed," Lemon says.

He's sober at present and runs the Castro Country Club in San Francisco, which is not a resort, simply a identify where gay men can become assist with addiction, specially meth. Lemon says syphilis comes with the territory.

"In the 12-step community, if meth was your thing, everybody had syphilis," he says.

In 2000, syphilis rates were and then low that public health officials believed eradication was on the horizon. But the rates started creeping up in 2001, grew steadily for the next two decades, then spiked 74% since 2015. There were nearly 130,000 cases nationwide in 2019, according to data released Tuesday by the Centers for Disease Control and Prevention.

In California and the U.S., about half of syphilis cases are in men who have sex with men. More a third of women in the western United states who have syphilis also utilise meth, a drug that has seen its own surge in recent years.

These are just some of the trends causing overall national cases of sexually transmitted diseases to hit an all-time loftier for the past 6 years in a row, reaching 2.5 million. And the consequences are now trickling down to babies who are contracting syphilis from their mothers; these congenital syphilis rates nearly quadrupled between 2012 and 2019.

This was all before the coronavirus pandemic took hold in the U.Southward., and with contact tracers and testing supplies diverted from STDs to COVID, the CDC is predicting 2020 numbers will be no amend.

"We are quite worried about this and have seen this trend over time," says Dr. Erica Pan, California'southward land epidemiologist. "Unfortunately, with years of not having enough funding and infrastructure in public health, and then in this past year, of class, both at the local and state level, a lot of personnel who had been focusing on STDs and syphilis follow-up have really been redirected to the pandemic."

Baton Lemon is executive director of the Castro Country Club in San Francisco, where gay men can become help with addiction. Lemon says that when information technology comes to methamphetamine utilise in particular, syphilis ofttimes comes with the territory. Beth LaBerge/KQED hide caption

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Beth LaBerge/KQED

Baton Lemon is executive director of the Castro Country Club in San Francisco, where gay men can get assistance with habit. Lemon says that when information technology comes to methamphetamine use in particular, syphilis often comes with the territory.

Beth LaBerge/KQED

A number of factors are fueling the syphilis surge

In that location are many factors that contribute to the rise of STDs, and syphilis in particular.

In the gay community in San Francisco, for example, the rise of mobile dating apps similar Grindr and Tinder made finding a date "faster than getting pizza delivered to your home," says Dan Wohlfeiler, an STD prevention specialist and co-founder of Building Healthy Online Communities, which uses these apps to improve gay men's health.

When the dating apps first came on the scene around 2009, they made it harder for disease investigators to track the spread of STDs and notify people who may have been infected, because men don't e'er know the names of the men they claw up with.

"They sometimes only know their online handle," says Dr. Ina Park, acquaintance professor at UCSF Schoolhouse of Medicine and author of the book Strange Bedfellows, about the history of STDs. "And if the sex didn't go well, then sometimes they volition block the person from their app and they don't fifty-fifty know how to reach that person again."

Online dating began back in the late 1990s, which was around the same time effective medications to forestall the manual of HIV became available: first, antiretrovirals that suppress the virus in those who are HIV-positive, so afterwards, in 2012, preexposure prophylaxis, or PrEP, which prevents new infections in people who are HIV-negative, but considered at-risk for exposure to the virus.

With the risk of contracting a mortiferous illness falling to almost nix, condoms fell even more out of favor than they already were, says Park.

"If one man is taking PrEP and the other 1 is virally suppressed, in that location's no HIV run a risk at all," she says. "So why use condoms if you lot don't listen having a bear upon of syphilis?"

Diagnosing syphilis is catchy

While syphilis is not benign — it can cause incomprehension, deafness, or brain harm — information technology is easy to treat. Typically, a shot of penicillin in the buttock will cure information technology.

Merely diagnosing syphilis tin be tricky, says Park, who treats patients with STDs at the San Francisco City Clinic. She oftentimes finds herself crouched low in the exam room, "lifting upwardly their scrotum and lifting up their penis," craning her caput to get a look from all angles.

She does these gymnastics to find rashes associated with syphilis. Some are obvious, others subtle. She says doctors in regular family medicine clinics often aren't trained on where to look, or when.

"The patient came in saying, 'I'k tired,'" Park says, referring to a common symptom of syphilis. "How many people are going to say, 'Take off your pants and lift up your scrotum, I desire to await? We just do that at the STD dispensary because that'south what we exercise."

But specialized public STD clinics, similar the one where Park works, take been shutting downwards nationwide. Ane reason is persistent underfunding of public wellness programs, a trend laid bare during the coronavirus pandemic. Another reason is the Affordable Care Human action. In a strange way, the 2010 police intended to aggrandize access to health care really contributed to the closure of STD clinics.

"Honestly, I think anybody thought they weren't going to be necessary," said Dr. Karen Smith in 2019, when she was the managing director of the California Department of Public Health. She says in one case Obamacare was in place, the idea was that STD testing would happen in primary care clinics.

"We sort of all assumed that if you've got wellness insurance and you've got access to a doctor, that's all that you need," she said. "Information technology turns out that that's not really all that you need."

People yet had affairs that they didn't want to talk about with their family physician. And some family doctors didn't desire to probe into their patients' sexual activity lives. Immature people, in particular, prefer clinics geared to them, out of their parents' purview.

"That loss of anonymous care really was a problem," Smith said.

The spread of syphilis is reaching newborns, also

When Christian Faulkenberry-Miranda decided to get a pediatrician, she never thought she'd go an good in syphilis.

In 2010, shortly after finishing her medical training and starting work at the Community Regional Medical Eye in Fresno, Calif., she began seeing babies with a rash on their tummies that looks like a blueberry muffin. At first she thought it was a mutual viral infection, until these babies tested positive for syphilis.

In those early days, Faulkenberry-Miranda saw peradventure a few instances of congenital syphilis each year. Now she sees two cases every week. It's of import to start the 10-day antibiotic treatment right away to avoid complications, just she nevertheless follows her patients through their first year of life, and often through their childhood, to watch for vision and hearing problems, developmental delays, attending deficits and learning disabilities, all of which tin consequence from congenital syphilis infections. In 2019, 128 of these built syphilis cases resulted in stillbirth or neonatal death.

"The disappointing thing is that syphilis is very treatable," she says. "This is something that'southward completely preventable with proper screening and handling of these moms during pregnancy."

Congenital syphilis cases hit a troubling milestone in 2019, increasing 279% over the previous 5 years and hitting a loftier of cases in the U.S. That is more female parent-to-child transmissions of syphilis than there were at the peak of mother-to-child cases of HIV in 1991.

"How could this be happening? Testing is cheap and widely available. The same treatment we've been using since the '40s still works," says Park, who has also seen an increase in congenital syphilis cases in San Francisco. "And yet we have this completely out of command epidemic amidst the most vulnerable babies in our society."

Many of the women who requite nativity to babies with syphilis have had no prenatal care. They often use drugs — mainly methamphetamine — and they are often homeless, said Dr. Karen Smith, former director of CDPH. This makes them more than probable to trade sex for housing, nutrient or drugs, prompting Smith to call built syphilis a "disease of despair." Drug use, in particular, makes women less likely to recognize that they're pregnant at all and less likely to seek health care if they practice.

"They're very concerned about what'southward going to happen when they're institute to exist pregnant and using drugs," said Smith. "They're concerned that their drug utilize will be reported and and so CPS will be involved and their children will be taken abroad."

Romni Neiman is a veteran contact tracer with the CDC. Before she got redirected to COVID-nineteen concluding yr, she was working on STD prevention in California, including the trouble of built syphilis. Neiman says when she tries to reach pregnant women who may have been exposed to syphilis, it's extremely challenging.

Neiman remembers looking for one adult female in the late '80s in Chicago. She used drugs, was significant and had been exposed to syphilis. The adult female's housing was so unstable that Neiman went to three different places earlier finding her. The adult female had no car, and then Neiman offered to drive her to the dispensary to become tested. The woman had no safe place to leave her toddler, because a man in the place she was staying was calumniating, so Neiman took intendance of the child while the woman saw the doctor.

"She was just trying to do the all-time that she tin can, and she was really afraid," Neiman remembers. "Sometimes it'south actually taxing and actually sad. And you come home at the end of the solar day and y'all're like, 'Wow. Wow.'"

Those challenges, combined with persistent underfunding for public health, are what led to the initial spike in congenital syphilis cases in Fresno County in the 2010s, says Park. Local contact tracers couldn't go on up, and the land had to step in with reinforcements. Afterward leveling off for a couple of years, congenital syphilis rates in Fresno spiked 900% in 2018.

The state is taking new measures to address the rates, says country epidemiologist Dr. Erica Pan, such equally requiring women to exist screened for syphilis twice during pregnancy, instead of merely in one case. And rather than waiting for women to come in for prenatal intendance, the state is doing more outreach and screening significant women in the emergency room and in prisons and jails.

Pan believes the coronavirus pandemic has created an opportunity to invest in a more nimble response to emerging and reemerging public health issues such as syphilis and congenital syphilis.

"It's been a really long, hard year responding to this pandemic, merely people have really acknowledged and realized the impact of divesting in public wellness infrastructure," she said. "I hope that a lot of the resources that we hope to bring to deport in the longer term after this pandemic will benefit STDs as well."

This story was part of NPR's health reporting partnership with KQED and Kaiser Health News .

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Source: https://www.npr.org/sections/health-shots/2021/04/14/986997576/once-on-the-brink-of-eradication-syphilis-is-raging-again

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