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Community-wide syphilis prevention effort showing results

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Marion County Public Health Department officials remain cautiously optimistic that a three-year long syphilis outbreak may be slowing.

A community-wide effort during the last 36 months has resulted in a leveling off of new syphilis cases. As of August 15, about 81 early syphilis cases have been diagnosed this year. At the current rate, the health department projects 130 early syphilis cases by the end of 2011 compared to 174 in 2010.

The majority of cases remain among men having sex with men. However, beginning in 2010 the rate of infection in heterosexuals increased. Health officials suspect there are undetected cases in both populations. Blacks were two times more likely to be diagnosed with syphilis than whites, and 13 times more likely than Hispanics. Data suggests the outbreak is spreading fastest among those with the least access to medical care in Indianapolis. Another troubling fact is that nearly half of the Indianapolis cases diagnosed between 2008 and 2010 were also co-infected with HIV. HIV-infected patients experience more severe forms of the disease like neurologic involvement.

Men having sex with other men met their partners online, in bars or bath-houses or at friends’ homes. They were also likely to engage in sexual intercourse without a condom or while high on drugs such as marijuana, alcohol or both. Infected individuals have other risk factors including anonymous partners, commercial sex work or sex with a commercial sex worker, and illicit drug use.

In the wake of the current syphilis outbreak, the Marion County Public Health Department’s low-cost STD testing center, Bell Flower Clinic, is working closely with social service providers and community-based organizations to educate at-risk populations about the signs and symptoms of syphilis.

“This initiative strives to improve the speed and effectiveness of detection, treatment, partner notification and risk-reduction counseling. Based on epidemiological data, we have increased screening activities in bars, bathhouses, jails and in neighborhoods with a high prevalence of syphilis,” said Virginia A. Caine, M.D., Director, Marion County Public Health Department.

In 1999, Indianapolis had the highest rate of new syphilis cases among major cities in the U.S. A strong effort by a specially assembled coalition of community organizations reversed that trend, making Indianapolis’ syphilis rate one of the lowest among major U.S. cities from 2003-2007.

In 2008, another outbreak of syphilis occurred in Indianapolis. The number of new infectious syphilis cases more than doubled from 34 cases in 2007 to 78 cases in 2009. In 2010, there were 121 new cases. Adding the infectious cases to the early asymptomatic cases brings the total to 174 cases in 2010.

“We need providers to remain on high alert for symptoms, understand new testing methods and report cases within 24 hours. We need patients to use precautions and if they develop symptoms to see their provider or come to the Bell Flower Clinic, where they can assist in identifying the best places to screen,” said Janet Arno, M.D., director of the MCPHD STD program and Bell Flower Clinic.

The health department continues to provide the public with information about the outbreak through press releases, letters to social service providers, and web postings (information available at http://www.mchd.com/syphilis_info.htm and http://www.bellflowerclinic.org/).

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