It was a scourge of centuries past, a disease that ravaged the body and brain,
drove geniuses to But syphilis, a sexually transmitted disease that was so rare
by 1998 that federal health officials had planned to declare it eliminated by
2005, has made a troubling comeback in New York City and across the nation. In
the first three months of this year, more than twice as many syphilis cases were
diagnosed than were in the first quarter of 2006, according to the city Department
of Health and Mental Hygiene.
In recent years, the disease has been most common in men who have sex with
men. But now, health officials say they are concerned about an increase in cases
among women in New York, following a trend seen nationally beginning in 2005.
After a decade with almost no female cases, health officials said the jump among
women was possibly fueled by an increase in the number of men having sex with
both men and women.
City health officials said they were receiving more reports of bisexual behavior
among men. And Dr. Stuart Berman, an epidemiologist at the federal Centers for
Disease Control and Prevention, said that in the last few years, New York men
with syphilis had reported engaging in bisexual behavior more often than men
with the disease in other cities.
Syphilis is highly contagious and can be hard to detect, but is easily curable
with antibiotics. Untreated in pregnant women, it can cause stillbirth, severe
birth defects and infant death.
The raw numbers are relatively modest — 260 cases in New York for the
first quarter of 2007, including 10 among women — but they also contain
a troubling signal: risky behaviors and unsafe sex appear to be on the rise.
And many health experts warned that a spike in H.I.V. cases could come on the
heels of the syphilis outbreak.
“There is risk going on out there,” said Perry N. Halkitis, a professor
of applied psychology at New York University who is studying the connection
between the use of highly addictive drugs like methamphetamine and unsafe sex.
“Most certainly you are going to see an increase in H.I.V. transmission.”
Federal health officials estimate that those infected with syphilis are two
to five times more likely to become infected with H.I.V., the virus that causes
AIDS, because of the open sores caused by syphilis. But doctors said that because
syphilis was on the decline until recently — medical providers do not
routinely screen for it except in pregnant women — many people do not
suspect the sores are a sign of infection.
There is debate over when syphilis, caused by the bacterium Treponema pallidum,
first appeared, but historians said it became a global plague in the 16th century.
It was called “the great pox,” to distinguish it from smallpox and
because of the large, blistered rashes that occur in the late stages.
A pantheon of historic figures and artists, including Al Capone, Manet and
Toulouse-Lautrec, are believed to have died of syphilis, and some historians
have suspected that others, including Hitler and Lenin, suffered from undiagnosed
cases of the disease.
Syphilis cases significantly declined with the advent of penicillin during
World War II.
The disease can look and feel like so many other ailments that it is also known
as “the great imitator.” In the final stage, as long as 30 years
after initial infection, it can cause severe damage to many internal organs,
depression, blindness and fits of creativity, and ultimately, death.
It can easily be spread through oral sex, unlike some other sexually transmitted
diseases, and is passed through direct contact with a syphilis sore. Symptoms
occur an average of 21 days after infection, according to federal health officials,
but they can take as long as 90 days to appear.
The first sign is often a small, firm and round lesion at the point of the
body where the disease was contracted. The lesion is painless and will heal
without treatment, so many people are not aware they are infected.
In 2005, the last year for which comparable federal data was available, the
city’s syphilis rate, 7.7 instances per 100,000 people, was more than
double the national average of 3.0 per 100,000.
Federal and local health officials said the rising rates of infection could
be attributed to several factors: substance abuse that leads to increased sexual
activity and unsafe sex; unsafe sex among people already infected with H.I.V.;
complacency about the risks of H.I.V. infection and what some call “condom
fatigue,” as the vigilance that surrounded the early days of the AIDS
epidemic has faded; and less fear of H.I.V. infection as the progress in treatment
for AIDS means that a diagnosis is often no longer a death sentence.
The last time city health officials reported a significant syphilis outbreak,
in the 1990s, it was linked to unsafe sex that accompanied the crack epidemic.
That outbreak was concentrated largely in poor neighborhoods outside Manhattan,
whereas the current one is centered in Manhattan, with infected men living in
Chelsea accounting for a majority of the cases.
Blacks and Hispanics accounted for most new cases of syphilis, according to
the city’s recent survey, but whites experienced faster rates of increase.
The 2007 numbers showed the incidence among white men was three times the incidence
during the same period in 2006.
A prominent theory nationally is that the methamphetamine epidemic has given
rise to the syphilis comeback — and the greater risk for H.I.V. infection
— because the highly addictive drug can cause hypersexuality, leading
users to have frequent sex with multiple partners, often without taking precautions.
Susan Blank, New York City’s commissioner for sexually transmitted disease
prevention and control, said the department had no data to prove that crystal
methamphetamine addiction was responsible for higher syphilis rates.
But Professor Halkitis, who is writing a book about methamphetamine, said drug
abuse in New York was unquestionably driving rising rates of sexually transmitted
Dr. Blank said the health department was alerting New Yorkers and their health
care providers about the importance of screening for syphilis, offering free
and confidential testing at all of its public clinics.
The increase in cases among women also highlights the need to learn the sexual
history of partners, health officials say, as some women may not know that their
partners have had sex with men.
The department launched a campaign in February to distribute millions of free
condoms, and for those with a syphilis infection, it will confidentially notify