September 25, 2018
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National resurgence of syphilis hitting Maine

Robert Sumpter | U.S. CDC
Robert Sumpter | U.S. CDC
In this 1967 photo, a rash caused by syphilis has broken out over the patient's neck and back.
By Meg Haskell, BDN Staff
Updated:

Syphilis, an infection once thought nearly eradicated in the United States, has come roaring back in recent years, including in Maine.

At the Portland Public Health Center’s sexually transmitted disease clinic, Medical Director Dr. Christina DeMatteo said the city has seen an uptick in syphilis and gonorrhea that parallels state and national trends.

“We’re seeing an increase in the number of syphilis cases in Maine,” she said. “While the disease is treatable, it’s easy to miss the signs of infection so regular condom use and screenings are important for anyone who might be at risk.”

According to recent data from the Maine Center for Disease Control and Prevention, 84 cases of syphilis were reported in the state in 2017, up from 48 cases in 2016 and an average of 20 cases in each of the previous five years.

National numbers for 2017 are not yet available from the U.S. CDC, but the trend has been upward for the past several years. Rates are spiking most rapidly among men who have sex with other men, but cases are rising in other populations as well, including older adults who are sexually active.

Syphilis is a bacterial infection transmitted by contact with body fluids during sexual activity. Early symptoms include small, sometimes painless lesions around the anus, genitals or mouth. Later symptoms include body rash, swollen lymph nodes and fever.

Caught early, syphilis responds to penicillin and related antibiotics. Allowed to progress untreated, syphilis can cause serious illness, including damage to the heart, brain and other organs.

Nationally, the disease has made a resurgence since hitting a historically low rate in 2000 of 2.1 cases per 100,000 people, or about 6,000 cases.

In 2016, there were 27,814 syphilis cases reported nationally, an increase of nearly 18 percent over 2015. That year, the number of reported cases was 23,872 and the U.S. CDC called for ramped-up interventions to reverse the trend.

Other sexually transmitted diseases, or STDs, are on the rise as well, including chlamydia, gonorrhea and hepatitis C. But, while the absolute number of syphilis cases is relatively small, its rapid spike has outpaced them all in Maine and the nation.

“Nationally, STD numbers are rising and Maine is unfortunately following that trend,” Emily Spencer, a spokeswoman for the Maine Department of Health and Human Services, which oversees the Maine CDC, said in an email Tuesday.

Spencer said the Maine CDC contacts sex partners of those those who test positive for syphilis and some other reportable STDs with a goal of ensuring the partners, too, are tested and treated. But, she said, “we don’t know why the numbers are increasing, and we haven’t been able to identify a specific risk factor that would account for the increase.”

Risk factors

A number of factors have driven the trend, DeMatteo said. Fewer concerns over HIV and AIDS have made people more open to having sex without a condom, for example, while the opioid crisis has increased the number of people who might make risky sexual decisions, she said.

At the same time, online dating has facilitated STD transmission between communities and social circles by making it easier for people to meet sexual partners outside their immediate friend group, the doctor said.

And, she said, better tests for the disease may have increased the rate at which it is diagnosed.

Younger health care providers and people who might be infected are less attuned to STD symptoms, DeMatteo said.

“It’s been such a rare disease here in Maine [until recently] that it’s not immediately familiar to many providers,” she said.

At Bangor Public Health and Community Services, Director Patty Hamilton said the walk-in public health clinic has not seen a significant recent uptick in positive syphilis testing. But that’s in part because they’re testing fewer people due to recent budget cuts from Augusta and Washington, D.C.

“We lost all our funding for the STD program,” Hamilton said.

The lab still tests “anybody who shows up,” but, with few exceptions, people who previously could be tested for little cost must now pay out of pocket. A test that screens for chlamydia, gonorrhea, syphilis and HIV costs $95 — money that many low-income or transient Mainers are unable to spare. The clinic does not bill commercial insurers or Medicaid, called MaineCare here.

The same budget cuts eliminated a position at the Bangor clinic for tracking down the sex partners of people who test positive so they, too, can be checked and treated for syphilis and other STDs. That investigative responsibility now resides with the Maine CDC in Augusta, Hamilton said, and it’s unclear how successfully partners are being contacted and treated across the state.

Those changes in prevention and treatment are bound to drive up rates of syphilis and other STDs, Hamilton said.

“You cut services, eliminate programs and stop following up — it’s a perfect storm,” she said.

At the private Mabel Wadsworth Center in Bangor, nurse practitioner Terry Marly-Derosier said STD rates are rising among specific populations she treats, including later-in-life couples.

“If people are not using condoms, because they assume they’re safe [against unintended pregnancy], that increases their risk of contracting an STD,” she said.

The rise in STDs among older sex partners may also be related to the popularity of sex-enhancing drugs such as Viagra, according to some reports.

The Maine Health Equity Alliance tests for diseases that are easily transmitted by blood through the use of shared needles for injecting drugs. Syphilis doesn’t fall into that category, but according to community organizer Hannah Ruhlin, the growing use of the drug Truvada, which protects against HIV and is also known as PrEP, may be changing STD testing trends.

That’s not because people who use the medication get overconfident about protecting themselves from diseases other than HIV, Ruhlin said, but because people who use Truvada, including sex workers and other high-risk individuals, are required to be checked for STDs on a regular basis.

Ruhlin said it’s important to counteract social stigma around STDs, making it easier for at-risk people to be tested regularly.

“Everyone should get tested,” Ruhlin said. “Having an STD doesn’t mean you’re dirty. You’re just someone who caught an illness and needs to be treated.”

BDN reporter Jake Bleiberg contributed to this report.

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