Syphilis Outbreak in California Linked to Risky Behavior and Failure of Public Health System

The recent rise in syphilis cases in California, most prevalent in Los Angeles County, reflects an increase in high-risk sexual behavior by gay and bisexual men and a failure of the state's public health tracking system, the Sacramento Bee reports. Early in 2000, syphilis had "nearly disappeared" from Los Angeles County's gay population, when an AIDS Healthcare Foundation clinic reported diagnosing about 50 cases among gay and bisexual men. Health officials then launched a $560,000 safe-sex media campaign and "four months later declared the outbreak under control." But this summer, the officials "made a startling about-face," conceding that syphilis -- which often indicates a rise in other sexually transmitted diseases, including HIV -- was endemic among men who have sex with men, "[b]ucking a nationwide trend." In San Francisco this year, syphilis cases have nearly doubled, while Sacramento County has recorded 10 cases -- six involving men who had sex with men -- compared to one last year. The outbreaks mark a "setback" for the CDC's national syphilis elimination project, launched two years ago.

A CDC official attributed the outbreak to a "combination of denial and incompetence." Investigators have discovered that most of the men who contracted syphilis "shrugged off the lessons of the AIDS epidemic and had unprotected sex." Meanwhile, doctors either failed to diagnose the disease or were "ignoring a state law" requiring them to report cases of 85 communicable diseases to the county. The Bee reports that the law is "rarely enforced," and fewer than a "handful of doctors" have been disciplined under it. Dr. Jonathan Fielding, Los Angeles County's health officer, said that some cases were reported "six months late" because doctors were "too busy or thought someone in their office would do the paperwork." Lee Klosinski, director of education for AIDS Project Los Angeles, said, "I don't think the public health people were ready for this [outbreak] in this community."

The failure of Los Angeles County's public health system to track the outbreak raises concerns that the same system may not be able to detect a bioterrorist attack, the Bee reports. According to public health officials, low funding levels have prevented them from "keep[ing] pace with infectious diseases they encounter on a day-to-day basis," leaving them uncertain whether they could quickly ascertain that a smallpox attack, for example, was underway. A 1998 survey by the California Conference of Local Health Officers estimated that counties would need $22 million in state funding to improve local disease surveillance across the state and upgrade communication across counties. But this proposal has "not generated much support" among state lawmakers, leaving strapped counties struggling to deal with disease outbreaks. Cesar Portillo, an outreach worker with the AIDS Healthcare Foundation, asked, "How are we ever going to stop anthrax or smallpox when we couldn't stop syphilis?" (Rojas, Sacramento Bee, 11/27).