Syphilis rise alarms county health officials

Sexually transmitted disease poses serious risks if it goes untreated

By Marissa Harshman, Columbian health reporter

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Stages of syphilis

Primary syphilis: The first symptom of syphilis is a single, raised sore called a chancre. It usually appears on the genitals, mouth or rectum about three weeks after exposure. The sore is painless and can last for several weeks and go away by itself. However, without treatment, the disease can progress to the next stage.

Secondary syphilis: This stage typically starts with a reddish-brown, spotted rash on one or more areas of the body. The rash, which most often occurs on the palms of the hands or soles of the feet, usually does not itch. The rash can appear as the chancre is healing or several weeks after the sore is gone. The rash can come and go for up to two years. Other symptoms during this stage may include swollen lymph nodes, fever, fatigue, patchy hair loss, weight loss and headache. These symptoms usually last two to six weeks and will clear up with or without treatment.

Latent syphilis: The latent stage begins when symptoms from the secondary stage disappear. During this stage, the disease shows no signs or symptoms; it can only be detected by blood test. A relapse of secondary syphilis can occur during the first two years of latency. Without treatment, latent syphilis continues for life and may progress to the final stage.

Tertiary (late) syphilis: Tertiary syphilis can cause paralysis, mental problems, blindness, deafness, heart failure and even death. Though treatment at this stage will cure the disease and stop future damage, it cannot repair or reverse the damage that occurred before treatment.

photo Secondary syphilis — the second phase of the disease — usually begins with a reddish-brown, spotted rash on one or more parts of the body, most often on the palms of the hands or soles of the feet. The rash usually doesn’t itch and can come and go for up to two years.

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photoSecondary syphilis — the second phase of the disease — usually begins with a reddish-brown, spotted rash on one or more parts of the body, most often on the palms of the hands or soles of the feet. The rash usually doesn’t itch and can come and go for up to two years.

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A fairly uncommon sexually transmitted disease is becoming more common in Clark County, causing concern among local health officials.

The number of syphilis cases in Clark County through the first seven months of 2012 has nearly doubled the 2011 total. The increase led Dr. Alan Melnick, Clark County health officer, to issue a health advisory to local physicians and other health care providers.

"The numbers are up, but it's not like an immediate epidemic we're facing," Melnick said. "It's enough of a concern in the community that we want providers to be aware of this."

From January through July, Clark County health officials have diagnosed 21 cases of syphilis, compared with 11 cases in all of 2011. About 85 percent of the cases this year are among men who have sex with men. However, women have also been diagnosed with syphilis, Melnick said.

The cases this year have occurred in people ranging from 19 to 73 years old, with an average age of 40, according to Clark County Public Health.

The syphilis increase isn't unique to Clark County, though. Disease case numbers are going up in Tacoma, Seattle and Portland, Melnick said.

Syphilis is a curable sexually transmitted disease. Syphilis is passed from person to person through direct contact with a syphilis sore. Because some sores can be hidden, it may not be obvious a person has syphilis.

Syphilis progresses through four stages: primary, secondary, latent and tertiary (late) syphilis. Transmission doesn't occur after the secondary stage.

Without treatment, syphilis continues through the stages and may lead to serious health problems. About a third of people without treatment suffer serious damage to the nervous system, heart, brain or other organs, according to health officials.

"Syphilis has really horrible long-term effects," Melnick said. "It basically can attack just about every organ."

In Clark County this year, a majority of the syphilis cases — 12 of the 21 cases — have been caught in the primary and secondary stages, according to Clark County Public Health.

Pregnant women can also transmit syphilis to their unborn babies. No cases of congenital syphilis have been diagnosed in Clark County this year, but Multnomah County, Ore., and King County have identified three cases.

Infections in utero can cause stillbirth or infant death, Melnick said. Babies born with congenital syphilis can have a number of complications, including deafness, blindness and damage to the brain, liver and other organs.

"It's got some nasty complications," Melnick said. "Congenital syphilis is preventable, so one case is a tragedy."

Syphilis can be treated with medication. Primary and secondary syphilis can usually be cured with a single injection of penicillin. Infections of longer than a year, or once the infection spreads to the nervous system, usually require several doses of penicillin over time. Pregnant women can also be treated for syphilis.

Treatment stops the infection, but if organ damage has already occurred, the damage cannot be repaired.

Health officials have no way of knowing exactly why syphilis is becoming more prevalent, but the increase suggests more people are having unprotected sex, Melnick said.

Melnick also suspects a few other factors are playing into the increase. One possibility is people are getting more complacent now that HIV isn't considered the death sentence it once was. Another possibility: People are getting screened for STDs less often because they're losing access to health care, Melnick said.

Health officials want providers and patients to be aware of the disease and its symptoms. Chlamydia and gonorrhea are much more prevalent in Clark County — 764 and 91 cases, respectively, so far this year — but syphilis is on the rise and should be considered by health care providers, Melnick said.

He also urges people to wear condoms and suggests screening for anyone — men, women and pregnant women — who experience symptoms.

"It's very important for people to know that they are infected," he said. "That goes for syphilis, HIV and other sexually transmitted diseases."

Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; marissa.harshman@columbian.com.