Increase in Syphilis Cases in Michigan Worries Local Health Departments

LANSING — Facing a significant increase in reported cases of syphilis infections, the Ingham County Health Department says it’s the midst of an outbreak of the sexually transmitted bacterial infection.

“An outbreak is defined as any incidence of disease that exceeds the usual and expected incidence,” said Renee Canady, deputy health officer for the Ingham County Health Department. “So by formal definition, we would have to refer to this situation as a syphilis outbreak.”

And exceeding the usual or expected incidence of syphilis is exactly where Ingham County is today with syphilis cases. But the county is not alone and local health officials across the state are on the lookout for signs of what could be a worsening situation.

In February, Ingham County called the first month of 2009 “alarming” because of a hike in the number of reported syphilis cases. Then it was only three, the same number the county, home to the state capital and East Lansing, had reported in all of 2008.

On Monday, Ingham health officials said that as of the beginning of this month, the number has jumped to 18 reported cases. Of those 18, 10 are considered infectious cases, meaning they are in primary or secondary stages. Eight are in the latent stage or have progressed to third stage indicators such as neuro-syphilis, where the bacteria attacks the brain and central nervous system. Persons with HIV are more likely to progress, and more quickly, to this level of infection.

In February, Kent County officials also expressed concerns about the increasing number of cases of syphilis in the men-who-have-sex-with-men category, but the health department there moved quickly to slow the cluster from gaining ground. In February, the department reported four confirmed cases. As of last week, Kent County had eight confirmed cases.

Bridie Kent, spokeswoman for the Kent County Health Department was unable to answer how the cases were transmitted, nor was she able to indicate how many people had been confirmed with the late stage, non-infectious version of the infection. Kent County, home to Grand Rapids, reported eight cases in all of 2008.

Health officials there said the county was able to stem the spread of the bacteria through effective community networking.

According to an Kent County Health Department explanation of the measures taken:

First, we were pleased by the amount of partners of infected individuals that we were able to reach through case investigations. By reaching these individuals, we could then epi-treat and educate on safer sex choices. Next, we are fortunate to have strong connections to local health care professionals, who were notified of the cluster and asked to increase testing and surveillance in their offices. Also, we increased syphilis screening in our own clinic. As you are aware, HIV takes a high toll on our MSM population. West Michigan is an area rich in resources for treatment and support of those living with HIV. One such resource is the St. Mary’s Advanced Immunology Services (formerly McAuley Health Center). In response to the syphilis cluster, the clinic began implementing syphilis screening for clients with every visit (as opposed to the once a year per client they typically offer testing). Finally, as I mentioned on the phone, our staff have established strong connections in the community with local nightclubs, bars, shops, and health clubs frequented by our MSM population. Owners were very supportive about spreading the word, encouraging patrons to get tested, and posting our health advisory. We need to continue our surveillance and increased vigilance in the wake of this cluster because, as with any infection, we could see a resurgence at any time.

According to Vennishia Smith, HIV/AIDS and STI prevention coordinator at the Ingham County Health Department, the county is ramping up its plans to address the spread of syphilis. Among the department’s plans are outreach efforts through the Lansing Area AIDS Network at local gay clubs, as well as information cards and posters made available at those bars. Smith also said the department, through LAAN, operates a profile on a website designed for sexually active gay men.

In Washtenaw County, which includes Ann Arbor and Ypsilanti, has seen six cases of syphilis, three of which were in people who are HIV-positive. The county also clocked an additional two cases in the third stage. In all of 2008, Washtenaw County saw nine cases of reportable syphilis. Cathy Wilczynski, program director of the Adult Health Clinic at the Washtenaw County Health Department, said the county has noticed a trend of increased numbers of sexually transmitted infections in young people, particularly African Americans and sexually active gay men.

Double diagnosis: Realities of the spreading threat

One of the six reported syphilis cases in Washtenaw County was in a 24-year-old man who recently learned he had also contracted HIV. The man, who spoke with Michigan Messenger on the condition of anonymity so he could talk openly about his very difficult personal health situation, had been suffering from swollen lymphnodes and low grade fevers for at least two months. But when the morning sore throat started, he searched online an explanation. What he found drove him to his doctor’s office, where blood was drawn. Days later, the doctor’s office confirmed that he had both HIV and syphilis.

“They said they think I have had it a long time. Like maybe a year or longer,” he said. “That’s why I got three shots instead of just one. Three shots in the ass.”

The shots were antibiotics, which quickly destroys the bacteria that causes syphilis, which has been a problem for sexually active humans for centuries.

The case of the 24-year-old from Washtenaw County highlights one of the problems public health officials have in combating diseases like syphilis. The disease can manifest with little or no visible symptoms, allowing the bacteria to settle in and lay dormant in the body for years. Then the bacteria comes back, attacking the internal organs including the brain and the central nervous system. This nearly invisible microbe can lead to infections in unborn children.

In Genesee County last year, officials tracked an outbreak that included more than 100 confirmed cases, including five where the bacteria infected a child during pregnancy.

“It’s unfortunate,” said Washtenaw’s Wilcynski. “We know that if you put yourself at risk for chlamydia or gonorrhea, it won’t be long before you are exposed to HIV, herpes, HPV or other diseases.”