It was inevitable that Dr. Peter Gulick, a physician and HIV and AIDS specialist at the Ingham County Health Department, would pull out a medical textbook to show gruesome pictures of what syphilis does to the body.
Primary syphilis, according to the pictures, gives you a nasty chancre on your genitals. One picture showed a bubbling sore on the shaft of a penis; another picture showed the sore hiding underneath a woman’s labia.
Secondary syphilis was scarier. One picture showed a person of indeterminate gender whose entire body was covered in purplish bumps. Another showed a pair of hands covered in yellow scabs.
But even scarier, Gulick said, is that sometimes you don’t show symptoms. Sometimes people go the dermatologist with symptoms of secondary syphilis and get diagnosed with a rash, never knowing that they have a sexually transmitted infection. If left untreated, syphilis can kill you, give you dementia or cause blindness.
Because of its ability to fly under the radar or mimic other infections, syphilis is known as “the great imitator.”
“Sometimes people have these things and just don’t know it,” Gulick said.
A 300 percent increase in the number of syphilis cases in Ingham County this year has caused alarm among public health workers who say that the disease is a indicator of a larger STI problem and people having less safe sex. Worse, health officials worry about the risk of co-infections that the syphilis outbreak could lead to, including new infections of HIV and AIDS.
According to the county Health Department, a total of 20 cases of pri mary and secondary syphilis have been reported so far this year. In 2008, a total of only 10 cases were reported in the entire year, according to state statistics. Health officials say the population most affected by the rise in syphilis cases are older men who have sex with men.
“This outbreak is the worst I’ve ever seen,” Gulick, who has worked with HIV patients for 20 years, said. “We’re not even done with 2009. It’s reasonable to believe that there’s more than 19 cases out there.”
Where syphilis is from and when it originated is in dispute, but references to the disease first appeared in western medicine around the 15th and 16th centuries, about when European sailors started interacting with foreign populations. Wherever it’s from, Treponema pallidum is a nasty looking bug shaped like a corkscrew that some might brush off as a rare STI. It is known more for killing Al Capone than its recent resurgence. According to statistics from the Centers for Disease Control, syphilis cases have risen over last year in many places across the U.S., including Michigan.
Primary syphilis, according to the CDC, may not show up for 10 to 90 days, if it shows up at all. It can heal within three to six weeks. Secondary syphilis may show up as the genital chancre is healing and a rash may appear on your hands and bottoms of the feet. Late stage syphilis develops in about 15 percent of people who were infected and were never treated and can affect your brain, heart, liver and joints.
The good news is that the earlier syphilis is detected, the quicker it can be treated. Syphilis can be squashed with one shot of antibiotics if you’ve had it for less than a year. Even after, treatment is as simple as regimen of antibiotics.
Last year, Genesee County, where Flint is, had an outbreak similar to Ingham County’s. By November, the county had 100 cases of the disease; exactly a year before it only had 10 cases.
“In March of 2008, we started noticing more cases,” Mark Valacak, director of community health services at the Genesee County Health Department, said. “In part, it was individuals having unprotected sex. A number of our cases were related to substance abuse. We also had individuals who exchanged sex for money. When you’ve got a down economy, unfortunately people are turning to alternatives to try and make a living. You get someone who’s infectious in that population and people not taking precautions and it spreads the disease.”
The question of “how” a disease like syphilis invades a population is both hard and easy to answer. It is doubtful that you can live in an area where there isn’t someone infected with the disease. But its transmission from person to person is the key. Experts say that transmission is likely the failure of people to protect themselves and to get tested if they have unprotected sex, either because they were never educated in safe sex practices, or are having risky sex.
“People are having more and more unsafe sex — it just takes one person with the organism,” Gulick said. “The numbers give us the indication there’s more unsafe sex. Just the culture of people going out and doing it.”
In the Flint area, Valacak said, syphilis was being spread among the hetero sexual population. The number of cases in Genesee County has been greatly reduced, but only after the Health Department launched a safe sex and STI testing campaign.
“We do a behavioral risk factor phone survey. When we ask the question, ‘With a new partner, do you always use a condom?’ half the population says no,” he said. Then there’s the sex. There are certain types of sex, says Chris Cobb, a communicable disease investigator with the Ingham County Department of Health, that are stigmatized, like sex work or married men having sex with other men on the “down low.”
Plus, with a disease like syphilis, some people might not know they have it. Unlike the pictures in Gulick’s medical textbook, primary syphilis might be too small to notice and secondary syphilis might be misdiagnosed.
“It’s a painless open sore and then it disappears,” Vennishia Smith, the HIV prevention coordinator for the Ingham County Health Department, said. “The first and second rash come and go. A lot of times the signs and symptoms get missed.”
Both Smith and Cobb are working on behalf of the Health Department to track the transmission of syphilis. They actually go out into the field and talk to the people who tested positive and find out how to get in touch with their partners.
But the Health Department can only do so much, which leaves those in doubt about their status to get tested and get treated.
The co-infection connection
The larger problem is that syphilis indicates a problem of unsafe sex practices. A chancre that you might develop with the disease is like a highway for other diseases. And that means you could be at risk for the incurable and more frightening HIV and AIDS if you’re having unsafe sex.
So far, said Gulick, two people in Ingham County who have tested positive for syphilis have also tested positive for HIV. Nationwide, 40 percent of those who test positive for HIV are co-infected with syphilis.
The behavior that causes more syphilis and thus more HIV, also, is on the rise. Injected drugs are being used more, Gulick said, and heroin especially has become more popular. Not only does that facilitate the sharing of dirty needles, but it also leads to risky sexual behavior. Alcohol, too, is an unfortunate lubricant for the transmission of HIV and STIs. Monogamy, Gulick said, seems to be on the decline, too.
One patient who came to his clinic at the Health Department was a sex worker in Florida. She was exhibiting oral yeast infections and was found to have fullblown AIDS.
carrying this deadly virus and no one knew,” he said. “Everyone, 13 to
65, should have a test for HIV.” Teon found out the hard way how easy
it is to get HIV. At 20, the Lansing resident was dating a man whom he
thought he was in love with. At first, Teon made sure that the sex was
safe — he says he was never taught about safe sex growing up, but did
his own research about it. But, when he fell in love, things changed.
happened was I let my guard down because I thought I was safe,” he
said. “I loved that person. But I obviously didn’t know everything I
needed to know about them. Anybody could’ve done the same thing.”
getting HIV was not related to syphilis, but people in his age group
are increasingly at risk because they haven’t been given access to
proper sex education.
Matt Hulbert, the prevention coordinator
for the Lansing Area AIDS Network, posits that younger people are not
getting enough sex education. Kids going to school over the
last eight years were exposed to a lot of abstinence only sex education
and not enough practical sex education.
Thus, there has been a
rise in coinfections over the last year in people under 24 and people
45 and up — another group that was underserved by practical sex
education. LAAN does not test for STIs, but urges those that come in for an HIV test to get tested for other diseases.
of the Detroit area, says Kay McDuffie, an early prevention coordinator
for LAAN, Ingham County has the highest number of HIV and AIDS cases in
the state. Her theory is that people in outlying communities come to
Lansing for more than just a Lugnuts game.
“Because even though it may
not seem to us in Lansing that we’re a booming, happening metropolis,
when you look at rural areas around Lansing, there’s the tendency for
people to look for opportunities. That might be educational, cultural
or sexual and might include drug use behaviors. Those are indicators
that put people at higher risk for STD infection,” she said.
Saturday is National HIV Testing Day. There will be
opportunities — all free — around the Lansing area to get tested and
know your HIV status. Further, the Ingham County Health
Department offers free STI and HIV testing.
If you have had unprotected
sex recently, you are urged to go get tested.
Chris Venetis is a strong
advocate of testing. Venetis, a Lansing resident, used to work in one
of the oldest gay nightclubs
in Detroit during the 1990s and during that time he got HIV.
all kinds of promiscuity,” he said. “I don’t know who I got it from.”
It wasn’t until he developed pneumonia that he found out his status. He
remembers that there was HIV/AIDS awareness going on all around him at
work, including testing and handing out of condoms. He used protection,
but there would be times when alcohol or drugs were be involved that
may have led to unprotected sex or not noticing a broken condom.
just goes to show you, you make that choice and say, ‘Oh, that person’s
clean.’ But it can be anyone at all. The only way to go is to treat
everybody like they have it,” he said.
Venetis is healthy now, but he
says it took a serious lifestyle change to get back to health. He’s
been in a relationship for nine years and his partner, who gets tested
for HIV regularly, has not been diagnosed with the virus. Although
HIV is incurable, advances in treatment are enabling those with the
virus to live, on average, 38 years, sometimes more. Teon, now 22, is
living without any symptoms of HIV.
“It’s not surprising that there’s a
syphilis outbreak; there’s a lot of sex going on out there,” Venetis
said. “The sooner you get tested, the sooner you know, the sooner you
can get medication.”
HIV Testing Day testing sites (June 24-27)
Lansing Area AIDS Network
913 W. Holmes St.
(Near the Kroger on Martin Luther King
2 – 6 p.m.
4 – 8 p.m.
10 a.m. – 2 p.m.
513 E. Grand River Ave.
(Across from the former Temple Club in
6 – 9 p.m.
FREE – appointment only
313 W. Grand River Ave.
(Across the street from People’s
6 – 9 p.m.
2003 E. Michigan Ave.
(Near the corner of Clemens Avenue)
10 a.m. – 2 p.m.
Olin Health Center
10 a.m. – 3 p.m.
Willow Health Center
306 W. Willow St.
3:30 – 6:30 p.m.
1 – 4 p.m.
Ingham County Health
5303 S. Cedar St.
8:30 a.m. – 4:30 p.m.
1:30 – 4:30 p.m.
Willow Health Center
Monday – Thursday
10 a.m. – 7 p.m.
10 a.m. – 5 p.m.
Ingham County Health
Appointment only, schedule 2 days in
Monday, Tuesday, Wednesday
8:15 a.m. – 10:45 p.m., 1:15 – 3 p.m.
10:15 a.m. – 12:45 p.m., 3:15 – 5 p.m.
1:15 – 3 p.m.