Syphilis cases in nation now at an all-time high

In certain circles of San Francisco, a case of syphilis can be as common and casual as the flu, to the point where Billy Lemon can’t even remember how many times he’s had it.

“Three or four? Five times in my life?” he struggles to recall. “It does not seem like a big deal.”

At the time, about a decade ago, Lemon went on frequent methamphetamine binges, kicking his libido into overdrive and silencing the voice in his head that said condoms would be a wise choice at a raging sex party.

“It lowers your inhibitions, and also your decision-making abilities are skewed,” said Lemon, who is 50.

He’s sober now and runs the Castro Country Club in San Francisco — which is not a resort, but a place where gay men come to get help with addiction, especially meth. Lemon said syphilis comes with the territory.

“In the 12-step community, if meth was your thing, everybody had syphilis,” he said.

In 2000, syphilis rates were so low that public health officials believed eradication was on the horizon. But the rates started creeping up in 2001. From 2015 to 2019 alone, cases rose 74%. There were nearly 130,000 cases nationwide in 2019, according to data released Tuesday by the Centers for Disease Control and Prevention.

In California and the U.S., about half of syphilis cases are in men who have sex with men. More than a third of women in the West who have syphilis also use meth, which has surged in recent years. These are just some of the trends causing overall national cases of sexually transmitted diseases to hit an all-time high for the last six years in a row, reaching 2.5 million. And the consequences are now trickling down to babies, who are contracting syphilis from their mothers: Congenital syphilis rates nearly quadrupled between 2012 and 2019.

This was all before the coronavirus pandemic took hold in the U.S., and with contact tracers and testing supplies diverted from STDs to covid-19, the CDC is predicting 2020 numbers will be no better.

“We are quite worried about this and have seen this trend over time,” said Dr. Erica Pan, California’s state epidemiologist. “Unfortunately, with years of not having enough funding and infrastructure in public health, and then in this past year, of course, both at the local and state level, a lot of personnel who had been focusing on STDs and syphilis follow-up have really been redirected to the pandemic.”

Many factors have contributed to the rise of STDs, and syphilis in particular.

In San Francisco’s gay community, for example, the rise of mobile dating apps like Grindr and Tinder made finding a date “faster than getting pizza delivered to your home,” said Dan Wohlfeiler, an STD prevention specialist and co-founder of Building Healthy Online Communities, which uses these apps to improve gay men’s health.

When the dating apps first came on the scene around 2009, they made it harder for disease investigators to track the spread of STDs and notify people who may have been infected, because men don’t always know the names of the men they hook up with.

“They sometimes only know their online handle,” said Dr. Ina Park, associate professor at the medical school of the University of California-San Francisco and author of “Strange Bedfellows,” about the history of STDs. “And if the sex didn’t go well, then sometimes they will block the person from their app and they don’t even know how to reach that person again.”

Online dating began back in the late 1990s, around the same time effective medications to prevent the transmission of HIV became available: first, antiretrovirals that suppress the virus in those who are HIV-positive, and then later, in 2012, pre-exposure prophylaxis, or PrEP, which prevents new infections in people who are HIV-negative but considered at risk for contracting the virus.

With the risk of contracting a deadly disease falling to almost zero, condoms fell even more out of favor than they already were, said Park.

“If one man is taking PrEP and the other one is virally suppressed, there’s no HIV risk at all,” she said. “So why use condoms if you don’t mind having a touch of syphilis?”