Sex, drugs and the return of syphilis

Outbreaks of the deadly sexually transmitted disease confound health officials

For months, health officials in this socially conservative state capital have been staggered by a fast-spreading outbreak of a disease that, for nearly two decades, was considered all but extinguished.

Syphilis, the deadly sexually transmitted infection that can lead to blindness, paralysis and dementia, is returning here and around the country, another consequence of the heroin and methamphetamine epidemics, as users trade sex for drugs.

To locate possible patients and draw their blood for testing, Oklahoma’s syphilis detectives have been knocking on doors in dilapidated apartment complexes and dingy motels, driving down lonely rural roads and interviewing prison inmates. Syphilis has led them to members of 17 gangs; to drug dealers; to prostitutes, pimps and johns; and to their spouses and lovers, all caught in the disease’s undertow.

“Syphilis doesn’t sleep for anyone,” said Portia King, a veteran Oklahoma state health investigator. “We have 200 open cases of sex partners we’re looking for. And the spread is migrating out of the city.”

It took months for investigators to realise Oklahoma City had a syphilis outbreak. Last fall, the juvenile detention centre reported three cases — a boy and two girls, the youngest, 14. The centre had never had a syphilis case in seven years of testing for it.

Investigators were mystified: The teenagers did not know each other, live in the same neighbourhood or attend the same school.

Then, in February, a prison inmate tested positive. In interviews, he listed 24 sex partners — some his own, others the so-called pass-around girls for gangs, usually in exchange for heroin or methamphetamine. Contact information from the Entertainment Manager, as he called himself, pointed the way to a syphilis spread that, by March, led health officials to declare an outbreak, one of the largest in the country.

Although syphilis still mostly afflicts gay and bisexual men who are African-American or Hispanic, in Oklahoma and nationwide, rates are rising among white women and their infants. Nearly five times as many babies across the country are born with syphilis as with HIV.

Syphilis is devilishly difficult to contain, but may be even more so now. Because most doctors haven’t seen a case since the late 1990s, they often misdiagnose it. The cumbersome twostep lab test is antiquated. Although syphilis can be cured with an injection, there has been a shortage of the antibiotic, made only by Pfizer, for over a year.

And funding for clinics dedicated to preventing sexually transmitted diseases is down. In 2012, half of state programs that address sexually transmitted infections experienced reductions; funding has largely stayed flat since then. The Trump administration has proposed a 17 per cent cut to the federal prevention budget.

Nearly 24,000 cases of early-stage syphilis, when the disease is most contagious, were reported in the United States in 2015, the most recent data. That was a 19 per cent rise over the previous year. The total for 2015, including those with later-stage disease, was nearly 75,000, according to the Centres for Disease Control and Prevention.

The way to shut down an outbreak is to locate all the sex partners of people who are infected and persuade them to get tested, treated and disclose other partners. That task has fallen on a handful of the health department’s disease intervention specialists.

This most recent wave of infections, spread through gang networks and prostitution rings, has made their jobs not only difficult but also dangerous.

Syphilis, caused by bacteria, has been well known for centuries, chronicled as a scourge since at least the 1400s. In 1932, the United States government began the ignominious “Tuskegee Study of Untreated Syphilis in the Negro Male” to observe the progress of the disease in black Alabama sharecroppers. Although penicillin had become accepted as the cure by 1945, Tuskegee researchers left the men untreated until 1972, when the study was shut down.