Syphilis seems like a bygone disease, but it's coming back, particularly in Sacramento.
New cases of the vicious sexually transmitted disease have been rising steadily for several years, locally and nationally. But Sacramento County has seen an even more pronounced spike since last summer.
Local doctors diagnosed 41 cases of primary and secondary syphilis (the early, less damaging phase of the disease) in the first half of 2011. In the second half, they identified 65 cases, an increase of 60 percent.
That's according to preliminary numbers from the California Department of Public Health, where officials expect Sacramento's totals to rise by at least 10 cases once the tallies are finalized in May.
Taken together, the 106 new cases in 2011 were twice as many as Sacramento saw the year before, and the county's highest annual total in at least a decade. They constitute the latest chapter in a return of the disease to the county, where only four syphilis cases were reported during 2001.
Sacramento's primary and secondary syphilis infection rate of 7.4 cases per 100,000 residents is now 25 percent higher than the statewide average.
"It's off the hook," said Emily Tsuchida, director of nursing at the CARES Clinic in midtown Sacramento. "Prior to June, we would get maybe four, five, six cases a month, and since June we're getting at least 12."
While the disease still predominantly affects gay men, as it has for years, Tsuchida said, "Now we're even coming up with it in straight women, which is really unusual."
Statewide, instances of the disease also rose last year, but not as quickly, going from 2,068 in 2010 to 2,276 in 2011. The state did not see a spike in the second half of the year, as Sacramento County did.
Nationally, the infection rate more than doubled in the decade ending in 2010, up from 2.1 to 4.5 cases per 100,000 residents.
Syphilis, rumored to have afflicted historical figures such as Ludwig van Beethoven and Adolf Hitler, is caused by a bacterium. The bug can pass from person to person during vaginal, anal or oral sex. If untreated, it can resurge years or decades after the initial infection and cause paralysis, blindness and famously dementia.
Sacramento County communicable disease investigator Vanessa S., who interviews every resident diagnosed with syphilis, suspects a surprising culprit for the recent rise: smartphones. (She asked that her last name be withheld because she communicates with patients via mail and doesn't want other household members guessing the purpose of her letters.)
Social networks and smartphones have made it easier for people seeking casual sex to find willing partners, Vanessa S. said. Some GPS-powered apps enable people to broadcast their location to others seeking "hookups" in their vicinity.
"It's been going on for a while, but I think a lot of people are having more access to computers, and the creation of the smartphone definitely has made an impact on quick access to partners," she said.
She has noticed her interviewees increasingly mentioning this in the past year as a way they've found sexual partners. Most are gay males, but some heterosexual men and women report using digital networks, too.
Testing has increased
Some of the increase also likely comes from the fact that clinicians are growing more aware of the problem and conducting more syphilis tests, she said. County and state officials have been notifying doctors to be on the lookout.
The community at large, too, needs warnings.
"A lot of people are still completely unaware of the incidence of syphilis that we have in the county," said Vanessa S. When she interviews patients, they often say, "Oh my God, I thought syphilis was eradicated."
In its primary and secondary phases, which occur over weeks or months, syphilis typically causes a single sore wherever the bacterium entered the body and a rash on the hands and feet, reports the Centers for Disease Control and Prevention. The symptoms are often mild and painless, and the sore may be hidden inside the genitals, anus or mouth, so many patients don't realize they're infected.
Those early symptoms resolve on their own. Then the germ remains in the body, inactive and invisible, for as long as 10 or 20 years. The infection can ultimately rebound and attack internal organs, including the brain.
Antibiotics used as cure
Syphilis is easily detected with a blood test and cured with antibiotics, though the damage done may not be reversible. The disease is contagious only in its earliest stage, via skin-to-skin contact with the sore. Condoms can prevent its spread if they cover the site of the sore.
"As a nurse practitioner, seeing all kind of things, syphilis gives me the creeps," Tsuchida said. "Nothing else gives me the creeps."
Vanessa S. has noticed patients getting younger lately.
"Syphilis historically has been seen in the older demographics, 30 and up, where we are seeing it now in the younger 20s, maybe late teens, and that is a concern for us," she said.
Part of the problem appears to be widespread ignorance of the dangers of oral sex, which can transmit STDs including syphilis, gonorrhea, chlamydia, HPV, herpes and, in rare cases, HIV. Nearly 100 percent of her interviewees say they do not use condoms for oral sex, even if they use them regularly for intercourse.
Younger people, especially, "are using oral sex a lot more than intercourse, because they (mistakenly) think their risk is going to be minimized that way," she said.
As part of her prevention work, Vanessa S. tries to identify and contact the sexual partners of each patient with syphilis, to get them testing and treatment. But it's not possible in every case.
Given that, she said, "I would not be surprised if we continue to see an increase in cases."