State has top rate of syphilis

Louisiana's rate of syphilis cases ranked No. 1 in the nation last
year, while its gonorrhea rate placed second and its chlamydia rate
was third, according to federal figures released Tuesday.

The numbers are grim but not surprising, state health experts said,
because occurrences of sexually transmitted diseases have always been
high, not only in Louisiana but also throughout the South.

Louisiana's syphilis rate is 7.4 cases per 100,000 people, compared
with 2.7 cases per 100,000 nationally. The state's gonorrhea rate is
234.4 cases per 100,000, while the national figure is 113.5 per
100,000. The chlamydia rate is 485.7 per 100,000, compared with 319.6
per 100,000 nationally.

"The numbers have been high because we haven't been able to do the
things we need to do to intervene," said Sharon Howard, director of
the state Office of Public Health.

Describing the approximately $2 million per year budget to fight these
diseases as "pretty static," Howard said, "If you have the same
funding but your needs continue to increase, your rates are going to
increase because you don't have enough resources to get ahead of the
problem. . . . We need to get the information out and get people
tested."

The interlocking reasons for these high rates are more than monetary,
said Patricia Kissinger, an epidemiologist at Tulane University's
School of Public Health and Tropical Medicine who specializes in
researching these bacterial infections.

"It's an economic phenomenon; it's a sociological phenomenon," she
said. "It'll be grim in Louisiana until we start getting people to
have protected sex. . . . It's hard to change people's behavior."

It may get even tougher, Howard said. Because of a hiring freeze and
hurricane evacuees that did not return, her office has lost five
disease-intervention specialists whose duties include educating people
and tracking down partners of infected people.

"These are your warriors that are on the ground that can make a
difference," Howard said. "We have to be able to put the resources in
place to get control of the problem."

Louisiana's syphilis rate was nearly three times the national figure,
according to figures from the federal Centers for Disease Control and
Prevention. The state's gonorrhea rate was slightly more than twice
the national figure and the chlamydia rate was 1 ½ times higher than
the national number.

In a telephone news conference, two of the CDC's experts in sexually
transmitted diseases said national figures on the three infections
carry mixed information.

Although the national syphilis rate last year was low, it had risen
nearly 29 percent since its lowest point of 2.1 cases per 100,000
people in 2000, said Dr. Ronald O. Valdiserri, acting director of the
CDC's National Center for HIV, STD and TB Prevention.

Two reasons for the increase are believed to be the cyclical nature of
the disease, whose rates rise and fall every decade or so, and an
increase in high-risk sexual behavior between men, said Dr. John M.
Douglas, director of the CDC's Division of STD Prevention.

Another CDC survey showed that about 64 percent of primary-stage
syphilis cases reported last year were in men who had sex with men, a
steep rise from 5 percent in 1999.

While the syphilis rate climbed, the national gonorrhea rate last year
was the lowest since 1941, when the federal government began tracking
sexually transmitted infections, Valdiserri said.

Chlamydia is the most common of the three diseases, with about 930,000
cases reported each year, according to CDC data. The national rate for
this infection rose nearly 6 percent from 2003. According to a CDC
statement, the increase probably is the result of better screening and
not necessarily a jump in infections.

About 19 million infections of all sexually transmitted diseases are
estimated to occur yearly in the United States, almost half of them in
people 15 to 24 years old, Valdiserri said.

Although these diseases are treatable, infection can make people more
susceptible to the human immunodeficiency virus, which causes AIDS.
Though advances have made AIDS a chronic condition for many people, it
has no cure.

Nationally, he said, medical costs attributable to these diseases
amount to about $13 billion per year.

Syphilis can be fatal if untreated, and untreated gonorrhea and
chlamydia can cause serious consequences for women, including tubal
pregnancies and infertility, Valdiserri said. During the news
conference, both men said efforts are under way to increase education
about these diseases and test for infections.

Screening for chlamydia has been made easier with a urine test,
Valdiserri said. He added that research earlier this year showed that
including a chlamydia screening in the annual gynecological checkups
of sexually active women increased by 30 percent the number of women
tested and, as a result, raised the likelihood of early detection.

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