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A year after reports of syphilis plunged in Mecklenburg, the number of new cases is creeping back up amid what health departments are calling a statewide epidemic of the sexually transmitted disease.
Syphilis had almost disappeared from North Carolina 10 years ago, but cases in the state have nearly doubled in the past year: 684 in the first nine months of this year, compared to 359 cases for the same period a year earlier.
Numbers are up across almost all age and racial groups, including teenage girls and African Americans - groups already disproportionately affected by STDs.
"I have to be honest: this is pretty bad," said Evelyn Foust, communicable diseases director for the N.C. Department of Health and Human Services. "We are in the middle of a really serious syphilis outbreak, and we're very, very, very concerned about it."
The trend mirrors national statistics, which show syphilis and other sexually transmitted disease rates rising across the country.
"In 2008, things dropped, really dropped for us," said Lorraine Houser, who oversees STD monitoring for the Mecklenburg County Health Department. "Things are spiking back up again."
She attributes the sharp decline last year to aggressive testing efforts started after 2007, when numbers also rose.
However, the rise this year in Mecklenburg is being fueled by increasing numbers of people engaging in risky sexual activity with strangers, Houser said.
"There's a lot of Internet activity, bar activity, very, very high-risk activity," she said. She called the Internet "a whole new playing field" in terms of casual sex and disease prevention.
The highly treatable infection - which can be eliminated with antibiotics - had largely been contained in North Carolina, which reported thousands of cases annually throughout the1990s.
In 1999, the Centers for Disease Control and Prevention began to fund a syphilis-elimination plan that focused on the 28 counties nationwide with major outbreaks. Five were in North Carolina, including Mecklenburg and Wake.
The extra resources helped. North Carolina's cases fell off after 2000. But as the state's numbers improved, the CDC moved more than $1.3million in funding for syphilis programs from North Carolina to other states, Foust said.
"We are back having this problem again because of a lack of commitment and investment," Foust said.
Left untreated, syphilis can worsen, even though symptoms may disappear, and can lead to death. And because people who contract syphilis increase their risk almost tenfold of getting HIV, the virus that causes AIDS, state health officials worry that HIV cases will increase, too.
Six years ago, buses in Wake were running large ads about syphilis. Doctors were routinely screening patients for the disease. Extra money allowed public health workers to reach out to communities and to offer screenings in bars and jails.
In 2007, though, the CDC changed the way it paid states for its syphilis elimination program, Foust said. When fewer N.C. cases were reported in 2005 and 2006, the federal agency moved money to other states. The state received less than $600,000 in 2008. Although the state's own budget provides some money for HIV/STD programs, there is nothing specific to syphilis.
In a written statement, CDC spokesman Scott Bryan said money was redistributed "in an effort to ensure a more equitable distribution of Syphilis Elimination funds based on morbidity." He added that funding for syphilis elimination programs nationwide has remained flat for years.
Syphilis cases across most age and racial groups have increased, but the current outbreak centers on young black men who have sex with men, said Dr. Peter Leone, chairman of the National Coalition of STD Directors and an epidemiologist in UNC-Chapel Hill's Division of Infectious Diseases. These men are otherwise healthy and often don't have health insurance. They may only visit emergency rooms and urgent-care clinics, which don't routinely test for syphilis, Leone said.
He added that North Carolina's current sexual-education curriculum could be better at informing students. "We have young men who have sex with men who know about HIV transmission but were never educated on risk prevention for other STDs like syphilis," he said.
"When we pulled back on our community education efforts, some teenagers didn't know painless sores could be syphilis, and they didn't know to go to the doctor," Foust said.
For now, the state's health priority is H1N1, Foust said. But she hopes for improved syphilis screenings and education.
"It is very frustrating to be in this position again," she said.
Observer staff writer Ely Portillo contributed
