Philadelphia Medicine Summer 2018 - 13

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Philadelphia's Syphilis Problem
Philadelphia is one of the disease's hot spots. The Pennsylvania
Department of Health reports that in 2017 the city had 29.28
cases per 100,000, a rate that's almost three times higher than the
second highest rate in the state - Dauphin County, with 10.6 cases.
Still, Philadelphia has half the rate of San Francisco, which has
60.4 cases. The City of Brotherly Love's syphilis rate ranks 12th
among the nation's counties and cities.
If not treated, syphilis can attack the eye, heart, nerves, and/
or brain. It can cause stillbirths and kill adults. Yet, it has a simple
and effective cure - antibiotics. Syphilis does not always cause
symptoms. Often the only way for someone to know he or she
has the disease is to get tested.
Syphilis instigated one of the more shameful chapters in
American history. In 1932, the United States Public Health Service
began the now infamous "Tuskegee Study of Untreated Syphilis
in the Negro Male." Researchers observed the disease's progress in
African-American sharecroppers in Alabama under the guise of
their receiving free health care. The study was actually conducted
to track the disease's natural progression. The several hundred men
in the study who had the disease did not receive penicillin, even
after it became clear in 1945 that the antibiotic led to a cure. The
study was not shut down until 1972.
Most syphilis cases today involve men having sex with men
(MSM). They make up about four percent of the general population, but account for nearly 60 percent of all reported primary
and secondary syphilis cases. In 2016, the rate of syphilis among
such men was 104 times higher than the syphilis rate among men
who have sex with women.

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Disease Spread in Part by Sex for Drugs
Dr. Lenore Asbell, medical specialist for the STD (sexually
transmitted disease) Control Program of the Philadelphia Department of Public Health, says one reason for the sharp rise in syphilis
cases is the opioid epidemic. "We find that sex in exchange for
drugs does produce higher rates of syphilis. But that alone does not
appear to be enough to explain the higher rates of syphilis among
men having sex with men."
She says a big part of the problem appears to be the number
of sex partners many of these men have, and the failure to use
condoms consistently. "It can be a nightmare. Sometimes people
have sex with people and they don't have great contact information."
Amorim says anonymous sex stemming from dating apps
makes it extremely difficult to track down sex partners. He cited
one of his recent typical cases - a gay white man with syphilis who
is in his mid-30s and has a stable job. He is not addicted to drugs
but uses them recreationally. He has been finding sex partners on
dating apps for a few years. During the last 12 months, he had
sex with 50 men.

Summer 2018 : Philadelphia Medicine 13


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Table of Contents for the Digital Edition of Philadelphia Medicine Summer 2018

Philadelphia Medicine Summer 2018 - 1
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