A syphilis outbreak that began in Vancouver, Canada's skid row is now believed to be the largest per capita in the world, medical officials say. "Now the concern is that it's beyond its original group and it's spreading. Clearly, we haven't got a handle on it," said Patricia Daly, health officer for the Vancouver Coastal Health Authority. "The [British Columbia] Center for Disease Control has stepped up and is being as aggressive as they can trying to identify cases. We've been advising doctors, trying to get cases treated and treat as many contacts as we can, but it's not working." Since a case was imported in 1997, likely by a traveler, syphilis has spread through the prostitution-plagued slum area east of downtown Vancouver. Reported syphilis cases in British Columbia, almost all in central Vancouver, have soared from 16 in 1993 to 250 so far this year.
In the United States, where syphilis is on the increase for the first time in more than a decade, most outbreaks have been among gay and bisexual men in big cities. Most of those with the disease in Vancouver have been prostitutes and their customers, but according to Michael Rekart, director of sexually transmitted disease control at the provincial CDC, that appears to be changing. This year 72 gay or bisexual men were diagnosed with syphilis, compared with 30 in 2002. Rates of HIV, gonorrhea, and hepatitis also have been rising in Vancouver's gay community, indicating that fewer are using condoms and raising the specter of a much larger syphilis outbreak, he said. "We know it spreads very quickly in the gay community," Rekart said. "Almost every other outbreak in the world is confined to that community. We'd be silly not to pay attention with all that staring us in the face."
Syphilis, which killed millions in the Middle Ages, is now easy to treat with antibiotics but also easy to miss in its early stages. Ulcerative lesions form on the genitals but usually are not painful. In women, the lesions can be inside the vagina, while in men, the sores typically go away, suggesting the problem has cleared up. Left unchecked, syphilis eventually attacks the heart and brain.