Since January of this year, San Angelo has seen a spike in sexually transmitted diseases, up 300 percent from 2012. Reports from the Department of State Health Services (DSHS) show a racial bias, and this time it deviates from the norm.
The increase was first addressed early in the year, when DSHS began monitoring a significant rise in early Syphilis in Tom Green County.
In an April 10, 2013 medical advisory from Tom Green County Health Department Health Services Director Sandra Villareal, STD Testing clinics and medical workers were made aware of the growing problem and instructed to increase testing and treatment of high-risk individuals.
The advisory defined high-risk individuals as those that may partake in injection drug use, particularly methamphetamine, those sharing needles, otherwise using meth, and those having sex or trading sex for money, drugs or with multiple partners.
The DSHS recently released the annual STD Surveillance Report for 2012, which shows a breakdown of total infections in the state of Texas by county for Chlamydia, Gonorrhea and Syphilis from 2005-2012.
The report includes information pertaining to the number of infections on a yearly basis, as well as a table in which the statewide total is broken down by sex, age and race.
Interestingly, there seems to not only be a consistent gender bias for each of the diseases, but is also reported to be most prevalent among certain racial groups.
According to the Surveillance Report, Syphilis shows a concentration on male cases, comprising 75.1 percent of the infections statewide in 2012, with the remaining 24.9 percent female. Of these cases, 36.9 percent were documented in African Americans, 37.4 percent in Hispanics and 23.4 percent in White races. These ratios have remained fairly consistent over the past seven years.
While the age/sex/race breakdown is not available for Tom Green County, one would expect those percentages to fall in a similar spread. That is, until the medical advisory proved otherwise.
The advisory, titled “Early Syphilis Case Increase in Tom Green County,” first introduces the problem and outlines meth users as high-risk individuals, then continues to say, “The clusters of cases identified are within the white community and involved in drug trade and transactions…If this current trend among this network is not contained, it could impact morbidity trends among the general population.”
Why the outbreak is concentrated specifically among the white race has not been stated, however factual reports suggest that the use of methamphetamine is by itself not enough to isolate infections among a single race.
Oscar Hernandez, HIV/STD Manager for the DSHS in our region emphasized the severity of the outbreak in Tom Green County.
“For Syphilis itself, we have 26 cases of Syphilis from January till this date [Oct. 15],” Hernandez said. “If you do a comparison on what we got in 2012, we got 8 cases. For this year, we’re already well into the 20-something mark. So, is that a significant increase? Yes, drastically. We got about a 300 percent increase.”
Even with the affected group isolated, it is difficult to gage why Angelo is seeing such a sudden and drastic spike.
According to the San Angelo Police Department, use of methamphetamine is rising throughout the city, however whether there is a correlation in the spread of drug use and the spread of the disease has not been identified.
Other ideas suggest that the closing of the Tom Green County STD clinic may have been an indirect contributor to the rise.
“It [the reason the clinic closed] was just a combination of things,” said Villareal. “January of 2012 the state had made some policy changes…to the Texas Acting for Children program, and those policy changes affected the revenues we were able to bring in.
“So with the decrease in revenue caused by that policy change, it affected the revenues and our budget for nursing, and therefore we ended up having to cut three positions. It’s the loss of staff. We were unable to do certain things, and STD was one of the things we were not able to maintain,” Villareal said.
The clinic was closed for the better part of a year and only recently reopened its doors to the public. Although there are other clinics who offer STD testing in the area, Hernandez suggests that this group in particular may not feel comfortable dealing with other authoritative organizations.
Ultimately, one can only speculate, and likely, a number of factors combine to account for it.
Syphilis causes a variety of symptoms, many of which dissipate or disappear after the first 6.5 months. Hernandez warns that the infection is a great imitator that is often misdiagnosed, and that early detection is key.
“Some people get a body rash and go to a dermatologist. It can be cured. It’s a bacteria,” Hernandez said.
There are a number of symptoms, and the first occur within 90 days of infection, or the primary phase. Most common in the primary phase is the appearance of a sore that may last for one to five weeks.
The sore on the skin is like a canker sore, with a small film over the top of it, when that film ruptures and the puss oozes out, the active bacteria spread to the other person and cause a sore where it touches their skin.
“Primary is the most contagious stage and there must be a sore present,” Hernandez says. “It doesn’t travel through bodily fluids.”
Since the sores spread the bacteria, a condom is not enough to protect from the spread of Syphilis. The infection is reliant upon contact.
“We’ve seen sores on the tongue, we’ve seen sores on the penis, rectum, vaginal area, the breast—so wherever it touches first is where the sore is going to be,” Hernandez said. “We’ve seen one person having a sore on a thigh.”
Sores may last one to five weeks, after which they disappear and a latency period sets in where no symptoms show for two to six weeks. This period is followed by the secondary stage, which is marked by body rash, alopecia, genital warts and mucous patches.
After the second stage ends, symptoms disappear and there are no further signs to indicate that one carries the disease, and that person is no longer infectious. The disease, however, does not leave the body.
“What we know about the disease is that it starts working its way up to the brain. You can have a heart condition, you can lose your eye sight, if you leave it untreated you can have some serious deformations in the long run,” Hernandez says.
So far, the majority of the cases in San Angelo have been in the early primary and secondary stages. The Tom Green County Health Department is doing work toward identifying and treating the disease.
Villareal said, “We’ve had some interventions and free clinics using our staff and their [DSHS] staff. We’ve had a couple of those in the last several months or so because there has been a spike in the early primary syphilis.”
Still, recommend practicing safe sex and getting checked regularly for sexually transmitted diseases as the most effective ways of avoiding the disease for those sexually active.
The Tom Green County Health Clinic may be contacted at (325) 657-4214. Testing is also offered at La Esperanza Clinic, 1610 S. Chadbourne St.