Pubdate: Wed, 14 Aug 2002
Source: Wilmington Morning Star (NC)
Copyright: 2002 Wilmington Morning Star
Contact:  http://www.wilmingtonstar.com
Details: http://www.mapinc.org/media/500
Author: Victoria Rouch
Note: The article discusses the high prevalence of syphilis among crack 
cocaine users who trade drugs for sex.

COLUMBUS RANKS HIGH FOR CASES OF SYPHILIS

Rural Health Care, Drugs Are Actors

Going door-to-door in search of those carrying a sexually transmitted 
disease may seem a little extreme, but in Columbus County, health officials 
think it may be the only way to stop syphilis in its tracks.

According to the Centers for Disease Control, North Carolina ranks fifth in 
the nation in syphilis cases, and state Division of Public Health 
statistics show that Columbus County is among five area counties that rank 
in the top quarter out of all counties statewide.

Left untreated, syphilis can eventually leave its victims with devastating 
effects, including heart and neurological damage. In a pregnant victim, the 
disease can lead to birth defects or stillbirth. And since syphilis is 
spread through contact with a lesion that develops in the early stage of 
the illness, its victims are also at higher risk for contracting AIDS.

If diagnosed early, syphilis is easily cured with just a few doses of 
penicillin, which is why health officials find it painfully ironic that 
pockets of it still exist in areas like Southeastern North Carolina.

"When we end up fifth compared to other states, that is pretty significant 
because every one of them has twice the population of North Carolina," said 
Del Williams, head of epidemiology and special studies for the HIV/STD 
Prevention and Care Branch in the Division of Public Health.

Mr. Williams said the lack of available health care for rural residents and 
the affected counties' position on what has become a drug supply corridor 
are factors in the outbreaks of syphilis.

Health officials have noted that the disease is higher among the users of 
crack cocaine who commonly trade drugs for sex.

In late 1997, North Carolina was among other high-risk states receiving 
funds from the CDC to establish the Syphilis Elimination Project, which 
employs an aggressive campaign of education and testing to fight the disease.

As part of the project, state health officials began coordinating Rapid 
Intervention Outreach Teams (RIOT) to target areas experiencing syphilis 
outbreaks.

"Raleigh sent down a group of people and they went out into the byways and 
highways," said Columbus County Health Director Marian Duncan. During a 
two-day RIOT event last November, Ms. Duncan said, the county Health 
Department kept the lab open after hours to accommodate those brought in 
for blood tests needed to diagnose the illness.

One of the coordinators was Rhonda Ashby, said of the nearly 600 residents 
contacted, 313 agreed to be tested. Of those, 12 new cases of syphilis were 
identified. What's even better, she said, was that 212 of those people 
agreed to also be tested for HIV.

After identifying syphilis sufferers, health officials then must identify 
and notify any sexual contacts of those infected so they can be tested and 
- - if necessary - treated as well.

Mr. Williams said that is the only way to really stop the disease, and if 
current numbers are any indication, the RIOT efforts paid off.

"Last year in Columbus County there were 54 cases for the entire year, and 
so far this year through June they have reported 19," he said. "If you make 
an assumption - which is always a dangerous thing to do - that you'll have 
the same number in the second half, they should have 38. It's not the end 
of it, but in looking at it on a weekly basis, the number of new cases are 
continuing to drop."

But he said in Robeson County, which has the nation's highest syphilis rate 
at 50 per 100,000 residents, progress is much slower.

"The size of the epidemic is still very large there," he said.
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MAP posted-by: Tom