Sexually transmitted disease spikes in Sonoma County, with homeless people at high risk

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Sonoma County syphilis cases

Homelessness and drug use have caused a spike in the sexually transmitted disease.

Year | Total Cases

2013: 41

2014: 63

2015: 94

2016: 74

2017: 153

2018: 231 (projection)

Source: Sonoma County Public Health Division

_______

Syphilis stages:

— Primary syphilis generally has a sore or sores at the original site of infection. The sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth.

— Secondary syphilis can include skin rashes, swollen lymph nodes, and fever. Symptoms of primary and secondary syphilis can be mild, and they might not be noticed.

— Tertiary syphilis, preceded by a latent stage where there are no symptoms, is associated with severe medical problems in which the disease can affect the heart, brain, and other organs of the body.

Source: Centers for Disease Control and Prevention

Despite aggressive public health efforts to halt the spread of syphilis, the number of syphilis cases in Sonoma County continues to grow at an alarming rate — nearly 48 percent in the past year.

The local increase mirrors the findings in a national report last week that shows a growing link between drug use and the incidence of syphilis among women and heterosexual men.

“We have been chasing this quite doggedly and have put in a lot of effort,” said Dr. Karen Holbrook, the county’s interim health officer. “We do have a lot of STDs (sexually transmitted diseases) in Sonoma and the trends are going up, but that is not specific to the county but aligns with California and the U.S.”

The number of syphilis cases in Sonoma County went from 41 in 2013 to a projected 231 in 2018 — about a 460 percent increase, according to county public health data reported to the state.

The county’s public health division released a health advisory on its website on Jan. 29, citing the soaring number of syphilis cases, with women of childbearing age being a big concern.

Women at that age who contract syphilis put their own health at risk as well as their babies’ health, and the disease can be fatal, said Dr. Susan Philip, director of the disease prevention and control branch at the San Francisco Department of Public Health.

Last year, 43 percent of Sonoma County residents with early stage syphilis reported experiencing homelessness and 51 percent reported using methamphetamine.

In 2017, only 12 percent reported being homeless, while 28 percent said they had used meth.

Similarly, a report released Thursday by the Centers for Disease Control and Prevention found that between 2013 and 2017, the use of meth, heroin and other injectable drugs more than doubled among the number of women and heterosexual men with early stages of syphilis. In 2017, California recorded about 13,700 of the 30,000 national syphilis cases, according to the CDC report. Last week, Sonoma County’s syphilis problem was cited by Gov. Gavin Newsom in his State of the State address.

While describing the hardships suffered by many of the state’s homeless people, Newsom said homelessness is increasingly becoming a public health emergency.

“Our homelessness crisis has increasingly become a public health crisis. Last year, there was a hepatitis A outbreak in San Diego. Recently, there was an outbreak of syphilis in Sonoma,” Newsom said. “And now, typhus in Los Angeles. Typhus. That’s a medieval disease. In California. In 2019.”

Likely Newsom was referring to an early 2018 outbreak of syphilis at the former Roseland Village homeless encampment in southwest Santa Rosa.

Last week, county health officials said they have been trying to track and stop the spread of syphilis in the local homeless population with the help of health care providers and homeless services groups.

The majority of syphilis cases in Sonoma County are among men who have sex with men, but the disease increasingly is affecting other groups, experts said. Now, counties throughout the state are reporting syphilis cases being spread more often between heterosexual partners, with a growing number of cases found in women.

State health officials said people most at risk of contracting syphilis are heterosexual homeless individuals and people who take methamphetamine.

Sonoma County syphilis cases

Homelessness and drug use have caused a spike in the sexually transmitted disease.

Year | Total Cases

2013: 41

2014: 63

2015: 94

2016: 74

2017: 153

2018: 231 (projection)

Source: Sonoma County Public Health Division

_______

Syphilis stages:

— Primary syphilis generally has a sore or sores at the original site of infection. The sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth.

— Secondary syphilis can include skin rashes, swollen lymph nodes, and fever. Symptoms of primary and secondary syphilis can be mild, and they might not be noticed.

— Tertiary syphilis, preceded by a latent stage where there are no symptoms, is associated with severe medical problems in which the disease can affect the heart, brain, and other organs of the body.

Source: Centers for Disease Control and Prevention

While syphilis isn’t limited to the homeless population, Holbrook said homeless people living together in a tent city or encampment could cause them to be more intimate because of their close quarters.

Combining homelessness with an increase in widespread meth use across California puts disenfranchised people at a higher risk for contracting STDs, the county’s health leader said.

“Homeless people may be pursuing money for drugs and having more sex in the pursuit of drugs,” Holbrook said. “If you think of someone using meth when they are high on it, their judgment is impaired and so they can have sexual encounters that are not safe sex.”

Unstable housing situations are long known to lead to risk factors in someone’s life, said Jennielynn Holmes, director of shelter and housing for Catholic Charities. Health risks are the most common among the homeless, she said.

“There is a huge linkage around trying to solve homelessness from a health care perspective and health care from a housing perspective,” Holmes said.

Holbrook said county health officials have been working closely with community partners throughout the area for years to stop the spread of STDs.

They’ve launched several efforts aimed at those who are at greatest risk of acquiring the diseases, including people who are homeless.

Efforts include working with local community clinics and hospitals, and increasing screening for syphilis, other STDs, HIV and the hepatitis C virus.

Also, county officials have been trying to educate homeless people about syphilis and STDs. Last year, Sonoma County screened about 600 homeless people for syphilis and HIV.

Recently, Holbrook provided local hospitals and health care facilities with discharge guidelines for infectious disease screening and immunizations.

The guidelines alert health care providers the county is “experiencing significant outbreaks, upticks in cases and/or exposures of select infectious diseases within our homeless population.”

Holbrook recommended that medical providers increase STD screening in hospital emergency departments and medical surgical units.

But one of the greatest challenges in combating the spread of syphilis is that there are no tools or a vaccine like there are for HIV, said Philip, the San Francisco public health director of the disease prevention and control branch.

“We are still exploring more preventative measures, but it’s still way in the early stages,” she said.

Her public health team has increased health campaigns in the city aimed at marketing safe sex as a response to the rise of STDs, she said, with a majority of their communication targeted to transgender people, adolescents and youth of color.

“It is very possible to get to a point where we are able to prevent syphilis or quickly treat it before it spreads,” Philip said. “We just all have to work together to get there.”

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