Ireland struck by syphilis epidemic

By Andrew Bushe

DUBLIN – High-risk sex in Dublin’s pubs and clubs with some people having casual encounters at least twice a week with partners they didn’t know, has been highlighted by a special team set up to control a syphilis epidemic that has hit the country.

“People are having a lot of anonymous partners and they need to know the risk they are putting themselves in by engaging in this kind of behavior,” said Dr Mary Cronin, public health specialist with the National Disease Surveillance Center (NDSC) who is a member of the special Syphilis Outbreak Control Team.

The surge in the number of infections has also led to six cases of congenital syphilis being reported where babies have been born with the disease passed on from their mother.

This had been unheard of in Ireland for decades and a special alert has been circulated to maternity hospitals where most doctors would never have dealt with the disease before in newborn babies.

“These babies can be still-born and it is really worrying. It is very serious as none of the pediatricians would have dealt with syphilis before,” Cronin said.

Pregnant women are routinely tested for syphilis but now Directors of Public Health throughout the country have also been asked to consider re-testing mothers-to-be later in their pregnancy.

The team found the average number of sexual partners in the three months prior to the diagnosis of syphilis was one for male heterosexuals, 12 for male homosexuals, 21 male and one female for male bisexuals and one for female heterosexuals.

Those infected used a variety of networks and contacts to meet.

Internet chat rooms had led to contacts by 14 people, 139 cases attended saunas, 121 implicated bars or clubs and 11 had sex outdoors in places such as parks.

A fifth of those diagnosed with early syphilis had sex abroad in the previous three months, most of them with partners in London and Manchester.

“There has been an outbreak in Belfast as well and some of them have reported links with Dublin. It’s a European phenomenon really. We have Paris, Antwerp, Brighton, London and Manchester. There is a lot of mobility now and people have a lot of disposable income,” Cronin said.

For years doctors had experienced as little as one case of syphilis a year. In 1999 there were six cases and between January 2000 and May 2002 there have been 458 cases.

“By any standards this is a dramatic increase. Technically it is an epidemic. We have a huge outbreak in Dublin,” Cronin said, “The main transmission is occurring between gay and bisexual men.

“A major worry is that 18 percent of people with syphilis also have HIV. The worry is that we are going to see a rise in the HIV cases in association with the outbreak.”

About two percent of the syphilis patients had two or more other sexually transmitted diseases apart from HIV. A third had had a sexually transmitted disease in the past.

Eighty percent of those infected have been men. Of these, 66 percent were homosexual, 15 percent bisexual, and 18 were heterosexual. The sexual orientation of the others is unknown.

The average age of those infected was 35 for men and 29 for women.

As part of a new strategy to battle the disease, blood tests are being undertaken in pubs and clubs.

Extra staff has been appointed as contract tracers to try and find those who may have been infected. It is fear that with many of the cases involving anonymous, untraceable contacts, the epidemic could continue for some time.

“What we are saying to people is to be tested regularly and to practice safe sex. We don’t want to be preaching to people but we do want them to know how to protect themselves. People are not going to abstain from sex.”

Syphilis was known as the “great pox” when it was the scourge of the 1800s and was even more feared than HIV/AIDS is today prior to the development of effective antibiotics to treat it.

It is also called the “great masquerader” as up to 50 percent of people have no symptoms and don’t realize they have been infected. If left untreated, it can damage the heart, liver, eyes, lung and brain.

“It is one of those diseases that can present in a myriad of ways. It affects all the systems of the body. People can present with syphilis very late in life, in their 70s or 80s.” Cronin said.