San Diego According to Dr. Robert Gunn of the county health department, the term "venereal" was phased out in favor of "sexually transmitted disease" (STD) in the 1970s because "the term 'venereal' comes from Venus, the goddess of love, and British officials called it venereal disease. In the British Venereal Disease Act, they only listed gonorrhea and syphilis, and there's a lot of things that are sexually transmitted, not just the old-fashioned venereal diseases. There are about 30 to 40 pathogens transmitted by sexual activity. I think we use the term STD instead of VD to keep a broader scope and say what it really is."
Gunn has been the director of the Sexually Transmitted Disease and Hepatitis Prevention Division for the county department of Health and Human Services since 1991. "The overall rates of sexually transmitted diseases, excluding AIDS, is down. Now the rates for 50 years ago, I don't know. But I know there was a lot of syphilis in the old days, until penicillin came along in the 1940s. Syphilis has come down pretty dramatically from the '40s and '50s."
What Gunn does have are the statistics from the beginning of his tenure at County Health, which indicate that between 1990 and 2001, syphilis rates have dropped from 323 cases to 26 cases (the lowest rates were in 1997 and 1998, when there were only 23 reported cases). The largest number of cases were in the 25-to-29- and 30-to-34-year-old age groups and primarily among men. "We had an upswing in the late '70s and early '80s among men who had sex with men, increasing the curve. It came down again, then there was another blip in the late '80s and early '90s from heterosexual transmission among African-Americans related to prostitution and crack cocaine.
"There's always been a lot of syphilis in the South too. It's come down pretty dramatically all over the country since the Centers for Disease Control put a syphilis elimination initiative in effect in 1997. We're almost at the elimination level right now. The rate is less than 1 per 100,000. However, Seattle in '99 was down to no cases, and they had a resurgence among men who have sex with men. San Francisco was down in the teens in numbers of cases, and now they're up to 150, 200 cases. And I had one a couple of weeks ago. We've had an upsurge in the number of cases among men having sex with men. We're afraid this little upsurge in San Diego might mirror what we're seeing in L.A. and San Francisco. The men who are getting syphilis are having multiple anonymous partners, bathhouse connections, soliciting partners over the Internet, and that sort of thing. It's a small portion of men that are doing this, but they are."
It takes approximately three weeks to see any noticeable signs of infection from syphilis. "It starts off with a syphilitic chancre or sore. It's a painless shallow ulcer that comes after the exposure, either on the penis, scrotum, vagina, or labia. It can also be internally in the anal canal and not noticed, since it's not painful. It could be in the throat, on the lips, anywhere where the spirochete enters the body. That sore will stay for about three weeks and then go away. Six weeks after that, you can have secondary symptoms, like a rash, fever, or chills. That means that the bacteria has gone all through your body. That usually lasts three or four weeks or longer, then it will go away too. Then you have this long latent period, where nothing can happen, or you can get long-term complications like neurosyphilis, cardiovascular syphilis -- things we don't hardly see anymore."
Gonorrhea ("the clap") and chlamydia are much more common than syphilis and a much bigger cause of concern for Gunn. In 1990 there were 4107 cases of gonorrhea in San Diego; by 1997, numbers were much lower at 1505. The last available statistical year, 2002, shows the rate escalating at 1875. The largest age groups were from 15 to 19, 20 to 24, and 25 to 29 years old. In the two younger groups, more cases were reported among females. "It was down to the 1500 range, then by 1999, it reversed and started back up again. There's been about a 20 percent increase in gonorrhea in the last couple of years -- again, among men who have sex with men." The symptoms include painful urination and genital discharge. "Lots of times women don't notice that they have anything. Chlamydia and gonorrhea have the same kind of symptoms. Gonorrhea symptoms are just more acute. Chlamydia is much more common."
It's more than common. Unlike the other charts showing syphilis and gonorrhea rates from 1990 to 2001, the chlamydia chart is moving in the opposite direction: up. In 1990 there were 4347 reported cases in the county. By 2001, that figure more than doubled with 9168 cases. The largest groups are the 15-to-19- and 20-to-24-year-old age brackets, with three times as many cases reported for females than for males. "It's a widespread bacterial infection that's prevalent among the population of teens and young adults. We have between 7000 and 9000 cases reported every year, and that's been on a steady upswing -- not so much because of increased infections -- that's hard to prove. It's more likely because of increased testing and using better, more sensitive tests."
Other diseases spread primarily by sexual contact include hepatitis B, herpes, and the human papilloma virus or HPV (also known as genital warts). Gunn does not have statistics on these diseases, claiming they are "hard to get a handle on" because they are not "reportable." Unlike syphilis, gonnorhea, chlamydia, and hepatitis, doctors and lab technicians are not required by law to report incidence of herpes lesions or genital warts to public health officials. Since they are not reportable, it's almost impossible to get accurate statistics. Gunn did say, however, that a few years ago, a random nationwide sample of adults found that about 16 percent had been infected with herpes.