Baltimore's syphilis rate, which has been both a badge of shame and the brunt of jokes on late-night television, has fallen from its position as the nation's highest.
That distinction now belongs to Indianapolis, which saw its rate more than double in 1999 in the wake of a sex-for-crack trade that hit the Midwestern city later than it did most urban centers.
According to a preliminary report released yesterday by the U.S. Centers for Disease Control and Prevention, Baltimore's rate dropped 45 percent last year. That put the city in third place - behind Indianapolis and Nashville.
"A little bit of a thorn"
The report came as a relief to Health Commissioner Peter L. Beilenson, who saw rates of the sexually transmitted disease soar in the 1990s even as it declined nationally to historic lows.
"It's been a little bit of a thorn," said Beilenson, acknowledging that the problem had helped to make Charm City something of a whipping boy for jokesters such as talk-show host Jay Leno.
"Any time a city is No. 1 in some health index that's not a good one -- well, it doesn't look good for the city as a whole," Beilenson said. "It's nice from a selfish standpoint to have the city rate come down, but it's better to have babies safe and everyone safer, healthier."
Though final statistics aren't due until November, the CDC reports that Baltimore's rate dropped from 69.4 cases per 100,000 people in 1998 to 31.1 cases per 100,000 last year.
In 1997, when the problem reached its zenith, the rate was 99 cases per 100,000.
Public health officials emphasize disease rates -- not the total number of cases -- because rates erase a city's size as a controlling factor. Even so, Baltimore officials were glad to learn that the number of cases declined from 456 in 1998 to 246 last year -- dropping the city from first to fifth place in the number of cases reported.
Beilenson, who had been criti- cized for easing up on syphilis con trol in the mid-1990s, said his department ment has become more aggressive in tracking and treating the sexual partners of men and woman afflicted with syphilis.
Also, he said, the agency has been doing a better job educating doctors about the early symptoms of syphilis. The sooner a case is identified and treated, the less chance there is for the infection to spread to others.
Syphilis is a bacterial disease spread mainly by sexual contact. In its early stages it causes genital sores and a skin rash. Though easily treated with a single injection of penicillin, the disease can cause widespread organ damage and even death if left untreated.
Beilenson said he intends to step up efforts in the coming year by sending a monthly statistical report to doctors and community groups, and by assigning two more disease trackers to the force of 12.
"In 2000, we will definitely be out of the top five," he said. "And we can say with a straight face that our goal is syphilis elimination by the year 2005."
Cases of congenital syphilis - infected babies born to infected mothers - dropped from 59 cases in 1997 to 20 last year.
"Crisis" in Indianapolis
The Indianapolis health commissioner declared a "health crisis" earlier this year as that city's syphilis rate soared, much as Baltimore's had a few years earlier.
Dr. George Counts, a CDC official in charge of syphilis elimination, said the Indianapolis epidemic is apparently being fed by the practice of exchanging sex for crack cocaine. It is possible, he said, that the city's statistics are rising also because officials are more aggressively tracking and reporting cases.
In just a year, Indianapolis' rate vaulted from seventh to first.